Imagine you are at your child’s high school basketball game. Suddenly, one of the opposing players collapses on the floor. Someone quickly assesses if the player is responsive, breathing and has a pulse. He is not breathing and has no pulse, so cardiopulmonary resuscitation (CPR) is started with 30 chest compressions followed by two breaths.
Meanwhile, someone calls 911 and gets an automated external defibrillator (AED). When applied, it recommends a shock, which is delivered, and CPR is resumed. During the next two-minute CPR cycle, the player begins to move and breathe. CPR is stopped, and emergency medical services (EMS) takes the player to the hospital, where he makes a full recovery.
Each year, 6,000 children experience an out-of-hospital cardiac arrest (OHCA). The key to improved survival is the provision of bystander CPR. OHCA often is associated with an initial cardiac rhythm that is potentially treatable with an AED.
How can you ensure bystanders are ready to perform CPR and AEDs are available when needed?
The updated AAP policy statement and technical report Advocating for Life Support Training of Children, Parents, Caregivers, School Personnel, and the Public address this issue. The documents are available at https://doi.org/10.1542/peds.2018-0704 and https://doi.org/10.1542/peds.2018-0705 and will be published in the June issue of Pediatrics.
While the incidence of OHCA is lower in children than adults, training school personnel in CPR could help save a student as well as a co-worker, parent or visitor.
In addition, age-appropriate life support training programs are available for students. Younger students can learn to recognize an emergency and call for help. Older students — especially those in high school — can learn CPR. Although 37 states require CPR training for high school graduation, funding still is an issue.
Pediatricians can help promote innovative funding sources such as foundations, civic organizations, hospitals and/or EMS agencies to make CPR programs available for students as well as school personnel, parents, caregivers and the public. In addition to formal classes, self-instruction methods can be completed in less than 30 minutes. In Canada, the Advance Coronary Treatment Foundation (a public-private partnership) has trained over 3.8 million students.
Having an AED in a higher-risk area such as a gymnasium or athletic field protects both students and adults. Currently, 21 states mandate the placement of an AED in public schools. Ideally, it should be one that can be used in younger children as well as older children, adolescents and adults. Even if only the adult pads are available, the AED still can be used on young children and even infants. Legal concerns should not be an issue as Good Samaritan laws are designed to protect lay rescuers who use AEDs.
Recommendations for pediatricians
- Stay up-to-date on recommendations for CPR instruction and AED use.
- Advocate for including age-appropriate life support training for children as part of their curriculum beginning in the primary grades and for providing life support training for all school personnel.
- Advocate to have AEDs placed first in public and private high schools then in additional schools, especially near high-risk areas such as an athletic field, as well as proper training on AED use and funding to promote these programs.
- Work with parents and legislators to mandate CPR training and AED placement in all schools if laws do not exist in their state.
Dr. Fuchs, the lead author of the technical report and co-author of the policy statement, is a former member of the AAP Committee on Pediatric Emergency Medicine.