Is teaching CPR appropriate in a low-resource environment?

Our article entitled ‘Feasibility of a CPR programme in Rural Bangladesh’ was recently published in the journal ‘Resuscitation’.

The publication was a result of a large research project in Bangladesh by the International Drowning Research Centre (IDRC-B) to investigate the feasibility of implementing a CPR training programme at the community level, with the aim of reducing deaths due to drowning – the leading cause of childhood death in Bangladesh. The World Health Organisation Drowning Report recently recommended lay people be trained in CPR as a drowning prevention intervention.

Key questions included:

• Are currently available training materials suitable for the low-resource context?
• For how long will participants retain their knowledge? Is retraining in this time-scale feasible given the rural nature of the programme?

Students in Raigonj, Bangladesh learn CPR on the First Responder program

The programme provided CPR and basic First Aid training to 2,398 participants over a 14 month period, in the rural community of Raigonj.  Participants came from a wide range of backgrounds including students, community leaders and local businessmen. Very few had any previous first aid experience, and non had any previous experience in CPR.

Programme material was developed following wide ranging review of training literature developed almost exclusively for use in high-income and high-resource areas. Of key concern were:

• The lack of recommendations for when to stop delivering CPR: Vigilante attacks in Bangladesh are common, and there is a lack of ‘good Samaritan’ laws commonly found in high income countries. There was a worry that responders might be put at risk after delivering CPR, particularly if the casualty died. A high level group of cardiac experts from Bangladesh were consulted, and consensus was agreed that a 30 minute ‘cut off’ would be appropriate for responders to cease delivery of CPR.

• The lack of low literacy materials: Nearly all materials reviewed were targeted towards people with high literacy. Training materials including posters, videos and a picture based manual were developed in Bangla and tested for contextual relevance.

Results

Almost 90 per cent (88.4) of participants qualified in post training assessment. Adolescents and community volunteers had higher pass rates than community elders. In all, CPR skills showed a significant decline over 9 months of assessment, while first aid knowledge appeared stable over the same period. Community leaders considered the programme useful for the community and expressed their support for the programme.

Conclusions

Our research suggested that CPR training is feasible in the rural Bangladesh context, if participants have secondary school attainment. Further research is needed to see if the training results in a reduction in drowning deaths, however early reports from the ongoing monitoring system suggests that a number of lives have already been saved due to the intervention.

Get the full article here:

• Aminur Rahman, Tom Stefan Mecrow, Saidur Rahman Mashreky, A.K.M. Fazlur Rahman, Nahida Nusrat, Mahruba Khanam, Justin Scarr, Michael Linnan, 2014, Feasibility of a First Responder programme in rural Bangladesh, Resuscitation, Volume 85, Issue 8, August 2014, Pages 1088–1092