Why You Need Regular Refresher Training

Research shows that periodic refreshers are an important part an AED program.

CPR Skills Deteriorate Quickly

CPR/AED skills are a "use it or lose it" proposition, particularly for rescuers who respond infrequently to emergencies. Like most psychomotor skills that involve a complex procedure, CPR when combined with automated defibrillation is not well remembered. Research shows that AED/CPR skills quickly deteriorate after initial training. 1-10

The American Heart Association (AHA) acknowledges that re-training every couple years may not be adequate. In its 2010 CPR and ECC Guidelines, they state "…frequency of retraining is a critical factor in improving the effectiveness of resuscitation." 11, p S642 In addition, regular traditional classes can be difficult and costly to provide. This why online skills refreshers like AED Challenge are an excellent tool for making sure your responders are prepared.

CPR Is Important

For the past several decades the emphasis for treatment of sudden cardiac arrest has been on defibrillation. Attention now is returning to CPR and chest compressions in particular. New developments in resuscitation science have found minimizing interruptions in chest compressions improves shock success and survival rates. 12-16 Why?

Chest compressions provide important blood flow to the brain and heart. Controlled studies demonstrate that delays or interruptions to chest compressions reduce survival rates for victims of sudden cardiac arrest. Scientists have found high-quality chest compressions keep blood flowing through the heart and prolong the heart's ability to respond to an electrical shock. Thus the two critical factors in survival from sudden cardiac arrest now are chest compressions and early defibrillation.

How Often Should You Do Refresher Training?

Refresher training is CPR/AED training that reviews CPR and AED skills sometime after an initial CPR class. Its goal is to assure competence in basic life-saving skills and improve responder confidence. Research shows periodic refresher training helps maintain CPR and AED skills. Studies that use a high standard for skill competence show CPR skills degrade within weeks after initial training. The skills diminish significantly after 4 to 6 months.

The authors of the AHA 2010 CPR and ECC Guidelines emphasize the importance of refresher training: “In order to prevent delays and maximize efficiency, initial training, ongoing monitoring and retraining programs should be offered to providers on a frequent and ongoing basis.” 17 Other scientists state that “…the need to move toward more frequent assessment and reinforcement of skills is clear.” 18

Ideally, the interval between re-training sessions should be tailored to the individual depending on past experience. Clearly, the practice of re-training once every two years is not enough for most responders. “Skill performance should be assessed during the 2-year certification with reinforcement provided as needed.” 18

The flexibility of online refreshers like AED Challenge makes quarterly or semi-annual refresher training easy to implement. They are a cost-effective choice for AED-equipped organizations who want assure and document their responders are prepared for an emergency.

References

1. Mahony PH, Griffiths RF, Larsen P, Powell D. Retention of knowledge and skills in first aid and resuscitation by airline cabin crew. Resuscitation. 2008 Mar;76(3):413-8. Epub 2007 Oct 31.

2. Andresen D, Arntz HR, Gräfling W, Hoffmann S, Hofmann D, Kraemer R, Krause-Dietering B, Osche S, Wegscheider K. Public access resuscitation program including defibrillator training for laypersons: a randomized trial to evaluate the impact of training course duration. Resuscitation. 2008 Mar;76(3):419-24. Epub 2007 Oct 31.

3. Mahony PH, Griffiths RF, Larsen P, Powell D. Retention of knowledge and skills in first aid and resuscitation by airline cabin crew. Resuscitation. 2008 Mar;76(3):413-8. Epub 2007 Oct 31.

4. Woollard M, Whitfeild R, Smith A, Colquhoun M, Newcombe RG, Vetteer N, Chamberlain D. Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study. Resuscitation. 2004 Jan;60(1):17-28.

5. Woollard M, Whitfield R, Newcombe RG, Colquhoun M, Vetter N, Chamberlain D. Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial. Resuscitation. 2006 Nov;71(2):237-47. Epub 2006 Sep 28.

6. Chamberlain D, Smith A, Woollard M, Colquhoun M, Handley AJ, Leaves S, Kern KB. Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.  Resuscitation. 2002 May;53(2):179-87

7. Anderson GS, Gaetz M, Masse J. First aid skill retention of first responders within the workplace. Scand J Trauma Resusc Emerg Med. 2011 Feb 8;19:11.

8. Berden HJ, Willems FF, Hendrick JM, Pijls NH, Knape JT. How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? BMJ. 1993;306:1576 –1577.

9. Berden HJ, Bierens JJ, Willems FF, Hendrick JM, Pijls NH, Knape JT. Resuscitation skills of lay public after recent training. Ann Emerg Med. 1994 May;23(5):1003-8.

10. Swor R, Compton S, Vining F, Ososky Farr L, Kokko S, Pascual R, Jackson RE. A randomized controlled trial of chest compression only CPR for older adults-a pilot study. Resuscitation. 2003 Aug;58(2):177-85.

11. Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O’Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656.

12. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, Merchant RM, Hoek TL, Steen PA, Becker LB. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006;71:137–145.

13. Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105:2270 –2273.

14. Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009;120:1241–1247.

15. Vaillancourt C, Everson-Stewart S, Christenson J, Andrusiek D, Powell J, Nichol G, Cheskes S, Aufderheide TP, Berg R, Stiell IG. The Impact of Increased Chest Compression Fraction on Return of Spontaneous Circulation for Out-of-Hospital Cardiac Arrest Patients not in Ventricular Fibrillation. Resuscitation. 2011 Jul 13. [Epub ahead of print]

16. Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R; Resuscitation Outcomes Consortium Investigators. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009 Sep 29;120(13):1241-7. Epub 2009 Sep 14.

17. Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks
SC, Daya M, Sutton RM, Branson R, Hazinski MF. Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S720–S728.

18. Bhanji F, Mancini ME, Sinz E, Rodgers DL, McNeil MA, Hoadley TA, Meeks RA, Hamilton MF, Meaney PA, Hunt EA, Nadkarni VM, Hazinski MF. Part 16: education, implementation, and teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S920–S933.