A Side-To-Side Comparison of the Effectiveness of Online CPR Training Versus In-Person Instruction
As society progresses technologically, many of the tasks which used to require an individual to be present can now be done in an online setting; including everything from renewing a driver’s license to earning a jurisprudence doctorate to practice law. When it comes to online instruction and course material, human nature resists changes. As such, there are many skeptics who question the effectiveness of such online certification. One of the more recent trends in online instruction is training or renewal courses for cardiopulmonary resuscitation (CPR) certification, which is a requirement for many professions, especially first responders, and other emergency medical service (EMS) personnel. There are some suppliers of these renewal courses which are less-than-scrupulous, over-advertising incredibly low-priced options to gain the required renewal certificate. With some of these programs, the “diploma mills” of old come to mind. Therefore, one must question the motives for which these organizations are providing their services. Are they in it to legitimately provide this crucial training? Are their methods and curricula sound and geared towards saving lives, or is their primary motivation for providing these courses simply to give the student a quick certification while earning a quick buck? However, this is not always the case, as the studies below will demonstrate there is a place for these online courses. In some cases, the roles certain people play in an emergency and the protocol which should be followed is very well covered in these online courses, and may serve those who need a general knowledge of how to save a life in the case of sudden cardiac arrest. However, most will agree there can be no solid replacement for an AHA-certified, in-person instructor who has experienced these traumatic events firsthand while being responsible for saving the lives of the patients they have treated.
Contents of Online Courses Compared to In-Person Instruction
First, to appreciate the differences between online CPR training and in-person CPR training, a quick examination of the process of online CPR training is necessary. While it is commendable for any agency or individual course to focus on the saving of lives, some of these programs simply consist of watching videos and taking a multiple choice test. In specific, one free course offers an Adobe Flash instruction course with videos which are very informative. However, the questions asked in the assessment are geared to be so simple anyone could pass them. While the idea of spreading awareness is to be commended, there is a fundamental belief by experts in the field which is in-person instruction by an experienced, certified trainer provides the suffering patient a greater chance of survival than electronic distance instruction accessed via multiple choice assessments and generalized video training. Of course, when dealing with strictly online assessments, and ethical dilemma also arises. The person taking the test may not be the person for whom the certification is being granted. Unfortunately, this type of dishonesty can create a serious risk to the patients these individuals have committed to saving. As such, the American Heart Association has certain requirements for courses to gain their approval. To wit:
Any course offered (by the above providers) which includes the following is approved by this department to fulfill the cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training objectives for persons who are required, as a condition of licensure, certification, or registration to be proficient in CPR or the use of an AED. 
Keeping these requirements in mind, this also means the AHA will allow accreditation to some courses which mix the convenience of the online classroom with the specialty training an in-person certified instructor brings to the table. In fact, there are certain AHA-certified traveling instructors who put quite a bit of faith in the effectiveness of these blended courses, while at the same time negating the possibility of any positive purpose of online-only training. While it is not necessarily true there is no positive impact from these courses, it is true the main purpose of CPR and ECC training is to save lives, and any course which can bring awareness to this goal does serve some purpose to society as a whole, without question. With that said, however, when it comes to the first responders who arrive on the scene, it is a given most people in society would rather their lives be in the hands of someone who has been properly trained by an on-site expert who has experience in the real-world event of saving a life during sudden cardiac arrest. This means the average layperson who may suddenly find themselves in an emergency situation could benefit greatly from the basic knowledge an online CPR course can provide, but the paramedic responding to this event has a better chance of assessing the situation and using the critical thinking skills and real-world training only an expert with experience can provide. Any CPR training is better than no CPR training, but proper CPR training will give a friend, relative, or innocent stranger a better chance of surviving the event.
However, there are some recent studies which suggest just the opposite of the above.  In one study, two sets of participants were given either a 34-minute online video course or a 4-hour AHA-approved course. In a simulated SCA event using dummies and artificial emergencies, the retention rate of the techniques taught were higher in the video-based course than in those who received the AHA course. However, this study is somewhat misleading, as the simulated situation is not a real-world event. Therefore, the results of this study can be easily disputed as an overreach for the effectiveness of the online classes, as real-world, unexpected sudden cardiac arrest emergencies were not a part of the observed response. Therefore, proponents of in-person courses will cite said reason to disprove these results. For instance, one argument could be since the mannequin-based simulated event is part of the in-person training, the only thing this study contributed to was to give the online-based participants the full experience of an in-person demonstration which is already part of the curriculum for the face-to-face course. This, while set up to appear as a study of the effectiveness of online courses, simply converted the online training of the study group into a basic blended course. In fact, in the published results of the study, a portion of the texts reads the real purpose and benefit of the online courses can truly be seen as a way to provide skills and raise awareness of CPR in underserved communities, which isn’t in dispute. 
Furthermore, the above study brings up another form of CPR/AED training which has been briefly mentioned above. As the study participants were given this demonstration as a “test” of the effectiveness of their online course, they were essentially provided with a form of CPR training known as “blended” training, which can be very beneficial. As mentioned above, this combines the convenience of an online course with the personal experience of an AHA-approved on-site instructor. The proliferation of these blended courses can provide a great service to society, and it would be more realistic to compare the results of this type of training with strictly in-person training. These courses are the best option for those who need or desire adequate training but are not able to commit the time requirements of taking a full course.
However, it is still the opinion of many experts in the field of emergency medical service training and certification where the best method of CPR training is comprehensive in-house, personal training by an AHA-certified instructor. For instance, the fundamental belief where those who have “been there, done that” can provide a unique experience for the trainee is a very logical conclusion. The interaction between the instructor and the students is simply something online training cannot provide. The on-site instructor can ask questions of the students, can engage with the students on various exercises, and can offer expanded advice on the role each person involved in an emergency may have to play. Furthermore, an instructor can interact with the students on other vital areas of concern with bystander response, including the documented hesitation which occurs when some bystanders, even if trained in CPR, may face when they encounter a true emergency. In this situation, the instructor can become the student, learning the reasons behind this phenomenon of hesitancy can mean saving a life or losing one. The instructor can then bring this feedback to the course creators, who can modify the course to address these issues specifically.
In summary, in no way should the role of online CPR courses be negated to nil, even though some experts may say otherwise. These courses offer great general education to the process of saving a life in the event of the patient needing CPR or AED treatment. The provide the bystander responder with the knowledge needed to act fast in case of said emergency. However, when it comes to renewal certifications for EMS providers, there is no substitute for receiving training face-to-face with an American Heart Association-certified, experienced CPR and ECC instructor, such as the courses offered by such providers as the AED Superstore.  Therefore, it is important to stress the fact EMS providers and other first responders not be swayed by advertisements offering a “certified online CPR course for $14.99.” Such a course, while providing a valuable service to the general public, tends to focus more on the fast buck than the fast response to an emergency, which can put a blemish on the image of the commendable service CPR training provides. Learn about AED Superstore’s on-site AED/CPR training and certification, or browse our selection of CPR Manikins & Training Products.
 The American Heart Association grants their approval to certain courses which have online components. These are known as “blended” CPR courses, and can be a very beneficial way to get the vital in-person training from a certified instructor while still gaining some of the convenience associated with online courses.
 See http://www.hlfirstaid.com/MilwaukeeCPRCertificationNews/AreOnlineCPRCertificationsLegit
 See http://www.protrainings.com/research for more information. Selected studies have shown that in simulated SCA events, online video training may be as effective as a 4-hour AHA course.
 For the full results of these studies, please see the resource listed in note 3. From reading these results, it also appears that the entity that sponsored the tests may have had their own interests in having the results of the study be published in the manner with which they were.
 VSG provides expert in-person CPR and AED training by AHA-certified instructors as well as all the necessary training equipment, including mannequins. For more information, or to learn about the programs and courses offered, please visit our Resources Page.