Using Blended Learning for CPR, AED, and First Aid

At some point, most learners will have little experience with traditional approaches to learning that don't involve technology. Finding newer methods is essential.

You are the safety director for a manufacturing organization that has a main campus and two remote locations. It is time to renew your employees' training in cardiopulmonary resuscitation (CPR), the use of an automated external defibrillator (AED), and first aid. As you sit down to schedule the training, you deal with the realities of the traditional process: how to minimize the impact on production…how to accommodate shift employees… how to include remote location employees… how to control costs…how to handle the few employees who cannot make the training session…

Maybe blended learning can help.

Blended learning, as its description implies, is an approach to learning that uses a combination or blend of delivery methods to provide learners with information, concepts, and skills on a particular subject.

Technology, through the Internet and local intranets, provides a great opportunity for a blended approach to education. Much of the knowledge content of a subject can be provided to a learner online, leaving face-to-face sessions with an educator and other learners to focus on interactive discussions and practices. The concept of blended learning is not unique to CPR, AEDs, and first aid training. Many traditional schools, hospitals, and universities today blend online and classroom approaches to learning.

The use of blended learning by training providers in CPR, the use of an AED, and first aid is relatively new. All of the national training organizations now have some form of blended learning available. The basic structure is an online training session, followed by a hands-on skills practice and evaluation session.

The potential benefits of blended learning include:

1. Greater convenience. Moving the learning of knowledge online can shorten hands-on skill sessions and allow for more scheduling alternatives.

2. Reduction in group time. The resulting effects of having groups of individuals together are reduced.

3. Consistency. All learners follow the same process and are exposed to the same information.

4. Cost savings. Shorter hands-on sessions or smaller groups can significantly reduce the cost of bringing a group of people together for training.

Different Approaches

Currently, there are two different approaches to blended learning that have emerged in emergency care instruction. The first is a centralized approach in which a learner initially goes to a training organization Web site to complete the online portion and then is directed to a list of localized training centers where the skills session can be attended. The greatest diffi- culty in this approach is the necessity of learners to deal with two separate organizations to get trained.

The other approach that has emerged is a decentralized one in which the local training center deals directly with groups or individuals to provide both the online and hands-on sessions. The learner still accesses the larger training organization's Web site, but it is arranged locally by the training center. Communication and logistics are oft en much improved by this approach.

Some organizations provide online-only training that does not include any hands-on skill practice or evaluation. They make themselves easily searchable on the Internet for quick and easy CPR certification or recertification. Any approach to training that does not require skill practice and evaluation for certification is not blended learning and needs to be avoided. The goal in training an individual in CPR, AED, and first aid skills is so he or she can perform those skills if a situation arises that requires them. Repeated exposure to skills practice and evaluation is essential for adequate performance in a real-life situation. Increasingly, regulatory authorities are implementing rules that require face-to-face instructor evaluation of skills by learners.

The Online Portion

Online education does offer a number of advantages over the classroom approach to learning cognitive content (typically, a lecture). The first and most important aspect is that online learning is individualized. In general, the flow, emphasis, and pace of going through the information is controlled by the learner. Greater time and effort will naturally be spent on things the learner is less familiar with, and less time will be spent on those things the learner is already aware of.

Online learning is consistent. The exposure to each learner is identical. This could be a benefit for companies or organizations that currently train learners in multiple locations with multiple instructors.

Using an online approach also allows for much greater learner interaction. Online training courses can reduce the dependency on text and imbed still images, video clips, and computer animations to convey content. Interactive exercises allow learners to be more engaged with the content to improve understanding and retention. These exercises can be as simple as ordering steps or rolling cursors over images to reveal names or defi- nitions. They also can include more involved computer animations, where a learner uses a mouse to operate a simulated device. Scenarios can be created in which learners work through a decision tree that can result in success or failure.

There are some difficulties that need to be considered with blended learning. The most important is the willingness of the individual learner to use it as it was designed. Motivating learners is a critical aspect of getting them to complete an online training class. This could prove to be the greatest challenge to overcome.

Novice computer users need something simple to use or they get overwhelmed quickly. Similarly, learners with lots of computer experience need something that is quick and familiar or they may move on to other things. All learners must be engaged or they will move on to something more engaging, whether online or somewhere else.

Part of the solution is a clear channel of communication. Having a system that can send e-mail reminders and provide status reports to administrators is very helpful in keeping learners on track and aware of completion deadlines.

The Hands-on Portion

The hands-on portion of blended training is critical for successful completion of the skill objectives for CPR, AED, and first aid training. It is important to understand that for most learners, this session is for practice and evaluation and is not simply a "skills checkoff ." The objective of the online portion is to cover the knowledge and concepts of the topic, but not to develop the physical skills. Skills can be improved and mastered only through hands-on practice.

Skill training can be facilitated through the same combination of proven techniques, such as demonstrations, practice-whilewatching, learner coaching in small groups, manikin feedback devices, and scenario applications, that are used in traditional classroom training classes. Video programs, lectures, and other means of conveying knowledge can be eliminated or shortened to reduce the training time.

Prior learner experience is always considered when structuring skill practice sessions. Less-experienced learners may require some form of knowledge refreshing prior to the hands-on portion. The degree of the refresher will depend on the overall level of understanding of the content by the learner.

In some cases, especially where there is a significant learner experience level, skill challenges can be used effectively. Challenging skills does not remove the necessity of learner practice. It also does not make the assumption that the online portion prepared a learner to perform the skills adequately. In a skills challenge, it is the responsibility of the learner to come prepared, most likely with self-conducted hands-on practice done. In a challenge, the potential of not being successful needs to be communicated to a learner up front. The personal decision to attempt a challenge needs to be made individually, with the option to go through a practicedriven approach available.

The New Frontier

Now that you know about the basic structure of blended learning, let's talk about how it will affect CPR, AED, and first aid training. Blended CPR, AED, and first aid training has been available for only a few years and currently is used by early adopters. Very little evidence of its effectiveness has been published. However, a recent U.S. Department of Education review of evidence-based practices in online learning found that, on average, blended learning is more effective than either face-to-face or online learning alone.

There are two things pushing along the move to things such as blended learning. The first is the rapid growth and application of technology in our lives. The second is the effect of that growth on the expectations of learners, especially young learners. At some point, the majority of learners will have little experience with traditional approaches to learning that don't involve technology. Finding newer methods that take advantage of technology is essential.

In essence, the success or failure of blended learning in our industry is up to us and the applications we find for its use. Significantly, shortened skill practice sessions can lead to new ways to schedule them. Individual skill practices or skill stations could provide more efficiency and logistical freedom for organizations. Remote locations or employees can be better managed with reduced travel costs.

Retention has long been an issue in our industry, especially with skill performance. Perhaps blended training solutions will provide a greater opportunity to improve ongoing refresher training that can maintain skills between certification periods.

How Do I Get Started?

As described above, all of the major training organizations have blended training choices available. The choices are different, so be sure to look around.

Centralized solutions can provide entrepreneurial training centers a chance to provide outsourced skills training.

Decentralized solutions allow businesses and organizations to control the entire training process and are the most benefi- cial to gaining the advantages that blended learning allows. Having a single point of contact for scheduling and administrating keeps things simple and reduces confusion.

Administrators need to have access to a system that allows for easy enrollment, at-a-glance learner completion status, effective e-minders, and effective recordkeeping. A system that integrates learner information between the online and hands-on portion makes administration much easier. Learners need an online learning platform that is simple to understand and navigate. Clear communication of completion status will help keep learners on track to meet training deadlines. The effective use of visual elements, such as still images, videos, computer animations, and interactive tools, will keep learners engaged in the content. Simulations can help them better understand skills and sequences in the content and help prepare them for the skills session. Ongoing quizzing of content and the use of interactive exercises, such as flashcards, ordering, matching, and rollover, help to increase exposure to critical content.

Access to enrichment information, such as Web links, downloadable documents, and extended videos, allow interested learners to go beyond the required information and develop more critical reasoning about content.

As noted, be careful about organizations attempting to provide questionable onlineonly training services. Make sure skills training is required, and check to make sure the completion document provided is accepted by the regulatory authority in your area.


Although new to the scene, blended learning for CPR, the use of an AED, and first aid is an acceptable approach to training. Its success, for the most part, depends on the collective acceptance by mainstream instructors in the industry. The emerging benefits are attractive and will certainly provide more innovative ways to accomplish training. The biggest obstacle to overcome will be the willingness of learners to direct themselves through the online portion.

This is the initial leg of a longer journey that will merge technology and training. Your involvement and willingness to explore new things is a vital part of making that journey productive and successful. Come along for the ride.



1. Graham, C. R. (2005). “Blended learning systems: Definition, current trends, and future directions.” in Bonk, C.J.; Graham, C.R. Handbook of blended learning: Global perspectives, local designs. San Francisco, CA: Pfeiffer. pp. 3–21.

2. Andresen D, et al. Public access resuscitation program including defi brillator training for laypersons: a randomized trial to evaluate the impact of training course duration. Resuscitation. 2008 Mar;76(3):419-24. Epub 2007 Oct 31.

3. Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies. U.S. Department of Education. May 2009. Available: Accessed 22 October 2009.

This article originally appeared in the February 2010 issue of Occupational Health & Safety.

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