First aid & CPR training for disasters

by Steve Donelan, Wilderness Emergency Care

History of first aid courses

Before the development of Emergency Medical Services (EMS) in the 1970s, first aid courses were comprehensive and included many practical skills. EMS is based on two concepts: that bringing medical care rapidly to the scene of emergencies will save more lives than merely transporting victims to hospitals; and that people can be professionally trained to do urgent medical procedures without going through medical school. As standards of training for Emergency Medical Technicians improved, and EMS systems became universal, first aid courses shrank because of the assumption that ambulances would bring trained professionals to the scene within 10 minutes. So Basic First Aid courses are now only a few hours long, and include almost no skills. Instead, they use video and discussion to teach people to recognize emergencies and support patients until an ambulance arrives.

Disaster preparation & wilderness first aid

In a major disaster, hospitals will be overwhelmed and the EMS system, as well as other services, may not be working. So first-aiders are likely to be on their own, and will need to improvise with whatever they have on hand. Wilderness first aid courses are now the only ones that train people to do emergency care in such situations. I teach many wilderness emergency care courses in the Bay Area, including Basic WFA (8 hours), WFA (16 hours) and Wilderness First Responder (80 hours). They are all described on my website (above).

CPR training

Most CPR classes are ineffective, and most people supposedly trained in CPR (including medical professionals) cannot do it well enough to make a difference in patient survival. This has been documented by many studies published in medical and EMS journals over the last 25 years. CPR instructors typically do not follow the course plan, waste class time with long lectures and war stories, allow too little time for skills practice, and fail to correct errors. Moreover, there were problems with the design and content of the old CPR courses. The new CPR guidelines and standards (published 2005) are revised and simplified based on the latest evidence of what works and what doesn’t. However, not all CPR course providers have revised their course plans to help instructors teach the skills more effectively.

Which CPR courses are the best?

CPR courses have been video-driven for many years. The videos show realistic scenarios, and how the techniques work, then provide demonstrations of specific skills. In the past, course plans called for students to watch each skill demonstrated on video, then practice it while instructors gave corrective feedback. However, many instructors would skip video sections or show large parts of it without pausing, then give live demonstrations of each skill before students practiced.

The American Heart Association (AHA) has completely redesigned its CPR courses, so that students practice the skills on the manikins while watching the video. Their other innovation is to break down the complex CPR skills into components (e.g., chest compressions) and have students practice each component before putting them all together. This technique, called whole-part-whole, has been used for many years to teach complex physical skills, especially in athletics, and it makes CPR training much more effective. The new AHA course plan also makes it hard for instructors to waste class time with long lectures or war stories. As a result, their Heartsaver CPR is 3 hours, and BLS for Healthcare Providers (professional level) 4 hours. American Red Cross CPR courses are twice as long and less effective.

Best place to take AHA CPR courses: San Francisco Paramedic Association, 657 Mission Street, Suite 302, San Francisco, CA 94105 (a few blocks from the Montgomery St. BART station; see map). Tel. (415) 543-1161

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