Faculty of Medicine
Department of Intensive care, Kosha Shirzad
Titel Page
The study of knowledge, attitude and practice of Basic
Life Support among trained and untrained medical
students at Lithuanian University of Health Sciences
(LUHS)
SUMMARY
Author: Kosha Shirzad
Title: The study of knowledge, attitude and practice of Basic Life Support among trained and untrained medical students at Lithuanian University of Health Sciences (LUHS).
Aim: To assess the difference in knowledge, attitude and practice of basic life support among trained and untrained participants.
Objectives:
1. To study the level of knowledge and practice of BLS among trained and untrained medical students.
2. To assess the attitude towards BLS among participants
3. To evaluate differences in knowledge, practice and attitude between trained and untrained participants.
4. To assess effect of previous training in BLS on participants
5. To provide the university with the results and conclusion of the research work.
Methodology: A cross-sectional study was conducted among 120 international students of LUHS from all years of study of medical faculty. Knowledge, attitude and practice of BLS was assessed by using a self-administered questionnaire consisting of multiple choice questions as well as yes/no/hesistant alternatives.
Study participants: Medical students of LUHS.
SANTRAUKA
Autorius: Kosha Shirzad
Pavadinimas: GFP žinių, požiūrio ir praktikos tyrimas tarp Lietuvos sveikatos mokslų universiteto (LSMU) apmokytų ir neapmokytų medicinos studentų.
Tikslas: Įvertinti žinias ir požiūrį apie pagrindinių gyvybinių funkcijų palaikymą (GFP) bei praktikos skirtumus tarp apmokytų ir neapmokytų studentų.
Uždaviniai:
1. Išnagrinėti GFP žinias ir praktikos lygį tarp apmokytų ir neapmokytų studentų. 2. Įvertinti dalyvių požiūrį į GFP.
3. Įvertinti žinių ir praktikos skirtumus tarp apmokytų ir neapmokytų studentų. 4. Įvertinti GFP mokymų poveikį tyrimo dalyviams.
5. Pateikti universitetui mokslinių tyrimų rezultatus ir išvadas.
Tyrimo metodai: tyrime dalyvavo visų kursų LSMU taprtautiniai studentai iš medicinos fakulteto. Atliktas kryžminis tyrimas, kurio metu vertintos žinios, požiūris ir praktikiniai GFP sugebėjimai, naudojant savarankišką klausimyną, sudarytą iš testinių klausimų, kuriuose buvo galimi keletą teisingų variantų, taip pat "taip / ne" tipo klausimai.
Tyrimo dalyviai: LSMU medicinos studentai.
Rezultatai: šiame tyrime nustatyta, kad netreniruotų dalyvių vidurkis buvo 4,85 ± 1,82 (žinios) ir 2,8 ± 1,35 (praktikiniai gebėjimai), rezultatai buvo aiškiai nepatenkinami, o
treniruoti studentai vidutiniškai siekė 8,76 ± 6 (žinios) ir 7.32 ± 1.11 (praktikiniai gebėjimai).
Išvados: Apmokyti dalyviai turėjo geresnes GFP žinias, palyginti su netreniruotais studentais. Nepatyrę dalyviai turėjo nepakankamai žinių, o apmokytų studentų rezultatai parodė
ACKNOWLEDGEMENTS
The author would like to thank the participants for the help by filling the surveys, and professor Vidas Pilvinis who contributed in this research with advices.
CONFLICT OF INTEREST
The author reports no conflicts of interest.ETHICS COMMITTEE CLEARANCE
Title: The study of knowledge, attitude and practice among trained and untrained medical students at Lithuanian University of Health Sciences (LUHS).
ABBREVIATIONS LIST
1. Lithuanian University of Health Sciences (LUHS) 2. Basic Life Support (BLS)
3. National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) 4. Automated External Defibrillator (AED)
5. Cardio Pulmonary Resuscitation (CPR) 6. Maximum (MAX)
INTRODUCTION
Having knowledge in the actions of BLS means knowing how to perform CPR, how to recognize signs of SCA, heart attack, stroke and foreign-body airway obstruction and how to defibrillate with an AED. These procedures and knowledge are applied to situations where there is danger to life until further care are provided at the hospital. [1-2]
SCA is when the heart stops beating which will eventually lead to stopped blood supply to vital organs such as the brain and if not treated promptly, sudden death will occur. [33] The outcome of SCA situations is highly dependent on time at which resuscitation is started, with too late or sporadic interventions leading to damages in heart and brain function due to the lack of oxygen in these areas. [3] For BLS providers to start resuscitation as quickly as possible requires education and knowledge in order to recognize signs of before mentioned clinical conditions, thereby the time between identification of symptoms and initiation of CPR can be decreased [4]. Yet, recent studies indicate that medical students are lacking knowledge required in order to recognize signs of serious medical conditions which will eventually require use of actions of BLS [5].
Education in BLS should be considered as an essential part of the medical curriculum since doctors are required to be able to resuscitate from the moment they finish their studies and enter their first posting. [4, 6] However, not all medical universities around the world have obligatory courses of BLS in their program. In India, not even medical and paramedical students have guidelines needed for BLS. A lot of medical students from India will not have the opportunity to learn the basics of BLS through classes with practice before they graduate.
AIM AND OBJECTIVES OF THE THESIS
Aim: To explore the knowledge gaps of BLS between trained and untrained participants consisting of medical students at Lithuanian University of Health Sciences (LUHS). The study is aimed for students to undergo a questionnaire were results will be analysed in order to assess the knowledge for both trained and untrained participants. This will be done in order to find out the effect of training and clinical practice on knowledge of BLS and in order to highlight the importance of training and retraining in both the aspect of learning actions of BLS and in order to retain them. Also, this study aimed to find out the attitude towards BLS. Objectives:
1. To study the level of knowledge and practice of BLS among trained and untrained medical students.
2. To assess the attitude towards BLS among participants
3. To evaluate differences in knowledge, practice and attitude between trained and untrained participants.
4. To assess effect of training in BLS on participants
5. To provide the university with the results and conclusion of the research work.
LITTERATURE REVIEW
Considering the fact that health care professionals constantly acquire situations were knowledge in the actions and skills of BLS is a must, it is of uttermost importance that they possess these kind of knowledge. [9-11]
working at a hospital, it was found that 85,5 % were not confident enough in order to manage a resuscitation case due to poor knowledge. [13]
In the United States ever since 1966, BLS has been recognized as a mandatory knowledge for all health care professionals [14-15] and for those workers that are frequently involved in situations were the skills of BLS will be used, it has been recognized even more. [16] United states on one hand, in the other hand there is countries all over the world were the demand for courses in BLS are increasing and yet the plea has not been recognized and a lot of countries, specially developing ones, still does not have any standards regarding BLS courses and routine resuscitation courses do not even exist for health care professionals. [15] Despite common knowledge that standardisation of training in BLS and the need for it to be a mandatory component of all medical, nursing and para-medical school undergraduate curricula is essential. [17]
The reflection of the outcome of the knowledge of BLS in a country which does not have any standards of BLS courses in their curricula is possible to see in a study conducted in India. In this study, 1,054 participants took part in a questionnaire which was conducted in order to find out the awareness and skills of BLS. Out of these participants, 345 were medical
students, out of which none had a mandatory component of training in BLS in their respective medical schools. 83 % of the students had scored less than 50 % of the marks. [18]
Developing countries experience many issues regarding the knowledge of BLS among both health care workers and students. [15, 18] However, low confidence among medical students in performing BLS has also been reported from Europe. [19]
In Switzerland a study was conducted among medical students with the aim to evaluate the knowledge regarding cardiac arrest, heart attack and stroke. The purpose of choosing specifically these three conditions was the fact that they are life-threatening and could
Studies exists that highlights the effect of training on the knowledge of BLS. [21-27] In a study conducted among medical students in Pakistan the aim was to compare the difference in knowledge between a group of students with training in BLS and a group without training. 250 students participated in the study with the groups being divided in to two halves. It was concluded that the trained students performed significantly better than their counterpart, nevertheless, the mean of the trained students was less than 50% of the marks. [21] Similar results could be found in a study conducted on high school students in New Zealand where students with training in BLS was compared to those without. It was shown that the group with training had more knowledge in the actions of BLS while none of the groups showed satisfactory results. [26] On the other hand, in Ljubljana, Romania, a study was done among first year medical students in order to find out what outcome completion of a BLS course will have. The students in this group were all evaluated of their knowledge soon after they had undergone training and all of them showed satisfactory results. [24]
The study conducted by Wiese C HR et.al in Germany also showed significant difference among trained and untrained bystanders. [27] Furthermore, a study conducted by Jiang YB et al showed that the trained students had better theoretical knowledge than untrained. [25]
Another study conducted in Turkey had the same aim, to compare difference regarding practical and theoretical knowledge of BLS. Here the comparison was between second and third year medical students, which consisted of the students with training in BLS, compared to first year students, which had no training. The students with training had undergone one previous course in BLS and out of all the participants, only a few had clinical experience from the past. It was shown that those with previous training and those with previous clinical experience, had better results regarding the theoretical questions. However, in regards to the practical questions, there was no significant difference in results between the different groups and results were below acceptable for all groups. Even though it was shown that practical experience and previous training had a positive effect on the marks, there was not a significant difference between the two groups in regards to their performances. [23]
that single courses are simply not enough. [21] Moreover, a study conducted in Germany where bystanders were tested on their knowledge in BLS, a similar conclusion was made. [27] A study in North America was done in order to find out how long participants would retain skills related to BLS after primary training and retraining in BLS. The effect of a primary training and then retraining was that a big majority (between 80-90 %) of the participants in the matter would competently perform skills up to 12 months, after which skills showed to decrease minimally, showing the importance of retraining. [28]
In India 241 undergraduate medical students participated in a study in order to find out the knowledge and attitude of BLS. The students in this study had begun their training in BLS from the third semester and the approach of this study was to find out how time passed from the beginning of BLS training would affect the knowledge of the participants. Therefore, a group of students belonging to third, fifth and seventh semesters were chosen, were the third, fifth and seventh semester students have received the training within 6 months, 1 year and 1 ½ years respectively. It was found out that the knowledge score decreased with increasing duration of training. It was therefore concluded that the differences in knowledge and attitude depending on the duration of time passed from first BLS training, pointed out the need for frequent refresher training and motivation of the students. [29] It was also stated in a study made in Turkey that students had unsatisfactory results when tested on their knowledge in BLS due to poor retention of previous training experience. In the same study it was found out that clinical experience and previous training would lead to better score results and therefore should therefore not be neglected. [23]
RESEARCH METHODOLOGY AND METHODS
Design
This study was a cross-sectional survey study which was conducted in Lithuanian University of Health Sciences (LUHS) after approval from the university and the ethical committee. Participants
120 medical students were included in the study from year 1-6 from LUHS. Sampling method
In total, 258 questionnaires were collected, the study was however devised for a finite population of 120, with a 50/50 distribution between trained and untrained medical students. All participants were approached for the study during Mars, 2018. It was carried out by the use of an anonymous self-administered questionnaire which was constructed and adapted in order to find out knowledge, attitude and practice of BLS among the participants, from whom written informed consent was achieved through forms.
Data collection/Questionnaire
In order to evaluate the levels of knowledge, attitude and practice of BLS a questionnaire (Annex 2) including 27 questions, based on AHA’s BLS guidelines, was used. The
questionnaires involved three parts: (1) Knowledge of BLS, (2) attitude towards BLS and (3) Practice of BLS. The questions regarding attitude were structured as yes/no/not sure while knowledge and practice questions were multiple choice answers with four options. The participants had to fill in whether or not they had prior training in BLS and faculty of studies. Data analysis
Results were submitted for analysis by the use of IBM SPSS Statistics Version 13.0 (IBM Corporation, New York, USA) were percentages was used for categorical variable. The data were divided into two groups (trained/untrained). From these two groups analysis was made by calculating the percent of correct answers for each question of knowledge and practice regarding the different groups, while the attitude based questions were analysed by
RESULTS
A total of 120 participants responded to the questionnaire, 60 were trained and 60 were untrained.
From the knowledge section of the questionnaire, consisting of 13 questions, the max number of correct answers for trained participants was 12 and min 6 (mean: 8.76 ± 1.68 questions). For the untrained students the mean was 4.85 ± 1.82 out of the total 13 questions.
From the practice section of the questionnaire, consisting of 9 questions, the max number of correct answers for trained participants was 9 and min 5 (mean: 7.32 ± 1.11 questions). For the untrained participants, the mean was 2.8 ± 1.35 out of the total 9 questions.
Table 1: Correct responses of trained and untrained participants for scenario based questions to assess their knowledge of First-Aid.
Questions: Knowledge
Right answer Trained
%(n)
Untrained %(n) P 1- what is the abbreviation of “BLS”? 57 (95%) 51(85%) 0,069 2- when you find someone unresponsive in the middle
of the road, what will be your first response? (Note: You are alone there)
57 (95%) 17 (25,0%) <0,001 3- if you confirm somebody is not responding to you
even after shaking and shouting at him, what will be your immediate action?
50 (83,3%) 5 (8,3%) <0,001
4- what is the location for chest compression? 50 (83,3%) 8 (13,3%) <0,001 5- what is the location for chest compression in
infants?
51 (85%) 14 (23,3%) <0,001 6- how do you give rescue breathing in infants? 44 (73,3%) 10 (16,7%) <0,001 7-Depth of compression in adults during CPR? 53 (88,3%) 11 (18,3%) <0,001 8-Depth of compression in Children during CPR 16 (26,7%) 10 (16,7%) 0,389 9-Depth of compression in neonates during CPR 13 (21,7%) 3 (5,0%) 0,052 10-Rate of chest compression in adult and Children
during CPR
54 (90,0%) 21 (35,0%) <0,001 11-what does abbreviation AED stands for? 59 (98,3%) 26 (43,3%) <0,001 12-what does abbreviation EMS stands for? 55 (91,7%) 28 (46,7%) <0,001 13-if you and your friend are having food in a canteen
and suddenly your friend starts expressing symptoms of choking but responsive, what will be your first response?
56 (93,3%) 9 (15,0%) <0,001
shake and shout (p <0.001). 50 (83.1 %) trained and 8 (13.3 %) untrained students knew the location of chest compression in adults (p <0.001) while 51 (85 %) trained and 14 (23.3 %) untrained students knew the location of chest compression in infants (p <0.001). 44 (73.3 %) trained and 10 (16.7 %) untrained responded correctly about how to give rescue breaths to infants (p <0.001). 53 (88.3 %) trained and 11 (18.3 %) untrained students responded correctly about the depth of chest compression in adults (p <0.001). 16 (26.7 %) trained and 10 (16.7 %) untrained students responded correctly about depth of chest compression in children (p <0.389). 13 (21.7 %) trained and 3 (5.0 %) untrained answered correctly how deep chest compressions should be in neonates during CPR (p 0.052). 54 (90 %) trained and 21 (35.0 %) untrained answered correctly about rate of compressions in adults and children during CPR (p <0.001). 59 (98.3 %) trained and 26 (43.3 %) untrained students answered correctly what abbreviation AED stands for (p <0.001). 55 (91.7 %) trained and 28 (46.7) untrained students responded correctly to what abbreviation EMS stands for (p <0.001). 56 (93.3 %) trained and 9 (15 %) untrained students answered correctly about first response when someone has symptoms of choking. (p <0.001).
Table 2: Results of knowledge among trained and untrained participants
Table 4: Table: Correct responses of trained and untrained participants for practice based questions Questions: Practice Right answer P Trained n(%) Untrained n(%) 1-The 5 links in the adult Chain of Survival include all of the
following EXCEPT:
40 (66,7%) (5) (8,3%) <0,001 2-The critical characteristics of high-quality CPR include which
of the following?
39 (65%) 10 (16,7%) <0,001 3-The initial Basic Life Support (BLS) steps for adults 46 (76,7%) 17 (28,3%) <0,001 4-Where in adult should you attempt to perform a pulse check? 59 (98,3%) 39 (65%) <0,001 5-The compression to ventilation ratio for the lone rescuer
giving CPR to victims of ANY age is:
57 (95,3%) 43 (71,3%) 0,002 6-The proper steps for operating an AED are: 47 (78,3%) 6 (10,0%) <0,001 7-The 2010 AHA Guidelines for CPR recommended BLS
sequence of steps are:
41 (68,3%) 13 (21,7%) <0,001 8-Signs of severe airway obstruction include all of the following
EXCEPT?
58 (96,7%) 37 (61,7%) <0,001 9-In an adult with an advanced airway in place during 2-rescuer
CPR, breaths should be administered how often?
47 (78,3%) 12 (20,0%) <0,001
Table 5: Results of practice among trained and untrained participants
0 trained and 28 untrained scored less than 30 %, 1 trained and 24 untrained scored 30-49 %, 2 trained and 5 untrained scored 50-59 %, 25 trained and 3 untrained scored 60-79 %, 26 trained and 0 untrained scored 80-89 % and 6 trained and 0 untrained scored 90 – 100 %. Table 7: Responses of trained and untrained participants for assessment of attitude towards BLS
Questions: Attitude
Yes No Not sure/hesitated
Trained %(n) Untrained %(n) P Trained %(n) Untraine d %(n) Trained %(n) Untrained %(n)
1-Do you think BLS is necessary? 59 (98.3%) 53 (88.3%) 0,028 0 3 (5.0%) 1 (1.7 %) 4 ( 6.7%)
2-Have you ever voluntarily performed BLS? 57 (95,0%) 25 (41.7%) <0,001 3 (5.0%) 34 (56.7%) 0 1 (1.7%) 3-Would you perform mouth to mouth ventilation 60 (100%) 58 (96.7%) 0.156 0 1 (1.7%) 0 1 (1.7%)
4-Would you like to undergo BLS training in a workshop / center with hands on practice under supervision? 55 (91,7%) 40 (66.7%) <0.001 1 (1.7%) 2 (3.3%) 4 (6.7%) 18 (30.0%)
Tre (5 %) untrained students did not think that BLS is necessary, 4 (6.7 %) untrained and and 1 trained were unsure/hesitant. 1 (1.7 %) trained student answered no to the question whether or not one would like to undergo BLS training in a workshop/center with hands on practice under supervision, 4 (6.7 %) trained were unsure/hesitant. 2 (3.3 %) untrained also answered no to this questions while 18 (30 %) were unsure/hesitant. 4 (6.7 %) trained students did not think that BLS training should be part of their curriculum and 2 (3.3 %) were not
sure/hesitant. 5 (8.3 %) of the untrained students also answered no to this question while 15 (25 %) were not sure/hesitant.
DISCUSSION OF THE RESULTS
Many studies exist showing that even trained participants do not have satisfactory results when assessed on their knowledge in BLS. [21, 23] This study however, discovered that among trained participants, results of knowledge and practice are satisfactory, while among the untrained ones they are not. Most of the trained participants were belonging to year five and six, were at least the fifth and sixth year students recently have had courses of BLS as in our faculty, training starts from fifth year and continues into sixth.
In a study made in Italy it was concluded that skills of BLS tend to deteriorate 6 months post-ALS course and in a study made in India it was also concluded that BLS skills tend to decay with increasing duration of training. [22, 29] In our study, not much time had passed since trained participants received their training and favourable results might be due to that deterioration of knowledge and skills had not yet made its mark. Another viewpoint is that after fifth year, students are once again starting a course of BLS, were they were allowed retraining from primary training. It has been considered that skills necessary to know in order to perform CPR are difficult to teach [30-31] and that once they have been successfully learned, a quick decline of knowledge will ensue. [28]
The effect of the phenomena of retraining was evaluated in a study were it was shown that retraining has a big influence on retention of knowledge. It was concluded that after
The reason for inadequate results among untrained participants might be due to lack of training. Similar results were achieved by studies made in India and Nepal, were inadequate knowledge of BLS were recorded which was stated to be due to lack of training. [11, 15, 32]
Observing the knowledge results achieved by the different groups, which can be visualized in table two, one can see that 50 of the untrained participants scored less than 50 % of the marks, only 10 of the untrained managed to pass the 50 % mark, which is clearly unsatisfactory. None of the untrained participants manage to score more than 60 % of the correct answers. On the contrary, among the trained participants only 6 students did not pass the 50 % mark with the lowest grades ranging between 30-49 % while the untrained participants had a lowest grade of less than 10 %. Majority of the trained participants (40) performed a result of 60-79 % and no one achieved full marks. Similar results, with differences among trained and untrained participants can be seen in other studies showing similar outcomes. [21, 23-27]
Regarding each question of the questionnaire belonging to knowledge, it is possible to see that the trained participants achieved better results than untrained and that results are satisfactory (most of the questions were correctly answered by more than 70 % of the participants except two were less than 30 % answered it correctly). None of the participants managed to answer all questions correctly, similar results can be seen in a related study
comparing knowledge of trained and untrained participants where none of the 250 participants managed to answer all questions correctly. [21] Furthermore, only one question was answered correctly by more than 50 % of the untrained participants and results show that questions which were not too specific were answered correctly by more of the untrained participants. These includes questions were one needed to know abbreviations. An example of such
question is “what is the abbreviation of “BLS” where 57 (95 %) of the trained participants and 51 (85 %) of the untrained ones answered this question correctly. Another example that can be used is a question about the abbreviation for AED, which was answered correctly by 59 (98.3 %) trained participants and 26 (43.3 %) untrained ones.
untrained) and depth of chest compression in neonates during CPR (13 (21.7 %) trained/3 (5.0 %) untrained). These two questions where the ones were lowest results were performed by the trained participants. This can be due to the fact that when it comes to infants and neonates, not many participants have had any encounters with these groups and the fact that most of the BLS and CPR courses focuses mostly on adults. It is however possible to see that 10 (16.7 %) untrained participants answered the question regarding depth of chest compressions in
children correctly, which is quite a high result considering results on other questions. A possible reason for this would be that many students has either guessed and succeeded or the outcome of logical thinking and thereby answering a questions as specific as this correctly, specially considering results of the trained participants were significantly lower on these questions compared to other results. Also one would consider p being <0.001 indicating a big difference between the two groups, which it is not (p 0.389).
Considering questions regarding CPR, the trained participants showed significantly better results than untrained, similar results could be found in a study conducted in Pakistan [21] and in Germany where a noteworthy difference between trained and untrained participants could be concluded regarding questions of CPR. [27]
Looking at results of practice, once again, trained participants scored better results, the
untrained did not perform well in this section either. Only 8 of the untrained students scored a mark of more than 50 %. One of the trained participants did not manage to pass the 50 % mark. Most of the trained students (51) performed results between 60 – 89 % and most of the untrained students (52) performed results of less than 30 – 49 %.
Ought to be said that most of the untrained participants in current study where students ranging from year 1-4 while the trained participants included students from year 5-6.
Therefore, one can not expect untrained participants having much knowledge when it comes to practice. Students from the latter years have had the privilege of getting training in BLS courses with mannequins and some might even had real clinical experience in the matter. This highlights the effect of clinical practice on performance of BLS skills, specially considering the practical part, which was also stated by a study done in Switzerland where it was
consequence for poor outcome of results. [7] This also explains why it was more difficult for students in performing well in practice part of questionnaire compared to knowledge part.
Looking at the distribution of correct answers for each question of practice, one can see that there were some questions were participants had the opportunity to collect points rather than viewing it as they actually had knowledge in the matter. Reason for this belief is that the majority of the trained participants performed well on each question, while untrained ones had a few questions were they performed well while most of the questions were too difficult to answer correctly. Example of a question was where to perform a pulse check in an adult which was correctly answered by 59 (98.3 %) trained participants and 39 (65 %) untrained, a high number when it comes to untrained participants. However, most of the people, even untrained laypersons, know that the carotid artery is where to check the pulse in an individual.
Another question asked what the compression to ventilation ratio for a lone rescuer is with the correct answer being 30:2. This questions was correctly answered by 57 (95.3 %) trained and 43 (71.3 %) untrained participants. The reason for so many untrained participants knowing this question might be the fact that it is such a basic one and most of the people might have heard it somewhere. Surprising to see that so many untrained participants managed to answer a questions regarding signs of airway obstruction correctly. The exact question was “Signs of severe airway obstruction include all of the following EXCEPT?” where 58 (96.7 %) trained and 37 (61.7 %) untrained participants managed to get the correct answer. Looking at the alternatives to choose from for this question, it shows that by using common sense, one might be able to get the correct answer. The alternatives to choose from were (a.) poor air exchange, (b.) high-pitched noise while inhaling, (c.) unable to cry and (d.) may wheeze between coughs with the correct alternative being (b.). Questions of this type indicate that common sense can be used in some aspect of BLS.
Regarding the attitude towards BLS among the participants, the majority had a positive attitude towards it. However, there were still a few students who were either not
what training in BLS is about, what they are to expect from it and therefore responded in this manner. For trained students, the issue might be that they are not satisfied with training they have had and therefore they could not have a positive attitude.
In this study, it was found that for the untrained participants, the mean was 4.85 ± 1.82
(knowledge) and 2.8 ± 1.35 (practice), which was clearly unsatisfactory while trained students had a mean of 8.76 ± 6 (knowledge) and 7.32 ± 1.11 (practice). In a study made in Pakistan were differences in knowledge between trained and untrained medical students were assessed, it was found that the knowledge of trained students was better than untrained. Nevertheless, the mean of the trained students was still less than 50 % (mean correct responses 6.13 ± 2.1), mean of correct responses for untrained students was 4.94 ± 2.06, with the conclusion that neither of the group performed results that were satisfactory. [21] On the contrary, a study by Starc B et al, where medical students were tested of their knowledge straight after the
completion of a BLS course, all of them showed skills that were satisfactory. [24] Similar results were achieved in a study conducted in New Zealand, were trained and untrained high school students were evaluated on their knowledge. It was found that trained students had better knowledge, yet they did not have satisfactory results. [26]
CONCLUSIONS
Based on the results and findings of this study, there is a need for medical students and health care workers to be allowed training in BLS. It is also important not to neglect the effect and weight of retraining in order to maintain knowledge and skills.
1. The level of knowledge and practice among trained participants are within desirable levels, among the untrained however, level is inadequate
2. Attitude towards BLS is positive among both trained and untrained participants. A bigger majority of the trained students had a positive attitude however.
3. Big gaps exist between trained and untrained participants both regarding knowledge and practice of BLS. Regarding attitude of BLS, both groups had a positive attitude towards it. 4. Differences in results between trained and untrained participants, with trained having
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ANNEX 2: Questionnaire
Which faculty of studies do you belong to?Answer:
Have you had previous training in Basic Life Support?
Yes/no
A. Knowledge: Questionnaire 1. What is the abbreviation of “BLS”? a) Best Life Support
b) Basic Life Support c) Basic Lung Support d) Basic Life Services
2. When you find someone unresponsive in the middle of the road, what will be your first response? (Note: You are alone there)
a) Open airway
b) Start chest compression c) Look for safety
d) Give two breathings
3. If you confirm somebody is not responding to you even after shaking and shouting at him, what will be your immediate action?
a) Start CPR b) Activate EMS
c) Put him in recovery position d) Observe
4. What is the location for chest compression?
a) Left side of the chest b) Right side of the chest
c) Centre of the chest on lower half bone d) Xiphisternum
5. What is the location for chest compression in
a) One finger breadth below the nipple c) At the intermammary line
b) One finger breadth above the nipple d) At Xiphisternum
6. How do you give rescue breathing in infants?
a) Mouth-to-mouth with nose pinched b) Mouth-to-mouth and nose
c) Mouth-to-nose only
7. Depth of compression in adults during CPR
a) At least 2 inches b) 21⁄2 – 3 inches c) 1 – 11⁄2 inches d) 11⁄2 inch
8. Depth of compression in Children during CPR
c) 1 - 11⁄2 inches d) 1⁄2 – 1 inch
9. Depth of compression in neonates during CPR
a) 11⁄2 – 2 inches b) 2- 21⁄2
c) 1 inch
d) approximately 11⁄2 inch
10. Rate of chest compression in adult and Children during CPR
a) at least 100 / min b) approximately 100 / min c) 80 / min
d) 120 / min
11. What does abbreviation AED stands for?
a) Automated External Defibrillator b) Automated Electrical Defibrillator c) Advanced Electrical Defibrillator d) Advanced External Defibrillator
12. What does abbreviation EMS stands for?
a) Effective Medical Services
b) Emergency Management Services c) Emergency Medical Services d) External Medical Support
13. If you and your friend are having food in a canteen and suddenly your
your first response? a) Give abdominal thrusts b) Give chest compression
c) Confirm foreign body aspiration by talking to him
d) Give back blows B. Attitude
1. Do you think BLS is necessary? Yes/ No/ can‟t say or not sure
2. Have you ever voluntarily performed BLS?
Yes / no / performed but not voluntarily 3. Would you perform mouth to mouth ventilation?
Yes/ no/ hesitant
4. Would you like to undergo BLS training in a workshop / centre with hands on practice under supervision? Yes / no / not sure
5. Do you think that BLS training should be a part of your curriculum? Yes/ No/ Not sure
C. Practice
1. The 5 links in the adult Chain of Survival include all of the following EXCEPT:
a. Early CPR
2. The critical characteristics of high-quality CPR include which of the following?
a. Starting chest compressions within 10 seconds of recognition of cardiac arrest b. Push hard, push fast
c. Minimize interruptions d. All of the above
3. the initial Basic Life Support (BLS) for adults are:
a. Assess the victim, give 2 rescue breaths, defibrillate, start CPR
b. Assess the victim, activate EMS & get AED, check pulse, start CPR
c. Check pulse, give rescue breaths, assess the victim, defibrillate
d. Assess the victim, start CPR, give 2 rescue breaths, defibrillate
4. where should you attempt to perform a pulse check in an adult?
a. Carotid b. Brachial c. Ulnar d. Temporal
6. The compression to ventilation ratio for the lone rescuer giving CPR to victims of ANY age is:
a. 15:1 b. 15:2 c. 30:1 d. 30:2
6. The proper steps for operating an AED are:
a. On the AED, attach electrode pads, shock the patient, analyze the rhythm b. On the AED, attach electrode pads, analyze the rhythm, clear the patient, deliver shock
c. Attach electrode pads, check pulse, shock patient, analyze rhythm d. Check pulse, attach electrode pads,
analyze rhythm, shock patient 7 The 2010 AHA Guidelines for CPR
recommended BLS sequence of steps are:
a. Chest compressions, Airway, Breathing
b. Airway, Breathing, Check Pulse c. Airway, Breathing, Chest
Compressions
d. Chest compression, Airway placement, Breathing
8. Signs of severe airway obstruction include all of the following EXCEPT? e. Poor air exchange
f. High-pitched noise while inhaling g. Unable to cry
h. May wheeze between coughs
9 In an adult with an advanced airway in place during 2-rescuer CPR, breaths should be administered how often? a. Every 5 seconds
