Impact of a child first aid wall calendar on lay people's skills and knowledge of infant CPR

Improving the cost-effectiveness of laypersons' paediatric basic life support skills training: A randomised non-inferiority study

AIM

To compare dyad (training in pairs without an instructor) with resource-intensive instructor-led training for laypersons' paediatric resuscitation skills in a non-inferiority trial and examine cost-effectiveness of the training methods.

METHODS

In this randomised parallel group non-inferiority trial, 155 dyad and 175 instructor-led laypersons were trained in Basic Life Support and Foreign Body Airway Obstruction Management. Dyads were given instructional videos, hands-on exercises and provided feedback to their partner for 50 min. Instructor-led laypersons trained in groups of six for two hours. Learning were assessed in scenarios immediately after training and, subsequently, at 14 days, 1, and 3 months. Pass rates, cost-effectiveness of producing a competent layperson (passing both tests), and non-inferiority were analysed.

RESULTS

Sixty-eight (45.6%) dyad and 130 (74.3%) instructor-led laypersons passed the basic life support test (p < 0.001). For Foreign Body Airway Obstruction Management 77 (54.2%) dyad and 130 (79.3%) for instructor-led laypersons passed (p < 0.001). Skills decreased over three months for both groups. Forty-two (30.4%) dyad and ninety-eight (59.8%) for instructor-led laypersons were competent after training (p < 0.001). The lower effectiveness of dyad training had reduced costs (p < 0.001). For each 10,000 USD allocated to training, dyad training would result in 71 vs. 65 competent laypersons for instructor-led training. Non-inferiority of dyad training could not be established.

CONCLUSION

Instructor-led training was the most effective but also the most expensive training method, making it less cost-effective than dyad training. When the aim is to train for quantity rather than quality, dyad training would be the preferred choice of training method.

The Knowledge of and Attitudes Toward First Aid and Cardiopulmonary Resuscitation Among Parents

PURPOSE

To determine the level of knowledge of first aid and cardiopulmonary resuscitation (CPR) among the parents of children who attended our Pediatric Emergency Department and to identify the factors that affect this knowledge.

DESIGN AND METHODS

Descriptive, transversal study. A questionnaire was distributed anonymously among parents to collect data about their previous CPR training, knowledge and experience.

RESULTS

A total 405 valid questionnaires were returned. The mean age of the sample was 38.08 (SD 7.1) years, and 66.9% of participants were female. The mean score of correctly answered questions was 6.76 out of 19 questions. Parents with a university education received a mean score of 7.16 versus 6.24 for those with a primary education (p = 0.022). Parents with previous training received a higher mean score (8.04 vs 6.17, respectively, p < 0.01). Parents with jobs related to healthcare or education received a higher mean score compared to those who did not (8.63, p < 0.01 and 7.16, p = 0.0013, respectively). No significant differences among parents with chronically ill children (p = 0.76) or related to the number of children (ρ = -0.101) were observed. Furthermore, 77.3% of parents expressed an interest in receiving further training.

CONCLUSIONS

Knowledge of first aid among the general population is lacking. Parents with previous training in this field, those with a university-level education, and those who are healthcare providers and educational professionals received significantly higher scores.

PRACTIC IMPLICATIONS

Studies based on surveys can be useful in estimating a population's knowledge base, allowing the development of community-based training activities.

Understanding and improving low bystander CPR rates: a systematic review of the literature

Objectives:

Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.

Methods:

For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.

Results:

We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch-assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.

Conclusion:

We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

Pediatric first aid knowledge among parents

OBJECTIVE

The American Academy of Pediatrics (AAP) has published simple guidelines for the first aid management of ill or injured children. We determined knowledge of these first aid practices in parents.

METHODS

Design-Descriptive survey.

PARTICIPANTS

A convenience sample of adult parents presenting to the emergency department.

SURVEY INSTRUMENT

Standardized collection of demographics was performed and adults were given a multiple-choice questionnaire concerning the proper management of stings and bites, burns and scalds, eye injuries, fractures and sprains, fever, head injuries, fainting, poisoning, dental emergencies, nosebleeds, seizures, and skin wounds.

OUTCOMES

Percentage of adults responding to questions appropriately based on AAP guidelines.

DATA ANALYSIS

Descriptive statistics and chi2 tests.

RESULTS

Six hundred fifty-four adults were surveyed. Mean age (SD) was 38.5 (13.8), 56% were female, 69% were white, 56% had at least a high school education. None of those surveyed answered all questions correctly with roughly half being familiar with 60% of the questions. Knowledge of specific guidelines ranged from 21% to 92%. Subjects especially lacked knowledge regarding the need to rapidly remove all bee stingers (only 36% aware); keep wounds moist and covered (79% felt that drying wounds was beneficial); the need to cover victims of large burns (only 43% aware); and the need to seek medical attention after tick bites (only 47% aware). Knowledge was unaffected by age, gender, and education.

CONCLUSIONS

Many adults are unfamiliar with AAP first aid measures according to the AAP guidelines and most believe that wounds should be allowed to dry. Further education is required to improve knowledge of first aid practices.

Comparison of bystander trauma care for moderate versus severe injury

At the scene of an accident, the most severely injured patients need trauma care urgently. Bystanders are often present before the emergency medical service arrives and may be able to limit trauma-related damage by providing trauma care at the scene. The aim of this prospective study conducted in Mainz, Germany, and Vienna, Austria, was to compare the frequency and quality of bystander trauma care in moderately versus severely injured patients. Five specific measures (making the scene readily visible for oncoming traffic, extrication and positioning of the trauma patient, control of haemorrhage, and hypothermia protection) were assessed in a questionnaire and evaluated statistically. Bystanders were present at the scene in 58.7% of all accidents. Making the scene readily visible for oncoming traffic, patient extrication and patient positioning were initiated significantly more often than haemorrhage control and hypothermia protection. Extrication, patient positioning and hypothermia protection were initiated significantly more often in moderately (NACA I-II) compared to severely (NACA III-VII) injured patients. In severely injured patients, bystanders attempted measures less frequently and the measures performed were more often incorrect compared to those in moderately injured patients. Our findings show that severely injured patients received less and less appropriate bystander trauma care than moderately injured patients. In an effort to correct this serious problem and to improve trauma care on-scene, we advocate offering lay persons more extensive training in bystander trauma care.

Bystander trauma care—effect of the level of training

BACKGROUND

The bystander is often the first person present at the scene of an accident. Our aim was to determine how often and how well bystanders perform trauma care and whether trauma care is affected by the bystander's level of training, relationship to the patient and numbers of bystanders present.

PATIENTS AND METHODS

In a prospective 1-year study, the emergency medical service in two European cities collected data on trauma calls. Questionnaires were used to document the bystanders' level of training (none, basic, advanced, professional), the bystander's relationship to the patient, and the number of bystanders present, and to assess whether five separate measures of trauma care (ensuring scene safety, extrication of the patient, positioning, control of haemorrhage, prevention of hypothermia) were performed correctly, incorrectly, or not at all.

RESULTS

Two thousand nine hundred and thirty-two trauma calls were documented and bystanders were present in 1720 (58.7%). All measures except ensuring scene safety and prevention of hypothermia were affected by the bystander's level of training. Correct extrication, positioning, and control of haemorrhage increased with the level of bystander training while the number of patients who were not attended decreased (P < 0.05, P < 0.005, P < 0.005), respectively. The relationship to the patient did not affect whether, or how well, any measure was performed. The number of bystanders present only affected prevention of hypothermia, which was performed most often when only one bystander was present.

CONCLUSION

Improved, more widespread training could increase the frequency and quality of bystander trauma care further.