Basic life support

Basic life support: knowledge and attitude of medical/paramedical professionals
Shrestha Roshana, Batajoo KH, [...], and Sharma MW

Additional article information

Abstract
BACKGROUND:
Basic life support (BLS), a key component of the chain of survival decreases the arrest – cardiopulmonary resuscitation interval and increases the rate of hospital discharge. The study aimed to explore the knowledge of and attitude towards basic life support (BLS) among medical/paramedical professionals.

METHODS:
An observational study was conducted by assessing response to self prepared questionnaire consisting of the demographic information of the medical/paramedical staff, their personnel experience/attitude and knowledge of BLS based on the 2005 BLS Guidelines of European Resuscitation Council.

RESULTS:
After excluding incomplete questionnaires, the data from 121 responders (27 clinical faculty members, 21 dental and basic sciences faculty members, 29 house officers and 44 nurses and health assistants) were analyzed. Only 9 (7.4%) of the 121 responders answered ≥11, 53 (43%) answered 7-10, and 58 (48%) answered <7 of 15 questions correctly. The clinical faculty members, house officers and nurses/HA had a mean score of 7.4±3.15, 7.37±2.02 and 6.63±2.16 respectively, while dental/basic sciences faculty members attained a least mean score of 4.52 ±2.13 (P<0.001). Those who had received cardiopulmonary resuscitation (CPR) training within 5 years obtained a highest mean score of 8.62±2.49, whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54±2.38 and 6.1±2.29 respectively (P=0.001). Those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all (P<0.001).

CONCLUSIONS:
The average health personnel in our hospital lack adequate knowledge in CPR/BLS. Training and experience can enhance knowledge of CPR of these personnel. Thus standard of CPR/BLS training and assessment are recommended at our hospital.

KEY WORDS: Basic life support (BLS), Cardiopulmonary resuscitation (CPR), Training, Knowledge, Attitude
INTRODUCTION
Survival after cardiopulmonary arrest is usually low and depends on early intervention, quality of cardiopulmonary resuscitation (CPR) and time to defibrillation.[1-4] Basic life support (BLS), a key component of the chain of survival decreases the arrest – CPR interval and increases the rate of hospital discharge.[3]

Individuals in the community at least the health care professionals should know how to perform BLS as they encounter such situation very often.[5] Health care professionals are expected to be competent to resuscitate from their first posting. In the United States, BLS training has been recommended for all health care professionals since 1966[6] especially for those who are involved in resuscitation.[7] Demand for courses of BLS is ever-increasing worldwide. However, in developing countries like Nepal, there is still no standard, and resuscitation training is not routine. Up to the present, few reports have addressed the current level of awareness and knowledge in this area among the health care professionals in Nepal.[8,9]

In recent years, several publications have highlighted the deficiencies in CPR quality, both out-of-hospital and in-hospital, which have partly been addressed in the newest BLS guidelines.[10,11] As a preliminary step, this study aimed to explore the level of knowledge and attitude towards BLS among medical/paramedical staffs in Kist Medical College Hospital, thereby to guide future planning of BLS program in this hospital. After this study, we hope that all aspects of BLS training for medical personnel will be improved and standardized.

METHODS
Study subjects
The medical/paramedical staffs who were on duty in different departments of the hospital in 2 weeks sample collection period. Those who were on leave, unwilling to participate in and incomplete questionnaires were excluded from the study.

Study tools
A questionnaire was prepared by the authors encompassing 3 main domains:

Demography and professional qualification of the participants;

Experience in and attitude of the participants to BLS/CPR (6 open-ended and MCQs);

Theoretical and practical knowledge of the participants related to BLS (set of self-prepared 15 MCQs with 5 options based on 2005 European Resuscitation Council BLS Guidelines.
The validity of the questionnaire was determined by piloting in other hospitals before it was finalized for the study. After appropriate changes made in the questionnaire after the piloting, ethical approval was obtained.

Ethical approval
The study was approved by the hospital ethical review committee and written informed consent was obtained before a respondent completed the questionnaire. The questionnaire didn’t contain the name of the participants, thus the confidentiality of the participants was maintained.

Data collection
The authors went to the respective departments and distributed the questionnaire to the subjects and collected the questionnaires after adequate time.

Data analysis
The collected data were calculated with Microsoft Excel and then statistical analysis was made by statistical package for social science (SPSS) 17 version. Descriptive and frequency analysis was made for counts, percentage and means or medians as appropriate to provide the overall picture of the responses. Mean score was compared for duration of clinical experience, professional qualification and previous training obtained by the participants by using ANOVA with Bonferroni’s test. The Kruskal Wallis test was used to compare the median score in reference to the previous involvement of participants in resuscitation. P values <0.05 were considered statistically significant.

RESULTS
Among 150 questionnaires which were distributed to the participants, 127 returned with a response rate of 84%. Among the 127 questionnaires, 6 incomplete ones were excluded from the study.

Of 121 responders, 27 were clinical faculty members, 21 faculty members of dental and basic sciences, 29 house officers, and 44 nurses and health assistants. The age of the participants (n=116) ranged from 18 to 61 years (mean of 30±8 years). Among all the participants, 68 (56%) were male and 53 (44%) were female. A larger proportion of females comprised nurses/HA group (36 of 44) and dental / basic sciences faculty members (13 of 21).

The duration of clinical experience was divided into <1 year, 1-5 years, 5-10 years and >10 years which comprised of 20 (16.5%), 55 (45.5%), 18 (14.8%) and 15 (12.2%) participants respectively. When the participants were inquired about any resuscitation training after graduation, 83 (69%) of them had had no training at all, and 27 (22%) had received some training within the last 5 years. Twenty-eight (23%) of the participants had not been involved in patient resuscitation after graduation, but 45(37%) have been involved rarely and 48 (40%) frequently.

The attitude of the participants towards BLS is summarized in Table 1. Most (95 %) of the participants thought that BLS should be included in the undergraduate curriculum, 82.6%(100) of the participants were not reluctant to perform CPR, 64% (78) preferred to use some type of barrier for mouth to mouth ventilation, and 7% (8) refused to perform it