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TO: Lance Mizumoto, Hawaii Board of Education Chairperson
FROM: Graham Uy
DATE: November 18, 2016
SUBJECT: Cardiopulmonary resuscitation education: requirement for high school graduation in
Timely initiation of Cardiopulmonary resuscitation (CPR) in critical events such as
drowning and cardiac arrest has been argued to be the strongest predictor in the outcome between
life or death, and it is estimated that only one in three witnessed, out-of-hospital cardiac arrests
involve early bystander CPR. These tragic, missed opportunities of bystander-witnessed events
have prompted the desire to train high school students whenever possible (Sorets and Manteen,
The number of states in the US mandating that CPR training be a graduation requirement
for all high schoolers is now 32; however, Hawaii currently has not yet adopted similar policy.
According to Hawaii Heart Foundation, 88 percent of sudden cardiac arrests that occur yearly in
Hawaii will happen at home with a survival rate of less than 10%. Factors that have been
determined to increase an individuals likelihood of survival includes high quality CPR and a
shock from an automated external defibrillator (AED) within the first 2 minutes of sudden
cardiac arrest. This brief will examine the recommendation of CPR training as a graduation
requirement for high schoolers, as proposed by the Assembly Bill 1719 to increase the numbers
of trained, competent bystanders in effort to save lives.
Sudden cardiac arrest is a sudden and unexpected pulseless condition attributed to
cessation of cardiac mechanical activity and is the leading cause of death among adults over the
age of 40 (Sudden Cardiac Arrest Foundation [SCAF], 2015). About 40 people each hour
experience a cardiac arrest while not in a hospital, and just over nine out of 10 do not survive
(American Heart Association [AHA], 2015). Each year, more than 350,000 out-of-hospital
cardiac arrests occur in the United States.
In Hawaii, drowning has persistently ranked as the 5th leading mechanism of fatal injury
by 5 year periods since 1995, following drug poisoning, falls, motor vehicle injury, and

suffocation (Galanis, 2015). In either event, cardiac arrest or drowning, the prompt initiation of
CPR and AED shock can significantly improve survival rates. However, barriers to bystanders
performing CPR which were once assumed to be fear of mouth-to-mouth resuscitation, were
panic and discomfort (SCAF, 2015).
Policy Solutions
The stakeholders that advocate for the success of mandatory high school CPR training programs
include students, out of hospital cardiac arrest survivors, family members of out-of-hospital
cardiac arrest victims, the Sudden Cardiac Arrest Foundation, the American Heart Association,
and the American Red Cross. Opponents and critics of such a program initiative focus on the
lack of funding and lack of time within an already dense high school curriculum.
I recommend the adoption of policy similarly to Assembly bill 1719 which will require school
districts and charter schools serving students in grades 9-12 to offer instruction in CPR as part of
a required course. Specifically, this bill would require that this instruction would include the
1. An instructional program based on national evidence-based emergency cardiovascular
care guidelines, such as those developed by the American heart association or the
American red cross training for students relative to the psychomotor skills necessary to
perform CPR.
2. Defines psychomotor skills as skills that are required to perform as hands-on practice
to support cognitive learning.
3. States that the Department of Education may consider an individual from any of the
following categories to provide instruction:
a. A licensed health care provider
b. An emergency medical technician
c. A peach officer
d. A firefighter
e. A teacher
f. An instructor certified to teach CPR by the American Red Cross or the American
Heart Association
4. Encourages the providing of general information on the use and importance of an
automated external defibrillator (AED).
5. The most cost-effective means possible to implement teaching program

To determine effectiveness and success of mandated CPR training in high schoolers, a

systematically designed database to understand the number of students trained and the range of
curricula employed, as well as the recording of the number and outcomes of cardiac arrests
attended by students will be necessary (Sorets and Mateen, 2015).

Hawaii Heart Foundation. (2015). Cardiac arrest statistics. Retrieved from
Galanis, Dan. (2015). Water safety and drownings in Hawaii. PDF. Accessed November 17,
Sorets, T. R., and Mateen, F. J. (2015). Mandatory CPR training in US high schools. Mayo
Foundation for Medical Education and Research. June 2015. Volume 90. Issue 6. P710712.
Sudden Cardiac Arrest Foundation. (2015). Sudden cardiac arrest: A healthcare crisis. Retrieved
from http://www.sca-aware.org/about-sca.