S98 Abstracts / Resuscitation 81S (2010) S1–S114 AP254 Brief structured educational intervention increases school students ability to respond to emergencies Cunningham L., Breen N., Bury G. School of Medicine, University College Dublin, Ireland Background: The key role of public education to raise awareness of CPR has been repeatedly highlighted, particularly among young people edn1. This study aimed to raise awareness of the Chain of Survival (COS) among secondary school students in rural Ireland. We report changes in knowledge, experiences and attitudes to community resuscitation among participants. • Over 9000 deaths occurred in Ireland in 2008 due to heart disease edn2. • It is estimated that 5000 sudden cardiac deaths occur annually, the majority out-of- hospital edn3. • NW and W of Ireland identified as regions disadvantaged for rapid access edn4. 3 Methods: A 90 min presentation on COS – “COS I Should Know” – was given to 210 Transition Year students from eight secondary schools in County Mayo, Ireland. An anony- mous questionnaire was administered pre-and post-presentation. Results: 176 students completed the questionnaire (84%). They were of mixed gender and aged between 16 and 18 years old. 71 students (40%) held a current provider certificate (57% First aid, 31% CPR and 35% AED). 87% would perform mouth-to-mouth resuscitation on a family member and 65% on a stranger. Knowledge of the concepts of CPR and ABC increased from 12% to over 90%. 20% of students did not initially know the emergency phone numbers for Ireland. This increased to 99% on completion. 98% said they were now more confident with making an emergency phone call. 98% said CPR and AED should be taught in secondary schools. 95% said how to make an emergency phone call should be taught in primary schools. Conclusion: A simple presentation on Chain of Survival increases school students’ perceived ability to respond to emergencies. Secondary school students benefit from a structured training programme on how to make an emergency call and manage collapse. doi:10.1016/j.resuscitation.2010.09.399 AP255 Healthcare professionals attending resuscitation courses have more positive attitude towards CPR guidelines Nikolaou N. 1 , Patialakas A. 2 , Christou A. 1 , Kokkinos P. 3 , Chasikides C. 4 , Tasouli A. 3 , Rompola A. 3 , Georgiou M. 5 , Papafanis T. 6 1 Konstantopouleio General Hospital, Athens, Greece 2 Athens Naval Hospital, Athens, Greece 3 Onassis Cardiac Surgery Center, Athens, Greece 4 Argos General Hospital, Argos, Greece 5 Nicosia General Hospital, Nicosia, Cyprus 6 Sismanogleio General Hospital, Athens, Greece Purpose of the study: To assess the association of cardiopulmonary resuscitation (CPR) courses on healthcare professionals’ attitude towards guidelines. Materials and methods: Data were collected using an anonymous questionnaire held online (www.hcs.gr) for 1 year, till the end of 2009. Responders age, gender, occupation (district, working for the National Health System – NHS, hospital practice), attendance of CPR courses, time from last attended course and number of CPR attempts/year, were con- sidered as factors potentially affecting attitude towards guidelines. Responders’ attitude was assessed through answers to questions regarding diagnostic accuracy of AED, pub- lic defibrillation programs, compression/ventilation ratio, rate of compressions, shock to CPR sequence, adrenaline use, and implementation of hypothermia. Grade 1 was assigned to answers accordant with ERC guidelines, and grade zero to all other answers. Thus a score (0–7) was formed. Reliability analysis for this score yielded a tetrachoric r of 0.78. Numeric variables are summarized as median (interquartile range) and compared using the Mann–Whitney U test. Qualitative variables are reported as counts (%). Results: There were 544 responders (158 females), median age 34 (30, 40). Of them 414 (76) were physicians, 384 (71%) hospital practitioners, 354 (65%) NHS employees, 169 had followed a CPR seminar >5 years ago or never, and 206 (38%) had >10 CPR attempts/year. Median score was 5 (3, 6). Responders that had followed a course had higher scores 5 (4, 6) vs 4 (2, 5), p < 0.0001 and were more likely to be involved in >10 CPR attempts/year. The effect for attending a course, however, remained significant after adjusting for all variables (beta = 0.29, SE beta = 0.06, p < 0.0001). Age (beta = -0.14 SE beta = 0.05, p = 0.006), involved in >10 CPR attempts/year (beta = 0.21, SE beta = 0.08, p < 0.006) and being a physician (beta = 0.16, SE beta = 0.06, p = 0.004) were other independent predictors of score. Conclusion: Healthcare professionals attending resuscitation courses have more pos- itive attitude towards CPR guidelines. doi:10.1016/j.resuscitation.2010.09.400 AP256 Cognitive and emotional coping strategies used during CPR in full scale cardiac arrest simulation—A qualitative analysis of post-test interviews Mykletun R.J. 4 , Neset A. 1,2 , Birkenes T.S. 1,3 , Furunes T. 4 , Myklebust H. 3 , Odegaard S. 1 , Olasveengen T.M. 1 , Kramer-Johansen J. 1 1 Institute for Experimental Medical Research, Oslo University Hospital Ulleval, Oslo, Norway 2 Faculty of Medicine, University of Oslo, Oslo, Norway 3 Laerdal Medical, Stavanger, Norway 4 Norwegian School of Hotel Management, University of Stavanger, Stavanger, Norway Purpose of the study: Cardiac arrest bystanders may experience stress in this threat- ening and ambiguous situation. Hesitation and lack of initiative is a typical response. 1,2 CPR training could provide adequate skills to assess the situation and cope by starting CPR; however, this is not always the case. This study was initiated to provide knowledge about emotional and cognitive coping strategies of the bystanders. Materials and methods: Seven months after CPR training lay rescuers aged 50–70 were recruited and subjected to realistic clinical simulation of ten minutes of telephone assisted CPR. The test started suddenly, leaving the participant alone in a confined and noisy apartment, with a manikin dressed like one of the researchers. The participants were interviewed (semis-structured) in a feed-back session after the test. The CPR-sessions and interviews were video-recorded, transcribed for verbal content and a qualitative analysis 3 of the data was applied to identify the subjects’ main coping strategies. Results: All participants coped by adequately interpreting the situation and coped actively by initiating CPR. Cognitively they focused on the technical aspects of the correct CPR performance, attempting to recall how to make compressions, how much pressure to apply, to find the rhythm, and to inflate air at the right intervals. Associations to previous real-life and training episodes occurred, in some cases providing relevant cues. For some, kinesthetic and tactile stimuli, pain and emotional reactions interfered with and disturbed the task relevant cognitions. The cognitive strategies were vague and no self-instructions were applied. The telephone support provided social support and was also used to improve the CPR performance. Conclusions: Our findings suggest CPR training should be improved by including robust cognitive coping strategies, self-instructions and selection of cues for optimal CPR performance. References 1. Axelsson A, Herlitz J, Fridlund B. How bystanders perceive their cardiopulmonary resuscitation intervention; a qualitative study. Resuscitation 2000;47:71–81. 2. Riegel B, Mosesso VN, Birnbaum A, et al. Stress reactions and perceived difficulties of lay responders to a medical emergency. Resuscitation 2006;70:98–106. 3. Miles MB, Huberman AM. Qualitative data analysis. Thousand Oaks: Sage; 1994. doi:10.1016/j.resuscitation.2010.09.401 AP257 Is there a benefit in refresher training for lay rescuers to improve CPR skills retention? Timerman L., Timerman S., Gonzalez M., Quilici P., Ramires A. Laboratory of Emergency Cardiology, Heart Institute – InCor, United States Background: International Guidelines on CPR recommend the training on Basic Life Support each two years. According to recent research, there seems to be a reduction in CPR skills after 6 months. After analyzing the result of the performance in CPR maneuvers and AED handling from the subway agents, who had carried out the HeartSaver AED course, it was set up a 90-minutes refresher training of the skills to each 6 months. Hypothesis: Does a semestral 90-min refresher training increase retention of CPR skills? Methods: Thirty-six Subway Agents who had carried out the HeartSaver AED course and the refreshment (Group A) were compared to 20 other agents who had carried out only the course (Group B). The evaluation was performed one year after the course, consisting in a cardiopulmonary arrest simulation in a training mannequin, by three certified AHA BLS instructors. The following criteria were valued: (1) Check for response; (2) Activate Emergency, ask for an AED; (3) Open airway; (4) Check breathing; (5) Give two breaths; (6) Perform chest compressions; (7) AED operation. Results: It was observed a global improvement in the skills (A vs B): Check for respon- siveness (91.7% vs 85%), ask for help (63.9% vs 55%), open the airways (63.9% vs 45%), check for breathing (77.8% vs 30%), provide two rescue breaths (94.5% vs 50%), correct hand position (91.7% vs 60%), apply 30:2 ratio (94.5% vs 80%), correct frequency of com- pressions (58,4% vs 35%), correct pad placement (83.4% vs 15%) and remove pads after shock (13.9% vs 15%). Conclusion: The results suggest an improvement in CPR skills subsequent to the refresher training. Even considering the study design limitations, the data reinforce the necessity to review the periodicity of training. Even so, it is observed the need of further research on this field. doi:10.1016/j.resuscitation.2010.09.402