Life supporting first aid training of the public - review and recommendations

Since the introduction around 1960 of external cardiopulmonary resuscitatio n (CPR) basic life support (BLS) without equipment, i.e. steps A (airway co ntrol)-B (mouth-to-mouth breathing)-C (chest (cardiac) compressions), train ing courses by instructors have been provided, first to medical personnel a nd later to some but not all lay persons. At present, fewer than 30% of out -of-hospital resuscitation attempts are initiated by lay bystanders. The nu mbers of lives saved have remained suboptimal, in part because of a weak or absent first link in the life support chain. This review concerns educatio n research aimed at helping more lay persons to acquire high life supportin g first aid (LSFA) skill levels and to use these skills. In the 1960s, Safa r and Laerdal studied and promoted self-training in LSFA, which includes: c all for the ambulance (without abandoning the patient) (now also call for a n automatic external defibrillator); CPR-BLS steps A-B-C; external hemorrha ge control; and positioning for shock and unconsciousness (coma). LSFA step s are psychomotor skills. Organizations like the American Red Cross and the American Heart Association have produced instructor-courses of many more f irst aid skills, or for cardiac arrest only-not of LSFA skills needed by al l suddenly comatose victims. Self-training methods might help all people ac quire LSFA skills. Implementation is still lacking. Variable proportions of lay trainees evaluated, ranging from school children to elderly persons, w ere found capable of performing LSFA skills on manikins. Audio-tape or vide o-tape coached self-practice on manikins was more effective than instructor -courses. Mere viewing of demonstrations (e.g. televised films) without pra ctice has enabled more persons to perform some skills effectively compared to untrained control groups. The quality of LSFA. performance in the field and its impact on outcome of patients remain to be evaluated. Psychological factors have been associated with skill acquisition and retention, and mot ivational factors with application. Manikin practice proved necessary far b est skill acquisition of steps B and C. Simplicity and repetition proved im portant. Repetitive television spots and brief internet movies for motivati ng and demonstrating would reach all people. LSFA should be part of basic h ealth education. LSFA self-learning laboratories should be set up and maint ained in schools and drivers' license stations. The trauma-focused steps of LSFA are important for 'buddy help' in military combat casualty care, and natural mass disasters. (C) 1999 Elsevier Science Ireland Ltd. All rights r eserved.