Indicators of response to a mass media CPR recruitment campaign

Basic Life Support Knowledge Among a Nonmedical Population in Jeddah, Saudi Arabia: Cross-Sectional Study

Background

Providing basic life support (BLS) at the site of an accident is crucial to increase the survival rates of the injured people. It is especially relevant when health care is far away.

Objective

The aim of our study is to assess the BLS knowledge level of the Saudi Arabian population and identify influencing factors associated with level of knowledge about BLS.

Methods

Our study is a cross-sectional descriptive study, which was conducted using a self-administered online questionnaire derived from the BLS practice test. The Saudi population was the target population. The questionnaire was divided into two parts: one contained demographic data and the second part contained questions to test the population’s perception about how to perform BLS techniques properly. The data were collected between July and August 2017. Statistically significant differences were defined as those with a P value <.05, and a score of five or more was considered a passing score on the second part. We used SPSS version 21 for data analysis.

Results

Our study included 301 participants. Our participants’ BLS online exam scores ranged from 0 to 10, with a mean of 4.1 (SD 1.7). Only 39.2% (118/301) of the participants passed the test. The percentage of bachelor’s degree or higher holders constituted 60.1% (181/301) of the study population. In addition, higher income was significantly associated with higher scores on the test (P=.04).

Conclusions

This study demonstrated that the theoretical knowledge level of BLS among the general population in Jeddah was below average. There is a critical need to increase the public’s exposure to BLS education through raising awareness campaigns and government-funded training programs that aim to curb the incidence of out-of-hospital cardiac arrest mortalities in the Saudi community.

Are Canadians more willing to provide chest-compression-only cardiopulmonary resuscitation (CPR)?-a nation-wide public survey

BACKGROUND

Bystander cardiopulmonary resuscitation (CPR) improves the likelihood of survival from out-of-hospital cardiac arrest (OHCA), yet it is performed in only 30% of cases. The 2010 guidelines promote chest-compression-only bystander CPR-a change intended to increase willingness to provide CPR.

OBJECTIVES

1) To determine whether the Canadian general public is more willing to perform chest-compression-only CPR compared to traditional CPR; 2) to characterize public knowledge of OHCA; and 3) to identify barriers and facilitators to bystander CPR.

METHODS

A 32-item survey assessing resuscitation knowledge, and willingness to provide CPR were disseminated in five Canadian regions. Descriptive statistics were used to characterize response distribution. Logistic regression analysis was applied to assess shifts in intention to provide CPR.

RESULTS

A total of 428 completed surveys were analysed. When presented with a scenario of being a bystander in an OHCA, a greater proportion of respondents were willing to provide chest-compression-only CPR compared to traditional CPR for all victims (61.5% v. 39.7%, p<0.001), when the victim was a stranger (55.1% v. 38.8%, p<0.001), or when the victim was an unkempt individual (47.9% v. 28.5%, p<0.001). When asked to describe an OHCA, 41.4% said the heart stopped beating, and 20.8% said it was a heart attack. Identified barriers and facilitators included fear of litigation and lack of skill confidence.

CONCLUSIONS

This study identified gaps in knowledge, which may impair the ability of bystanders to act in OHCA. Most respondents expressed greater willingness to provide chest-compression-only CPR, but this was mediated by victim characteristics, skill confidence, and recognition of a cardiac arrest.

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.

An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

Background

Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.

Methods/Design

The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.

The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).

Discussion

The study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.

Trial Registration

ClinicalTrials.gov NCT00664443

A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR) knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

BACKGROUND

Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR) can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%). Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85%) and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories.

METHODS/DESIGN

The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim.

DISCUSSION

The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to witnessing a victim in cardiac arrest. The findings can then be applied to the design of trials of various interventions designed to promote attendance at CPR classes and improve CPR performance.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00665288.

The ‘ABC for life’ programme—Teaching basic life support in schools

BACKGROUND

Less than 1% of the general public know how to assess or manage someone who has collapsed. It has been estimated that if 15-20% of the population were capable of performing cardiopulmonary resuscitation (CPR), mortality of out of hospital cardiac arrest could be decreased significantly. Training basic life support (BLS) skills to school children would be the most cost effective way of achieving this goal and ensuring that a large proportion of the population acquire basic life saving skills.

AIMS

To assess retention of knowledge of basic life support 6 months after a single course of instruction in cardiopulmonary resuscitation designed specifically for school children.

SETTING

School pupils in a rural location in one region of the United Kingdom.

METHODS

A course of instruction in cardiopulmonary resuscitation - the 'ABC for life' programme - specifically designed to teach 10-12-year-old school children basic life support skills. The training session was given to school pupils in a rural location in Northern Ireland. A 22 point questionnaire was used to assess acquisition and retention of basic life support knowledge.

RESULTS

Children instructed in cardiopulmonary resuscitation showed a highly significant increase in level of knowledge following the training session. While their level of knowledge decreased over a period of 6 months it remained significantly higher than that of a comparable group of children who had never been trained.

CONCLUSION

A training programme designed and taught as part of the school curriculum would have a significant impact on public health.

Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools

BACKGROUND

Life-supporting first-aid (LFSA) training in primary schools might prove a useful means of increasing cardiac arrest survival rates. We thus studied the feasibility of introducing first-aid training to 6-7-year old primary school children.

METHODS AND RESULTS

During 1 week medical students and emergency physicians provided LSFA training to 47 first- and second-year pupils, including semi-automatic defibrillation. A course assessment was made using cartoon-style questionnaires for the pupils, video tapes of the training and telephone interviews with the children's parents. Prior to training, only eight pupils (17%) were able to place in the correct sequence a series of pictures illustrating the various stages of the procedure of semi-automatic defibrillation. After training that figure rose to 24 (51%). Using a semi-automatic defibrillator, excellent performances were recorded by video camera in eight pupils. Post-training telephone interviews were conducted with 34 parents (79%), 28 (82%) of whom now considered their children capable of reacting properly in an emergency situation. The children had been given stickers displaying the European Emergency Call Number 112 together with a set of brochures. In 25 cases (74%), the children applied the stickers to their parents phones at home.

CONCLUSIONS

LSFA training is a feasible proposition for 6-7-year olds who might well be in a position to save the lives of cardiac-arrest victims. Future training sessions should determine the impact of repeat courses and the findings should be used to convince politicians and administrators of the need of LSFA training as a mandatory subject in schools.

Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscitation

STUDY OBJECTIVE

Cardiorespiratory resuscitation (CPR) nonprovision-the failure of bystanders to provide CPR to cardiac arrest victims-remains a well-documented public health problem associated with significant mortality. Multivariate data on failure to provide CPR are limited. Given the established independent contributions of neighborhoods to explaining many behaviors, we asked the following questions: Do neighborhood characteristics affect the likelihood of CPR nonprovision? In particular, we sought to identify the characteristics of areas that have had the most success in providing CPR.

METHODS

We performed multivariable logistic regression analysis of a prospectively collected cohort of 4,379 cardiac arrests linked at an individual level to neighborhood data from the US Census. These arrests represent all out-of-hospital cardiac arrests in the City of Chicago in 1987 and 1988.

RESULTS

In multivariate analysis, patients who had cardiac arrests who lived in neighborhoods where cardiac arrests were more common were significantly more likely to receive CPR. Patients with arrests in racially integrated neighborhoods were most likely to be provided with CPR, followed by those in predominately white neighborhoods, with the lowest rates of CPR provision in predominately black neighborhoods. Neither the socioeconomic status, number of elderly, nor the occupational characteristics of the neighborhood appeared to influence CPR provision. At the individual level, in-home arrests and arrests among middle-aged black residents (relative to older black and all white residents) were less likely to receive CPR.

CONCLUSION

Substantial variation in rates of CPR nonprovision exists between neighborhoods; the variation is associated with neighborhood characteristics. Combining individual and neighborhood data allows identification of important factors associated with the failure to provide CPR.

Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland

Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. Questionnaires were mailed to all the 45 Scottish cardiac rehabilitation programmes on the British Heart Foundation's register. A 93% response rate was achieved. Only 37% of programmes provided information to families about attending a CPR course and 37% actually provided CPR training The numbers trained by these programmes were very small. Hospital programmes were significantly more likely than community programmes to provide CPR training (chi2 = 6.65, P < 0.01) as were those which included an exercise component (chi2 = 7.63, P < 0.01). Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.

Ethnicity and proficiency in English as factors affecting community cardiopulmonary resuscitation (CPR) class attendance

Communities with a high prevalence of cardiopulmonary resuscitation (CPR) knowledge have a greater out of hospital cardiac arrest survival rate. Within metropolitan Adelaide, 12.4% of the community is from a non-English speaking country and 20.3% of these have a poor proficiency in English. The purpose of this study was to examine the effect of ethnicity (specifically, Southern European born (SEB) and South East Asian born (SEAB)) and a poor proficiency in English (PENG) on CPR skill acquisition. Population Census postcode data were compared to postcode student CPR classes attendance. Results showed a negative correlation between SEB (-0.44), SEAB (-0.36), PENG (-0.42) with CPR class attendance. Postcodes with a less than community average of SEB, SEAB and PENG had an average proportion of CPR class attendees of 2.64% (C.I. 2.43, 2.85), 2.54% (C.I. 2.35, 2.73) and 2.65% (C.I. 2.35, 2.73), respectively, whilst those postcodes with a greater than community average had 2.03% (C.I. 1.90, 2.16), 2.07% (C.I. 1.90, 2.24) and 2.04% (C.I. 1.90, 2.18) proportion of CPR class attendees. The difference for each category was significant to a P < 0.001. This study points to SEB, SEAB, and PENG as factors associated with fewer CPR class attendances. Future CPR classes should specifically target and cater for ethnic groups from non-English speaking countries with poor English skills if CPR skills are to be widely disseminated throughout the entire community.

Characteristics of volunteers who deliver health education and promotion: a comparison with organization members and program participants

The use of volunteers in this culture for community health endeavors is an understudied area. Yet, there may be many potential benefits for utilizing volunteers in the delivery of community health education and promotion. Volunteers may have more immediate access to their peers, credibility, and familiarity with the cultural environment and organization elements. An assumption of volunteer use is that persons drawn from a targeted organization (or community subgroup) will be like other members. Such an assumption, however, should be confirmed or disproved. This article compares a sample of volunteers to a sample of members from organizations from which the volunteers were recruited. The paper also compares the volunteers to a sample of program participants. The participants were persons to whom the volunteers delivered CVD prevention programming and, in most cases, were also organization members. Collectively using the variables under investigation, multivariate analyses of variance found that the volunteers were different from the organization members, and different from program participants. To assess differences between the samples on each individual variable, univariate tests were conducted stratifying the samples by age. Statistically significant differences were found regarding organization activity, formal education level, success with past health habit change, health self-assessment, occupation, gender, and marital status.

Targeted recruitment of senior citizens and cardiac patients to a mass CPR training course

CPR courses attract a predominance of young, healthy adults. Targeted recruitment of senior citizens and family members of cardiac patients has been suggested but inadequately studied. We used a targeted recruitment strategy for our annual mass CPR training course to determine if such an approach would be effective in attracting the target group. Targeting significantly increased the percentage of senior citizen participants and participants who took the course because they or a close friend or relative had cardiac disease (P less than .00001). These data have important implications regarding potential future CPR training course recruitment methods compared with nontargeted recruitment approaches.

Citizen cardiopulmonary resuscitation training and use in a metropolitan area: the Minnesota Heart Survey

To assess the prevalence and utility of citizen cardiopulmonary resuscitation (CPR) training, a systematic population-based sample of Minneapolis-St. Paul area adults, age 25-74 years, was interviewed in 1980-81. Twenty-three per cent were CPR trained. Of these, 13 percent have encountered out-of-hospital cardiac arrests and 38 per cent reported using their skills in such an emergency. Most of those performing out-of-hospital CPR (59 per cent) were health professionals. Only 19 per cent of trainees have maintained their certification by retraining within one year.

Communicating health information to the public: effectiveness of a newsletter

Following a review of health information campaign issues and research on the efficacy of selected communication channels, this paper reports an investigation of a specific medium--a health information newsletter--including whether and how much of it recipients read, its perceived information value, its impact on self-reported actions, its comparative role as a source of health information, and the extent to which results vary with selected characteristics of recipients who responded to a mail survey (n = 887). Results indicate that the newsletter is read and utilized by most recipients and serves for many as a major source of health information. Moreover, there is evidence of direct and indirect newsletter effects on respondents' self-reported health practices. Findings varied significantly with the sex and health professional status of recipients.