Program Requirements To Attain Quality CPR

1. Paris Hotel and Casino  Las Vegas, Nevada Program Requirements To Attain Quality CPR Eric Chappell Ph.D

2. Presenter Disclosure Information Eric Chappell, Ph.D Program Requirements To Attain Quality CPR FINANCIAL DISCLOSURE: • Share Position in V4EMS Inc UNLABELED/UNAPPROVED USES DISCLOSURE: • None

3. Profession Professional Educator/ Researcher Given the guidelines, the science behind them, and training programs, I will discuss what would improve CPR Performance Aim of Presentation

4. Quality (of CPR) QUALITY • We all understand something by the word • As CPR trainers and performers (people who must perform CPR) we need performance details • Without specification it is a meaningless term

5. QUALITY Make it more than a Motherhood Statement Change it to a Deliverable Define it, give accurate measurable parameters, distinguish those who meet it from those who do not, objectively verify

6. The Science is On-Going Discovering, Defining and Refining and Quantifying what matters to patients In the field we need people who can perform physical actions which are indicated by that science

7. Education Issues not Hard Science Issues • We need to convert the information produced in the hard sciences into an Applied Science • That is we need to turn it into something practical where people can perform specific skills

8. Applied Science Issues • What level is reasonable for a person to perform to • What can be taught to many people • What cost are we willing to endure to achieve what level of accuracy in performance? • What cost to maintain skills at the target level

9. Application Requirements It needs Behavioral Objectives to be specified It needs a way for people to attain those targets It needs objective evaluation of whether a person has met the behavioral objectives

10. Mismatch in current Application ? What does Quality mean in terms of performance • if people do not even get to touch a manikin in their renewal class • if there is no objective evidence based assessment of a performance? • if there is no objective performance metric?

11. Mismatch in current Application ? What does Quality mean in terms of performance • if retention is not taken seriously • if there is no distinction/recognition of those who can and those who cannot • if a certificate does not certify

12. Standards • We have lots of science, but • In the field, for performance … • we lack properly defined parameters • we lack proper implementation programs • we lack accountability

13. Accuracy & Devices • Guidelines say at least 2 inches - Is a manikin that only goes 2.1” sufficient • Guidelines say Hard and Fast - if a person is banging off the bottom of the manikin is that acceptable • Guidelines say full release of chest – if manikins do not report non-release, or – if there is significant chest sag is this acceptable

14. Accuracy & Devices • Accuracy for training/measuring devices is important • this is what we use and depend on • we need a standard set of parameters for these devices • we need a standard minimum tolerance of accuracy • Devices must measure the same thing • Eg. Compressions Depth – if a device is accurate to • 0.25 of an inch then 2.0 inches can mean 1.75 inches. • Eg. Compressions Depth – many devices do not report chest non-releases or are very inaccurate

15. Threshold • Threshold is the level where the • performance improves survival 62% 23% • Threshold is the minimum level a person must achieve to be said to be competent 75% 86%

16. Threshold 62% • Threshold is implied in the idea of Quality • for it to be a Quality Compression, how accurate does it need to be • how does Quality degrade with inaccuracy • Science? – At what point do we see a strong relationship to improved survival 23% 75% 86% • Quality without a threshold???

17. Threshold • Quality without a threshold What does it mean? • Without a threshold anything • a person does is good enough

18. Competence • It means being able to perform required skills to a specific level (threshold) • It means that the level of performance can be demonstrated on an objective evidence based criteria • It means that the tolerance of the performance (accuracy of the device) is within an acceptable range

19. Competence Once these criteria are specified • Industry will produce devices • Industry will produce procedures • Accuracy of devices can be verified • Accuracy of performance can be assessed

20. Confidence A part of being competent is being confident. • ACCURATE: trusting that the devices are accurate • FAIRNESS: trusting that the requirement applies to everyone equally • VALUED: trusting that it is worth the effort to perform well With Confidence and Competence you have a winning formula

21. Confidence “ If you can’t measure it how do you know how well you are performing?” “ Without accurate measurement how can confidence be anything more than arrogance based on ignorance”

22. Training & Accountability Even if all parameters are defined, even if all parameters are part of a program, who is accountable? In many courses neither the trainer nor the student is accountable for Quality • No consequence for any performance level • Reward for poor performance • No real indication of how well skills performed

23. Cost Determine what is a reasonable cost for a reasonable level of performance. Before this can be done … • Training needs to mean something – that people can be expected to perform particular skills to a particular level • Cost to maintaining a body of competent responders can be measured in number of lives saved, or time, or capital cost …

24. Differentiation (of Skills) Should everyone be able to perform all CPR skills? • Perhaps for the cost we are willing to pay, including time to assure competence, we should nominate people for specific roles: • some competent to do chest compressions • some competent to ventilate • some competent to intubate

25. Differentiation (of Recognition) Recognize Different Levels: • Card With No Objective Assessment • Professional Card with Objective Assessment and including a threshold score • Proved Every 3 or 6 Months Maybe

26. Summary Set Behavioral Performance Standards So Everyone Knows How Target for the Trainer and the Trained Set Minimum Tolerances For Devices and Performance Levels Objective Evidence Based Assessment Honest Achievement Levels Make Programs Accountable

27. The End The Guidelines Could Be SoMuchMore!