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Tangpaisarn T, Chaiyakot N, Saenpan K, Sriphrom S, Owattanapanich N, Kotruchin P, Phungoen P. Surgical mask-to-mouth ventilation as an alternative ventilation technique during CPR: A crossover randomized controlled trial. Am J Emerg Med 2023; 72:158-163. [PMID: 37536087 DOI: 10.1016/j.ajem.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/07/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Chest compression with rescue breathing improves outcomes in cardiac arrest. However, the efficacy of rescue breathing through surgical masks has not been investigated. OBJECTIVE We aimed to compare the tidal volume generated by mouth-to-mouth ventilation (MMV) with that generated by surgical mask-to-mouth ventilation (SMV), mouth-to-surgical mask ventilation (MSV), and surgical mask-to-surgical mask ventilation (SSV) in a manikin. METHODS A crossover randomized controlled trial was conducted in 42 medical personnel volunteers randomly assigned to perform four ventilation techniques: MMV (no protective equipment), SMV (participant wearing a mask), MSV (manikin wearing a mask), and SSV, (both participant and manikin wearing a mask). The average tidal volume and the proportion of adequate ventilation, evaluated using a manikin, were compared across different ventilation methods. RESULTS The average tidal volume of MMV (828 ± 278 ml) was significantly higher than those of the MSV (648 ± 250 ml, P < 0.001) and SSV (466 ± 301 ml, P < 0.001), but not SMV (744 ± 288 ml, P = 0.054). Adequate ventilation was achieved in 144/168 (85.7%) cases in the MMV group, a proportion significantly higher than in the SMV (77.4%, P = 0.02), MSV (66.7%, P < 0.001) and SSV (39.3%, P < 0.001) groups. The willingness to perform SMV was higher than that to perform MMV. CONCLUSIONS MMV resulted in a superior average tidal volume when compared to both MSV and SSV. However, SMV achieved a comparable average tidal volume to MMV.
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Affiliation(s)
- Thanat Tangpaisarn
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Narubet Chaiyakot
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Konglar Saenpan
- CPR training unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Sumana Sriphrom
- CPR training unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Natthida Owattanapanich
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
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Geerts A, Herbelet S, Borremans G, Coppens M, Christiaens-Leysen E, Van de Voorde P. Five vs. two initial rescue breaths during infant basic life support: A manikin study using bag-mask-ventilation. Front Pediatr 2022; 10:1067971. [PMID: 36582512 PMCID: PMC9792851 DOI: 10.3389/fped.2022.1067971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children are more likely to suffer a hypoxic-ischaemic cause for cardiac arrest. Early ventilation may provide an advantage in outcome during paediatric cardiopulmonary resuscitation [CPR]. European Resuscitation Council guidelines recommend five initial rescue breaths [IRB] in infants, stemming from the hypothesis that rescuers might need 5 attempts in order to deliver 2 effective ventilations. This study aimed to verify this hypothesis. METHODS Participants (n = 112, convenience sample) were medical students from the Faculty of Medicine and Health Sciences Ghent University, Belgium. Students were divided into duos and received a 15 min just-in-time training regarding the full CPR-cycle using BMV. Participants then performed five cycles of 2-person CPR. The IRB were given by 1-person BMV, as opposed to a 2-persons technique during the further CPR-cycle. Correct ventilations for the infant were defined as tidal volumes measured (Laerdal® Q-CPR) between 20 and 60 ml, with n = 94 participants included in the analysis. The primary outcome consisted of the difference in the % of medical student duos providing at least 2 effective IRB between 2 and 5 attempts. RESULTS Off all duos, 55,3% provided correct volumes during their first 2 initial ventilations. An increase up to 72,4% was noticed when allowing 5 ventilations. The proportional difference between 2 and 5 IRB allowed was thus significant [17,0%, 95% confidence interval (5.4; 28.0)]. CONCLUSION In this manikin study, 5 IRB attempts during infant CPR with BMV increased the success rate in delivering 2 effective ventilations. Besides, students received training emphasizing the need for 5 initial rescue breaths. This study provides evidence supporting European Resuscitation Council guidelines.
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Affiliation(s)
- Anke Geerts
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Sandrine Herbelet
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Gautier Borremans
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Marc Coppens
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium
| | | | - Patrick Van de Voorde
- Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium.,Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.,Federal Department of Health, EMS Dispatch Centre 112 Flanders, Ghent, Belgium
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Abstract
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.
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Al-Anazi AF. Pediatric emergency medical services and their drawbacks. J Emerg Trauma Shock 2012; 5:220-7. [PMID: 22988399 PMCID: PMC3440887 DOI: 10.4103/0974-2700.99687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/10/2012] [Indexed: 12/04/2022] Open
Abstract
Aim: To survey the literature on Pediatric Emergency Medical Services (PEMS) with an aim to focus its drawbacks and emphasize the means of improvement. Materials and Methods: Published articles selected for inclusion were based on the significance and understanding of literature search on different aspects of PEMS. To meet this criterion, PubMed, PubMed Central, Science Direct, Uptodate, Med Line, comprehensive databases, Cochrane library and the Internet (Google, Yahoo) were thoroughly searched. Results: PEMS provide out-of-hospital medical care and/or transport the patients to definitive care. The task force represents specialties of ambulance transport, first aid, emergency medical care, life saving, trauma, emergency medicine, water rescue, and extrication. Preliminary care is undertaken to save the patients from different medical exigencies. The techniques and procedures of basic and advanced life-support are employed. A large number of weaknesses are recorded in PEMS system, such as ambulance transport irregularities, deficit equipment, lack of expertise, and ignorance of the pre-hospital care providers. These are discussed with special reference to a few examples of medical exigencies. Conclusions: The appointments in PEMS should be regularized with specific qualifications, experience, and expertise in different areas. Responsibility of PEMS should not be left to pre-hospital care providers, who are non clinicians and lack proper education and training. Pediatricians should be adequately trained to play an active role in PEMS. Meetings should be convened to discuss the lapses and means of improvement. Networks of co-operation between pre-hospital providers and experts in the emergency department should be established.
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Affiliation(s)
- Abdullah Foraih Al-Anazi
- Department of Pediatric Emergency, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Camacho HM. Las nuevas guías de resucitación cerebro-cardiopulmonar básica del año 2010. análisis crítico. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Reinhardt L, Bahr J, Schmid O, Kettler D, Roessler M. Das Göttinger AED-Modell. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alexander R, Chinery J, Swales H, Sutton D. “Mouth to mouth ventilation”: A comparison of the laryngeal mask airway with the Laerdal Pocket Facemask. Resuscitation 2009; 80:1240-3. [DOI: 10.1016/j.resuscitation.2009.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/10/2009] [Accepted: 07/20/2009] [Indexed: 12/01/2022]
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Emergency department evaluations of non-percutaneous blood or body fluid exposures during cardiopulmonary resuscitation. Prehosp Disaster Med 2008; 22:330-4. [PMID: 18019101 DOI: 10.1017/s1049023x00004969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The demography of healthcare workers (HCWs) and non-HCWs seeking medical care at emergency departments after a non-percutaneous potential exposure to human immunodeficiency virus (HIV) during cardiopulmonary resuscitation (CPR), the types and body locations of their exposures, the time elapsed from exposure to emergency department presentation, and usage of HIV-post-exposure prophylaxis (PEP) for these exposures are described. METHODS A retrospective study of emergency department patients who were exposed to blood or body fluids during CPR in Rhode Island from January 1995-June 2001 was performed. The demography, characteristics of the exposure, and HIV-PEP usage for these patients were compared, and the elapsed time from exposure to evaluation in the emergency department was calculated. RESULTS Of the 39 patients exposed to non-percutaneous blood or body fluid during CPR, 22 were healthcare workers (HCWs) and 17 were non-HCWs. Thirty-four patients sustained mucous membrane exposures. Most of the patients (69.2%) were exposed to saliva or sputum (p <0.001), experienced a mouth exposure (71.8%; p <0.0001) and presented to the emergency department within one day of their exposure (84.4%; p <0.0001). Three HCWs and no non-HCWs were offered HIV-PEP for their CPR exposure. Of the three HCWs offered PEP, two actually received it. CONCLUSIONS Nearly half of the patients who presented with non-percutaneous exposures acquired during CPR were not HCWs. Most of the exposures were to saliva or sputum and occurred on their mucous membranes. Continuing education programs on maintaining universal precautions to prevent blood or body fluid exposures and appreciating the benign nature of most non-percutaneous exposures possible during CPR are needed.
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Paal P, Falk M, Sumann G, Demetz F, Beikircher W, Gruber E, Ellerton J, Brugger H. Comparison of mouth-to-mouth, mouth-to-mask and mouth-to-face-shield ventilation by lay persons. Resuscitation 2006; 70:117-23. [PMID: 16764983 DOI: 10.1016/j.resuscitation.2005.03.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Revised: 02/17/2005] [Accepted: 03/14/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE AND METHODS A prospective randomised study on 70 volunteers without previous first aid education (42 males, 28 females, mean age 17) was performed to compare mouth-to-mouth ventilation (MMV, n = 24) versus mouth-to-pocket-mask ventilation (MPV, n = 25) and mouth-to-face-shield ventilation (MFV, n =21), and to evaluate if an instruction period of 10 min would be sufficient to teach lay persons artificial ventilation. Every volunteer performed three ventilation series using a bench model of an unprotected airway. RESULTS MMV and MPV show higher mean tidal volume (TV) than MFV (values of series 3: 976 +/- 454 and 868 +/- 459 versus 604 +/- 328 ml, P = 0.002 and P = 0.025, respectively). We found a higher inter-individual variation in TV than in previous studies (P = 0.031). The recommended TV of 700-1000 ml was reached in only 23%, most frequently with MPV (MMV 16.7%, MPV 32%, MFV 19%) but the difference was not significant (P = 0.391). However, we found a significantly higher percentage with a TV below 700 ml with MFV (MMV 33.3%, MPV 36%, MFV 66.7% P = 0.047) and a significantly higher percentage of TV exceeding 1000 ml with MMV (MMV 50%, MPV 32%, MFV 14.3%) (P = 0.039). "Stomach" inflation was highest with MMV (79.2%) followed by MPV (52%) and MFV (42.9%) (P = 0.034). We found further differences between the sexes; males produced a higher TV (P = 0.003) and a higher percentage of stomach inflation (P = 0.029). CONCLUSION MPV showed the best ventilation quality. It resulted in a more adequate TV than MMV and MFV and lower stomach inflation than MMV. Only a relatively low percentage of ventilations were within the recommended range for TV and this may be related to the short training duration. We found different performances between the sexes, a high inter-individual variation and mainly a low ventilation quality. Therefore, further studies have to focus more on teaching duration, sex differences and ventilation quality.
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Affiliation(s)
- Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, South Tyrolean Alpine Association, International Commission for Mountain Emergency Medicine ICAR MEDCOM, Innsbruck Medical University, Innsbruck, Austria.
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Comparison of the Disaster Management Frameworks of the US and the UK: Similarities and Differences. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00014801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sherif C, Erdös J, Sohm M, Schönbauer R, Rabitsch W, Schuster E, Frass M. Effectiveness of mouth-to-mouth resuscitation performed by young adolescents on a mannequin. Am J Emerg Med 2005; 23:51-4. [PMID: 15672338 DOI: 10.1016/j.ajem.2004.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Bystanders are reluctant to perform basic life support (BLS) because of fear of failure and of infection, especially with mouth-to-mouth resuscitation (MTM). A possibility to enhance willingness could be the giving of MTM or BLS instructions at a very early age to the potential rescuers. The study aimed to investigate the effectiveness of MTM with respect to ventilation and the time needed for performing 5 ventilations. In this study, MTM was performed on a mannequin by 57 children and adolescents aged 10 and 14 years. This study showed that 14-year-olds effectively perform MTM, reaching the recommended tidal volumes. Ten-year-old children have already developed sufficient motor skills for MTM with no significant time differences compared with the 14-year-olds. However, physical demands may be rather high at this age. Further long-term studies are needed to investigate clinical benefits of early teaching of MTM or BLS that may lead to international guidelines with low age limits.
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Affiliation(s)
- Camillo Sherif
- Intensive Care Unit, Department of Internal Medicine I, University of Vienna, A 1090 Vienna, Austria
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Marley CT, Levsky ME, Talbot TS, Kang CS. SARS and its impact on current and future Emergency Department operations. J Emerg Med 2004; 26:415-20. [PMID: 15093847 PMCID: PMC7135160 DOI: 10.1016/j.jemermed.2003.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Revised: 10/16/2003] [Accepted: 12/09/2003] [Indexed: 10/29/2022]
Abstract
A long-standing concern for international spread of new, virulent pathogens became a reality with the advent of Severe Acute Respiratory Syndrome (SARS). This respiratory syndrome, caused by a coronavirus, spread rapidly across 30 nations since its first recognition in late 2002. SARS has presented the greatest recent threat to U.S. public health, and has come at a time when purposeful introduction of pathogens by terrorists is also of heightened concern. SARS has forced the international medical establishment to reexamine how best to manage such incidents.
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Affiliation(s)
- Chad T Marley
- Madigan Army Medical Center-University of Washington Affiliated Residency in Emergency Medicine, Tacoma, Washington 98431, USA
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Hubble MW, Bachman M, Price R, Martin N, Huie D. Willingness of high school students to perform cardiopulmonary resuscitation and automated external defibrillation. PREHOSP EMERG CARE 2003; 7:219-24. [PMID: 12710782 DOI: 10.1080/10903120390936815] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the willingness of high school students to perform cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED). METHODS A convenience sample of high school students was surveyed regarding how they would respond if they witnessed a cardiac arrest. Participants were first shown a video segment on the operation of an automated external defibrillator. They were then shown a series of video clips depicting six different cardiac arrest scenarios: motor vehicle collision (MVC) with facial bleeding, pediatric drowning, intravenous (IV) drug user, choking family member, victim of differing race, and victim with facial vomitus. Following each video, the subjects were asked how they would respond had they actually witnessed a similar event. RESULTS With parental permission and institutional review board approval, 683 students participated, representing 6.8% of the total student body. Of these, 585 (86%) were trained in CPR and 142 (21%) in AED. One hundred six participants (16%) had witnessed a cardiac arrest prior to the survey. Of these, 24 (23%) had intervened in some way. Twenty (19%) had performed mouth-to-mouth resuscitation (MMR), 15 (14%) had performed chest compressions (CC), and one (0.9%) had performed AED. Across all six mock scenarios and all 683 respondents collectively (4,098 simulated cardiac arrest events), the respondents indicated they would be willing to perform AED 1,308 times (32%). In comparison, the respondents indicated they would be willing to perform MMR 1,768 times (43%) and CC 2,249 times (55%). More respondents were willing to intervene on behalf of a child or family member, while fewer were willing to act in the setting of blood, vomitus, or an IV drug user (p < 0.05). There was no association between willingness to intervene and prior experience with any of the interventions. Fear of infection, legal consequences, and fear of harming the patient were the most frequently cited reasons for not intervening. CONCLUSIONS Among high school students, few are willing to perform automated external defibrillation. Willingness to perform MMR and CC appears to depend on the circumstances.
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Affiliation(s)
- Michael W Hubble
- Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina 28723, USA.
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Larsson EM, Mártensson NL, Alexanderson KAE. First-aid training and bystander actions at traffic crashes--a population study. Prehosp Disaster Med 2002; 17:134-41. [PMID: 12627916 DOI: 10.1017/s1049023x00000352] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Traffic crashes constitute a major, worldwide public-health problem that cause disabilities, life-long suffering, and huge economic losses. When a person is injured in a traffic crash, actions taken by bystanders often are of crucial importance. To perform first-aid actions in a correct manner, bystanders, often laypersons, need both the courage and the knowledge to do so. For preventive purposes, society spends large resources to inform and educate the public in order to enhance people's ability to take correct actions. However, there only is little information on the rate in a population of persons who have had first-aid training, have been bystanders at a traffic crash, on the actions taken by such persons, and on effects of first-aid training on patient care. OBJECTIVE The aim of this study was to acquire knowledge about: (1) the prevalence of first-aid training; (2) the incidence of being a bystander and of the first aid provided at traffic crashes and other emergencies; and (3) the impact of first-aid training on the risks people take in road traffic. METHODS A questionnaire was administered to 2,800 randomly selected persons aged 18-74 years. RESULTS The response rate was 67.5%. During the previous five years, 39% of the population had received first-aid training, with a higher rate among younger individuals and those with a higher education. After training, 30% of the respondents had used their skills, and 41% took fewer risks in traffic, particularly those who were older or had a lower level of education. Fourteen percent of those with training (significantly more men) had been bystanders at a traffic crash. At 20% of the crashes, a bystander had administered first aid, and one-third of those who provided such assistance had had use of their training. CONCLUSION Intensified first-aid training of the general public could lead to citizens who are more cautious in traffic and to bystanders who provide more immediate and adequate first aid at traffic crashes and other emergencies.
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Affiliation(s)
- Eva M Larsson
- Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping, Sweden
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