EP Initiatives

Force for Health Foundation and Sudden Cardiac Arrest Foundation Jointly Launch Student Health Force Chain of Survival Grant Program

Robert G. Gillio, MD1 and
Mary M. Newman, MS2
1Founder, Force for Health Foundation, and Co-founder, Sudden Cardiac Arrest Foundation, Lancaster, Pennsylvania; 2President, Sudden Cardiac Arrest Foundation, Pittsburgh, Pennsylvania

Robert G. Gillio, MD1 and
Mary M. Newman, MS2
1Founder, Force for Health Foundation, and Co-founder, Sudden Cardiac Arrest Foundation, Lancaster, Pennsylvania; 2President, Sudden Cardiac Arrest Foundation, Pittsburgh, Pennsylvania

In recognition of National Sudden Cardiac Arrest Awareness month in October, the Force for Health Foundation (www.force4health.org/) and the Sudden Cardiac Arrest Foundation (www.sca-aware.org/) jointly launched the Student Health Force Chain of Survival Grant Program in Lodi, New Jersey, where a new state law (NJ A2072) mandates that public schools provide education in CPR and how to use an automated external defibrillator (AED) to students before high school graduation.  The innovative, cost-effective program provides an effective option for schools seeking to meet state requirements. While the program was launched in New Jersey, it is also available nationally.

Background on State Requirements Related to CPR/AED Education in Schools

In 2011, the American Heart Association issued a statement urging state legislatures to make CPR education a requirement for all students before high school graduation and to provide the necessary funds to make this feasible. At that time, 36 states had legislation that “encouraged” CPR training.

A compilation of reports from the American Heart Association, the Sudden Cardiac Arrest Foundation, and other sources indicates there are 19 states that require quality CPR/AED education that includes psychomotor skills training before high school graduation, including New Jersey. In Utah, CPR/AED training is not only required, but funding is available to schools to provide such training.

Other states have CPR/AED education requirements for schools, but there are limitations. For example, in Illinois, schools are required to offer CPR/AED training, but students are not required to undergo training (HB 3724). In Indiana, CPR/AED training is a requirement for graduation from high school, but schools can get waivers to opt out of the training requirement (HEA 1290). In Nevada, students must undergo CPR/AED training as long as funds are available.

Still other states recommend CPR/AED training, but do not require it. In Wisconsin, for example, schools have been required to offer CPR/AED instruction since the 2011-2012 school year; however, it is not a requirement for high school graduation. In Connecticut, school boards will be required to make CPR/AED training available (Public Act 12-198) beginning in school year 2015-2016. In South Dakota, CPR/AED training is recommended, but it is not a requirement that all students undergo such training (AB 414). Other states considering legislation related to CPR/AED training in schools include Maine (LD 709, LD 1366), Massachusetts (SB 266), Michigan (HB 4272), and New York (S 6410, A 8232).   

Genesis of the Student Health Force Program

The Student Health Force program grew out of a need among health educators in post-Katrina New Orleans. Medical volunteer Robert Gillio, MD, started training local high school students with a simple concept around complex issues pertaining to health issues. Everything was broken down into three action steps: “Learn it,” “Live it,” and “Share it.” The teens became role models for their friends and families, and eventually became paid temporary staff of the school district, teaching health to middle school and elementary school youth. The success of the program led to the addition of CPR/AED education to the nutrition, fitness, safety, and health literacy messaging.  

The Chain of Survival  course is one outcome of that activity. The “Learn It” component invites youth to learn about heart and lung anatomy and physiology, and understand sudden cardiac arrest and how to intervene in the event of an emergency by addressing the links in the Chain of Survival:

  • Recognize the life-threatening situation
  • Call for help
  • Start CPR
  • Use an AED
  • Transfer care to healthcare professionals, and
  • Live a healthier lifestyle upon recovery.  

The “Live it” component invites students to practice lifesaving skills in a classroom with CPR manikins (or other malleable material) and become comfortable with compressing the chest two inches deep at a rate of 100 beats a minute — to the tune of “Stayin’ Alive,” by the BeeGees, “Lay Your Hands on Me,” by New Jersey’s own Bon Jovi, or one of dozens of other songs with a similar beat.

The “Share it” component invites students to take what they have learned and share it with family members, friends, and others. The program takes three or four class or club sessions to complete. The participant, while not formally certified by an organization such as the American Heart Association or the American Red Cross, becomes familiar with the basic terms, concepts, and physical skills needed to save a life.

The Chain of Survival program includes an online educational curriculum with lesson plans, lessons, assessments, simulations, and hands-on practice. Students gain access to the HealthForce app (www.force4health.org/health-force-app/) and augmented reality posters (www.force4health.org/posters/), which are designed not only for learning, but also for real-time coaching in actual emergencies.

The HealthForce app is downloadable at the app store for smartphones and tablets. Once installed, it can be used to scan an image in the gallery at www.StudentHealthForce.com/Wellness and then play an instructional video and link to web resources. The Chain of Survival graphic may be printed on stickers and placed on AED device cabinets for real-time instruction or coaching in an actual event. The user is encouraged to download and widely share these images and apps.  

Program Debut in Lodi, New Jersey

The School Health Force Program debut was hosted by the Boys & Girls Club of Hackensack/Lodi, represented by Joseph Licata, president of the Lodi Board of Education. About 20 Lodi High School honor students attended, along with school and public officials, and other guests.

 “We believe all students can be a force for health by learning, living, and sharing lifesaving skills,” said Dr. Gillio of the Force for Health Foundation. “Our goal is to engage them to learn a skill and be motivated to practice it, teach others, and use that skill if it is ever needed. We have seen where informed and motivated teenagers have become a force for health in their families and communities. We want to expand that force to include lifesaving skills in the Chain of Survival from sudden cardiac arrest. We hope they download the app and poster, and at a minimum, share the links or images with others, and make it a viral awareness campaign. I am hoping EP professionals will do the same.”

Mary M. Newman, MS, of the Sudden Cardiac Arrest Foundation, concurred, describing the rationale for the program. “Sudden cardiac arrest, a leading cause of death in the U.S., affects about 1,000 people each day, including 26 young people,” she said. “This is equivalent to three 747s crashing daily and killing everyone onboard. While the average survival rate is about 10 percent, when bystanders call 9-1-1, start CPR, and use the nearest AED, survival rates increase to 40 percent and higher,” she said. “The Student Health Force Program is designed to help create a new generation of lifesavers who are ready, willing, and able to help save lives in sudden cardiac emergencies.”

According to Assemblyman Benjie E. Wemberly (D-Paterson), who spoke at the event, “As a legislator and a long-time coach, I wholeheartedly support this effort.” Further affirming the new program was Frank Quatrone, Lodi Superintendent of Schools. “It’s vital for students to have this type of training,” he said. “It can increase the survival rate.”

After the presentations, students explored the online course in the club’s computer lab, and practiced hands-on CPR, using “CPR Anytime” kits donated by Laerdal Medical and Enerspect Medical Solutions. Going forward, students planned to share their experience with other students and with family and friends.

How the Student Health Force Grant Program Works

Two high schools from each county in New Jersey will be selected to receive the grant-funded program at no cost for 2014-2015. Each grant-funded high school may share its program with an after-school program or other community partner. All other interested schools will receive a 50 percent grant and may participate in the educational program for an annual subscription of $250 or $1.99 per student, whichever is greater. New Jersey schools may apply for the grant here: https://docs.google.com/forms/d/1_kjsCdJ6Y-KBE0Y5lupOrfoh8KQuD6zNpYNluLN-9_Q/viewform. Schools in other states should contact info@force4health.org.

Bringing it Home

The importance of preparing for sudden cardiac arrest in school settings was underscored by several poignant stories shared during the Lodi event. JoAnne Babbitt, of the John Taylor Babbitt Foundation in Chatham, described the loss of her teenage son to sudden unexpected cardiac arrest and her family’s subsequent efforts to place AEDs in schools in his memory. Fred Hirsch, of Lodi, described the work of the Gregory M. Hirsch Heart Foundation, created in memory of his son, which provides heart screening for local schools.

Joining the event via video were school nurse, Mary Ellen Urbanowicz, and physical education teacher, Erin Durborow, from Eisenhower Intermediate School in Bridgewater, New Jersey. Urbanowicz described the day last November when she saved Durborow’s life by giving her CPR and using the school’s AED. Little did she know, Durborow was 14 weeks pregnant, so two lives were saved that day. Erin has returned to teaching and her son, Sean, is a healthy eight-month-old baby.
Steven Papa, an athletic trainer at Pascack Hills High School in Montvale, recounted his experience as a rescuer, having helped save the life of student-athlete Anthony Cortazzo last spring by giving CPR and using the school’s AED. “After all those years of practicing and teaching CPR, you never think you are going to need to use it. But then, one day, you do…and you need to be ready.”

Cortazzo, now a senior, was at track practice last spring when he suddenly collapsed in cardiac arrest. “I know that I’m standing here today because of an AED and individuals who were properly trained,” he said. The young athlete since underwent open-heart surgery and is expected to return to the football field this season.

The AED Readiness Project

In addition to requiring students to learn CPR and how to use an AED before graduation from high school, New Jersey also requires all K-12 schools to have AEDs on site. The Garden State is not alone: at least 18 other states require that schools have AEDs.

The AED Readiness Project (http://www.sca-aware.org/schools/school-news/the-aed-readiness-project-a-cost-effective-solution-for-schools-seeking-aeds), a related opportunity, provides a way for schools to acquire recertified AEDs at a fraction of the cost of new AEDs. Schools seeking to acquire AEDs should submit an inquiry at: https://15a88e.campgn2.com/Donate-450-support-a-vital-cause-and-receive-a-lifesaving-AED.

During the event, Newman presented a recertified AED, donated by the Sudden Cardiac Arrest Foundation and Enerspect Medical Solutions, to Michael Nardino, Executive Director of the Boys & Girls Club. He expressed his gratitude, stating that the facility’s AED — used to save a bingo player at the club event a few years ago — had been destroyed in a flood in 2012.

For more information on the Student Health Force Program, contact info@force4health.org. For more information on the AED Readiness Project, contact info@sca-aware.org. ■



  1. Bills 2014-2015. New Jersey State Legislature. Available online at http://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A2072. Accessed December 5, 2014.
  2. The Four R’s: Reading, ‘Riting, ‘Rithmetic, and Resuscitation: An Overview of CPR/AED Education in American Schools. Sudden Cardiac Arrest Foundation. Published July 17, 2014. http://www.sca-aware.org/schools/school-news/the-four-rs-reading-‘riting-‘rithmetic-and-resucitation-an-overview-of-cpraed-ed. Accessed December 5, 2014.
  3. The Chain of Survival metaphor was created by Mary Newman and the concept was first published in the Journal of Emergency Medical Services in 1989. It was later adopted by the American Heart Association and other health organizations worldwide.
  4. AED Laws. Sudden Cardiac Arrest Foundation. Available online at http://www.sca-aware.org/aed-laws. Accessed December 5, 2014.