Strengthening the In-Hospital Chain of Survival With Rapid Defibrillation by First Responders Using Automated External Defibrillators: Training and Retention Issues

• Published in: Annals of emergency medicine Vol. 25; no. 2; pp. 163 - 168
• Main Authors: Kaye, William, Mancini, Mare E, Giuliano, Karen K, Richards, Nancy, Nagid, Denise M, Marler, Connie A, Sawyer-Silva, Sandra
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.1995; Elsevier
• Subjects: Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Education, Nursing, Continuing; Electric Countershock - instrumentation; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medical Services - standards; Emergency Nursing - education; Heart Arrest - therapy; Hospitals, University; Humans; Intensive care medicine; Longitudinal Studies; Medical sciences; Nursing Staff, Hospital - education; Resuscitation - education; Resuscitation - standards; Retention (Psychology); United States; Ventricular Fibrillation - therapy; United States; Intensive cardiocirculatory care; Arrhythmia; Heart disease; Instrumentation therapy; Cardiovascular disease; Vocational aptitude; Defibrillation; Occupational education; Dummy; Excitability disorder; Ventricular fibrillation; Nurse
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(95)70318-7

Study objective: To determine whether staff outside critical care areas who were proficient in basic life support (BLS) could be easily trained to use automated external defibrillators (AEDs) and whether they would retain these skills. Design: Prospective, longitudinal cohort series. Setting: Two university teaching hospitals. Participants: One hundred forty nurses who had previously learned BLS and constituted the staff from three medical/surgical nursing units from each study hospital. Interventions: The nurses were taught how to use the Heartstart 1000s, a lightweight portable shock-advisory AED, in a 2-hour class with an instructor and manikin-to-student ratio of 1:5. The course emphasized hands-on practice of the BLS-AED algorithm on a computerized manikin. Results: Using a similar scenario, each nurse was evaluated on the computerized manikin immediately after training (posttest). At 1 to 3, 4 to 6, and 7 to 9 months after the initial training, convenience samples of the cohort in three different groups were evaluated for retention. Satisfactory performance was defined as delivery of the first AED shock within 2 minutes of recognition of the arrest. At the posttest after training, 139 of 140 nurses (99%) demonstrated satisfactory performance. Of 77 nurses evaluated, 31 of 32 at 1 to 3 months, 18 of 18 at 4 to 6 months, and 24 of 27 at 7 to 9 months after initial training (95% overall) performed satisfactorily. Conclusion: As has been demonstrated with prehospital emergency personnel, nurses outside critical care areas who are proficient in BLS can easily learn and retain the knowledge and skills to use AEDs. Automated external defibrillation, a BLS skill, should be incorporated into BLS programs (BLS-AED) for all hospital personnel expected to respond to a patient in cardiac arrest, with rapid defibrillation taking priority over CPR. [Kaye W, Mancini ME, Giuliano KK, Richards N, Nagid DM, Marler CA, Sawyer-Silva S: Strengthening the in-hospital chain of survival with rapid defibrillation by first responders using automated external defibrillators: Training and retention issues. Ann Emerg Med February 1995;25:163-168.]