[Hierarchical first aid training scheme for elementary and middle school students: the practices from the construction of "Baoan Model" social emergency medicine training]

To share the implementation experience of hierarchical first aid training scheme for elementary and middle school students in Baoan District of Shenzhen City and evaluate its effect of training.

During August 2018 and August 2019, elementary and middle schools students who participated in the first aid training held by emergency rescue training center of Baoan District were enrolled. Baseline information including the number of students, the number of attending tutors, the number of cardiopulmonary resuscitation (CPR) training models, automated external defibrillator (AED) models were recorded. According to hierarchical levels of three age, students received different courses with content from simple to hard: the course of elementary school students was consisting of dialing 120, smart animation on how to identify accidental damage, demonstration of AED and Hemlick techniques, CPR practise (40 minutes). The course of junior high school students was consisted of how to dial 120, how to identify accidental damage and simple disposal, application of CPR and AED, practice CPR and AED and Hemlick techniques (90 minutes). The course of high school students was consisted of how to dial 120, identify accidental damage and right disposal, identification of out-of-hospital cardiac arrest, the key-point of CPR and AED, practice CPR and AED, Hemlick techniques and hemostatic bandage (120 minutes). At the end of course, elementary school students were voluntary for skill assessment; junior high school students only were compulsory for skill assessment in small classes but not required in large classes, just for demonstration; additionally, the whole high school students were compulsory for skill assessment. The characteristics of first aid training students at different levels were collected in order to compare the differences on the usage of CPR training model and AED training model, the distribution of emergency resource, the ratio for passing examination.

A total of 12 896 students and 2 086 training instructors took parted in 200 lists of first aid training courses, 8 557 CPR models and 8 493 AED models were used. On average, there are 65.27±5.61 students in each session, and 10.52±10.43 training instructors. There are 43.09±19.06 CPR training models and 42.77±18.61 AED training models. The mean ratio of student to tutor was 6.07±1.47, student to CPR model was 1.54±1.02, and student to AED model was 1.54±1.03. In the end of course, 10 494 students participated in the examination with the participation rate of 81.37%; 10 114 students passed the examination with the passing rate of 96.38%. Hierarchical analysis showed: compare to elementary school students, the average number of junior high school students in every training session significantly increased (cases: 69.94±8.77 vs. 58.69±6.12, P < 0.05), but the average number of high school students in every training session significantly decreased (cases: 57.35±5.79 vs. 58.69±6.12, P < 0.05). The proportion of instructors in junior high school students' training significantly reduced (5.94±1.39 vs. 6.48±2.02, P < 0.05). The examination ratio of junior high school students and high school students was increased significantly [81.07% (6 667/8 224), 100% (2 313/2 313) vs. 64.18% (1 514/2 359), both P < 0.05], but the ratio of passing the examination was significantly reduced [95.47% (6 365/6 667), 96.88% (2 241/2 313) vs. 99.60%(1 508/1 514), both P < 0.01]. This might be related to the low difficulty of elementary school students' assessment and the low proportion of compulsory examination.

Hierarchical scheme is feasible for first aid training in elementary and middle school students, the content of course should be desighed from easy to hard. Synchronously, sufficient training instructors and training models should be equipped to ensure the quality.