October 29, 2015
7 min read

CPR in schools: Empowering students with lifesaving skills

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Sue Denis doesn’t need a law to remind her of the importance of knowing CPR.

In 1979, when Denis was a 24-year-old nurse, she was recovering from back surgery at her parents’ home in Sag Harbor, New York, when she found her father lying in the family’s driveway.

“He’d had a cardiac arrest,” she said, “At that time, nurses weren’t even trained to do CPR. So I did the best I could, but I couldn’t save him.”

Years later, when Denis took a job as a school nurse and health education teacher at her alma mater, Pierson High School in Sag Harbor, she came in with a vision.

“Immediately, the first year I was there, I started a program of teaching CPR to my students,” she said. “Initially, I offered it as an optional evening course for my high school students that very first year. A number of them showed up, and the next year, everyone showed up.”

Today, 21 years later, Denis’ vision has paid off — every student who graduates from the Sag Harbor School District is certified in CPR, and high school students have the opportunity in turn to become trained CPR instructors. It has been a challenge the students have taken up enthusiastically — and it isn’t just academic. To date, Denis’ students have saved at least 20 lives.

“It’s a wonderful thing, and not only because 326,000 people in our country suffer cardiac arrest outside of the hospital each year,” Denis said. “It’s also great because when you give these kids a skill, they run with it. They’re so available and they so want to help.”

Now, this lifesaving skill will automatically be provided to every student in the state of New York, which recently became the 26th U.S. state to pass legislation making CPR training a required part of the curriculum for high school graduation. New York was a milestone for the CPR in Schools initiative by training students in life-saving in more than half of U.S. states. Shortly thereafter, Illinois became the 27th state to pass the legislation. The initiative has gained significant momentum since the American Heart Association launched it 4 years ago; at that time, only a few states had mandatory school CPR laws.

“What we know is that bystander CPR doubles or even triples a person’s chance of survival,” said Dianne Atkins, MD, professor of pediatrics and cardiology at the University of Iowa and a strong proponent of the legislation. “So the [AHA] has a goal of training as many people as possible in CPR. There is a 2020 impact goal of doubling survival.”

A generation of lifesavers

Currently, the states that have mandatory school CPR training legislation on the books are Alabama, Arkansas, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Mississippi, Minnesota, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington and West Virginia. The AHA estimated that with the passage of New York’s CPR in School’s legislation, there will now be more than 1.6 million U.S. students trained to perform CPR each year. This equals at least four CPR-certified people for every cardiac arrest within the United States.

According to Atkins, the current survival rate from out-of-hospital cardiac arrest in the United States is roughly 8% to 10%. 

“But, with good bystander CPR, an organized EMS system and good post-resuscitation care, success rates as high as 50% to 60% are clearly achievable,” Atkins said.

Saving lives at home

In many cases, students who perform bystander CPR will be much more than bystanders to those they help — often, they are family.

“Most cardiac arrests occur in the home, so it is most likely that you will perform this on someone you know,” Atkins said. “These students often end up doing CPR on their parents or perhaps their grandparents.”

Such was the case for Liam Keating, a student of Denis’ who, at age 15 years, found himself putting his training to use in an important real-life situation.

“It was a Saturday morning in January, and Liam had just played a basketball game. His father was driving him home in their truck,” Denis recounted. “There were 2 or 3 feet of snow on the ground. All of a sudden, Liam’s father looked at him and said, ‘Something’s not right,’ and he collapsed on the steering wheel.”

Keating quickly sprang into action, steering the truck onto the road, calling for help and initiating CPR on his father. A bystander called 911, and the police arrived in minutes.

“They used a defibrillator and brought him back,” Denis said. “Liam’s ability to do CPR saved his father’s life.”

Keating’s story is just one of many Denis has amassed in a scrapbook of real-world rescues performed by her students. She discussed the girl who, weeks after being trained, saved the life of her 2-year-old nephew, who had an undiagnosed heart defect; the student who, while babysitting at a pool party, performed CPR after retrieving a child who was unresponsive in the water; students who have rescued strangers in France and Italy.

“We know that if you have been trained in CPR, you are much more likely to respond,” Atkins said. “Also, young brains are able to absorb this very well, especially when it comes to using an automated external defibrillator. These kids are not afraid of technology.”


According to Denis, they don’t fear much of anything.

“The kids are amazing — they’re fearless,” she said. “I love the idea of connecting this training with young people who are so enthusiastic and just ready to go out and do things in the world. What better skill to give them than this?”

‘The great equalizer’

Another compelling case for teaching CPR in schools is its ability to address some of the socioeconomic disparities that exist between communities.

“There are large communities, such as Latino, African American, low socioeconomic communities, in which bystander CPR is especially low,” Atkins said. “In these communities, there are even fewer people trained, so they might be more hesitant to initiate CPR.”

According to study results published in the Annals of Emergency Medicine, people who live in predominantly Latino, African American or poor neighborhoods are 30% less likely to receive bystander CPR in an emergency. The study also cited reluctance to call 911 due to distrust of law enforcement, language barriers or lack of information about CPR.

“People in these communities are less likely to receive CPR that could save their lives,” Denis said. “We’re thinking that by making CPR required in schools, we can reach these communities. We’re hoping their children will be the answer to this problem. School is the great equalizer.”

Worth the time

Considering the countless benefits of empowering all high school graduates with this lifesaving skill, mandatory CPR in schools would seem to be an inevitability. However, concerns with time, cost and, even, liability may prompt hesitation by some states.

“Schools are asked to do a lot of things,” Atkins said. “There has been pushback on cost, and there’s even been a little bit of pushback on liability, like if they’ve trained people and they don’t do it, that kind of thing. All of these things we’re slowly showing are just not real obstacles.”

Companies such as Ross stores have stepped up to support the AHA’s efforts by providing free CPR training resources to 1,131 nearby public schools. Schools earmarked for the resources were chosen based on need, determined by having 70% of students receiving free or reduced lunches.

Additionally, Atkins clarified that the CPR training proposed through the legislation is not necessarily time-intensive.

“We’re not recommending the full 4-hour basic life support course that the [AHA] gives,” she said. “We’re emphasizing learning the technique of CPR, practicing the psychomotor skills, understanding how an AED works. It turns out you can probably do this in just a couple of hours in a school year. Each student spends an hour or two in the entire academic year.”

In terms of liability, Atkins said good Samaritan laws protect CPR practitioners.

“Unfortunately, in the United States, we’re always concerned about liability, but it hasn’t turned out to be much of a problem,” she said. “A lot of people are even afraid they could harm the patient. But what I emphasize to them is that doing something is better than doing nothing.”

Denis agreed, although she has made it her mission to ensure that her students are able to feel more confidence than she felt as a young person trying to help her father.

“Even though I know I did the best job I could, I felt incompetent that day, and I never wanted anyone to feel like that again,” she said. “I’ve had a few kids who have done CPR on their dads, and they didn’t survive. But in both cases, these were massive heart attacks, and the kids knew they did everything they possibly could do.”

With her lengthy scrapbook of CPR saves and the new lifesavers and instructors she sends out into the world each year, Denis hardly needs to question all the good she has accomplished. After she and some of her students traveled to Albany, New York, to advocate for the legislation, she achieved the bittersweet victory of having the legislation pass on Sept. 17 — the 36th anniversary of her father’s death.

“We’ve got CPR onboard in 27 states now, and we have 23 to go,” she said. “The [AHA] is doing a wonderful job pushing for this important education. They haven’t let up because it is so important. The power to save a life is in our hands.” – by Jennifer Byrne


American Heart Association. Cost, fear, lack of information may limit CPR usage for urban minorities. Newsroom.heart.org/news/cost-fear-lack-of-information-may-limit-cpr-usage-for-urban-minorities?preview=5e567. Accessed on Oct. 12, 2015.

Sasson C, et al. Ann Emerg Med. 2014;e2:545-552.

Disclosure: Atkins and Denis report no relevant financial disclosures.