The effects of implementing CPR training with the use of AED on the knowledge of schoolchildren and their prosocial behavior was investigated. The study demonstrated an improvement in theoretical knowledge after CPR training. The provided training clearly increased the prevalence of schoolchildren’s prosocial behavior. Our findings indicate that CPR training alone can raise not only children’s level of CPR knowledge, but also prosocial behavior.
Specifically, children showed an improvement after training in theoretical knowledge on the question of which information has to be provided to paramedics in case a person is found unconscious and the correct position of an unconscious victim. Virtually all schoolchildren were familiar with the emergency telephone number in Slovenia, a result is comparable to the findings of previous studies [10], which underlies the positive effects of trainings. The greatest progress in 566 schoolchildren was seen in the knowledge of actions to be taken with an unconsciousness person, the placement of AED electrodes in correct positions, and the frequency and depth of chest compressions. Knowledge on the latter point after training was similar to findings reported from other studies [10]. Most of the schoolchildren in our research knew the right answer on how to use an AED; however, they were not as familiar with the fact that the emergency telephone number can also be dialed to receive instructions on its use. Schoolchildren are capable of determining whether the victim is conscious, calling for help, providing relevant information on the victim, and using AED [22]. Our research showed some progress on the correct CPR of a drowning victim, but the percentage of incorrect answers still remains high. Therefore, CPR instructions to schoolchildren should be simple and delivered uniformly for all causes of OHCA.
Our results revealed that the level of schoolchildren’s theoretical knowledge on CPR was higher after CPR training and that the level of knowledge was retained one to two months after training. Similarly, other researchers found not only greater knowledge after CPR training, but also its retention [23, 20, 24]. Prior to CPR training, the level of CPR knowledge was highest in children with a mean age of 14.5 years, while children with mean ages of 12.5 and 13.5 years were less successful. After the implemented CPR training, the level of knowledge increased in all age groups. The greatest progress was seen in the youngest age group (mean age 12.5), because children in this group had to gain the most knowledge to be on par with their older peers. Therefore, we support early introduction of CPR training. Other authors have made similar recommendations [25, 22, 16, 24]. What is more, younger schoolchildren have a greater capacity to learn the practical aspects of resuscitation compared to older children [24]. In Germany, research showed that the ability to implement practical CPR interventions among 10-year-olds was the same as among 13-year-olds [15]. However, schoolchildren aged 13 or more have greater theoretical knowledge [15, 24, 26]. Considering the assessed effectiveness of CPR training in schoolchildren, some advocate the introduction of CPR training between the ages of 10 and 11. In this age group, schoolchildren have the necessary intellectual capacity and, on average, an appropriate body weight to provide effective chest compressions [15, 16]. Moreover, younger schoolchildren know how to place electrodes on the chest fast and effectively, while also ensuring safety beforehand [16, 24].
In the second part of our research, we compared the level of prosocial behavior prior to and after CPR training. After training, participants showed the most significant increase in confidence to help others, helping behavior somewhat increased, while the level of internal motivation remained the same prior to and after CPR training. In children of the final three grades of elementary school, increased CPR knowledge led to increased prosocial behavior. Similar conclusions were also reached by previous researchers [13, 23]. As in our research findings, previous studies showed that CPR training boosts the confidence of schoolchildren [13]. Our findings showed that boys were more confident than girls.
CPR training for schoolchildren significantly increased their self-worth and moral responsibility towards themselves and the people around them [23]. CPR training reduced the fear of making a mistake in persons providing assistance to cardiac arrest victims, raised self-confidence, and promoted children’s helping behavior [15]. Our research results also showed that, after CPR training, the percentages of those willing to help others increased. Similar studies stress the importance of early learning and implementation of training in intervals, because they believe that recurring trainings strengthen the prosocial and social behavior of schoolchildren [16]. Similarly, previous studies demonstrated that early learning of helping others makes schoolchildren better understand the importance of helping others and evolves their capacity for expressing empathy [27].
We were also interested in the instructors’ experiences and opinions on the effects of the conducted CPR training. Analysis of the focus groups suggests training in CPR has to start at an early stage, with the content and teaching tools adjusted to the children’s age.
The European Resuscitation Council Initiative and World Health Organization Statement endorse making CPR training a mandatory part of school curricula, as this would have a significant influence on the public health issue related to sudden cardiac arrest [5, 11, 28]. Focus group results showed obstacles for introducing CPR training in Slovenian schools, most notedly that CPR is at the moment an elective subject, not part of the mandatory school curricula. Furthermore, current instructors have been found to have different levels of knowledge and skills, highlighting the need for setting minimum criteria for certified CPR instructors. Closer cooperation with professional associations, which should set the minimum criteria for the implementation of trainings and for the potential instructors, is also required. According to the focus group members, these minimum criteria are: introduction of mandatory CPR training in school curricula, appropriate qualifications of instructors who must follow ERC recommendations on CPR, appropriate teaching methods employed by instructors, appropriate equipment and tools, the ability to adapt the content according to children’s age, trainings in small groups, refreshment of knowledge both for instructors and schoolchildren. Support and guidance of instructors and other adults involved is crucial for the development of a responsible and emphatic approach towards teaching schoolchildren CPR [29].
Our results revealed the benefits and advantages of teaching schoolchildren CPR. It can be concluded that early CPR training for children is crucial and should be introduced as a mandatory part of school curricula in those countries where CPR is not yet mandatory.