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Can improve outcomes but implementation needs to be earlier and more widespread
Basic life support performed by bystanders improves outcomes in cardiorespiratory collapse, yet less than 1% of the general population can perform it effectively. It has been estimated that if 15-20% of the population could perform basic life support, out of hospital mortality could be significantly reduced.1 The most effective way of achieving this is to teach this technique in schools, making it a “life skill.”
In this week's BMJ, a study by Jones and colleagues assesses the effect of a basic life support programme on the ability of children to administer effective chest compressions on a manikin.2 Of the three age groups compared (9-10, 11-12, 13-14 years), only children aged over 13 years could perform chest compressions to the recommended depth of 38-51 mm as effectively as adults. However, younger children could place their hands in the correct position on the chest to perform basic life support. The authors suggest that younger children could use this knowledge to instruct an adult on the appropriate technique, despite not being able to do it themselves. Also, young children could be taught how to assess the need for basic life support and activate the emergency medical services. These conclusions support the teaching of basic life support to children.
Structured courses such as the “Injury minimisation programme for schools” (www.impsweb.co.uk), which started in 1994, have integrated the teaching of basic life support into the school curriculum (with the support of local hospitals) and have trained more than 114000 children in the United Kingdom.
Courses are also taught by the British Red Cross, St John's Ambulance Service, St Andrew's Ambulance Service, Heartstart, and Opportunities for Resuscitation and Citizen Safety (ORCS). In Northern Ireland, the “ABC for life” programme was set up in 2005 by the Queen's University Belfast, with the aim of teaching 25000 primary schoolchildren each year. Most of these courses focus on teaching children aged 10 years and older. At this age children are more likely to be developing “abstract thinking” and may be physically capable of performing chest compression.
Basic life support courses can change children's attitudes and behaviour. A large study comparing children who received such training with those who did not showed that after five months the trained children were more willing to undertake emergency life saving procedures and conducted resuscitation significantly better.3
Despite these promising results some caveats exist. In both adults and children the skills decline over time, so refresher courses are needed. A study that repeated the training after six months in school aged children found that knowledge was maintained and that the children's resuscitation skills improved.4
“Hands-on” practice is needed to maintain the motor skills required to perform basic life support. Although additional teaching aids such as online resuscitation training may help with the child's knowledge, they do not improve the child's skills.5
Effective skills can only be attained through high quality training.6 Poor performance arises from inadequate instruction and not allowing sufficient time for the child to learn the technique. This includes time for the method to be demonstrated and for the child to practise the technique under adequate supervision.
High quality teaching can only improve outcomes if uptake is adequate. In countries where teaching basic life support in schools is optional, the uptake of training is low. Barriers include funding and time constraints in the “overfull” school curriculum.7 8 Compulsory training is probably necessary to obtain the levels of skill required to improve outcomes.
The final barrier to implementing basic life support training is lack of resources. Head teachers in Barcelona, sampled in a questionnaire survey, thought that school was the most appropriate setting for teaching these skills, and that such training would increase children's self esteem and could potentially save lives. However, they identified funding as a potential problem, estimating that the cost would be between €5 (Â£3.40; $6.80) and €10 per child—this seems a small price to pay for improving survival.9
Out of hospital survival from cardiorespiratory collapse could be improved if basic life support was routinely taught to all schoolchildren. Introducing it as early as possible in the school curriculum, perhaps in story and online learning formats, would be non-threatening to young children, who are usually keen to learn and able to absorb new information. Once they are physically able, the transition from theoretical knowledge to practical skills should be relatively easy.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.