title: A novel approach to life support training using "action-linked phrases".
abstract: BACKGROUND
  Observations of cardiopulmonary arrests (CPAs) reveal concerning patterns when clinicians identify a problem, (e.g. loss of pulse) but do not immediately initiate appropriate therapy (e.g. compressions) resulting in delays in life saving therapy.
  
  
  METHODS
  We hypothesized that when individuals utilized specific, short, easy-to-state action phrases stating an observation followed by an associated intervention, there would be a higher likelihood that appropriate action would immediately occur. Phase I: A retrospective analysis of residents in simulated CPAs measured what proportion verbalized "There's no pulse", statements and/or actions that followed and whether "Action-Linked Phrases" were associated with faster initiation of compressions. Phase II: Two prospective, quasi-experimental studies evaluated if teaching three Action-Linked Phrases for Basic Life Support (BLS) courses or six Action-Linked Phrases for Advanced Cardiovascular Life Support (ACLS) courses was associated with increased use of these phrases.
  
  
  RESULTS
  Phase I: 62% (42/68) of residents verbalized "there's no pulse" during initial assessment of a pulseless patient, and only 16/42 (38%) followed that by stating "start compressions". Residents verbalizing this Action-Linked Phrase started compressions sooner than others: (30s [IQR:19-42] vs. 150 [IQR:51-242], p < 0.001). Phase II: In BLS courses, the three Action-Linked Phrases were used more frequently in the intervention group: (226/270 [84%] vs. 14/195 [7%]; p < 0.001). In ACLS courses, the six Action-Linked Phrases were uttered more often in the intervention group: (43% [157/368] vs. 23% [46/201], p < 0.001).
  
  
  CONCLUSIONS
  Action-Linked Phrases innately used by residents in simulated CPAs were associated with faster initiation of compressions. Action-Linked Phrases were verbalized more frequently if taught as part of a regular BLS or ACLS course. This simple, easy to teach, and easy to implement technique holds promise for impacting cardiac arrest teams' performance of key actions.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Penn State Hershey Medical Center Department of Anesthesiology, Hershey, Pennsylvania, USA.
authors.forename: Hillenn
authors.initials: H
authors.lastname: Cruz-Eng
authors.affiliation: Uniformed Services of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: Jamie Haggerty
authors.initials: JH
authors.lastname: Bradshaw
authors.affiliation: Penn State University College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Hodge
authors.affiliation: Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA.
authors.forename: Tammi
authors.initials: T
authors.lastname: Bortner
authors.affiliation: Penn State Hershey Medical Center Department of Anesthesiology, Hershey, Pennsylvania, USA; Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA.
authors.forename: Christie L
authors.initials: CL
authors.lastname: Mulvey
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
authors.forename: Kristen N
authors.initials: KN
authors.lastname: McMillan
authors.affiliation: Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Galvan
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Duval-Arnould
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
authors.forename: Kareen
authors.initials: K
authors.lastname: Jones
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA; Perdana University Graduate School of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Shilkofski
authors.affiliation: Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Rodgers
authors.affiliation: Penn State Hershey Medical Center Department of Anesthesiology, Hershey, Pennsylvania, USA; Penn State University College of Medicine, Hershey, Pennsylvania, USA; Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA; Penn State Hershey Medical Center Department of Neurosurgery, Hershey, Pennsylvania, USA. Electronic address: esinz@psu.edu.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Sinz
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D014705:Verbal Behavior
keywords: ACLS; Action-linked phrases; BLS; CPR training; Education; Response time