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tatistically analyzed to identify the independent predictors of mor-ality in pulmonary embolism.

Results: The cohort consisted of 890 subjects with venoushromboembolism: 362 with pulmonary embolism and 528 witheep venous thrombosis. The mortality in pulmonary embolismas 21.54% (78 subjects died). From surgical risk factors, ortho-edic surgery was most common (5.8% in pulmonary embolismnd 6.4% in deep venous thrombosis), followed by general surgery2.3% in pulmonary embolism and 3.4% deep venous thrombosis)nd gynecologic surgery (0.82% in pulmonary embolism, 1.13%n deep venous thrombosis). Multivariate analysis showed thatbesity (OR = 10.47, CI = 2.93–37.32, p = 0.0003), hyperglycemiaOR = 27.25, CI = 3.14–235.83, p = 0.0027), shock (OR = 13.78,I = 2.5–75.95, p = 0.0026), anemia (OR = 11.04, CI = 1.42–85.045,= 0.0214), renal failure (OR = 32.19, CI = 7.66–135.3, p < 0.0001)nd short time between admission and death (OR = 0.696,I = 0.602–0.805, p < 0.0001) were the only significant predictorsf mortality in pulmonary embolism.

Conclusions: Mortality in patients with pulmonary embolisms high and screening of risk factors and comorbidities is impor-ant to identify patients at risk of developing clinically significanthromboembolic events.

ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.265

ducationP207

ffects of train the trainer course on the quality and feedbackn a basis life support course for first year medical students – Aandomized controlled trial

vet Benthem ∗, Eva van de Pol, Harry van Goor, Edward Tan

Radboud University Nijmegen Medical Centre, Nijmegen, Theetherlands

Introduction: Adequate education in first aid and basic life sup-ort (BLS) is an essential part of the medical curriculum. Since 2005ll first-year medical students of the Radboud University Nijmegenedical Centre participate in a first aid and BLS-course. Senior med-

cal students, who have attended an in-service training but are notfficially certified, are the course instructors. Recently, the Dutchesuscitation Council (DRC) provides and certifies a 2-days trainhe trainer course for BLS. The aim of this study was to evaluatehe additional value of such course on the quality of feedback andands-on exercises.

Materials and methods: Ten senior student certified DRC-nstructors (in-service training + train the trainer) and 14 studentontrol instructors (in-service training only), and 350 first yearedical students participated in this study. Students were random-

zed to receive training from either a control instructor (n = 202) orRC-instructor (n = 148). They were blinded for the type of instruc-

or. Every student filled in a questionnaire after the first, fourth andighth lesson scoring the quality of the training and the feedbackhey received. Secondary endpoint was the result of the final BLSxamination by type of instructor.

Results: Cronbach’s alpha of the questionnaire was 0.915. Theppreciation of feedback increased from lesson one to lesson eight.RC-instructors scored significantly higher on the practical trainingf BLS (p = 0.008) whereas control instructors performed signifi-antly better on parts of the theoretical BLS training (p = 0.001). The

ype of instructor had no effect on the result of the final exam ofhe first year students (p = 0.949).

Discussion: The additional value of a train the trainer course onop of in-service training for senior medical students is not evident

tion 83 (2012) e24–e123 e103

from the trainee perspective. Further research will focus on differ-ence in self-confidence of senior medical student instructors andexpert assessment on quality of training and feedback.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.266

AP208

Feasibility of developing a First Responder training course inrural Bangladesh

Thomas Mecrow 1,2,∗, Aminur Rahman 1,2, Nahida Nusrat 1,2

1 Centre for Injury Prevention and Research Bangladesh, Dhaka,Bangladesh2 Nile Swimmers, Khartoum, Sudan

Introduction: CPR is recognized as being a life-saving interven-tion if it is begun soon enough, particularly in drowning victims.Experience has shown that both adults and adolescents in high-income countries can learn the skills associated with CPR veryeasily. This success may depend on a basic knowledge of physiol-ogy, basic levels of literacy, as well as cultural attitudes that permitstrangers to come into intimate contact with victims in order todeliver CPR.

No research has been conducted on the feasibility of introduc-ing a large scale CPR project in a low-resource setting such asBangladesh. The aim of this study was to test the feasibility of devel-oping, piloting, and monitoring a CPR project in Raigonj Upazilla,Bangladesh.

Methods: The CPR project has been developed using inter-national guidelines, and has been modified for Bangladesh usingexpert and community forums. The project has been implementedin Raigonj Upazilla, Bangladesh.

Quantitative and qualitative research as well as observationalstudies are being conducted in various populations of older chil-dren, adolescents and young adults with differing levels of generalknowledge, and various levels of literacy.

Results: Approximately 2400 people have been trained in CPRacross 10 villages. Results from village level courses have showna number of religious and cultural barriers to CPR training inBangladesh. The majority of participants noted that they wouldfeel uncomfortable conducting CPR on a person of the oppositesex due to religious concerns. Despite their concerns, all partici-pants have shown competence in CPR following a comprehensivetwo day training course. Data regarding retention is currently beinganalysed.

Conclusions: Results from trials provides evidence that CPRcompetence can be achieved across a broad spectrum of groupswith varying levels of knowledge about physiology, literacy and inolder children as well as adults.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.267

AP209

Peer-assisted learning in CPR using laypersons as instructor

Nathalie Charlier

Peter Iserbyt KU Leuven, Leuven, Belgium

Purpose: This study investigates (i) the quality of peer-assistedlearning (PAL) compared to instructor-led instructions for learn-ing cardiopulmonary resuscitation (CPR) and (ii) the extent towhich peer tutors can be trained to qualitatively instruct a peer on

these skills. PAL has been used extensively in medical education.1

However, while most studies use senior students trained to beinstructor,2,3 this study deploys laypersons who have been trained

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ither chest compression or ventilation for only 30 min precedinghe PAL-phase.

Study design: Sixty-nine master students were randomized inton intervention cohort implementing PAL and a control cohorteing trained by an expert instructor. The intervention cohort wasandomly split in a chest compression group and a ventilationroup. For 30 min each group was instructed the respective skill byn expert instructor. Both groups were reunited and randomizednto pairs with a member of each group. The student of the chestompression group taught his peer the acquired skill for 6 minutesn a manikin. Subsequently, the student of the ventilation groupaught his peer the ventilation skill. This cycle was repeated once

ore. Both skills were individually assessed on a manikin using aC-Skill Reporting System. Performance was measured one weekefore intervention (baseline), 2 weeks after (post) and 6 weeks

ater (retention).Results: All groups improved significantly at post and retention

esting in CPR. No significant difference in learning gains was foundetween the students instructing their peers and those taught byheir peer for neither the chest compression nor ventilation. Noignificant difference in learning gains was found between thetudents taught by their peers and those taught by the expertnstructor.

Conclusions: This study demonstrated that a 54-min PALetting with laypersons as instructors is as effective as expertnstruction for learning and retention of CPR-skills.

ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.268

P210

mproving resuscitation using a post-arrest debriefing tool

rainne Gallagher ∗, Clare Morkane, Davina Sharma

NHS, London, UK

Purpose of the study: Debriefing is utilised across industrieslobally to enhance services and training. Existing studies havehown advances in managing cardiac arrests with its use1–3 –ncluding optimising Acute Life Support (ALS) skills, leadership, andeamwork. With no existing formalised approach to debriefing, thispportunity is often lost. The purpose of our study was to create aexible, succinct debriefing tool that could be used by arrest teamso salvage this valuable opportunity for training, and encourageontinuous improvement.

Materials and methods: We surveyed 60 members of the car-iac arrest team – asking 47 (78%) doctors and 13 (22%) nurses, ofll grades, if they learned from cardiac arrests, and whether theirerformance as individuals and teams would benefit from debrief-

ng. We explored learning and facilitation models, and integratedhe technical and non-technical aspects of arrests to structure theost-arrest debriefing tool. We ran hospital-wide teaching sessionshat we created, to introduce our debriefing tool, and establish theulture of debriefing. We then simulated arrests using ALS man-equins around the hospital over a month. On call teams subject tounning the arrest within their shifts were observed implementingur debriefing tool, and then re-surveyed.

Results: 71.7% (n = 43) surveyed reported they previously foundt difficult to discuss concerns after a cardiac arrest. 93% (n = 55)elt post-arrest debriefing would be beneficial. Observation and re-urvey from simulated arrests using our debrief tool demonstratedmprovements in technical and non-technical skills during arrestsas individuals and teams. All participants reported an educational

enefit from debriefing.

Conclusions: Valuable learning from resuscitation is not capi-alised on. The debriefing tool we have created addresses integral

tion 83 (2012) e24–e123

components to a successful resuscitation: technical skills, lead-ership, teamwork, human factors. The evident value using ourdebriefing tool supports the argument for structured debriefingafter all arrests, so as to constantly strive for more efficient teams,self-directed improvement, and excellence.

References

. Edelson DP, et al. Improving In-Hospital Cardiac Arrest Process and Outcomeswith Performance Debriefing. Arch Intern Med 2008;168:1063–9.

. Dine CJ, et al. Improving cardiopulmonary resuscitation quality and resuscita-tion training by combining audiovisual feedback and debriefing. Crit Care Med2008;36:2817–22.

. Marsch SC, et al. Human factors affect the quality of cardiopulmonary resuscita-tion in simulated cardiac arrests. Resuscitation 2004;60:51–6.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.269

AP211

‘ABC for life’ – A programme of BLS (Basic Life Support) trainingto primary school children in Northern Ireland since 2004

Michael Connolly ∗, Philip Toner, Patrice McGrath, Leanne Laverty

‘ABC for Life’ Association, Queens University Belfast, UK

Purpose: The ‘ABC for Life’ programme is a regional course inBLS (Basic Life Support) training in Northern Ireland specificallydesigned for 10–12 year old children. It was set up in the med-ical school of QUB (Queens University Belfast) in 2004. We havepreviously shown that children trained through his unique train-ing programme showed a highly significant increase in knowledgefollowing the training session, which remained higher than non-trained pupils at 6 months following training.1,2 An official charitystatus has been granted and the charity committee continue to raisefunds to purchase equipment.

Materials and methods: Medical students are trained asinstructors of BLS and subsequently attend primary schools andeducation training boards to instruct teachers how to train theirpupils. The scheme is overlooked by the ‘ABC for life’ committeeincluding postgraduate doctors and representatives from the Divi-sion of Medicine at QUB. Resource packs (DVDs of a cardiac arrestsituation, a simple faint requiring recovery position, communica-tion with ambulance control, an instruction manual and a trainingmanikin) are provided to each school to retain for future trainingsessions. Refresher courses are offered yearly. A dedicated websitevia QUB is in use for teachers to access resources and contact thecoordinators if needed.

Results: By using medical students and teachers, a large num-ber of children can be trained. To date, the programme has trainedand provided resources to approximately 300 schools in NorthernIreland. With an average primary school class containing 25 pupils,we estimate that 7,500 pupils have been trained.

Conclusion: Resuscitation skills are essential for lay membersto perform immediate post cardiac arrest care. Children as youngas eleven can perform these life-saving skills. We plan to con-tinue training, provide refresher courses and expand our trainingto include use of an AED (Automated External Defibrillator).

References

].Connolly M, Toner P, Connolly D, McCluskey DR. The ‘ABC for life’ programme –teaching basic life support in schools. Resuscitation 2007;72:270–9.

].Toner P, Connolly M, Laverty L, McGrath P, Connolly D, McCluskey DR. Teach-ing Basic Life Support to school children using medical students and teachers in

a ‘peer-training’ model – results of the ‘ABC for life’ programme. Resuscitation2007:169–75.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.270