30-minute CPR Classes Just As Effective As Multi-hour Courses

UT Southwestern Medical Center researchers have found that a user-friendly, 30-minute, video-based cardiopulmonary resuscitation training session is just as effective as the traditional three- to four-hour course in teaching basic life-saving techniques to laypersons. In addition, at six months after the training — a critical point for CPR skill retention — those who took the shorter course performed CPR and used an automated external defibrillator (AED) just as well or better than those who take the traditional training.

These findings, published in the August issue of the journal Resuscitation, are the first to evaluate and document the effectiveness of long-term retention of the new 30-minute CPR-AED training.

“The results of this formal investigation should not only facilitate more widespread training and frequent re-training in CPR techniques, but it also diminishes some of the inefficiencies and labor-intensity inherent in traditional CPR training,” said Dr. Paul Pepe, chief of emergency medicine at UT Southwestern.

	Dr. Lynn Roppolo (right), assistant professor of emergency medicine, and Dr. Ahamed Idris, professor of emergency medicine, were part of a group of researchers who have found that a user-friendly, 30-minute, video-based cardiopulmonary resuscitation training session is as effective as the traditional three- to four-hour course in teaching basic life-saving techniques to the public.

Traditional CPR courses last half a day, as six to eight people take turns practicing their skills on a shared manikin. The remainder of the time is spent listening to instruction, leaving little time for skills practice, the researchers report.

“Using individualized kits, the trainees can focus on uninterrupted skills practice and develop muscle memory from more intensive, focused and reiterative practice,” said Dr. Pepe.

The shorter course is much more convenient and easily accessible, said Dr. Lynn Roppolo, assistant professor of emergency medicine and lead author of the study.

“Individuals practice while they learn, allowing more time to perform and retain the critical hands-on skills required to provide more effective CPR,” Dr. Roppolo said. “All of these factors will likely translate into more people knowing what to do — and doing it right — whenever CPR is needed. As a result, hopefully, many more lives will be saved in years to come.”

For the study, volunteers recruited in Fort Worth were selected randomly to take either the 30-minute course or a traditional three-hour session.

The short course consisted of a 23-minute digital video disc program, developed by the American Heart Association, which covers basic adult CPR skills, including recognition of signs of life, calling for help, opening the airway, rescue breaths and chest compressions.

As two dozen or more students watched the video in each session simultaneously, they practiced the CPR techniques almost continuously for nearly 20 minutes on their own personal mini-manikin, supervised by a “facilitator” who generally only needed to answer an occasional question from the trainees once the DVD was started.

Also included was a three-minute discussion and demonstration on the recognition of and best procedures for choking, as well as a five-minute demonstration of the use of an AED.

In the traditional course, students attended a three-hour session consisting of lectures supplemented by related video-based instruction, practice of basic CPR skills, choking procedures and instruction and hands-on practice in the use of an AED. During this course, there was one certified instructor for every six to eight students during the skills practice.

After their respective training, the students from both groups were tested using a life-sized manikin, which was connected to a laptop computer that objectively measured parameters such as the rate and depth of ventilations and chest compressions.

In addition to the computer measurements, overall CPR performance and AED use were videotaped and later judged as being appropriate by CPR training experts, who graded each study participant without knowing whether the he or she had taken the half-hour course or the traditional training.

Immediately after taking the class, there were no significant differences in CPR performance between the students who took the three-hour course as compared to those who took the 30-minute course.

After six months, however, trainees who took the 30-minute course called 9-1-1 and provided adequate ventilation more frequently than those who took the longer course. Also, both at the initial and six-month follow-up test, the students who took the traditional course took 30 percent longer to assess for signs of life, and they took significantly more time to pause between chest compressions to perform ventilations.

In grading AED use immediately after the courses, the trainees who took the 30-minute course placed the AED pads and delivered a shock correctly in 98 percent of the cases, compared to 92 percent of those who took the longer course. Moreover, at the critical six-month follow-up, 93 percent of those in the half-hour course still operated the AED well and 93 percent were still judged to be performing chest compressions adequately.

“The results of this investigation were very compelling. This study suggests that hands-on practice is not necessary to learn how to operate an AED, a device that directly provides the rescuer with vocal instructions once it is turned on,” said Dr. Roppolo. “Thus, training tools that utilize cognitive modes, such as the Internet and DVD demonstrations, may be just as effective.”

Other UT Southwestern researchers contributing to the study included Dr. Ahamed Idris, professor of emergency medicine, and Dr. Ronna Miller, assistant professor of emergency medicine.

The research was supported by the American Heart Association, the Laerdal Medical Corp., and Phillips Medical Systems and American Airlines.

Safety In China

News about Chinese products and foods, exported to other countries, causing health problems seems to be in the news almost daily. However, an even bigger problem is that of product safety within China. It's a country in which safety is of secondary (or even tertiary) importance to the number one objective of making money.

An example is reported in today's issue of the International Herald Tribune. Over a period of just two days, last Sunday and Monday, there were three accidents involving the manufacturing of explosive devices by home businesses. You can read the article at:

http://www.iht.com/articles/ap/2007/07/18/asia/AS-GEN-China-Blast-Deaths.php

Free Lean Manufacturing Guides

Several lean manufacturing guides are available free for the asking. The cover areas such as 5S, kaizen and kanban. Here are some links:

A free guide to standard 5s colors shows the color coding system that has developed for use with 5S. There is no organization that establishes standards for 5S, but this color coding system has come about as a result of common usage.

There is also a free guide to implementing 5S available. It provides a quick overview of 5S, describing what it is, the benefits of 5S, and how to start your own 5S program.

If you'd like to learn about kaizen, a kaizen quick start guide is available from a poster printer web site. Poster printers are used to enlarge 8-1/2" x 11" originals to poster-sized. They provide a quick and convenient way to create visuals to support all of your lean manufacturing efforts.

Kanban is a method for reducing costs and waste, and improving quality and productivity by improving your logistics. It is often assocated with JIT (Just In Time) delivery, which is a key component of lean manufacturing. A free introductory guide to kanban is available from the Facility Signs web site.

FDA Clears First Respirators for Use in Public Health Medical Emergencies

The U.S. Food and Drug Administration (FDA) today cleared for marketing the first respirators that can help reduce the user's exposure to airborne germs during a public health medical emergency, such as an influenza pandemic.

These two filtering facepiece respirators, manufactured by St. Paul, Minn.-based 3M Company (and called the 3M Respirator 8612F and 8670F), will be available to the general public without a prescription.

The devices are also certified as N95 filtering facepiece respirators by the National Institute for Occupational Safety and Health (NIOSH). NIOSH certifies respirators for use in occupational settings in accordance with an appropriate respiratory protection program.

An N95 filtering facepiece respirator is a type of face mask that fits tightly over the nose and mouth. It is made of fibrous material that is designed to filter out at least 95 percent of very small airborne particles. The filter and a proper fit determine the effectiveness of the product.

"While the exact nature and concentration of the biological agent or germ may not be known in a public health medical emergency, we believe that minimizing exposure will help reduce risk," said Daniel Schultz, M.D., director, FDA's Center for Devices and Radiological Health. "These respirators are only one part of a combination of approaches that can be used to help reduce the spread of infection between individuals during such events."

Many companies make N95 respirators for workplaces, including health care settings. However, the 3M respirators are the first devices to receive FDA clearance for use by the public during public health medical emergencies to reduce exposure to airborne germs.

Under Occupational Safety and Health Administration and other occupational health regulations, respirators used in the workplace must be individually selected for each worker and tested to ensure a proper fit. This kind of fit testing is not generally employed outside the workplace now and would probably not be feasible during a public health medical emergency.

FDA is requiring those who want to market respirators for use during public health medical emergencies to assure that they are certified by NIOSH to provide adequate filtration without hampering people's ability to breathe. In addition, companies must conduct fit assessment testing, conduct biocompatibility testing to reduce the chance for allergic skin reaction, and provide instructions that will enable wearers to achieve a protective fit and use the devices properly.

3M evaluated fit characteristics in healthy adults to determine that a user could achieve a protective fit following the instructions on the label. They measured how many airborne test particles were able to get inside the respirator through small leaks between the edges of the respirator and the wearer's face. While individual results varied, all participants tested achieved some reduction in exposure to airborne test particles.

The 3M respirators are sized for adults and may not form a proper fit on children. Anything that comes between the respirator and the face, such as facial hair, may interfere with its fit. Persons with pre-existing heart or lung disease or other health conditions may have difficulty breathing through a respirator. The devices are for single use. Wearers should not wash, disinfect, reuse or share their respirator with others. The respirators should be discarded after use.

FDA will soon issue a guidance document outlining its regulatory approach to this new type of device.

Inhaling particles is just one route of exposure to disease-causing organisms. Others include touching contaminated surfaces and coming into close contact with those who have infectious diseases. A total approach to personal protection includes hand hygiene, cough etiquette and other protection practices such as avoiding crowded settings.