More than 1 million high school students a year will be trained in CPR, thanks to the latest state laws requiring the lifesaving skill as a graduation requirement.

Oklahoma this year became the 16th state to pass a CPR law – measures the American Heart Association and other organizations have pushed for in legislatures across the country. Based on federal education statistics, the combined number of graduates in those states surpasses 1 million a year.

“This is an amazing development that has the potential to save so many lives,” American Heart Association CEO Nancy Brown said. “Just imagine the possibilities of 1 million young people who are trained and ready to save a life. That’s a number that will go up by 1 million every single year, but we can do so much more if every single state steps up and makes CPR a graduation requirement.”

The new laws are critical because 424,000 people a year suffer out-of-hospital cardiac arrest, which stops the heart and requires immediate CPR or death can occur in minutes. Only one of 10 victims currently survives an out-of-hospital cardiac arrest, although research shows that CPR doubles or triples survival rates when it’s given right away.

The problem is, so many people don’t get help from bystanders who could provide CPR.

“If you have a cardiac arrest in a public place or at home, you almost have to be lucky enough to have someone nearby who can do CPR,” said Robert Neumar, M.D., Ph.D., chair of Emergency Medicine at the University of Michigan Health System. “Introducing CPR training in school makes a difference in the culture by building an expectation that you will be able to provide this to fellow community members.”

At least half of all sudden cardiac arrests occur in the home, so training students helps ensure that every home has someone who can respond, said Neumar, who is also a volunteer with the American Heart Association.

With training required before graduation, people may be more likely to act in a cardiac emergency, Neumar said.

Casey Stashenko of Albany, N.Y., is a perfect example. He used the skills he learned in school to save his father’s life two years ago when Casey was just 13. At the time of his in-class lessons, Casey said he remembered thinking, “I don’t think I’ll ever need to know this stuff.”

But, he did. After Casey’s mother found her husband not moving and with a gray color to his face, Casey did chest compressions the way he learned. When a paramedic asked Casey if he could continue performing chest compressions while they brought in their equipment, he told them: “I can keep doing it. He’s my dad.”

After his father was saved, Casey and his mother have since shared their story and have joined the efforts urging New York state legislators to require CPR training before graduation.

In all, nine states require current graduates to know CPR: Alabama, Georgia, Iowa, Maryland, Mississippi, Rhode Island, Tennessee, Vermont and Washington. The graduating class of 2014-15 will be required to be trained in Arkansas, Minnesota, North Carolina and Texas. Idaho graduates must be trained by 2015-16. Seniors in Oklahoma and Virginia must know CPR before graduating in 2016-17.

In addition to the states that have already passed CPR graduation laws, Colorado, North Dakota and Utah have approved funding for the training, although it’s not yet required. The AHA is continuing to encourage other states to follow suit.

Of the 16 states, 14 have passed laws since the AHA issued a science advisory in 2011 calling for state legislatures to mandate and fund CPR training for graduation.

That advisory cited studies showing that CPR in school had the potential to be one of the most effective ways to train more people in CPR, ensuring lifesavers were more likely to be found at public places such as malls, health clubs, or swimming pools or family gatherings.

The recommended CPR training has evolved over the years – many school programs use video-based instruction and inflatable versions of the larger manikin used to train earlier generations. The AHA developed these kind of materials to allow more people in the community, including schools, to have a convenient way to learn CPR. Students can learn the lifesaving skill in just 30 minutes, at an average cost of about $1 per student.

Even so, persuading lawmakers took some work in some states.

In Oklahoma, for example, the AHA and partner organizations collected hundreds of petitions, testified before lawmakers and got the word out through social media, said Naomi Amaha, the AHA’s director of government relations for Oklahoma. AHA advocacy staff also worked closely with education organizations to ensure that new requirements could be easily implemented.

As for students, some say the training has prepared them.

“I thought that CPR training was fun and a good life skill,” said Katie Erb, 14, an eighth-grader at Riverglen Junior High School in Boise, Idaho. “The easiest thing was finding the center of the chest. The hardest thing was pushing hard enough and doing that consistently. The training made me feel more confident and I feel if I needed to do CPR, I would be able to do it!”

The AHA helped develop CPR more than 50 years ago, and continues to develop materials that train more than 14 million people a year worldwide. The association also develops science-based guidelines that guide CPR and advanced resuscitation practices.

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