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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2017

Open Access 01-12-2016 | Research article

A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

Authors: Line Zinckernagel, Carolina Malta Hansen, Morten Hulvej Rod, Fredrik Folke, Christian Torp-Pedersen, Tine Tjørnhøj-Thomsen

Published in: BMC Emergency Medicine | Issue 1/2017

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Abstract

Background

Student training in use of automated external defibrillators and deployment of such defibrillators in schools is recommended to increase survival after out-of-hospital cardiac arrest. Low implementation rates have been observed, and even at schools with a defibrillator, challenges such as delayed access have been reported. The purpose of this study was to identify barriers to the implementation of defibrillator training of students and deployment of defibrillators in schools.

Methods

A qualitative study based on semi-structured individual interviews and focus groups with a total of 25 participants, nine school leaders, and 16 teachers at eight different secondary schools in Denmark (2012–2013). Thematic analysis was used to identify regular patterns of meaning using the technology acceptance model and focusing on the concepts of perceived usefulness and perceived ease of use.

Results

School leaders and teachers are concerned that automated external defibrillators are potentially dangerous, overly technical, and difficult to use, which was related to their limited familiarity with them. They were ambiguous about whether or not students are the right target group or which grade is suitable for defibrillator training. They were also ambiguous about deployment of defibrillators at schools. Those only accounting for the risk of students, considering their schools to be small, and that time for professional help was limited, found the relevance to be low. Due to safety concerns, some recommended that defibrillators at schools should be inaccessible to students. They lacked knowledge about how they work and are operated, and about the defibrillators already placed at their campuses (e.g., how to access them). Prior training and even a little knowledge about defibrillators were crucial to their perception of student training but not for their considerations on the relevance of their placement at schools.

Conclusions

It is crucial for implementation of automated external defibrillators in schools to inform staff about how they work and are operated and that students are an appropriate target group for defibrillator training. Furthermore, it is important to provide schools with a basis for decision making about when to install defibrillators, and to ensure that school staff and students are informed about their placement.
Literature
1.
Institute of Medicine (IOM). Strategies to Improve Cardiac Arrest Survival: A Time to Act. Washington: Institute of Medicine; 2015.
2.
Georgiou M, Lockey AS. ERC initiatives to reduce the burden of cardiac arrest: the European Cardiac Arrest Awareness Day. Best Pract Res Clin Anaesthesiol. 2013;27(3):307–15.CrossRefPubMed
3.
Herlitz J, Svensson L, Holmberg S, Angquist KA, Young M. Efficacy of bystander CPR: intervention by lay people and by health care professionals. Resuscitation. 2005;66(3):291–5.CrossRefPubMed
4.
Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, Jans H, Hansen PA, Lang-Jensen T, Olesen JB, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013;310(13):1377–84.CrossRefPubMed
5.
Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000;343(17):1206–9.CrossRefPubMed
6.
Hansen CM, Lippert FK, Wissenberg M, Weeke P, Zinckernagel L, Ruwald MH, Karlsson L, Gislason GH, Nielsen SL, Kober L, et al. Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers. Circulation. 2014;130(21):1859–67.CrossRefPubMed
7.
Bohn A, Lukas RP, Breckwoldt J, Bottiger BW, Van Aken H. ‘Kids save lives’: why schoolchildren should train in cardiopulmonary resuscitation. Curr Opin Crit Care. 2015;21(3):220–5.CrossRefPubMed
8.
Bottiger BW, Van Aken H. Training children in cardiopulmonary resuscitation worldwide. Lancet. 2015;385(9985):2353.CrossRefPubMed
9.
Cave DM, Aufderheide TP, Beeson J, Ellison A, Gregory A, Hazinski MF, Hiratzka LF, Lurie KG, Morrison LJ, Mosesso Jr VN, et al. Importance and implementation of training in cardiopulmonary resuscitation and automated external defibrillation in schools: a science advisory from the American Heart Association. Circulation. 2011;123(6):691–706.CrossRefPubMed
10.
11.
Hart D, Flores-Medrano O, Brooks S, Buick JE, Morrison LJ. Cardiopulmonary resuscitation and automatic external defibrillator training in schools: “is anyone learning how to save a life?”. CJEM. 2013;15(5):270–8.CrossRefPubMed
12.
Hansen CM, Zinckernagel L, Ersbøll AK, Tjørnhøj-Thomsen T, Wissenberg M, Lippert FK, Weeke P, Gislason GH, Køber L, Torp-Pedersen C et al. Rates of, Barriers and Facilitators to Cardiopulmonary Resuscitation Training in Schools Following Eight Years of Mandating Legislation: a nationwide survey. 2017.
13.
Lafferty C, Larsen PD, Galletly D. Resuscitation teaching in New Zealand schools. N Z Med J. 2003;116(1181):U582.PubMed
14.
Miro O, Jimenez-Fabrega X, Espigol G, Culla A, Escalada-Roig X, Diaz N, Salvador J, Abad J, Sanchez M. Teaching basic life support to 12–16 year olds in Barcelona schools: views of head teachers. Resuscitation. 2006;70(1):107–16.CrossRefPubMed
15.
Mpotos N, Vekeman E, Monsieurs K, Derese A, Valcke M. Knowledge and willingness to teach cardiopulmonary resuscitation: a survey amongst 4273 teachers. Resuscitation. 2013;84(4):496–500.CrossRefPubMed
16.
Reder S, Quan L. Cardiopulmonary resuscitation training in Washington state public high schools. Resuscitation. 2003;56(3):283–8.CrossRefPubMed
17.
Zinckernagel L, Malta Hansen C, Rod MH, Folke F, Torp-Pedersen C, Tjornhoj-Thomsen T. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools? A qualitative study. BMJ Open. 2016;6(4):e010481.CrossRefPubMedPubMedCentral
18.
Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. Br J Sports Med. 2013;47(18):1179–83.CrossRefPubMed
19.
Watson AM, Kannankeril PJ, Meredith M. Emergency response planning and sudden cardiac arrests in high schools after automated external defibrillator legislation. J Pediatr. 2013;163(6):1624–7. e1621.CrossRefPubMed
20.
Rothmier JD, Drezner JA, Harmon KG. Automated external defibrillators in Washington State high schools. Br J Sports Med. 2007;41(5):301–5. discussion 305.CrossRefPubMedPubMedCentral
21.
Kovach J, Berger S. Automated external defibrillators and secondary prevention of sudden cardiac death among children and adolescents. Pediatr Cardiol. 2012;33(3):402–6.CrossRefPubMed
22.
Undervisningsministeriet. Fælles Mål 2009 Færdselslære. Faghæfte 20. Undervisningsministeriets håndbogsserie. 2009.
23.
Plant N, Taylor K. How best to teach CPR to schoolchildren: a systematic review. Resuscitation. 2013;84(4):415–21.CrossRefPubMed
24.
Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of InformationTechnology. MIS Q. 1989;13(3):319–40.CrossRef
25.
Davis A, Bagozzi RP, Warshaw PR. User Acceptance of Computer Technology: A Comparison of Two Theoretical Models. Manag Sci. 1989;35:982–1003.CrossRef
26.
Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119(10):1442–52.CrossRefPubMed
27.
Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 2001;358(9279):397–400.CrossRefPubMed
28.
Patton M. Qualitative Research & Evaluation Methods. London: Sage Publication; 2002.
29.
30.
31.
32.
Strudwick G. Predicting nurses’ use of healthcare technology using the technology acceptance model: an integrative review. Comput Inform Nurs. 2015;33(5):189–98. quiz E181.CrossRefPubMed
33.
Money AG, Barnett J, Kuljis J. Public claims about automatic external defibrillators: an online consumer opinions study. BMC Public Health. 2011;11:332.CrossRefPubMedPubMedCentral
34.
Moore JE, Eisenberg MS, Cummins RO, Hallstrom A, Litwin P, Carter W. Lay person use of automatic external defibrillation. Ann Emerg Med. 1987;16(6):669–72.CrossRefPubMed
35.
Mosesso Jr VN, Shapiro AH, Stein K, Burkett K, Wang H. Effects of AED device features on performance by untrained laypersons. Resuscitation. 2009;80(11):1285–9.CrossRefPubMed
36.
Yeung J, Okamoto D, Soar J, Perkins GD. AED training and its impact on skill acquisition, retention and performance--a systematic review of alternative training methods. Resuscitation. 2011;82(6):657–64.CrossRefPubMed
37.
Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, Sinz EH, Cheng A. Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S561–73.CrossRefPubMed
38.
Uray T, Lunzer A, Ochsenhofer A, Thanikkel L, Zingerle R, Lillie P, Brandl E, Sterz F. Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools. Resuscitation. 2003;59(2):211–20.CrossRefPubMed
39.
Harrison-Paul RS. Training Laypeople to use Automatic External Defibrillators: Are all of their needs being met? PhD thesis. 2009.
40.
The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 4: the automated external defibrillator: key link in the chain of survival. Circulation 2000;102(8 Suppl):I60–76.
41.
Hazinski MF, Markenson D, Neish S, Gerardi M, Hootman J, Nichol G, Taras H, Hickey R, O’Connor R, Potts J, et al. Response to cardiac arrest and selected life-threatening medical emergencies: the medical emergency response plan for schools: A statement for healthcare providers, policymakers, school administrators, and community leaders. Circulation. 2004;109(2):278–91.CrossRefPubMed
42.
Rega P, Fink B. AED Education: A Dilemma for Public Health and a Challenge for Critical Care Specialists. J Intensive Crit Care. 2015;1(1):9–13.CrossRef
43.
Bogle B, Mehrotra S, Chiampas G, Aldeen AZ. Assessment of knowledge and attitudes regarding automated external defibrillators and cardiopulmonary resuscitation among American University students. Emerg Med J. 2013;30(10):837–41.CrossRefPubMed
44.
Swor R, Grace H, McGovern H, Weiner M, Walton E. Cardiac arrests in schools: assessing use of automated external defibrillators (AED) on school campuses. Resuscitation. 2013;84(4):426–9.CrossRefPubMed
45.
Hansen CM, RosenKranz SM, Folke F, Zinckernagel L, Tjørnhøj-Thomsen T, Torp-Pedersen C, Sondergaard KB, Nichol G, Rod MH: Lay Bystanders’ Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests. 2017.
46.
Metadata
Title
A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools
Authors
Line Zinckernagel
Carolina Malta Hansen
Morten Hulvej Rod
Fredrik Folke
Christian Torp-Pedersen
Tine Tjørnhøj-Thomsen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2017
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-017-0114-9

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