PROJECT PROPOSAL

Project Title- High Performance Cardiopulmonary

Resuscitation(CPR) Educational Module
Sponsoring Organization
Thetford Volunteer Fire Department, Inc
The Thetford Volunteer Fire Department, Inc was established in 1960 for the sole purpose of
providing fire protection to the Town of Thetford Vermont. In 1970, their mission was expanded
to include Emergency Medical Services and Rescue Operations. Today, the department is made
up of 25 volunteers, many of whom are certified Vermont Firefighters and Emergency Medical
Technicians (EMTs).

Project Description
Cardiovascular disease is the single greatest cause of death in the United States. Each year
upwards of a quarter of a million persons receive attempted resuscitation from cardiac arrest
from EMTs. The prognosis for the majority of these arrests remains poor. High performance
CPR is a method that increases survival from cardiac arrest. When CPR is performed to these
guidelines, scientific studies have shown the chances of resuscitation increase substantially.
Based on these goals training will be provided to include the following:
Minimal breaks in compressions
Proper perfusion of cardiac muscle prior to defibrillation
Full chest recoil to maintain appropriate perfusion to the coronary arteries
Proper ventilations to maintain appropriate intrathoracic pressure

Aim
Provide high performance CPR to all patients in cardiac arrest and increase potential for
spontaneous return of circulation.

Target Audience
The target audience will be the firefighters and EMTs who are active members of the Thetford
Volunteer Fire Department. This will include those already trained in standard cardiopulmonary
resuscitation (CPR) as well as new volunteers needing training.

Delivery Options
The instruction for this project will be delivered in a blended format. There is a need for students
to work through educational modules related to the theory behind the psychomotor skills. This
work can be completed in an online format with the students participating in an asynchronous
manner. In order to complete the training, there is a psychomotor element to this education that
is completed in a group setting utilizing the skills presented in the online format. In order to
perform this life-saving skill well, students need to understand what is happening in the body of
the patient when performing the skill as well as how to perform the skill. Hands on practice is
critical to the skill being performed the right way when needed as muscle memory will be critical
to success. The outcomes will be measure both by a written and psychomotor exam

FRONT-END ANALYSIS: INSTRUCTIONAL NEED

Instructional Need
As noted in the project description, cardiovascular disease is the single
greatest cause of death in the United States. Management of cardiac arrest
in the pre-hospital setting has been largely unchanged over the last 5 years.
Standard Cardiopulmonary Resuscitation is guided by the research
conducted by the American Heart Association. Every 4-5 years, the
guidelines are reviewed and adjusted based on both survival rates for prehospital and in-hospital CPR. While the AHA guidelines evidence-based,
additional research has shown that increasing the number of chest
compressions prior to defibrillation with no interruptions for positive-pressure
ventilations improves the rate of spontaneous return of circulation (ROSC).
High-performance CPR is being used in various areas across the US including
cities such as Miami, Phoenix and New York. These cities have large career
fire departments and rescue services and the ability to provide significant
data for these studies based on patient volumes. It is based on their
experiences and the data provided, that this format is now being reviewed in
other areas of the US including Vermont.
While Thetford does not have a significant number of cardiac arrest
emergencies each year, the number they do have has a low rate of ROSC.
This was determined through evaluating the last several years of emergency
call data and outcomes of patients. In an effort to improve upon this rate
and provide exceptional care in a rural setting, the Thetford Volunteer Fire
Department is adopting the High-performance CPR methods.
In adopting these methods, a simple policy change is not enough. This type
of change requires both didactic and practical training for all personnel. The
skills taught are slightly different and have a different sequence than
previous training programs. For the purposes of staff development as well as
expansion of services, the training is needed. Creating various training
opportunities for staff to work through the didactic program as well as
opportunities to practice through simulation is important for this training to
create practice change. In evaluating this program, the leadership of the
department will add a data field to all Quality Assurance reviews so that all
cardiac arrest calls are reviewed and evaluated for use of the new training,
outcomes of the patients, and evaluation by the Medical Director.

FRONT-END ANALYSIS: LEARNER CHARACTERISTICS

Learner Analysis
Primary Audience
Active EMTs within the Thetford Volunteer Fire Department
Active Firefighters within the Thetford Volunteer Fire Department
Secondary Audience
EMTs within EMS Training District 9 (Thetford Fire Department is a
part of this district)
General Learner Characteristics (Primary Audience)
All learners are volunteers
Ages of learners range between 21 and 62
2/3 of the learners have EMT training
Learners are generally well educated with good reading and
cognitive skills
1/2 of the learners have advanced degrees
All learners have received prior CPR training
Learners need flexibility in training (ability to stop and start due to
other responsibilities)
Learners need time to be planned efficiently
Entry Characteristics
Basic knowledge of CPR techniques
Knowledge of emergency medical equipment that is available
through the Fire Department
Basic computer skills accessing the web, point and click activities
Some learners have attitude of why change the training from what
is working
All have trained in basic techniques, only 15% have used the skills
on a patient

Contextual Analysis
Orienting Context
Learners have the following goals in participating in this education
module: stay in compliance with workplace requirements for training,
provide excellent, high performance care to patients, learn a new way
of providing care that is evidence based.
Learners perceive this new training with high utility based on the
potential for better patient outcomes and the use of limited personnel
in the field.

Learners are accountable to participate in the training due to changing

regulations at the workplace as well as proven better patient
outcomes.

Instructional Context
Training will be scheduled on existing training dates so as to not add
burden to volunteer schedules
Typical classroom setting with overhead lighting on dimmers. Blinds
are on all windows to allow for room darkening when utilizing projected
materials.
Practical portion of training is distracting due to noise and will need to
be in breakout room. No other mechanical noises are noted in this
space that could create a problem.
Lecture style and round table discussion style depending on portion of
training. All tables and chairs are available in the scheduled training
room. Tables can be moved as needed.
Training will be scheduled in Fire Department training room. All
primary learners live within a 10-mile radius and overnight
accommodations are not necessary.
CPR manikins, AED trainers, Bag Valve masks, simulated drugs, EZ-IO
trainer and bones, computer, LCD projector, metronome are all
available at the Fire Department.

Transfer Context
Transferability is high in this case. Skills can be adapted for use with
patients and transferred to new employees through regular training.
Opportunities for using new learning include: through monthly training
exercises, on emergency calls with patients, and through teaching
other area departments the new skills.
The leadership of the Fire Department is in favor of this new training
and has provided all materials necessary to complete the training and
operate efficiently with actual patients.

INSTRUCTIONAL IMPACT BASED UPON LEARNER

CHARACTERISTICS
Application of Learning Theories
The target audience in this setting is an adult population. As such,
consideration for past experiences will be important in the construction of
this training. Case based learning examples will be utilized for both the
didactic and practical portions of the training. The didactic portion of the
training will be a mix of both in person training as well as asynchronous, selfdirected training. This will allow for some autonomy for the learners as well
as demonstrate respect for their schedules and time.
Resources and research demonstrating the need for the new techniques as
well as details relating to improved patient outcomes will accompany all
training. In addition to this material, time will be provided for participants to
detail their prior knowledge of this technique as well as previous experience,
if any with ROSC. Practical demonstrations and learning will take place
within group settings and will be presented as scenarios for the staff to work
through as a team.

Application of Motivational Theories

In considering what will motivate the students to participate and excel with
this training program, it seems that achievement motivation theory is one
that rises to the top. This is a group of volunteers that are motivated to
succeed. Success in this case is defined by return of spontaneous
circulation. The ability to make such a difference in someones life and
family is an intrinsic motivator for these students. Understanding that
success and achievement is what motivates this group can assist in creating
opportunities within the learning for the students to stay engaged in this
program and work to the best of their abilities. As part of the training is
psychomotor involving mock codes, the training will create opportunities for
the students succeed if the skills are applied appropriately to the situation.

Impact of a Diverse Audience on Instruction

The primary audience is relatively homogenous in makeup. While there are
age differences in the learners, the training that all staff have participated in
and the structure of the department creates a similarity in staff. It is
important to be aware of the potential differences in abilities in accessing
computer resources as well as the difference in understanding of both
anatomy and physiology for staff members. It is possible modules detailing
this information may need to be created as asynchronous learning for those
than need additional support.

TASK/GOAL/PERFORMANCE ANALYSIS
Goal Analysis
Original Goal:
Students will gain the skills to provide High Performance CPR through didactic and hands on
training utilizing a new curriculum.
Key points to show achievement of goal:
Students will perform High Performance CPR at appropriate rate of compressions
Students will perform high Performance CPR at appropriate ratio of compressions to
breaths
Students will apply defibrillator after performing 200 compressions
Students will describe the physiologic actions occurring when compressions are delivered
The training was applicable to my practice
The training was presented using evidence based medicine (EBM) guidelines
Students will apply the skills during cardiac arrest calls
Content was delivered in an easy to understand manner
I understand why this method of CPR is more effective in reviving a patient
The content met the stated objectives provided.
Content Development:
create materials (flow-sheet) of compressions/breaths ratios
create written materials detailing physiologic actions
provide EBM guidelines to students in didactic sessions
create case studies for students to apply new knowledge to
provide new clinical education in topical chunks (creating organized, easy to understand
material)

Measure of success
Educational content defined the EBM for High Performance CPR and provided a clinical flowsheet for the steps to be performed.
Content Delivery reserve classroom with appropriate space for skill practice
provide skill sheets detailing practical skills to be performed
simulation models used to present clinical cases
provide engaging presentations utilizing achievement motivational theory
Measure of success
Students remain engaged in instruction and demonstrate ability to perform skills as defined
during instruction.

INSTRUCTIONAL OBJECTIVES
Project (Instructional) Goal
Students will demonstrate ability to perform High Performance CPR as
defined using EBM guidelines and apply this ability to a variety of clinical
settings involving cardiac arrest.

Terminal Objectives and Enabling Objectives

Students will define the physiologic actions that occur during the
application of High Performance CPR Cognitive (Knowledge level of
Blooms Taxonomy)
o Describe the oxygenated blood flow during compressions
(Cognitive)
o Identify the importance of perfusion of the coronary arteries
(Cognitive)
o Describe the purpose of early perfusion of the heart and brain
(Cognitive)
o Identify why increased intrathoracic pressure can negatively
affect resuscitation (Cognitive)

Students will demonstrate effective compressions and breaths on a

simulation mannequin. Psychomotor (Application level of Blooms
Taxonomy)
o Demonstrate compressions at a rate of over 100 per minute
(Psychomotor)
o Demonstrate compressions at a depth of greater than 2 inches
(Psychomotor)
o Demonstrate effective use of a bag-valve-mask (BVM) at rate of 6
breaths per minute

Students will be able to complete a mock code utilizing the skills of

High Performance CPR Cognitive/Psychomotor (Application level of
Blooms Taxonomy)
o Apply knowledge of High-Performance CPR through progression
of a case study (Cognitive)
o Demonstrate providing 200 compressions prior to application of
AED (Psychomotor)
o Demonstrate working as a team to provide evidence based care
(Psychomotor)

ENABLING OBJECTIVES MATRIX & SUPPORTING CONTENT

Terminal Objective: Students will define the physiologic actions that occur
during the application of High Performance CPR
Pre-instructional Strategy: Review of Anatomy and Physiology with question
and answer section. The purpose is to review the students current
knowledge of the systems being reviewed.
Enabling
Objective

Level on
Blooms
Taxonomy*

Learner Activity

Delivery Met

Knowledge

Fact, concept,
principle, rule,
procedure,
interpersonal, or
attitude?
Fact

Describe the
oxygenated
blood flow
during
compressions

Learners will
diagram the flow of
oxygenated blood
during
compressions in
small groups.

Identify the
importance of
perfusion of the
coronary
arteries

Knowledge

Principle

Describe the
purpose of early
perfusion of the
heart and brain

Knowledge

Principle

Learners will
participate in a
game of physiology
jeopardy. Learners
will be able to
answer all questions
related to perfusion.
Learners will
participate in a
game of physiology
jeopardy. Learners

In a small gr
learners will
template of
with the maj
and vessels
the page. Th
groups will t
the path of
oxygenated
during comp
including the
blood during
compression
The content
objective wil
delivered by

(What would learners do

to master this
objective?)

(Group
presentation/le
paced, or smal

The content
objective wil
delivered by

Identify why
Knowledge
increased
intrathoracic
pressure can
negatively affect
resuscitation

Principle

will be able to
answer all questions
related to perfusion.
Learners will be able
to successfully
answer questions
and discuss the
correct care to be
provided throughout
a case.

Instructional/Supporting Content:
To support the first enabling objective, students will diagram and trace the
blood flow through the body during compressions. After participating in a
lecture, students will work in small groups to diagram the flow. To facilitate
this work, several templates will be provided. (Attached to project plan).

Learners will
within small
work through
case.

REFERENCES
Adult Learners. Retrieved January 18, 2015, from
http://www.rit.edu/academicaffairs/tls/course-design/instructionaldesign/adult-learners
High Performance CPR. (n.d.). Retrieved January 18, 2015, from
http://www.resuscitationacademy.com/index.php/2011/08/test-3/
Instructional Design. (n.d.). Retrieved February 2, 2015, from
http://instructionaldesign.org/
Morrison, G., & Ross, S. (2013). Designing effective instruction (7th ed.).
Hoboken, NJ: J. Wiley & Sons.
Atlas of Human Cardiac Anatomy. (n.d.). Retrieved February 25, 2015, from
http://www.vhlab.umn.edu/atlas/index.shtml
Flow through the heart. (n.d.). Retrieved February 26, 2015, from
https://www.khanacademy.org/test-prep/NCLEX-RN/nclex-rn-circulatorysystem/rn-circulatory-system/v/flow-through-the-heart