Table 1

PLSP curriculum for bystander training in CPR and bleeding control

	Component	Teaching pedagogy		Time duration (min)
Section A: introduction of PLSP	Introduction and rationale of PLSP	PowerPoint presentation, succeeded by a video* incorporating the following domains: Current burden of cardiac arrest and severe post-traumatic bleeding in Pakistan. Role of bystanders in these emergency situations. Objectives of PLSP and creation of life-savers as a potential solution to this issue.		5
Section B: response to emergency situations	Initial response as a bystander in an emergency situation dealing with cardiac arrest/severe bleeding	A video highlighting the dos and don’ts as a bystander:		10
		Dos	Don’ts
		Ensure scene safety.	Do not step up before affirming your safety.
		Call an ambulance.	Do not be a passive observer.
		Relevant information for relay to the ambulance service.†	Do not waste time in capturing visuals of the scene.
		Participants are then engaged through use of examples and gauging their initial response of action.
Section C: CPR	Preconceived notions of participants regarding CPR	Verbal discussion to engage participants and determine their preconceived notions.		5
	Basic information of the process of CPR delivery	A video demonstrating an example of cardiac arrest and initial response of a bystander incorporating CPR. Step-by-step demonstration of proper bystander response to cardiac arrest as follows: ‘Shake & Shout’ to ascertain response of the patient. ‘Call for Help’ using the number of any ambulance service. ‘Check for Breathing’ by looking at his/her chest’s movement. ‘Start Chest Compressions’ if no sign of breathing until help arrives/patient responds.		10
	Details of appropriate delivery of quality CPR	A video demonstrating proper hand and body positioning of bystander while providing CPR. In-person demonstration with explanation of all steps of CPR by a master trainer on a manikin. Verbal repetition of all steps while emphasizing on when to stop CPR. Short Q/A session to answer all queries of the participants.		15
Section D: bleeding control	Preconceived notions of participants regarding bleeding control	Verbal discussion to engage participants and determine their preconceived notions.		5
	Basic information of the process of bleeding control	A video demonstrating an example of severe bleeding and initial response of a bystander in such a situation. Step-by-step demonstration of proper bystander response to severe bleeding as follows: ‘Check for Response’; if none, then check breathing status. ‘Call for Help’ using the number of any ambulance service. ‘Check for Bleeding Site’ after covering your own hands. ‘Provide Direct Compression’ on the bleeding site using a clean cloth for at least 10 min. ‘Perform Wound Packing’ if the wound is deep.		10
	Details of appropriate bleeding control	In-person demonstration with explanation of all steps of bleeding control by a master trainer using a manikin. Verbal repetition of all steps of bleeding control. Short Q/A session to answer all queries of the participants.		15
Section E: implication of COVID-19	Safeguarding oneself from COVID-19	A video highlighting strategies on how to decrease spread of COVID-19 while helping patients with cardiac arrest/severe bleeding.		5
Section F: practical demonstration and assessment	Proper application and practice of skills	Provision of 2 min practice for each participant on a manikin using metronome for CPR. Assessment of skills of each participant using their response to a hypothetical situation on a manikin.		40

*Video used in PLSP sessions is audio recorded in Urdu with English subtitles available for convenience of understanding of the participants.
†This includes contact information of the caller, location of the emergency (mentioning a famous landmark if applicable), age of the patient, chief complaint, status of patient’s consciousness and breathing.
CPR, cardiopulmonary resuscitation; PLSP, Pakistan Life Savers Programme; Q/A, question/answer.