Adults with developmental disabilities may not learn the safety skills needed to maintain the safety of those within their communities. Basic life-saving skills are valued by community members and increase independent and integrated living and employment opportunities. This study used an instructional package consisting of modeling, task analysis, and simultaneous prompting to teach college students with developmental disabilities a basic life-saving skill, specifically how to perform cardiopulmonary resuscitation (CPR) with the use of an automated external defibrillator (AED). Phase 1 of the study used the instructional package to teach the students to perform CPR. Once mastered, Phase 2 of the study taught students to use an AED, incorporating it into the CPR chain. Results showed that the students’ accuracy with the tasks increased after the introduction of the instructional package, generalized to a novel environment, and maintained once the instructional package was removed. Implications and future research are discussed. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21296号 / 医博第4385号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 福原 俊一, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Pesquisa de abordagem qualitativa que consistiu em avaliar o potencial de leigos para atuar como circunstantes nos procedimentos de reanimação cardiorrespiratória e no manejo do desfibrilador externo automático (DEA). Teve como objetivos: descrever o perfil dos participantes; realizar um processo de capacitação dos participantes sobre os primeiros atendimentos à PCR, utilizando o protocolo de atendimento à PCR da AHA para leigos; destacar as habilidades apontadas por eles e analisar suas percepções sobre o processo de atendimento inicial à PCR e o manejo do DEA. Pela especificidade do objeto de estudo, a metodologia utilizada foi pesquisa-ação. A investigação foi realizada na cidade de Marília/SP. O local foram selecionados por meio de mapeamentos específicos e de acordo com a legislação estadual e municipal sobre quais deveriam atender as exigências ao disponibilizar pessoas com capacitação específica, além da manutenção do dispositivo DEA. Selecionou-se um local público, o Terminal de Transporte Urbano de Marília/SP, segundo o número de circulação de pessoas por dia. Os sujeitos deste estudo foram pessoas voluntárias, leigas, trabalhadores de diversas categorias profissionais e ocupacionais do Terminal. Os sujeitos participaram de reuniões informativas sobre a pesquisa e a importância dos procedimentos iniciais à PCR. Realizou-se-se o curso de capacitação e, em seguida, um grupo focal para coleta de dados. Focou-se nas percepções dos participantes sobre o atendimento inicial à PCR, os sentimentos e habilidades relatadas em relação ao processo preconizado como um todo, incluindo o manejo dos materiais envolvidos nessa situação simulada. Posterior à coleta, os dados foram categorizados, tendo sido usada a técnica de análise de conteúdo descrita por Bardin. Os dados foram analisados e discutidos à luz dos referenciais teóricos e pedagógicos propostos por Paulo Freire, a teoria do modelo de crenças em saúde do campo da promoção da saúde e o papel do Estado democrático. Como resultados obteve-se os Grupos 1 e 2, compostos por 11 participantes, em sua maioria constituído de homens. Observaram-se diferenças relacionadas a escolaridade, capacidade comunicativa e intensidade na participação. As principais categorias empíricas foram: as percepções sobre cidadania; as vivências antes do curso; a percepção sobre o processo de capacitação e a não operacionalização do preceito legal. Em síntese, verificou-se o desconhecimento sobre a existência do arcabouço legal, assim como direito de acesso aos serviços e bens públicos decorrentes dos princípios normativos no resgate à cidadania. Emergiram expressões inusitadas de medo de agir por desconhecimento e por temer consequências do insucessos enfrentamento de processos judiciais, em contraste à solidariedade. Sobre habilidade antes do curso de simulação, os participantes relataram alguma vivência na preparação para o advento mal súbito, sobressaindo a insuficiência no aprendizado das habilidades manuais. Após a simulação, houve relatos de possibilidade e de enfrentamento da situação como circunstante, valorizando a oportunidade de aprendizado e apontando a necessidade de maior tempo para a assimilação de conteúdo, com foco nas habilidades em massagem cardíaca e segurança na condução da situação. Quanto à tecnologia DEA, foram unânimes quanto à facilidade interativa com o circunstante. Enfatizaram a necessidade de implementar processos de capacitação para leigos com o uso do DEA, condicionados à mobilização da sociedade civil n a operacionalização dos dispositivos legais por meio de reordenamento das políticas públicas locais. / Qualitative research, which was to assess the potential for laymen to act as bystanders in CPR procedures and management of the automated external defibrillator (AED). Aimed to describe the profile of the participants, conduct a training process with the participants on the first calls to PCR using the PCR protocol compliance with AHA for laymen; highlight the skills mentioned by participants and analyze the perceptions of participants about the process of initial care and management of the PCR DEA. The specificity of the object of study, the methodology was action research and the test was performed in the city of Marilia / SP. The sites were selected through specific mappings and in accordance with state law and city where they should meet the requirements to provide people with specific training in addition to maintaining the device DEA. We selected the public place, Terminal Urban Transport Marilia/SP according to the number of movements of people per day. The subjects of this study were secular groups, made up of volunteers / workers of various professional and occupational this Terminal. Proceeded methodological following routes: the subjects participated in briefings on the research procedures and the importance of the initial PCR. Proceeded to the training course and programming focus group data collection. Focused on participants\' perceptions about the initial care to PCR, feelings and skills reported in relation to the process advocated as a whole, including the handling of the materials involved in this situation simulated. After collection, the data were categorized, relying on the technique of content analysis described by Bardin. Data were analyzed and discussed in the light of theoretical / pedagogical proposed by Paulo Freire\'s, theory of health belief model in the field of health promotion and the role of the democratic state. The results obtained Groups 1 and 2, comprising 11 participants, mostly consisting of men. Observed among members, differences related to education: communication ability and intensity of participation. The main categories were: perceptions of citizenship; experiences before the course, the perception about the training process and not operationalize the legal precept. In summary there was ignorance about the existence of the legal framework for the majority, as well as right of access to public goods and services resulting in the rescue of normative principles to citizenship. Emerged unusual expressions of fear to act by ignorance and/or fear the consequences of failure to act and facing lawsuits contrast with the predominance of either solidarity. About skills before the course simulation, emerged on experience in preparation for the event sudden illness, highlighting the inadequacy of learning with regard to craftsmanship. After the simulation showed reports of chance and face the situation as bystander, valuing the learning opportunity and pointing the need for more time in the assimilation of content focusing on skills in CPR and driving safety of the situation. As for technology DEA was unanimous to its ease interactive with the bystander. It was emphatically the need to implement the processes of training lay people using the DEA, conditioned the mobilization of civil society in the operationalization of legal devices through reorganization of local public policies.

Pesquisa de abordagem qualitativa que consistiu em avaliar o potencial de leigos para atuar como circunstantes nos procedimentos de reanimação cardiorrespiratória e no manejo do desfibrilador externo automático (DEA). Teve como objetivos: descrever o perfil dos participantes; realizar um processo de capacitação dos participantes sobre os primeiros atendimentos à PCR, utilizando o protocolo de atendimento à PCR da AHA para leigos; destacar as habilidades apontadas por eles e analisar suas percepções sobre o processo de atendimento inicial à PCR e o manejo do DEA. Pela especificidade do objeto de estudo, a metodologia utilizada foi pesquisa-ação. A investigação foi realizada na cidade de Marília/SP. O local foram selecionados por meio de mapeamentos específicos e de acordo com a legislação estadual e municipal sobre quais deveriam atender as exigências ao disponibilizar pessoas com capacitação específica, além da manutenção do dispositivo DEA. Selecionou-se um local público, o Terminal de Transporte Urbano de Marília/SP, segundo o número de circulação de pessoas por dia. Os sujeitos deste estudo foram pessoas voluntárias, leigas, trabalhadores de diversas categorias profissionais e ocupacionais do Terminal. Os sujeitos participaram de reuniões informativas sobre a pesquisa e a importância dos procedimentos iniciais à PCR. Realizou-se-se o curso de capacitação e, em seguida, um grupo focal para coleta de dados. Focou-se nas percepções dos participantes sobre o atendimento inicial à PCR, os sentimentos e habilidades relatadas em relação ao processo preconizado como um todo, incluindo o manejo dos materiais envolvidos nessa situação simulada. Posterior à coleta, os dados foram categorizados, tendo sido usada a técnica de análise de conteúdo descrita por Bardin. Os dados foram analisados e discutidos à luz dos referenciais teóricos e pedagógicos propostos por Paulo Freire, a teoria do modelo de crenças em saúde do campo da promoção da saúde e o papel do Estado democrático. Como resultados obteve-se os Grupos 1 e 2, compostos por 11 participantes, em sua maioria constituído de homens. Observaram-se diferenças relacionadas a escolaridade, capacidade comunicativa e intensidade na participação. As principais categorias empíricas foram: as percepções sobre cidadania; as vivências antes do curso; a percepção sobre o processo de capacitação e a não operacionalização do preceito legal. Em síntese, verificou-se o desconhecimento sobre a existência do arcabouço legal, assim como direito de acesso aos serviços e bens públicos decorrentes dos princípios normativos no resgate à cidadania. Emergiram expressões inusitadas de medo de agir por desconhecimento e por temer consequências do insucessos enfrentamento de processos judiciais, em contraste à solidariedade. Sobre habilidade antes do curso de simulação, os participantes relataram alguma vivência na preparação para o advento mal súbito, sobressaindo a insuficiência no aprendizado das habilidades manuais. Após a simulação, houve relatos de possibilidade e de enfrentamento da situação como circunstante, valorizando a oportunidade de aprendizado e apontando a necessidade de maior tempo para a assimilação de conteúdo, com foco nas habilidades em massagem cardíaca e segurança na condução da situação. Quanto à tecnologia DEA, foram unânimes quanto à facilidade interativa com o circunstante. Enfatizaram a necessidade de implementar processos de capacitação para leigos com o uso do DEA, condicionados à mobilização da sociedade civil n a operacionalização dos dispositivos legais por meio de reordenamento das políticas públicas locais. / Qualitative research, which was to assess the potential for laymen to act as bystanders in CPR procedures and management of the automated external defibrillator (AED). Aimed to describe the profile of the participants, conduct a training process with the participants on the first calls to PCR using the PCR protocol compliance with AHA for laymen; highlight the skills mentioned by participants and analyze the perceptions of participants about the process of initial care and management of the PCR DEA. The specificity of the object of study, the methodology was action research and the test was performed in the city of Marilia / SP. The sites were selected through specific mappings and in accordance with state law and city where they should meet the requirements to provide people with specific training in addition to maintaining the device DEA. We selected the public place, Terminal Urban Transport Marilia/SP according to the number of movements of people per day. The subjects of this study were secular groups, made up of volunteers / workers of various professional and occupational this Terminal. Proceeded methodological following routes: the subjects participated in briefings on the research procedures and the importance of the initial PCR. Proceeded to the training course and programming focus group data collection. Focused on participants\' perceptions about the initial care to PCR, feelings and skills reported in relation to the process advocated as a whole, including the handling of the materials involved in this situation simulated. After collection, the data were categorized, relying on the technique of content analysis described by Bardin. Data were analyzed and discussed in the light of theoretical / pedagogical proposed by Paulo Freire\'s, theory of health belief model in the field of health promotion and the role of the democratic state. The results obtained Groups 1 and 2, comprising 11 participants, mostly consisting of men. Observed among members, differences related to education: communication ability and intensity of participation. The main categories were: perceptions of citizenship; experiences before the course, the perception about the training process and not operationalize the legal precept. In summary there was ignorance about the existence of the legal framework for the majority, as well as right of access to public goods and services resulting in the rescue of normative principles to citizenship. Emerged unusual expressions of fear to act by ignorance and/or fear the consequences of failure to act and facing lawsuits contrast with the predominance of either solidarity. About skills before the course simulation, emerged on experience in preparation for the event sudden illness, highlighting the inadequacy of learning with regard to craftsmanship. After the simulation showed reports of chance and face the situation as bystander, valuing the learning opportunity and pointing the need for more time in the assimilation of content focusing on skills in CPR and driving safety of the situation. As for technology DEA was unanimous to its ease interactive with the bystander. It was emphatically the need to implement the processes of training lay people using the DEA, conditioned the mobilization of civil society in the operationalization of legal devices through reorganization of local public policies.

L’arrêt cardiaque extra-hospitalier (ACEH) est un problème de santé publique majeur. La réanimation cardio-pulmonaire (RCP) précoce ainsi que la défibrillation par les témoins sont associées à une augmentation du taux de survie. Cependant, malgré d’importants efforts ces dernières années, les taux de survie restent faibles dans la plupart des pays. Ce travail avait pour objectif d’identifier des facteurs ayant un impact sur la défibrillation publique, la RCP précoce et les connaissances du public sur la défibrillation. Nous avons testé différentes stratégies de déploiement des défibrillateurs automatisés externes (DAE). Nous avons également analysé l’effet du niveau socio-économique des quartiers sur la RCP par les témoins. Enfin, nous avons cherché à évaluer les connaissances du public concernant la localisation et les conditions d’utilisation du DAE le plus proche dans des lieux publics très fréquentés. Tous les ACEH survenus à Paris entre 2000 et 2010 ont été enregistrés dans un registre et géocodés. Nous avons comparé une stratégie basée sur les recommandations de placement d’un DAE dans les lieux où plus d’un ACEH survenait tous les cinq ans à deux nouvelles stratégies : une stratégie de maillage régulier du territoire avec des DAE placés à distances régulières et une stratégie de placement dans différents types de lieux publics. Le nombre de DAE nécessaires ainsi que la distance médiane entre les ACEH et le DAE le plus proche étaient calculés pour chaque stratégie. Nous avons également recherché l’association entre le niveau socio-économique des quartiers sur le fait de bénéficier d’une RCP. Enfin, nous avons réalisé une enquête dans des lieux publics très fréquentés (gare, centres commerciaux, jardin public) auprès de toutes les personnes situées dans un rayon de 100 mètres autour d’un DAE pour analyser leur connaissance de la localisation du DAE et leur capacité à l’utiliser. Parmi 4176 ACEH, 1372 (33%) sont survenus dans des lieux publics. La stratégie basée sur les recommandations aurait conduit au placement de 170 DAE avec une distance aux ACEH de 416 (180-614) mètres et une augmentation continue du nombre de DAE. Avec la stratégie de maillage régulier du territoire, le nombre de DAE et la distance aux ACEH auraient changé selon la taille du maillage avec un nombre optimal de DAE évalué entre 200 et 400. Avec la stratégie de placement dans différents types de lieux publics, la distance médiane entre les ACEH et les DAE aurait été de 324 mètres pour les bureaux de poste (195), 239 mètres pour les stations de métro (302), 137 mètres pour les stations Velib’ (957) et 142 mètres pour les pharmacies (1466). Parmi les 4009 ACEH géocodables enregistrés, 777 (19,4%) ont bénéficié d’une RCP par un témoin. Ceux qui en ont bénéficié étaient plus fréquemment dans un lieu public, en présence d’un témoin et dans un quartier de statut socio-économique (SSE) non défavorisé. Dans une analyse multiniveaux la RCP par les témoins était significativement moins fréquente dans les quartiers de SSE défavorisé que dans les quartiers d’autres SSE (OR 0,85 ; 95% IC 0,72-0,99). Notre enquête a été menée auprès de 301 participants. Environ la moitié des participants (49%) avaient bénéficié d’une formation aux premiers secours, dont 70% après 2007 et 37% qui avaient suivi une initiation d’une heure. Le logo universel des DAE était reconnu par 37% des participants et 64% pouvaient reconnaître un DAE en photo. La localisation du DAE le plus proche était connue par 16% des participants avec un impact positif des formations après 2007 et de la reconnaissance du logo ou des photos (p<0,0001). Une majorité de participants (66%) savaient qu’ils avaient le droit d’utiliser un DAE et 59% savaient dans quelles circonstances l’utiliser. Seulement 25% des participants déclaraient savoir comment utiliser un DAE. Notre travail présente une approche originale pour optimiser les stratégies de déploiement des DAE. (...) / Out-of-hospital cardiac arrest (OHCA) is a major public health concern. Early bystander cardiopulmonary resuscitation (CPR) and defibrillation are associated with higher survival rates for OHCA victims. Unfortunately, despite major efforts over the past decade, survival rates remain low in many communities. This work sought to highlight factors affecting public defibrillation, early CPR and public knowledge on defibrillation. We assessed different strategies for Automated External Defibrillators (AEDs) deployment. We also aimed to focus effect of neighborhood socio-economic status on bystander CPR. Finally, we sought to analyze public awareness of the AED nearest location and knowledge of AED use. All OHCAs attended by EMS in Paris between 2000 and 2010 were prospectively recorded and geocoded. We compared a guidelines-based strategy of placing an AED in locations where more than one OHCA had occurred within the past five years to two novel strategies: a grid-based strategy with a regular distance between AEDs and a landmark-based strategy. The expected number of AEDs necessary and their median (IQR) distance to the nearest OHCA were assessed for each strategy. We also evaluated the relationship between neighbourhood SES characteristics and the fact of receiving bystander CPR. Then, we performed a survey in three kinds of places (train station, city mall and public park) of all individuals within 100 meters from an AED to analyze their knowledge of the closest AED location and their confidence to use it. Of 4,176 OHCAs, 1,372 (33%) occurred in public settings. The guidelines-based strategy would result in the placement of 170 AEDs, with a distance to OHCA of 416 (180-614) meters and a continuous increase in the number of AEDS. In grid-based strategy, the number of AEDs and their distance to the closest OHCA would change with the grid size, with a number of AEDs between 200 and 400 seeming optimal. In landmark-based strategy, median distances between OHCAs and AEDs would be 324 meters if placed at post offices (n=195), 239 at subway stations (n=302), 137 at bike-sharing stations (n=957), and 142 at pharmacies (n=1466). Of the 4,009 OHCA with mappable addresses recorded, 777 (19.4%) received bystander CPR. Those receiving it were more likely to be in public locations, have had a witness to their OHCA, and to have collapsed in a non-low SES neighbourhood. In a multilevel analyses, bystander CPR provision was significantly less frequent in low than in higher SES neighbourhoods (OR 0.85; 95% confidence interval [CI] 0.72-0.99). A total of 301 people responded to the survey. About half respondents (49%) had a Basic Life Support training experience with 70 % of them trained after 2007 and 37% who attempted a one hour training initiation. The universal AED sign was recognized by 37% of all respondents and 64% could recognize an AED on a picture. The closest AED location was known by 16% of the respondents with a positive impact of training after 2007 and knowledge of AED sign and picture (p<0.0001). A majority of respondents (66%), considered they had the right to use an AED and 59% knew in which circumstances it is necessary to use it. Only 25% of the respondents declared to know how to use an AED. Our work presents an original evidence-based approach to strategies of AED deployment to optimize their number and location. This rational approach can estimate the optimal number of AEDs for any city. In Paris, OHCA victims were less likely to receive bystander CPR in low SES neighbourhoods. These first European data are consistent with observations in North America and Asia. Our survey conducted in places known to be at risk of OHCA highlights the need for a better AED visibility in public places and the need to improve public knowledge and confidence in the use of AED. (...)

Introdução: Apesar do desenvolvimento tecnológico, permanece baixa a sobrevida hospitalar das vítimas de parada cardiorrespiratória extra-hospitalar. Há importante dúvida na literatura quanto à retenção de habilidades de ressuscitação cardiopulmonar (RCP) e a periodicidade adequada de treinamento para manutenção dessas habilidades. O presente estudo investigou a retenção, em alunos a partir de treinamento no primeiro semestre de ingresso no curso médico, das habilidades práticas de RCP até 42 meses após o referido treinamento. Métodos: Estudo de corte transversal, realizado com 298 alunos de graduação de uma faculdade de Medicina, treinados com base nas diretrizes de ressuscitação de 2010 da American Heart Association. Foram avaliados 205 alunos sem retreinamento das habilidades, divididos em quatro grupos conforme o tempo decorrido desde o treinamento de ingresso: 73 alunos após 1 mês, 55 após 18 meses, 41 após 30 meses e 36 após 42 meses. A análise da retenção das habilidades foi comparada com 93 alunos que referiram ter realizado retreinamento em RCP. Dezenove habilidades de RCP e nove potenciais erros de técnica na execução das ventilações pulmonares e compressões torácicas foram avaliados por meio de simulação realística e revisados com utilização de filmagem e avaliadores independentes. Resultados: A média de retenção das dezenove habilidades nos alunos sem retreinamento foi: 90% após 1 mês, 74% após 18 meses, 62% após 30 meses e 61% após 42 meses (p < 0,001). Nos alunos que referiram retreinamento, a retenção foi de 74% após 18 meses, 70% após 30 meses e 66% após 42 meses do treinamento inicial. Realizada curva de predição da retenção de habilidades, com estimativa de 80% das habilidades mantidas após 10 meses, 70% após 21 meses e 60% após 42 meses. A profundidade das compressões torácicas foi a habilidade com maior retenção ao longo do tempo (87,8%), sem diferença estatística entre os quatro grupos. Houve aumento da prevalência de compressões realizadas com menos de 5 cm de profundidade quando realizadas em frequência maior que 120 por minuto. A média da frequência de compressões torácicas obtidas nos grupos após 1, 18, 30 e 42 meses foi, respectivamente, 114, 114, 104 e 108 compressões por minuto; 104 (50,7%) alunos mantiveram frequência média entre 100-120 por minuto. As ventilações pulmonares apresentaram diminuição progressiva de retenção, de 93% após 1 mês até 19% após 42 meses (p < 0,001). Todos os alunos efetivaram o choque com o desfibrilador externo automático, porém com o grupo após 1 mês do treinamento com menor tempo para efetivação do choque e maior prevalência de posicionamento adequado das pás do desfibrilador. Conclusões: O presente estudo demonstrou diferentes níveis de retenção para as habilidades de RCP e diferentes níveis de decréscimo de tais habilidades ao longo de 42 meses. A profundidade das compressões torácicas e o uso do desfibrilador externo automático foram as habilidades com maior retenção ao longo do tempo. Treinamentos adicionais ao longo do curso de Medicina atenuaram a perda de habilidades, mas sem retorno ao desempenho observado após 1 mês do treinamento. Sugerimos que o intervalo mínimo de retreinamento para manutenção de pelo menos 70% das habilidades deva ser de 18 a 24 meses / Introduction: Despite technological development, the survival of victims of out-ofhospital cardiac arrest remains low. There are important questions in the literature regarding the retention of cardiopulmonary resuscitation (CPR) skills and the ideal frequency of retraining required to enhance retention of skills. This study investigated the retention of practical CPR skills by medical students over 42 months after training in the first semester of admission to the medical course. Methods: A cross-sectional study was conducted with 298 undergraduate medical students who were trained based on the 2010 American Heart Association resuscitation guidelines. A total of 205 students divided into four groups according to the time elapsed since the entrance training were evaluated without retraining (73 students after 1 month, 55 students after 18 months, 41 students after 30 months and 36 students after 42 months). The analysis of the retention of skills was compared to 93 students who reported having performed retraining in CPR. Nineteen CPR skills and nine potential technical errors in ventilations and chest compressions were evaluated by realistic simulation and reviewed using filming by independent examiners. Results: The mean retention of the nineteen skills in not retrained students was: 90% after 1 month, 74% after 18 months, 62% after 30 months and 61% after 42 months (p < 0.001). In retraining students, retention was 74% after 18 months, 70% after 30 months, and 66% after 42 months of initial training, with statistical difference between the students with and without retraining in the 30-month group (p=0.005). The estimation of mean skill retention was 80% after 10 months, 70% after 21 months and 60% after 42 months. The depth of chest compressions was the skill with greater retention over time (87.8%), with no statistical difference among groups. There was an increase in the prevalence of compressions performed with less than 5 cm depth when performed at a frequency greater than 120 per minute. The mean chest compressions rate obtained in the groups after 1, 18, 30 and 42 months were 114, 114, 104 and 108 per minute, respectively, and 104 (50.7%) students maintained a mean frequency of 100-120 per minute. Pulmonary ventilation showed a progressive decrease in retention from 93% after 1 month to 19% after 42 months (p < 0.001). All students delivered the shock with the automated external defibrillator; however, for the group one month post-training, the time for the application of the shock was lower, and the prevalence of adequate positioning of the defibrillator pads was greater. Conclusion: This study showed different retention levels for CPR skills and different decrease levels of these skills over 42 months. Depth of chest compressions and use of automated external defibrillator were the skills with the highest retention over time. Additional training throughout the medical course attenuated the loss of skills, but no return to the initial performance achieved after 1 month. We suggest that the minimum retraining interval for maintenance of at least 70% of skills should be 18 to 24 months

The theme for this thesis is based on the European Resuscitation Council's guidelines for cardiopulmonary resuscitation of 2015. One of the important points of these procedures is the use of an automatic external defibrillator (AED). These devices were developed for informed responders without the knowledge of cardiac rhythm diagnostics and allow to perform an early defibrillation of the heart, before the arrival of emergency services. AED is a sophisticated device that is a part of the equipment of I - firefighters and policemen. Training of these so-called first aid responders performs the local emergency service team. Over the years 2015 and 2016, the majority of the professionally active firefighters and police officers in one selected Czech district who have the automatic external defibrillator in their equipment attended a training in how to use this device. The aim of this thesis is to determine whether the concept of the training courses is sufficient. If the theoretical part is well understandable for the respondents, and whether the practical training is sufficient - not only the actual compressions and ventilation, but also the use of an automatic external defibrillator, or whether it would be appropriate to extend this training. In this research I used a quantitative method - an...

Introdução: Apesar do desenvolvimento tecnológico, permanece baixa a sobrevida hospitalar das vítimas de parada cardiorrespiratória extra-hospitalar. Há importante dúvida na literatura quanto à retenção de habilidades de ressuscitação cardiopulmonar (RCP) e a periodicidade adequada de treinamento para manutenção dessas habilidades. O presente estudo investigou a retenção, em alunos a partir de treinamento no primeiro semestre de ingresso no curso médico, das habilidades práticas de RCP até 42 meses após o referido treinamento. Métodos: Estudo de corte transversal, realizado com 298 alunos de graduação de uma faculdade de Medicina, treinados com base nas diretrizes de ressuscitação de 2010 da American Heart Association. Foram avaliados 205 alunos sem retreinamento das habilidades, divididos em quatro grupos conforme o tempo decorrido desde o treinamento de ingresso: 73 alunos após 1 mês, 55 após 18 meses, 41 após 30 meses e 36 após 42 meses. A análise da retenção das habilidades foi comparada com 93 alunos que referiram ter realizado retreinamento em RCP. Dezenove habilidades de RCP e nove potenciais erros de técnica na execução das ventilações pulmonares e compressões torácicas foram avaliados por meio de simulação realística e revisados com utilização de filmagem e avaliadores independentes. Resultados: A média de retenção das dezenove habilidades nos alunos sem retreinamento foi: 90% após 1 mês, 74% após 18 meses, 62% após 30 meses e 61% após 42 meses (p < 0,001). Nos alunos que referiram retreinamento, a retenção foi de 74% após 18 meses, 70% após 30 meses e 66% após 42 meses do treinamento inicial. Realizada curva de predição da retenção de habilidades, com estimativa de 80% das habilidades mantidas após 10 meses, 70% após 21 meses e 60% após 42 meses. A profundidade das compressões torácicas foi a habilidade com maior retenção ao longo do tempo (87,8%), sem diferença estatística entre os quatro grupos. Houve aumento da prevalência de compressões realizadas com menos de 5 cm de profundidade quando realizadas em frequência maior que 120 por minuto. A média da frequência de compressões torácicas obtidas nos grupos após 1, 18, 30 e 42 meses foi, respectivamente, 114, 114, 104 e 108 compressões por minuto; 104 (50,7%) alunos mantiveram frequência média entre 100-120 por minuto. As ventilações pulmonares apresentaram diminuição progressiva de retenção, de 93% após 1 mês até 19% após 42 meses (p < 0,001). Todos os alunos efetivaram o choque com o desfibrilador externo automático, porém com o grupo após 1 mês do treinamento com menor tempo para efetivação do choque e maior prevalência de posicionamento adequado das pás do desfibrilador. Conclusões: O presente estudo demonstrou diferentes níveis de retenção para as habilidades de RCP e diferentes níveis de decréscimo de tais habilidades ao longo de 42 meses. A profundidade das compressões torácicas e o uso do desfibrilador externo automático foram as habilidades com maior retenção ao longo do tempo. Treinamentos adicionais ao longo do curso de Medicina atenuaram a perda de habilidades, mas sem retorno ao desempenho observado após 1 mês do treinamento. Sugerimos que o intervalo mínimo de retreinamento para manutenção de pelo menos 70% das habilidades deva ser de 18 a 24 meses / Introduction: Despite technological development, the survival of victims of out-ofhospital cardiac arrest remains low. There are important questions in the literature regarding the retention of cardiopulmonary resuscitation (CPR) skills and the ideal frequency of retraining required to enhance retention of skills. This study investigated the retention of practical CPR skills by medical students over 42 months after training in the first semester of admission to the medical course. Methods: A cross-sectional study was conducted with 298 undergraduate medical students who were trained based on the 2010 American Heart Association resuscitation guidelines. A total of 205 students divided into four groups according to the time elapsed since the entrance training were evaluated without retraining (73 students after 1 month, 55 students after 18 months, 41 students after 30 months and 36 students after 42 months). The analysis of the retention of skills was compared to 93 students who reported having performed retraining in CPR. Nineteen CPR skills and nine potential technical errors in ventilations and chest compressions were evaluated by realistic simulation and reviewed using filming by independent examiners. Results: The mean retention of the nineteen skills in not retrained students was: 90% after 1 month, 74% after 18 months, 62% after 30 months and 61% after 42 months (p < 0.001). In retraining students, retention was 74% after 18 months, 70% after 30 months, and 66% after 42 months of initial training, with statistical difference between the students with and without retraining in the 30-month group (p=0.005). The estimation of mean skill retention was 80% after 10 months, 70% after 21 months and 60% after 42 months. The depth of chest compressions was the skill with greater retention over time (87.8%), with no statistical difference among groups. There was an increase in the prevalence of compressions performed with less than 5 cm depth when performed at a frequency greater than 120 per minute. The mean chest compressions rate obtained in the groups after 1, 18, 30 and 42 months were 114, 114, 104 and 108 per minute, respectively, and 104 (50.7%) students maintained a mean frequency of 100-120 per minute. Pulmonary ventilation showed a progressive decrease in retention from 93% after 1 month to 19% after 42 months (p < 0.001). All students delivered the shock with the automated external defibrillator; however, for the group one month post-training, the time for the application of the shock was lower, and the prevalence of adequate positioning of the defibrillator pads was greater. Conclusion: This study showed different retention levels for CPR skills and different decrease levels of these skills over 42 months. Depth of chest compressions and use of automated external defibrillator were the skills with the highest retention over time. Additional training throughout the medical course attenuated the loss of skills, but no return to the initial performance achieved after 1 month. We suggest that the minimum retraining interval for maintenance of at least 70% of skills should be 18 to 24 months