Dramatic, yes, but it’s a scene that could happen, and it’s the plot of a new CPR training film developed by a University of Louisville doctor. , physician director for resuscitation at and an assistant professor at the UofL School of Medicine, is hoping the novel approach will improve high school CPR training by helping students remember what they have learned by applying it to a real-life situation they can relate to.

CPR instruction in high school is now required by law in a growing number of states. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed its law in 2016. Similar laws are being considered in the remaining states.

“The goal is to create a real, emotional scenario,” said Brown. “There are so many lives that could be saved if more Americans knew CPR, and we have all of these students coming out of high school with CPR training.”

About 4 million students per year now graduate with CPR training. Brown has studied CPR training in high school, with her work in the . She found CPR skill retention in high school students was poor, with only 30 percent able to perform adequate CPR six months after training. She also found that there was no standard method of implementation.

“We wanted to know, is there a better way to do it?” she said.

That’s where the film comes in. Working with the local and using $10,000 in grant money she received from winning the prestigious Stamler award for young researchers at Northwestern University last October, she modeled the film after one done in the United Kingdom, where CPR training also is required.

The interactive film, designed for classroom use in high schools and shot at by a local film company, forces students to make choices along the way about how to respond. It will be rolled out in local high schools this fall, then Brown will determine whether it improves skill retention. If it does – and Brown said she believes it will – the plan is to expand it across Kentucky and the nation.

“This could be a game-changer in the way CPR is taught in the United States,” she said.

The film used six local high school and college actors, and paramedics from , who brought an ambulance for one scene. In the film, the coach (Brown’s real-life husband, who auditioned for the part) suffers cardiac arrest during basketball practice, and staggers out into the lobby, where he becomes unconscious and falls onto the floor. He is found by a player, who, along with the other students at practice, must call an ambulance and perform CPR on the coach together until the paramedics arrive. The coach regains consciousness, and the students are congratulated by paramedics for saving his life.

In the United States, 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects whether they survive, Brown said. Only 11 percent of the 350,000 receive CPR. Brown has said that if CPR survival improved by just 1 percent, 3,500 more people would live.

Expanding and improving CPR training has been a personal mission for Brown, who has worked for several years on unique approaches.  These days, effective CPR is hands-only, removing a barrier for some from the old mouth-to-mouth method. She also founded and directs a program called “Alive in 5” (), a 5-minute method of teaching CPR she developed.

The wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations.

“It’s important that people be willing to act, and that they remember the skills that they’ve learned,” she said. “As most cardiac arrests that don’t occur in a hospital happen in homes, it is likely they will save the life of someone important to them.”

See the filming

To watch a video on the making of the film, click .

The study by Lorrel Brown, MD, an assistant professor at the UofL School of Medicine and physician director for resuscitation at UofL Hospital, is titled “CPR instruction in U.S. high schools: What is the state in the nation?”

In the U.S., 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects survival, Brown said. Only 11 percent of those 350,000 survive.

“If we improve survival by just 1 percent, that’s 3,500 more people who will live,” Brown said.

The American Heart Association wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed a law last year. Similar laws in the remaining 11 states are being considered.

For the study, Brown examined the state laws and characterized them based on stringency of training.

“We know high school students can learn CPR. However, we have found CPR skill retention in high schoolers is poor, with only 30 percent performing adequate CPR six months after training,” she said. “We wanted to know, is there a better way to do it? How can we make the best use of this opportunity?”

The study had two parts:

1. What the law in each state requires and
2. How the laws are being implemented in schools

To find out, Brown sent a survey to schools in the 39 states. She asked how CPR was being taught, who was doing the teaching and at what grade level.

“We found a wide degree of variability from state to state, and even school to school,” she said. “While the laws all have some similar features, such as teaching the hands-only method, they still leave a lot to the individual schools to decide.”

Most laws don’t recommend a specific program. Some require the training take place in a specific grade, while others don’t. Most training was being taught as part of a physical education class, but it varied widely who taught it, from a firefighter, a nurse, to the American Red Cross. Most laws don’t require the instructor to be certified to teach, an important distinction, Brown said, since not everyone who is certified in CPR will necessarily be a good instructor.

She said a major barrier for schools is the cost of CPR training. Certified instructors are not always readily available, and most states don’t provide funding for CPR training, leaving it to individual schools and districts. And high-quality mannequins, which are important for a more realistic experience and muscle memory, are expensive, Brown said. Thirty-six percent of schools surveyed were using a low-quality, inexpensive inflatable one.

She said the study “hopefully will help standardize the process to provide high-quality training.” Brown was assisted in the study by two UofL medical students, third-year Carlos Lynes, and fourth-year Travis Carroll, with Henry Halperin, MD, of Johns Hopkins University School of Medicine, advising on the study.

She said it’s too early to tell whether the training in U.S. high schools has been effective in saving lives, but in some places such as Denmark, similar laws lead to increased rates of bystander CPR and survival.

“We’re still about 10 years out in the U.S.,” she said. With about 4 million students per year now graduating with CPR training, “by then we’ll have an army of people trained in CPR.”

Expanding CPR training has been especially important to Brown, who has worked for several years on unique approaches such as halftime demonstrations at UofL men’s basketball games. She founded and directs a program called “Alive in 5,”  a 5-minute method of teaching CPR she developed that could become a standard for training. She studied the method at the Kentucky State Fair and found adults could learn high-quality CPR in just 5 minutes.

“We are still investigating the best method that is effective and efficient,” she said.

It stands to reason: If you want to educate large numbers of people, go where large numbers of people go.

In case, that place was the Kentucky State Fair – and the nation’s premier cardiology association has presented her an award for her innovative thinking.

Brown, assistant professor of medicine in , won first place in the category of “Young Investigator Awards in Cardiovascular Health Outcomes and Population Genetics” from the American College of Cardiology earlier this month. The award was presented at the organization’s 65^th Annual Scientific Session in Chicago. It also was published in the April 5 issue of the Journal of the American College of Cardiology.

Brown headed a group of researchers that included Dr. Glenn Hirsch, associate professor of medicine, cardiology fellows Dr. Wendy Bottinor and Dr. Avnish Tripathi, medical student Travis Carroll, Dr. Bill Dillon, who founded the organization Start the Heart Foundation, and Chris Lokits  of Louisville Metro Emergency Medical Services, Office of Medical Direction and Oversight. They tackled the problem of surviving cardiac arrest – the sudden stopping of the heart – by increasing the number of people trained in hands-only cardiopulmonary resuscitation (CPR).

Titled “ the research effort brought CPR training to the Kentucky State Fair’s Health Pavilion in August 2015.

Nearly 400,000 people in the United States have out-of-hospital cardiac arrest each year, she said, or nearly 40 people every hour. Only one in 10 survives.

“The vast majority of people who suffer cardiac arrest don’t experience it in a well-equipped hospital with highly-trained medical staff,” Brown said. “They experience it as they go about their daily lives, and just 30 percent of cardiac arrest victims receive CPR, usually from bystanders. Yet we know that bystander CPR dramatically improves chances for survival.”

The group created a 10-minute training module that uses a short video and hands-on coaching to teach people the basics of hands-only CPR. To further determine their mastery of CPR, participants completed a post-training survey and were asked to return to the training site at the fair one hour after training to re-test their CPR ability.

The state fair location also provided an additional benefit: the ability to reach people from communities and counties throughout Kentucky with low rates of bystander CPR.

“In Jefferson County alone, bystander CPR rates vary dramatically according to zip code, ranging from 0 percent to 100 percent,” Brown said. “We know there is the same variation throughout the state, and 77 percent of the Jefferson County residents we trained at the fair were from zip code areas with bystander CPR rates under the national average of 31 percent.”

Since the 2015 fair, Brown has led efforts to conduct bystander CPR training at other locations. “Through the Take It to the Heart tour with KentuckyOne Health, we provided this training in hospital lobbies throughout the state, at UofL women’s and men’s basketball games and even at the Capitol in Frankfort with the Kentucky Senate,” she said. “Through these efforts, we have trained more than 1,000 individuals in CPR and educated another 43,000. We hope that these efforts not only raise the rates of bystander CPR and survival from cardiac arrest in our own communities, but also serve as a model for other communities.”

Brown will bring the training back to the Kentucky State Fair again this year.

“These results suggest that by providing brief trainings in public venues, such as the state fair, we can effectively train people and potentially improve the rate of bystander CPR in this country,” she said.

Organizations or businesses also can schedule their own bystander CPR training session via the Start The Heart Foundation, for which Brown serves as a board member, by calling 502-852-1837.