Most Lose Their Skills in 3 Months

Are you ready to respond to sudden cardiac arrest? Many people trained in CPR and automated external defibrillation lack the confidence and skills to do so.

How often you need to practice depends on a number of factors. Most researchers agree that practicing just once every two years is not enough to remain competent.

CPR/AED Skills Deteriorate Quickly
How well do we retain resuscitation skills after training? You might be surprised. Most research on the subject shows that skills decline significantly after just three months.1-8

Studies that use a high standard for skill competence indicate skills degrade within weeks after initial training. Therefore, CPR/AED skills are a use it or lose it proposition. This is particularly true for trained lay responders who respond infrequently to workplace emergencies.

Skill loss after 6 months

Figure 1. Average Skill Loss

Both the American Heart Association (AHA) and federal guidelines recommend lay responders practice regularly.9,13 The AHA states that "The quality of rescuer education and frequency of retraining are critical factors in improving the effectiveness of resuscitation. Ideally retraining should not be limited to 2-year intervals. More frequent renewal of skills is needed..."13 There are several reasons why.

Combining CPR with AED Makes It Complicated
It's true that automated external defibrillators (AEDs) are easy to use. However, when combined with cardiopulmonary resuscitation (CPR) the procedure becomes complex. It's not just slapping on the electrodes and pushing a button. Resuscitation involves over two dozen steps and at least a dozen different skills (see Figure 2).

Figure 2. AED Combined with CPR is a Complex Skill

CPR retention

How Often Should You Practice?
It long has been known that regular practice of a skill will improve performance. But how often should you practice AED/CPR skills? Most people wait for two years to practice when they renew their CPR cards.

Many EMS professionals complete skill refreshers every 90 days to keep their skills current. A hands-on skill session every 90 days is ideal for workplace lay responders. However, some employers would be hard-pressed to provide instructor-led, hands-on practice every 90 days. In these situations, you might consider alternatives like an online AED/CPR skill refresher or simulator.

The maximum time between practice sessions should be no more than six months.4 However, you should take into account past experience and background of the individual when selecting a refresher interval.

CPR is Important in Survival
For the past several decades the emphasis for treatment of sudden cardiac arrest has been on defibrillation and the use of an AED. Attention now is returning to CPR and chest compressions in particular. It is known that defibrillation and CPR are important therapies in reviving a victim of cardiac arrest, but new evidence points to the importance of the quality of CPR.

Researchers in the field of resuscitation recently found “high-quality” CPR improves defibrillatory shock success and boosts survival rates.10 In order to perform high-quality CPR, rescuers must: compress the chest at a rate of at least 100 times per minute, allow full chest recoil when doing compressions, minimize interruptions of chest compressions and avoid excessing force in rescue breaths. 

Chest compressions provide temporary blood flow to the brain and heart. Even minor delays or interruptions to chest compressions are correlated with poor outcomes for victims of sudden cardiac arrest. If you stop chest compressions only for a short time the coronary perfusion pressure (CPP) goes down considerably. It then takes another minute of chest compressions to build up enough CPP to start circulating blood effectively again. Thanks to this new understanding we know the combination of high-quality CPR and defibrillation provide the best chances for survival.

What Kind of Practice Do I Need?
A classroom environment with a skilled instructor is ideal, however this can be difficult and costly to provide. Online skills refreshers are an excellent alternative in making sure you are prepared for an emergency. Online AED/CPR simulators are inexpensive and can be accessed conveniently through the Internet.

Several studies suggest they are equivalent to hands-on practice after initial training once AED/CPR skills have been acquired.11-12 Any online skill refresher should be highly interactive and require users to rehearse AED/CPR procedures in a variety of scenarios.

Conclusion
Because AED/CPR skills are complex they are a use it or lose it proposition. Retention studies show skills decline rapidly over a few months. Make sure your responders are confident and competent by giving them the opportunity to practicing their AED/CPR skills every three months. This can be either in an instructor-led practice session or with an online AED/CPR simulator.

This revised article was written by John Jerin and first published at Occupational Health and Safety magazine on November 1, 2012. (external website)

References
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