|Year : 2014 | Volume
| Issue : 2 | Page : 91-94
A survey of basic life support awareness among final year undergraduate medical, dental, and nursing students
HT Srinivas, Nalini Kotekar, Sindhu R Rao
Department of Anaesthesiology, Jagadguru Sri Shivarathreeshwara Medical College Hospital, Mysore, Karnataka, India
|Date of Web Publication||19-May-2014|
Department of Anaesthesia, Jagadguru Sri Shivarathreeshwara Medical College Hospital, M G Road, Mysore, Karnataka 570 009
Source of Support: None, Conflict of Interest: None
Context: Cardiac arrest or respiratory arrest is the most common emergency which results in grave consequences and mortality and can be easily prevented by simple maneuvers and skills with the knowledge of basic life support (BLS), thus ensuring the survival of the patient. This study aims to assess the awareness of BLS and cardiopulmonary resuscitation (CPR) among the medical, dental, and nursing students. Aims: To assess the awareness of BLS among medical, dental, and nursing undergraduate students. Settings and Design: The study was carried out on undergraduate students randomly chosen from medical college, dental college, and nursing institute using response to a structured questionnaire. Materials and Methods: A cross-sectional study was conducted in Mysore during April-May 2012 among medical, dental, and nursing student. A questionnaire was given interrogating them regarding various aspects of awareness and skills involved in BLS. The results were analyzed using an answer key employing appropriate statistical tools. Statistical Analysis Used: The data was analyzed using software version Statistical Package for Social Sciences (SPSS) 12.0. Demographic data were analyzed using analysis of variance. Unpaired t-test and Chi-square tests were used where appropriate. Sample size of 500 was determined. Standard tests of significance were applied to determine the P < 0.05 was considered significant. Results: More than half of the medical students had fair knowledge of the basics in BLS. Poorer number of students had a general idea about the skills and techniques used in BLS. Response during an emergency real life situation was disappointingly low among the respondents and it was found that the students considerably lagged behind in the knowledge of cognitive and practical skills of BLS. Conclusions: We conclude that awareness regarding BLS among the study groups was varied and was generally poor, which calls for standardizing training in BLS and making it a mandatory part of all medical and paramedical teaching program.
Keywords: Awareness, basic life support, cardiac arrest, practical skills
|How to cite this article:|
Srinivas H T, Kotekar N, Rao SR. A survey of basic life support awareness among final year undergraduate medical, dental, and nursing students. Int J Health Allied Sci 2014;3:91-4
|How to cite this URL:|
Srinivas H T, Kotekar N, Rao SR. A survey of basic life support awareness among final year undergraduate medical, dental, and nursing students. Int J Health Allied Sci [serial online] 2014 [cited 2020 Mar 31];3:91-4. Available from: http://www.ijhas.in/text.asp?2014/3/2/91/132692
| Introduction|| |
Since atherosclerotic heart disease is the overall leading cause of death and trauma, the leading cause of death among those aged 1-44 years,  it is of paramount importance to train and regularly update undergraduates among medical professionals in resuscitation techniques. Care providers must be proficient in providing resuscitation within the first 10 min in cardiac emergency and within the first 'golden' hour in trauma cases.  Resuscitation "is the act of restoring life or consciousness of one apparently dead".  This awareness has placed a growing demand on medical professionals for expertise in resuscitation skills.
Knowledge of basic life support (BLS) and expertise in cardiopulmonary resuscitation (CPR) techniques ensures the survival of the patient long enough till experienced medical help arrives and in most cases is itself sufficient for survival. CPR skills are not constantly stressed upon as a part of the curriculum among the student population. In a similar assessment study, it was found that many of the students after failing abysmally initially, were particularly receptive after practical tutorials. 
The objective of this study was to assess the awareness about BLS among medical, dental, and nursing students and the prospective of introducing these skills into the regular curriculum.
| Materials and methods|| |
A cross-sectional study was conducted in the months of May and June 2012 among the undergraduate students of medical, dental, and nursing institutes, Mysore, Karnataka, India.
Study group comprised of 500 final year students randomly chosen to be part of the study, which included 270 medical students, 160 dental students, and 70 nursing students. Permission was taken from all the institutional heads before involving students. Students were requested not to write their names or name of institution to avoid bias.
Study was conducted among the above student population by assessing the response to a structured questionnaire. The questionnaire was designed based on American Heart Association (AHA) guidelines. The questionnaire was validated by testing it among a pilot study group. It consisted of 20 selected questions regarding awareness and skills involved in BLS. The questionnaire was designed to include questions regarding abbreviations, protocol, skills, diagnosis of cardiac arrest, recognition of acute coronary syndrome, resuscitation techniques with regard to circulation, airway and breathing in unresponsive victims of different age groups, and response in case of emergency situations. Questions were grouped with similar focuses of discussion like basic knowledge of BLS, real life scenarios and skills, and to identify the areas in which the study group was lagging.
The response sheets of the three groups were coded and allocated for evaluation by single blinding method.
After the individual answer sheets were evaluated and scored, the study group was divided into five categories based on their percentage scores: 0-20%, 20-40%, 40-60%, 60-80%, and 80-100%.
The percentage scores of medical, dental, and nursing students were further segregated and compared to one another.
Each individual question was marked as 'correct', 'wrong', and 'don't know' for the unattempted ones.
| Results|| |
After collecting the data, it was statistically analyzed and tabulated.
[Figure 1] shows the different categories into which the members of the study group fall after calculating the percentage scored by them in the questionnaire. Majority of the students scored between 40 and 60%.
[Figure 2], [Figure 3], [Figure 4] shows the scoring pattern of medical, dental and nursing students respectively. [Figure 2] shows the results obtained after the data was analyzed separately for medical, dental, and nursing students. By comparing the outcomes, it was seen that majority of the medical students scored between 60 and 80%; whereas, most of the dental students scored between 20 and 40% and nursing students fell into the category of 0-20%, which was found to be statistically significant (P < 0.001).
Students who scored less than 60% in the questionnaire were considered to have inadequate knowledge of BLS, comprising 38% medical students, 64% dental students, and 86% nursing students.
[Figure 5] and [Figure 6] shows response of students for questions 1-10 and 11-20, respectively. Data was analyzed pertaining to individual questions as correct, wrong, and not answered; and was depicted graphically. [Figure 3] and [Figure 4] highlight the areas of deficiency among the study group, that is, practical skills pertaining to delivering effective CPR (depth and rate of chest compressions in adults and pediatrics, compression ventilation ratio, end point of CPR, etc.).
|Figure 5: Response for questions 1-10 (read as correct, wrong, and don't know in that order for each question; question number plotted against percentage scores)|
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|Figure 6: Response for questions 11-20. (read as correct, wrong, and don't know in that order for each question; question number plotted against percentage scores)|
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| Discussion|| |
Cardiac arrest or cardiopulmonary arrest is the most common medical crisis that occurs and can leave the victims with severe morbidities or lead to death if not attended to instantly.
Cardiac arrest begins as abrupt cessation of normal circulation of the blood due to ineffective contraction of the heart. This proceeds to decreased circulation and hence decreased oxygen supply to all organs of the body. Lack of oxygen supply to the brain leads to respiratory depression which progresses to generalized ischemia, leaving the patient with less than 10 min to survive. 
The probability of achieving successful resuscitation from cardiac arrest is related to the interval from onset of loss of circulation to institution of resuscitative efforts. Return of circulation and survival rates deteriorates almost linearly from the 1 st min to the 10 th min. After 5 min, survival rates are no better than 25-30% in out-of-hospital settings. Although the outcome in case of a sudden cardiac arrest is predominantly influenced by the patient's preceding clinical status, a setting where it is possible to institute prompt and effective CPR followed by defibrillation is chiefly reliant and vital for a better chance for a successful outcome.  Early identification and intervention of cardiac arrest victims therefore forms the cornerstone of BLS. It is intended to maintain organ perfusion until definitive treatments can be instituted.
BLS which forms a part of adult chain of survival includes prompt recognition of signs of sudden cardiac arrest, heart attack, stroke and foreign body airway obstruction, and activation of the emergency response system. , This is followed by early CPR, which sustains a pump function by sequential filling and emptying of the chambers by chest compressions and maintains ventilation by mouth-to-mouth respiration. 
In our study, it was found that there was a gross lack of awareness of BLS among the medical, dental, and nursing students emphasizing the need for improved training of the students.
After grouping the questions with similar focuses of discussion and analyzing the responses, it was inferred that majority of the students (70%) had fair knowledge of the basics of BLS such as the terms and abbreviations used in BLS. Whereas, the awareness of cognitive skills and techniques used in BLS was observed to be poor among the medical students and even poorer in the dental and nursing students. Group of questions related to real life situations, received a disappointingly low response from the students.
Training the students of medical profession at an early stage will not only have a stronger impact in reducing the morbidity and mortality but also boost the student's confidence to face critical situations and act immediately and appropriately. To achieve this goal there should be adequate improvements in the education system so that students are kept abreast and master the basics of BLS. Implementation of practical sessions where the students are taught hands on about how to apply the skills and techniques learnt is of utmost importance to make sure there is no hesitancy in the event of an emergency. Working on mannequins to practice and perfect their skills is highly recommended for the students. BLS trained personnel can give BLS even if he/she is student. While training mannequins are used and in a clinical setup only trained clinicians are allowed to give BLS. However, students trained can impart their knowledge in scenarios where healthcare facilities are not available (remote locations, forests, rural areas, etc.).
Even the general public should be made aware by campaigns, public messages, and media forums about CPR and emergency medical services. 
| Acknowledgment|| |
We thank the principals of medical, dental, and nursing institutions for their cooperation in conducting this study.
We also thank Dr Lancy D'Souza for his help in compiling data and statistical analysis.
| References|| |
|1.||Goldstein DH, Beckwith RK. A survey of resuscitation training in Canadian undergraduate medical programs. CMAJ 1991;145:23-7. |
|2.||Eisenberg M, Bergner L, Hallstrom H. Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation. Am J Public Health 1979;69:30-8. |
|3.||Miller BF, Keane C. Encyclopaedia and dictionary of medicine, nursing and allied health. 2 nd ed. Saunders: Toronto; 1978. p. 878. |
|4.||Skinner DV, Camm AJ, Miles S. Cardiopulmonary resuscitation skills of preregistration house officers. Br Med J (Clin Res Ed) 1985;290:1549-50. |
|5.||Savary-Borioli G. Basic Life Support: The primary ABC (D) of cardiopulmonary resuscitation. Ther Umsch 1996;53:624-9. |
|6.||Myerburg R, Castellanos A. Cardivascular collapse, cardiac arrest and sudden cardiac death. In: Casper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 18 th ed., Vol. 2. New York: McGrawhill; 2011. p. 2238-46. |
|7.||Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, et al. Part 1: Executive summary: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:S640-56. |
|8.||Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar, Shabbir PM, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian J Anaesth 2010;54:121-6. |
|9.||Steen PA, Kramer-Johansen J. Improving cardiopulmonary resuscitation quality to ensure survival. Curr Opin Crit Care 2008;14:299-304. |
|10.||Zamir Q, Nadeem A, Rizvi AH. Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan. J Pak Med Assoc 2012;62:1361-4. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]