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Why Online Learning Could Change the Face of First Aid

The 2020 American Heart Association Guidelines, Heart & Stroke Foundation of Canada Edition, indicated spaced learning and booster training had improved retention rates. A combination of self-instruction or instructor-led, along with hands-on training is recommended as an alternative to solely instructor-led courses, with no clear outline as to what blended method(s) should entail, nor any indication regarding how much time should be allotted for each skill. There are several ways to deliver blended programs and some have proven to be more effective than others.   


The new 2020 American Heart Association Guidelines Heart and Stroke Foundation of Canada Edition indicated that there are alternative training methods that could prove to be as effective or more effective than traditional in-class training. With industries changing and the progression of technology, the door has opened for new, effective ways for adult learners to retain and learn information. There are several methods for virtual-based program delivery. They are cited below for easy reference. Where blended delivery is becoming more prominent, there needs to be better outlines and expectations for these options.   


The International Liaison Committee on Resuscitation, commonly known as ILCOR, has emphasized three main essential components for best resuscitation outcomes. They are:   

1.     Sound resuscitation science and guidelines  

2.     Proper education for the public and first aid providers  

3.     Implementation of the chain of survival  


The following excerpts are from the 2020 American Heart Association Guidelines, outlining best practices along with scientific evidence.  


“Part six of the 2020 guidelines “resuscitation education science” includes recommendations about various instructional design features in resuscitation training, including deliberate practice, spaced learning, booster training, teamwork and leadership training, in situ education, manikin fidelity, CPR feedback devices, virtual reality and gamified learning and recourse preparation.”   


“Booster training: it is recommended to implement booster sessions when using massed learning approach for resuscitation training. Most current resuscitation courses use massed learning approach: a single training event lasting hours or days coupled with re-training every 1 to 2 years. The addition of booster training (i.e., brief, frequent sessions focused on the repetition of prior content) to resuscitation courses is associated with improved CPR skill retention over 12 months.”  


“Spaced learning: it is reasonable to use a spaced learning approach in place of massed learning approach for resuscitation training. In contrast to the traditional or massed learning approach involving a one or two-day course, a spaced learning approach separates training into multiple sessions over time, with intervals of weeks to months between sessions. Each spaced session involves the presentation of new content and may include repetition of content from prior sessions.  


“In situ simulation training: it is reasonable to conduct in situ, simulation-based resuscitation training in addition to traditional training. In situ simulation is a form of simulation training activity that occurs in an actual patient care area. One advantage of in situ training is that it provides learners with a more realistic training environment. In situ training can be focussed on the development of the individual provider, technical skills or team-based skills, including communication, leadership, role allocation and situational awareness.”  


“Lay rescuer training: a combination of self-instruction and instructor lead teaching with hands-on training is recommended as an alternative to instructor-led courses for lay rescuers. If instructor-led training is not available, self-directed training is recommended for lay rescuers. The primary goal of resuscitation training for lay rescuers (i.e., non-healthcare professionals) is to increase immediate bystander CPR rates, automated external defibrillator (AED) use, and timely emergency response system activation during an OHCA. Studies comparing self-instruction or video-based instruction with instructor-led training demonstrates no significant difference in performance outcomes. A shift to more self-directed training may lead to a higher proportion of trained lay rescuers, thus increasing the chances that a trained lay rescuer will be available during OHCA.”  


The Stakeholders Workshop on a Proposal for a National Standard on Workplace First Aid Competencies and Training (CSA Group - WA 02-15) indicated several gaps and issues with the current programs and systems across the country. Some of the identified issues, barriers and topics for discussions were:  


·       Resistance to change “if it’s not broken, why is this needed?”  

·       Content is not always evidence-based and does not reflect changing workplace injuries  

·       Challenges on how to best integrate new training delivery systems and methods  

·       Need for linkage between Canadian requirements and what is taking place internationally in the scientific community such as ILCOR  

·       Best practices regarding procedures and delivery methods.  


Some key themes that arose from the workshop were:  

·       The status quo is not an option. There is an urgent need for new policy approaches in a number of jurisdictions in light of changing regulatory framework  

·       The standard could be updated regularly to reflect current scientific evidence and best practices  

·       A standard-based approach could help ensure more consistent high-quality and measurable training based on core competencies  


Given the 2020 scientific recommendations to adopt more spaced learning along with self-led video-based modules, the key topics of discussion during the workshop have scientific evidence to revisit, integrating new training delivery methods along with closing the gap between national standards. An evidence-based curriculum should continue to be used in first aid training moving forward. Opening the standards to review delivery methods could assist with the feasibility of a national standard for first aid competencies and training. Opening the standards for an in-depth review of delivery methods could assist the following issues:  


·       Auditing tools for Workplace First Aiders – if participants are electing to do online delivery for booster programs this will allow better tracking for future studies  

·       Expedited scientific-based curriculum - moving more to an online delivery system could enable participants to have up-to-date information on national standards and it provides a sustainable solution. This will limit the amount of time needed to update all standards. Instead of waiting 12-18 months to update standards, this can allow it to be done in a fraction of the time.  

·       Self-paced delivery - could enable participants to review the content at their leisure along with improving retention rates.  

·       Consistent program delivery – this will allow participants to receive the exact same key information across the entire country for a national standard.  

·       Program delivery evolution – as with other programs that have adopted online delivery, this ensures that status quo and archaic methods are being revisited and re-evaluated to produce the best possible outcomes.   


“In 2015 approximately 350,000 adults in the United States experienced non-traumatic out of hospital cardiac arrest (OHCA) attended by emergency medical services (EMS) personnel. Approximately 10.4% of the patients with OHCA survive their initial hospitalization and 8% survive with good functional status. The key drivers of successful resuscitation from OHCA are lay rescuer cardiopulmonary resuscitation (CPR) and public use of an automated external defibrillator (AED). Despite recent gains, only 39.2% of adults receive layperson-initiated CPR and the general public applied an AED in only 11.9% of cases.”   

-2020 American Heart Association Guidelines Heart & Stroke Foundation of Canada Edition  




Although there have been significant improvements to OHCA survival rates, they have plateaued since 2012, indicating there is a need to revisit how first aid programs are being delivered. With recent evidence-based studies, adopting self-paced programs with hands-on instructor-led skill sessions, may encourage more employers to send their staff for training, thus increasing numbers of qualified First Aiders and as a result, increasing bystander intervention and subsequently survival rates.   


The overarching goal for a national standard is to ensure consistent training programs across the country, delivering timely scientific and evidence-based curriculum, along with reducing worksite injury and maintaining compliance. We look forward to working with you towards these goals. Thank you for your time, please do not hesitate to contact me should there be any questions or concerns.