Abstract 237: Curriculum Development of Pitt Bystander Response Education: Developing "Caring Leaders" Through Early Exposure to Cpr Fundamentals

Introduction: Fewer than 25% of US adults feel trained in bystander CPR (bCPR). Barriers include the lack of social acceptance of bCPR, poor understanding of Good Samaritan laws, and inadequate knowledge of the steps needed to help a patient suffering out-of-hospital cardiac arrest. Hypothesis: We developed a novel, streamlined curriculum for children ages 11-13 to introduce the principles of bCPR and frame it as a shared social responsibility, hoping to increase bystander response and motivate young citizens to seek future CPR certification. Methods: The curriculum development process employed the Assess Design Develop Implement Evaluate (ADDIE) method of the Instructional System Design (ISD) model. We used an iterative approach where the novel curriculum was developed and then presented to stakeholders for review, editing and revision. Stakeholders included experts in CPR training, educational theory and elementary/middle school education. Pre- and post- survey tools were designed to evaluate curriculum outcomes, using the same process. Upon completing the iterative review, the curriculum and surveys were prepared for a pilot implementation in a middle school setting. Results: Using the ISD approach, we consulted with 9 experts to design the CPR curriculum. Three curriculum goals were identified: awareness, social responsibility and training. The novel curriculum will meet these goals through a single 50 minute in-class session of didactic, technique demonstration of compression-only CPR, and hands-on practice with manikins. Due to the present global pandemic, the curriculum has not yet been implemented as planned. Current efforts are being made to determine the feasibility of potential future implementation of the program and/or virtual options due to need for social distancing. Conclusions: An iterative process can be used to bring together multiple stakeholders to design a novel, age appropriate CPR training curriculum. Another round of stakeholder review of the curriculum is planned post piloting prior to wider dissemination.

Does sexual orientation of bullying target influence bystander response?

The Bystander Intervention Model (BIM) is applied to explore how bystanders to workplace bullying assess situations and choose responses based on the (female) target’s sexual orientation. We investigate how attitudes of homophobia and amnestic heterosexism (AH) affect these responses. Vignettes of workplace mistreatment against lesbian, female bisexuals, or female heterosexual targets were randomly presented to respondents, who were asked to assess the degree of “mistreatment” they perceive, their feelings of personal responsibility, and their anticipated responses. Analysis of covariance was used to analyze the data. Regardless of levels of homophobia or AH, respondents report less active intervention when the target is lesbian compared to bisexual or heterosexual females. Respondents do not distinguish between conditions in clarity or severity of bullying. However, those higher in homophobia and AH feel less personal responsibility and are less likely to intervene when the target is lesbian.

Immediate Bystander Response to Sudden Cardiac Arrest During Sports is Associated with Improved Survival -- A Video Analysis.

Background Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander response.Aims To determine the effect of rapid bystander response to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet.Methods We searched images.google.com, video.google.com and YouTube.com, and included any camera-witnessed non-traumatic SCA in athletes and other sports participants at any sports facility. The rapidity of starting bystander chest compressions and defibrillation was classified as <3, 3-5, or >5 minutes. The year SCA occurred was allocated to 1990-2009, 2010-2014 or 2015 onwards, compatible with the current guidelines.ResultsWe identified and included 28 victims of average age 27.9 years (SD=9.8); 27 were males, 22 elite athletes, and 17 participated in soccer. Bystander response <3 minutes (6/28) or 3-5 minutes (1/28) and defibrillation <3 minutes was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/28), and >5 minutes delay of intervention with worse outcome (death 4/28, severe neurologic dysfunction 1/28). Survival was highest between 2010-2014 (71.4%).ConclusionsAnalysis of internet videos showed that immediate bystander response to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. The observed bystander responses to SCA during sports do not show awareness of current guidelines.

Abstract 273: Exploring the Role of the Emergency Medical System in Promoting Bystander Cardiopulmonary Resuscitation During Out-of-hospital Cardiac Arrests

Introduction: Early bystander initiated cardiopulmonary resuscitation (BCPR) is a key link in the cardiac arrest chain of survival. Prior work indicates that BCPR has a greater impact on survival outcomes when arrests are witnessed, and bystanders are actively prepared. This study explores the role of the emergency medical system—including dispatch, police, fire, and emergency medical services (EMS), in promoting timely bystander response during an out-of-hospital cardiac arrest (OHCA) event. Methods: This sequential mixed-methods study used 2014-2017 data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to analyze the effect of BCPR on OHCA survival outcomes. Logistic regression models were used to analyze the effect of BCPR on sustained ROSC with pulse upon emergency department (ED) arrival and secondary outcomes. These data were supplemented with semi-structured key informant interviews and multidisciplinary focus groups conducted during site visits to 9 emergency medical systems across Michigan including dispatch, police, fire, EMS, and ED. Results: A total of 21,044 OHCA incidents met inclusion criteria. OHCA patients who received BCPR had 1.32 times higher odds of achieving ROSC with pulse upon ED arrival than those that did not after multivariable adjustment (Table 1). Qualitative data from interviews suggest that emergency medical systems can play a critical role in promoting BCPR. Several salient themes emerged across stakeholders including: 1) Preparing the community for proactive bystander response through educational campaigns; 2) Facilitating BCPR during an event through dispatch-assisted CPR and on-scene responders providing positive reinforcement to bystanders; and 3) Reinforcing the importance of performing bystander CPR to the involved community after post arrest care. Conclusion: We found that BCPR was associated with statistically significant improvements in survival outcomes compared to those that did not receive BCPR. These findings emphasize the importance of training bystanders to initiate and perform CPR, and points to engaging the emergency medical system as a leader for this initiative to improve OHCA survival across US communities.

Does sexual orientation of bullying target influence bystander response?

The Bystander Intervention Model (BIM) is applied to explore how bystanders to workplace bullying assess situations and choose responses based on the (female) target’s sexual orientation. We investigate how attitudes of homophobia and amnestic heterosexism (AH) affect these responses. Vignettes of workplace mistreatment against lesbian, female bisexuals, or female heterosexual targets were randomly presented to respondents, who were asked to assess the degree of “mistreatment” they perceive, their feelings of personal responsibility, and their anticipated responses. Analysis of covariance was used to analyze the data. Regardless of levels of homophobia or AH, respondents report less active intervention when the target is lesbian compared to bisexual or heterosexual females. Respondents do not distinguish between conditions in clarity or severity of bullying. However, those higher in homophobia and AH feel less personal responsibility and are less likely to intervene when the target is lesbian.