Challenges in basic life support and automated external defibrillator training of deaf individuals

Objectives: Basic life support (BLS) with the use of an automated external defibrillator (AED) is linked to survival of patients with out-of-hospital cardiac arrest (OHCA). However, the BLS protocol is not tailored to specific needs of the deaf who encounter many challenges during BLS training.

Methods: The BLS and AED protocol was modified according to the challenges faced by deaf people. Pre-course BLS and AED knowledge was tested using a questionnaire. After completion of a practical course, each participant was presented with an OHCA scenario using a manikin. Qualitative and quantitative data on BLS and AED performance were collected with a modified Cardiff test and the QCPR mobile application. Results of the knowledge test and performance scores are presented with values and frequencies. Correlations between pre- and post-course BLS and AED knowledge and performance were analyzed and presented with Spearman’s rho.

Results: 51 deaf volunteers from seven Slovenian deaf associations participated in the study. The pre-course knowledge test scores were 3.5 points out of 10 and considered low. The rest of the results were also poor. BLS performance using the modified Cardiff test post-course was as follows: 52.9% of the participants used a safe approach, 58.8% checked responsiveness and 51.0% sent a text message to the rescue service. Only 43.1% opened the airway and 49.0% checked initial breathing. 80.4% of deaf rescuers performed chest compressions on the lower half of the sternum and 52.9% compressed with adequate depth. According to the QCPR application the best performance was achieved with a compression score of 61.1% and flow fraction 74.9%.

Conclusions: This study shows that a comprehensive and assiduous approach is needed for effective BLS and AED training courses for deaf individuals.

Automated external defibrillator; Cardiopulmonary resuscitation; Deafness; Education

[1] Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016; 105: 188-195.

[2] Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015; 95: 81-99.

[3] Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG. European resuscitation council guidelines for resuscitation 2015: section 10. Education and implementation of resuscitation. Resuscitation. 2016; 95: 288-301.

[4] Unnikrishnan R, Babu AS, Rao PT, Aithal V, Krishna HM. Training individuals with speech and hearing impairment in basic life support: a pilot study. Resuscitation. 2017; 117: e23-e24.

[5] Kerber RE, Becker LB, Bourland JD, Cummins RO, Hallstrom AP, Michos MB, et al. Automatic external defibrillators for public access defibrillation: recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety. a statement for health professionals from the American Heart Association Task Force on Automatic External Defibrillation, Subcommittee on AED Safety and Efficacy. Circulation. 1997; 95: 1677-1682.

[6] Sandroni C, Fenici P, Franchi ML, Cavallaro F, Menchinelli C, Antonelli M. Automated external defibrillation by untrained deaf lay rescuers. Resuscitation. 2004; 63: 43-48.

[7] Tomasetti JA, Beck KH, Clearwater HE. An analysis of selected instruc-tional methods on cardiopulmonary resuscitation retention competency of deaf and non-deaf college students. American Annals of the Deaf. 1983; 128: 474-478.

[8] Valli C, Lucas C, Mulrooney K. Linguistic of American sign language. 4 ed. Washington DC: Gallaudet University Press. 2005.

[9] Holt JA. Stanford achievement test-8th edition: reading comprehension subgroup results. American Annals of the Deaf. 1993; 138: 172-175.

[10] Margellos-Anast H, Estarziau M, Kaufman G. Cardiovascular disease knowledge among culturally deaf patients in Chicago. Preventive Medicine. 2006; 42: 235-239.

[11] Pollard RQ, Barnett S. Health-related vocabulary knowledge among deaf adults. Rehabilitation Psychology. 2009; 54: 182-185.

[12] Smith SR, Samar VJ. Dimensions of deaf/hard-of-hearing and hearing adolescents’ health literacy and health knowledge. Journal of Health Communication. 2016; 21: 141-154.

[13] Smith SR, Kushalnagar P, Hauser PC. Deaf adolescents’ learning of cardiovascular health information: sources and access challenges. Journal of Deaf Studies and Deaf Education. 2016; 20: 408-418.

[14] Borovnik Lesjak V, Šorgo A, Strnad M. Development, validation and assessment of the test on knowledge about basic life support and use of automated external defibrillator among schoolchildren. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019; 27: 114.

[15] Rihtar A. Level of knowledge of basic resuscitation procedures with the use of the automated external defibrillator at lay persons before and after 2- hour education. Maribor: University of Maribor. 2019. (In Slovene).

[16] Bylow H, Karlsson T, Claesson A, Lepp M, Lindqvist J, Herlitz J. Self-learning training versus instructor-led training for basic life support: a cluster randomised trial. Resuscitation. 2019; 139: 122-132.

[17] Müller MP, Poenicke C, Kurth M, Richter T, Koch T, Eisold C, et al. Quality of basic life support when using different commercially available public access defibrillators. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2015; 23: 48.

[18] Beck KH, Tomasetti JA. A national survey of cardiopulmonary resus-citation training for the deaf. American Annals of the Deaf. 1983; 128: 909-912.

[19] Bavelier D, Tomann A, Hutton C, Mitchell T, Corina D, Liu G, et al. Visual attention to the periphery is enhanced in congenitally deaf individuals. The Journal of Neuroscience. 2000; 20: RC93.

[20] Dye MW, Hauser PC, Bavelier D. Is visual selective attention in deaf individuals enhanced or deficient? The case of the useful field of view. PLoS ONE. 2009; 4: e5640.

[21] Dye MWG, Baril DE, Bavelier D. Which aspects of visual attention are changed by deafness? The case of the attentional network test. Neuropsychologia. 2007; 45: 1801-1811.

[22] Dye MWG, Hauser PC. Sustained attention, selective attention and cognitive control in deaf and hearing children. Hearing Research. 2014; 309: 94-102.

[23] Horn DL, Davis RAO, Pisoni DB, Miyamoto RT. Development of visual attention skills in prelingually deaf children who use cochlear implants. Ear and Hearing. 2005; 26: 389-408.