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CPR and First Aid Skill Retention
RS2006-IG06
Final Report Date: January 2008
| Principal Applicant: | Gregory Anderson (University College of the Fraser Valley) |
| Co-Applicants: | Michael Gaetz (University College of the Fraser Valley); Declan Lawlor (Academy of Emergency Training) |
For more information about this project, please contact Dr. Gregory S. Anderson.
Issue
Expiry dates for first aid and CPR certificates vary between training agencies, provinces and regulatory bodies. However, it is not currently known how long trained rescuers can remember the course information. Some recent literature indicates that many necessary skills of CPR and first aid are forgotten shortly after certification in laypersons. The purpose of this study was to determine the decline in First Aid and CPR skill and knowledge in those who are required to respond to emergency situations within workplaces.
Key findings
- Many skills deteriorate rapidly over the course of the first 90 days.
- Repetition (the number of times trained/certified in First Aid or CPR) may be more important to skill retention than the length of time since the last training.
- A number of skills were performed poorly regardless of how much time had passed since the last training.
- Simple and cost effective updating strategies for first aid and CPR are needed to reduce the rate of knowledge and skill deterioration.
Objectives
- To determine the decline in First Aid and CPR skills and knowledge in those who are paid to respond to emergency situations within a workplace
Method
Participants were recruited through large industrial employers in the Lower Mainland. There were a total of 278 participants with at least one complete data set, with 258 having first aid training and 244 having CPR training.
Participants were observed during their performance of two scenarios: one involving choking and one requiring CPR. The mannequin used in the scenarios was equipped with sensors and a computer that recorded the rate, depth, and frequency of breathing, and the rate, depth, and location of chest compressions.
A multiple choice first aid exam was also administered to participants.
Data were analyzed to determine if skill and knowledge levels were associated with the length of time since the individuals’ most recent training/certification.
Results
First aid knowledge was higher in those with more advanced training, and did not significantly decline over time. Those who had renewed their certificate once or more generally had better results in the first aid exam than those who had learned the information only once, although this difference was not statistically significant (p=0.0587).
CPR skill and knowledge also were more closely related to the number of times participants had been certified than to time since last training. The reduction in knowledge is most likely influenced by the repetition of training in those that had recertified their first aid one or more times.
First aid and CPR skill-based components appeared to deteriorate in a more predictable fashion following training. In the choking scenario, skill in compressions after the victim became unconscious showed deterioration after 30 days. In the CPR scenario, poor performance of skills was linked to time since last training for: correctly landmarking for chest compressions; controlling the airway for ventilations; a pre-CPR safety check variable (e.g. skills such as remembering to “tap or gently shake the patient” or “ear over mouth, observe chest: look, listen, and feel for breathing”); periodic checks for breathing, head positioning, and patient placement; and, number of chest compressions for CPR cycles one to four.
Some skills were performed poorly regardless of days since last training. This included hand placement and abdominal thrusts in the choking scenario and the number of compressions and ventilations attempted in CPR cycles five to eight.
Conclusions
The findings suggest that repetition may be more important to skill and knowledge retention than the length of time since the last training. Therefore, strategies for increasing the repetition of the skills and knowledge should be explored.
Many skills deteriorate rapidly over the course of the first 90 days. This suggests that methods of regularly “refreshing” a skill more often — such as every 90 days — should be explored.
Future directions
This data provides a baseline for future research so that the impact of changes in policy and training practice can be evaluated. To date, very little information exists concerning the ability of those in a service or industrial settings who are trained to provide first aid and CPR to actually provide such emergency life-saving service. Baseline data allows for the evaluation of new training strategies, or changes in criteria to be evaluated.
Efforts should be made to investigate skill deterioration further, and determine if simple and cost effective updating strategies (e.g., email, web-based scenarios that include video and/or text, posters) can reduce the rate of decline. Strategies should be simple and effective, independent of time and place, and cause minimal disruption of one's working day.
Publications
Gregory S. Anderson, Michael Gaetz, Jeff Masse: First Aid Skill Retention of First Responders within the Workplace, an article published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.