O3280: Enhancing Cardiac Emergency Preparedness in Schools: A CFIR-Guided Evaluation of Project ADAM Implementation in Rhode Island Public High Schools

Background: Early recognition of sudden cardiac arrest (SCA) and immediate response with cardiopulmonary resuscitation (CPR) and defibrillation significantly improves survival rates. However, many schools face challenges in implementing effective SCA preparedness programs, and Rhode Island specifically does not have any legislation mandating cardiac response teams in schools. Project ADAM® has demonstrated promise in overcoming such barriers by providing schools with the resources to develop cardiac emergency response plans. Our study not only evaluates the implementation and sustainability of Project ADAM in Rhode Island public high schools, entitled “HeartSAFE Schools Rhode Island,’ using the Consolidated Framework for Implementation Research (CFIR) model, but also showcases an innovative approach to medical education and advocacy.

Project Description: This study, conducted between September 2022 and December 2024, engaged high school nurses who volunteered as CPR Champions for their schools. Participants were recruited through partnerships with organizations such as the Rhode Island Chapter of the American Academy of Pediatrics and the Rhode Island School Nurse Teacher Association. Throughout the study period, our research team collaborated with schools and local EMS crews to perform school walk-throughs to assess their cardiac readiness, and then ran simulated cardiac arrest drills on site with school faculty to establish and practice their school-specific cardiac emergency response plans. The CFIR model was applied to assess factors affecting the intervention’s adoption, implementation, and sustainability across multiple domains. Data were collected via pre- and post-surveys and focus groups, and quantitative responses were analyzed for themes.

Discussion: The implementation of HeartSAFE Schools Rhode Island as a medical education and advocacy initiative in the community resulted in significant improvements in cardiac preparedness. Key outcomes included an increase in the proportion of schools with CPR-AED site coordinators (from 26.7% to 100%), schools with annual SCA training for all staff (from 0% to 85.7%), and schools with a written cardiac emergency response plan (from 0% to 93.3%). When reviewing qualitative responses from participants, participants identified challenges such as time constraints and funding, but also identified successful adaptations such as increased leadership engagement and partnerships with local EMS providers.

Conclusion: The implementation of HeartSAFE Schools Rhode Island demonstrated substantial improvements in cardiac emergency preparedness outcomes, and highlighted that partnership with schools and simulation teaching is an innovative approach to medical education and community engagement. By applying an implementation science framework early in the process, we were able to identify modifiable factors that influenced the success of cardiac arrest emergency action plans in public schools. These factors included leadership support, training adequacy, resource allocation, and stakeholder engagement. Our results highlight the importance of using structured frameworks like CFIR to identify key barriers and facilitators that subsequently affect the sustainability of such initiatives in schools.