S44 Poster Presentations / Resuscitation 84S (2013) S8–S98

mandatory for anaesthetists too? We acknowledge the low num-ber of EM trainees that responded to the survey and, would liketo assess trainees’ perspectives on the courses usefulness and rel-evance to practice.

References

1. College of Emergency Medicine. ACCS training – an overview [online]. Available athttp://www.collemergencymed.ac.uk/Training-Exams/EMTA/ACCS/default.asp[accessed 18.05.13].

2. Royal College of Anaesthetists. Clinical Standards FAQs [online]. Available athttp://www.rcoa.ac.uk/clinical-standards-and-quality/faqs [accessed 18.05.13].

http://dx.doi.org/10.1016/j.resuscitation.2013.08.115

AP088

Teaching basic life support to citizens: Choosingthe most efficient target population

Miguel Angel Díaz Castellanos 1,∗, AlbertoFernández Carmona 2, Aida Díaz Redondo 3,Raimundo García del Moral 1, Antonio CárdenasCruz 4

1 Hospital Santa Ana, Motril, Spain2 Hospital Virgen de las Nieves, Granada, Spain3 Hospital San Cecilio, Granada, Spain4 Hospital de Poniente, El Ejido, Spain

Purpose: The aim of this study is to analyze the efficiency ofBLS courses in an andalusian rural population, after a massive BLStraining program (Plan Salvavidas).

Materials and methods: From January 2003 to September2009 we have trained 3493 persons in BLS. Four hours instructor-led training courses were undertaken according to the SpanishNational Plan of CPR (ERC supported). In 2010, we carried out atelephonic survey, asking pupils about out of hospital emergency(OHE) situations witnessed. Statistical analysis included bivariateand successive backward steps multivariate analysis.

Results: We have called 3493 pupils of BLS courses. 1131answered correctly our survey. Mean age was 26.7 years, 59% werewomen. OHE witness rate was 10.43% (118 pupils). Life supporttechniques were applied in 87.5% of cases, including: call EMS 49%,mouth to mouth 42%, chest compressions 49%, airway obstructiontreatment 24%, recovery position 19%. Location of OHE were: publicenclosures 27.3%, street 23.9%, home 20.5%, work place 13.6%, road11.1%. The time delayed between BLS course date and first emer-gency witness was less than one year in 20.3% of cases, two yearsin 39.8% and higher in 39.9%.

If we assume a cost of course of 1000 Euros for 20 pupils. Accord-ing to the rate of intervention of every 20 pupils trained 2.1 aregoing to attend an OHE. Therefore the cost for intervention is 476.2Euros. If we apply this cost to the interventions in the first two yearsafter the course it rises up to 2.220 Euros.

Conclusions: The results of the efficiency analysis revealed thatthe cost per intervention performed in our environment was nothigh. However, many people would have to be trained to producea measurable impact on the overall statistics for interventions bywitnesses.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.116

AP089

Debriefing after in-hospital cardiopulmonaryresuscitation—Does it work? A literature review

Anne Mette Kristiansen 1,∗, Jette R. Svanholm 1,Klas Karlgren 2

1 Department of Cardiology, Aarhus UniversityHospital, Aarhus, Denmark2 Department of Learning, Informatics, Managementand Ethics (LIME), Karolinska Institutet, Stockholm,Sweden

Purpose: Debriefing could be one of several initiatives toimprove cardiopulmonary resuscitation (CPR) performance.1 How-ever, resuscitation is rarely addressed as a learning opportunity.The purpose of this study was to review existing models or meth-ods of debriefing after in-hospital resuscitation and the argumentsand evidence put forth for these.

Methods: A structured literature search2 was conducted in 10educational and medical databases. Nine articles met the inclu-sion criteria and were critically reviewed by two authors. Results:Debriefing primarily aims at either ‘improving knowledge and per-formance’ or ‘dealing with stress and emotions’. Debriefing aiming at‘improving knowledge and performance’ is usually weekly, includesinvolved an uninvolved staff, and can last up to 60 min. This modelhas shown that debriefing resulted in improved CPR and return ofspontaneous circulation. Debriefing ‘dealing with stress and emo-tions’ typically takes place shortly after an event, with involved anduninvolved staff, and can last up till 90 min. This model has shownlimited effectiveness. Debriefings aiming at ‘improving knowledgeand performance’ did not attend to emotions. Not all elements of thedebriefings were reported. Studies implicitly referred to the impor-tance of reflection but without describing the process or stating thetheoretical frame.

Conclusions: Debriefings aiming at ‘improving knowledge andperformance’ were associated with improved CPR processes. Allcharacteristics of the debriefing process were not reported in depth,lacked consistency and leaving some elements of the debrief-ing process unanswered or only partly answered. Future researchshould aim at clearly describing all characteristics of effective mod-els of debriefing including clarifications of how and why they work.

References

1. Seethala RR, et al. Approaches to improving cardiac arrest resuscitation perfor-mance. Curr Opin Crit Care 2010;16:196–202.

2. Polit DF, et al. Nursing research: generating and assessing evidence for nursingpractice. Lippincott Williams & Wilkins 2008.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.117

AP090

How can we improve resuscitation skillstraining in anaesthesia and emergencymedicine: The trainees’ perspective?

Elizabeth Horncastle ∗, Selin Kabadayi

Leeds General Infirmary, Leeds, UK

Introduction: We have previously surveyed both anaesthe-sia and emergency medicine (EM) trainees in our deanery ontheir current certification status of ALS (Advanced Life Support),ATLS (Advanced Trauma Life Support) & APLS (Advanced PaediatricLife Support) and, reasons for not re-certifying/attempting eachcourse.1 Trainees felt there were a number of barriers to attend-ing these courses, time and money, for example, and also some felt

Poster Presentations / Resuscitation 84S (2013) S8–S98 S45

their value was very limited. We therefore set out to determinehow trainees feel the vital skills required for resuscitation wouldbe best taught in our deanery.

Methods: We conducted an online survey of all anaesthesia andemergency medicine trainees in the Yorkshire & Humber Deanery,from first year of core training to final year of specialist training(CT1-ST7), between October 2012 and March 2013 – assessing howtrainees feel resuscitation skills training could be improved.

Results:• Total responses – 144–109/144 (68.8%) anaesthesia; 35/144

(24.3%) EM trainees.• West Yorkshire 59 (41%); South Yorkshire 48 (33.3%); North and

East Yorkshire 37 (25.7%).• Grade of trainees ranged: CT1 22 (15.3%); CT2 20 (13.9%);

CT2+/CT3 12 (8.3%); ST3 24 (16.7%); ST4 9(6.3%); ST5(+) 57(39.6%).

• Of those surveyed: 76 (53.1%) stated increased study leave bud-get; 60 (42%) stated greater amount of study leave; 71 (49.7%)stated mandatory local/regional resuscitation update courses; 50(35%) stated more exposure to resuscitation calls with seniorsupport; 114 (79%) stated regular simulation training; and 10trainees stated ‘other’ – reasons including a clear induction tolocal hospital and/or equipment and clearer guidance on how toorganise named courses.

Discussion: The responses varied and supported previous rea-sons given by trainees for not holding current certification – forexample, increasing study leave time or money. However, mostnotably, simulation training by far the most popular choice, with79% of trainees stating this would improve resuscitation training.Simulation training has previously been shown to improve knowl-edge and resuscitation skill performance on manikins2; howeverevidence for any effects on real life performance and patient out-come is more limited. These results would support the introductionof more regular, perhaps mandatory, simulation training for anaes-thesia and EM trainees to teach resuscitation skills. The optimaltime intervals between training and ‘level of realism’ (high fidelityversus low fidelity) that is best is however controversial, as evi-dence regarding these is also lacking.2

References

1. Horncastle E, Kabadayi S. Anaesthesia & emergency medicine trainees’ certifi-cation status of resuscitation courses in Yorkshire & Humber Deanery; 2013.Unpublished abstract.

2. Soar J, Monsieurs KG, Balance JHW, et al. European Resuscitation Council Guide-lines for Resuscitation 2010, Section 9. Principles of education in resuscitation.Resuscitation 2010;81:1434–44.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.118

AP091

Automated assessments with feedback forimproving CPR skills: A randomisednon-inferiority trial

Nicolas Mpotos 1,∗, Nick Cleymans 2, JorisRaemaekers 2, Bram De Wever 3, Tom Loeys 4, LucHerregods 5, Martin Valcke 3, Koen Monsieurs 2,Koen Monsieurs 6, Koen Monsieurs 7

1 Emergency Department, Ghent University Hospital,Ghent, Belgium2 Faculty of Medicine and Health Sciences, GhentUniversity, Ghent, Belgium3 Department of Educational Studies, GhentUniversity, Ghent, Belgium4 Department of Data Analysis, Ghent University,Ghent, Belgium5 Department of Anaesthesiology, Ghent UniversityHospital, Ghent, Belgium6 Emergency Department, Antwerp UniversityHospital, Antwerp, Belgium7 Faculty of Medicine and Health Sciences, Universityof Antwerp, Antwerp, Belgium

Objectives: To investigate if medicine students achieve an equalcardiopulmonary resuscitation (CPR) skill level after repetitivetesting with feedback compared to testing followed by computer-guided practice.

Methods: In a non-inferiority trial, 196 third year medicine stu-dents were randomised to repetitive testing (T) or testing withadditional practice (TAP). Testing and practising took place in aself-learning station equipped with a manikin connected to a com-puter. Automated testing consisted of a two minutes CPR testfollowed by feedback and feedforward. In the TAP group, addi-tional practice consisted of CPR exercises with computer voicefeedback. To pass the test, students had to achieve a combined scoreconsisting of ≥70% compressions with depth ≥50 mm and ≥70%compressions with complete release (<5 mm) and a compressionrate of 100–120/min and ≥70% ventilations with a volume of 400-1000 ml. Skill retention was measured after six months. The marginfor non-inferiority was defined as a 10% difference in proportions.

Results: After training the success rate in both groups was 96%:99/103 (T) and 89/93 (TAP). After six months, 4 students were lostto follow up in each group. The success rate in the testing groupwas 26/99 (26%) and 33/89 (37%) in the TAP group. The differencein success rate was 11%, with a 95% CI ranging from −3% to 24%. Asthe upper bound of this 95% CI exceeded 10%, non-inferiority wasinconclusive.

Conclusions: Both training methods were equally effective toimprove skills. For skill retention, testing alone seemed less effec-tive than testing followed by practice. The substantial skill decay inboth groups indicates the need for more frequent assessment andretraining.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.119