Knowledge of prevention and first aid in burn injuries among health care workers and non-health care persons in India

Appropriate and timely first aid reduces morbidity in burns. This study aims to assess the knowledge of first aid in burns among healthcare workers (HCW) and nonhealthcare workers. (NHCW).

METHODS

A survey, distributed in both paper and Google survey formats, presented five sample cases with multiple-choice answers. Participants recorded the most suitable first aid management for each scenario. Correct answers were provided on completion.

RESULTS

Out of the total 753 participants, only 89 (11.8%) got all five answers correct. 16% HCW and 6% NHCW could answer all 5 questions correctly (with a true HCW:NHCW ratio of 2.67:1). Providing care for individuals with burns substantially raised the probability of giving accurate responses (p = 0.0001). While attending the general First Aid Course did not affect the responses (p = 0.08), participation in the Burns First Aid Course demonstrated slightly improved results (p = 0.052). The scenario involving liquid petroleum gas leakage saw a high proportion of correct responses, likely influenced by media coverage.

CONCLUSION

We find a clear need for adequate training in burns first aid due to low awareness among healthcare workers (HCW) and non-healthcare workers (NHCW). Factors such as participation in burn first aid courses and gaining firsthand experience in treating burns were found to be linked to improved knowledge of burns prevention and first aid. Utilizing various media channels could be a valuable strategy to reach a broader audience, especially in remote and inaccessible areas.

Misinformation on resuscitation and first aid as an uncontrolled problem that demands close attention: a brief scoping review

OBJECTIVES

Misinformation is currently recognised by the World Health Organization as an apparent threat to public health. This study aimed to provide an outline of published evidence on misinformation related to the potentially life-saving interventions - first aid and cardiopulmonary resuscitation (CPR).

STUDY DESIGN

A scoping review.

METHODS

The review was conducted in accordance with the PRISMA Extension for Scoping Reviews. English-language publications describing original studies that evaluated the quality of publicly available information on first aid and/or CPR were included without limitations to the year of publication.

RESULTS

Forty-four original studies published between 1982 and 2023 were reviewed. Annual number of publications varied from 0 to 6. The studies have focused on the evaluation of information concerning initial care of cardiac arrest, choking, heart attack, poisoning, burns, and other emergencies. Forty three studies (97.7 %) have reported varying frequencies of misinformation, when public sources, including websites, YouTube videos, and modern artificial intelligence-based chatbots, omitted life-saving instructions on first aid or CPR or contained incorrect information that contradicted relevant international guidelines. Eleven studies (25.0 %) have also revealed potentially harmful advice, which, if followed by an unsuspecting person, may cause direct injury or death of a victim.

CONCLUSIONS

Misinformation concerning CPR and first aid cannot be ignored and demands close attention from relevant stakeholders to mitigate its harmful impacts. More studies are urgently needed to determine optimal methods for detecting and measuring misinformation, to understand mechanisms that drive its spread, and to develop effective measures to correct and prevent misinformation.

Psychological first aid practice self-efficacy of nurses in disasters

In the present cross-sectional study, we determined the self-efficacy of nurses to apply psychological first aid (PFA) during disasters. The study sample consisted of 580 nurses working in Turkey. The data were collected online between July and November 2022 using the "Personal Information Form" and the "PFA Application Self-Efficacy Scale." The data were analyzed using descriptive statistical methods (number, percentage, mean, and standard deviation), generalized linear models, Bonferroni correction, and linear regression analysis. The mean PFA scale scores of male nurses, nurses working in intensive care units, working as service nurses, nurses who have previously received PFA training and applied PFA in disaster situations were higher. Moreover, 91.3% of nurses did not receive PFA training and 90.3% did not receive PFA service earlier, 31.0% did not apply for PFA, 18.3% did not know about PFA. The mean score of the PFA practice self-efficacy scale of nurses was 131.61 ± 19.41. There exists an urgent requirement to develop nurses' PFA application self-efficacy. It is recommended that nurses should be provided repeated PFA training and applied studies focusing on PFA interventions.

Diversity and training delivery trends in psychological first aid during COVID-19: Implications for researchers and practitioners

OBJECTIVE

Psychological first aid (PFA) refers to evidence-supported intervention by nonmental health professionals to assist those affected by disaster to achieve stability. This study probed the level of PFA academic discourse on three important topics (race/ethnicity, general training and delivery, and online training delivery) and explored PFA training delivery trends.

METHOD

This study reviewed all available abstracts in the Web of Science database from 1975 to 2021 with keyword searches for PFA. The corpus linguistic analyses using #Lancsbox 6.0 and Sketch Engine explored the usage rate of PFA and how the PFA was used. The study also examined race/ethnicity, learning delivery except for online, and online training delivery methods. The change in online PFA training delivery with the advent of the COVID-19 pandemic was analyzed using Tau with the subcorpora (2012-2020, 2020-2021).

RESULTS

The race and diversity usage rates were only 6.11 per 10,000 counts, while the substantive discourse was on PFA service and delivery. There was a significant increase in PFA online training since COVID-19 started (Tau = 0.667, p = 0.041, SETau = 0.333).

CONCLUSIONS

Training and delivering online PFA is the safest method to meet the need for psychological aid during the global health crisis. Additionally, there is a significant need to address multicultural competency in PFA training and service delivery. PFA as an early critical intervention should be promoted as an early government response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Knowledge, attitude, and sources of information towards burn first aid among people referred to a burn centre in the north of Iran

Optimal management of burns begins with first aid from the first hours of injury. Adequate knowledge of how to perform first aid for burns can reduce the consequences of injury. Therefore, this study aims to determine the knowledge, attitude, and sources of information assessment towards burn First aid among people referred to a burn centre in the north of Iran. A questionnaire-based survey was conducted to assess knowledge, attitude, and sources of information towards burn first aid among people referred to a burn centre in the north of Iran in 2023. In this survey, a convenience sampling method was adopted. The variables consisted of four items on socio-demographic information, 15 items on knowledge, ten items on attitude, and one item on sources of information related to burn First aid. A total of 371 individuals responded to the survey. The mean age of participants was 31.90 ± 8.49 years old. The mean score of the total knowledge of the participants in the research was 6.04 ± 3.05. There was a statistically significant relationship between the variables of age, sex, marital status, place of residence, level of education, and history of receiving first aid training with the participants' knowledge level. The average score of the total attitude of the participants was 44.08 ± 3.88. Out of 371 participants, 214 people (57.7%) had an average attitude, and 157 people (42.3%) had a good attitude towards burn first aid. There was a statistically significant relationship between place of residence, level of education, and history of receiving first aid training with the participants' attitudes in the research. In addition, the level of knowledge had a statistically significant relationship with the participants' attitude level in the research (p-value <0.001). The majority of participants have limited knowledge of burn first aid. This lack of knowledge could lead to severe consequences. Therefore, healthcare organizations should review and promote consistent guidelines for burn first aid to tackle and minimize the effect of this grave injury.

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

BACKGROUND

Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context.

METHODS

A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels.

RESULTS

Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs.

CONCLUSIONS

A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

Nursing, history, and orthopedics in manuals (1875-1928)

OBJECTIVES

to discuss the content of manuals, with emphasis on orthopedics, in support of the development of nursing care culture.

METHODS

cultural-historical method articulated with document analysis technique. The sources were nursing manuals - Portuguese, French, English, and Spanish - from 1875 to 1928.

RESULTS

this study pointed to 12 works - 6 authored by physicians, 2 by nurses, 3 institutional, and 1 by a Sister of Charity - that presented, in a transversal way, the professionalization process initiated in Europe. The manuals addressed first aid care and immobilization methods, from the simplest, such as improvised splints, to the application of plaster casts.

CONCLUSIONS

the nurses' work, even in a limited capacity, showed that they were able to observe warning signs so that doctors could act, with some exceptions.

Effects of an Aboriginal and Torres Strait Islander Mental Health First Aid training programme for non-suicidal self-injury on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions: an uncontrolled trial with precourse and postcourse measurement and 6-month follow-up

OBJECTIVES

Non-suicidal self-injury (NSSI) is a complex issue affecting Aboriginal and/or Torres Strait Islander Peoples in Australia. We evaluated the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid (AMHFA) training course on assisting an Aboriginal and/or Torres Strait Islander person engaging in NSSI, including the effects on stigmatising attitudes, confidence in ability to assist, and intended and actual assisting actions.

DESIGN

Uncontrolled trial with precourse and postcourse measurement (n=49) and 6-month follow-up (n=17).

SETTING

Participants attended courses that were run in Queensland and Victorian communities and through one national organisation.

PARTICIPANTS

Participants were 49 adults who worked directly with Aboriginal and/or Torres Strait Islander Peoples.

INTERVENTION

The 5-hour 'Talking About Non-Suicidal Self-Injury' course was delivered by accredited AMHFA instructors and teaches people how to support an Aboriginal and/or Torres Strait Islander person who is engaging in NSSI.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures were stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a person engaging in NSSI.

RESULTS

Improvements were observed in stigmatising attitudes, with significant changes from precourse in both the 'weak-not-sick' (postcourse p<0.0623; follow-up p=0.0058) and 'dangerous/unpredictable' (postcourse p<0.0001; follow-up p=0.0036) subscales. Participants' confidence in ability to assist increased significantly both postcourse (p<0.0001) and at follow-up (p<0.0001). Despite a high level of endorsement for the nine recommended assisting actions at precourse, significant improvements (p<0.05) were observed in endorsement for six and four of the assisting actions postcourse and at follow-up, respectively. Course content was rated as being somewhat (3.4%), mostly (13.8%) or very (82.7%) culturally appropriate by participants who identified as Aboriginal and/or Torres Strait Islander.

CONCLUSIONS

The results of this uncontrolled trial were encouraging, suggesting that the Talking About Non-Suicidal Self-Injury course was able to improve participants' attitudes, confidence and intended assisting actions.

Effectiveness of Psychological First Aid e-Orientation among the General Population in Muntinlupa, the Philippines

This present study examined the effectiveness of the Psychological First Aid (PFA) e-orientation as well as face-to-face PFA orientation among the general population in Muntinlupa City, the Philippines. The e-orientation group consisted of 150 participants who received a two-hour PFA e-orientation (male: 47, female: 97, others: 6, mean age: 33.4 (SD = 12.1)), the face-to-face (F2F) group consisted of 139 participants who received a two-hour face-to-face PFA orientation (male: 41, female: 95, others: 3, mean age: 35.0 (SD = 13.8)), and the control group consisted of 117 participants who received a two-hour face-to-face health promotion orientation for obesity (male: 48, female: 65, others: 4, mean age: 34.2 (SD = 13.8)). In order to see the effect of these interventions, the confidence to provide PFAs was compared between the pre- and post-interventions in each group with paired t-tests. Further, the number of correct answers regarding the knowledge on PFA was also compared between the pre- and post-interventions utilizing a McNemar test. The results demonstrated that the mean scores on the confidence increased significantly in the e-orientation (pre: 25.1 (SD = 4.7), post: 26.1 (SD = 5.3), p = 0.02) and F2F (pre: 26.2 (SD = 6.0), post: 29.6 (SD = 6.9), p < 0.01) groups. Regarding knowledge on PFA, in the e-orientation group, the number of those who answered correctly increased significantly in a question (pre: 10, post: 24, p = 0.01), and there was a trend for improvement in another question (pre: 63, post: 76, p = 0.06). In the F2F group, the number of those who answered correctly increased significantly in two questions (pre: 21, post: 38, p < 0.01, and pre: 5, post: 14, p = 0.05), and there were trends for improvement in two questions (pre: 69, post: 82, p = 0.06, and pre: 17, post: 27, p = 0.09), while in the control group, there were no significant differences in any of the questions between pre- and post-intervention. The results suggest that both the PFA e-orientation and face-to-face orientation are effective for the general population in terms of increasing confidence and knowledge related to PFA.

Impact of the Use of Simulated Patients in Basic First Aid Training on Laypeople Knowledge, Skills, and Self-efficacy: A Controlled Experimental Study

BACKGROUND

First aid training is a cost-effective way to improve public health, but the most effective methods to teach first aid are currently unclear. The aim of this research was to investigate the added value of simulated patients during first aid certification trainings.

METHODS

Occupational first aid trainings organized by the Belgian Red Cross between September 2018 and August 2019 were allocated to either training with a simulated patient or regular training, for the topics "stroke" and "burns." Participants' knowledge and self-efficacy related to these topics were assessed at baseline, directly after training and after 1 year. First aid skills for "stroke" and "burns" and participant satisfaction were assessed after training. Knowledge and self-efficacy were measured via a questionnaire, and skills were assessed during a practical skills test. Data were analyzed using generalized linear mixed model analyses.

RESULTS

A total of 1113 participants were enrolled, 403 in the simulated patient group and 710 in the control group. First aid knowledge and self-efficacy increased strongly immediately after training. These increases did not differ between groups, nor did the level of practical skills. The simulated patient group had a significantly increased retention in first aid knowledge after 1 year, compared with control, while retention in self-efficacy did not differ. Participant satisfaction with training was similar between groups.

CONCLUSIONS

Using simulated patients during occupational first aid trainings for laypeople did not improve outcomes immediately after training but did improve retention of first aid knowledge after 1 year. These results support the use of simulated patients during first aid training.

The needs and opportunities of older laypeople to acquire first aid skills

We aimed to determine the needs and opportunities of older lay people to obtain first aid skills. We determined the level of theoretical knowledge of performing first aid with a structured questionnaire, performed on the sample of 842 adult inhabitants of Slovenia. The method of sampling was balanced by using a system of sampling weights in order to correct deviations in the structure of the sample to the level of the population structure. We also checked their attitude regarding the renewal of first aid knowledge. The level of self-assessment of first aid knowledge and actual theoretical knowledge of proper first aid measures typically decreased with age. The percentage of those who had attended first aid courses at any time was statistically significantly lower among respondents over the age of 60; 38% of elderly respondents thought they needed to renew their first aid knowledge, and 44% would attend a suitable first aid course. None of the 29 European Red Cross and Red Crescent Societies member states that responded have a developed a formally adopted first aid program to train the elderly. A tailored first aid training program for the elderly could be one of the many steps that should be taken to ensure adequate health care for the elderly population.

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11-13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students' role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.

Differing Effects of Vinegar on Pelagia noctiluca (Cnidaria: Scyphozoa) and Carybdea marsupialis (Cnidaria: Cubozoa) Stings-Implications for First Aid Protocols

The jellyfish species that inhabit the Mediterranean coastal waters are not lethal, but their stings can cause severe pain and systemic effects that pose a health risk to humans. Despite the frequent occurrence of jellyfish stings, currently no consensus exists among the scientific community regarding the most appropriate first-aid protocol. Over the years, several different rinse solutions have been proposed. Vinegar, or acetic acid, is one of the most established of these solutions, with efficacy data published. We investigated the effect of vinegar and seawater on the nematocyst discharge process in two species representative of the Mediterranean region: Pelagia noctiluca (Scyphozoa) and Carybdea marsupialis (Cubozoa), by means of (1) direct observation of nematocyst discharge on light microscopy (tentacle solution assay) and (2) quantification of hemolytic area (tentacle skin blood agarose assay). In both species, nematocyst discharge was not stimulated by seawater, which was classified as a neutral solution. In P. noctiluca, vinegar produced nematocyst discharge per se, but inhibited nematocyst discharge from C. marsupialis. These results suggest that the use of vinegar cannot be universally recommended. Whereas in case of a cubozoan C. marsupialis sting, the inhibitory effect of vinegar makes it the ideal rinse solution, in case of a scyphozoan P. noctiluca sting, vinegar application may be counterproductive, worsening the pain and discomfort of the stung area.

A new scheduling method based on sequential time windows developed to distribute first-aid medicine for emergency logistics following an earthquake

After an earthquake, affected areas have insufficient medicinal supplies, thereby necessitating substantial distribution of first-aid medicine from other supply centers. To make a proper distribution schedule, we considered the timing of supply and demand. In the present study, a “sequential time window” is used to describe the time to generate of supply and demand and the time of supply delivery. Then, considering the sequential time window, we proposed two multiobjective scheduling models with the consideration of demand uncertainty; two multiobjective stochastic programming models were also proposed to solve the scheduling models. Moreover, this paper describes a simulation that was performed based on a first-aid medicine distribution problem during a Wenchuan earthquake response. The simulation results show that the methodologies proposed in this paper provide effective schedules for the distribution of first-aid medicine. The developed distribution schedule enables some supplies in the former time windows to be used in latter time windows. This schedule increases the utility of limited stocks and avoids the risk that all the supplies are used in the short-term, leaving no supplies for long-term use.

Hyperbaric oxygen for decompression sickness

Decompression sickness (DCS, "bends") is caused by formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during any of the following: ascent from a dive; depressurization of a hyperbaric chamber; rapid ascent to altitude in an unpressurized aircraft or hypobaric chamber; loss of cabin pressure in an aircraft; and during space walks.

The Safety and Feasibility of a Family First Aid Approach for the Management of Postpartum Hemorrhage in Home Births: A Pre-post Intervention Study in Rural Pakistan

Objective

To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births.

Methods

A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for first aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes.

Results

Of the 4008 participants enrolled, 97% were successfully followed-up postpartum. Half of the participants in each phase delivered at home. Among home deliveries, the odds of reporting PPH almost doubled among in the intervention phase (OR 1.98; CI 1.43, 2.76). Among those reporting PPH, women in the intervention phase were significantly more likely to have received PPH treatment (OR 10.49; CI 3.37, 32.71) and 90% administered the dose correctly. No maternal deaths, invasive procedures or surgery were reported in either phase after home deliveries.

Conclusions

The Family First Aid approach is a safe and feasible model of care that provides timely PPH treatment to women delivering at home in rural communities.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA

Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.

An educational pathway and teaching materials for first aid training of children in sub-Saharan Africa based on the best available evidence

BACKGROUND

First aid training is a cost-effective way to decrease the burden of disease and injury in low- and middle-income countries (LMIC). Since evidence from Western countries has shown that children are able to learn first aid, first aid training of children in LMIC may be a promising way forward. Hence, our project aim was to develop contextualized materials to train sub-Saharan African children in first aid, based on the best available evidence.

METHODS

Systematic literature searches were conducted to identify studies on first aid education to children up to 18 years old (research question one), and studies investigating different teaching approaches (broader than first aid) in LMIC (research question two). A multidisciplinary expert panel translated the evidence to the context of sub-Saharan Africa, and evidence and expert input were used to develop teaching materials.

RESULTS

For question one, we identified 58 studies, measuring the effect of training children in resuscitation, first aid for skin wounds, poisoning etc. For question two, two systematic reviews were included from which we selected 36 studies, revealing the effectiveness of several pedagogical methods, such as problem-solving instruction and small-group instruction. However, the certainty of the evidence was low to very low. Hence expert input was necessary to formulate training objectives and age ranges based on "good practice" whenever the quantity or quality of the evidence was limited. The experts also placed the available evidence against the African context.

CONCLUSIONS

The above approach resulted in an educational pathway (i.e. a scheme with educational goals concerning first aid for different age groups), a list of recommended educational approaches, and first aid teaching materials for children, based on the best available evidence and adapted to the African context.

Smartphone apps on burns first aid: A review of the advice

AIMS

Many websites giving first aid advice are disappointingly inaccurate and at times dangerous in regard to burn injuries. With more patients relying on their smart phones to obtain online information the aim of this study was to compare first aid applications (apps) burn advice against those guidelines set by the British Burns Association (BBA).

METHOD

A content analysis of all freely available English written first aid apps from Google Play and the Apple Store was performed. The information was compared against BBA guidance which was split into 12 domains and scored appropriately.

RESULTS

61 of the 103 first aid apps included in the study, had information on the treatment of burn injuries. The mean score for all apps was 3.3 out of 12. 85% of apps postulated the need to cool the burn. However, only 11% of apps stipulated the need for 20min of cooling, while 3% suggested the burn can be cooled up to 3h post injury. Disappointingly even apps produced by reputable first aid charities scored poorly.

CONCLUSION

Burns first aid is documented as being poorly given in the community. With easy access to the internet and specifically smart device apps, more needs to be done to improve burn first aid information online.

Rescue and resuscitation factors in scuba diving and snorkeling fatalities in Australia, 2001-2013

AIM

The aim of this study was to examine first aid measures applied in a large series of Australian dive-related fatalities to better determine where improvements can be made.

METHODS

The National Coronial Information System was searched to identify scuba diving and snorkeling-related cases reported to various Australian Coroners for the years 2001-2013 inclusive. Coronial documents examined included witness statements, police reports and ambulance and medical reports where available. Information relating to the recovery, rescue and/or resuscitation of the victims was extracted, compiled and analyzed.

RESULTS

126 scuba diving and 175 snorkeling-related fatalities were identified during the study period, with airway management complications reported in one-third. Cardiopulmonary resuscitation was performed in three-quarters of the incidents. An automated external defibrillator was attached to 40 victims as a first aid measure, and shocks were indicated and delivered in five cases. Although three-quarters of the reports included no information about whether supplemental oxygen was provided, it was confirmed in 19% of both the scuba diving and snorkeling incidents.

CONCLUSION

There were often considerable delays in the recognition, rescue and/or recovery of an unconscious snorkeler or diver and, consequently, the time to commencement of basic life support. Such delays can affect chances of survival and need to be minimized. Delivery of supplemental oxygen during resuscitation appears to be relatively infrequent and sometimes suboptimal; improvement appears necessary. Some measures that would have improved availability and/or better use in these cases include the selection of appropriate equipment compatible with likely circumstances and operator skills; improved training and ongoing skills practice; and regular checking and maintenance of equipment. Improved data collection and recording by official on-site investigators, preferably with knowledge of diving, would better inform potential or necessary improvements.

An effective snakebite first aid training method for medics in the Chinese troops: a RCT

BACKGROUND

Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics' ability to manage snakebite first aid.

METHODS

This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants' socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the SPs (standardized patients) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n = 27), group B received a self-learning training on the SOP and checklist (n = 27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n = 26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.

RESULTS

The baseline measurement yielded no significant difference (H = 1.647, P = 0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P = 0.008, P < 0.001 and P < 0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F = 8.841, P < 0.001). Both post-intervention scores of group B and group C were higher than that of group A (P < 0.001 and P = 0.001, respectively), but no difference was found between group B and C (P = 0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62 ± 0.61 and 4.82 ± 0.45, respectively.

CONCLUSIONS

In this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics' cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.

Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study

OBJECTIVES

The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme.

DESIGN

A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis.

SETTING

The County of Stockholm, Sweden.

PARTICIPANTS

Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin.

RESULTS

Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted.

CONCLUSIONS

Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.

When This Happens, You Want the Best Care: Players' Experiences of Barriers and Facilitators of the Immediate Management of Rugby-Related Acute Spinal Cord Injury

Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.

Human model of burn injury that quantifies the benefit of cooling as a first aid measure

BACKGROUND

Burn injuries are a major cause of morbidity and mortality worldwide. Cooling is widely practised as a first aid measure, but the efficacy of cooling burns in human skin has not been demonstrated. A safe, consistent, ethically acceptable model of burning and cooling in live human skin in vivo was developed, and used to quantify the effects of cooling.

METHODS

Novel apparatus was manufactured to create and cool burns in women who were anaesthetized for breast reconstruction surgery using a deep inferior epigastric artery perforator flap. Burns were excised between 1 and 3 h after creation, and analysed using histopathological assessment.

RESULTS

All 25 women who were approached agreed to take part in the study. There were no adverse events. Increased duration of contact led to increased burn depth, with a contact time of 7·5 s at 70°C leading to a mid-dermal burn. Burn depth progressed over time following injury, but importantly this was modified by cooling the burn at 16°C for 20 min. On average, cooling salvaged 25·2 per cent of the dermal thickness.

CONCLUSION

This study demonstrated the favourable effects of cooling on human burns. Public heath messaging should emphasize cooling as first aid for burns. This model will allow analysis of the molecular effects of cooling burns, and provide a platform for testing novel therapies aimed at reducing the impact of burn injury.

MOOCs, an innovative alternative to teach first aid and emergency treatment: A practical study

The fast and constant evolution of Massive Open Online Courses (MOOCs) has gained the attention of the educational community, achieving widespread popularity among many universities. However, there is very little research on the use and acceptance of MOOCs by students in disciplines such as health and medicine. The principal focus of this study is to explore the behavior of students from a MOOC on Health Emergencies, analyzing the completion and drop-out rates. The data were collected from three self-administered questionnaires; the first identified general demographic information and the students' learning preferences, the second determined the level of MOOC adoption and the level of identification and satisfaction the students had with the course content, and the third measured the completion and drop-out rates. The MOOC had more than 2114 registered participants. The enrolled students showed high levels of commitment and motivation to learn about this topic through a varied of innovative educational resources, such as videos, learning activities, and interactive animations. In general, the participants expressed their desire to continue learning with this type of methodology. However, the results also showed important issues to be considered in the design and development of a MOOC of these characteristics.

ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study

Introduction

Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making processes that have been used in different fields of science. Our aim was to evaluate the lifeguards’ capacity to perform the ABCDE (Airway-Breathing-Circulation-Disability-Exposure) approach when facing a simulated critically ill-drowned victim.

Methods

A cross-sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status by following the ABCDE primary assessment approach. The two kinds of variables were recorder: those related to the quality of each step of the ABCDE approach and the visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA).

Results

None of the study participants were able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This was also represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06; p = 0.008).

Conclusion

Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected the lifeguards’ limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes.

Quality of Electrocardiograms Obtained in Flight by Airline Flight Attendants

BACKGROUND: Handling cases of chest pain aboard commercial flights is challenging for crewmembers, onboard medical volunteers, and ground-based doctors providing remote advice. Obtaining an electrocardiogram (ECG) in-flight could help in dictating the management of such cases. The ability to diagnose or rule out ST-segment elevation myocardial infarction (STEMI) would have clinical and prognostic implications. The feasibility of obtaining good quality ECG tracings by flight attendants in flight is not known.METHODS: A series of 200 consecutive ECG tracings transmitted to a ground-based medical support provider were independently reviewed by four observers who ranked the ECG tracings according to a quality score (QS) criteria, as well as trying to identify or rule-out cases of STEMI.RESULTS: ECG quality was considered good enough to extract useful information in 170 of 200 tracings (85%). Seven cases of STEMI were identified. A STEMI was confidently ruled out in 104 cases. Additional abnormalities of variable clinical importance were also detected.DISCUSSION: ECGs are essential in the prehospital management of chest pain cases. ECGs obtained in flight by airline flight attendants were mostly of diagnostic quality, allowing confirmation or ruling out of STEMI, as well as detecting arrhythmias of clinical significance in case management.Alves PM, Lindgren JA, Streitwieser DR, Anzola E, Ahmed N, Nerwich N. Quality of electrocardiograms obtained in flight by airline flight attendents. Aerosp Med Hum Perform. 2019; 90(4):405-408.

Inadequate knowledge about snakebite envenoming symptoms and application of harmful first aid methods in the community in high snakebite incidence areas of Myanmar

Introduction

Every year millions of people in developing countries suffer from snakebite, causing a large number of deaths and long term complications. Prevention and appropriate first aid could reduce the incidence and improve the health outcomes for those who suffer bites. However, many communities where snakebite is a major issue suffer from a lack of information about prevention and first aid measures that a family or community member could take to prevent severe envenoming, complications and poor outcomes. Myanmar suffers from a high burden of snakebites with a large number of deaths. As part of a health services and community development program, a community survey was conducted to identify communities’ knowledge about snakebite and their sequelae, and knowledge and practice about first aid and health services use.

Method

4,276 rural residents of Kyaukse and Madaya townships in the Mandalay region were recruited by cluster sampling, involving random selection of 144 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire.

Results

The incidence of snakebite was 116/100,000 people. Respondents reported 15 different types of snakes in the area, with Russell’s Viper, Cobra and Green snakes as the most common. 88% of the people informed that working in the fields and forests was when most of the bites occur. A majority knew about snakebite prevention methods such as wearing long boots. However, only a few people knew about the specific symptoms caused by snakebites. Only 39% knew about the correct methods of first aid. More than 60% mentioned tourniquet as a first aid method, though this may cause significant complications such as ischaemia of the limb. 88% said that they would take a snakebite victim to a government hospital, and 58% mentioned availability of antivenom as the reason for doing this. At the same time, the majority mentioned that traditional methods existed for first aid and treatment and 25% mentioned at least one harmful traditional method as an effective measure that they might use.

Conclusion

The community is aware of snakebites as a major public health issue and know how to prevent them. However, the high incidence of snakebites point to lack of application of preventive methods. The community recognise the need for treatment with antivenom. However, inadequate knowledge about appropriate first aid methods, and a reliance on using tourniquets require a targeted education program. Existing knowledge in communities, albeit insufficient, provides a good starting point for mass media educational campaigns.

Snakebite is a major public health problem, particularly in developing countries in the tropics, and every year millions of people suffer from snakebite causing a large number of deaths and long term complications. Communities’ knowledge about snakebite prevention practices and appropriate basic first aid could reduce the number of snakebites and improve the health outcomes for those who suffer bites. However, many communities where snakebite is a major issue may lack information about prevention and first aid measures that a family or community member could take to prevent severe complications and poor outcomes. Myanmar suffers from a high burden of snakebites with a large number of deaths. We conducted a community survey in two townships to identify communities’ knowledge about snakebite prevention, first aid and health services use. The survey informed that a large majority of people were aware that working in the fields and forests was when most of the bites occur. Similarly, a majority has the knowledge about snakebite prevention methods such as wearing long boots. However, the majority did not know about the correct methods of first aid, with many people mentioning tourniquet as a first aid method. While the community is aware of how to prevent snakebites, the fact that number of snakebites is high points to lack of application of those preventive methods. The inadequate knowledge about appropriate first aid methods with a reliance on using tourniquets informs about the need for public health education programs.

Patients' Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan

Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients' expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged > 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients' wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.

First aid interventions by laypeople for acute oral poisoning

BACKGROUND

Oral poisoning is a major cause of mortality and disability worldwide, with estimates of over 100,000 deaths due to unintentional poisoning each year and an overrepresentation of children below five years of age. Any effective intervention that laypeople can apply to limit or delay uptake or to evacuate, dilute or neutralize the poison before professional help arrives may limit toxicity and save lives.

OBJECTIVES

To assess the effects of pre-hospital interventions (alone or in combination) for treating acute oral poisoning, available to and feasible for laypeople before the arrival of professional help.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, ISI Web of Science, International Pharmaceutical Abstracts, and three clinical trials registries to 11 May 2017, and we also carried out reference checking and citation searching.

SELECTION CRITERIA

We included randomized controlled trials comparing interventions (alone or in combination) that are feasible in a pre-hospital setting for treating acute oral poisoning patients, including but potentially not limited to activated charcoal (AC), emetics, cathartics, diluents, neutralizing agents and body positioning.

DATA COLLECTION AND ANALYSIS

Two reviewers independently performed study selection, data collection and assessment. Primary outcomes of this review were incidence of mortality and adverse events, plus incidence and severity of symptoms of poisoning. Secondary outcomes were duration of symptoms of poisoning, drug absorption, and incidence of hospitalization and ICU admission.

MAIN RESULTS

We included 24 trials involving 7099 participants. Using the Cochrane 'Risk of bias' tool, we assessed no study as being at low risk of bias for all domains. Many studies were poorly reported, so the risk of selection and detection biases were often unclear. Most studies reported important outcomes incompletely, and we judged them to be at high risk of reporting bias.All but one study enrolled oral poisoning patients in an emergency department; the remaining study was conducted in a pre-hospital setting. Fourteen studies included multiple toxic syndromes or did not specify, while the other studies specifically investigated paracetamol (2 studies), carbamazepine (2 studies), tricyclic antidepressant (2 studies), yellow oleander (2 studies), benzodiazepine (1 study), or toxic berry intoxication (1 study). Eighteen trials investigated the effects of activated charcoal (AC), administered as a single dose (SDAC) or in multiple doses (MDAC), alone or in combination with other first aid interventions (a cathartic) and/or hospital treatments. Six studies investigated syrup of ipecac plus other first aid interventions (SDAC + cathartic) versus ipecac alone. The collected evidence was mostly of low to very low certainty, often downgraded for indirectness, risk of bias or imprecision due to low numbers of events.First aid interventions that limit or delay the absorption of the poison in the bodyWe are uncertain about the effect of SDAC compared to no intervention on the incidence of adverse events in general (zero events in both treatment groups; 1 study, 451 participants) or vomiting specifically (Peto odds ratio (OR) 4.17, 95% confidence interval (CI) 0.30 to 57.26, 1 study, 25 participants), ICU admission (Peto OR 7.77, 95% CI 0.15 to 391.93, 1 study, 451 participants) and clinical deterioration (zero events in both treatment groups; 1 study, 451 participants) in participants with mixed types or paracetamol poisoning, as all evidence for these outcomes was of very low certainty. No studies assessed SDAC for mortality, duration of symptoms, drug absorption or hospitalization.Only one study compared SDAC to syrup of ipecac in participants with mixed types of poisoning, providing very low-certainty evidence. Therefore we are uncertain about the effects on Glasgow Coma Scale scores (mean difference (MD) -0.15, 95% CI -0.43 to 0.13, 1 study, 34 participants) or incidence of adverse events (risk ratio (RR) 1.24, 95% CI 0.26 to 5.83, 1 study, 34 participants). No information was available concerning mortality, duration of symptoms, drug absorption, hospitalization or ICU admission.This review also considered the added value of SDAC or MDAC to hospital interventions, which mostly included gastric lavage. No included studies investigated the use of body positioning in oral poisoning patients.First aid interventions that evacuate the poison from the gastrointestinal tractWe found one study comparing ipecac versus no intervention in toxic berry ingestion in a pre-hospital setting. Low-certainty evidence suggests there may be an increase in the incidence of adverse events, but the study did not report incidence of mortality, incidence or duration of symptoms of poisoning, drug absorption, hospitalization or ICU admission (103 participants).In addition, we also considered the added value of syrup of ipecac to SDAC plus a cathartic and the added value of a cathartic to SDAC.No studies used cathartics as an individual intervention.First aid interventions that neutralize or dilute the poison No included studies investigated the neutralization or dilution of the poison in oral poisoning patients.The review also considered combinations of different first aid interventions.

AUTHORS' CONCLUSIONS

The studies included in this review provided mostly low- or very low-certainty evidence about the use of first aid interventions for acute oral poisoning. A key limitation was the fact that only one included study actually took place in a pre-hospital setting, which undermines our confidence in the applicability of these results to this setting. Thus, the amount of evidence collected was insufficient to draw any conclusions.

Mental health first aid training among pharmacy and other university students and its impact on stigma toward mental illness

BACKGROUND AND PURPOSE

Information on effective and replicable methods employed in pharmacy and other college students to combat stigmatizing beliefs toward those with mental illness is limited. Mental Health First Aid (MHFA) is an international, standardized, eight-hour course focused on helping members of the general public triage a mental health crisis. The objective of this study was to determine the effect of MHFA training on stigmatizing attitudes toward those with mental illness among pharmacy and non-pharmacy students.

EDUCATIONAL ACTIVITY AND SETTING

Pharmacy and non-pharmacy students were invited to voluntarily participate in one of two MHFA sessions. A survey utilizing the Social Distance Scale (SDS) and Attitudes to Mental Illness Questionnaire (AMIQ) was given to participants before and after the MHFA session to assess change in stigmatizing behavior.

FINDINGS

Thirty-four pharmacy students and 21 non-pharmacy students participated in the study. Overall, stigma toward depression and schizophrenia decreased. For the SDS schizophrenia vignette, a statistically significant improvement (p < 0.05) was seen on six of the seven responses for pharmacy students and on four responses in non-pharmacy students. Both pharmacy and non-pharmacy students improved on one item in the SDS depression vignette. For the AMIQ, pharmacy students demonstrated statistically significant improvement on four items in the schizophrenia vignette and five items in the depression vignette. Non-pharmacy students showed improvement on two items for both the AMIQ schizophrenia and depression vignettes.

DISCUSSION AND SUMMARY

MHFA was effective in decreasing stigmatizing beliefs among pharmacy and non-pharmacy students. These findings support the utilization of teaching methods that emphasize the patient experience and humanize mental illness.

Nurses' knowledge and practices in the face of the challenge of using the systematization of nursing care as an instrument of assistance in a first aid in Brazil

To analyze the performance of nurses in the implementation of nursing care systematization (NCS). This study is a descriptive research developed from a qualitative approach. The content analysis (CA) must be developed through 3 chronological poles allowing the researcher to construct an analysis structure that corresponds to the needs of the research and the objectives of the proposed research; The chronological poles of CA are described as: Phase 1-preanalysis, phase 2-exploration of the material: phase 3-treatment of the results obtained and interpretation. Only a semistructured interview will be conducted with the research subjects who meet the inclusion criteria of the study, preserving the identity of the individuals and guaranteeing the right to quit the research at any time during the interview. The Research Ethics Committee of Hospital of the clinics of Acre, Brazil (Amazon region) under the opinion no. 1.460.960 approved this protocol. The clinical protocol was registered in the "Brazilian Registry of Clinical Trials" validated by the World Health Organization, and received clinical trials "RBR-882rg2."

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait islanders who are experiencing suicidal thoughts and behaviour

BACKGROUND

Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

METHODS

The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

RESULTS

From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines.

CONCLUSIONS

Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies

(Mitchell SJ, Bennett MH, Bryson P, Butler FK, Doolette DJ, Holm JR, Kot J, Lafère P. Pre-hospital management of decompression illness: expert review of key principles and controversies. Diving and Hyperbaric Medicine. 2018 March;48(1):45е.doi.10.28920/dhm48.1.45-55.) Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled "Management of mild or marginal decompression illness in remote locations." A contemporary review was initiated by the Divers Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; first aid strategies for DCI; remote triage of possible DCI victims by diving medicine experts; evacuation of DCI victims; effect of delay to recompression in DCI; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Scientific Meeting, discussion by registrants at that workshop and, finally, several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis on resolving controversies around the definition of "mild DCI" arising over 12 years of practical application of the 2004 workshop's findings, and on the controversial issue of in-water recompression. The guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication.

First aid knowledge, attitude, practice, and associated factors among kindergarten teachers of Lideta sub-city Addis Ababa, Ethiopia

Background

Injuries are very common and can occur at any point of time in a day. Unintended injuries in kindergarten children are the most common and need immediate life saving care which is known as first aid. This study aimed to investigate knowledge, attitude, practice, and associated factors of first aid among kindergarten teachers of Lideta sub-city Addis Ababa, Ethiopia.

Method

A cross-sectional study was conducted among kindergarten teachers. Data was collected using pretested, structured and self-administered questionnaire S1 File. The collected data was entered in to Epi Data version 3.1 software and analyzed using SPSS version 20. Logistic regression analysis was used to identify association between kindergarten teachers’ knowledge and attitudes towards first aid and different variables. Odds ratios with 95% CI and p<0.05 were computed to determine the presence of the association.

Result

One hundred and ninety-four teachers participated in the study with a response rate of 95%. Only 40% of the teachers were knowledgeable and 75% of them had positive attitude for first aid. Eighty percent of teachers encountered with children in need of first aid. Kindergarten teachers older than 35 years [AOR = 4.2, 95%CI: (1.02, 16.9)], five years’ experience [AOR = 3.1, 95%CI: (1.2, 7.6)], having previous first aid training [AOR = 3.1, 95%CI: (1.2, 7.7)], source of first aid information and teachers serving in private kindergarten are associated with having knowledge of first aid. Long time experience, type of kindergarten, previous training, and exposure to children in need of first aid were positive association with attitude towards first aid.

Conclusion

Low first aid knowledge and high positive attitude among kindergarten teachers. Having long time experience, being older age, previous first aid training, and serving in private kindergarten were positively associated with first aid knowledge and positive attitude. Creating awareness and including first aid courses in the kindergarten teachers’ curriculum need to be considered.

Knowledge and Sociodemographic Determinants of Emergency Management of Dental Avulsion among Parents in Kuwait: A Cross-Sectional Study

OBJECTIVES

The aim of this study was to evaluate the knowledge of first aid measures for a permanent tooth avulsion among parents in Kuwait and to assess the effect of different sociodemographic characteristics.

MATERIALS AND METHODS

A cross-sectional study was conducted among 554 parents who visited 5 dental specialty centers in Kuwait. Parent sociodemographic data and responses to avulsion management questions were collected through a self-administered questionnaire. Descriptive and binary logistic regression analyses were used for data analysis.

RESULTS

In the 554 responses from patients, gaps were identified in the following areas: replantation (199, 35.9%), cleaning of the tooth (182, 32.9%), and transport media (84, 15.2%). Most parents demonstrated satisfactory knowledge levels regarding the urgency to seek professional help (391, 70.6%) and the first place of contact after the injury (525, 94.8%). Having previous information on emergency management of dental avulsion was a significant predictor of good knowledge (OR 2.138, 95% CI 1.347-3.395, p = 0.001). Of the 544 parents, 99 (17.8%) had received information on dental avulsion management: 30 (30.3%) from the Internet, 19 (19.2%) from books, 12 (12.1%) from television, 6 (6%) from smart phone applications, 2 (2%) from newspapers, and 30 (30.3%) from other sources.

CONCLUSION

In this study, parents in Kuwait did not have adequate knowledge of emergency management for dental avulsion. Future educational campaigns on dental avulsion are urgently needed to educate parents.

Use Your Noodle to Simulate Tourniquet Use on a Limb With and Without Bone

BACKGROUND

The purpose of this study was to simulate first aid by mechanical use of a limb tourniquet on a thigh with and without bone to better understand best caregiving practices.

METHODS

Two investigators studied simulated first aid on a new pool "noodle," a plastic cylinder with a central air tunnel into which we inserted a wood dowel to simulate bone. Data were gathered by group (study and control, n = 12 each). The control group comprised data collected from simulated tourniquet use on the model with bone present. The study group comprised data from simulated tourniquet use on the model without bone.

RESULTS

Comparing compression with and without bone, the mean volumes of compressed soft tissues alone were 303mL and 306mL, respectively. When bone was present, the volume of soft tissues was squeezed more, yielding a smaller size by 3mL (1%). The bone had a volume of 41mL and pressed statically outward with an equal force oppositely directed to the inward compression of the overlying soft tissues. With bone removed and compression applied, the mean residual void was 16mL, because 25mL (i.e., 41mL minus 16mL) of soft tissues had collapsed inward. The volume of the limb under the tourniquet with and without bone was 344mL and 322mL, respectively. The collapse volume, 25mL, was 3mL more than the difference of the mean volume of the limb under the tourniquet. More limb squeeze (22mL) looked like better compression, but it was actually worse-an illusion created by collapse of the hidden void.

CONCLUSION

In simulated first aid, mechanical modeling demonstrated how tourniquet compression applied to a limb squeezed the soft tissues better when underlying bone was present. Bone loss altered the compression profile and may complicate control of bleeding in care. This knowledge, its depiction, and its demonstration may inform first-aid instructors.

[First aid education - a questionnaire survey]

OBJECTIVE

Introduction: The ability to provide first aid, especially cardiopulmonary resuscitation (CPR) in accordance with the guidelines of the European Resuscitation Council (ERC) is a key element in helping and rescuing people with pre-hospital cardiac arrest. As recommended by the ERC 2015 guidelines, one of the most important steps to be taken to increase the rate of CPR appraisal by participants or cardiac arrest witnesses is to teach these skills to all children in schools. Numerous studies have shown that school-age children are positive about learning resuscitation, and moreover, they are important multipliers of knowledge because they are happy to transmit the information they receive to family members and the closest surroundings. The aim: To get to know the opinions of young people about the need for first aid education and the period in which it is best to start learning in this area.

PATIENTS AND METHODS

Materials and methods: The study was attended by 498 people, students of various types of universities, the research method was an online diagnostic survey, a self-help questionnaire tool.

RESULTS

Results: The study involved 309 women (62%) and 189 (38%) men. The respondents are young people between 18-30. Almost all respondents (97.2%) are of the opinion that learning first aid should be compulsory in the course of school education. The majority of respondents (76.7%) expressed the opinion that the knowledge regarding first aid should be updated, 16.3% had no opinion on this subject, while only 7.0% of respondents believed that there was no need to do so. Almost half of respondents (48.3%) are of the opinion that learning first aid should take place from the elementary school, while 30.3% of respondents think that they should be educated at pre-school age.

CONCLUSION

Conclusions: The vast majority of respondents consider first aid education to be significant and needed during education. Young people are aware of the need to practice skills and to repeat and update information on first aid. The majority of respondents are of the opinion that education in this area should be started very early, even in the pre-school period.

New and Established Models of Limb Tourniquet Compared in Simulated First Aid

BACKGROUND

The performance of a new tourniquet model was compared with that of an established model in simulated first aid.

METHODS

Four users applied the Combat Application Tourniquet (C-A-T), an established model that served as the control tourniquet, and the new SAM Extremity Tourniquet (SXT) model, which was the study tourniquet.

RESULTS

The performance of the C-A-T was better than that of the SXT for seven measured parameters versus two, respectively; metrics were statistically tied 12 times. The degree of difference, when present, was often small. For pretime, a period of uncontrolled bleeding from the start to a time point when the tourniquet first contacts the manikin, the bleeding rate was uncontrolled at approximately 10.4mL/s, and for an overall average of 39 seconds of pretime, 406mL of blood loss was calculated. The mean time to determination of bleeding control (± standard deviation [SD]) was 66 seconds (SXT, 70 ± 30 seconds; C-A-T, 62 ± 18 seconds; p = .0075). The mean ease-of-use score was 4 (indicating easy) on a scale of 1 to 5, with 5 indicating very easy (mean ± SD: SXT, 4 ± 1; C-A-T, 5 ± 0; p < .0001). C-A-T also performed better for total trial time, manikin damage, blood loss rate, pressure, and composite score. SXT was better for pretime and unwrap time. All users intuitively self-selected the speed at which they applied the tourniquets and that speed was similar in all of the required steps. However, by time segments, one user went slowest in each segment while the other three generally went faster.

CONCLUSIONS

In simulated first aid with tourniquets, better results generally were seen with the C-A-T than with the SXT in terms of performance metrics. However, the degree of difference, when present, was often small.

Study of Tourniquet Use in Simulated First Aid: User Judgment

BACKGROUND

The purpose of this study was to survey the judgments of tourniquet users in simulation to discern opportunities for further study.

METHODS

The study design constituted two parts: questions posed to four tourniquet users and then their tourniquet use was surveyed in simulated first aid, where the users had to decide how to perform among five different cases. The questions addressed judged confidence, blood volumes, a reason bleeding resumes, regret of preventable death, hemorrhage assessment, need for side-by-side use of tourniquets, shock severity, predicting reliability, and difference in blood losses. The mechanical performance was tested on a manikin. Case 1 had no bleeding. Case 2 had limb-wound bleeding that indicated tourniquet use in first aid. Case 3 was like case 2, except the patient was a child. Case 4 was like case 2, except caregiving was under gunfire. Case 5 was like case 4, but two tourniquets were to be used side by side. Each user made tests of the five cases to constitute a block. Each user had three blocks. Case order was randomized within blocks. The study had 60 tests.

RESULTS

In answering questions relevant to first-aid use of limb tourniquets, judgments were in line with previous studies of judgment science, and thus were plausibly applicable. Mechanical performance results on the manikin were as follows: 38 satisfactory, 10 unsatisfactory (a loose tourniquet and nine incorrect tourniquet placements), and 12 not applicable (case 1 needed no mechanical intervention). For cases 1 to 5, satisfactory results were: 100%, 83%, 100%, 75%, and 58%, respectively. For blocks 1 to 3, satisfactory results were 50%, 83%, and 83%, respectively.

CONCLUSION

For tourniquet use in simulated first aid, the results are plausibly applicable because user judgments were coherent with those in previous studies of judgment science. However, the opportunities for further studies were noted.

Availability of Life Support Equipment and its Utilization by Ambulance Drivers

BACKGROUND

An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers.

METHODS

Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection.

RESULTS

More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered.

CONCLUSIONS

The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.

Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) disproportionally affects Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is engaging in NSSI. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islanders who are engaging in NSSI were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions.

METHODS

The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is engaging in NSSI. The statements were sourced from systematic searches of peer-reviewed literature, grey literature, books, websites and online materials, and existing NSSI courses. A panel was formed, comprising 26 Aboriginal and Torres Strait Islanders with expertise in NSSI. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important.

RESULTS

From a total of 185 statements shown to the expert panel, 115 were endorsed as helping statements to be included in the re-developed guidelines.

CONCLUSIONS

A panel of Aboriginal and Torres Strait Islander people with expertise in NSSI were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander engaging in NSSI. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version. The re-developed guidelines will form the basis of an Aboriginal mental health first aid short course on NSSI for Indigenous community members and non-Indigenous frontline workers that will be evaluated in an upcoming trial.

[Not Available]

Zusammenfassung. Zusammenfassung: Schwere Unfälle zählen weiterhin zu den häufigsten Todesursachen bei jungen Erwachsenen. Die Notfallmedizin hat im Bereich der Traumaversorgung in den vergangenen Jahren grosse Fortschritte erzielen können. In diesem Artikel werden die strukturelle Entwicklung der Notfallmedizin in der Schweiz und die medizinischen Behandlungsstrategien bei Schwerstverletzten dargestellt.

[Evaluation of Knowledge-Attitudes-Practices of the populations in the health districts of Benoye, Laoukassy, Moundou and South N'Djamena towards canine rabies in Chad]

INTRODUCTION

Canine rabies remains a concern in Africa as well as in Chad. Our study aimed to evaluate the knowledge, attitudes and practices of the populations towards the appropriate management of people exposed to canine rabies and effective fight against it.

METHODS

We conducted a cross-sectional, descriptive study in four health districts in Chad in July and in September 2015. Data were collected from households recruited by three-stage random sampling by means of a questionnaire.

RESULTS

We conducted a survey of 2428 individuals having completed at least primary education level (54,12%). The average age was 36 ± 13.50 years. Surveyed individuals were farmers (35,17%), merchants (18,04%), households (12.81%). Rabies was defined as a disease transmitted from the dog to the man (41.43%), an alteration in brain function (41.27%), an undernourishment (10.26%). The cat was little-known to be a reservoir(13.84%) and a vector (19,77%) as well as licking was little-known to be a transmission medium (4.61%) and cat vaccination to be a preventive measure (0.49%). First aid for a bite at home was the traditional practice (47,69%), wounds washing (19.48%) or no action undertaken (20.43%). Households consulted the Health Service (78.50%), the Animal Health Service (5.35%) and the traditional healers (27%).

CONCLUSION

A communication campaing for implementing first aid at home in the event of a bite, knowledge about the cat as a reservoir and a vector and licking as a transmission medium as well as the promotion of the consultation of veterinary services in the event of a bite are necessary.