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

  1. The AHA has recently increased the prices of their cards dramatically. This coupled with requirements for upgraded equipment and a lengthening of time requirements may be putting CPR for the masses in jeopardy.

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

    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!
    Last edit by Joe V on Jun 14
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    About jeastridge

    Joy has been a nurse for 30+ years. She currently serves as a Faith Community Nurse and is a CPR instructor.

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    12 Comments

  3. by   Alex Egan
    I'm pretty confused. I haven't felt any of these changes in my region. I'm being charged 7.00 per card and have not heard anything about this from my TC. Besides the manikin requirements, which are a bit of a pain. (Just the ratio though. They will have to pry my simulants Brad out of my cold dead hands)

    That said. CPR has never been about teaching everyone in the country CPR. It's an income generator for the heart association and Red Cross. If it was about teaching everyone theybwould have made a 30 second Super Bowl ad years ago with all the money they take in from the healthcare providers who are mandated to vary the cards.

    As for me. I do what I can. Free classes for boy scouts once a year, I pay for their cards out of my own pocket. I offer discount rates to non health care providers and let them sit in on classes as space allows for the cost of the card and materials. Unfortunately besides the scouts I don't get a lot of interest.
  4. by   asnewnurse2017
    I'm an instructor as well, the prices only rised for Heartsaver cards. The BLS,ACLS and PALS cards have remained the same.

    You are are required to have each student perform in a dual feedback mannequin by 1/2019.
  5. by   jeastridge
    Quote from asnewnurse2017
    I'm an instructor as well, the prices only rised for Heartsaver cards. The BLS,ACLS and PALS cards have remained the same.

    You are are required to have each student perform in a dual feedback mannequin by 1/2019.
    You are correct that it is only the heartsaver cards that have gone up so dramatically which is really hard to understand since these are the "community" cards. I'm still puzzled about this. Joy
  6. by   norasallnurse1
    I am an instructor as well and have been one for 23 years. I am with the Red Cross, Heart Association, and an organization called EMS Safety, which follows ECC Guidelines and is a completely valid certification. The card cost that this article is discussing does not affect Healthcare Providers. The AHA BLS card is $7 and the re-cert time is only about 3 hours.

    I work for a huge medical group in California and we allow our staff to take the online course (at their own speed) and then do the manikin skills with one of our instructors. I charge $25 for the manikin skills and it takes about 30 minutes (and sometimes only 20 minutes) to do those. If I have less than 3 students doing the manikin skills, I charge an additional $10 to process their card. Otherwise, I include it in the $25.
  7. by   feelix
    The Heartsaver was always the kicker. It is impossible to do a long class with CPR plus First Aid. If they raised the prices on that, what a shame. What incentive do they give for lay people to learn this skill? I am glad I gave up my instructor license years ago and did not renew. It was near impossible keeping AHA pleased and all my money, any way went into purchasing equipment, paying the TC and AHA.
  8. by   efoley
    I am an instructor, my t.c. Gave us a heads at the end of last year the prices were going to spike, right now it was just heart saver but we could anticipate the spike reaching all the courses. We can expect to have adjust our prices to accommodate.
    it is going to effect about half of our instructors. I Personally do more advanced classes than anything else, so I will be ok. I agree with the article, now is not the time to create barriers to saving lives
  9. by   FranEMTnurse
    I was a Basic First Aid and a CPR instructor for 10 years, but it was several years ago. Back then I hauled the full mannequins around, I know the times for the classes have changed and the mannequins have become smaller and lighter, plus the recertification time was always a short class, but if I remember correctly, It did take a 6 hour day for two instructors to recertify a class of 20 students.
  10. by   she244
    I was a CPR instructor at the Hospital I worked for and also my current position. When the new requirements started I gave up being an instructor. As a Nurse I stay currents with all the requirements. I have done CPR on a woman in a restaurant and was glad for knowing what to do and being able to recognize agonal breathing. EMS showed up and shocked her 2 times and she was transported to the Hospital. Unfortunately, she passed the next day while they were doing a procedure at the Hospital. I was glad the family were able to be with her.
  11. by   AnnieOaklyRN
    At the first read of the headline I was like, what? wait... Annie does NOT need a kiss! Then I realized.... you were talking about Rescue Annie!
  12. by   FranEMTnurse
    I saved a little girl from choking to death in a department store a few years ago. She had a large gum ball lodged in her throat. I got on my knees and positioned myself behind her, told her what I was going to do, then provided the Heimlich maneuver. Nothing happened with the first thrust, so I told her I would have to perform the procedure a second time. Success! It flew out of her throat and rolled under a display shelf. Boy did I ever feel happy!
  13. by   jeastridge
    Quote from FranEMTnurse
    I saved a little girl from choking to death in a department store a few years ago. She had a large gum ball lodged in her throat. I got on my knees and positioned myself behind her, told her what I was going to do, then provided the Heimlich maneuver. Nothing happened with the first thrust, so I told her I would have to perform the procedure a second time. Success! It flew out of her throat and rolled under a display shelf. Boy did I ever feel happy!
    So grateful for the training and for people like you who put it into action! Joy
  14. by   Rocknurse
    Our BLS is always free in my hospital for employees. We now do the online HeartCode and then just show up to do the skills portion that takes 5 minutes. I like the way they do it and the HeartCode is really excellent. It really helps you get to grips with the basics. Before it was instructor dependent. I think the consistency is better now.

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