BLS Education in Integrated Education: Saving Lives and Learning the Importance of Life

On Saturday, March 2, the symposium "Practice and Social Significance of BLS (Basic Life Support) Education" was held at the Mita West School Building, hosted by the Keio University Affiliated Schools BLS Committee and the Keio University Sports Medicine Research Center.

When an arrhythmia that feels like fine trembling occurs in the ventricles of the heart, which acts as a pump to send blood throughout the body, the heart can no longer fulfill its role. This leads to loss of consciousness within seconds and eventually cardiac arrest. Therefore, it is essential for someone nearby to immediately perform chest compressions (cardiac massage) and use an AED (Automated External Defibrillator) to give an electric shock to the heart to normalize the heartbeat. BLS education is designed to enable anyone to put this method into practice immediately.

At Keio University, BLS education began in 2002 at all affiliated schools from the elementary to high school levels and continues to this day. The year 2022 marked the 20th anniversary, but due to the COVID-19 pandemic, an event to reaffirm its pioneering nature and social significance could not be held, so it was held this year instead.

The catalyst for the start of BLS education at the Juku was a tragic incident in 1998 where a student passed away during a marathon at Shiki High School. Following a proposal from Shingo Hori, then Deputy Director of the Emergency Department at the School of Medicine, and Hajime Yamazaki, Director of the Sports Medicine Research Center, BLS education began at Shiki High School the following year. Then, in 2001, when Mr. Yamazaki assumed the post of Vice-President in charge of affiliated schools, he organized the BLS Committee and proposed implementing it across all integrated education curricula, leading to its adoption at all schools starting in 2002.

Initially, there seemed to be some confusion at each school. However, by ensuring that BLS education could be received at every stage of schooling, several educational benefits were confirmed. First, repeating the training at each advancement in schooling improved skills. Second, it became a program that went beyond simply acquiring life-saving techniques to instill judgment in emergencies, crisis management, the dignity of life, and civic duties. Furthermore, the momentum was driven by the accumulation of practice and awareness across various Keio University institutions. This included not only the Department of Cardiovascular Medicine at the School of Medicine but also the Sports Medicine Research Center, which had over a decade of experience in medical checks for Kanagawa Prefecture National Sports Festival athletes and professional sumo wrestlers to prevent sudden death during competition, as well as awareness from surveys on sudden deaths among high school students in Yokohama. The School of Medicine's Emergency Department had also been focusing on sudden death and commotio cordis (cardiac arrest caused by a strong impact to the chest during sports) even before the Japanese term for it had become established.

The year 2002, when BLS education began at all schools, was also the year Prince Takamado passed away suddenly while playing squash. At that time, AEDs could not be used without specific instructions from a doctor, but discussions progressed following the Prince's passing, and it was exactly 20 years ago, in July 2004, that they became available for use by the general public. Keio University began installing AEDs at each school slightly ahead of this, largely influenced by the experience of Keio Academy of New York, which had already installed them in accordance with New York State's 2002 mandate for installation in public schools.

At the symposium, after the author introduced these developments in a talk titled "The Beginnings and Subsequent Development of BLS Education at Keio University," Akiko Koyama, a teacher at the Girls' Senior High School, gave a lecture titled "The Practice of BLS Education in Keio University Integrated Education." As a member of the BLS Committee since its inception, she reflected on the initial struggles and provided a detailed introduction to the initiatives and transitions at each school. The methods have become diverse, with each school applying its own ingenuity. Some schools conduct it within health and physical education classes, while others receive outside cooperation from medical professional alumni (Yochisha), Athletic Association trainers (Shiki High School), or local fire departments (Fujisawa Junior and Senior High School). The Girls' Senior High School previously received help from KAPPA, a student organization from medical-related faculties dedicated to spreading CPR, but since the pandemic, third-year students have been participating in the school as teaching assistants to instruct first-year students.

Next, under the title "Social Significance of BLS Education from the Perspective of Utstein Statistics (Fire and Disaster Management Agency Out-of-Hospital Cardiac Arrest Data) Analysis," Aya Yuzawa and Kazuhiro Shirakawa, graduates of the Graduate School of Health Management, introduced empirical analysis results such as "Typology of Out-of-Hospital Cardiac Arrest (Are people who collapse in the city being saved?)" and "Differences in Resuscitation Rates by Witnesses of Out-of-Hospital Cardiac Arrest (Are family members being saved?)." Furthermore, Hiroyuki Ishida, Professor at the Sports Medicine Research Center and Dean of the Graduate School of Health Management, gave a lecture titled "How to Prevent Sudden Death During Sports Activities."

In addition to Ms. Koyama and Mr. Ishida, a panel discussion was held featuring Junichi Sasaki, Professor of Emergency Medicine at the School of Medicine, and graduates who had received BLS education. During this, Yuri Banno, a fifth-year medical student, shared that receiving repeated BLS education since Yochisha lowered the psychological hurdle to saving people, and that her current activities as a member of KAPPA stem from realizing the importance of nurturing people who take the initiative to help others. Also, Michitaro Hayakawa, a graduate of the School of Medicine who now assists with training at Yochisha, spoke about the importance of establishing accurate knowledge and skills at the junior and senior high school levels, drawing on his experience competing in lifesaving competitions during his university years. In response to these comments, both Mr. Ishida and Mr. Sasaki expressed expectations for moving to the next stage by further developing the Keio-style system where those who learned at each affiliated school go on to teach their juniors, with faculty members working as one.

At the end of the symposium, Hideo Mitamura, Chairman of the AED Foundation and former professor at the School of Medicine, who has consistently continued advocacy activities for society, introduced national examples of "children saving children, children being saved." He concluded the event by speaking about the significance of BLS as education for the heart, noting that the experience of working hard to save an individual's life nurtures people who value human life.

When the Juku first began BLS education, it strove to raise awareness through media outreach and other means. In the current National Curriculum Standards revised a few years ago, both junior and senior high schools are now required not only to understand but also to be able to perform CPR. With BLS education becoming commonplace and explained in detail even in elementary school textbooks, the symposium served as an opportunity to reaffirm the social significance of the role played by the Juku and to share the responsibility of advancing this to the next level.