Putting the CP back into CPR

13 March 2018

How can you help ensure members of the public are equipped with basic life-saving skills, and is it even your role to do so? Journalist Rima Evans investigates.

Around one in five adults in the UK witness someone collapse needing immediate cardiopulmonary resuscitation (CPR). Yet the majority of people do not act, according to a recent survey of 2000 people. Funded by the British Heart Foundation (BHF) and led by Warwick Medical School (2017), the survey findings point to lack of training as a problem. The current rate of bystanders that intervene with CPR when witnessing someone collapse is as low as 39% in some parts of the country (Hawkes et al, 2017). Yet there seems to be a clear answer – the survey shows that people were nearly three times more likely to perform CPR if they had been taught how to do it (Warwick Medical School, 2017). And it’s estimated that thousands of lives could be saved every year if CPR was taught more widely.

The current survival rates for people suffering out-of-hospital cardiac arrest (OHCA) each year are worryingly low. Ambulance services attempt resuscitation in nearly 30,000 such people in England alone (OHCA Steering Group, 2017) – fewer than one in 10 survive (Warwick Medical School, 2017). ‘CPR is a crucial skill that can actually double a person’s chances of survival,’ says Julie Ward, senior cardiac nurse at the BHF. ‘And it’s not something that is hard to learn.’

Where do you fit in?

Every so often, stories hit the headlines about members of the public coming to the rescue of bystanders with the emergency life-saving skills they’ve learned. In a number of recent cases, the training provided by community practitioners has made all the difference.

For instance, a teenager from Lisburn, Northern Ireland, saved her mum’s life by performing CPR she had learned from a school nurse (Buck, 2017). In Wales, a mum saved her four-year-old choking son by recalling the techniques she had been taught by a community nursery nurse from the local health visiting team (Hayward, 2017).

Even though teaching clients life-saving skills isn’t usually a part of the universal service delivered by community practitioners, there is a growing realisation of how vital such an offering could be. 

A Community Practitioner poll of more than 30 CPs highlighted that the vast majority (83%) feel they should be more actively involved in delivering life-saving lessons to clients, whether parents, carers or school pupils.

However, 77% of respondents said they aren’t trained to teach members of the community CPR, for example. More than 80% also said they haven’t been trained to teach other life-saving techniques, such as helping someone who is choking.

Things might be starting to change, however. A handful of CP teams have already made it a core part of the services they offer while a small number of other teams are considering introducing it.

The move may be a result of greater awareness of how few people in the UK can administer basic yet life-saving skills such as CPR.

Improving the situation

Julie explains it’s important that members of the public feel confident about performing CPR in any situation, even if a public access defibrillator (PAD) is available. PADs have visual and verbal prompts and can be used with no training. But standard CPR should still be given until a bystander can fetch the PAD, or the ambulance arrives (OHCA Steering Group, 2017).

‘In Norway, where the bystander CPR rate is much higher than ours at 73%, they teach CPR in schools and encourage more widespread training in the community and workplaces,’ reveals Julie. ‘We are trying to do the same to make progress, since our cardiac arrest survival rates remain low.’

The BHF has set a target of training five million people in CPR by 2020. Every year, it organises Restart a Heart Day across the UK in a bid to raise awareness. And it’s not working in isolation – the Resuscitation Council (UK), St John Ambulance (SJA), British Red Cross (BRC), NHS ambulance services, and fire and rescue services have all joined forces to boost CPR skills.

Significantly, there is a concerted drive to increase training uptake among school pupils – and calls for it to be made mandatory. In fact, SJA along with the BHF and BRC have called for first aid to be on the school curriculum as part of personal, social, health and economic (PSHE)education. The government is considering making part, or all, of PSHE education mandatory from 2019, with decisions expected later this year (SJA, 2018).

School nurses in Stoke-on-Trent have identified school children as a key group. For the past two years, they have delivered training alongside public health advisors to all the city’s secondary schools, offering it to either Year 7 or Year 8 pupils.

‘We feel this age group is particularly relevant,’ says Kara Walley, team leader for Our Health 5 to 19 service, public health advisory service at Staffordshire and Stoke-on-Trent Partnership NHS Trust. ‘They are more receptive to learning these skills and retaining them. We have found youngsters really engage with the task, and schools always seem eager to take up the training offered.’

Hour-long sessions are based on a DVD and the Call Push Rescue kits provided by the BHF, and covers areas such as rescue breaths, chest compressions, defibrillators, and how to put someone in the recovery position.

Kara says: ‘We accompany this with heart health messages that educate young people about eating well, and the risks associated with smoking and drinking too much alcohol.’

This CPR training is an initiative that is unusual in being delivered by community practitioners rather than first aid organisations, adds Kara.

‘We have trained over 2500 young people in our city. It’s a valuable investment of our time, and commissioners love what we are doing.’

Power to parents

As well as school pupils, new parents or carers are clearly another key group to teach life-saving skills to. And in south Wales, CPs are as equally as passionate as those in Stoke-on-Trent about ensuring members of the community are armed with the right skills and techniques to deal with emergencies.

Across the Abertawe Bro Morgannwg University Health Board (ABMU) area, health visitors teach all new parents how to deal with a choking baby, as well as how to perform basic life support during one-to-one sessions in the home. The training is carried out routinely in the health board region when health visitors carry out their follow-up home visit, so the infants will be three to eight weeks old. All the health visitor bases have access to resuscitation dolls.

‘We know from the Resuscitation Council (UK) that if babies have a cardiac arrest out of hospital they have low survival rates,’ says Jane O’Kane, health-visiting lead for public health at ABMU. ‘The sooner some sort of resuscitation can be started, the better the outcome, so it’s clearly important parents are aware of what to do in an emergency. We also dovetail this with safer sleep messages and reviewing where babies are sleeping, aiming to prevent sudden infant death syndrome.’

The service is popular, says Jane, with few parents refusing the training. At some sessions parents have invited along friends, family or carers too, which is welcomed.

The training has proved to be a life-saver in a few instances so has had immeasurable payback. Jane explains: ‘One eight-month-old baby was reported to have been found by his dad in the cot, turning blue. He rang 999 and did chest compressions. The baby was taken to hospital and monitored but was later discharged. It appears his dad saved him because of the techniques we showed him.’

‘For me, this work is vital,’ Jane adds. ‘The skills are not complicated to learn and easy to impart. It’s also an example of prudent healthcare as the costs are low. Once you have invested in resuscitation dolls and the training of CPs to teach CPR, staff are going into family homes anyway. Health visitors also report that this is a very positive part of their job. Why wouldn’t we do it?’

Other health boards in Wales are now looking at introducing a similar service. ‘Certainly one health board is in the process of training staff to get it up and running and another is seriously considering it,’ Jane says.

While incorporating life-saving training into the core service currently remains fairly rare, how can CPs realistically play a part in upskilling communities?

Community practitioners have a huge role to play since they are frontline staff, says Julie. ‘There are a range of resources they can use, such as the Call Push Rescue training kits that anyone can use.
So community practitioners can organise events in community settings and help roll out training. They are an ideal audience to carry the campaign forward.’

Further resources

For more about the Call Push Rescue CPR training kits, see bit.ly/BHF_CPR_kits

For general resources for CPs on heart health, including teaching CPR (click on 3), see bit.ly/BHF_CPs

A list of helpful FAQs from the OHC Steering Group can be found at bit.ly/OHCA_FAQ

Read the Resuscitation to recovery national framework for England at bit.ly/resus_recovery

A reminder of the CPR technique can be found at bit.ly/NHS_CPR and bit.ly/BHF_do_CPR


Buck K. (2017) Lisburn girl Melissa who learnt CPR at school saved her mum’s life after heart attack. The Belfast Telegraph. See: https://www.belfasttelegraph.co.uk/news/northern-ireland/lisburn-girl-melissa-who-learnt-cpr-at-school-saved-her-mums-life-after-heart-attack-36254113.html (accessed 23 February 2018).

Hayward W. A mother saved her son's life when he choked on bubblegum – just 24 hours after she learned first aid skills. See: https://www.walesonline.co.uk/news/wales-news/mother-saved-sons-life-choked-12466665 (accessed 23 February 2018).

Warwick Medical School. (2017) One in five witness someone collapse who requires CPR but the majority do not act. See:

warwick.ac.uk/newsandevents/pressreleases/one_in_five/ (accessed 16 February 2018).

OHCA Steering Group. (2017) Resuscitation to recovery. A national framework to improve care of people with out-of-hospital cardiac arrest (OHCA) in England. See: https://www.resus.org.uk/publications/resuscitation-to-recovery (accessed 23 February 2018).

Hawkes C, Booth S, Ji C, Brace-McDonnell SJ, Whittington A, Mapstone J, et al. (2017) Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 110: 133–40.

SJA. (2018) Let's get first aid onto the school curriculum. See: sja.org.uk/sja/support-us/our-campaigns/every-child-a-lifesaver.aspx (accessed 16 February 2018).

West Midlands Ambulance Service NHS Foundation Trust. (2018) How to mend a broken heart. See: https://wmas.nhs.uk/advice-resources/campaigns/how-to-mend-a-broken-heart/ (accessed 23 February 2018).


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