What Prevents Layperson CPR Response?

By J.M. Hendry

 

Does anxiety or the stress of responding to a medical emergency prevent laypersons trained in cardiopulmonary resuscitation (CPR) from implementing their skills?

 

A group of researchers from Canada and the United States shed some light on this question through their assessment of stress levels and types of stress felt by 1,243 layperson participants in the Public Access Defibrillation Trial.

 

The researchers analyzed data collected during post-response interviews with study participants who responded to an emergency medical episode after being trained in CPR alone or in conjunction with automated external defibrillator (AED) training. Study participants typically worked at shopping centers or in office buildings, or lived or worked in gated communities and received standardized training consistent with then current American Heart Association HeartSaver programs.

 

Overall, layperson responders reported low stress levels from responding to a medical emergency. But responding to an out-of-hospital cardiac arrest elicited higher levels of stress — median levels of 2.0 compared with 1.0 during response to a non-cardiac arrest event on a scale from 0 (low) to 5 (high).

 

“At least among those who choose to respond to an event, doing CPR on a stranger was not a traumatic experience,” explained Barbara Riegel, DNSc, RN, CS, FAAN, associate professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia.

 

Just 16% of the responders indicated stress levels of 3 or above. This group's comments commonly reflected stress and anxiety, and Riegel and colleagues wrote, “and may have been accentuated by lack of confidence in their skills.”

 

Female responders and responders speaking English as a second language reported overall higher levels of stress as did responders to residential settings and situations involving presumed cardiac arrest.

 

Aspects of airway management and helping victims who had vomited were additional, oft cited concerns as were:

  • Experiencing resistance to care from conscious but confused patients;
  • Communicating with EMS;
  • The physical effort required to move a patient;
  • The difficulties of crowd control; and
  • being unprepared to deal with the grief of patients' families and friends.

 

Riegel and colleagues suggested the findings of this study may be useful for those involved in training laypersons in the use of CPR and AED. Inviting a layperson who has ‘done it' to training sessions “would make the class so much more salient for learners,” Riegel said, and “it might change the emphasis a bit from the theoretical to the practical skill.”

 

She and colleagues also suggested communities consider implementing a tracking system that will collect information on the reactions of and difficulties faced by layperson responders to medical emergencies. Other countries keep registries of trained laypersons, Riegel told Merginet. “After responding to an event, those laypersons can report details for formal tracking.”

 

Riegel sees the value of a similar system in the US, “ a ‘thank you' debriefing about the event,” that affords lay responders the opportunity to relay their experience, what they feel are positive and negative aspects of their training, and what might make training better in the future.

 

Resource

Riegel B. Mosesso VN. Birnbaum A. Bosken L. et al: “Stress reactions and perceived difficulties of lay responders to a medical emergency.” Resuscitation (2006) 70, 98-106.