Does the prospect of having to perform CPR in an emergency scare you? If you’re anything like me then it probably terrifies you. And being terrified is a perfectly rational response if you’re an average member of the public and unlikely to find yourself in such a situation. What if you’re training to be a doctor though?
Welcome to my world! Despite being a fourth-year medical student, intercalating in Prehospital Medicine last year and working as a Healthcare Assistant (HCA) during holidays, I am yet to undertake CPR outside of a simulation scenario - and the prospect of doing so in a real life emergency scares me to death (forgive the pun). I suspect however that I am not alone and that many Basic Life Support (BLS) and Advanced Life Support (ALS) trainees might feel this way.
Over the past decade I’ve received BLS training in a variety of situations: at school; at university; at work. However, it’s only when I came to study the European Resuscitation Council Guidelines as part of my Prehospital Medicine BSc that I began to evaluate in greater depth the importance of BLS/ALS education: who receives it; how it should be adapted to its audience; and how it could be improved!
So, who should receive BLS training? I think it’s reasonable to expect that all able-bodied adults should have access to BLS training to equip them with the skills to deal with an emergency. However, I also believe that the more people over the age of five who know what to do when someone collapses in front of them, the better. This includes children, people with disabilities and elderly people. Many school children are now taught to ‘CALL, CHEST, COMPRESS’ when they find someone unresponsive, but we can still do more. Ensuring people of all ages and differing abilities can perform at least some aspects of BLS would not only save lives, but would also encourage individuals who may not have had the opportunity previously to develop these skills to feel empowered - both as individuals and as members of wider society - whether they are required to use their BLS skills or not.
However, delivering effective BLS training to 6-year-old school children or someone with visual impairment is no mean feat. I felt daunted when my peers and I were presented with the challenge of delivering a session on ‘How to put someone in the recovery position’ to an audience of 6-year-olds. We decided however to treat it as an opportunity to bring some creativity to the field of healthcare education and constructed a story of a pirate who needed to put his friend ‘the crab’ into the recovery position. I was reminded of a previous experience on a medical volunteering trip in Tanzania when I was asked to deliver BLS training to a group of preschool children. Aside from their young age, the main difficulty was the language barrier which meant I had to communicate through actions rather than words.
Turning my attention to how BLS/ALS training could be improved brings me back to my starting point - my own anxieties about performing CPR in a real emergency. Despite having received BLS training over many years in many different environments, I have no recollection of any discussion about the psychological impact that providing life support may have on the individual providing that support until I received ALS training last year. In the BLS training I have received, there has been little mention of how to deal with the anxiety of having never performed CPR on a human being; how to deal with the high-pressure environment that a cardiac arrest brings; the worry that your compressions are not effective; or how you will cope afterwards if the person does not survive. However, these anxieties are not limited to ALS: these fears were real for me learning BLS - and if they were real for me, then chances are they are real for others as well. Surely any life support training should not be limited to the knowledge and practice of the skills required, but the psychological impact that having to use these skills brings - before, during and after such an event - and developing strategies to help practitioners manage that impact in a positive way.
I am learning to reflect on my fears and anxieties and am developing strategies to cope with them. For example, when receiving ALS training during my intercalated degree I was introduced to the concept that - in a situation where someone requires CPR there is very little you can do to make the outcome worse - whatever you do is only going to increase the chances of a better outcome for the person. When I remind myself of this concept, my anxiety about performing CPR in a real emergency is reduced. I share it here as it might help others also. Another strategy I have developed is to be honest with myself and others about my own competence so that when I am required to perform CPR for the first time, I will share with the team around me that I have never done this before. Ensuring there is a debrief with the team after the event will be an important space to talk about what happened, ask questions and voice any concerns I have. The experience will undoubtedly have an impact on my mental health, particularly if the person does not survive. Making sure I have space and time to process my thoughts as I do now when I go running and swimming will be even more important after an experience like this.
We can save more lives if we provide life support training to a wider range of people. We can make that training more effective by tailoring it to our audience. And perhaps most importantly, we can better prepare and equip BLS and ALS trainees by addressing the psychological impact BLS and ALS can and does have on those delivering it.