Cities such as Seattle, where a high proportion of the public have received training in CPR, show the impact this can make on survival (Cummins et al. 1991). The challenge for future programmes is to train significantly more people whilst encouraging those who have previously been trained to return for annual updates. Other ways to deliver training are being explored, including replacing the instructor with a video. This system of group self-instruction has, in some studies, shown significant improvement over instructor-led classes (Woolard 2003).

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