Annie Needs KIS (Keep It Simple): CPR in Crisis?

jeastridge, BSN, RN

Our small town newspaper's headline screamed the story: "Baby Saved by CPR." Choking and turning blue, the infant had stopped breathing when a neighbor, trained in CPR, was able to appropriately address the choking and proceed with CPR until the baby revived. By the time EMS arrived, the baby was alert and crying to the joyful gratitude of his mother.

In our heads we hear the repeated phrase, "Annie, Annie, are you all right? YOU, call 9-1-1. Get the AED!" The training plays back in our heads because of the the familiarity of the often repeated training. But something has happened to CPR: over the last few years we have seen increased prices and increased length of classes and more demands on training centers regarding equipment. All of this begs the question: Is Annie going to continue to thrive or simply survive? What can we do together to apply the KIS (Keep It Simple) principle to CPR?

Statistics vary, but it is estimated that only 18% persons in the United States of the US population is current in their CPR certification. While 65% of people responding to a survey stated they have had training at some point in their lives,much smaller numbers respond that they are willing to actually perform CPR as a bystander, reporting feelings of inadequacy or lack of preparedness and fear of injuring someone. Fewer than 1 in 5 U.S. adults have CPR training

In October of 2017, CPR instruction and certification changed drastically when the American Heart Association increased the prices for their cards from $2.20 to $17, a price increase of 772%. Concurrently, they drastically decreased the prices of the student booklet from $15 to $2.50, in an effort to encourage each student to purchase and use their own books. The change caught many off guard and has made CPR instruction and certification even more challenging than it was previously.

A careful look at American Heart Association (AHA) vs. American Red Cross (ARC) shows more similarities than differences. The American Red Cross has classes that are a little longer, maybe a little easier, but priced very similarly to their American Heart Association counterpart. The AHA is the flagship organization for doing the research and promoting universal CPR training. Their classes are the ones often required by hospitals and health care institutions. Both have provisions for 2 year certifications and are moving toward more online formats, although these formats are always combined with some type of check-off system which contributes to make the whole process take a longer total time.

In addition to increased prices, the AHA class time has increased. In order to offer a class with a 2:1 manikin ratio, instructors are looking at approximately 4-5 hours of class time, a requirement that leads many to delay or totally omit optional training. It is hard for anyone to set aside that much time, especially if it is not paid for by their employer, and it is simply a personal skill they wish to obtain. It also makes it nearly impossible to complete training in an evening after work, requiring instead that the participant set aside week-end time or take time off from work.

The AHA's abrupt move to increase the prices of their cards, has caused a great deal of turmoil in the ranks of instructors and students. Many persons who are required to have CPR certification in order to do their jobs, now face increased prices and those who depend on being a CPR instructor for their income, find it challenging to continue to be able to make ends meet.

The central question in all of this upheaval is this: how will the patient be affected? Will fewer persons know how to do CPR? Will fewer persons be willing to offer this life-saving intervention to someone in need? Have we gone to the extreme of making CPR less accessible instead of more?

At their core, providing compressions, breaths, using an AED and relieving choking are all pretty basic practices. While these skills require some instruction and some review, they are, in essence easy. By raising prices, increasing time demands, and requiring electronic retrofitting of manikins, we see new and costly barriers being created; barriers that can potentially affect the total numbers of people being trained and staying current. Both the ARC and the AHA ultimately have a mission to teach CPR well and to as many as possible. Presumably, they would like to see every single person in this country know how to do CPR and feel competent to respond in an emergency situation. What steps can we take to help instructors to help people learn without being unduly hampered by excessive restrictions and cost? Is it possible that in recent times, these organizations may have lost site of one of their central helping missions?

As professional nurses, we have a vested interest in seeing even more of the public trained to do CPR. Let us all work together to ensure continued access to competent, excellent training. Maybe we need to re-examine our approach and move back toward the KIS principle: Keeping it simple-streamlined, quick, efficient and well-taught. Let's remove barriers and get back to helping one another, to reaching out in our communities. Let's find ways to offer CPR for a minimal fee or-no charge at all! Let's train our young people, our old people, our babysitters, our grocery clerks. Instead of moving toward tight control and less people trained, let's turn this thing on its head and move in the other direction-CPR for all!

Annie Needs KIS (Keep It Simple): CPR in Crisis?

About jeastridge, BSN, RN

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