Background The benefits of cardiopulmonary resuscitation training for schoolchildren are well known, but the appropriate age for introducing training is still being discussed. This is a very important issue, since out-of-hospital cardiac arrest is a major public health concern. The objective of this study was to investigate the effects of implemented cardiopulmonary resuscitation training on the knowledge of schoolchildren in the last three grades of Slovenian elementary schools and theirs willingness, attitudes, and intentions toward helping others and performing cardiopulmonary resuscitation. The experience of training instructors was also explored.
Methods A mixed methods research design was employed, using a Separate Pre-Post Samples Design and focus groups. Research was conducted in 15 Slovenian public elementary schools offering cardiopulmonary resuscitation training. Focus groups included training instructors and developers. Data was collected with a structured questionnaire from April to June 2018 and analyzed using univariate and bivariate analyses. The three focus groups were convened in September and October 2018. Content analysis of the discussion transcriptions was conducted. The sample included 764 schoolchildren aged 12.5–14.5 years before cardiopulmonary resuscitation training and 566 schoolchildren after training. Three non-homogeneous focus groups included eight cardiopulmonary resuscitation instructors.
Results Significant progress in cardiopulmonary resuscitation knowledge was noted after training implementation, with the greatest progress seen in the youngest age group (mean age 12.5). The greatest increase after training was seen for the variables Attitude toward helping others (p = 0.001) and Self-confidence (p = 0.001). Analysis of the focus groups yielded two themes: (a) the effects of cardiopulmonary resuscitation training on schoolchildren, and (b) the systemic responsibility of the school system and professional bodies.
Conclusions Significant progress in schoolchildren’s cardiopulmonary resuscitation knowledge after training was established. Early introduction of training is recommended. Cardiopulmonary resuscitation knowledge raises awareness of the responsibility to help others and increases self-confidence to provide bystander cardiopulmonary resuscitation. It can be concluded that early cardiopulmonary resuscitation training for children is crucial. It should be a mandatory part of school curricula in those countries where cardiopulmonary resuscitation is not yet mandatory.
Out-of-hospital cardiac arrest (OHCA) is a major public health concern accounting for a substantial number of deaths worldwide. Each year, over 700,000 people in Europe and the USA suffer from OHCA. The survival to hospital discharge rate following OHCA remains low, ranging from 5 to 10% [1–3]. Bystander cardiopulmonary resuscitation (CPR) is crucial for improving the chances of survival of sudden cardiac arrest patients and their neurological outcomes . Bystander CPR rates differ widely across European countries . It is estimated that at least 15% of the population would have to be trained in CPR for a significant increase in survival rates after OHCA, but this cannot be achieved through voluntary trainings for the lay population alone; therefore, mandatory training of schoolchildren would be an important measure [5, 6].
Awareness of the importance of CPR must be raised in early childhood education , as CPR training improves the safety culture in schools and shifts the responsibility from adults to children, which could result in long-term structural changes .
The introduction of CPR training in schools has been advocated by the World Health Organization . In Scandinavia, teaching schoolchildren CPR has increased lay bystander CPR rates, resulting in higher survival rates after OHCA. Besides that, the productivity of society raises and consequently, the costs of health care decline . Teaching the importance of OHCA recognition and CPR skills should begin early, as schoolchildren have greater motivation and learn faster than adults and also maintain learning abilities [9, 10]. In some countries, CPR training for schoolchildren is already mandatory, in others it is being gradually introduced into curricula, with 2 hours of CPR training a year being recommended . Nevertheless, the appropriate age to start CPR training remains controversial. If children learn CPR at a young age, they will not forget lifesaving skills, much like swimming or bike-riding skills . In addition, children can serve as CPR multipliers as they may pass on the acquired awareness and CPR skills to family members and friends . The advantages of early CPR teaching are reflected by attitude toward helping others, increased confidence in the positive outcome of resuscitation, internal motivation to help people requiring assistance, and development of empathy [13–17].
The research findings provide the basis for decisionmakers to introduce CPR training as mandatory part of school curricula. We must also be aware that the endeavors for CPR topics to become a mandatory part of school programs can only be successful by employing a comprehensive, responsible approach and with the awareness of social responsibility. Nevertheless, it is very important to involve the CPR training into curricula. The youngest age group (12.5 years) made the most progress in CPR knowledge.
Results of the quantitative and qualitative research clearly demonstrate the positive effects of training schoolchildren in CPR. We found that the level of CPR knowledge correlated with the willingness, attitudes and intentions toward helping others important factors in schoolchildren’s social development and the development of their values, opinions, and beliefs. This research gives an important contribution to public health policy. It provides criteria for implementation of training schoolchildren in CPR, which is one of crucial factors of higher survival rate at cardiac arrest.
Our study findings are important for decision-makers and developers of school curricula who are responsible for making CPR training a mandatory part of school curricula. CPR training should be conducted continuously, for several years from the time schoolchildren are 12, and should be part of the mandatory school curricula. By doing so, we believe that CPR outcomes in cardiac arrest victims could significantly improve in the future. What is more, the necessary equipment, teaching materials, and teaching aids should be available to CPR training instructors, both for theoretical and practical training, as they are indispensable for efficient learning. This equipment should be provided by the institutions responsible for offering CPR training with the use of AED.