Since cardiopulmonary resuscitation (CPR) was introduced by Kouwenhoven in 1960,¹ many studies have shown the effectiveness of this technique.^2-3 However, the inherent inefficiency of this approach and the challenges related to teaching and retaining the skills needed to perform the technique correctly have limited its overall effectiveness.⁴ Effective CPR was defined as performance of both adequate ventilation (with visible expansion of the chest wall during mouth-to-mouth ventilation) and compressions (with palpable pulse during chest compressions).⁵ Now, millions of people around the world are currently trained in basic CPR. And our Department of Education will also initiate new CPR curriculum in senior high school in 2006. It seems therefore important to secure and facilitate the possibility of learning good CPR. Quality assurance of the education is therefore of great importance and ought to be included as a routine procedure,⁵ including quality assurance as a routine procedure necessitates easily conducted performance tests. In order to optimize CPR education it is of great value to compare various training methods, in terms of quality of performance. However, comparable data of initial CPR performance has been difficult to obtain. Brennan et al. emphasize the importance of objective comparable assessment of training outcomes.⁶ These authors provide a valid instrument for this purpose, containing a checklist revised by ILCOR in 2003, to be used in combination with an instrumented manikin. In the present study, a specially designed computer software which calculates new parameters from those measured by the instrumented manikin, was used in combination with the revised Brennan et al. checklist, in an attempt to make the assessments even more precise. The aim of this study was to describe the initial behavior before the new curriculum, and test a model of quality assurance, consisting of a Video Recording combined with the Recording Resusci Anne Printout(VIDRAP), combined with the ILCOR checklist, for evaluation of CPR performance.

1.The Five-point subjective overall rating:
149 of the participants(94.9%)are rated ?ot competent? 5 of the participants(3.18%)are rated "uestionably competent" 2 of the participants(1.27%)are rated ?competent? And only 1 of the participants(0.64%)are rated "Outstanding "
2. CPR skill checklist:
27.4% participants checked for unresponsiveness. 42.7% participants calling for help or indicating that help is needed, after check of unresponsiveness and before chest compressions. 6.4% participants opening of the airway prior to checking for breathing. 1.3% participants checked the breathing for a minimum of five seconds before any breaths were given. 1.9% participants given adequate ventilation (with visible expansion of the chest wall during mouth- to- mouth ventilation ) . Only 0.6% participants checked the circulation signs last for at least 5 seconds according to guidelines used in this study. 8.9% participants find the right position on lower half of the sternum. 10.8% participants correctly followed at least 3 and no more than 5 cycles of compressions and ventilations. Average score is 2.96 (SD=+2.94), varied between 1 and 22, as shown in Table 4 and 5.

Understanding the initial behaviors in CPR is beneficial to educational design, comparing educational outcomes, and research analysis. The initial behavior of 1^st grade senior high school students in CPR skills has been shown as Table 3 to 6. Most of participants are "Not competent" the score of checklist is low, and rescue breathing and compression performance measured by the computer software is still poor, although about half of all participants prior to CPR training experience. It approved that resuscitations skills deteriorate quickly and theoretical knowledge may be retained longer than practical skills.⁸ Therefore, we must concern that a course enough to learn and retain this skill or not. Are retraining courses effective? And after how long should retraining courses be offered? To increase the quality of CPR performance is of great importance for the outcome of the cardiac arrest victim. ⁹ It is suggested that only effective CPR improves survival rates.¹⁰ NRCT as well as AHA have presented guidelines stating how CPR should be performed. Existing guidelines are supposed to reflect effective CPR. and we should strain CPR training courses in senior high school.
Otherwise, in order to enable comparisons of various methods of CPR training, the importance of making objective assessments of training outcomes is stressed by Brennan et al.⁷ Using a computerized manikin in combination with a complete checklist,and video recording minimizes the possibility of subjective judgements.¹¹ As the instrumented manikin and the computer perform assessments of the quality of chest compressions and ventilations, subjective judgements are eliminated. However filling in the checklist must be done by a person and therefore entails a risk for mis-judgement. The computer software provides the instructor with valuable information concerning CPR performance skills for each student without the need for further analyses. ¹² In the future, the instructors can use this instrument in order to make their own quality control. The prerequisite for making quality controls, as a routine procedure, is that it is easy to accomplish.¹³ Moreover, data gathering via the computer enables data collection from many students, enabling the finding of weaknesses in the education system.¹⁴ This also enables comparisons of various training methods at national and international levels.