Method Paper Implementing an Undergraduate, Team-Based, First Aid Education Course

The goals of first aid (FA) are to preserve life, alleviate suffering, prevent further illness or injury, and promote recovery. Despite on-going progress to improve care delivery practices for the acutely ill and injured, the question as to how best educate and provide on-going effective training for FA, including Cardiopulmonary Resuscitation (CPR), remains unanswered (Singletary et al., 2015). Results of a 2010 review of FA and CPR educational topics found no evidence to support Abstract First aid (FA) skills, including Cardiopulmonary Resuscitation (CPR) are the foundation of first responder care. Best practice guidelines to educate FA trainees are lacking. The current structure of FA training programs is based on pedagogy, derived indirectly from hospital-based and Emergency Medical Services training models. Most FA training programs focus on educating the participant to function as the sole provider of care; however there may be instances when individuals providing FA find themselves suddenly engaged as functioning members of teams caring for an individual in need. Findings indicate that patients are safer and receive higher quality care when providers work as a highly effective team. As a result, teamwork training programs have been integrated into multiple health training programs. Teamwork training has been found to reduce medical errors, promote patient safety, enhance positive patient outcomes, and improve communication in a variety of medical settings; however the impact of team-based training in FA education is unknown. We describe the development of a semester long, undergraduate-level, FA educational course incorporating team-based training. Results of this project may impact the methods by which individuals receive FA education. Further investigation into the use of teamwork training as the foundation for FA training is indicated to determine the outcomes for the acutely ill and injured.

or recommend any method of evaluating or monitoring a first aid trainee's educational progress and knowledge (Markenson et al., 2010). The need for further investigation into FA education to promote safe and effective care has been further supported by the International Liaison Committee on Resuscitation (ILCOR) as findings from the 2015 recommendations indicate that little data exist on this topic (Bhanji et al., 2015).
Many questions regarding FA/CPR education remain unanswered, and research is desperately needed, particularly in the realm of teaching techniques (Hazinski & Nolan, 2015). Interprofessional collaborative practice, inclusive of health professionals from multiple disciplines working together as a team, is key to providing safe, quality, and effective patient-centred care (IPEC, 2011). Teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success. It is important that individuals learn how to function as a member of a team providing care for acutely ill or injured individuals (Fernandez, Russo, Reithmuller & Boos, 2013). Conditions under which FA is provided can be challenging for responders as the stressful nature of these situations can lead to increased confusion, impaired communication and poor clinical outcomes. Teams of highly trained rescuers often use an integrated approach that accomplishes multiple steps and assessments simultaneously rather than the sequential approach used by individuals (Fernandez et al., 2013). Teamwork training for health care providers has been found to enhance positive outcomes for patients; however its integration into FA/CPR education has been limited (Capella et al., 2010;Neily et al., 2010).

Inter-professional Education
Health profession students are traditionally educated within the confines of their discipline.  (Weaver et al., 2014). Interdisciplinary, teambased simulation experiences lead to more effective team skills (Robertson et al., 2010;Tucker et al., 2003). In addition, utilizing simulation to enhance teamwork has been shown to enhance the quality of patient care while best preparing providers for practice (Bandali, Parker, Mummery, & Preece, 2008;Robertson & Bandali, 2008).

Course Development and Implementation
We patients in cardiac arrest (Capella et al., 2010). 3) CUS-a mutual support acronym tool that asks for team members to call attention to problems by using nonthreatening phrases such as-"This is a safety issue" "I am Concerned about the patient's condition" "I am Uncomfortable with the patient's condition and "I believe the Safety of the patient is at risk."

4) Call out-a communication tool used to
convey information about the patient to all member of the team.

5) Check backs-a communication tool used to verify orders.
To evaluate the impact of Essential  (Cooper, et al., 2010;Walker et al., 2011 (Cooper et al., 2010). It is for these reasons we used TEAM as one of our assessment tools.
While TEAM provides a global assessment of teamwork, it provides little information at the individual provider level. Therefore, we also used a second tool: OSCAR. This tool has been found to be valid and reliable tool when assessing teamwork and non-technical skills in resuscitation contexts in a simulated environment (Walker et al., 2011). OSCAR also allows for detailed breakdown of the assessment of teamwork and non-technical skill as well as identification of areas of weakness in sub-teams and individuals facilitating constructive feedback to all team-members (Walker et al., 2011). It is for these reasons we decided to use OSCAR.
After completion of the teamwork training program, students then participated in a team-  We have planned additional measurement of these characteristics for future courses.
We plan to continue offering the interprofessional first aid/CPR course in the future and complete an ongoing literature review to continually identify best practices, keeping course content current and accurate. Another course focusing on teamwork and communication as the infrastructure for electrocardiogram interpretation is in development.

Implications for the Field
FA/CPR trainers have an obligation to the public and future employers to prepare responders who are equipped with knowledge and experience to assume their roles and responsibilities as a highly effective team member caring for the acutely ill and injured. Teamwork training has improved patient outcomes in the areas of healthcare including trauma resuscitation and surgical teams (Capella et al., 2010;Neily et al., 2010).
Incorporation of team-based training as the infrastructure for FA/CPR may help to improve patient outcomes. Future work will be needed to understand how to best incorporate team training into first aid/CPR education.

Conclusion
Teamwork training has been incorporated for inhospital critical situations and has improved patient outcomes. While little work exists exploring teamwork training for FA, we describe an undergraduate team training FA and CPR course that may help to address these gaps.
Future work will be needed to identify the ideal way to perform FA team training and identify its impact on patient outcomes.