Code One, national CPR provider, good fit in Roanoke

An education company trains health care workers, coaches and others from Maine to Georgia in lifesaving technologies from an office marked with a red heart in a Roanoke shopping center.

Code One Training Solutions has operated for 16 years since its founding in a University of Connecticut dormitory. While temporarily shut down because of the pandemic, it retooled for hybrid instruction and reemerged on a fast track. Along the way its owners relocated to Roanoke, where they have caught the attention of economic developers.

Code One is one of five tech-driven companies believed to have high growth potential chosen for the Regional Accelerator & Mentoring Program or RAMP. This spring’s cohort of technology, health and life sciences companies receive 12 weeks of assistance, $20,000 and an opportunity to meet investors. Nearly 40 companies have graduated since the public-private RAMP formed in 2017 with money from the city of Roanoke, Virginia Western Community College and GO Virginia, a state economic development organization.

Code One applied to RAMP to receive marketing help. The business had been built — and rebuilt.

The story began in 2007 at the University of Connecticut where Richard Shok, an undergraduate nursing student, started a small business presenting CPR certification training to fellow students, aiming to make the requirement easier to obtain. Aided by his girlfriend Allison, also a nursing student, the enterprise grew into a busy American Heart Association-affiliated training center issuing thousands of certificates.

The couple married and began a family.

As COVID-19 began to flourish in early 2020, Code One personnel ceased in-person training and huddled over a number of months looking for a new approach.

“Gone are the days of sitting in a classroom with 12 other people, watching videos and then trying to breathe into a mannequin,” according to Shok.

Instead, Code One went in a different direction. Its clients complete American Heart Association certification lessons online and then practice hands-on application of cardiopulmonary resuscitation in a physical location set up by Code One for skills development. They work on a simulator, developed by the AHA, with mannequins representing one adult and a child.

But these are not dummies. They are CPR feedback devices that spontaneously report metrics about the quality of the rescuer’s chest-compressions, such as depth, rate and hand placement.

The simulators use adaptive learning to respond to the student’s specific needs, which Shok called “a better way to learn.”

A virtual instructor employed by Code One appears on a screen to coach the learner through to the completion of certification testing. Three-fourths of Code One’s clients are health care providers. The rest include athletic coaches, teachers, babysitters and others who do not work in health care but want or need to know how to react in an emergency.

The owners consider the facility COVID-safe because it is unmanned and receives regular cleaning and maintenance.

“This provides a really flexible, convenient way for people to get their training done,” Shok said.

And it’s scalable. No longer in need of group classrooms, the company’s space requirements fell to as few as 150 square feet for each location. Code One has grown from 12 training sites at the onset of the pandemic to 53 and employs 68 people, Shok said. The company is based at Towers Shopping Center.

After serving about 18,000 people in 2022, Code One hopes to increase that by 25% and expand to 60 sites this year, Shok said.

Shok, 36, is trained as a nurse and paramedic and volunteers at Read Mountain Fire and Rescue but devotes his time primarily to serving as CEO of Code One, which he said is the largest domestic CPR certification provider in terms of geographic coverage that’s affiliated with the heart association. The heart association does not provide CPR training, but relies on organizations such as Code One to provide it.

Allison Shok, 35, works part-time as a nurse at Roanoke Memorial Hospital and serves as the company’s chief strategy officer. She and her husband moved to Roanoke in late 2020 to live in a mountain community.

The Shoks are “all in, enthusiastic, dedicated, coachable, and hard working,” said Lisa Garcia, the business accelerator’s executive director. “These are all qualities that we look for as well as what any financial investor looks for in a company. They have all the right qualities to make the most of the RAMP experience and the affiliated support services.”

Spending a few minutes with Shok raises a question about the pronunciation of his last name. It’s ‘shock’, a segue to the rest of the story. The couple also sell automated external defibrillators, whose shock can prompt a near-lifeless heart back to rhythm. CPR followed by defibrillation vastly improves cardiac arrest survival and expanded access to both holds the promise of reduced death, but the journey will be long.

The Roanoke-based Compress & Shock Foundation works to teach chest compressions and AED use “to everyone.” Bystander rescue efforts in the first moments of a cardiac arrest often impact survival more than the efforts of rescuers and emergency room personnel, said Jack Perkins, a Roanoke emergency room doctor who started the nonprofit group six years ago.

When it comes to survival, he said, “It’s largely up to the public and unfortunately the public doesn’t understand their role in cardiac arrest [or] that, really, life or death starts with whether that victim gets bystander CPR and then, how quickly can you get a defibrillator or AED placed on that victim.”

Calling 911 upon witnessing a heart-related event is only the first step. CPR, even without blowing air into the lungs, circulates the blood. The strong AED shock positions the heart to restart on its own. Shok estimated that six minutes or more might elapse before rescuers arrive. “We don’t have a viable patient if no one’s done anything,” Shok said.

A pickle ball player in Westfield, Mass., collapsed 15 feet from an AED installed inside a Code One weatherproof enclosure and a textbook rescue followed. “They were awake before EMS arrived,” Shok said.

But if no bystanders are present or no one present acts, survival rates are low.

A large, ongoing study of out-of-hospital cardiac arrest incidents in the United States finds that nearly 91% of sufferers perish. Those rates have remained more or less unchanged for 30 years, according to the Cardiac Arrest Registry to Enhance Survival, or CARES, based at the Woodruff Health Sciences Center in Atlanta.

While cardiac arrests kill 91% of victims nationally, lethality varies from community to community, the group said.

The Citizen CPR Foundation, based in Kansas, strives to help communities improve their response to cardiac arrest through widespread CPR training, expanded access to AEDs and aggressive EMS and hospital resuscitation protocols. Localities that excel in those areas can receive a designation called a HEARTSafe Community.

Asked if Roanoke would qualify, Shok — who is the foundation’s volunteer interim program director — said “Far from it.”

Nor would the vast majority of American cities qualify, but the program, which has seen Chesapeake and Arlington getting involved, is “picking up steam,” Shok said.

Wider AED availability is one driver of the Shoks’ AED business, called AED Team. AED owners most often place the units in a car or building where, Shok noted, they’re accessible only a portion of the day. AED Team described itself as the only vendor of a lockable cabinet suited for outside mounting, such as at a pickle ball court or a building entrance. To prevent theft or tampering, the units feature a keypad to open up the box when a bystander enters a code from a 911 dispatcher.

There are four outdoor units mounted in the city, three in parks and one beside the door to Fresh Market at Towers, and 911 operators are prepared to release the code when needed, Shok said. More are coming.

The Compress & Shock Foundation, which receives grants, has distributed 75 AEDs and plans to distribute 20 to 30 more, including five in outdoor locations to be determined, Perkins said. AED Team will provide them, according to Perkins, who expressed the hope that such initiatives could exist in every city in the country, tied in with free CRP training.

The foundation plans to hold a CRP and AED education event in Roanoke June 3 in which members of the public can receive basic CPR training not leading to certification.

“You don’t need a card in your wallet to save a life, you just need the skills,” Perkins said.

Here are brief descriptions provided by RAMP of the four other companies inducted into the accelerator.

• Cairina Inc. of Salem, which “provides technologies that non-invasively measure biologic fluid flow using clinically standard imaging protocols for personalized medicine applications.”
• MOVA Technologies of Pulaski, which “specializes in air capture technology applying sustainable, circular principles to selectively capture and harvest air contaminants as valuable byproducts that can be sold and reused.”
• SchedulerHUB of Roanoke, “an intuitive scheduling and analytics platform for manufacturers to manage complex production projects.”
• Trova Commercial Vehicles Inc. of Pulaski, which “develops battery electric spotter tractors (designed to move trailers and cargo containers around ports, truck terminals and distribution centers) as well as class 8 diesel to electric conversion kits.”

RAMP expects to accept applications for its fall cohort in a few weeks.