CPR Training Can Boost Community Engagement

Imparting lifesaving knowledge throughout a population can help community members form bonds of trust with healthcare professionals. It can also enable population health advocates to generate community interest in other proactive healthy lifestyle choices.

First, the bad news: A study this week in JAMA Internal Medicine from researchers at Duke Clinical Research Institute in Durham, NC, shows that cardiopulmonary resuscitation training rates are low in rural and poorer counties, and in areas with higher minority populations, particularly in the South, Midwest and West.

Each year, the Duke study notes, more than 350,000 people suffer cardiac arrest outside of hospital walls and less than 9% of them survive, an average that fluctuates considerably with geography. That is because the rates of bystanders performing CPR vary from 10% to 64% depending on where they live.

It seems logical to presume that if survival rates more than double when bystanders administer CPR, then the best way to get them to perform CPR is to train them in this relatively simple procedure.

In a first-of-its-kind study, Duke cardiologist Monique L. Anderson, MD, and fellow researchers analyzed a year's worth of CPR training data from the American Heart Association, the American Red Cross, and the Health & Safety Institute for 13.1 million people living in 3,143 counties, with a median county training rate of just under 2.4%, which again, fluctuates considerably from county to county.

The researchers looked at associations between annual rates of CPR training completion and a county's geographic, population, and healthcare characteristics. As is so often the case in population health studies, rural, poor, and minority populations did not fare well.

I asked Dr. Anderson to explain why some populations aren't getting CPR training, and she flipped the question.

Knowledge is Power
"We need to take a step back and ask 'why are some people CPR-trained?'" Anderson says. "The American Red Cross, the American Heart Association, and the Health & Safety Institute have a pretty good community base for CPR training, but it's largely healthcare institutions and professionals and persons who require CPR training on the job for safety reasons such as (Occupational Safety and Health Administration) requirements or lifeguards."

Now, the good news: While it's discouraging to see that some segments of the population appear to be left behind in CPR training, this is a teachable moment.

"I don't think we have officially known where people weren't getting training until this study," Anderson says. "This study brings to light more areas for focus and intensive research. It also is an opportunity not only for CPR training organizations but community leaders and local governments to come together and ask these questions: 'What are our training rates? What are our bystander CPR rates? How does our survival look when compared nationally? And how do we come together to build systems of care program that will bring about a change?'"

The Duke research gives community health champions a cause and a blueprint and an opportunity to engage the people they serve. If successful, the results will be tangible. People will survive. CPR training is so simple and inexpensive that Anderson says she can teach it "in a matter of minutes."

For starters, as a part of coordinating post-discharge patient care with families, clinicians should ensure that there is a CPR-trained person in the home because most cardiac events outside of the hospital occur inside the house, not in public.

In North Carolina, it's now a state law that high school students must complete a CPR training course before they can graduate. Anderson says there are other opportunities to train large swaths of the population by making CPR training mandatory during the drivers' license application process.

On the local front, hospitals, health clinics, emergency responders, schools, and large employers are the logical candidates to lead a CPR training initiative in their communities.

Spreading the Message
Population health champions can speak with local media about CPR training, how simple the process is to learn—especially now that mouth-to-mouth resuscitation has been phased out in favor of chest compression—and how it can benefit everyone in the community.

Write an op-ed piece for the local paper. Get an interview on local radio or TV. Tweet it on Twitter! 'Like' it on Facebook. Post it on your Web site. All of this can be done at minimal cost. Hospitals, and other community health assets already have CPR-trained staff and organizations such as the American Heart Association, ARC and HSI can provide guidance to build CPR training programs.

"Think about it. If the county government, the major hospitals in the area and the largest businesses required all of their employees to be CPR trained we would make amazing strides," Anderson says.

Unlike other worthy and vital public health initiatives such as cancer screenings or flu shots, people undergoing CPR training are not passive recipients of services provided. They are being challenged to learn a lifesaving skill for the betterment of their families, friends, and communities.

Imparting lifesaving knowledge gives people a sense of accomplishment. It will create a bond of trust with the healthcare professionals who teach them. That is powerful stuff and it can provide that foot in the door for population health advocates to pursue other proactive healthy lifestyle choices such as diet and exercise.