Because One CPR Class is Not Enough: Part 1

September 15, 2014

Looking beyond into student learning, preparedness, and assessment

Shannon Dere
University of Arkansas

Julie Saldiva
Texas State University

Editor’s Note: This is the first of two parts.

Risk Management, the big buzz word floating around campus recreation right now, has a lot of recreation professionals on edge but many may not be quite sure of how to go about managing risk properly. One of the biggest risks that campus recreation departments have involves their student staff. Generally speaking, these staff members are expected to work front-line operations and carry out daily risk management practices, including applying first aid and CPR/AED skills when needed. But are we properly preparing our students to succeed in situations where this knowledge and these skills will be needed most?

Many campus recreation programs are taking a proactive step in ensuring that most or all student staff is trained in CPR/AED and first aid, however, many programs stop after the initial certification class. Most of these certifications, regardless of the provider, last typically from one to three years before a renewal is needed. Additionally, many certification providers are not only simplifying the techniques they teach, but also offer online courses where students never have the opportunity to practice their skills. With such a variation of training and certification renewal options, inconsistencies in knowledge and skills are significant, and student staff are likely to forget much of their training.

CPR/First Aid Knowledge and Skill Retention

Although research is severely lacking in the study of retention of CPR/first aid skills among campus recreation students specifically, there has been other research conducted on different groups. Among the general population of participants, the American Red Cross has found that retention of CPR/AED and first aid skills are shown to decline in as little as three months following a certification; there does not seem to be any published evidence of adequate CPR skill retention at two years (ARC, n.d.a; ARC, n.d.b). Among nursing undergraduate students it was found that the retention of CPR knowledge and skills depended greatly on how frequent trainings were (Madden, 2006). The same conclusion was made in another study with registered nurses, and it was concluded that a decrease in retention of the material was found just 10 weeks after the initial training course (Broomfield, 2008). Almost all research on the topic supports the importance of refreshers for course participants on a regular basis. It is up to campus recreation professionals to determine the best method(s) for providing these refreshers.

Refreshers

There are many ways campus recreation programs can create and implement refresher programs for their student employees. Some ways are:

(1) Have staff complete the full CPR/AED and first aid class at a predetermined interval (such as every six months)

(2) Have staff complete a challenge CPR/AED and first aid course at a predetermined interval (such as every semester)

(3) Continually review CPR/AED and first aid topics and skills at in-service trainings

(4) Create online learning centers with exercises and quizzes by utilizing online programs, such as Blackboard, where students must complete these exercises and quizzes at a predetermined interval (such as a new topic every other week)

(5) Audit staff skills through drills (mock scenarios)

(6) Quiz staff on training topics by utilizing other student staff

The method(s) for delivery of a refresher program your department should do will depend greatly on the resources available. It is highly recommended that departments create a Risk Management committee to not only assist in the creation and implementation of the refresher program, but to also have outside people serve on the committee that will be a valued asset to the group when planning the program. Beyond professional, graduate, and student staff serving on this committee, consider getting your university’s police department, fire marshall, and other safety officials involved. Their expertise and resources can become extremely valuable when creating and implementing refreshers.

This article will specifically focus on methods and best practices for conducting mock safety drills/scenarios as well as how to assess the drills.

Mock Safety Drill

Creating and implementing mock safety drills allows you to not only assess your student employees’ skill level (e.g. confidence, knowledge, etc.), but to also determine weak areas in your department’s risk management plan. Drills are not necessarily used as a discipline tool, rather, it should be used to help students learn about how to react professionally to emergencies. Developing and executing drills can range from simple to complex, and can be a great tool if utilized properly. The following explains the overall process for initiating mock safety drills into your campus recreation program.

The Basics
Starting simple is a wise plan when tackling mock safety drills. Once your department has created a more streamlined process for conducting drills, then you can begin to practice more realistic and challenging drills. At a more advanced and practiced stage you can also bring in more resources, such as using a moulage kit, which allow for more realistic drills through the use of makeup or faux injuries/body parts, or having EMS respond as if it were an actual emergency. We cannot emphasize enough that starting small is the best practice until your department is extremely comfortable running more complex drills.

To assist in keeping your department on track, creating a calendar can be helpful. This allows you to organize dates, staff, injury type, and more. Having a rotation cycle for the mock scenario drills–informal recreation, fitness, intramural sports, outdoor recreation, club sports, aquatics, repeat, etc.–can help the department in following a schedule. Based on your calendar you can also pick the type of injury and when to conduct the drill. For example, drilling on the skill of hypothermia would make more sense to do with outdoor recreation than fitness or conducting a drill at 9:00 am may be more logical than during a intramural sports championship game. The idea is for staff to practice real life scenarios, not to necessarily disrupt patrons or activities.

Conducting the Drills
Drills can be ran during meetings, in-services, or during employee’s regular shifts. The students can be aware of the drills ahead of time or they can come as a complete surprise. Once you start the drill you, as the drill evaluator, should find the appropriate time to inform the student-employee that “it is a drill but you must treat it as if it were real”. If emergency responders have agreed to be a part of the drill and your staff will be calling them, be sure you have communicated with them how the call will be placed. For example, some emergency personnel services will require the staff member placing the call start and end the call with “this is a drill” to ensure that they know the call is a drill and that a real emergency did not occur coincidentally. If those statements are not made, emergency personnel may have no choice but to treat the drill as if it were real, even if they were notified of the drill ahead of time.

Careful planning of the drills needs to take place to ensure the drill runs smoothly. “Victims” should be chosen wisely since a “bad” victim can set the tone for the entire drill. If your victim is not well rehearsed or does not know how to act very well, it can often make the drill less effective. For example, if a “drowning” victim is not taught what an actual drowner looks like, the lifeguards may think they are playing around in the pool and never realize they should be going in and rescuing the victim. It is also helpful if the scenario is written out on paper (including ailments, amount of time a victim should wait before they go unconscious, etc.) for the actor to study beforehand.

Ideally, drills will involve local first responders. In our experience this is when the students learn the most. They get a realistic idea of how long it will take first responders to arrive. For mock scenario drills the responders do not typically turn on sirens to get to your building as fast as they would in a real emergency, which makes response time longer than normal. This may actually help the students get a realistic feel how awkward and uncomfortable it can be to wait for advanced help. Upon arrival, the first responders can take the students all the way through getting the victim into the ambulance. It is often helpful for the students to hear first hand from the responders what they could have done better to help the first responders more. Working with first responders has really taught the students at Texas State University to start providing more details when they call 911. Drill after drill we had learned that the responders did not realize the severity of the “accident” until they arrived – due to lack of communication and information provided.

Other Special Considerations

Based on our experiences with conducting mock scenario drills, we want to cover some important considerations.

– Picking the wrong type of injury at the wrong time can create potential problems. If you are drilling a serious injury, such as a heart attack, and do not have the drill completely planned out, both your student-employees and patrons may believe it to be a real emergency and call EMS. It is important to think through the drill to ensure that all the pieces are in place before conducting a mock scenario drill.

– There are often student-employees and professional staff who want to run the drills as if they were real. While this idea is respectable in the sense that the drills should be as realistic as possible, please note that many people’s reaction will be to get very angry with you if they completed a drill while thinking it was real the entire time. We teach children at a young age not to cry “wolf” when there is no wolf. Therefore, if your drills will be a surprise to the staff, it is recommended that all staff are told from their first day on the job that they could be a part of a drill at any moment.

– You should also make sure you notify the student-employee as to whether or not they can actually call 911. If emergency personnel are to be involved either with a phone call or an actual response, a notification should go out to these personnel informing them of the drill and/or asking for their assistance at least one week before the drill. A follow up call should be made the day of the drill as a reminder to emergency personnel.

– Student staff can typically tell when a drill is about to take place, even when there are no obvious indications, such as signs warning of a drill or mannequins lying around. Student-employees will begin to act uneasy or perform their job at a level which is atypical, which is not the point of the drill. To help combat this, two things should happen. First, plan well. If there is certain equipment that is needed before a drill, set it up well before the time of the drill so as not to make students suspicious. Second, mix up who the “victims” are as well as the evaluators. At Arkansas, students have learned to associate me (Shannon) with drills, so they also perk up when I walk around and are suddenly extremely observant of the areas in which they are supervising. Varying the actors (someone staff do not know) and evaluators will not only keep students alert, but also involve different parties in the process.

– Some Universities have also found that running the drills all in one week makes it easier for those coordinating the drills to remain focused on the drills. Correspondence with all who are involved, especially the first responders is also easier to maintain when the drills occur concurrently. When the drills are spread out over a semester or even a year, those in charge of the drills can tend to forget one is coming up, first responders forget what it is you wanted them to do, etc.

In Part II, we’ll look at the importance of debriefing and assessment.

Citations

American Red Cross (ARC). (n.d.a). ACFASP advisory CPR skill retention. Retrieved from
http://www.instructorscorner.org/media/resources/SAC/CPR%20Skill%20Retention.pdf

American Red Cross (ARC). (n.d.b). Welcome instructor trainers. Retrieved from
http://www.watersafetyguy.org/documents/IT_Orientation_v6_4_15_11FINAL.pdf

Broomfield, R. (2008). A quasi-experimental research to investigate the retention of basic
cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development.
Journal of Advanced Nursing, 23(5), 1016-1023.

Council for the Advancement of Standards (2009). CAS learning and development outcomes. In Council for the Advancement of Higher Education (Ed.), CAS professional standards for higher education (7th Ed.). Washington, DC: Author.

Madden, C. (2006). Undergraduate nursing students’’ acquisition and retention of CPR knowledge and skills.
Nurse Education Today, 26, 218-227.