key: cord-0744119-8mmhjkud authors: Böttiger, B. W.; Lockey, A.; Georgiou, M.; Greif, R.; Monsieurs, K. G.; Mpotos, N.; Nikolaou, N.; Nolan, J.; Perkins, G.; Semeraro, F.; Wingen, S. title: KIDS SAVE LIVES: ERC Position statement on schoolteacherś education and qualification in resuscitation date: 2020-04-24 journal: Resuscitation DOI: 10.1016/j.resuscitation.2020.04.021 sha: beabc42a88bd926e2a55bb88b3427e1dd4c2d7ad doc_id: 744119 cord_uid: 8mmhjkud nan Educating schoolteachers in CPR and qualifying them to teach CPR to children as part of the worldwide "KIDS SAVE LIVES" initiative ( Fig. 1) will help improve survival after sudden out-of-hospital cardiac arrest (OHCA) considerably and sustainably [1, 2] . Teachers can easily be educated to become competent in Basic Life Support (BLS; CPR in this position statement includes all measures of BLS -chest compressions, ventilation and the use of an automated external defibrillator (AED)) instructors for their schoolchildren within four hours by using specially developed CPR instructor courses [3] . OHCA is the third leading cause of death in developed countries [4] . The overall survival rate after cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) is currently below 10% [5] [6] [7] . As up to 70% of OHCAs are witnessed by bystanders, the most promising way to really improve overall survival in OHCA worldwide is to enhance the rate of bystander CPR [8] [9] [10] [11] [12] [13] [14] . There are several effective possibilities to increase lay CPR rates worldwide, and one of the best and most sustainable ways to do so is to increase mandatory nationwide CPR education of schoolchildren [1, 2, [15] [16] [17] [18] . Schoolchildren will grow up and may maintain the acquired skills for the rest of their life. Besides that, they can easily serve as multipliers by teaching CPR to their families and friends [1] . Countries where CPR education of schoolchildren has been mandatory for decades show impressively higher bystander CPR rates [2, 10, 11, 13] , and this concept is starting to spread all over Europe, in the United States and in the rest of the world [19, 20] . The European Resuscitation Council (ERC) has committed to the promotion of CPR education for lay people in basic life support since 1992, culminating in the first European Restart a Heart Day on the 16 th of October 2013 with the motto "Children Saving Lives" [21] [22] [23] . CPR education in schoolchildren successfully increases their CPR knowledge and skills, and strengthens their self-confidence in helping OHCA patients [24, 25] . CPR education in children facilitates the development of this psychomotor skill just like swimming, playing an instrument or riding a bike: they will never forget and remember lifelong how to save a life [1, 2] . A key question is how to implement CPR education of schoolchildren in the most effective way in all schools all over the world. Schoolteachers have long-lasting experience in teaching children, and there is already evidence that schoolteachers educated in CPR are able to teach schoolchildren as effectively as any healthcare professional [1, 2, 25] . In addition, schoolteachers are motivated to educate and they can serve as initial multipliers. Subsequently, CPR knowledge and skills can be spread further by asking children to serve as peers for other children, or to teach all their family members and friends [1, 2] . The ERC has developed 10 principles as an action framework for the education of teachers and for the qualification of schoolchildren in CPR. It consists of a two-steps CPR teaching approach, firstly by teaching CHECK -CALL -COMPRESS [3, 8, 9, 12, 23] , and secondly by teaching ventilation and the use of an AED [3, 12] . Teachers already know how to teach, and our program adds the specifics of CPR education. 3. Teachers can teach the specifics of CPR to schoolchildren as effectively as healthcare professionalsindeed they are primarily qualified to teach children. 4. The ERC proposes that the qualification for educating CPR to schoolchildren can be obtained by a four hours CPR "teach the teachers" course. 5 . The ERC recommends the use of commercially available manikins or low-cost manikins for teaching CPR to schoolchildren. To stimulate engagement, new technology applications (e.g. smartphones apps, social media, serious games and virtual reality) as teaching methods are highly useful and recommended. 6. All schoolteachers should be educated in CPR as part of their curriculum they have to fulfill to become a certified teacher. For every school and/or for every 1,000 schoolchildren, we recommend that at least ten teachers should be trained as certified CPR instructors. The school medical service may provide additional support for teaching CPR to schoolchildren and should be involved into the program. 7. Each school should have at least one teacher and one deputy teacher responsible for sustainable CPR education. They should be the lead of the CPR education in a school driving the program and curriculum integration. 8. Following schoolchildren CPR education, the ERC recommends that teachers foster learning and dissemination of CPR competences by enabling their schoolchildren to become multipliers. The homeworkwe suggest in the following two weeksis to show 10 other people how to do CPR, to write peoples´ names down and to bring this information back to school. 5 9. Educating schoolteachers and schoolchildren in CPR will also increase safety in schools, competent help is always available, not only for all schoolchildren, but also for all teachers and other people present. 10 . Saving a life is a child's play. CPR needs only two hands and a bit of competence to save a life. Educating teachers and subsequently schoolchildren in CPR will help to save hundreds of thousands additional lives annually worldwide. a The ERC includes into the terms school, schoolchildren and schoolteachers all types of schools, from kindergarten to higher education including medical schools and universities. b During infectious epidemics (like the COVID-19 pandemic), potential transmission of virus has always to be taken into account. This might also impact teaching and delivery of CPR. Therefore, both should always stay with the local recommendations. Moreover, the International Liaison Committee on Resuscitation (ILCOR) and the ERC have developed actual Guidelines for these specific situations that can be found at https://costr.ilcor.org/document/covid-19-infectionrisk-to-rescuers-from-patients-in-cardiac-arrest and at https://www.erc.edu/. . We very much appreciate and acknowledge that the IRC is providing this logo for free to all participating in the "KIDS SAVE LIVES" campaign in Europe and all over the world. Kids Save Lives -ERC position statement on school children education in CPR KIDS SAVE LIVES: School children education in resuscitation for Europe and the world Modularer Lehrerausbildungskurs des Deutschen Rates für Wiederbelebung (GRC) für den Wiederbelebungsunterricht in Schulen -Positionspapier des GRC nach der Empfehlung der Deutschen Kultusministerkonferenz und dem aktuellen GRC-Mustercurriculum Cardiac arrest: a public health perspective 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 ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary Part 1: Executive summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations World Restart a Heart initiative: all citizens of the world can save a life Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide -The "World Restart a Heart (WRAH)" initiative 2018 Association of national initiatives to improve cardiac arrest management with rates of bystander interven-tion and patient survival after out-of-hospital cardiac arrest Return to work in out-of-hospital cardiac arrest survivors: a nationwide registerbased follow-up study The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council Survival in Out-of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services: Nationwide Study During Three Guideline Periods Adult basic life support and automated external defibrillation section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and auto-mated external defibrillation Kids save lives': why schoolchildren should train in cardiopulmonary resuscitation Training children in cardiopulmonary resuscitation worldwide Kids save lives -Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO) Education and implementation of resuscitation section Collaborators. European Resus-citation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation KIDS SAVE LIVES-Three years of implementation in Europe. Resuscitation KIDS SAVE LIVES BRAZIL: A successful pilot program to implement CPR at primary and high schools in Brazil resulting in a state law for a training CPR week Restart a Heart Day: a strategy by the European Resuscitation Council to raise cardiac arrest awareness. Resuscitation Children can save lives. Resuscitation All citizens of the world can save a life" -The World Restart a Heart (WRAH) initiative starts in 2018. Resuscitation Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled study in secondary schools in Germany Kids save lives: a sixyear longitudinal study of schoolchildren learning cardiopulmonary resuscitation: Who should do the teaching and will the effects last? We cordially thank all schoolchildren, teachers, politicians, medical personnel, colleagues and all others who have been involved in our respective activities over the last years. Several authors are supported by the ERC Research NET.