Simulation and educationEducation in cardiopulmonary resuscitation in Sweden and its clinical consequences☆
Introduction
In Sweden, a large number of patients die suddenly every year and the majority of cases have a clear cardiac aetiology.1 The majority of these deaths occur out of hospital. The most common fatal rhythm in OHCA is ventricular fibrillation.2, 3 The aetiology of OHCA varies between the patient age groups. With advancing age, cardiac causes are more prevalent. Other causes of OHCA include drug overdoses, suffocation, trauma, drowning and suicide.4
The implementation of the ‘chain of survival’ is fundamental for the outcome of OHCA.5 Time is the most critical factor at every link in the chain. Particularly, early access to the emergency medical services (EMS) and early CPR have been shown to improve outcomes.6, 7 As a result, bystander CPR has been reported to be associated with a clear increase in survival among patients found in a shockable and non-shockable rhythm.8, 9
In 1981, Holmberg, as the chairman of a working group within the Swedish Society of Cardiology (SSC) started to develop a national CPR education programme. Inspired by the American Heart Association programme and a local education programme from Rogaland in Norway, the Swedish education programme was completed in 1983. The implementation of CPR in Sweden started by inviting 24 doctors from different parts of Sweden to Marstrand, a small island off the Swedish west coast, where they participated in the very first CPR-course and became the first instructor-trainers. They then returned home to start their own CPR-cascades. The cascade principle for education in CPR is designed for both health care providers and lay people.10
The aim of this study was to describe the use of CPR training programmes in Sweden over the last 25 years and to relate it to changes in the percentage of patients with OHCA who receive bystander CPR.
Section snippets
Setting and target population
The target population is the country of Sweden with 9.1 million inhabitants.
CPR training programme
The CPR training programme that was published in 1983 was a 3-hour programme for training in the “adult one-rescuer CPR” technique. It was designed both for lay people and for medical professionals. It was standardised for medical content, teaching material and teaching methodology using a detailed instructor's manual. It started with a 20-minute video that first showed a dramatic cardiac arrest situation to motivate
Adult
Almost 2 million rescuers in Sweden have been educated in CPR since 1983 with a mean of nearly 100,000 persons a year and about 1000 per 100,000 inhabitants per year (Table 1). The numbers of rescuers educated every year do not appear to change much over time (Fig. 1). A total of 50,000 instructors and 2500 instructor-trainers have been educated simultaneously during this period (Fig. 2). Between 1983 and 1989, some 250,000 rescuers were educated in CPR.
Child
Nearly 100,000 rescuers have been
Bystander CPR can save lives
Persons suffering a cardiac arrest can be kept alive with CPR in the majority of cases until professional help arrives and further action including defibrillation can be taken.12, 13 For CPR to have a real life-saving effect in society a large percentage of the population must be trained in CPR. To achieve this, it is not enough to have guidelines or describe the CPR procedure and have training programmes that could apply to the population. The most important step is to implement large-scale
Conclusion
Using a cascade principle for CPR education, almost 2 million rescuers were educated in Sweden (9 million inhabitants) between 1983 and 2007. This has resulted in a marked increase in bystander CPR attempts particularly those performed by non-health care providers during the same period.
Conflicts of interest
No conflict of interest has been declared by the authors.
Acknowledgement
This study was supported by grants from the Laerdal Foundation.
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Cited by (52)
A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls
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Smartphone activated community first responders’ experiences of out-of-hospital cardiac arrests alerts, a qualitative study
2022, Resuscitation PlusCitation Excerpt :The program includes lecture and practical training and is standardized for content, teaching material and teaching methodology. The program was originally provided through a cascade principle in which instructor trainers taught instructors who would then teach rescuers, which has allowed efficient dissemination to a large number of people.20 In recent years, the standardized CPR training has also been provided as a web program, which has reduced the dependence on instructors.
When is a bystander not a bystander any more? A European survey
2019, ResuscitationCitation Excerpt :The methods to shorten the interval between cardiac arrest and the initiation of CPR have evolved rapidly in recent years.10 These measures include: introduction of dispatch-assisted CPR11,12; more widespread basic life support (BLS) training in the community members13,14; BLS training of school children15,16; and alerted first responders.7,17 First responder systems may include official organisations such as police18,19 and firefighters,20,21 off-duty emergency or medical personnel, or laypeople dispatched by ambulance control to provide a first response to OHCA in partnership with their local ambulance service.22
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.10.014.