How would you like CPR to be taught?

In the last paragraph of our first reading by Ellen Langer she brings up a scenario where a friend’s seven year old daughter needs CPR after an accident in the pool. She poses the question about whether we would want our training to have been conditionally rather than “mindlessly sequential” and then asked how should we teach CPR? I’m having trouble answering her questions.

Without a doubt, I think the mindful learning as a whole is a great concept. The example she provided about the musicians that were taught “mindfully” performing better and enjoying their practice shows how tasks that are so traditionally rooted in memorization (oh god all those scales… up and down up and down…. now D minor…. up and down) and repetition don’t necessarily have to rely on those two factors.

But, in the case of CPR I think it gets a little muddled. While I’ve never had to perform CPR and hope that I never will, it’s a high stress situation. You essentially have a corpse in front of you, and CPR alone is not going to revive them. Perhaps you’re the only trained person in the vicinity so it’s on you to act as their heart until medical help can arrive. Every step can potentially make a large difference in whether they are able to be revived and also in the quality of life if they are revived.   Would small “mindlessly sequential” methodical steps taught absolutely work in this situation? I think so. I think that could help a person work through the stress. There’s a reason they include easy to recall acronyms-ABC airway-breathing-compression.

Now maybe that’s the wrong way to look at it. Maybe Langer is saying that there should be a mindful component to CPR training. She specifies that the young girl is much smaller than your average adult at only 50 lbs. So the mindful component would focus on how hard one would have to push to achieve the proper compression. Maybe there is a mindful addition to the ‘assess the scene’ component. A restaurant is  a very different location than a crosswalk. These I will agree should be taught in the CPR class, but I don’t think that they take the place of the small mindless methodical steps.

Maybe a sort of hybrid style would work better in this situation. One that teaches the sequential steps that must be met, but expands upon those steps as well.

 

3 Replies to “How would you like CPR to be taught?”

  1. I agree with you that this becomes murky water when mere memorization of material will suffice to get a point across. When it comes to something like CPR or a life saving skill, I would think you’d want to just simply memorize the procedure rather than “think outside the box” of the implications of doing CPR or trying to immerse yourself with the learning experience. I’m certain the person who needed CPR would thank you for approaching it that way. Though you do bring up a good point with assessing a scene to determine some outside factors that may affect your decision making. Certainly a text book can’t teach you every nuance but can rather give guidance than specific answers.

  2. Thank you for your post Jonathan. You are posing some important questions and I am glad you brought up the life and death scenario (sort of). I like that you thought enough about it to see that a hybrid could be an option…your post reminds me of the show House…he is depicted as doing things pretty “outside the box” and because it is a TV show, it works of course…the important thing however, is the underlining message that sometimes the automation may not work…and if there are other factors then who is responsible for noticing those?! In my field we triage clients all the time and it takes some imagination and creativity to know that when you let someone walk out the door that you will not hear about them in the newspaper the next day. Now done mindlessly, the difference may be losing someone you care about as a counselor because even though they answer the questions one asks in the way they need to be, what else in the picture needs to be considered that could be missed?!…done mindfully, even though there is no perfect science to it…you know that you will see them next week…the trick is to create that hybrid

  3. I agree with you 100%, MHJON88. CPR is no place for “creativity”.

    I had serious doubts as to the medical competency of the author when reading the passage to which you refer. They seem to have missed a *basic* concept from CPR training.

    The current algorithm for CPR requires the responder to gauge the length/force of the compression stroke as a fraction of the patient’s chest depth — it works despite the patient being a child (skinny or overweight). The main two questions in the scenario that the author proposed that might allow for some flexibility with the basic CPR algorithm would be:

    1) Was the arrest witnessed? and…
    2) despite the incident being pool-adjacent, what was the suspected cause of the arrest?

    If the author knew and understood the “basics” of CPR, they wouldn’t be making such outlandish claims about how to perform it.

    “Creative” alternatives to the standard CPR algorithm exist ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741663/ ) but their use is better left to experinced professionals with the correct training and proper authorization.

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