The Need for Mandatory CPR Training in Hong Kong

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, and Hong Kong is no exception. With an OHCA survival rate of just 2.3%—far below the global average of 8-12%—the city faces a critical need for more bystanders trained in cardiopulmonary resuscitation (CPR). Studies show that bystander CPR can double or even triple survival rates, yet only 20.4% of Hong Kong respondents are willing to perform it, often due to lack of training.

Multiple school-based resuscitation education programs have been conducted overseas in Spain, Singapore, and New Zealand, and legislation mandating compulsory training was established in Denmark, Canada, and >20 states in the United States. Secondary schools are the ideal setting for mandatory CPR training because students are physically capable. Research confirms that by ages 10-12, children can perform effective chest compressions. Besides, training students creates a generation of lifesavers who retain skills into adulthood. And students can share knowledge with family and friends, amplifying community preparedness.

The European Resuscitation Council (ERC) and International Liaison Committee on Resuscitation (ILCOR) strongly advocate for school-based CPR programs. The ERC calls it an "effective way to lower death rates from cardiac arrest," while ILCOR’s 2023 scientific statement emphasizes that training children as young as 4 in basic life support (BLS) improves survival outcomes.

ILCOR’s Recommendations for Effective School CPR Training

In 2023, ILCOR’s published a comprehensive review which outlines key strategies for teaching CPR to schoolchildren:

• Start Early: Children as young as 4 can learn to recognize emergencies and call for help. By 10-12, they can perform proper chest compressions

• Hands-on Practice: At least 2 hours of annual training, with small group sizes (3-5 students per instructor), ensures skill retention.

• Use of Technology: Virtual reality, apps, and video lessons enhance engagement, especially where resources are limited.

• Teacher-Led Training: Schoolteachers, after proper training, are just as effective as medical professionals in teaching CPR.

• AED Integration: Students should learn AED use alongside CPR, as early defibrillation drastically improves survival. Integrate AED education and practice in schoolchildren gradually.

While these suggestions align with Hong Kong’s "Heart-safe School Project", which already trains teachers in CPR, expanding it to all students would maximize impact.

Encouragingly, school principals overwhelmingly support CPR training. A 2018 survey of 110 Hong Kong secondary schools found that 69.1% of principals agreed CPR training should be compulsory. More than 90% of schools with existing CPR programs reported positive student feedback, with students feeling more confident and willing to help in emergencies.

Obstacles to Implementing Mandatory CPR Training in Hong Kong

Despite strong evidence, several challenges are currently faced by Hong Kong schools in making CPR training compulsory which include:

• Curriculum Overload: 34.1% of schools struggle to fit additional training into packed schedules.

• Lack of Funding: 14.6% of principals in the 2018 survey cited financial constraints as the biggest barrier

• Fear of Liability: Without "Good Samaritan" laws, some teachers and students worry about legal risks if CPR is performed incorrectly

To overcome these barriers, we can, at government level, legislate compulsory CPR training in secondary schools, allocate funding for manikins, instructor training, and AEDs, integrate CPR into existing subjects to minimize disruption and enact Good Samaritan laws to protect rescuers.

To conclude, Hong Kong’s dismal OHCA survival rate demands urgent intervention. Mandatory CPR training in schools, backed by ILCOR’s evidence-based strategies and ERC’s advocacy, will be an effective solution. By empowering students with lifesaving skills, Hong Kong can transform bystanders into responders and save immeasurable number of lives.