For my American friends - happy Fourth of July eve, and for those of you who happen to be neighbors in the north, I hope you had a relatively wildfire-free Canada Day!
With the holiday giving a lot of people a four-day weekend, I thought I'd keep this one brief, so many can enjoy the day. I wanted to touch on drills. If you have been following this newsletter for a while, way back in May I introduced a core theme, Self Determination Theory, which hypothesizes that that extrinsic motivation is most effective when three main elements (autonomy, competence, and relatedness) are satisfied. Give it a read if you need a refresh, but in subsequent articles for a bit I really focused on relatability as an oft-overlooked part of CPR advocacy and training.
Today's article shifts focus a bit onto the idea of competence. We've known for a while that low-dose, high frequency training of a wide variety of topics produces better results, especially in the healthcare world. Many of us have adopted this into our own practices to make sure competence stays high. However, resuscitation is our business, so regular training has a direct impact on what our core mission is in healthcare. Inspiring this mentality among other, non-healthcare fields is a task that has been met with varied success.
I do want to acknowledge, however, that safety is often antagonized by fatigue, and poorly designed drills can actually have a negative impact on overall safety. I vividly remember touring a college (that won't be named) that talked about how, when the fire alarm was pulled, it meant they'd go into their dorms and go grab party supplies to have fun outside while the fire department responded. Every firefighter has a "no crap" story about how an automatic "smells-and-bells" call turned into some multi-alarm event that caught them unprepared. Even lockdown drills for active shooters have questionable success rates. 
For low dose/high frequency drills in safety, one of the ways to combat this fatigue is through the use of measurements. Yes, "measure & improve" is important here as well. It's great to have a fire drill, but it's even better to report to your crews that "the building was evacuated in X seconds and all people accounted for in Y minutes." Maybe, if a desired improvement was noted during drills, you then rewarded college students with a party there would be less risk of a student re-entering a hazardous dorm.
Measurements for a Cardiac arrest drill are simple and improvable.
- Time to recognition someone is in arrest and start of compressions
- Time to AED arrival
- Compression rate/ratio
Measuring and reporting the results from drills at random times, with different people performing different roles, can build an SCA-resilient environment.
Some programs already encourage drills as part of accreditation. Project Adam and HeartSafe Communities are two off the top of my head that encourage regular practice of a Cardiac Emergency Response Plan. I know several discussions have taken place about increasing the frequency of athletic drills at schools-the NCAA published a "3-Minute Drill" specifically encouraging this.
For maximum effectiveness, drills need to take place as part of a course of normal business/operations/run of play, but are usually best proceeded and followed up with education. For example, at the start of a sports camp, a trainer explains how to respond if a teammate goes down and there is a chance of sudden cardiac arrest. They explain signs, symptoms, and teach how to start CPR.
Then, an athlete is pulled aside and told to be the victim during a scrimmage. The trainer measures recognition time, CPR times and performance (swapping out a dummy), and AED arrival times. Then at the end of a session the performance is shared with the team, an open dialogue is encouraged on how to improve or to address any questions, and the team is told "this could happen again at any time."
Just think of many lives could be saved by this drill being taught at 20% more schools this year.
We'll continue exploring the idea of competence in the weeks to come, for now, especially for my American friends, have a safe and happy holiday (and don't be the one who loses any fingers this Fourth of July!)