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Cardiopulmonary Resuscitation↗
Biomedical subjects
Michael Colquhoun
Publications and source records attributed to Michael Colquhoun.
Defibrillators in public places: the introduction of a national scheme for public access defibrillation in England.
OBJECTIVE: To implement a government-led project-the 'Defibrillators in Public Places' Initiative-to deploy Automated External Defibrillators (AEDs) in public places. BACKGROUND: A Defibrillator Advisory Committee (DAC) was formed to assist the government with the implementation of the project. Its particular tasks were to: recommend criteria for the selection, training and assessment of those individuals likely to use the devices; procure the equipment necessary for the implementation of the project; procure the training services required for the implementation of the project; ensure the AEDs are sited where they are most likely to be of benefit; establish a mechanism to audit the use of this equipment and the outcome of this initiative. To co-ordinate this project a National Project Manager was appointed. Consultation with Ambulance Services NHS Trusts established the places where cardiac arrest occurred under circumstance where the availability of a defibrillator might be most likely to be effective. Defibrillators were procured under the direction of the NHS Purchasing and Supply Agency in conjunction with medical advisors. Devices that were reliable, safe, simple in operation and with good data retrieval systemes were selected. Training contracts were awarded under the direction of the NHS Purchasing and Supply Agency in conjunction with medical and educational advisors. Organisations with accredited training experience and possessing the appropriate administrative and data handling abilities were selected. The ability to undertake training in an area concordant with current NHS regions was an essential requirement. In the first stage of implementation, pilot trials were successfully established at sites where persons were willing to be trained in the use of automated defibrillators. Arrangements for national progress of the project were made on the basis of the experience gained at pilot sites. A robust system for monitoring the outcome of the project has been established in partnership with the Resuscitation Council UK. The long-term success of this innovative project requires: Continuing central administrative support in the short to medium term. Central audit and data collection. The results of this project should contribute to national databases being established by the Resuscitation Council UK. Continuing adequate funding. The recognition that the provision of defibrillation to the victims of cardiac arrest is a key feature of the NHS.
Cardiopulmonary Resuscitation↗
Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.
A randomised controlled trial comparing staged teaching of cardiopulmonary resuscitation (CPR) with conventional training provided the additional opportunity to investigate skill acquisition and retention in those attending conventional CPR classes. All subjects were tested immediately after their first instruction period and again at 6-9 months at an unheralded home visit. We were able to assess how far performance was related to poor acquisition of skills and how far it was related to skill decay. Out of 262 subjects who were randomised to receive conventional CPR instruction, 166 were available for home testing at 6-9 months. An invitation to attend for re-training had been accepted by 39 of them. The remaining 127 who attended only a single class comprise the principal study group, with additional comparative observations on the smaller re-trained cohort. Important failings were observed in the acquisition of skills in all modalities tested after the initial instruction. These were particularly marked in skills related to ventilation. Immediately after a class, 68% of trainees performed an effective check of breathing, but only 33% opened the airway as taught and no more than 18% provided an ideal ventilation volume. The technique of chest compression was also less than ideal. Although 80% of subjects placed their hands in an acceptable position, compression to an adequate depth and an adequate rate of compression were achieved by 54 and 63%, respectively. Seventy-eight percent demonstrated a careful approach, and 46% remembered to call for help. A carotid pulse check was simulated by 61% of trainees. When tested 6-9 months later, skill deterioration from this baseline was observed in all modalities tested except for the ventilation volume. The skill decay was significant (P<0.05) for the careful approach, performing an effective breathing check, the carotid pulse check, placing the hands in an acceptable position for chest compression, and compressing at an optimal rate. The minority who attended for re-training showed a trend to protection against skill decay for seven of the ten variables, compared with those who had attended only one training session. This improvement was significant for only two of them, but all were relatively small with limited practical value. Many who attend conventional CPR classes fail to acquire the necessary skills, and the skills that are acquired decline appreciably over the subsequent 6-9 months. The value of conventional re-training was modest in this study of community volunteers.
Adult↗