title: Does real-time objective feedback and competition improve performance and quality in manikin CPR training--a prospective observational study from several European EMS.
abstract: BACKGROUND
  Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train.
  
  
  METHODS
  Ten European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p < 0.05.
  
  
  RESULTS
  Overall mean Improvement of CPR performance from Stage 1 to Stage 2 was significant. The improvement was greater for the infant assessment. The participants thought the real-time feedback very useful (mean score of 8.5) and very easy to use (mean score of 8.2). Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0.
  
  
  CONCLUSIONS
  The results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.
authors.affiliation: Research Consultant for South East Coast Ambulance NHS Trust (SECAmb), Banstead, UK. jonathanrsmart@outlook.com.
authors.forename: J R
authors.initials: JR
authors.lastname: Smart
authors.affiliation: Swiss Institute of Emergency Medicine (SIRMED), Nottwil, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Kranz
authors.affiliation: Sistema Emergencias Mediques (SEM), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Carmona
authors.affiliation: Norwegian Air Ambulance Foundation, Drøbak, Norway.|SAFER (Stavanger Acute medicine Foundation for Education and Research) and Stavanger University Hospital, Stavanger, Norway.
authors.forename: T W
authors.initials: TW
authors.lastname: Lindner
authors.affiliation: South East Coast Ambulance NHS Trust (SECAmb), Banstead, UK.
authors.forename: A
authors.initials: A
authors.lastname: Newton
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004632:Emergency Medical Services; D005060:Europe; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D007223:Infant; D008297:Male; D008348:Manikins; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013997:Time Factors