Resuscitation Council (UK)

Frequently asked questions (FAQs)

Training in CPR and AEDs

There are no statutory legal provisions in the UK relating to the practice of resuscitation or defibrillation, but both the users of AEDs and those who provide training in their use have obligations under common law. Further details may be found in our publication: The Legal Status of those who Attempt Resuscitation.

    
The Resuscitation Council (UK) recommends that those who train others in CPR and the use of AEDs should be appropriately qualified. Provided that they are skilled in teaching, and able to demonstrate competency in CPR and the use of an AED, the following people are suggested: doctors, nurses, resuscitation officers, community defibrillation officers, paramedics, statutory ambulance service trainers, voluntary aid society and voluntary rescue organisation trainers, and other individuals such as accredited first aid trainers. This list is not exhaustive.

Currently, courses are offered by the voluntary aid societies and voluntary rescue organisations, some statutory ambulance trusts, resuscitation officers, and community defibrillation officers. Whilst there is no prescriptive course programme, these organisations should be teaching the Resuscitation Council (UK) recommendations and using the CPR and AED learning outcomes as a framework.

The Resuscitation Council (UK) does not provide CPR and AED training, nor does it accredit CPR/AED courses or CPR/AED instructors.

There are a number of ways in which training can be delivered. Traditionally, instructor led training has been used to facilitate acquisition of knowledge and skills. A number of other methods have been employed successfully which involve little or no instructor involvement. A well designed and validated self-instructional programme using DVD or e-learning can be an effective alternative to instructor-led training. It is essential that this method includes hands-on practice as part of the programme. Validation can be by the publication (and peer acceptance) of appropriate studies of the DVD programmes, or by the internal validation of such training programmes by the organisation that wishes to use it.

The length of CPR/AED courses across Europe varies and is dependent on the method of delivery; ratio of instructors to participants; the amount of hands-on training; the equipment available; and, most importantly, the characteristics of the learners. For these reasons, it is not possible to recommend an optimum duration for a CPR/ AED course. The aim is to ensure all participants acquire the knowledge and skills required for them to act correctly in actual cardiac arrests and thereby improving patient outcomes.

It is important that resuscitation skills are refreshed regularly, particularly by those who have a duty to respond in an emergency. The principle is that skills should be maintained at an effective level at all times. Individual employers and organisations should make arrangements for retraining to be available, but the frequency of this refresher training will depend on the individual. For guidance, skills should be refreshed at least once a year, but preferably more often.

Training organisations often provide a certificate of course completion or course attendance. Ideally, this certificate should state that the participant has attended the course and demonstrated those skills listed as CPR and AED learning outcomes, as well as providing a recommended time frame for retraining.

The ratio of instructors to participants will vary according to the method of delivery and time available for instruction. There is inadequate evidence from formal studies to recommend any particular ratio; the important issue is that all students have adequate time to practice. The precise arrangements will be determined by the number of instructors and training manikins available. Where these are limited classes will inevitably take longer to ensure that all participants have sufficient experience to feel confident in the techniques that are learning.

Some DVD methods of delivery require a facilitator rather than an instructor while others consist entirely of DVD / electronic material and require no instructor or facilitator. Where non-instructor methods of delivery are employed it remains important to ensure an adequate ratio of manikins to participants.

Ideally every student should have their own manikin and training AED but resources rarely permit this. Once again, the important point is that every student has adequate time to practise in a simulated environment. Where resources are limited more time will need to be invested to ensure all participants have adequate practice. Where individuals undertake distance learning programmes it is important that they have access to manikins and training AEDs to ensure adequate practical experience.

There is no specific legal requirement for employers to provide defibrillators in the workplace. The Health and Safety Executive’s syllabus of first aid training for offshore installations does include the use of defibrillators, but this is not extended to onshore first aid. However, the Health and Safety (First-Aid) Regulations 1981 do not prevent an employer from providing defibrillators which could benefit both their employees and the public.

For information on workplace health and safety legislation please refer to the Health and Safety Executive’s website.

The full paediatric BLS sequence is for healthcare professionals with a duty to respond to paediatric emergencies (e.g. Emergency Department staff, paediatric doctors and nurses, paramedics).These people usually work in teams of two or more rescuers.

Lay people with responsibility for the care of children (e.g. teachers, lifeguards) should be taught the adult sequence with the paediatric modifiers (see note below). It is recognised, however, that there are other potential rescuers that fall between these two groups, where it is unclear which sequence is the more appropriate.  The decision as to what should be taught may be made locally (e.g. by the Resuscitation Committee) according to circumstances and available resources. In coming to a decision, it may be helpful to ask the following questions:

  1. Are the providers healthcare professionals?  
  2. Would they normally be expected to have to resuscitate an infant or child during the course of their work?
  3. o they usually work in a team?
Generally, the full paediatric sequence and compression: ventilation ratio of 15:2 should be taught to those who give a positive answer to all three questions.

General practitioners, health visitors, and school nurses, for example, are healthcare professionals working with children, but they often work alone.  Although they may have to resuscitate a child, this would be a very unusual event and they are more likely to have to resuscitate a parent or grandparent. It would be sufficient to teach these groups the adult sequence of 30:2 with the paediatric modifiers unless they expressed a particular wish or interest to learn the full paediatric sequence.

Mental Health nurses working in child mental health units are healthcare professionals working in teams of two or more.  Although it would be unusual in most such units to have to resuscitate a child, some may treat high-risk children (such as those with severe anorexia nervosa) so it would be reasonable to allow training decisions to be based on local circumstances.

Note
Modifications to the adult BLS sequence of 30 compressions: 2 ventilations that will make it more suitable for use on children:

  • Give 5 initial breaths before starting chest compression.
  • If on your own, perform CPR for approximately 1 minute before going for help.
  • Compress the chest by one-third of its depth, approximately 4 cm for an infant and approximately 5 cm for an older child. Use two fingers for an infant under 1 year; use one or two hands for a child over 1 year to achieve an adequate depth of compression.

October 2015

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