Awareness, knowledge and attitude towards CPR, BLS training among general population in Chennai – A cross sectional survey

Introduction

Public awareness is of great key importance in all countries, especially on topics based on life-saving information and skills.1 Globally, many countries are taking various efforts on emphasizing and promoting programs in educational institutions and workplaces regarding Basic lifesaving program. 2 Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that would be useful when someone’s breathing or heartbeat has been stopped. This procedure is known only to less than 2% of India’s population.3 Road traffic accidents emerge as the commonest mode of death nowadays. Road accidents occur due to multiple causes such as the use of mobile phones on the go, drunken driving/consumption of alcohol/drugs, overloaded vehicles, poor light conditions, jumping red lights, overspeeding, overtaking, weather conditions, driving on the wrong side of the road, etc. As per reports released by Government of Tamil Nadu Transport Department, in a survey conducted on road traffic accident analysis, Chennai continued to lead in the first place for the third consecutive year. Out of the reported 5173 road accidents, 689 were from Chennai, and out of the 993 deaths, 114 were in Chennai.4 Extrapolating the data to national mortality figures, it can be roughly estimated that annually about 7-lakh Sudden Cardiac Death cases occur in India. Approximately 50,000 people survive after cardiac arrest when basic life support (BLS) measures are performed properly as per the data. Proper BLS training and knowledge about CPR helps to reduce the fatal rate due to sudden cardiac deaths.

The very first person to be closer to the subject undergoing a sudden cardiac arrest is common by stander, followed by the arrival of para- medics and medical professional help.

Cardiopulmonary resuscitation (CPR) given by bystander increases survival rate of out-of-hospital cardiac arrest (OHCA) by at least twofold.5 By increasing the level of knowledge for BLS and CPR the necessary treatment can be given in the Golden Hour thereby increasing the rate of survival. Early recognition of a cardiac arrest paves a pathway for early action of Basic Life support which can reduce the mortality rate. Survival after OHCA is in lower range (3%–30%) but showed improvement after increased public education and increased use of automatic external defibrillators. 5

This study aims to evaluate the knowledge on CPR and basic life support methods among general population excluding the medics and paramedics in Chennai which may lead us to conduct awareness camp and campaign to make the public aware.

Materials and Methods

A structured questionnaire consisting of 15 questions was formulated for the purpose of the survey. The questionnaire was formulated by the authors of the study. This consists of only closed ended questions. This questionnaire survey primarily focussed on evaluation of general population’s knowledge and awareness on CPR.

A pilot study was conducted amongst 40 individuals who were common public was conducted Chennai city. Power analysis was performed to calculate the sample size by using Open Epi, Version 3, open – source calculator – SSPropor. Assuming 95%power and 3% precision the required sample size calculated as 1066. So total study population planned in this survey 1172 considering 10% as attrition and dropout rate. The target population were general population in Chennai within the age group of 17 – 60 years with eligibility write or read English or vernacular language (Tamil). Consent was obtained from each participant to be in part of the study. The medics and paramedics were excluded from the study. Ethical committee clearance was obtained from the university.

Results

All the participants were general population and persons from medical field were excluded. The mean age of the study population was 35.84 + 13.17. The urban locality was found to be the overall residence of the study population (n = 1200, 100%). According to the basic educational qualification, 443 (36.9%) was found to be unemployed, 481 was found to be college students (40.1%) and 276 were found to be working professionals. (23%). (Table 1)

When we analyze the distribution of the study results of the questionnaire among the study population with respect to question 1 which states that Have you ever given first aid to a person? 77 (6.4%) answered yes and 1123 (93.6%) answered no and this difference was said to be statistically very highly significant (p<0.001***). And to the question 2 which states that “How can heart stoppage be checked?”, 369 (30.8%) answered “Check for consciousness”, 350(29.2%) answered “Trying to communicate with wounded person”, 265 (22.1%) answered “check for breathing” and 216(18%) answered “ I don’t know” and this difference was said to be statistically very highly significant (p<0.001***). When persons were asked “Where will you check for pulse?”, 1186 (98.8%) answered “Wrist”, 10 (0.8%) answered “Face”, 4 (0.3%) answered “check for breathing” and 0(0%) answered “ I don’t know” and this difference was said to be statistically very highly significant (p<0.001***). With respect to question which states that “What is “golden hour” after accident?”, 935 (77.9%) answered “First 1 hour”, 88 (7.3%) answered “First 24 hours”, 123 (10.3%) answered “First 12 hours” and 54(4.5%) answered “ I don’t know” and this difference was said to be statistically very highly significant (p<0.001***). When we asked the participants “Do you know what CPR (Cardio pulmonary resuscitation)? 52 (4.3%) answered yes and 1148 (95.7%) answered no and this difference was said to be statistically very highly significant (p<0.001***).

With respect to question 6 which states that “Have you received formal CPR (Cardio pulmonary resuscitation) training in the past??”, 52 (4.3%) answered yes and 1148 (95.7%) answered no and this difference was said to be statistically very highly significant (p<0.001***) . To question 7 which states that “Why we have to give CPR (Cardio pulmonary resuscitation)?”, 488 (40.7%) answered “To restart heart” and 391 (32.6%) answered “To restart lungs” and 321 (26.8%) answered both and this difference was said to be statistically very highly significant (p<0.001***)

When the participants were questioned which states that “Have you ever seen anyone giving CPR (Cardio pulmonary resuscitation)?”, 52 (4.3%) answered “Yes” and 1148 (95.7%) answered “No” and this difference was said to be statistically very highly significant (p<0.001***) when they were asked “When should you perform CPR (Cardio pulmonary resuscitation)?”, 491 (43.6%) answered “When there is no heartbeat”, 245 (20.4%) answered “When wounded person is unconscious”, 223 (18.6%) answered “When wounded person is not breathing” and 241 (20.1%) answered both. and this difference was said to be statistically very highly significant (p<0.001***) With respect to question 10 which states that : Have you ever given CPR (Cardio pulmonary resuscitation) to someone? 52 (4.3%) answered yes and 1148 (95.7%) answered no and this difference was said to be statistically very highly significant (p<0.001***) With respect to question 11 which states that “Do you think schools/ colleges/ offices CPR (Cardio pulmonary resuscitation) training programs would be useful?”, 53 (4.4%) answered yes and 1147 (95.6%) answered yes and this difference was said to be statistically very highly significant (p<0.001***) With respect to question 12 which states that “Do you think it is easy to give CPR (Cardio pulmonary resuscitation)?”, 131 (10.9%) answered yes, 936 (78%) answered yes and133 (11.1%) answered I don’t know and this difference was said to be statistically very highly significant (p<0.001***) When the participants were questioned that “After demonstration will you are able to perform CPR (Cardio pulmonary resuscitation)?” 65 (5.4%) answered yes, 1033 (86.1%) answered yes and 102 (8.5%) answered I don’t know and this difference was said to be statistically very highly significant (p<0.001***). With respect to question which states that “What concerns may prevent you from giving CPR (Cardio pulmonary resuscitation) to a stranger after training?” 335 (27.9%) answered “Contact with coved infected people”, 573 (47.8%) answered “legal reasons” and 120 (10.0%) answered Stopping a working heart and 172 (14.3%) answered “contamination by blood or vomit” and this difference was said to be statistically very highly significant (p<0.001***) With respect to question that “Do you know emergency ambulance number?” 1105 (92.1%) answered “yes” and 95 (7.9%) answered no (Table 18) and this difference was said to be statistically very highly significant (p<0.001***)

Questions that are asked to analyze the Basic knowledge of general population on first aid and basic life support.

Questions that are asked to analyze the knowledge on Cardio pulmonary resuscitation (CPR).

Discussion

BLS knowledge and awareness are critical not just for healthcare professionals, but also for everyone in the community, in order to save lives, improve quality of life, and overall community health. In our survey, 95.7% of the population did not know what CPR is and had no prior experience with CPR / BLS training, whereas 4.3% had experience and an understanding of what CPR is. This explains why the general people is unaware of the importance of CPR. The proportion of awareness is comparatively low when compared to previous cross-sectional polls conducted in other states and countries, and this must be regarded seriously. 6, 7

According to this report, just 6.4% of people have provided first aid to the general population, which includes any sort of basic life support. 93.6% of people never gave victims immediate help. One cause could be ignorance, but it has been evaluated from another perspective. According to the other poll results, the general public is concerned about disease transmission from the sufferer by providing mouth-to-mouth ventilation while performing CPR, and the biggest concern for the public is the legal issue.8 As a result, public education, and legislation to safeguard CPR providers are required. People should be informed of the regulations governing Good Samaritans. The entire public must be made aware of this issue.

According to the findings of this study, most untrained respondents would not consider taking CPR training for the following reasons: "no time", "not necessary", or "not interested". A prominent cause cited in various research is a lack of time for CPR instruction. Self-instruction, such as video or internet training, may be considered to alleviate this issue. According to studies, video self-instruction training is just as good as traditional classroom training and is not only less expensive but also more flexible than traditional classroom training. Self-willingness to perform CPR among the population in this study was about 95.5%, which shows the positive attitude towards the training.9 The current findings encourage the use of innovative methods to reach a specific high-volume, younger demographic in order to raise knowledge about civilian CPR.10, 11 The excellent evaluations offered by participants of CPR training at music festivals in general, and of our training modules, support the idea of increasing the use of public events for (short) CPR training.

Research on regular CPR training used Twitter to gauge public opinion and discovered that most tweets were negative and that time, place, and duration of training were often noted hurdles. In this context, the short duration of our training modules is another appealing feature for those who do not want to devote a lot of time to acquiring and maintaining CPR abilities.

Conclusion

Most people still lack understanding of CPR. The proportion of citizens who have been given CPR instruction is quite low. Unwillingness to conduct CPR is especially prevalent among individuals who did not receive CPR instruction.

Government and non-government groups are required to promote educational activities and explore new techniques to reinforce and renew training content. The government must raise public understanding of CPR and pass legislation to protect bystanders performing CPR. It has also been recommended that CPR instruction be included in high school and college curriculum.

Source of Funding

None.

Conflict of Interest

None.