Cardiopulmonary Resuscitation (CPR) and Public Access Defibrillators (PAD) Collected May 2011 December 2011 Analyzed October 2012 Monitor Introduction This RRFSS Monitor describes training and awareness related to Cardiopulmonary Resuscitation (CPR) and Public Access Defibrillators (PADs) among adults aged 18 and older in Waterloo Region. For information on the Community Awareness and Response to Emergencies (CARE) program, which promotes public access defibrillators in Waterloo Region, please refer to https://resuscitation.heartandstroke.ca/. In this report, unless eplicitly stated otherwise, analysis of the CPR and PAD module used the total population of adults 18 and older as its denominator. Fast Facts (2011) Per cent of Waterloo Region adults who have ever received some CPR training: 61.3% (CI: 57.9-64.6) Per cent of Waterloo Region adults who were trained in CPR within the last year: 8.8% (CI: 6.8-10.7) Per cent of Waterloo Region adults who have been trained on cardiac defibrillators: 19.4% (CI:16.6-22.1) Per cent of Waterloo Region adults who believe that anyone can use a Public Access Defibrillator (PAD): 26.2% (CI:23.2-29.3) There were 811 responses to the CPR/PAD module in 2011. Questions were asked from May to December 2011. Estimates are presented with 95% confidence intervals (CI) and appear in the following format: XX.X% (CI: XX.X-XX.X). Note that, overall, there were no statistically significant difference between the 2011 CPR and PAD RRFSS module results compared to the 2010 CPR and PAD RRFSS module results, which was analyzed in 2011 and can be found on the public health website here: http://chd.region.waterloo.on.ca/en/researchresourcespublications/resources/cpr_pad.pdf. Majority of Waterloo Region adults have received some CPR training Over the three most recent time periods, 2009, 2010 and 2011, the majority (63.7% CI: 60.4-67.0, 64.0% CI: 60.7-67.3, and 61.3% CI: 57.9-64.6 respectively) of Waterloo Region adults had ever taken a CPR course or another type of training in CPR. RRFSS Monitor CPR and PAD Page 1 of 12
Age, education level and household income were significant predictors of CPR training Adults aged 65 and older were significantly less likely than adults in all other age groups to have ever received some CPR training (Table 1). Table 1: Per cent of adults who have ever received CPR training, by age group, Waterloo Region, 2011 CPR trained 18-24 25-44 45-64 65+ 59.7% (CI: 48.4-71.1) 67.1% (CI: 61.3-72.8) y 66.8% (CI: 61.7-71.9) z 38.8% (CI: 30.7-47.0),y,z Adults in Waterloo Region with a completed post-secondary education (71.5% (CI: 67.4-75.6) ) were significantly more likely to have ever been trained in CPR than adults with a high school education or some post-secondary education (49.3% (CI: 43.3-55.2) ), as well as adults with less than a completed high school education (46.2% (CI: 35.1-57.2) ). In 2011, Waterloo Region adults from higher income households were significantly more likely than adults in lower income households to have ever been trained in CPR (Table 2). Significant differences eisted based on Immigration status, presence of children in the home and employment level Waterloo Region adults born in Canada (65.6% (CI: 61.9-69.3)) were significantly more likely to have ever had CPR training than adults born outside of Canada (46.4% (CI: 39.1-53.7) ). In addition, adults in households with children aged 17 years or under were significantly more likely than adults without children 17 or under to have ever had CPR training (69.6% (CI: 64.3-75.0) versus 56.7% (CI: 52.5-61.0)). As well, adults employed full-time for wages (including self-employed) (68.2% (CI: 64.3-72.2) ) were significantly more likely to have ever had CPR training Table 2: Per cent of adults who have ever received CPR training, by household income group, Waterloo Region, 2011 Income group Per cent CPR trained <$30,000 45.8% (CI: 33.1-58.5) w, $30,000-$69,999 52.9% (CI: 46.1-59.8) y,z $70,000-$99,999 80.6% (CI: 73.7-87.6) u,w,y $100,000+ 77.2% (CI: 71.3-83.1) v,,z Don t know/refused 48.9% (CI: 42.5-55.4) u,v Lowercase superscript a,b,c,...,y,z, following the confidence interval represent significant differences between two proportions (%) based on non-overlapping confidence intervals, e.g. two proportions with an net to them are statistically different from each other. compared to adults employed part-time (including those that were retired, a student, or had other family responsibilities), and adults that were unemployed or unable to work (47.8% (CI: 41.3-54.3) and 48.8% (CI: 33.5-64.1) respectively). No differences in CPR training were found between adults by se, municipality of residence, marital status, or association with a health care facility (i.e. employees, volunteers, or students). RRFSS Monitor CPR and PAD Page 2 of 12
Less than one third of Waterloo Region adults had CPR training within the last five years Nearly forty percent of Waterloo Region adults had never been trained in CPR, while another third was trained five or more years ago. Therefore, less than one third of adults in Waterloo Region had CPR training within the last five years (Figure 1). Figure 1: Per cent of adults by time since last CPR training, Waterloo Region, 2011 Never trained 39.0% (CI: 35.6%-42.3%) 5 years or more 33.8% (CI: 30.5%-37.0%) 3 years, but less than 5 years ago 4.3% (CI: 3.1%-6.0%) 2 years, but less than 3 years ago 6.8% (CI: 5.1%-8.5%) 1 year, but less than 2 years ago 7.4% (CI: 5.6%-9.2%) <1 year ago 8.8% (CI: 6.8%-10.7%) Public Access Defibrillator Training and Awareness When available, CPR should be performed in conjunction with cardiac defibrillators. Cardiac defibrillators are devices which use an electric shock to stop a person s unhealthy heartbeat so the heart can beat normally again. In 2011, 19.4% (CI: 16.6-22.1) of all Waterloo Region adults and 32.2% (CI: 28.1-36.4) of adults trained in CPR were also trained on cardiac defibrillators. The proportion of those trained on cardiac defibrillators was highest among individuals who received their CPR training within the last year (Figure 2). RRFSS Monitor CPR and PAD Page 3 of 12
Time since last CPR course Figure 2: Per cent of CPR trained adults who received cardiac defibrillator training with their CPR training, by time since last CPR course, Waterloo Region, 2011 5 years or more E 7.5 I = 95% Confidence Interval 3 years, but less than 5 years ago E 34.3 2 years, but less than 3 years ago 41.8 1 year, but less than 2 years ago 70.2 <1 year ago 89.9 0 10 20 30 40 50 60 70 80 90 100 Per cent The superscript E denotes high sampling variability, and estimates must be interpreted with caution. Awareness of the CARE program In Waterloo Region, the CARE program makes cardiac defibrillators available for use in public places such as office buildings, arenas, schools, and shopping malls. When found in a public place a cardiac defibrillator is referred to as a Public Access Defibrillator (PAD). In 2011, 65.5% (CI: 60.2-66.8) of Waterloo Region adults had seen, read, or heard about such a program. The proportion of adults who had either seen, heard, or read about such a program did not differ by se, municipality of residence, marital status, presence or absence of children in the household, employment status, and association with a healthcare facility. Significant differences eisted by age group, level of educational attainment, and immigration status Adults aged 18 to 24 years were significantly less likely to have seen, heard or read about a public access defibrillator program than adults aged 25 or older. As well, adults aged 25 to 44 years were significantly less likely to have seen, heard or read about a public access defibrillator program than adults aged 45 to 64 years (Table 3). RRFSS Monitor CPR and PAD Page 4 of 12
Table 3: Per cent of adults who have seen, heard, or read about a public access defibrillator program, by age group, Waterloo Region, 2011 18-24 25-44 45-64 65+ 36.6% (CI: 25.4-47.8),y,z 58.8% (CI: 52.7-64.8),w 70.9% (CI: 65.9-75.9) y,w 66.9% (CI: 59.1-74.1) z Significant differences also eisted by education level and immigration status. Adults who have completed post-secondary education were significantly more likely to have seen, heard or read about a public access defibrillator system than adults who have not completed high school (Table 4). Adults born in Canada (70.0% (CI: 66.4-73.6) ) were significantly more likely to have seen, heard or read about a public access defibrillator program than adults who had immigrated to Canada (40.7% (CI: 33.4-47.9) ). Table 4: Per cent of adults who have seen, heard, or read about a public access defibrillator program, by level of educational attainment, Waterloo Region, 2011 Less than high school 48.7% (CI: 37.4-59.9) Completed high school or some post-secondary Completed post-secondary 60.0% (CI: 54.1-65.9) 68.4% (CI: 64.2-72.7) Awareness of the presence of cardiac defibrillators in public places Cardiac defibrillators are about the size of a laptop computer and are usually found hanging in a case on the wall. They often have a picture of a heart with a lightning bolt or the letters AED on it (meaning Automated Eternal Defibrillator). When required, anyone can use a cardiac defibrillator, regardless of prior training eperience. Approimately half (43.3% (CI: 39.8-46.7) ) of adults reported seeing a cardiac defibrillator in a public place in Waterloo Region. Significant differences eisted by gender, age, education level, household income, immigration status, employment status and presence of children in the home Male Waterloo Region adults were significantly more likely to have ever seen a cardiac defibrillator in a public place than females (50.6% (CI: 45.3-55.8), 37.5% (CI: 33.0-42.0) ). Adults aged 65 years and older were significantly less likely to have ever seen a cardiac defibrillator in a public place than adults aged 18 to 24, 25 to 44 or 45 to 64 years (Table 5). Table 5: Per cent of adults who have ever seen a cardiac defibrillator in a public place, by age group, Waterloo Region, 2011 18-24 25-44 45-64 65+ 60.0% (CI:48.5-71.5) 47.4% (CI:41.3-53.6) y 45.3% (CI:39.9-50.8) z 19.5% E (CI:12.8-26.3),y,z RRFSS Monitor CPR and PAD Page 5 of 12
Adults who have completed post-secondary education were significantly more likely to have ever seen a cardiac defibrillator in a public place than adults who had less than a high school diploma or who had completed high school or some post-secondary education. As well adults who had less than a high school education were significantly less likely to have seen a cardiac defibrillator in a public place when compared to adults who had completed high school or had some post-secondary education (Table 6). Table 6: Per cent of adults who have ever seen a cardiac defibrillator in a public place, by level of educational attainment, Waterloo Region, 2011 Less than high school Completed high school or some post-secondary 13.2% E (CI: 5.6-20.8),y 38.0% (CI: 32.2-43.9),z Completed post-secondary 51.7% (CI: 47.0-56.3) y,z The superscript E denotes high sampling variability, and estimates must be interpreted with caution Adults with a household income of $70,000 or more were significantly more likely to have ever seen a cardiac defibrillator in a public place than adults with a household income of less than $30,000 or adults who did not disclose their income (Table 7). Table 7: Per cent of adults who have ever seen a cardiac defibrillator in a public place, by household income, Waterloo Region, 2011 <$30,000 $30,000 to $69,999 22.4% E (CI:11.7-33.1),y 38.6% (CI:31.8-45.4) 53.7% (CI:44.8-62.5),z $70,000 to $99,999 $100,000 + 57.4% (CI:50.3-64.4) w,y Don t know/ Refused 35.4% (CI:29.2-41.6) z,w non-overlapping confidence intervals, e.g. two proportions with an net to them are statistically different from each other Adults who were born in Canada (90.4% (CI: 87.2-93.6) ) were significantly more likely to have ever seen a cardiac defibrillator in a public place than adults who immigrated to Canada (29.6% (CI: 22.7-36.5) ). Adults who are employed full-time (including self-employed) were significantly more likely to have ever seen a cardiac defibrillator in a public place than adults who are employed part-time (including those that were retired, a student, or had other family responsibilities) (Table 8). Table 8: Per cent of adults who have ever seen a cardiac defibrillator in a public place, by employment status, Waterloo Region, 2011 Employed full-time Employed part-time Unemployed Unable to Work 49.3% (CI:45.1-53.6) 29.5% (CI:23.5-35.6) F F An F denotes unacceptable sampling variability, and estimates or conclusions based on these data will be unreliable and most likely invalid.. Adults who have children under the age of 18 years in their home were significantly more likely to have ever seen a cardiac defibrillator in a public place than adults who did not have any children under the age of 18 in the home (55.4% (CI: 49.6-61.2) versus 36.5% (CI: 32.3-40.6) ). RRFSS Monitor CPR and PAD Page 6 of 12
Awareness of who can use a cardiac defibrillator When adults in Waterloo Region were asked who they thought could use cardiac defibrillators, 26.2% (CI: 23.2-29.3) of respondents said anyone, 46.5% (CI: 43.1-50.0) said only people who had been trained, and 27.2% (CI: 24.1-30.3) were not sure. Adults aged 65 years and older were significantly less likely to say that anyone can use a cardiac defibrillator than adults aged 25 to 44 or 45 to 64 years (Table 9). As well, adults who had completed post-secondary education (32.7% (CI: 28.3-37.0) ) were significantly more likely to say that anyone can use a cardiac defibrillator than adults who had some post-secondary education or less (19.6% (CI: 14.8-24.4) and 11.8% E (CI: 14.6-19.1) respectively). Table 9: Per cent of adults who say anyone can use a cardiac defibrillator, by age group, Waterloo Region, 2011 18-24 25-44 45-64 65+ 19.7% E (CI:10.5-29.0) 31.5% (CI:25.8-37.2) 27.6% (CI:22.8-32.5) y 16.2% E (CI:10.0-22.4),y The superscript E denotes high sampling variability, and estimates must be interpreted with caution. Adults with a household income of $100,000 or greater were significantly more likely to say that anyone can use a cardiac defibrillator than adults with a household income of $30,000 to $69,999 or adults who did not disclose their income. As well, adults with a household income of $70,000 to $99,999 were significantly more likely to say anyone can use a cardiac defibrillator than adults with a household income of $30,000 to $69,999 Table 10). Table 10: Per cent of adults who say anyone can use a cardiac defibrillator, by household income, Waterloo Region, 2011 <$30,000 F $30,000 to $69,999 20.4% (CI:14.8-26.0),y $70,000 to $99,999 $100,000 + 34.4% (CI:26.0-42.9) y 37.7% (CI:30.8-44.6),z Don t know/ Refused 20.8% (CI:15.5-26.1) z An F denotes unacceptable sampling variability, and estimates or conclusions based on these data will be unreliable and most likely invalid Adults who are employed full-time (including self-employed) (28.5% (CI: 24.7-32.4) ) were significantly more likely to say that anyone can use a cardiac defibrillator than adults who are employed part-time (including those that were retired, a student or had other family responsibilities) (19.3% (CI: 14.1-24.5) ). Finally, adults who have children under the age of 18 years in their home (34.8% (CI: 29.2-40.4) ) were significantly more likely to say that anyone can use a cardiac defibrillator than adults who do not have children under the age of 18 in their home (21.6% (CI: 18.0-25.1) ). RRFSS Monitor CPR and PAD Page 7 of 12
Majority of Waterloo Region adults willing to perform CPR or use a PAD In 2011, the majority of Waterloo Region adults were either very willing or somewhat willing to perform CPR or use a PAD. Respondents were significantly more willing (either very or somewhat) to perform CPR on a family member or a close friend than someone they did not know (81.4% (CI: 78.7-84.1) versus 68.5% (CI: 65.2-71.7) ). Significant differences eisted by age, household income and immigration status for adults willing to do CPR on a family member Adults aged 45 to 64 years (86.0% (CI: 82.2-89.8) ) were significantly more likely to be very willing or somewhat willing to perform CPR on a family member compared to adults aged 65 years or older (70.5% (CI: 62.7-78.2) ). Adults who have a household income of $70,000 or more were significantly more likely to be very willing or somewhat willing to perform CPR on a family member compared to adults who have a household income of less than $30,000 or who did not disclose their income (Table 11). Table 11: Per cent of adults who are very willing or somewhat willing to perform CPR on a family member, by household income, Waterloo Region, 2011 <$30,000 70.2% (CI:58.3-82.1),y $30,000 to $69,999 77.9% (CI:72.1-83.7) 89.4% (CI:84.0-94.9) z, $70,000 to $99,999 $100,000 + 92.1% (CI:88.2-95.9) z,y Don t know/ Refused 73.7% (CI:67.9-79.4) z Adults who were born in Canada (83.8% (CI: 80.9-86.8) ) were significantly more likely to be very willing or somewhat willing to perform CPR on a family member than adults who immigrated to Canada (73.6% (CI: 67.0-80.1)). Significant differences eisted by se, age, and household income for adults willing to do CPR on someone not known to them Male adults (74.1% (CI: 69.6-78.7) ) were significantly more likely to be very willing or somewhat willing to perform CPR on someone not known to them than females (64.2% (CI: 59.7-68.7) ). As well, adults aged 65 years or older were significantly less likely to be very willing or somewhat willing to perform CPR on someone not known to them than adults aged 18 to 24, 25 to 44 or 45 to 64 years (Table 12). Table 12: Per cent of adults who are very willing or somewhat willing to perform CPR on someone not known to them, by age group, Waterloo Region, 2011 18-24 25-44 45-64 65+ 76.1% (CI:66.1-86.0) 71.7% (CI:66.1-77.2) y 71.3% (CI:66.4-76.3) z 53.5% (CI:44.9-62.1) z,y,z RRFSS Monitor CPR and PAD Page 8 of 12
Adults with a household income of $70,000 or more were significantly more likely to be very willing or somewhat willing to perform CPR on someone not known to them than adults with a household income of less than $70,000 or adults who did not disclose their income (Table 13). Table 13: Per cent of adults who are very willing or somewhat willing to perform CPR on someone not known to them, by household income, Waterloo Region, 2011 <$30,000 58.6% (CI:45.9-71.3) s,t $30,000 to $69,999 64.8% (CI:58.2-71.5) u,v $70,000 to $99,999 $100,000 + 79.7% (CI:72.6-86.8) w,s,u 78.9% (CI:73.2-84.7),t,v Don t know/ Refused 59.4% (CI:52.9-65.9) w, Significant differences eisted by se, age, education level, and household income for adults willing to use a PAD on someone not known to them Male adults (66.1% (CI: 61.1-71.0) ) were significantly more likely to be very willing or somewhat willing to use a PAD on someone not known to them than females (54.9% (CI: 50.3-59.6) ). As well, adults aged 45 to 64 years (67.8% (CI: 62.7-72.9) ) were significantly more likely to be very willing or somewhat willing to use a PAD on someone not known to them than adults aged 65 years or older (46.5% (CI: 37.9-55.1) ). Adults who have completed post-secondary education (66.6% (CI: 62.2-71.0) ) were significantly more likely to be very willing or somewhat willing to use a PAD on someone not known to them than adults who had some post-secondary education or less (51.9% (CI: 45.9-58.0) and 50.0% (CI: 38.5-61.5) respectively). Adults who have an income of $100,000 or more were significantly more likely to be very willing or somewhat willing to use a PAD on someone not known to them than adults with an income between $30,000 and $99,999 or adults who did not disclose their income (Table 14). Table 14: Per cent of adults who are very willing or somewhat willing to use a PAD on someone not known to them, by household income, Waterloo Region, 2011 <$30,000 $30,000 to $69,999 58.2% (CI:45.1-71.2) 58.5% (CI:51.7-65.3) u $70,000 to $99,999 $100,000 + 55.4% (CI:46.5-64.2) v 73.2% (CI:66.9-79.5) t,u,v Don t know/ Refused 53.4% (CI:46.8-60.0) t There were no significant differences in willingness to perform CPR or use a PAD by employment status, marital status, municipality of residence, or by presence of children in the home for any of the response categories. Previous CPR and PAD training was influential on the respondent s willingness to perform CPR or use a cardiac defibrillator. In 2011, 59.9% (CI: 56.5-63.3) of Waterloo Region adults were very or somewhat willing to use a cardiac defibrillator. Adults who took a CPR course that included training on the use of cardiac defibrillators were significantly more likely to be willing to use a cardiac defibrillator on someone than adults who had CPR training but had not taken a course on the use of cardiac defibrillators (92.9% (CI: 88.9-97.0) versus RRFSS Monitor CPR and PAD Page 9 of 12
Per cent of adults aged 18 and older 54.7% (CI: 49.3-60.2) ). In general, regardless of their level of training, adults were not as willing to use a PAD as they were to perform CPR (Figure 3). Figure 3: Per cent of adults willing to perform CPR or use a PAD, by level of willingness and training, Waterloo Region, 2011 100 90 I = 95% Confidence Interval 80 70 60 50 40 30 20 10 0 CPR trained Not CPR trained CPR trained Not CPR trained CPR trained Not CPR trained Very or somewhat willing Not very or not at all willing Not sure CPR on family or close friend 92.3 63.4 E E E 2.6 10.1 5.1 26.5 CPR on someone not known 80.3 49.5 7.9 17.8 11.8 32.7 PAD on someone 67.1 48.5 27.5 36.0 E 5.4 15.5 The superscript E denotes high sampling variability, and estimates must be interpreted with caution. It is important to note that Ontario has a Good Samaritan Act (2001) which protects individuals from legal fault or court action when they try to help those who are ill or injured. As a result, any person who feels comfortable helping someone who appears lifeless or unresponsive may do so, regardless of prior training eperience, although training is highly recommended. RRFSS Monitor CPR and PAD Page 10 of 12
About RRFSS survey Information here is presented from the Rapid Risk Factor Surveillance System (RRFSS). RRFSS is an on-going telephone survey occurring in participating public health units across Ontario. On a monthly basis, a random sample of approimately 100 adults aged 18 and older are interviewed regarding risk behaviours of importance to public health. The survey is conducted by the Institute for Social Research (ISR) at York University, on behalf of Region of Waterloo Public Health. For more information, please visit www.rrfss.ca Analyzed Questions (total weighted 2011 sample (n) = 811) Have you ever taken a CPR course or any other type of training in CPR? (n = 811) When did you take your last CPR course? (n = 495) Did the course you took include training on the use of cardiac defibrillators? (n = 487) How willing would you be to perform CPR on a family member or close friend who appeared lifeless or unresponsive? (n = 791) How willing would you be to perform CPR on someone you did not know who appeared lifeless or unresponsive? (n = 789) Have you ever seen, read, or heard about a program that makes cardiac defibrillators available for use in public places such as office buildings, arenas, schools, and shopping malls? (n = 805) Have you ever seen a cardiac defibrillator in a public place in Waterloo Region? (n = 793) Do you think that cardiac defibrillators can be used by anyone, or only by people who have been trained to use them, or are you not sure? (n = 797) How willing would you be to use a cardiac defibrillator on someone lifeless or unresponsive? (n = 796) Analyzed Indicators Per cent of adults (18+) who have been trained in CPR. Length of time since last CPR course. Per cent of adults (18+) with CPR training who have also received training on cardiac defibrillators. Per cent of adults (18+) willing to perform CPR on a family member or a close friend. Per cent of adults (18+) willing to perform CPR on someone they did not know. Per cent of adults (18+) who have ever seen, read, or heard about a program that makes cardiac defibrillators available for use in public places. Per cent of adults (18+) who have seen a cardiac defibrillator in a public place. Per cent of adults (18+) who think cardiac defibrillators can be use by anyone, or only people trained to use them, or are not sure Per cent of adults (18+) willing to use a cardiac defibrillator on someone. Important definitions and cautions All data were analyzed according to the 2012 RRFSS Manual of Operations. Uppercase superscript E denotes high sampling variability, and estimates must be interpreted with caution. Uppercase superscript F denotes unacceptable sampling variability, and estimates or conclusions based on these data will be unreliable and most likely invalid. A "module" in RRFSS is a self-contained group of questions on a specific public health topic. Modules may be added or removed from RRFSS each cycle of the on-going survey system. RRFSS Monitor CPR and PAD Page 11 of 12
Confidence intervals and coefficient of variation were calculated using weighted sample sizes and weighted estimates to reflect the number of adults in a household. Tests of significance were not performed; statistically significant differences were determined by non-overlapping confidence intervals. The survey was only administered in English, using a random digit dialling methodology and represents the behaviours, attitudes, and beliefs of adults in Waterloo Region. Participants who provided a don t know or refused or other response to a CPR/PAD module question were ecluded from analysis. Region of Waterloo Public Health Epidemiology and Health Analytics Team 99 Regina Street South, Third Floor Waterloo, Ontario, N2J 4V3 Canada Phone: 519-883-2004 Fa: 519-883-2241 TTY: 519-575-4608 Email: eha@regionofwaterloo.ca Internal access to report: DOCS #1317956 RRFSS Monitor CPR and PAD Page 12 of 12