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Observing the stages of bystander intervention in virtual reality simulation

World Journal of Emergency Medicine 2019年第3期10卷 145-151页

作者： David G. Buckler Alfredo Almodovar Jr Paul Snobelen Benjamin S. Abella audrey blewer Marion Leary Center for Resuscitation Science University of Pennsylvania Philadelphia PA 19104 USA Peel Regional Paramedic Service 1600 Bovaird Dr. E Brampton ON L6R 3S8 Canada Department of Community & Family Medicine Duke University Medical Center DUMC 2914 Durham NC 27710 USA School of Nursing University of Pennsylvania 418 Guardian Drive Philadelphia PA 19104 USA

BACKGROUND: Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages. METHODS: In a secondary analysis of an observational cohort study, we analyzed bystander self-effi cacy for stages of BI before and after simulated SCA. Each subject participated in a singleplayer, immersive, VR SCA scenario. Subjects interacted with simulated bystanders through voice commands (“call 911”,“get an AED”). Actions taken in scenario, like performing CPR, were documented. Scenario BI actions were compared based on dichotomized comfort/discomfort. RESULTS: From June 2016 to June 2017, 119 subjects participated. Average age was 37±14 years, 44% were female and 46% reported CPR training within 2 years. During the scenario, 98%“noticed the event” and “interpreted it as a problem”, 78%“took responsibility”, and 54%“possessed the necessary skills”. Self-effi cacy increased from pre- to post-scenario: noticing the event increased from 80% to 96%;interpreting as a problem increased from 86% to 97%;taking responsibility increased from 56% to 93%;possessing necessary skills increased from 47% to 63%(P<0.001). CONCLUSION: Self-efficacy to respond to an SCA event increased pre- to post-scenario. Bystanders who reported feeling comfortable “taking responsibility to intervene” during an emergency were more likely to take action during a simulated emergency.

关键词： Virtual reality Bystander intervention Emergency preparedness

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The association of layperson characteristics with the quality of simulated cardiopulmonary resuscitation performance

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World Journal of Emergency Medicine 2017年第1期8卷 12-18页

作者： Marion Leary David G.BucMer Daniel J.Ikeda Daiane A.Saraiva Robert A.Berg Vinay M.Nadkarni audrey L.blewer Benjamin S.Abella Center for Resuscitation Science and Department of Emergency Medicine Department of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA School of Nursing University of PennsylvaniaPhiladelphiaPennsylvaniaUSA Children's Hospital of Philadelphia PhiladelphiaPennsylvaniaUSA

BACKGROUND: Few studies have examined the association of layperson characteristics with cardiopulmonary resuscitation(CPR) provision. Previous studies suggested provider characteristics, including age and gender, were associated with CPR quality, particularly chest compression(CC) depth. We sought to determine the association of subject characteristics, including age and gender with layperson CPR quality during an unannounced simulated CPR event. We hypothesized shallower CC depth in females, and older-aged ***: As part of a larger multicenter randomized controlled trial of CPR training for cardiac patients' caregivers, CPR skills were assessed 6 months after training. We analyzed associations between subject characteristics and CC rate, CC depth and no-? ow time. Each variable was analyzed independently; signi? cant predictors determined via univariate analysis were assessed in a multivariate regression ***: A total of 521 laypersons completed a 6-month CPR skills assessment and were included in the analysis. Mean age was 51.8±13.7 years, 75% were female, 57% were Caucasian. Overall, mean CC rate was 88.5±25.0 per minute, CC depth was 50.9±2.0 mm, and mean no-flow time was 15.9±2.7 sec/min. CC depth decreased signi? cantly in subjects >62 years(P62 years and female gender are associated with shallower CC depth.

关键词： Cardiac arrest Cardiopulmonary resuscitation Bystander CPR quality Layperson Demographics

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维普期刊数据库

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Impact of the 2010 resuscitation guidelines training on layperson chest compressions

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World Journal of Emergency Medicine 2015年第4期6卷 270-276页

作者： audrey L.blewer David G.Buckler Jiaqi Li Marion Leary Lance B.Becker Judy A.Shea Peter W.Groeneveld Mary E.Putt Benjamin S.Abella Department of Emergency Medicine and Center for Resuscitation Science University of Pennsylvania School of Nursing University of Pennsylvania Department of Medicine University of Pennsylvania Department of Biostatistics and Epidemiology University of Pennsylvania

BACKGROUND: Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown whether training laypersons using updated guidelines resulted in changed CPR performance. We hypothesized that laypersons taught CPR using the 2010 guidelines performed deeper and faster compressions than those taught using the 2005 ***: This work represents a secondary analysis of a study conducted at eight hospitals where family members of hospitalized cardiac patients were trained in CPR. An initial cohort was trained using the 2005 guidelines, and a subsequent cohort was trained using the 2010 guideline materials. Post training, CPR skills were quantified using a recording ***: Between May 2009 to August 2013, 338 subjects completed the assessment. Among the subjects, 176 received 2005 training and 162 underwent 2010 training. The mean compression rate in the 2005 cohort was 87(95%CI 83–90) per minute, and in the 2010 cohort was 86(95%CI 83–90) per minute(P=ns), while the mean compression depth was 34(95%CI 32–35) mm in the 2005 cohort and 46(95%CI 44–47) mm in the 2010 cohort(P<0.01).CONCLUSIONS: Training with the 2010 CPR guidelines resulted in a statistically significant increase in trainees' compression depth but there was no change in compression rate. Nevertheless, the majority of CPR performed by trainees in both cohorts was below the guideline recommendation, highlighting an important gap between training goals and trainee performance.

关键词： Cardiopulmonary resuscitation Cardiac arrest Sudden death Education Guidelines

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