Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study.

AIMS: Evaluation of school pupils' resuscitation performance after different types of training relative to the effects of training frequency (annually vs. biannually), starting age (10 vs. 13 years) and facilitator (emergency physician vs. teacher). METHODS: Prospective longitudinal study investigating 433 pupils in training and control groups. Outcome criteria were chest compression depth, compression frequency, ventilation volume, ventilation frequency, self-image and theoretical knowledge. In the training groups, 251 pupils received training annually or biannually either from emergency physicians or CPR-trained teachers. The control group without any training consisted of 182 pupils. RESULTS: Improvements in training vs. control groups were observed in chest compression depth (38 vs. 24 mm), compression frequency (74 vs. 42 min(-1)), ventilation volume (734 ml vs. 21 ml) and ventilation frequency (9/min vs. 0/min). Numbers of correct answers in a written test improved by 20%, vs. 5% in the control group. Pupils starting at age 10 showed practical skills equivalent to those starting at age 13. Theoretical knowledge was better in older pupils. Self-confidence grew in the training groups. Neither more frequent training nor training by emergency physicians led to better performance among the pupils. CONCLUSIONS: Pupils starting at age 10 are able to learn cardiopulmonary resuscitation with one annual training course only. After a 60-min CPR-training update, teachers are able to provide courses successfully. Early training reduces anxieties about making mistakes and markedly increases participants' willingness to help. Courses almost doubled the confidence of pupils that what they had learned would enable them to save lives.

[Do sociodemographic factors influence emergency medical missions? : analysis in the City of Münster]. / Beeinflussen soziodemografische Faktoren Notarzteinsätze? : Analyse in der Stadt Münster.

BACKGROUND: Demographic development and changes in healthcare utilization have led to a rising number of calls for emergency services. In Germany life-threatening situations are responded by physician-staffed ambulances in a 2-tier system whereas paramedic-staffed ambulances are dispatched in non-life-threatening emergencies. A nationwide protocol guides dispatchers in triage decisions. In the years 1999 to 2009 a continuous rise in the number of calls for a physician-staffed ambulance in Münster was recorded. The degree of healthcare utilization according to socioeconomic status and age structure was retrospectively examined. METHODS: For the year 2006 all emergency calls in the City of Münster responded to by physician-staffed ambulances were analyzed. Each call was assigned to 1 of the 45 urban districts. The local incidence of emergency calls (calls/100 residents/year) was determined and compared to the socioeconomic status which was defined as the percentage of welfare and unemployment benefit recipients per district. Patient condition was assessed by the Munich National Advisory Committee for Aeronautics (M-NACA) score. This scoring system allows calls to be allocated to either life-threatening conditions or non-life-threatening conditions by objective vital parameters. The age structure of the emergency callers was also examined. RESULTS: Urban districts with a low socioeconomic status showed a higher incidence of emergency calls requiring physician-staffed ambulance responses than districts with a high socioeconomic status. Measured by the M-NACA scoring system, the fraction of life-threatening emergencies among all calls proved to be equal to districts with a high socioeconomic status. A correlation between elderly patients and increasing numbers of life-threatening emergencies was found. CONCLUSIONS: A low socioeconomic status of an urban district will result in more ambulance responses. However, the proportion of life-threatening emergencies is equal to districts with a high socioeconomic status. Thus, the greater need for physician-staffed ambulance responses matches clinical needs and legitimates current resource use in a 2-tier ambulance system. Indications for the abuse of physician-staffed ambulances were not found. Considering an aging population the number of emergency calls will rise in the future.

[Real-time feedback systems for improvement of resuscitation quality]. / Echtzeit-Feedback-Systeme zur Verbesserung der Reanimationsqualität.

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

[Chest compression quality : Can feedback technology help?]. / Thoraxkompressionsqualität : Hilft Feedback-Technologie?

BACKGROUND: The outcome of cardiopulmonary resuscitation (CPR) depends on the quality of chest compressions. Current European Resuscitation Council (ERC) guidelines promote the development of feedback systems. However, no studies presenting satisfactory results of feedback use have been published. METHODS: A total of 60 patients with cardiac arrest (> or =18 years of age) received resuscitation attempts using an automated external defibrillator (AED) with real-time feedback by the ambulance service of the City of Münster. The frequency of chest compressions, no-flow time (NFT) and depth of chest compressions were analyzed for the first three cycles of CPR and compared to the ERC guidelines 2005. RESULTS: Chest compression frequency did not differ significantly from the ideal as set out in the guidelines. Analysis of NFTs showed significantly longer NFT for the first cycle but NFT for the second and third cycles did not differ significantly from the ideal. The target depth of 4-5 cm was achieved in 80% of all chest compressions in the first 3 cycles. CONCLUSION: With the AED real-time feedback technology used in this study standardized performance of chest compressions could be maintained in a professional ambulance service. Implementation of a feedback system requires training of ambulance staff.