CPR Preparedness Across Massachusetts Public High Schools: A Statewide Cross-Sectional Study

Abstract

Background: Out-of-hospital cardiac arrest accounts for over 350,000 deaths annually in the United States, and survival depends on early bystander cardiopulmonary resuscitation (CPR). Although many cardiac arrests occur on or near school grounds, Massachusetts has no statewide CPR graduation requirement and little current data on school preparedness. Methods: We conducted a cross-sectional electronic survey of all 413 public high schools in Massachusetts (including charter, vocational, and technical) between September 29 and November 17, 2025. The 14-item survey asked about enrollment, staff size, CPR and automated external defibrillator (AED) resources, student and staff training, and the presence of a cardiac emergency response plan. The CERP item was excluded from analysis due to inconsistent interpretation. We summarized resources per 1,000 students or staff, compared Title I and non-Title I schools, and explored geographic variation and multivariable predictors of AED availability and CPR teaching. Results: One hundred schools responded (24.2%), representing 13 of 14 counties, with a median enrollment of 662 students, and 33.0% were Title I schools. Overall, 72.0% reported teaching CPR. The median student training rate was 138.2 per 1,000 students, though only 10.0% of schools with non-missing data reported all students trained and 15.0% reported at least 70% of students trained. Among responding schools, Title I schools had fewer trained students than non-Title I schools (median 50.3 vs 199.8 per 1,000; Holm-Bonferroni adjusted p = 0.025), despite similar AED and manikin availability. This disparity persisted in sensitivity analyses using median imputation for missing student training data. County-level analyses suggested geographic variation in both training rates and AED density, although county-level estimates were based on small numbers of responding schools. Conclusions: Among responding Massachusetts high schools, most reported some CPR instruction, but only a small minority achieved broad student coverage, with particularly low training rates in Title I schools. These exploratory findings underscore the need for policies ensuring equitable CPR training access, particularly in Title I schools, and support targeted investment in school-based cardiac emergency preparedness

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