Mandating CPR Training

Student

Herzing University

Mandating CPR Training

In 2013 there were 325,257 out-of-hospital cardiac arrest deaths in the United States (Go, et al., 2012, p. e 169). Many of these deaths could have been prevented if someone close by knew what to do to help save these people. In order to preserve life we must implement a mandated Cardio Pulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) education for all able body adults who possess a driver’s license so we may increase the chances of survival for out-of-hospital cardiac arrest.

The out-of-hospital cardiac arrest survival rate for adults is 9.5% (Go, et al., 2012, p. e169). The heart going into a lethal rhythm Ventricular Fibrillation (v-fib) or Ventricular Tachycardia (VT) is when the ventricles of the heart just quiver and cannot pump blood, which causes sudden cardiac arrest. Of all the out-of-hospitals cardiac arrests 40.1% had bystander CPR initiated (Go, et al., 2012, p. e169). In-hospital cardiac arrest the survival rates jump to 23.9% (Go, et al., 2012, p. e221). This can be attributed to all hospital personnel having taken CPR and continued with biannual re-education. In other words, CPR saves lives.

CPR Needs and Education

With the current out-of-hospital survival rates being so low, there needs to be a mandated CPR education program that is linked to a driver’s license. The American Heart Association has a Family and Friends CPR course that teaches CPR and AED use on adults and children. The public could take this course at a local hospital, fire station, and police station or the public could hire a private instructor to come out to their homes for instruction. This needs to be coupled with a biannual refresher course to keep skills sharp (American Heart Association, n.d). If more people were required to know CPR, many lives would be saved.

In Denmark, authorities have rolled out an education program for the country’s children in which they teach CPR and allow the children to take the course material home to show their family and friends to teach them how to perform CPR hands only (Laerdal, n.d. para. 4). Denmark has also moved to make CPR education mandatory to receive a driver’s license (Rice, 2013, para. 2). Mandating that new drivers be require to obtain CPR training would be a good starting point here in the United States because Denmark has seen positive results from their increased CRP certification.

Denmark’s initiative to increase CPR education was started in 2005 and resulted in an increase of bystander CPR from 21.1% to 44.9% in only 5 years (Journal of the American Medical Association, 2013, para. 5). From 2001 to 2010, Denmark also saw a 13.9% increase in hospital survival (Journal of the American Medical Association, 2013, para. 6). This increased cardiac arrest survival rate of in-hospital survival could be attributed to an increase of bystander CPR on out-of-hospital cardiac arrest patients if victims of cardiac arrest received care before admission to the hospital. Denmark’s one-year survival rate after out-of-hospital cardiac arrest prior to their CPR education program was 2.9%, but after the CPR education initiative, their one-year survival rate went up to 10.2% (Journal of the American Medical Association, 2013, para. 6). During the 9-year study in Denmark, AED use on out of hospital cardiac arrest victims rose from 1.1% to 2.2% (Journal of the American Medical Association, 2013, para. 5). If the United States were to implement a similar program such as Denmark’s, the United States should expect to see a similar rise in cardiac arrest survival rates.

The idea of mandated CPR training is controversial, but public will can be swayed toward the cause by several incentives. To encourage people to act and help their fellow man, the government should create a positive reinforcement strategy. For example, for rendering aid, a police officer will issue a coupon for a discount on a citizen’s vehicle registration cost and put his or her name on a Good Samaritan web site. There could be a law put into place that if a person stops and renders aid, that his or her employer cannot take disciplinary action towards the Good Samaritan who was late to work.

AED Statistics and Deployment

The use of an AED coupled with the implementation of CPR is an essential part of cardiac resuscitation, and mandating AED training along with CRP training as well as increasing the number of available defibrillators would save lives. About 40% of out-of-hospital cardiac arrest is caused by the victims going into VT or V-fib (American Heart Association, 2008, pp. IV-19). The American Heart Association recommends AED deployment as soon as it can be confirmed that a victim is unresponsive (American Heart Association, 2011, p. 51). The quicker an AED can be deployed, the greater chance of survival for the victim. For every one minute that a victim goes without being defibrillated and without CPR, their chance of survival decreases 7% to10%, while CPR being performed will bring that rate down to 3% to 4% (American Heart Association, 2008, pp. IV-19). With an AED not immediately available, CPR alone has been shown to improve of the chance of survival rate, but not as much. There is a need for deployment and use of an AED as soon as possible when a person collapses to improve chance of survival even more.

The general public needs more awareness and AED training, and there needs to be an increase in AED availability. The best chance of survival is when an AED is deployed and delivers a shock in the first 3-5 minutes of cardiac arrest (American Heart Association, 2008, pp. IV-27). To meet that time range, there must be an ease of access to these vital machines. Some states have already enacted some AED requirements. Rhode Island and District of Columbia require health clubs to have at least one AED on site (National Conference of State Legislatures, 2013). However, the majority of states have not enacted such laws. In addition to required AED education, we must create a program that will encourage the general public to purchase and maintain AEDs. Local governments and healthcare institutions can help increase the number of AEDs available. Every town would benefit from creating a list of people who are willing to purchase an AED, and then the town can get a bulk discount from an AED manufacturer. In addition to the discounted price, as long as the owner keeps the AED in their vehicle and in operational condition in accordance with manufacturer guidelines, the town could provide the owner with a tax break. Additional incentives could further encourage people to have and use AEDs. For example, if an AED is deployed to help a cardiac arrest victim, the owner of the AED could be given a voucher for a gift card and have the AED supplies replaced free of charge. By mandating AED training when a citizen receives a driver’s license and providing incentives to increase AED availability, death rates from cardiac arrest would significantly decrease.

Resistance to Mandatory CPR Training

Some people may say that you cannot force them to get CPR training to get their driver’s license. They may say it violates their constitutional right as an American citizen. Yet, nowhere in the bill of rights or constitution does it guarantee you the right to drive. According to the California Department of Motor Vehicles website, “Having a driver’s license is a privilege, not a right” (Driving Responsibilities, n.d, p. 1).

People may also worry that they will be sued for providing aid to others. For example, there was a lawsuit in California involving a Good Samaritan. In this case, a passenger in a car was worried because the car was filled with smoke and that the car might be one fire, so she pulled her friend out of the car and in doing so paralyzed her. The Good Samaritan in this case was sued and not covered by the Good Samaritan laws in California (Donaldson James, 2008). However, the Good Samaritan in this case had drugs and alcohol in her system, and would otherwise likely have been exonerated (Bennett, 2009, para. 6). Under current laws, a Good Samaritan that renders aid while sober will not be held accountable for any injuries that may come to the victim.

Conclusion

For the preservation of human life, we must as a society come together and mandate CPR training for the masses and a greater availability of AED to the general public. The current survival for out-of-hospital cardiac arrest rates leaves us with plenty of room for improvement. If we look to Denmark as starting point, we can save many more lives and improve on their already impressive success. We must not be stagnant in trying to improve our community. The next life that might be saved could be your own.

References

American Heart Association. (2011). Advanced cardiovascular life support: Provider manual. Dallas, Texas: American Heart Association. American Heart Association. (2008, November 8). Circulation AHA. Retrieved from http://circ.ahajournals.org/content/112/24_suppl/IV-19.full.pdf+html American Heart Association. (n.d). CPR learn more. Retrieved from www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/LearnMore/Learn-More_UCM_440810_FAQ.jsp Bennett, L. (2009, January). Good samaritan immunity limited to medical assistance. Retrieved from www.emsworld.com/article/10320650/good-samaritan-immunity-limited-to-medical-assistance California Department of Motor Vehicle. (n.d). Driving responsibilities. Retrieved from www.dmv.ca.gov/pubs/curriculum/Unit%201.pdf Donaldson James, S. (2008, December 19). Woman sued for rescue effort in car crash. Retrieved from ABC News: http://abcnews.go.com/TheLaw/story?id=6498405&page=1 Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B., et al. (2012, December 12). Heart disease and stroke statistics- 2013 update: A report from the American Heart Association. Retrieved from American Heart Association: http://circ.ahajournals.org/content/early/2012/12/12/CIR.0b013e31828124ad.full.pdf Journal of the american medical association. (2013, October 1). For the media. Retrieved from media.jamanetwork.com/news-item/study-finds-increase-survival-following-bystander-cpr-hospital-cardiac-arrest/ Laerdal. (n.d). Disseminating CPR training in the population. Retrieved from www.laerdal.com/us/UserStories/43258467/Disseminating-CPR-training-in-the-population National Conference of State Legislatures. (2013, January). State laws on cardiac arrest & defibrillators. Retrieved from National Conference of State Legislatures: http://www.ncsl.org/research/health/laws-on-cardiac-arrest-and-defibrillators-aeds.aspx Rice, K. (2013, October 4). Denmark’s CPR Success Story. Retrieved from Health and Safety Institute: http://www.hsi.com/Blog/bid/102360/Denmark-s-CPR-Success-Story

Rear Facing Car Seats

In April of 2014, I made a Facebook post saying I was excited my son was turning one, and it was time to flip his car seat around to forward facing. About thirty minutes later I got a message from a friend with a link attached. I rolled my eyes because I hate when people tell me how to parent. However, when I opened the link, I learned something new. I learned what a huge risk it was to switch my son’s car seat around so soon and those children who remain rear-facing until at least two years old have a greater chance of survival than those who are forward facing. Laws change, and research is updated all the time. It is hard for parents to keep up with all the new recommendations, but it's critical that we do. To protect children, parents should keep them rear-facing in car seats until age two or until the child exceeds the height or weight limit of the seat.

History of the Car Seat

Car seats have been around since the 1930’s, and over the years they have improved tremendously. The first car seat appeared almost eighty years ago when safety was not the focus; it was made to keep children contained in moving vehicles and allow them to see out the windows (Babble, 2011, para. 2). According to Babble (2011), “In the 1960’s an impact protection car seat was finally designed, but due to a lack of information on the subject, the general public did not embrace the notion of children’s car seats for safety" (para. 2). The 1960's marked the beginning of using car seats to keep children safe, but it was not until the 1970’s that the government put regulations into place. According to Smith (2015), "The very first standard was set in 1971 by the National Highway Traffic Safety Administration, which required all seats be held by safety belts and include a harness to keep the child in the seat, though, no crash testing was required. By 1985 the first laws requiring children under a certain age to be properly restrained was passed" (pg. 7). Today, car seats have strict regulations. Over the years, researchers keep finding ways to improve children's safety while traveling in vehicles. Looking at where child safety started, it is safe to say car seats have come a long way and recommendations and safety measures continue to improve. The latest research recommends parents keep children rear facing for as long as possible.

Outdated Recommendations

Once car seats were mandated, each year car seat companies made new adjustments and discovered something safer. The experts used to suggest keeping children rear facing until one-year-old or twenty pounds. Many people still follow these guidelines and seem to be unaware of a new standard. According to Consumer Report News (2012), “The latest guidance from the American Academy of Pediatrics and the National Highway Traffic Safety Administration (NHTSA) recommends that children should remain rear-facing up until they reach the age of two or when they reach the height or weight limits of a rear-facing seat" (para. 3). In most states switching a child's car seat to forward facing at one-year-old is not breaking any state laws because it takes legislation time to catch up with new recommendations. Although laws do not require keeping a child rear facing until two years old, the industry has clearly indicated that it is safest.

Many parents celebrate milestones for their babies. For example, parents celebrate sitting up, crawling, first words, and walking. Switching children’s car seats from rear facing to forward facing should not be rushed or considered a milestone. According to Consumer Reports’ program manager for vehicle and child safety, “It can be tempting to 'graduate' your child to the next level of restraint or the front seat as often that change is more convenient, but when parents better understand the increased risk for injury or worse, they are more likely to delay for the safety of their children" (Consumer Reports Auto Test Center, 2012, para. 9). I thought it was a milestone before a friend corrected me and showed me why I should not rush this process.

Children Under Two Are Safer when Rear Facing

Riding rear facing is the safest way to travel, especially for children under two. Car crashes are the number one killer of children in the United States. Researchers have proven children have a greater chance of survival during an accident when they are rear facing. Infants under the age of one simply do not have the back and neck strength to travel facing forward. In the rear-facing position, the force of a crash or sudden stop is spread across the child’s body, and absorbed into the back of the car seat. According to the American Academy of Pediatrics (2009), “Forward-facing children are more likely to be injured because of the force of the crash is concentrated on seat belt contact points, and younger children’s heads are disproportionally large for their small, weak necks” (para. 4). Young children are safer while in car seats that are rear facing because the car seat does a better job at supporting their head and immature neck and spine. According to Watson and Monteiron (2009), “The relatively large head mass and differences in the anatomy of the cervical spine in young children can lead to excessive stretching or even transection of the spinal cord if a child is involved in a frontal (head-on) crash while in a forward facing car seat. The younger the child, the lower the crash force required to cause spinal injury” (para. 3). The older a child is the more time their spinal column has to strengthen. Therefore, to help prevent severe damage to a child's spine or even death, children should remain rear facing in the car until they are two or have reached the maximum weight or height limit for the car seat. Knowing a child is safer makes it worth the wait to make the big switch.

Holly Wagner, a mother in Louisiana, shared a heartbreaking story and pleaded with everyone to keep their children rear facing. Wagner lost her eleven-month-old son, Cameron, in a tragic car accident. Cameron was thrown from his forward-facing car seat in the crash and died sixteen days after being in intensive care. Wagner said, “If he had been kept rear facing and was buckled in, he would have survived" (Donaldson James, 2014, para. 11). Wagner now has a Facebook page called Cameron’s Story is Saving Lives and a YouTube channel educating parents about the importance of car seat safety and how to properly use and install car seats in Cameron’s honor. Although Cameron may not be here physically, his story lives on and is helping parents everywhere realize how critical it is to keep children rear-facing past one. Awareness

Parents need to become aware of the risks switching a car seat too early brings. There is ample evidence proving a child has a higher chance of surviving a crash while rear facing. It can be deadly switching a child to a forward facing seat before the child’s body and spine are ready. Parents need to know this. I never heard of the new studies regarding changing car seats; I had always assumed since the law required children to be rear facing until one years old that it was safe. It can be uncomfortable having to correct parents because nobody wants to be told how to raise their children. I know I was annoyed when my friend messaged me, but I’m thankful I listened to her and did research. Strangers should not have to have the burden of stepping on other people’s toes and telling them that their car seats are installed wrong. It should be the states’ and doctor’s responsibility to educate parents.

Sadly, out of the fifty states, only four states have updated their car seat laws. According to the Governors Highway Safety Association (2016), “4 states (California, New Jersey, Pennsylvania and Oklahoma) require children younger than two be in a rear-facing child seat.” States need to enforce these laws since they know what the recommendations are now. Having a law in forty-six states allowing parents to switch their child’s car seat around when they turn one is sending a confusing message. Many parents mistake the minimum for the ideal age to make the switch. Knowing all the risks and to keep children safer, laws in all fifty states need to be updated requiring parents to keep children rear facing until they reach their car seat weight limit or are two years of age.

Opposing Views

To some people having a child rear facing until two can sound strange, and people have a lot of questions. For example, some worry that their kids’ legs will be too cramped in a rear facing seat. Busting the myth about leg room is pretty simple. Kids are flexible because their joints are not entirely formed, so even though we cannot imagine working our grown-up bodies into that position, the kids are comfortable.

Parents also worry about leg injuries. However, studies show that forward facing children face more leg injuries. According to the Department of Pediatrics at the University of Washington, "Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them” (Bennett, Kaufman, Schiff, Mock, & Quan, 2006, para. 15). While kids in rear facing seats may have leg injuries in serious accidents, they are usually less severe because the forward facing children’s legs get rammed into the seat in front of them while the children rear facing legs usually scrunch up.

For parents who are still not convinced about the leg room, Graco has an excellent car set that is recommended by the The American Academy of Pediatrics. It is called Graco Extend2Fit, and it provides 5" additional legroom and seats a child up to 50 lb. to ride rear facing, allowing children to be comfortable and safe in the rear facing position longer. These car seats can be found at Target. Babies R Us, and any other major store that sells baby items.

Conclusion

In conclusion, keeping children rear-facing until at least two years old is critical. Hopefully, with all the research proving the importance of waiting to switch over to forward facing new laws will be enforced. The minimum requirements of the fifty-six states are not the safest; we need to be proactive and ride our kids to the max limits of their seats. It can be the difference between surviving a crash or not.

References

Bennett, T. D., Kaufman, R., Schiff, M., Mock, C., & Quaun, L. (2006, September). Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16966993

Evarts, E. (2012, August 7). Study shows too many kids graduate early to inappropriate car seats. Retrieved from http://www.consumerreports.org/cro/news/2012/08/study-shows-too-many-kids-graduate-early-to-inappropriate-car-seats/index.htm

Governor Highway Safety Association. (2016). Retrieved from http://www.ghsa.org/html/stateinfo/laws/childsafety_laws.html

James, S. D. (2014, December 9). 'Car seat cop' mom wants to save your child's life – TODAY.com. Retrieved from http://www.today.com/parents/car-seat-cop-mom-wants-save-your-childs-life-1D80345801

Jordan, M. E. (2011). History of the Car Seat. Retrieved from https://www.babble.com/baby/history-of-the-car-seat/#the-1940s

O'Keefe, L. (2009, April). New Advice; Rear-facing carseats safer for children until they are 2. The official Newsmagazine of the American Academy of Pediactrics, 30(4). Retrieved from http://www.aapanews.org

Smith, L. (2015, October 21). History of Car Seats – The Evolution of the Car Seat. Retrieved from http://www.goodhousekeeping.com/life/parenting/g2870/car-seat-history/

Watson, E. A., & Monteiro, M. J. (2009). Advice use of rear facing child car seats for children under 4 years old. British Medical Journal, 338. Retrieved from http://dx.doi.org/10.1136/bmj.b1994

Welfare

Student

Herzing University

Welfare

In August of 2012 my wife and I were applying for state help because we were about to have our first daughter. We knew that we were going to need some financial assistance when Madison was born because my wife, Megan, and I didn’t make a lot of money, and we were worried about being able to take care of our daughter. We decided to go through the long process of applying for state aid, also known as welfare. At the time, I was working as a computer sale lead at Best Buy and my wife Megan worked as an office administrator. We both made less than $12 an hour. We were having trouble paying the bills we did have let alone making sure we could provide for our soon to be daughter.

A few weeks later, we got a letter from the state saying that we did not qualify for welfare because we make too much money. The letter we that we received from the state informed us that we were $300 over the poverty line and therefore could not receive state aid. In September our daughter was born, and we were barely hanging on. Things only got worse. Megan lost her job, so once again we turned to the state for some help, but once again we were denied because I was receiving money from the VA for being a full time college student. Now, I am still working full time and going to school full time to try and make it by living pay check to pay check with no end in sight. My experiences with the welfare process have made me feel that the welfare system is unjust and not helping those that really need it. The welfare system needs to be reformed.

History

During the great depression there were many Americans that were losing their homes, living out on the streets, and having trouble finding work. With all of this happening, the United States government decided to step in and help those in need: “President Franklin D. Roosevelt focused mainly on creating jobs for the masses of unemployed workers; he also backed the idea of federal aid for poor children and other dependent persons. By 1935, a national welfare system had been established for the first time in American history” (Constitutional Rights Foundation, 2013, para. 5). Welfare consists of many different programs, but the three most common ones in Wisconsin are Women, Infants, and Children Program (WIC), Aid to Families with Dependent Children (AFDC), and Temporary Assistance for Needy Families (TANF).

Culture of Dependency

Welfare was developed to help those in need, not to be a life style. This is a statement that we hear a lot these days because of the current number of people on a form of welfare. According to Pavetti (1996), “About 90 percent of those currently on the rolls will eventually spend more than 24 months on the welfare rolls and 76 percent will receive welfare for longer than five years” (para. 7). In 2011, 1.2 million households with children that received food stamps were not bringing in any other income (Lower-Basch, 2013, para. 5). Not only are there a high number of people receiving welfare with no supplemental income, but Pavetti (1996) reports that “the majority of families who leave the welfare system do so after a relatively short period of time — about half leave within a year; 70 percent within two years and almost 90 percent within five years. But many return almost as quickly as they left — about 45 percent return within a year and 70 percent return by the end of five years.” (para. 5). That is almost half of all welfare recipients who will return to some form of welfare. If 70 percent of the families can leave the welfare system within two years why are they going back to welfare so quickly? This is because the welfare system makes it too easy to return to the program and become dependent on the government. The welfare system should do more to encourage people to stay off the program and become financially independent.

Financial Hardships

Who carries the burden of welfare? Where does the money come from to support welfare? The tax payers are the ones who support families and individuals currently on welfare. In 2011, the median household income was right around $50,000; that comes out to right around $137 a day (Pavlich, 2012, para. 1). Pavlich (2012), finds families who live below the poverty line can receive as much as $168 a day in food stamps, housing, childcare, and healthcare benefits. That is higher than what a median family makes in a day. The average taxpayer can’t afford to offer such a high level of financial assistance to others. In 2011, the money spent on welfare programs was 1 trillion dollars, according to The National Review Online. Out of that 1 trillion spent on welfare, 750 billion came from federal and another 250 billion came from state funding (NRO Staff, 2012, para. 1). The average working American is getting charged twice for their contributions to the welfare system.

To make matters worse, the tax system is arranged that not everyone shoulders this financially responsibility equally: “Each year, approximately 143 million federal income tax returns are filed in the United States. Of these, about 58 million have no tax liability after taking deductions and credits, leaving roughly 85 million people to shoulder the nation's entire federal income tax burden. It is these 85 million people who fund the $746 billion federal portion of the nation's total welfare spending. On average, each of them spends $8,776 to keep federal welfare programs afloat” ( The Welfare State’s Cost to American Taxpayers, 2012, para. 3). That means just about every working tax payer pays $8000 or more into a broken system. If a welfare reform were to happen, then maybe tax payers wouldn’t have to lose a good part of their yearly income to a broken system. Maybe the money the taxpayers save on a more strictly regulated, revised welfare program could be filtered back into the economy, creating more jobs for those currently relying on government assistance.

Welfare Abuse

While welfare has helped out many families in need, there have also been individuals who take advantage of and abuse the assistance. A news team out of Tennessee investigated this issue, and their findings were shocking. The news team found that some of welfare recipients were using the money they received to buy booze, concert tickets, and other, nonessential items: "We looked at Memphis in particular and over a three month period we surveyed $140,000 different transactions and found some very interesting expenditures" (WMC-TV, 2012, para. 4). Some of the findings included over $2,000 spent at liquor stores, $120 spent on concert tickets and even $80 spent at Graceland. All of these purchases were made by Electronic Benefit Transfer (EBT) cards. EBT is an electronic system that allows state welfare departments to issue benefits in the form of a debit or credit card. The EBT cards can then be used at many retailers, gas stations and even at ATM machines. This makes it very easy for anyone that is on welfare and has one of these EBT cards to buy the things they need. However, while the EBT method of redeeming welfare benefits makes it easier for the welfare recipient to get the benefits, it also makes it way too difficult for regulators to track whether or not the credit is being used for approved items.

The EBT program should put stricter limits on what it can be used on and should not be allowed to be used as a general debit card or ATM card. Items that should be restricted when using an EBT card or any form of welfare should in