Education Bill

Memorandum submitted by the Resuscitation Council (UK) (E 89)

Emergency Life Support (ELS) Training for Children

1) Introduction

1.1 The Resuscitation Council (UK) is a charity with the main objective of saving life by education of the public and improving education of healthcare providers. To improve the outcomes from cardiac arrest, the Resuscitation Council (UK) is principally involved in producing and disseminating evidence-based national guidelines in cardiopulmonary resuscitation.

1.2 Resuscitation Council (UK) welcomes the opportunity to provide written evidence to the Committee on the need to ensure Emergency Life Support training for children is given a strong role following changes to the education system.

2) What is Emergency Life Support

2.1 Emergency Life Support (ELS) includes performing cardiopulmonary resuscitation (CPR), dealing with choking, serious bleeding and helping someone who may be having a heart attack. These are key skills that can enable bystanders to provide a potentially life-saving role.

2.2 Ambulances or other professional help may take up to 8 minutes or longer to arrive and in this time a life can be lost if fundamental and easily learnt resuscitation skills are not applied by bystanders.

3) What are we calling for?

3.1 We are calling for ELS, including vital CPR, to be a mandatory part of the National Curriculum in England. Secondary school students should be taught it from year 7, and their skills should be refreshed every year until they leave school.

3.2 Currently, first aid training is a non-mandatory component of the PSHE curriculum and its delivery is variable. With this in mind, it is important to note that we are not calling for an addition to the current curriculum but greater emphasis. There are many areas of the curriculum where ELS could sit (PSHE, PE, Science, Citizenship) and we believe that there should be compulsory delivery of these essential skills to all children before they leave school.

4) What is the science behind our recommendation?

4.1 There is a clear medical need behind ensuring that children leave school trained in ELS:

a. There are just over 25,000 emergency medical services (EMS)-treated cardiac arrests each year in England and bystander CPR is only provided in 30% of out-of-hospital cardiac arrests.I

b. Around two thirds of cardiac arrests that occur outside of hospital occur in the home, and nearly half that occur in public are witnessed by bystandersII

c. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10%.III

d. When bystander CPR is provided, the decline in survival is more gradual and averages 3–4% per minuteIV

e. Immediate CPR in a shockable out of hospital cardiac arrest can improve the chances of survival by up to a factor of three.IV

f. Early defibrillation, the definitive treatment for ventricular fibrillation (VF), is delivered safely by laypeople using Automated External Defibrillators (AEDs). These devices are becoming increasingly available in public locations (airports, train stations, shopping malls, sports centres) and used successfully. Instruction in the purpose and use of AEDs increases the chances of their effective use. All CPR training should include an explanation of the purpose and basic function of an AED to all trainees regardless of age.V

5) How could it be delivered?

5.1 There are numerous organisations that currently provide ELS training programmes for schools (e.g. British Heart Foundation, St John Ambulance). We have been working closely with BHF and are aware that they have submitted a separate evidence paper to your committee. We are strongly supportive of this concept for delivery of training.

5.2 The delivery of this training would not provide a burden on schools that teach it, as children can be taught these skills in as little as two hours per year.

6) International comparisons

6.1 There are clear examples from education systems abroad where ELS skills have been successfully delivered as a part of the curriculum:

a. Scandinavia: School programmes have been demonstrated to be effective with children learning the techniques readily, retaining the skills, and distributing them to surrounding family members. In 2005, TrygFonden (a private insurance company) funded 35,000 personal training kits (inexpensive manikin and DVD) facilitating CPR training for all Danish 12-14 year olds at 806 different primary schools. Training led by PE teachers took place in classrooms during school hours and lasted for 30 minutes. Kits were taken home so that family members and friends could also learn CPR. On average, for each pupil another 2.5 individuals were trained in CPR. More than half of Danish elementary schools have signed up for free training kits provided by the TrygFonden foundation.VI

b. USA: Legislation in 36 American states encourages the inclusion of CPR training programs in school curricula. A recent statement on science by the American Heart Association (AHA) concludes that CPR training should be required for graduation from secondary school.V

7) Summary

7.1 Victims of cardiac arrest need immediate CPR. This provides a small but critical blood flow to the heart and brain. It also increases the likelihood that a defibrillatory shock will enable the heart to resume an effective rhythm and cardiac output. Chest compression is especially important if a shock cannot be delivered sooner than the first few minutes after collapse.

7.2 If all children leave school with the skills to save a life, there is a greater likelihood that a significant number of lives will be saved with consequent benefits to the general economy.

ELS is a set of essential skills – all children should learn how to save a life!

8) References

I. 2006 national Out-of-hospital Cardiac Arrest (OHCA) project [managed by the Ambulance Service Association (ASA) and the Joint Royal College Ambulance Liaison Committee (JRCALC)]

II. Virdi, G. et al (2010). London Ambulance Service Cardiac Arrest Annual Report 2008/09

III. Nolan JP et al. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive Summary. Resuscitation 2010;81:1219-76

IV. Koster RW et al. (2010). European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010;81:1277-92

V. Cave DM, Aufderheide TP, Beeson J et al. Importance and implementation of training in cardiopulmonary resuscitation and automated external defibrillation in schools: A science advisory from the American Heart Association. Circulation 2011 published online.

VI. Isbye DL, Rasmussen LS, Ringstead C, Lippert FK. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children. Circulation 2007:116;1380-85

March 2011