Cardiac Arrest Training and Preparedness in High Schools: A Descriptive Study

Background: Prehospital cardiac arrests have a 90% fatality rate, but effective bystander cardiopulmonary resuscitation (CPR) can triple survival rates. One out of every 250-600 cardiac arrests occurs on school grounds. To maximize the chances of survival from an emergency, both the American Heart Association and the American Academy of Pediatrics endorse the training of school staff and graduating high school students in CPR. Currently, 39 states have passed laws requiring such CPR training, yet the impact of these laws has not been well studied.

Methods: We distributed a 33 question survey using REDCap to staff at three school districts within one northeastern state where CPR and automated external defibrillator (AED) training in high schools is mandated by law.

Results: A total of 61 responses were collected from teachers (74%), coaches (15%), school nurses (11%), school administrators (10%), and other respondents (8%). The minority of respondents reported that despite the mandate, their school provided training in CPR (26%) and AEDs (22%) to students. Of schools offering CPR training, 81% taught CPR in 12th grade, 81% taught CPR in health class, 44% assigned a grade to learning CPR, and teachers taught the class in the majority of schools (69%). Of respondents at schools that teach CPR, only 25% reported instructors were certified in CPR, and the majority (56%) reported the curriculum used to teach CPR was a teacher or instructor self-designed course. Only 31% of those that reported CPR training had hands-on practice. 94% felt it was important for high school graduates to have CPR certification. The majority (86%) disagreed that most students would be able to perform effective and high-quality CPR until EMS arrived (Figure 1). In addition, 85% felt most students would not be able to find and properly use a defibrillator. The biggest barriers to training all high school students in CPR were: time (85%), budget concerns (82%), and materials to practice (79%) (Figure 2).

Conclusion: Despite state-level laws requiring CPR and AED training, the majority of high school students are not receiving CPR training. Of those who teach CPR at their schools, the majority of instructors are not certified and do not use a standardized CPR curriculum. Most respondents felt students did not graduate with the ability to perform high-quality CPR or use a defibrillator.