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Knowledge of the Portuguese population on Basic Life Support and availability to attend training

Conocimiento de la población portuguesa acerca del Soporte Básico de Vida y disponibilidad para realizar formación

Abstracts

OBJECTIVE

To evaluate the level of knowledge and the availability of the Portuguese population to attend training in Basic Life Support (BLS) and identify factors related to their level of knowledge about BLS.

METHOD

Observational study including 1,700 people who responded to a questionnaire containing data on demography, profession, training, interest in training and knowledge about BLS.

RESULTS

Among 754 men and 943 women, only 17.8% (303) attended a course on BLS, but 95.6% expressed willingness to carry out the training. On average, they did not show good levels of knowledge on basic life support (correct answers in 25.9 ± 11.5 of the 64 indicators). Male, older respondents who had the training and those who performed BLS gave more correct answers, on average (p<0.01).

CONCLUSION

The skill levels of the Portuguese population are low, but people are available for training, hence it is important to develop training courses and practice to improve their knowledge.

Cardiopulmonary Resuscitation; First Aid; Knowledge; Health Education


OBJETIVO

Evaluar el nivel de conocimiento y la disponibilidad de la población portuguesa para llevar a cabo la formación sobre Soporte Básico de Vida (SBV) e identificar algunos factores relacionados con su nivel de conocimiento acerca del SBV.

MÉTODO

Estudio observacional realizado con 1.700 personas que respondieron a un cuestionario compuesto de datos sociodemográficos y profesionales, formación, interés en la formación y conocimientos sobre SBV.

RESULTADOS

De los 754 hombres y 943 mujeres, solo el 17,8% (303) asistió a un curso sobre SBV, pero el 95,6% manifestó disponibilidad para realizar la formación. En promedio, no presentaron buenos niveles de conocimientos en soporte básico de vida (contestaron bien 25,9 ± 11,5 de los 64 indicadores). Los respondedores mayores, del sexo masculino, los que llevaron a cabo la formación y los que ya prestaron SBV contestaron bien, en promedio, más cuestiones (p<0,01).

CONCLUSIÓN

Los niveles de conocimiento de la población portuguesa son bajos, pero las personas están disponibles para la formación, por lo que es importante desarrollar cursos de formación y entrenamiento a fin de mejorar sus conocimientos.

Resucitación Cardiopulmonar; Primeros Auxilios; Conocimiento; Educación en Salud


OBJETIVO

Avaliar o nível de conhecimento e a disponibilidade da população portuguesa para realizar formação sobre Suporte Básico de Vida (SBV) e identificar alguns fatores relacionados ao seu nível de conhecimento sobre SBV.

MÉTODO

Estudo observacional realizado com 1.700 pessoas que responderam a um questionário composto por dados sociodemográficos e profissionais, formação, interesse na formação e conhecimentos sobre SBV.

RESULTADOS

Dos 754 homens e 943 mulheres, apenas 17,8% (303) frequentou um curso sobre SBV, mas 95,6% manifestou disponibilidade para realizar a formação. Em média, não apresentaram bons níveis de conhecimentos em suporte básico de vida (acertaram em 25,9 ± 11,5 dos 64 indicadores). Os inquiridos mais velhos, do sexo masculino, os que efetuaram formação e os que já prestaram SBV acertaram em média mais questões (p<0,01).

CONCLUSÃO

Os níveis de conhecimento da população portuguesa são baixos, mas as pessoas estão disponíveis para formação, sendo importante desenvolver cursos de formação e treino para melhorar os seus conhecimentos.

Ressuscitação Cardiopulmonar; Primeiros Socorros; Conhecimento; Educação em Saúde


Introduction

A medical emergency is the health sector activity comprising all the events happening from where an emergency situation takes place, until the moment of its conclusion with restoration of an adequate health level(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.). In Portugal, those involved in the emergency medical integrated system are: the public, the emergency center operators (emergency number 112), the technicians of the emergency patients guidance center (CODU - Centro de Orientação de Doentes Urgentes), law enforcement officers, firefighters, ambulance crews, emergency ambulance technicians, doctors and nurses, technical and hospital staff, telecommunications and informatics technical staff(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

Saving lives involves a sequence of steps that constitute the chain of survival, with four steps, namely: early access to integrated medical emergency; early initiation of basic life support (BLS); early defibrillation and advanced life support (ALS)(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

The BLS under citizen responsibility(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.) is a well-defined set of procedures with standardized methodologies and the following objectives: recognize life threatening situations; know when and how to ask for help; have the ability to start immediately and without aid of any equipment, maneuvers to preserve oxygenation and circulation until the arrival of specific teams and eventually, the restoration of normal cardiac and respiratory function(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

The prevalence of accidents in Portugal has caused victims at home, at work and on public spaces, being a current health problem that reflects the way of life and the organization of spaces and society. In 2011, there were 32,541 road accidents in Portugal resulting in 42,851 casualties. The fatalities (30 day-period) amounted to 891(3Portugal. Instituto Nacional de Estatística. Estatísticas dos transportes. Lisboa: INE; 2011.).

Ischemic heart disease is the leading cause of death worldwide. In Europe and the US, ischemic heart disease is the leading cause of sudden cardiac arrest(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.). About a third of victims of acute myocardial infarction die before reaching the hospital, most within an hour of the symptoms onset. Data from various European countries show the annual incidence of cardiac arrest in the prehospital system is almost 40 per 100,000(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

Sudden cardiac arrest is about 11% of deaths per year in Germany(4Meissner TM, Kloppe G, Hanefeld C. Basic life support skills of high school students before and after cardiopulmonary resuscitation training: a longitudinal investigation. Scand J Trauma Resusc Emerg Med [Internet]. 2012 [cited 2014 Apr 10];20:31. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353161/
http://www.ncbi.nlm.nih.gov/pmc/articles...
). In this and other emergencies, a rapid intervention would save people and prevent complications. About 50 to 65% of cardiac arrests occur at home. In such cases, family members who are close have the power to intervene. Many of these people would be saved if they were rescued in the first 3-4 minutes after the critical event(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.-2European Resuscitation Council. Guidelines for Resuscitation [Internet]. 2010 [cited 2014 Apr 10]. Available from: http://www.cprguidelines.eu/2010/
http://www.cprguidelines.eu/2010/...
,4Meissner TM, Kloppe G, Hanefeld C. Basic life support skills of high school students before and after cardiopulmonary resuscitation training: a longitudinal investigation. Scand J Trauma Resusc Emerg Med [Internet]. 2012 [cited 2014 Apr 10];20:31. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353161/
http://www.ncbi.nlm.nih.gov/pmc/articles...
). Given this fact, many authors stress the importance of including first aid training in school curricula(5Lešnik D, Lešnik D, Golub J, Križmarić M, Mally S, Grmec S. Impact of additional module training on the level of basic life support knowledge of first year students at the University of Maribor. Int J Emerg Med [Internet]. 2011 [cited 2014 Apr 10];4:16. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095545/
http://www.ncbi.nlm.nih.gov/pmc/articles...
).

To provide proper care, people need sufficient and adequate knowledge on BLS, which sometimes does not happen, requiring training(8Marton J, Pandúr A, Pék E, Deutsch K, Bánfai B, Radnai B, et al. Knowledge about basic life support in European students. Orv Hetil. 2014;25;155(21):833-7.) either in person or online(1010 Mori S, Whitaker IY, Marin HF. Evaluation of an educational website on first aid. Rev Esc Enferm USP [Internet]. 2013 [cited 2014 Aug 10];47(4):950-7. Available from: http://www.scielo.br/pdf/reeusp/v47n4/en_0080-6234-reeusp-47-4-0950.pdf
http://www.scielo.br/pdf/reeusp/v47n4/en...
). If the latter is of quality(1212 Liu KY, Haukoos JS, Sasson C. Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet. Resuscitation. 2014;85(1):131-7.), it can favor the increased number of trained people by reducing the need to travel to attend courses.

Given the above and the potential value of first aid training as a strategic element to reduce mortality and morbidity caused by accidents and emergencies(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
), this study aimed to: assess the knowledge level on BLS of the Portuguese population; know their willingness to carry out training in BLS and identify some factors (age, gender, frequency to a BLS course and previous experience in BLS) related to the level of knowledge about BLS.

Method

We conducted an observational descriptive and correlated study. The population comprised Portuguese residents in continental Portugal, the Azores and Madeira islands, aged 18 years or over, able to read and write and who where working in public and private institutions. The selection of data collection sites and sample was conducted as follows:

  1. We made a list of all public and private institutions to which we had access in the yellow pages;

  2. Two public or private institutions in each city of Portugal, including the islands of Azores and Madeira were selected by lot;

  3. The study protocol and its respective applications for authorization were submitted to the board of directors and ethics committee of the chosen institutions;

  4. After authorizations were granted, the employees of each institution in charge of instruments application were defined. They were sent instructions for data collection;

  5. The instruments were applied to respondents in a room chosen for this purpose, before the start or in the end of the work activity.

  6. After filling out the questionnaires, respondents put them in a ballet box in the room to maintain anonymity;

  7. The employees returned the completed questionnaires to researchers by mail.

  8. The non-probabilistic sample consisted of 1,700 respondents of both genders (55.6% women and 44.4% men), mean age of 37.7 years (SD = 10.5), who exercised functions in 250 of the 318 institutions selected (participation rate of 78.6%).

The applied instrument contained three parts, described below:

Sociodemographic and professional data: residence; age; gender; marital status; educational level and profession.

Training and interest in BLS training: frequency to any BLS course; experience in performing BLS; any citizen can help a victim in life-threatening situation: who should have knowledge about BLS; opinion about beginning BLS training in a teaching program; BLS training in the workplace; BLS training in associations; BLS training providers; interest in receiving BLS training; willingness to undertake BLS training and previous experience of volunteering or in health institutions.

BLS knowledge: 64 affirmations based on orientation defined in national and international guidelines for this article(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.-2European Resuscitation Council. Guidelines for Resuscitation [Internet]. 2010 [cited 2014 Apr 10]. Available from: http://www.cprguidelines.eu/2010/
http://www.cprguidelines.eu/2010/...
,1313 American Heart Association. 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation [Internet]. 2010 [cited 2014 Aug 10];122 Suppl 3:S639-946. Available from: http://www.counselling-care.it/pdf/pdf_ps/2010-aha-guidelines.pdf
http://www.counselling-care.it/pdf/pdf_p...
). The correct answers received the score 1, and wrong answers received the score 0 (zero). Thus, the total score ranged from 0-64 points. For content validation, the instrument was appreciated by field experts (doctors and nurses), and a pretest was applied to 20 people with the same characteristics of the target population. There was no need to make changes.

The study protocol was approved by all the ethics committees of the institutions. In institutions where there was no ethics committee (180 institutions), the protocol was approved by their administration boards. Before the application of instruments, the study objectives and purposes were explained for all the subjects. Before completing, all participants signed the informed consent form.

The SPSS (Statistical Package for the Social Sciences), version 17, and descriptive and inferential statistics were used. Since the variable of level of knowledge about basic life support presented normal distribution (Kolmogorov-Smirnov), we used the Pearson correlation and the t Student test, establishing a significance level of 95% with p<0.05.

Results

Sociodemographic and professional characteristics of the sample

More than half of the respondents were female (55.6%), married (60.7%) with mean age of 37.7 ± 10.5 years. The education of the majority (65.1%) was until 12th grade or higher education, and 30.2% of respondents were administrative staff or similar (Table 1).

Table 1
Distribution of the sample answers regarding sociodemographic and professional characteristics - Portugal, 2010-2012.

Training and experience of the Portuguese population in basic life support

Only 303 (17.8%) had attended a BLS course, the majority in the Portuguese Red Cross (23.5%) or qualified training centers (21.8%); 14.6% needed to perform BLS, with traffic accident (22.5%) as the most cited situation. The intervention carried out more times (47.5%) was calling 112 (Table 2).

Table 2
Distribution of the sample answers in relation to training and experience in BLS - Portugal, 2010-2012.

According to 54.1% of the participants, any citizen can help a victim and, therefore, must have knowledge on BLS (81.4%). They also indicated that training should be done in the workplace (84.9%). The National Institute of Medical Emergency (63.6%) and the Firefighters (62.1%) were the most cited to conduct training in BLS (Table 3).

Table 3
Distribution of the sample answers regarding the opinion about who should attend BLS training and where - Portugal, 2010-2012.

Among the respondents, 522 (30.9%) emphasized that training in BLS should be initiated in the 2nd grade; 482 (29.8%) in the 1st grade, 502 (28.6%) in the 3rd grade, 155 (9.8%) in secondary school, and 13 (0.8%) mentioned it should be integrated into higher education (0.4%), with equal percentage mentioning that BLS training is not necessary (0.4%). Regarding availability to attend a training, 655 (38.6%) said they had plenty of availability, 378 (22.2%) said they were available, 592 (34.8%) reported being a bit available, and 75 (4.4%) have not expressed any availability.

Knowledge of the population about basic life support

Before a breathing victim, more than 90% of respondents would ask someone to call 112 (Portuguese Medical Emergency number). More than half of respondents gave correct answers for several indicators, among which: before approaching a victim, one should evaluate the security situation (79.9%); in a situation of electrocution, the rescuer must ensure that the power source was turned off before approaching the victim (79.6%); ensure there are safe conditions for approaching the victim (79%); try to see, hear and feel if the victim breathes for 10 seconds (77.9%).

Table 4
Distribution of the sample answers about knowledge on BLS - Portugal, 2010-2012.

Among the 64 indicators, participants have given correct answers for 25.9 ± 11.5 on average, which is less than half of the proposed indicators. The level of knowledge on BLS (r=0.98; p <0.01) increased as the respondents' age increased. On average, male participants who already had the training and those who had performed BLS hit more questions than female participants who did not have the training nor have performed BLS (p<001), as shown in Table 5.

Table 5
Results of the Student t test application regarding the knowledge level* * values may range between 0 and 64. of the sample on BLS - gender, frequency of some BLS course and performance of BLS - Portugal, 2010-2012.

Discussion

More than half of the study sample was female (55.6%), a percentage similar to the Portuguese population(1414 Portugal. Instituto Nacional de Estatística. Censos 2011. XV Recenseamento Geral da População. V Recenseamento Geral da Habitação. Resultados definitivos. Lisboa: INE; 2012.). According to the 2011 census(1515 Murad MK, Husum H. Trained lay first-helpers reduce trauma mortality: a controlled study of rural trauma in Iraq. Prehosp Disaster Med. 2010;25(6):533-9.), about 47% of the population is married. Data in this study are different, with a greater number of married subjects (60.7%). However, data include 13% of individuals living in common-law marriage, which is different from information in the 2011 census.

According to the census, 15 %(1414 Portugal. Instituto Nacional de Estatística. Censos 2011. XV Recenseamento Geral da População. V Recenseamento Geral da Habitação. Resultados definitivos. Lisboa: INE; 2012.)of people have higher education, which is much lower than the percentage observed in this study (31.3%). Approximately 30.2% of the sample have a profession in the area of administrative personnel and alike, and this value is explained by the selected data collection sites (companies and schools). In the general population,trade, hotels, transports and communications, and other service activities, are the professional activities where more people are employed, approximately 30% and 29%, respectively(1414 Portugal. Instituto Nacional de Estatística. Censos 2011. XV Recenseamento Geral da População. V Recenseamento Geral da Habitação. Resultados definitivos. Lisboa: INE; 2012.).

The results of several studies show that the implementation of basic life support measures by the citizen/lay people with training reduces mortality and morbidity rates(7Pergola AM, Araujo IEM. Laypeople and basic life support. Rev Esc Enferm USP [Internet]. 2009 [cited 2014 Apr 10];43(2):335-42. Available from: http://www.scielo.br/pdf/reeusp/v43n2/en_a12v43n2.pdf
http://www.scielo.br/pdf/reeusp/v43n2/en...
,1515 Murad MK, Husum H. Trained lay first-helpers reduce trauma mortality: a controlled study of rural trauma in Iraq. Prehosp Disaster Med. 2010;25(6):533-9.-1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
). Individuals who had cardiopulmonary resuscitation (CPR) of a trained citizen/lay person are four times more likely to survive for 30 days that those in which CPR was not applied(1717 Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013;310(13):1377-84.).

In the present study, the low percentage (17.8%) of people who attended a BLS course is noteworthy. In this regard, several studies have mixed results: in some, the vast majority of spectators of critical events did not have first aid training(7Pergola AM, Araujo IEM. Laypeople and basic life support. Rev Esc Enferm USP [Internet]. 2009 [cited 2014 Apr 10];43(2):335-42. Available from: http://www.scielo.br/pdf/reeusp/v43n2/en_a12v43n2.pdf
http://www.scielo.br/pdf/reeusp/v43n2/en...
), in others, on the other hand, more than half of the sample (54.1%) had CPR training, and 21.2% immediately initiated CPR(1919 Swor R, Khan I, Domeier R, Domeier RM. CPR training and CPR performance: do CPR-trained bystanders perform CPR? Acad Emerg Med. 2006;13(6):596-601.). In another study(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
), the authors found that 77.9% of participants had attended some kind of preparation in the area of first aid, although 61% had not done any training in the past five years(2020 Larsson EM, Martensson NL, Alexanderson KA. First-aid training and bystander actions at traffic crashes: a population study. Prehosp Disaster Med. 2002,17(3):134-41.).

Among the most frequently cited training locations are the qualified training centers (21.8%) and the Portuguese Red Cross (23.5%), different from data found in other studies(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
,2020 Larsson EM, Martensson NL, Alexanderson KA. First-aid training and bystander actions at traffic crashes: a population study. Prehosp Disaster Med. 2002,17(3):134-41.

21 Jones CM, Owen A, Thorne CJ. Comparison of the quality of basic life support provided by rescuers trained using the 2005 or 2010 ERC guidelines. Scand J Trauma Resusc Emerg Med. 2012;20:53.
-2222 Akpek EA, Kayhan Z. Knowledge of basic life support: a pilot study of the Turkish population by Baskent University in Ankara. Resuscitation. 2003;58(2):187-92.). In a study conducted through telephone interviews with 7,320 respondents, the most common sources of training in first aid, more specifically in burns, were books (41.7%) and the internet (32.9%). In only 9.8% of cases the respondents resorted to the health authorities and surgery doctors as sources of information/training(2323 Harvey LA, Bar ML, Poulos RG, Finch CF, Sherker S, Harvey JG. A population- based survey of knowledge of burns in New South Wales. Med J Aust. 2011;195(8):465-8.). On the other hand, in a study in Brazil, the authors(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
) found that 35.6% had their training in the drivers' preparation course and 20.6% had it in the workplace. These differences may be due to the type of sample, place and type of data collection instrument.

Of the 1,668 people participating in the study, 1,425 (85.4%) never had to perform BLS. Traffic accident was the most reported situation (22.5%) for those who had already provided assistance, a slightly higher data (12.2%) than that found in another study(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
).

Citizens have taken several measures in an emergency situation, such as: application of a bandage/dressing(1818 Mauritz W, Pelinka LE, Kaff A, Segall B, Fridrich P. First aid measures provided by bystanders at the accident site: a prospective epidemiological study in the area of Vienna. Wien Klin Wochenschr. 2003;115(19-20):698-704.), positioning the victim(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
), bleeding control(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
), ensure safety at accident site(1010 Mori S, Whitaker IY, Marin HF. Evaluation of an educational website on first aid. Rev Esc Enferm USP [Internet]. 2013 [cited 2014 Aug 10];47(4):950-7. Available from: http://www.scielo.br/pdf/reeusp/v47n4/en_0080-6234-reeusp-47-4-0950.pdf
http://www.scielo.br/pdf/reeusp/v47n4/en...
), release of the victim(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
), opening the airway(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
), precautions against hypothermia(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
), cardiopulmonary resuscitation(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
)and providing tranquility to the victim(1111 Arbon P, Hayes J. First aid and harm minimization for victims of road trauma: a population study. Final Report June 2007 [Internet] . Adelaide, Australia: Flinders University; 2007 [cited 2014 Apr 24). Available from: http://clicktosave.com.au/wp-content/uploads/2013/06/Australian_Population_Study_on_victims_of_Road_Trauma1.pdf
http://clicktosave.com.au/wp-content/upl...
).

Taking into account the probability of avoiding 4.5% of potential prehospital deaths with immediate BLS(2424 Ashour A, Cameron P, Bernard S, Fitzgerald M, Smith K, Walker T. Could bystander first-aid prevent trauma deaths at the scene of injury. Emerg Med Australas. 2007; 19(2):163-8.), and considering the first link in the chain of survival(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.), in this study, 47.5% of participants asked for help by immediately accessing the emergency medical system (dial 112), which is in agreement (31%) with results from another study(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
).

When asked about who should offer the training, 63.6% mentioned the National Institute of Medical Emergency. Training is carried out by doctors and nurses in this institution, which is in line with the highlighted information in the literature, stating that it should be done by skilled personnel(7Pergola AM, Araujo IEM. Laypeople and basic life support. Rev Esc Enferm USP [Internet]. 2009 [cited 2014 Apr 10];43(2):335-42. Available from: http://www.scielo.br/pdf/reeusp/v43n2/en_a12v43n2.pdf
http://www.scielo.br/pdf/reeusp/v43n2/en...
,1010 Mori S, Whitaker IY, Marin HF. Evaluation of an educational website on first aid. Rev Esc Enferm USP [Internet]. 2013 [cited 2014 Aug 10];47(4):950-7. Available from: http://www.scielo.br/pdf/reeusp/v47n4/en_0080-6234-reeusp-47-4-0950.pdf
http://www.scielo.br/pdf/reeusp/v47n4/en...
,1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
).

Approximately 95.6% of the sample showed availability to attend the training, and similar results (94.45%) were found in the study carried out with students(2525 Khan A, Shaikh S, Shuaib F, Sattar A, Samani SA, Shabbir Q, et al. Knowledge attitude and practices of undergraduate students regarding first aid measures. J Pak Med Assoc. 2010;60(1):68-72.). Training must be offered in cultural associations aimed at community groups (88.4%) or in the workplace (84.9%). These options would facilitate adherence to training by avoiding the displacement of participants.

Training in BLS should begin in the student population and before the start of higher education(6Miró Andreu O, Escalada Roing X, Jiménez-Fábrega X, Díaz Miranda N, Sanclemente G, Villena O, et al. Programa de Reanimación Cardiopulmonar Orientado a Centros de Enseñanza Secundaria (PROCES): conclusiones tras 5 años de experiencia. Rev Soc Esp Med Urgencias Emerg. 2008;20(4):229-36.). Authors of recent studies(4Meissner TM, Kloppe G, Hanefeld C. Basic life support skills of high school students before and after cardiopulmonary resuscitation training: a longitudinal investigation. Scand J Trauma Resusc Emerg Med [Internet]. 2012 [cited 2014 Apr 10];20:31. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353161/
http://www.ncbi.nlm.nih.gov/pmc/articles...
) showed that even nine-year-old children can perform CPR if properly prepared. Having the training is important and there should be recycling to improve knowledge and confidence of those involved(4Meissner TM, Kloppe G, Hanefeld C. Basic life support skills of high school students before and after cardiopulmonary resuscitation training: a longitudinal investigation. Scand J Trauma Resusc Emerg Med [Internet]. 2012 [cited 2014 Apr 10];20:31. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353161/
http://www.ncbi.nlm.nih.gov/pmc/articles...
).

In a quasi-experimental study of students with average age of 21.5 ± 0.74 years who received formal training and practice in first aid, the authors(2525 Khan A, Shaikh S, Shuaib F, Sattar A, Samani SA, Shabbir Q, et al. Knowledge attitude and practices of undergraduate students regarding first aid measures. J Pak Med Assoc. 2010;60(1):68-72.) found these students had better knowledge than those who had not attended training (p <0.001). Similar results were found by other authors(8Marton J, Pandúr A, Pék E, Deutsch K, Bánfai B, Radnai B, et al. Knowledge about basic life support in European students. Orv Hetil. 2014;25;155(21):833-7.) in a study with Danish students (average age of 17.5±1.2 years) and students from 13 European countries(2626 Aaberg AMR, Larsen CEB, Rasmussen BS, Hansen CM, Larsen JM. Basic life support knowledge, self-reported skills and fears in Danish high school students and effect of a single 45-min training session run by junior doctors; a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2014, 22:24.). Some studies have shown that even individuals who had training presented low values of knowledge(2525 Khan A, Shaikh S, Shuaib F, Sattar A, Samani SA, Shabbir Q, et al. Knowledge attitude and practices of undergraduate students regarding first aid measures. J Pak Med Assoc. 2010;60(1):68-72.) and some said they did not feel prepared(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
). Still, it is proven that adult training in BLS is effective and necessary(2828 Janisha KP, Priya V, Fermina J. Effectiveness of planned teaching programme on knowledge regarding basic life support among young adults. Int J Nurs Educ. 2012;4 (1):28.), reinforcing the need for recycling and updating knowledge(7Pergola AM, Araujo IEM. Laypeople and basic life support. Rev Esc Enferm USP [Internet]. 2009 [cited 2014 Apr 10];43(2):335-42. Available from: http://www.scielo.br/pdf/reeusp/v43n2/en_a12v43n2.pdf
http://www.scielo.br/pdf/reeusp/v43n2/en...
).

Regarding the level of knowledge, as in another study(7Pergola AM, Araujo IEM. Laypeople and basic life support. Rev Esc Enferm USP [Internet]. 2009 [cited 2014 Apr 10];43(2):335-42. Available from: http://www.scielo.br/pdf/reeusp/v43n2/en_a12v43n2.pdf
http://www.scielo.br/pdf/reeusp/v43n2/en...
), it was found that the studied population had insufficient and some incorrect knowledge. Male respondents who attended a course in BLS and those with experience in BLS showed higher levels of knowledge on BLS, on average. In a study with students, the authors(2525 Khan A, Shaikh S, Shuaib F, Sattar A, Samani SA, Shabbir Q, et al. Knowledge attitude and practices of undergraduate students regarding first aid measures. J Pak Med Assoc. 2010;60(1):68-72.) found that women and those who had previous training showed higher level of knowledge on BLS. The rate of correct answers in 64 questions was 25.9%, higher than the 10% found in another study(1616 Pergola AM,. Araujo IEM The layperson in emergency situations. Rev Esc Enferm USP [Internet]. 2008 [cited 2014 Aug 10];42(4):769-76. Available from: http://www.scielo.br/pdf/reeusp/v42n4/en_v42n4a20.pdf
http://www.scielo.br/pdf/reeusp/v42n4/en...
). However, the content and the questions are not similar with those of the present study (degree of difficulty/different scope).

According to international guidelines(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.-2European Resuscitation Council. Guidelines for Resuscitation [Internet]. 2010 [cited 2014 Apr 10]. Available from: http://www.cprguidelines.eu/2010/
http://www.cprguidelines.eu/2010/...
,1313 American Heart Association. 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation [Internet]. 2010 [cited 2014 Aug 10];122 Suppl 3:S639-946. Available from: http://www.counselling-care.it/pdf/pdf_ps/2010-aha-guidelines.pdf
http://www.counselling-care.it/pdf/pdf_p...
), more than 50% gave wrong answers for the questions related to chest compressions. However, 79.9% of respondents gave correct answers on the items concerning the safety of rescuer.

When the victim breathes and if not traumatized, 51.4% gave right answer for the question of the proper placement, a higher value than that from another study(1414 Portugal. Instituto Nacional de Estatística. Censos 2011. XV Recenseamento Geral da População. V Recenseamento Geral da Habitação. Resultados definitivos. Lisboa: INE; 2012.). The victim should be placed in the recovery position to prevent airway obstruction and consequent respiratory arrest(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

When the victim chokes, only 33% of respondents said the Heimlich maneuver should be performed. Such maneuver should be performed whenever there is serious airway obstruction and the victim is conscious. If choking is mild and the cough is effective, coughing should be encouraged and the person monitored. However, if the person is unconscious and the obstruction is severe, the rescuer should call 112 and begin CPR(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

The area of interventions to the child had the lowest percentage of correct answers, between 22.5% (faced with the unconscious child, perform CPR for a minute before calling help) and 11.8% (in an infant in cardiac arrest, five chest compressions should be alternated with two breaths). In infants, chest compressions must follow the compression-ventilation ratio of 15: 2 (with two rescuers)(1Portugal. Instituto Nacional de Emergência Médica. Manual de suporte avançado de vida. 2ª ed. Lisboa: INEM; 2011.).

Conclusion

The results of this study reinforce the need for training laypeople in BLS to reduce mortality and morbidity rates in situations of accident and sudden illness in extra-hospital setting. Although there are several courses in the Portuguese community, both in the classroom and online, some mandatory, it is necessary to introduce the subject in the school curricula of all young people as early as possible. Theoretical and practical training programs should be conducted in schools and workplaces to empower the population in this area, reducing morbidity and mortality due to accidents and emergencies.

Respondents had low levels of knowledge on BLS, evidencing the need and the availability to have the training. Courses should be managed by health professionals, including nurses, maximizing the skills of these professionals in BLS. Despite some difficulties in completing the instrument given its extent, respondents found it useful to realize the knowledge gaps and the importance of attending the training.

We encourage replication of the study in other research scenarios, particularly with children and teachers. In future studies, it would be important to increase the sample size and develop longitudinal studies, after conducting theoretical and practical training, aiming to assess their effectiveness. It would also be interesting to develop documentary analysis to verify the morbidity and mortality of victims of accident or sudden illness rescued or not by lay people with and without training.

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    Aaberg AMR, Larsen CEB, Rasmussen BS, Hansen CM, Larsen JM. Basic life support knowledge, self-reported skills and fears in Danish high school students and effect of a single 45-min training session run by junior doctors; a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2014, 22:24.
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Publication Dates

  • Publication in this collection
    Jul-Aug 2015

History

  • Received
    24 June 2014
  • Accepted
    13 May 2015
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br