The ability to provide first aid is one of the most powerful skills which can save someone's life. The survival rate of out-of-hospital cardiac arrest in Europe is only 9%, even though AED (automated external defibrillators) can be accessed in public places to treat it successfully in most cases. AEDs can be correctly operated without prior experience. However, emotional and psychological barriers to action, such as fear, can delay or prevent AED's lifesaving use.
The best way to gain willingness and confidence to use AED in cardiac arrest and save someone's life is AED training. Nevertheless, AED training is complex and dynamic. Multiple participants perform the exercises at the same time. It is challenging for the instructor as it requires to assess multiple students simultaneously by keeping track of their actions and the device instructions. Moreover, when the instructor interacts with participants to provide feedback, he/she loses track of the rest of the class. As a result, an instructor is stressed and overwhelmed, and participants can receive limited or incorrect feedback. Currently, AED training requires a small number of participants so the instructor can assess them correctly and provide feedback. However, small class groups significantly increase both cost and accessibility of AED training. It is therefore not included in many first aid courses.
QAED is the first AED training device concept that supports and empowers instructors throughout the teaching process. QAED system consists of smart AED training device, pads with NFC reader, stickers with NFC tag, and an app. The system collects participants' performance such as correct pad placement, following instructions, and a combination of AED and CPR skills. The QAED Classroom app analyses the data and translates the results into guidelines for the instructor. The app provides information about the most problematic tasks and points to the students who might require more attention. The concept aims to provide an accessible overview of students' performance. It will allow the instructor to focus more on interaction with participants to gain confidence in their skills to use AED in an emergency. Moreover, QAED increases the quality of the training and allows to increase the number of participants, so AED is a part of every first aid course, even mass CPR classes. The more people will be trained, the more people will have the ability and courage to use AED and saves someone's life. Also, with a higher quality of the training, participants will become more confident. It will affect the reaction speed, increasing victims' chances of survival.
As part of the research, multiple methods were used, including interviews, observation, and autoethnography study, to gather relevant information from various stakeholders and understand different perspectives. Also, research was conducted in multiple locations, including Poland, the Netherlands, Norway, and the United Kingdom.
Literature and desktop research
The literature review and desktop research were done to gain a holistic perspective about the legal, user, and market requirements of AED training and equipment. It also gave an understanding of the current conditions of training by including different fields such as psychology, sociology, medical science.
Company visit, Norway
A trip to Laerdal Medical, headquarter, was made just before the start of the project. The aim was to define the final assignment and to recognize the client's perspective. During those three days, the company had presented its current work, manufacturing facility, and future vision of first aid training. Besides, the testing of their products, including AED trainers and mannequins, was done.
Autoethnography, the Netherlands and Poland
To understand the context of AED training, the autoethnography method was used by participating in two certificated first aid courses. The first course was Basic Life Support with additional AED training, and the second course was Basic First Aid for Adults. They were provided in different locations by different providers, but they were both aligned with European Resuscitation Guidelines. Also, there were differences in the curriculum, but both included AED training and provided insights for the research topic.
Observation study, the United Kingdom
Two different courses were observed at St John Ambulance. The first was the AED course, and the second one was the first aid course. These observation studies gave insight into methods used for teaching, course dynamics, and the interaction between instructor, participants, and the equipment.
Interview with St John Ambulance and Qualsafe instructors, the United Kingdom
During two days of the visit, six semistructured interviews were conducted with certified instructors from St John Ambulance and Qualsafe. Participants were selected based on the availability and experience in providing diverse courses, which include AED training. Interview questions were prepared to understand instructors' perspectives on the course, teaching methods and evaluate AED training devices.
Interview with Projekt AED, Poland
At the beginning of the project, the office of Projekt AED was visited. It is a company that distributes AED devices and provides AED training for clients. An interview was conducted with a person who is the project coordinator and a certified first aid instructor. The aim was to understand the market of AED devices used in emergencies and its connection with first aid training.
Interview with participants
Short, semistructured interviews were conducted with seven participants. Participants were selected based on their knowledge about AED and experience with first AED training. The purpose of the interviews was to understand potential bystanders' perspectives before and after exposure to the training.
Laerdal Medical is a company that provides a wide range of training equipment and is specialized in advanced CPR mannequins. Laerdal's QCPR (Quality CPR) technology addresses the problem of students' assessment and accurate feedback efficiently. However, no solution can be applied while students practice the AED use. Student's not only don't receive any feedback about the AED use, but also their CPR skills can't be evaluated by current products. The designed system recognizes appling pads and delivering a shock as a mistake. QAED aims to use the company resources and experience to become the first one to deliver smart AED assessment and feedback and provide a complete first-aid training system that includes both skills AED and CPR.
The research showed that gaining the confidence to act is as important as gaining skills and knowledge. In that process, the vast part plays the practice with the device and the instructor's positive and constructive feedback. As a result, the project focused on empowering instructors to train and support students without unnecessary equipment limitations. Moreover, research showed a lack of AED training in many first aid courses, and when there are present, it is described as challenging for the instructor. The current training devices require the instructor's close supervision (e.g., controlling each device's audio with the remote control, assessing pad placement), which is impossible with the bigger number of participants. Currently, AED practice with a device is not included in the big group first-aid course. It is run as a separate training with a small number of students. It results in a higher cost of AED training and low accessibility, although it a crucial part of first-aid. As a result, the main challenge is evaluating multiple students' performance simultaneously and providing constant feedback without losing track of other students.
There are two end-users of the QAED concept: instructors and AED course participants. Currently, instructors are struggling with multitasking between assessing students, providing feedback, and controlling multiple training devices. QAED measures participants' performance so, the instructor is not alone in the assignment process anymore. It is also not restricted by limited visibility of participants' actions in a crowded room and the ability to hear device instructions in a loud environment. Instructors are less stressed as they don't have to be everywhere at the same time to spot each mistake. QAED also helps to keep track of participants' progress during the course with a digital record to decrease cognitive overload. With high-quality ongoing assessment, instructors can take time to provide accurate and as much feedback to the students as they need. Detailed and complex data about participants' performance is translated into simple feedback suggestions for each student to deliver more detailed feedback than ever before. The QAED Classroom app can also control all devices simultaneously, removing current unreliable IR remote controls. For participants to gain willingness and confidence in their skills, they need reassurance from the instructor. With the supporting tools, instructors will be able to interact more with them so they will receive all the attention they need. With the group feedback on the projector, each of them receives feedback and can understand their performance within the group.
AED training devices' appearance and interaction should mimic the medical AED to provide as close experience as in the real situation. There are more than 25 AED models approved by FDA. However, there are no guidelines for the design of AED devices. As a result, there is a high diversity in size, shapes, voice prompts, buttons, or even the way it is turned on. The first step was an analysis of AED to find the device characteristics representing the biggest part of the market: rectangular shape, neutral color, interaction buttons in one line, and pads location. In terms of dimensions, the training unit has to be big enough to be similar to the AED device so participants will have a similar experience and small to support storage and transportation. It resulted in a size oscillated around the mean value of this comparison and was empirically tested positive. It was also important to include space for electrodes in the AED form, so it is compact and easy to store. QAED device consists of the main body where all components are, and the interaction takes place and a silicone cover. It protects the device in a dynamic environment of the AED training, where devices are being often dropped. Also, the surface of the screen is lowered to limit the possibility of scratches. The purple textile is a colorful accent that integrates the product with the brands' QCPR product line.
The NFC (Near-Field Communication) is a precise and secure method of pairing the AED with the mannequin and assessing correct pad placement. NFC tags are placed in the right position of pads under the skin of the mannequin. The NFC reader antenna is placed in the pads, and the PCB to process data is placed in the AED. The system will detect the presence of AED when pads are placed in the right location on the mannequin and connects it with the data from the correct mannequin (CPR feedback).
To understand if the concept could work in the context of AED training and how it could be improved, it was evaluated with both instructors and potential participants of the AED course. Two tests were done to evaluate the AED design, interface of instructors' app, and interface for participants. Overall, the QAED training device's design was assessed positively and, according to the instructors, has a potential for further development. They have also expressed the willingness to use the QAED training device at their course. The main advantages were assessment tools, simplicity, small size, rechargeable battery, and battery status. In terms of the app, the instructors appreciated the information and the visuals of the interface. Firstly, they agreed that the chosen qualities (right pads position, shocked delivered, delays in CPR) are the most important to assess from their perspective and that icons are the most efficient communication tool during the training for live feedback.