CPR Education in Schools: A Novel Approach to Bystander CPR Disparities Louderback, Reed 1 ; Sasson, Comilla, MD, PhD 1,2 ; Bell-Haggard, Whitney 2 ; Ramon, Rene 2 ; Engeln, James 1 ; Johnson, Bailey 1, Tromza, Jettie 2 1. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; 2. American Heart Association, Denver, CO. BACKGROUND METHODS OBJECTIVE Community CPR initiatives represent an important mechanism for increasing CPR awareness, particularly in lower-income areas, which tend to have a higher incidence of out- of-hospital cardiac arrest coupled with lower rates of bystander CPR. CPR education within school systems remains a novel approach to address these bystander CPR disparities within communities. Population: Over 30 middle schools (grades 6-8) in the Denver and Aurora school system were offered the opportunity to participate during the 2014 calendar year based on location and proportion of lower-income population. Intervention: Participants completed a pre-test to assess baseline knowledge of CPR and comfort performing CPR. After familiarization, the school teacher led a group Hands-Only CPR training lasting 1 hour with the CPR in Schools Training Kit™. This kit includes manikins, an instructional DVD, a lesson plan and hands-on practical skills training. Data Collection: Participants then completed a post-test to assess post-intervention knowledge and comfort performing CPR. Data Analysis: McNemar’s test and two-sample t-tests were conducted to assess for differences in CPR knowledge and comfort pre- and post-intervention. Implement a sustainable Hands-Only CPR education program in Denver and Aurora middle schools with a focus on schools in lower-income areas, and evaluate the effect of the intervention on student CPR knowledge and comfort. Figure 4: Income Map of Denver Metro Area Schools plotted with arrows. Dark red = median yearly income $150,000 Figure 1: CPR in Schools Training Kit TM Figures 2-3: Students Performing CPR Training

RESULTS Demographics (Table 1) 16 middle schools agreed to participate and received the intervention along with a CPR in Schools Training Kit. Participating school students were predominantly Hispanic (50%), Black (22%), and White (21%). 43% of participating students were eligible for free and reduced-price lunch. Survey Results (Table 2) Statistically significant increase in the proportion of correct responses between pre- and post- intervention tests for each of the knowledge-based questions (1-5). The majority of students (80.7%) felt comfortable performing CPR following the intervention. Statistically significant increase in mean number of total knowledge questions answered correctly per paired pre-/post test following the intervention. LIMITATIONS CONCLUSIONS Schools were not randomly sampled but rather had to opt in to participate. Thus, the data might not be generalizable to the entire population of interest. Post-tests were administered either the same day of the intervention or the following day, therefore we were unable to assess long term retention of CPR knowledge. At this time, there is no measure in place to ensure that school teachers continue to offer Hands-Only CPR training with the donated kits in the future. Middle school students in the Denver and Aurora school system demonstrated increased knowledge and comfort with Hands-Only CPR following standardized instruction with CPR in Schools Training Kits TM. Implementation of a CPR in schools education program using a train-the-trainer model is feasible and effective. This is a creative, novel and effective way of increasing CPR awareness for students in areas with high incidence of out-of-hospital cardiac arrest yet low rates of bystander CPR. CPR Education in Schools: A Novel Approach to Bystander CPR Disparities Louderback, Reed 1 ; Sasson, Comilla, MD, PhD 1,2 ; Bell-Haggard, Whitney 2 ; Ramon, Rene 2 ; Engeln, James 1 ; Johnson, Bailey 1, Tromza, Jettie 2 1. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; 2. American Heart Association, Denver, CO. Topic Tested Correct on Pre-Test (N=1,679) Correct on Post-Test (N=1,679) n(%) n Compression rate 273(16.3)1,041(62.0)* When to stop CPR 838(49.9)1,520(90.5)* Depth of compressions 789(46.9)1,553(92.5)* What an AED does 934(55.6)1,387(82.6)* Correct steps of HOCPR 894(53.3)1,403(83.6)* Comfort performing HOCPR 932(55.5)1,355(80.7)* Mean Score (Questions 1-5) 2.22 (44) 4.1 (82.2)* Table 2: Pre-/Post-test Survey Results * p<0.001 Characteristic Average School Percentage ‡ (N=16) Free and Reduced Lunch Students Eligible for Free or Reduced-Price Lunch43% Gender Male52% Female48% Race/Ethnicity Hispanic50% Black22% White21% Asian2% Other5% Type of School Public70% Charter30% Table 1: Participating School Demographics ‡ Aggregate school data extracted from National Center for Education Statistics Elementary and Secondary Information System ( This study was funded by a grant from the Salah Foundation.