Elsevier

Resuscitation

Volume 71, Issue 1, October 2006, Pages 80-88
Resuscitation

Training and Educational Paper
Training lay-people to use automatic external defibrillators: Are all of their needs being met?

https://doi.org/10.1016/j.resuscitation.2006.02.008Get rights and content

Summary

Aims

We explored the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED?

Methodology

Fifty-three semi-structured, qualitative interviews were conducted, some with those who had been trained and others with trainers. Locations included airports, railway stations, private companies and first responder schemes. Geographically, we covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK.

Results

Our analysis of the data indicates that most people believe scenarios based within their place of work were most useful in preparing for ‘real life’. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal.

Conclusion

Training scenarios should be conducted outside the classroom. There should be more focus on critical incident debriefing during training and a clear identification of who should provide support after an incident. Other issues which were of interest included: (1) people's views on do not attempt resuscitation (DNAR); (2) perceived boundaries of responsibility when using an AED; (3) when is someone no longer ‘qualified’ to use an AED?

Introduction

The placement of automatic external defibrillators (AEDs) in public locations in the United Kingdom continues to increase annually. The National Defibrillator Programme (NDP) supplied 681 AEDs in 2000, and in October 2004 the British Heart Foundation announced that a further 2285 were to be distributed amongst the NHS ambulance service NHS trusts for placement in community settings.1 In addition to these AEDs there are an unknown number that are purchased by local councils, voluntary aid societies, private companies and single site organisations, such as pubs and golf courses.2 These initiatives have led to hundreds of non-healthcare professionals being trained, each year, to operate AEDs outside hospital settings.

Section snippets

Rationale for the study

This research was prompted by a small-scale qualitative study conducted in a shopping centre in the East Midlands by one of the authors in 2002. The findings from that study highlighted a number of issues, which were of relevance to the implementation of Public Access Defibrillation (PAD), programmes. A much larger study seemed appropriate to explore these issues in other locations and an approach was made to the Resuscitation Council (UK) for funding in order to do this. A grant was received

Literature search

A comprehensive review of the literature was conducted using MEDLINE, Cinahl, Embase, Web of Science, Science Direct, ASSIA and the Cochrane Library. It was found that a plethora of literature existed relating to PAD which concerned issues, such as training, survival outcomes and the debate about the cost implications of these schemes.3, 4, 5, 6 The dominant approach in this research is quantitative and focusses on the practical and pragmatic issues involved. However, there was a dearth of

The value of qualitative research

Qualitative research is now part of the methodological mainstream in medical and health services research. Its value has been argued in the BMJ and the Lancet.15, 16 It has been accepted by the NHS Health Technology Assessment Programme as a key methodology in technology assessment.17 Qualitative research is complementary to the substantial body of existing quantitative work on AED which demonstrates that, for instance, AEDs are safe, effective and non-medical people can be trained to use them.

Results

Initially, we looked for comments that related to the original research questions.

Our first question asked respondents about their views on the training and how it could prepare people to deal with real life situations. There was an overall satisfaction with the content and standard of training received. A typical comment was:

I thoroughly enjoyed the training

All participants agreed that the training had prepared them to operate an AED with confidence. When asked how the training could be

Information and support

As the study progressed, we realised that we would be unable to answer our third question as we had originally phrased it. Instead we explored the processes by which employees might receive feedback after using an AED in relation to two particular aspects that had been highlighted in the original study. Firstly, people had questions about their actions during the resuscitation attempt. For example, had they done all they could, did they provide adequate BLS? Secondly, rescuers would want to

Views on do not attempt resuscitation in first responder schemes

Although, we only conducted three interviews in first responder schemes we did encounter some comments that related to the issue of DNAR procedure, which we felt were of interest:

“I would myself query whether I would actually do it if I got there and found somebody had been unconscious and out for a long period of time.”

“If you’ve got a 90 year old woman, and you are ripping her bra off.. I’m not sure I’d be prepared to do that.”

Unfortunately, these interviews were conducted towards the end of

Discussion

The placement of AEDs in public locations continues to increase each year in the United Kingdom. Despite the debate that surrounds PAD there appears to be widespread support for this continued expansion. The aim of these schemes is to save lives through early and effective defibrillation. One intention of training is to equip the lay-person with the necessary skills and confidence to operate an AED in an emergency situation. It is suggested that a major outcome of any training should also be a

Training

Our research indicates that people would generally like the training to be as realistic as possible. The training of healthcare professionals is becoming more realistic with the use of clinical skills labs and advanced, multifunctional manikins.24 However, BLS and AED training for the lay person is primarily conducted with standard manikins and is usually classroom based. More realistic training may be achieved through a combination of conducting scenarios in the places where victims are likely

Debriefing

It would appear that training is generally focussed on the individual achieving the necessary practical skills involved in providing BLS and using the AED. There is evidence that little emphasis is placed on the emotional consequences for the rescuer who has been involved in a resuscitation attempt. Our study highlights the fact that some individuals who have been involved in resuscitation attempts will require support and counselling afterwards. Comments from those who had used an AED, or

Other issues

Our study has highlighted the issue of how people perceive their ‘qualification’ to use an AED. The guidance on training at the time of this study recommended refresher training at 6-monthly intervals and some trainers issued certificates that were valid for a 6-month period. As we discovered, this is occasionally being interpreted by people as meaning that they perhaps should not use the AED after this period. There were also some people who would be reluctant to take their AED away from their

Conclusions

The public access defibrillation programme has had many reported successes where victims have survived a cardiac arrest due primarily to prompt defibrillation and BLS by a trained lay-person. We hope that this programme continues to expand and further lives are saved due to the action of lay-people who are willing to be trained in these skills. There is a responsibility to provide them with training that meets their needs, by those who plan such training. We suggest that training scenarios

Limitations of the study

We acknowledge that due to the qualitative design of this study there may be limits to how generalisable it is to all AED initiatives. However, we are confident that the people interviewed and the locations are broadly (if not statistically) representative of the study population as a whole. Likewise there is the inevitable problem of the perceived subjectivity of a qualitative study. We would contend that the varied perspectives of the research team, as well as the transparent, rigorous and

Conflict of interest

None.

Acknowledgements

We would like to thank the Resuscitation Council (UK) for providing the funding for this study. Also all of the organisations that willingly agreed to allow us to interview their employees and provided the facilities to do so. Finally, our thanks to those who participated in the interviews.

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    A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2006.02.008.

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