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A cardiac arrest can happen to anyone. But resuscitation is easy. 100 pro!

 

Training School Children in Cardiopulmonary Resuscitation Worldwide

A Statement from the European Patient Safety Foundation (EUPSF1), the European Resuscitation Council (ERC2), the International Liaison Committee on Resuscitation (ILCOR3) and the World Federation of Societies of Anesthesiologists (WFSA4)
This Statement has been endorsed by the World Health Organization (WHO)

Prof. Dr. Dr. hc Hugo K. Van Aken (University Hospital Münster, Germany)
Prof. Dr. Bernd W. Böttiger (University Hospital Cologne, Germany)

Sudden Cardiac Death, A Public Health Problem

Sudden cardiac death is one of the major issues in global health care. In Europe and the U.S., at least 700,000 people die each year following sudden cardiac death with unsuccessful out-of-hospital cardiopulmonary resuscitation (CPR) [1,2]. This is 2,000 deaths every day. The same happens in many other areas of the world. Thus, sudden cardiac death is the third commonest killer after cancer and other cardiovascular diseases in industrialized nations [3]. Teaching CPR to all school children will therefore lead to a marked improvement in global health.

Following sudden cardiac arrest, the brain can only survive for 3-5 mins without oxygen. This is much less time than the emergency medical services take to arrive in almost all cases. Therefore, less than 1 out of 10 patients with out-of-hospital cardiac arrest survive today [4-7]. There is sound scientific evidence that immediate initiation of basic life support by lay bystanders improves the survival after out-of-hospital cardiac arrest by a factor of 2-4 [5-7]. Out-of-hospital cardiac arrest is witnessed in 60-80% [5-7]. Thus, lay resuscitation can fill the time gap between collapse and the arrival of the emergency medical services in most cases. Today, bystander CPR is delivered in less than 1 in 5 out-of-hospital cardiac arrests [4]. Increasing this rate will save 200,000 additional lives in Europe and in the U.S. every year, and far more worldwide.
While educating the lay public in basic life support is clearly the most important way to increase survival in this area, it is difficult to reach the entire population with the training required, if programs are not obligatory. It is logical therefore to include resuscitation training in school programs. The American Heart Association advocated compulsory resuscitation training in American schools in 2011 [8], and countries in which resuscitation has been integrated into educational programs in schools report significantly higher resuscitation rates [4,9]. Thus one of the most important steps in increasing the rate of bystander resuscitation and improving survival worldwide is to educate all school children. This can be easily done by educating them – beginning at the age of 12 years – for just two hours per year [8-11]. School children at a young age have a less inhibited approach to resuscitation training and both medical professionals and teachers achieve success after appropriate training themselves [11].

The Way to Improve Survival

We recommend educating school children in resuscitation from the age of 12 years or earlier for 2 hours per year. If school children receive such training, they are also likely to teach this to their family at home – and they themselves will never forget. We will see not only an increase in the number of cardiac arrest survivors worldwide, but also the social benefits of enthusiastic and positive young people. They learn to help others. School children and teachers are important “multipliers” in both private and public settings and thus, in the longer term, the proportion of trained individuals in society will markedly increase, leading to an increase in the overall rate of lay resuscitation.
This concept is already very successful in Scandinavia. In Denmark, it was shown that the rate of bystander CPR nearly doubled after five years, with a threefold improvement in survival following out-of-hospital cardiac arrest over ten years [9]. A threefold improvement in survival cannot be achieved solely by improvements in professional medical care in this area.

Why Introduce Resuscitation Training During School Education?

  • All groups of society can be reached. To achieve a statistically significant increase in the resuscitation results, it has been estimated that at least 15% of a population need to be trained and such numbers cannot be achieved by offering voluntary courses.
  • Access to health-related information is often less adequate in the lower social groups, with the result that more cases of unsuccessfully treated cardiac arrest per capita occur in socially disadvantaged areas [12].
  • A sense of responsibility can be firmly established at an early stage. Social skills – particularly if they are to be effective across social barriers – need to be established at an early point in the course of a child’s education.
  • Altruism research has shown that schoolchildren have a less inhibited approach to resuscitation training while they are still pre-pubertal. Furthermore, the strongest factor inhibiting the taking of practical action in the real-life situation is a fear of making mistakes. This aspect of implementation can also be communicated much more naturally and easily during school time.
  • The response to instruction is easier and better at a younger age. A more favorable attitude to learning is also reflected by the fact that practical training can be communicated in a more positive way.
  • Embedding resuscitation in related school subjects such as biology, sports or health education is meaningful and possible.

Conclusion

Sudden cardiac death is one of the most frequent preventable causes of death in the industrialized world. In countries with organized emergency medical services, more lives could be saved by increasing the lay bystander resuscitation rate. Providing resuscitation training in schools has measurable effects, and by a “multiplier effect” it can increase the lay bystander resuscitation rate and the survival rate. The earlier such instruction in resuscitation is started, the more sustainable the training will be.The message to the public is clear: successful CPR is easy to undertake and straightforward to teach. Lay people cannot do anything wrong – the only wrong thing would be to do nothing. It can easily be done by everyone, saving hundred thousands of lives each year all over the world.

The supporting organisations have particular expertise in CPR delivery and training and fully endorse this statement.

Supporting Organisations

  1. The European Patient Safety Foundation is a multi-disciplinary non-profit foundation composed of medical associations, policy makers, clinicians, healthcare professionals, med-tech industry and patient advocates.
  2. The European Resuscitation Council is an interdisciplinary multi-specialty non-profit organisation for resuscitation medicine and emergency medical care. It is the umbrella organisation of 33 national resuscitation councils from Europe, Asia and Africa.
  3. The International Liaison Committee on Resuscitation (ILCOR) is a forum for liaison between principal resuscitation organisations worldwide: American Heart Association, Australian and New Zealand Council of Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of South Africa, Resuscitation Council of Asia
  4. The World Federation of Societies of Anaesthesiologists is a global network of 120 national societies of anaesthesiologists

References

  1. Anonymous, European cardiovascular disease statistics 2012.
  2. Berdowski J, Berg RA, Tijssen JG et al. (2010) Global incidences of out-of- hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 81:1479-1487
  3. Taniguchi D, Baernstein A, Nichol G. Cardiac arrest: a public health perspective. Emerg Med Clin North Am 2012; 30: 1–12.
  4. Gräsner JT, Bossaert L (2013) Epidemiology and management of cardiac arrest: what registries are revealing. Best practice & research. Clinical anaesthesiology 27:293-306
  5. Holmberg M, Holmberg S, Herlitz J. Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 2000; 47: 59–70.
  6. Herlitz J, Bang A, Gunnarsson J et al. (2003) Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Goteborg, Sweden. Heart 89:25-30
  7. Böttiger BW, Grabner C, Bauer H, Bode C, Weber T, Motsch J, Martin E. Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 1999; 82: 674-9.
  8. 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; 123: 691–706.
  9. Wissenberg M, Lippert FK, Folke F et al. (2013) Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 310:1377-1384
  10. Plant N, Taylor K. How best to teach CPR to schoolchildren: a systematic review. Resuscitation 2013; 84: 415–21.
  11. Bohn A, Van Aken HK, Möllhoff T, Wienzek H, Kimmeyer P, Wild E, Döpker S, Lukas RP, Weber TP. Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study. Resuscitation. 2012; 83: 619-25
  12. Reinier K, Thomas E, Andrusiek DL, et al. Resuscitation Outcomes Consortium Investigators. Socioeconomic status and incidence of sudden cardiac arrest. SMAJ 2011; 183:1705-12

See also

 

Kids save lives - Training School Children in CPR Worldwide

“Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed is two hands“. This revolutionary statement was already formulated in 1960 by Jude, Kouwenhoven and Knickerbocker [1]. Introduced more than 50 years ago we know nowadays that resuscitation is simple, cheap and can be done by almost anyone, potentially saving thousands of lives per year. Following this notion, lay cardiopulmonary resuscitation (CPR) should have already been established widely in public. But what is the current reality? Out of hospital cardiac arrest (OHCA) is still one of the leading causes of death worldwide and bystander resuscitation is not generally delivered. Only every third to fifth patient suffering from cardiac arrest receives bystander CPR [2]. In this context, even simple measures can improve survival after OHCA more than twofold and everybody can learn it – even kids. If we want to reduce the number of deaths from cardiac arrest dramatically and save hundreds or even thousands of lives every year, let us pronounce our knowledge about CPR! What could be better than begin this tuition even in children – our future? The best way is to establish resuscitation training in the curriculum of schools. Let "Kids Save Lives" [3]!

Epidemiology of out of hospital cardiac arrest and survival

In the United States more than 300,000 people suffer from sudden cardiac arrest annually, and this number is consistently high in the last few decades [4][5]. Current extrapolations reported even up to 600,000 deaths per year in the United States attributed to cardiac arrest [6][7]. This corresponds to approximately 1.5 cases per 1000 person years [7]. Altogether cardiac arrest is the 3rd most frequent cause of death, thus becoming a global public health issue, equivalent to cancer, HIV and Malaria with nearly 2,000 deaths per day worldwide [8][9]! Though cardiac arrest is common, this does not apply for survival after cardiac arrest: Even if cardiac arrest occurs in hospitals, less than a quarter of affected patients survive – in the case of public cardiac arrest survival is much worse; in average less than 6% of patients survive [7].

Effects of training on bystander CPR and survival – No CPR without training!

In the United States more than 300,000 people suffer from sudden cardiac arrest annually, and this number is consistently high in the last few decades [4][5]. Current extrapolations reported even up to 600,000 deaths per year in the United States attributed to cardiac arrest [6][7]. This corresponds to approximately 1.5 cases per 1000 person years [7]. Altogether cardiac arrest is the 3rd most frequent cause of death, thus becoming a global public health issue, equivalent to cancer, HIV and Malaria with nearly 2,000 deaths per day worldwide [8][9]! Though cardiac arrest is common, this does not apply for survival after cardiac arrest: Even if cardiac arrest occurs in hospitals, less than a quarter of affected patients survive – in the case of public cardiac arrest survival is much worse; in average less than 6% of patients survive [7].

Effects of training on bystander CPR and survival – No CPR without training!

Resuscitation is easy and saves lives. Nevertheless, the incidence of bystander CPR (individuals present at cardiac arrest) is often low and in many countries less than 50% [2]. For example, in Europe, known to be a patchwork of 47 states, there is an inhomogeneous distribution in rates of bystander CPR ranging from 6 to over 70 % [2]. Various reasons, e.g. feelings of helplessness and fear to do something wrong, may be responsible for the dramatic differences in the incidence of bystander CPR between the countries of Europe, as illustrated in Table 1.

  • I do not know, what to do …
  • I am afraid to do it not correct ...
  • What do I need to do ? Lateral recumbent position ?
  • Mouth-to-mouth ventilation is disgusting, I rather do nothing ...
  • Maybe I become infected ....
  • What happens, if I do anything wrong ?
  • I am afraid of harming the patient.

Table 1: Teaching lay resuscitation means to be responsible for fears and anxieties of the participants of CPR training. The table shows examples of these fears. These anxieties and fears may be the reasons why bystander resuscitation is not performed.

One of the main preconditions for bystander performed CPR is that bystanders previously have participated in a CPR training – without training, it is unlikely that resuscitation is initiated. Without training, only 4.8% of bystanders initiated CPR in the case of cardiac arrest. In contrast, this rate is substantially higher (35.1%) when a training has been completed (Figure 1) [10]. Despite training not all bystander initiate CPR: Swor et al. identified reasons, why CPR-trained bystanders (N=279) do not initiate CPR: The most frequently used argument was that they were panicking (38.7%), that they were afraid of performing CPR incorrectly (10.8%) or potentially harm the patient (1.8%) [10]. Surprisingly only a small fraction of respondents did not perform CPR because of mouth-to-mouth ventilation (1.4%) and no one because of concerns about infectious diseases [10]. In this context, the available data suggest that one single training session is not enough to initiate live long resuscitation competency. Therefore, repetitive training should take place at least every 12-24 months [11]. In conclusion, it can be stated that there will be no CPR without training. In addition, teaching lay resuscitation means to be responsible for fears and anxieties of the participants of CPR training (Table 1). These anxieties and fears may be the reason why bystander resuscitation is not performed and, further, it can be assumed that the rate of bystander CPR can be increased by addressing feelings and concerns of bystanders.


Effects of training
Figure 1: Effects of training on the rate of bystander cardiopulmonary resuscitation (CPR): Without training, it is unlikely that resuscitation is initiated and only 4.8 % of untrained bystanders initiated CPR in the case of cardiac arrest. In contrast, this rate is substantial higher (35.1 %) when a training has been completed [10].

But does bystander CPR affect survival? Yes! Already in 1999 Böttiger et al. reported that patients had a significantly higher survival after cardiac arrest if CPR was initiated by bystanders: One-year survival after bystander-initiated CPR was 15.9% (n = 88) compared to 10.4% in patients without bystander CPR (n = 250; p = 0.09) – this corresponds to an approximately 1.5-fold increase in survival through bystander CPR [12]! How can this be explained? It is generally known that survival of human cells depends on oxygen supply. The critical organ in cardiac arrest is the brain – few minutes after cardiac arrest irreversible cell damage occurs (Figure 2). It is an illusion to speculate that within this period a professional resuscitation by Emergency Medical Services (EMS) is initiated. In fact, it is this period, which is decisive for survival and neurological outcome, and both, survival and neurological outcome, crucially depend on bystander initiated CPR [13][14][16]. Through an early start of bystander-initiated CPR, the time frame until occurrence of irreversible brain damage may be extended and thus bridge the time until arrival of EMS.

Figure 2

Figure 2: Avoidance of brain damage with bystander cardiopulmonary resuscitation (CPR): The brain has a limited tolerance of oxygen deprivation. After cardiac arrest already after a few minutes irreversible cell damage can occur. The dashed line indicates the likelihood of a good outcome. Through an early start of bystander-initiated CPR, the time frame until occurrence of irreversible brain damage may be extended and thus bridge the time until arrival of Emergency Medical Services [13][14].

In a recent publication Hasselquist-Ax et al. reported on the experience of bystander CPR in Sweden by evaluating the Swedish Cardiac Arrest Registry, which included more than 90% of all persons who had an out of hospital cardiac arrest from January 1, 1990, through December 31, 2011 and 30,381 witnessed OHCA were examined. In Sweden, a country with 10 million inhabitants, to now almost three million citizens are trained in CPR [13]. Initiation of bystander CPR before the arrival of EMS was associated with a more than 2 times higher survival (odds ratio 2.15 for higher 30-day survival rate; 95% confidence interval, 1.88 to 2.45) [13]. Figure 3 shows the number of those who participated CPR training in Sweden since 1990. Notably, the cases of bystander CPR strictly follows the number of persons who completed a CPR training – without the development of a plateau!
The effect of bystander CPR on survival and neurological outcome was repeatedly demonstrated in recent studies and in average, survival increased two to three times [13][15][16][17]. For the United States this means saving more than 100,000 lives a year!

Figure 3
Figure 3: Changes over time in CPR training and survival rates in Sweden. The figures show the number of persons who were trained in cardiopulmonary resuscitation (CPR) and the proportion of cases where CPR was started before emergency medical services (EMS) arrived. The dashed line indicates the introduction of telephone-assisted CPR (T-CPR) in Sweden [13].

Considerations regarding CPR training in schools – Let "Kids Save Lives"!
As illustrated by the example of Sweden above, survival after cardiac arrest crucially depends on the proportion of CPR-trained individuals in a population. Therefore, it is the logical consequence to integrate CPR training in the curriculum of schools and thus increase the proportion of CPR-trained individuals in a population over time [3]. Meanwhile, there are many publications on teaching children in CPR and table 2 summarizes the current knowledge. Briefly, an age of 12 years is optimal for the start of CPR training and 2 hours tuition each year are enough [3].

Recently the statement ”Kids save lives – Training school children in cardiopulmonary resuscitation worldwide“ was published by the European Patient Safety Foundation (EuPSF), the European Resuscitation Council (ERC), the International Liaison Committee on Resuscitation (ILCOR) and the World Federation of Societies of Anesthesiologists (WFSA) (Read the “Kids save lives”-statement, written by Hugo K.Van Aken and Bernd W. Böttiger, at the end of this text). Fortunately, this statement was endorsed by the World Health Organization (WHO) in Geneva on Jan 20th, 2015.
Meanwhile, it is encouraging that more and more countries begin to integrate CPR lessons in their curricula. In Germany, for example, the ministers of education of the 16 German states decided that CPR training in schools should become mandatory for pupils beginning in 2015.

Also in the United States, more and more states add CPR training into the curricula of schools and even make it prerequisite for high school graduation (Figure 4).
In summary, it is now a great opportunity, challenge and obligation for all countries around the world to implement school children training in CPR worldwide. This will help to save thousands of lives worldwide! Let "Kids Save Lives".

  • It is extremely easy and effective to educate school children in CPR.
  • Before puberty, children have a very open approach to CPR training.
  • Teachers who have been educated can teach CPR; they do it as well and as effectively as healthcare professionals.
  • It is sufficient to have 2 hours of training per year.
  • The optimal age to start teaching chest compressions is around 12 years.
  • It can be helpful to use small manikins.
  • School children serve as multipliers: at home they teach their brothers and sisters, their parents, their grandparents and many others in their families.
  • Educating school children in CPR is fun, and teachers tell us that they seldom have seen their pupils so enthusiastic as during CPR training.
  • There are social benefits of enthusiastic and positive young people that result from CPR training: school children learn to help others.
  • The proportion of trained and “willing to help” individuals in the society will markedly increase with school children training in CPR, leading to an increase in overall lay resuscitation rates.

Table 2: What we already know about teaching kids in cardiopulmonary resuscitation (CPR) [3].



United-States-High-School-CPR-Map

Figure 4: United States High School CPR Map. The map shows the states where cardiopulmonary resuscitation (CPR) is mandatory for high school graduation [18].

Appeal

  • Let's begin! NOW! Teaching children in resuscitation is possible and effective. Resuscitation is easy. 100pro!
  • It is up to us now to establish appropriate measures in the curricula of schools worldwide to make it happen that "kids save lives“.
  • It should be announced that “Lay people cannot do anything wrong – the only wrong thing would be to do nothing.” Cardiopulmonary resuscitation can easily be done by everyone, saving hundred thousands of lives each year all over the world.” [3]


Reproduction of the “kids save lives” statement endorsed by the World Health Organisation [3]:

This statement highlights the importance of teaching CPR to all school children around the globe. The document reinforces the effect that early CPR can have on survival outcomes following sudden cardiac arrest (SCA), an issue that causes 2,000 deaths worldwide every day. By introducing just two hours of CPR teaching per year for all children over 12, the WHO believes that SCA survival rates would improve and in turn lead to improved global health.


Literature

  1. JUDE JR, KOUWENHOVEN WB, KNICKERBOCKER GG. A new approach to cardiac resuscitation. Ann Surg. 1961 Sep;154:311-9.
  2. Gräsner JT, Bossaert L. Epidemiology and management of cardiac arrest: what registries are revealing. Best Pract Res Clin Anaesthesiol. 2013 Sep;27(3):293-306.
  3. Böttiger BW, Van Aken H. Kids save lives--Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO). Resuscitation. 2015 Sep;94:A5-7.
  4. Kong MH, Fonarow GC, Peterson ED et al. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011 Feb 15;57(7):794-801.
  5. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med. 1993 Dec 15;119(12):1187-97.
  6. Becker LB, Aufderheide TP, Graham R.Strategies to Improve Survival From Cardiac Arrest: A Report From the Institute of Medicine.JAMA. 2015 Jul 21;314(3):223-4.
  7. Daya MR, Schmicker RH, May S, Morrison LJ. Current burden of cardiac arrest in the United States. http://www.iom.edu/~/media/Files/Report%20Files/2015/ROC.pdf. Accessed January 07, 2016.
  8. Taniguchi D, Baernstein A, Nichol G. Cardiac arrest: a public health perspective. Emerg Med Clin North Am. 2012 Feb;30(1):1-12.
  9. Website of the World Health Organization (WHO). http://www.who.int/gho/en/. Accessed January 07, 2016.
  10. Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S. CPR training and CPR performance: do CPR-trained bystanders perform CPR? Acad Emerg Med. 2006 Jun;13(6):596-601.
  11. Greif R, Lockey AS, Conaghan P, Lippert A, Vries W de, Monsieurs KG. European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation 2015;95:288–301.
  12. Böttiger BW, Grabner C, Bauer H, Bode C, Weber T, Motsch J, Martin E. Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart. 1999 Dec;82(6):674-9.
  13. Hasselqvist-Ax I, Riva G, Herlitz J et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015 Jun 11;372(24):2307-15.
  14. Breckwoldt J, Schloesser S, Arntz HR. Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation. 2009 Oct;80(10):1108-13.
  15. Lee SY, Ro YS, Shin SD et al. Interaction effects between highly-educated neighborhoods and dispatcher-provided instructions on provision of bystander cardiopulmonary resuscitation. Resuscitation. 2015 Dec 23. pii: S0300-9572(15)00913-2.
  16. Malta Hansen C, Kragholm K, Pearson DA, Tyson C et al. Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013. JAMA. 2015 Jul 21;314(3):255-64.
  17. Nakahara S, Tomio J, Ichikawa M et al. Association of Bystander Interventions With Neurologically Intact Survival Among Patients With Bystander-Witnessed Out-of-Hospital Cardiac Arrest in Japan. JAMA. 2015 Jul 21;314(3):247-54.
  18. Website of School CPR – Free Student CPR by ProTrainings. http://schoolcpr.com/about/states-where-cpr-training-is-mandatory-for-high-school-graduation/
 
      
 

WHAT YOU NEED TO KNOW


1.

Sudden cardiac arrest , arrest (when the heart suddenly stops beating) is something that can happen toanybody at any time. The person affected immediately loses consciousness and stops breathing normally, or even at all.
 

2.

Unless a few simple steps are taken inside 5 minutes — above all heart massage — the person is unlikely to survive after a cardiac arrest.
 

3.

The emergency services are almost never able to reach the scene within 5 minutes after a cardiac arrest.
 

4.

The chances of the person surviving will be three times higher if bystanders carry out very simple resuscitation measures (heart massage 100 times a minute)! You are the only person who can now save the person’s life!
 

5.

About 50–80 cases of cardiac arrest per 100,000 people happen every year that are recorded in the resuscitation registry. That’s about 40,000–64,000 people per year. About 10–20 percent of the patients are able to leave hospital again afterwards. Getting the best possible coordination all the way along the chain of rescue services gives the patients involved a crucial advantage. The first link in the rescue chain is called “lay resuscitation” — done by non-professional helpers. Experience from other countries shows that good lay resuscitation doubles or triples the survival rate for people with cardiac arrest. That would mean more additional people surviving than the number who die in car accidents every year in Germany.
 

6.

Automated external defibrillators (AEDs) can save lives. And they’re quite easy to use! An AED is a device that’s available in lots of public places and buildings, attached to walls like a fire-extinguisher. The device itself helps you use it, and it can apply a life-saving electric shock to the heart if needed.
 

7.

There is a very high probability that at least once during your own life, you’ll be able to save someone else’s life using simple methods. It’s also quite likely that the person involved will be someone you know well — it could be your parents, a friend, or a relative.
 

8.

If you’ve had some training in mouth-to-mouth ventilation, then you can do that as well as heart massage — at a ratio of 30 heart compressions to two ventilations. If you don’t have any training in it, then you should concentrate on heart massage. That’s already doing a lot of good!
 

9.

You can’t do anything wrong! You’re perfectly right to carry out heart massage and use an AED — even if you’ve never done it before or not for a long time, it could still be crucial for saving the person’s life.