More Than 40 States Require CPR Training for High School Graduation. Is Yours One of Them?
CPR can double or triple a person's chance of survival after cardiac arrest. Here's where CPR training is required for graduation, how the mandates typically work, and what research says about teaching lifesaving skills in schools.
Cardiopulmonary resuscitation (CPR) training has become a graduation requirement in much of the country, particularly over the past decade. Today, more than 40 states and Washington, D.C., require students to receive CPR instruction before earning a high school diploma.
The first state to do so was Alabama in 1984, followed by Iowa in 2008. Most of the remaining states that enacted CPR training graduation requirements did so between 2013 and 2021.
Below is the complete breakdown, curated by the American Heart Association.
States With CPR Training Requirements for Graduation
- Alabama
- Arizona
- Arkansas
- Connecticut
- Delaware
- Florida
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nevada
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- Washington, D.C.
- West Virginia
- Wisconsin
States Without CPR Training Requirements for Graduation
- Alaska
- California*
- Colorado
- Hawaii
- Massachusetts
- Nebraska
- New Hampshire
- Wyoming
*California passed legislation requiring students enrolled in a health class to learn CPR, which covers 89% of the student population.
How High School CPR Requirements Typically Work
In most states, the CPR requirement is embedded into an existing course, most commonly health or physical education. Schools typically don't create a standalone CPR class just to satisfy the mandate. It is also important to note that most states require training, not certification.
This often consists of:
- Hands-on CPR practice
- Instruction on AED use
- Exposure to nationally recognized CPR guidelines
States have increasingly favored CPR training requirements in the last decade because they are relatively low-cost, can be incorporated into existing curriculum, and provide students with skills they can carry with them for life.
Many school safety directors become certified American Red Cross instructors and are then able to conduct the trainings themselves, which can save districts money.
Why Most States Require CPR Training for High School Graduation
Cardiac arrest is responsible for 5-10% of all deaths among children age 5–19 years, according to the National Library of Medicine.
More than 350,000 out-of-hospital cardiac arrests occur each year in the U.S. Immediate CPR can double or triple a person's chance of survival after cardiac arrest.
However, only about 40% of cardiac arrest victims receive bystander CPR before EMS arrives, making schools one of the most effective places to equip the next generation with lifesaving skills.
Research on School-Based CPR Training
Research suggests these efforts are making a difference.
A 2022 systematic review of fourteen studies on the effectiveness of school-based CPR training among adolescents concluded that CPR training within school settings "effectively promoted a change in CPR knowledge and skills among adolescents." The researchers noted that continuous training in CPR among schoolchildren "should be encouraged by policymakers, school authorities, parents, and teachers to optimize the prompt usage of the skills in any cardiac event."
High school CPR training laws have been associated with higher rates of bystander CPR in those states compared with states that do not require CPR education, according to researchers at Children's Hospital of Philadelphia.
A 2023 scientific statement from the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association, and the European Resuscitation Council reviewed more than 100 research articles related to CPR education. The writing group concluded that school-aged children are "highly motivated to learn life-saving skills" and often pass what they learn on to others.
The statement also noted that CPR education can begin as early as age 4 and build over time, with many children able to perform effective chest compressions on training manikins by age 10.
A Real-World Example
In one Alabama high school, the campus safety director became a certified American Red Cross instructor and began offering CPR training to students.
While the original goal was to train teachers, he eventually expanded the training to students. Approximately 120 students took him up on the offer.
The training was offered through a one-week course called "Adulting 101," which also covered life skills such as cooking, laundry, and self-defense.
One of those students later used his training to revive his girlfriend after she went into cardiac arrest due to an undiagnosed heart condition.
CPR/First Aid Training Resources
- American Red Cross offers courses for all ages, starting as young as elementary school
- The American Heart Association offers courses for grades 6-12
Additional Resources
- Involving Students in School Safety Can Save Lives; This Campus Safety Director Has Proof
- CPR and AED Training in Schools Saves Lives
- Student Who Learned CPR at School Saves Child Who Fell Into Pool
- UVM’s Cat ECare Provides AEDs on Campus to Save Lives of Cardiac Arrest Victims
- Texas Lawmakers Pass ‘Landon Payton Act,’ Mandating More AEDs, CPR Training in Schools
- The Wrong Placement of AEDs and Bleeding Control Gear Could Cost You
- What Is Bystander Care and Why Is It So Important?