DARE Train-the-Trainer Pedagogy Development Using 2-Round Delphi Methodology

Table 1

List of items that obtained consensus.

⁢Consensus statements showing agreement from Delphi survey rounds 1 and 2
Consensus statements	⁢Number of respondents in agreement		Established in round
		%
(1) The focus of general CPR
(a) Early access is the most important aspect to focus on during the trainers’ programme	14	70.0	1
(b) Early CPR is the second most important aspect to focus on during the trainers’ programme	15	75.0	1
(c) Early defibrillation is the least important of the three aspects to focus on during the trainers’ programme	16	80.0	1
(2) How the train-the-trainer session should be conducted
(a) There should be more than one person (instructor) conducting the session for the trainers	14	70.0	1
(b) There should be hands-on component for the trainers during the session	18	90.0	1
(c) The session should not be conducted entirely through a video for standardisation	14	70.0	1
(d) Qualification an instructor should have to carry out the session
CPR/AED instructor level	18	94.7	2
CPR/AED trained	17	89.5	2
(e) Video for the train-the-trainer programme should be of a professional tone	17	89.5	2
(f) Video for the train-the-trainer programme should be of a matter-of-fact (factual) tone	16	84.2	2
(g) Video should not cater to English speaking trainers only	16	80.0	1
(h) The video should have both subtitles and voice-over in other languages	14	70.0	1
(i) Hands-on component should be conducted after the video screening	16	80.0	1
(j) During the train-the-trainer session, there should be time allocated for each trainer to role-play with fellow trainers to be the main instructor	17	89.5	2
(k) Topics to be included in the curriculum
(i) Calling 995 and dispatcher’s assistance	19	100.0	2
(ii) The importance of quality CPR/AED	16	84.2	2
(iii) How to carry out CPR and the concerns faced when performing CPR	16	84.2	2
(iv) Spotting common CPR mistakes	16	84.2	2
(v) How to find and use an AED	19	100.0	2
(vi) Material to motivate bystanders to step up and respond to a cardiac arrest	14	73.7	2
(vii) DARE’s objectives and effectiveness	17	89.5	2
(viii) Importance of the trainer in DARE	19	100.0	2
(ix) Address the introduction of the CPR card (tells you the depth of chest compression) and MyResponder Application (notifying myResponders to nearby cardiac arrest cases who may render first aid before ambulance arrival)	16	84.2	2
(x) Recognising a cardiac arrest	19	100.0	2
(xi) Trainers’ ethics	14	73.7	2
(3) Key points in recognising a cardiac arrest
(a) Bystanders’ descriptions of agonal breathing should be taught to the trainers	20	100.0	1
(b) Warning signs like that of lack of breathing should be taught	14	73.7	2
(c) Head-tilt-chin-lift should be covered during the trainers’ training session	15	75.0	1
(d) Tapping on the shoulders of a person in possible cardiac arrest should be taught to the trainers	18	90.0	1
(e) Checking for danger should be included in the curriculum	17	85.0	1
(4) How CPR should be taught
(a) Locating the landmark for chest compression: trainers should be taught to position hands in between the nipples	15	78.9	2
(b) The latest American Heart Association updated guidelines stated for rescuers to push hard and fast. However, the guidelines state that compressions should be at least 5 cm but not greater than 6 cm and that chest compressions should be performed at a rate of 100 to 120/min. In a basic resuscitation programme like DARE, the new guidelines should not be taken into consideration and implemented in our train-the-trainer curriculum	15	78.9	2
(c) Trainers should correct the positioning of the DARE lay participants	20	100.0	1
(d) Trainers should physically move the participant’s hands into position	15	75.0	1
(e) The same resuscitation method can be taught during the session to be applied to a child in possible cardiac arrest	15	75.0	1
(f) Precautions specific to the paediatric age group should be taught to the trainers	15	75.0	1
(g) CPR should still be instituted to a person in cardiac arrest who had a fall	20	100.0	1
(h) CPR should still be carried out although the patient has a chest injury	18	94.7	2
(i) CPR should still be carried out although the patient has a spinal injury	18	94.7	2
(j) CPR should still be carried out although the patient has bony fractures [rib(s)/limb(s) etc.]	18	94.7	2
(5) Teaching the usage of AED
(a) The person conducting the training session should be using a real AED trainer set to demonstrate how to operate it to the trainers	15	75.0	1
(b) All trainers should practice on a real AED set made for trainers during the session	14	73.7	2
(c) At any one point in time, only 1 person should be operating the trainer AED	15	78.9	1
(d) It is necessary for every trainer to be taught how to use a community AED	16	80.0	1
(e) During training, a real community AED set should be available for the trainers to familiarise themselves with	14	70.0	1
(f) Trainers should be taught where AEDs are found in the community	19	95.0	1
(g) When applying the AED chest pads, the modesty of a female patient should be taken into consideration	16	84.2	2
(h) Her top should be lifted up slightly and not completely to paste the chest pads	16	80.0	1
(i) If she is wearing a dress, the entire dress should not be removed and expose her lower extremities to apply the AED pads	15	75.0	1
(6) Reading materials catered to the trainers’ session
(a) Budget should be set aside for the trainers’ precourse materials	18	90.0	1
(b) A trainer’s manual (to be given out on the training day itself) should be provided for the trainers	18	90.0	1
(c) The trainer’s manual should include a DVD of the trainer’s video	15	75.0	1
(d) The trainer’s manual should include basic CPR and AED guidelines	20	100.0	1
(e) The manual should be translated to cater to non-English speaking trainers	14	70.0	1
(f) There should be an online prelearning component for the trainers prior to attending the training session	15	78.9	2
(7) Frequently asked questions
(a) Trainers should be allowed to answer DARE participants’ questions based on their own knowledge	14	70.0	1
(b) There should be a fixed Q&A guidelines for the trainers to refer to and answer from when posed with questions from DARE participants	20	100.0	1
(c) The trainers should be taught to direct all questions to the person conducting the session for the DARE participants that day	14	70.0	1
(d) If participant trainers have any controversial questions during the train-the-trainer’s training session, the questions should be collated and answered after a consensus from the DARE coordinators is reached	18	94.7	2
(e) Should participant trainers have any questions during the session, they should approach the DARE coordinators directly during the training	14	73.7	2
(8) Trainers’ qualities and qualifications
(a) The minimum qualification a trainer should have before he/she is allowed to sign up to be a trainer for the DARE programme is BCLS and AED certification	14	70.0	1
(b) In view that the DARE programme hopes to reach out to the elderly as well, trainers who are well-versed in dialects should be taught how to teach lay participants in dialects	19	95.0	1
(c) In view of the high dependency on IT equipment to deliver the session, trainers should be taught how to operate IT equipment (i.e., projectors, computers, and basic IT skills)	16	80.0	1
(d) Adolescents (teenagers/students) who are allowed to become a trainer in the future should receive monetary remuneration	17	85.0	1
(9) Assessment of trainers
(a) Trainers should be assessed prior to training to gauge their competency level and suitability	17	85.0	1
(b) Trainers should be required to complete and pass an assessment after the training session before becoming an official DARE trainer	18	90.0	1
(c) Trainers should be assessed on their competency and knowledge in DARE/CPR and AED technique	18	94.7	2
(d) Trainers should be assessed on their ability to conduct the lessons and manage the classroom	19	100.0	2
(e) Trainers should be assessed on their attitude, communication skills, and confidence when teaching	18	94.7	2
(10) Continuity of the programme
(a) E-mailing the trainers is the best platform to disseminate updates to the trainers	16	84.2	2
(b) It is necessary for qualified DARE trainers to attend refresher courses (training session again)	14	70.0	1

Note: total number of responders was 20 for the first round and 19 for the second round.
CPR, cardiopulmonary resuscitation; BCLS, basic cardiac life support; AED, automated external defibrillator; DARE, dispatcher-assisted first responder; Q&A, question and answer; IT, information technology.