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Original Research (Original Article) 


Hatem Tarig Alzahrani et al, 2019;3(8):681–685.

International Journal of Medicine in Developing Countries

Awareness and interpretation of basic life support and emergency medical services and its associated factors among students

Hatem Tarig Alzahrani1*, Adel Saeed Eid Alghamdi1, Abdullah Saad Alzahrani1, Seraj Mohammad Alzahrani1, Mohammed Mahdi Alghamdi1, Ahmed Saleh Minqash1

Correspondence to: Hatem Tarig Alzahrani

*King Fahad Hospital, Al-Bahah, Saudi Arabia.

Email: t.16 [at] outlook.com

Full list of author information is available at the end of the article.

Received: 15 January 2019 | Accepted: 30 January 2019


ABSTRACT

Background:

Cardiopulmonary resuscitation (CPR) success rate depends on the knowledge and skills of basic life support (BLS) and advanced life support. The main objective of the present study was to measure the level of awareness of BLS and other skills in a tertiary care hospital among doctors and medical students of the medical, dental profession, nursing students, and interns.


Methodology:

A cross-sectional descriptive study was conducted in a tertiary care hospital. The level of awareness on BLS and the associated factors which included age, sex, training level (undergraduate, internship, and postgraduate groups), the course of study (nursing, dental, and medical groups), and previous BLS experience were assessed by using a structured questionnaire. The association of these variables with awareness level was evaluated by independent-test, analysis of variance, and linear regression analysis.


Results:

Among 1,000 study subjects, 450 (45%) were students, 300 (30%) interns, and 150 (15%) were postgraduate students. The total mean score of awareness was 4.5 ± 1.7 (score range: 0–10). Level of training, the course of study, and previous exposure to BLS were significantly associated with the level of awareness (p < 0.05), while age and sex demonstrated no significant association.


Conclusion:

BLS awareness is limited among different medical personnel. It is mandatory to conduct professional training programs at all levels in tertiary care health institutions. Regular course, hands-on workshops, and updated research studies are strongly recommended to increase CPR skills awareness among medical and paramedical personnel.


Keywords:

Awareness, basic life support (BLS), cardiopulmonary resuscitation (CPR).


Introduction

Cardiac arrest is a life-threatening event that accounts for 15% of the global mortality and is more common in individuals with a pre-existing cardiovascular condition [1]. Cardiac arrest management involves a group of simple maneuvers, defined as basic life support (BLS) [2]. These techniques include knowing the signs of sudden cardiac arrest, heart attack, stroke and foreign-body airway obstruction, cardiopulmonary resuscitation (CPR), and defibrillation with an automated external defibrillator (AED) [36]. BLS skills can lessen the high mortality rate caused by cardiac arrest in patients with cardiovascular disease. Moreover, the cardio-respiratory arrest can also be seen in neonates and infants with slight differences in the BLS algorithm which has a small difference when applied to infants and neonates, and the medical doctors should be aware of these differences [7].

CPR is simple and effective resuscitation skills, for BLS that sustains the patient’s life in the most critical minutes after cardiac and respiratory arrest. BLS composed of prompt recognition and immediate support of ventilation and circulation in respiratory or cardiac arrest [8]. If CPR is delayed, chances of survival will lessen by 7%–10% for every passing minute. It is the first step in the survival chain and it is most effective when applied immediately after body collapse to avoid permanent injury to the brain. When the heart stops, lack of oxygenated blood causes irreversible damage of the brain. It is imperative that every person in the community recognize and practice BLS skills to save lives and improve the quality of public life [9]. It is formed of group clinical skills to support ventilation and chest compression to enhance blood transfer to the brain and vital organs. Interpretation of BLS and applying of CPR techniques can guarantee patient survival for enough time until the patient gets the experienced medical help [10]. Proper practice of BLS maneuvers and procedures allows a person to resuscitate a critically ill patient effectively. Every person should be aware of BLS and CPR skills; however, its awareness among medical staff is mandatory. Freshly graduated doctors are expected to practice resuscitation from their first day [11].


Subjects and Methods

A descriptive cross-sectional study was conducted in the period between November and December 2018 in Al-Bahah. The participants were proportionally selected from each division of the course and all the participants in the randomly collected groups were involved. The yielded final sample size was 1,000. A structured questionnaire was used to measure awareness, practical information, and attitude toward BLS. The investigated items were about the abbreviation of BLS, AED, advanced cardiovascular life support (ACLS), Emergency Medical Services (EMS), and the clinical details of these skills. The questionnaire interrogated skills awareness and CPR knowledge. Previous experiences, BLS training, and the attitude toward BLS were also evaluated. The ethical institutional clearance was approved before the research. A total sample of 1,000 individuals was involved and asked to answer the questionnaires. The participants are undergraduate and postgraduate students of the medical and dental profession, as well as nursing students and interns. The participants were grouped according to age, sex, level of training (undergraduate, internship, and postgraduate), the course of study (nursing, dental, and medical), and according to previous BLS experience. Analysis of the results was conducted by the Statistical Package for the Social Sciences (SPSS) version 16.0. The variables relating to BLS awareness among different groups was done by independent t-test and analysis of variance. The results were tabulated and compared among different groups. A p value less than 0.05 is considered significant.


Results

One thousand subjects were included for analysis. A total of 450 (45%) were students, 300 (30%) were interns, and 150 (15%) were postgraduate students (Table 1). And 160 (16%) of participants were from nursing faculty, 200 (20%) were from dental college, and the majority of subjects 640 (64%) were from medical school. Two hundred and thirty-one (23.1%) of participants were females and 769 (76.9%) of participants were males.

The mean score of BLS awareness and emergency medical services general aspects was 3 ± 0.8 with a score range of 0–6. The mean score of the knowledge about the skills of BLS was 1.5 ± 0.9 with a score range of 1–4. The total mean score of awareness was 4.5 ± 1.7 (score range 0–10) (Table 2).

Among 1,000 study subjects, 960 (96%) had heard about BLS and 972 (97.2%) considered it is useful to know about BLS/ACLS. Only 177 (17.7%) had heard about EMS. However, 573 (57.3%) could expand AED. Only 179 (17.9%) answered that BLS is not conclusive to be done in hospitals. Around 542 (54.2%) of participants knew the number to call in case of a medical emergency (Table 3).

Table 1. Necessary demographic data of participants.

Characteristics N (%)
Position
   Students
   Interns
   Post-graduate students
 
450 (45%)
300 (30%)
150 (15%)
College
   Nursing
   Dental
   Medical
 
160 (16%)
200 (20%)
640 (64%)
Sex
   Male
   Female
 
769 (76.9%)
231 (23.1%)
Age
   <25 years
   ≥25 years
 
700 (70%)
300 (30%)
Previous exposure to BLS
   Have you ever seen a CPR being done?
      Yes
      No
   Have you ever done a CPR on a patient?
      Yes
      No
   Have you ever attended a workshop on CPR?
      Yes
      No
 
 
742 (74.2%)
258 (25.8%)
 
291 (29.1%)
709 (70.9%)
 
691 (69.1%)
309 (30.9%)

Table 2. Awareness level of study subjects.

  (Mean ± SD) Range
Awareness of BLS and other general aspects of emergency medical services 3 ± 0.8 0–6
Knowledge about the skills of BLS in the study group 1.5 ± 0.9 1–4
Total score 4.5 ± 1.7 0–10

Table 3. Awareness of basic life support.

Question Correct answer
N (%)
Have you heard about BLS? 960 (96%)
Have you heard about EMS? 177 (17.7%)
Is it useful to know about BLS/ACLS? 972 (97.2%)
Expand AED 573 (57.3%)
Do you think BLS should be done only in hospital settings? 179 (17.9%)
What number will you dial to call for help in case of a medical emergency in our set up? 542 (54.2%)

Table 4. Awareness about the skills of basic life support.

Question Correct answer No. (%)
How many chest compressions to be done in 1 minute in an adult? 391 (39.1%)
What is the ratio of chest compression to breath in adults? 440 (44%)
Arrange them in orderly sequence. a. airway, b. breathing, and c. chest compression 109 (10.9%)
What is the location of chest compressions? 424 (42.4%)

Table 5. Association of awareness level about basic life support with associated factors.

Characteristics (Mean ± SD) p-value
Position
   Students
   Interns
   Postgraduate students
 
3.9 ± 1.2
4.5 ± 1.1
4.7 ± 0.9
0.001
 
 
 
College
   Nursing
   Dental
   Medical
 
3.8 ± 1.1
4.1 ± 1.4
4.6 ± 1.2
0.03
 
 
 
Sex
   Male
   Female
4.5 ± 1.2
4.6 ± 1.1
0.09
 
 
 
Age
   <25 years
   ≥25 years
4.9 ± 1.2
4.8 ± 1.2
0.5
 
 
 
Previous exposure to BLS
   Have you ever seen a CPR being done?
      Yes
      No
   Have you ever done a CPR on a patient?
      Yes
      No
   Have you ever attended a workshop on CPR?
      Yes
      No
 
 
4.6 ± 1.1
4 ± 1.2
 
4.9 ± 1.4
4.1 ± 1.3
 
4.8 ± 1.1
4.3 ± 1.1
 
0.04
 
 
0.002
 
 
0.001 
 

As regard to awareness of BLS skills, about 391 (39.1%) of subjects knew the number of chest compression in 1 minute, whereas 440 (44%) knew the ratio of chest compressions to breaths in adults. Desperately only 109 (10.9%) could arrange (a) airway, (b) breathing, and (c) chest compression in the right sequence. Among the total, 424 (42.4%) of individuals knew the area of chest compressions (Table 4).

Level of training, course, and previous BLS experience were significantly associated with awareness level in univariate analysis. Age and sex showed non-significant relation (Table 5).


Discussion

Cardiopulmonary resuscitation skills are considered mandatory knowledge to be present in all medical and paramedical personnel, a necessary lifesaving skill that must be interpreted and correctly practiced. The medical curriculum should be updated, especially about these lifesaving skills. Our study results, as well as Aroor et al. [12], showed that the majority of the study participants do not know of the recent change of A-B-C sequence to C-A-B as per American Heart Association 2010 guidelines. Recognition of the correct site, rate, and depth of chest compressions are essential. Chest compression at the proper location could guarantee adequate pumping of the blood to the circulation to maintain cerebral perfusion. Ghanem et al. [6] study showed that more than 70% of participants could not identify the proper location of chest compression in adults and also our data showed that only 424 (42.4%) of students knew the correct position. In acute coronary syndrome and stroke cases, there is a limited time in which the early vascular occlusion should be recognized before the irreversible ischemic changes happen. However, Ghanem et al. [6] data identified that only 20% of participants could know those signs. Following cardiac arrest, time = life. Every minute post-arrest with no resuscitation leads to decrease survival by 7%–10% [11]. A survival rate of 50%–75% is possible if CPR and defibrillation are applied within 3–5 minutes [13]. It is expected from the practicing physicians to have good BLS skills because they face cases of cardiac arrest daily in their hospitals [14]. If cardiac arrest happened, it is the role of paramedical personnel and non-medical individuals in the scene to apply the initial care, which may save patient life [15].

The present study data showed that the total awareness means score was 4.5 ± 1.7 (score range 0–10), which concludes that the average rating was <50%. Another study described BLS awareness between students, doctors, and nurses to be weak with 84.82% score (<50%) [16,17]. There was a serial improvement in the total mean score from students to residents and interns in-between. Similar results were seen between participants in nursing, dental, and medical groups. The mean score in all groups was less than 50%—related data were recorded by Aroor et al. [12]. Also, Berg [18] study described that untrained students had a poor knowledge in comparison with trained students and recommended regular permanent training and courses to improve outcomes, as well as hands-on practice regularly to retain the skills [19]. Beck et al. [20] study showed that practicing and teaching doctors in this study achieved a lower score than nursing teaching college, which explained why some doctors were not good in performing effective CPR. In contrast to the present study results that showed higher knowledge and experience of BLS among medical and dental students. A recent study showed that junior doctors lacked the needed confidence in actual resuscitation scene [21]. Also, this study confirmed that the majority of students were not familiar with the algorithms and guidelines despite the enthusiasm and adequate knowledge, similar results were obtained in Chandrasekaran et al. [14] data.


Conclusion

BLS awareness is limited among different medical personnel. It is mandatory to conduct professional training programs at all levels in a tertiary care health institution. Regular course, hands-on workshops, and updated research studies are strongly recommended to increase CPR skills awareness among medical and paramedical personnel.


List of Abbreviations

ACLS Advanced cardiovascular life support
AED Automated external defibrillator
BLS Basic life support
CPR Cardiopulmonary resuscitation
EMS Emergency medical services
SD Standard deviation

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

A verbal approval was sought from King Fahad Hospital to conduct the research.


Author details

Hatem Tarig Alzahrani1, Adel Saeed Eid Alghamdi1, Abdullah Saad Alzahrani1, Seraj Mohammad Alzahrani1, Mohammed Mahdi Alghamdi1, Ahmed Saleh Minqash1

  1. King Fahad Hospital, Al-Bahah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alzahrani HT, Alghamdi ASE, Alzahrani AS, Alzahrani SM, Alghamdi MM, Minqash AS. Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. IJMDC. 2019; 3(8): 681-685. doi:10.24911/IJMDC.51-1547592684


Web Style

Alzahrani HT, Alghamdi ASE, Alzahrani AS, Alzahrani SM, Alghamdi MM, Minqash AS. Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. http://www.ijmdc.com/?mno=26403 [Access: July 23, 2019]. doi:10.24911/IJMDC.51-1547592684


AMA (American Medical Association) Style

Alzahrani HT, Alghamdi ASE, Alzahrani AS, Alzahrani SM, Alghamdi MM, Minqash AS. Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. IJMDC. 2019; 3(8): 681-685. doi:10.24911/IJMDC.51-1547592684



Vancouver/ICMJE Style

Alzahrani HT, Alghamdi ASE, Alzahrani AS, Alzahrani SM, Alghamdi MM, Minqash AS. Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. IJMDC. (2019), [cited July 23, 2019]; 3(8): 681-685. doi:10.24911/IJMDC.51-1547592684



Harvard Style

Alzahrani, H. T., Alghamdi, . A. S. E., Alzahrani, . A. S., Alzahrani, . S. M., Alghamdi, . M. M. & Minqash, . A. S. (2019) Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. IJMDC, 3 (8), 681-685. doi:10.24911/IJMDC.51-1547592684



Turabian Style

Alzahrani, Hatem Tarig, Adel Saeed Eid Alghamdi, Abdullah Saad Alzahrani, Seraj Mohammad Alzahrani, Mohammed Mahdi Alghamdi, and Ahmed Saleh Minqash. 2019. Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. International Journal of Medicine in Developing Countries, 3 (8), 681-685. doi:10.24911/IJMDC.51-1547592684



Chicago Style

Alzahrani, Hatem Tarig, Adel Saeed Eid Alghamdi, Abdullah Saad Alzahrani, Seraj Mohammad Alzahrani, Mohammed Mahdi Alghamdi, and Ahmed Saleh Minqash. "Awareness and interpretation of basic life support and emergency medical services and its associated factors among students." International Journal of Medicine in Developing Countries 3 (2019), 681-685. doi:10.24911/IJMDC.51-1547592684



MLA (The Modern Language Association) Style

Alzahrani, Hatem Tarig, Adel Saeed Eid Alghamdi, Abdullah Saad Alzahrani, Seraj Mohammad Alzahrani, Mohammed Mahdi Alghamdi, and Ahmed Saleh Minqash. "Awareness and interpretation of basic life support and emergency medical services and its associated factors among students." International Journal of Medicine in Developing Countries 3.8 (2019), 681-685. Print. doi:10.24911/IJMDC.51-1547592684



APA (American Psychological Association) Style

Alzahrani, H. T., Alghamdi, . A. S. E., Alzahrani, . A. S., Alzahrani, . S. M., Alghamdi, . M. M. & Minqash, . A. S. (2019) Awareness and interpretation of basic life support and emergency medical services and its associated factors among students. International Journal of Medicine in Developing Countries, 3 (8), 681-685. doi:10.24911/IJMDC.51-1547592684