Effect of basic life support training on the knowledge and skills of first aid of first year medical students

Esra Karaman, Nazire Avcu, Ozlem Guneysel

Department of Emergency Medicine, Faculty of Medicine, Maltepe University, Istanbul, Turkey

ABSTRACT Objective: To determine the timing of first aid training in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine.Method: The study was conducted prospectively with 168 first year medical students at Faculty of Medicine, Maltepe University in October 2019.An 8-hour course plan consisting of theoretical and practical applications was prepared.Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques,basic life support scenarios, Heimlich’s Maneuver and the coma position.Students were sent a link consisting of 17 questions created with Google forms at the beginning and the end of the course.Learned knowledge was measured with the posttest, and pre-and post-training results were compared.Results: A significant increase was found in the rate of correct answers compared to the pre-training period.Even the rate of correct post-test answers increased significantly in all questions;the increase in the questions related to the subjects supported by practical applications was more remarkable.It was found that more incorrect answers were given to questions about environmental injuries.Conclusions: It is possible to improve the public recognition of first aid, even with one day of theoretical and practical training.Thus,adding first aid practical courses to the first-year medical school curriculum and raising awareness at an earlier age will play an essential role in medical education.

KEYWORDS: Medical education; First aid; Basic life support;Medical school curriculum

1.Introduction

Out-of-hospital cardiopulmonary arrest and its low survival rates are some of the most critical health problems worldwide.In its lexical sense, first aid means “first help or emergency care performed for a person who is injured or suddenly becomes ill”.The American Heart Association (AHA) defines first aid as lifesaving interventions without using any medical equipment[1].A first aid provider should recognize and evaluate the need for first aid,provide care using appropriate competencies, and seek additional help when necessary[2].In recent guidelines released by AHA,early recognition of arrest, early and effective cardiopulmonary resuscitation (CPR), and defibrillation were especially emphasized as the most essential steps of first aid in saving lives.First aid can be performed by anyone anywhere.It is also known that people who have not received first aid training are often obliged to do it.In AHA 2019 “Basic Life Supports in Adult”, it is stated that despite the advances in technology and techniques, the survival rate of suddencardiac deaths in the last 50 years is still low[3].

Although the medical education of developed countries is similar,there is no recommendation about the timing of Basic Life Support(BLS) training.As there are different practices in each country,different institutions have their unique practices as well.Traditionally basic life support is taught as “theoretical lectures and practical applications on mannequins” but still no consensus on curriculum proposal[4].This study aims to determine the timing of the first aid subjects in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine.

2.Participants and methods

2.1.Ethical approval

The study was performed prospectively in October 2019 at Maltepe University Faculty of Medicine.Approval was obtained from the Maltepe University Clinical Research Ethics Committee(2019/900/68).

2.2.Participants and courses

First-year medical students from Faculty of Medicine, Maltepe University were included in the study, and none of them had received basic life support training previously.A two-stage, 8-hour course plan consisting of theoretical lectures, and practical applications was prepared.The course was planned and implemented by 3 lecturers who were experts in the field and had at least 5 years of experience.Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques, basic life support scenarios, Heimlich’s Maneuver and the coma position.

2.3.Questions

At the beginning of the course, a link consisting of 17 questions(Supplementary material) containing information to be explained to the students was created using Google forms.This link was shared with the students participating in the course through the group(WhatsApp) created from the digital database, allowing them to answer the test.Twenty minutes were given for the test, and when the time ended, the connection was closed for use, preventing answering during the day and incorrect results.

At the end of the training, a new link was created with the same questions, and the students were asked to answer the test again.Students who participated in both theoretical and practical applications were included in the study.Answers of students who attended only one part of the course were excluded from the study.

2.4.Statistical analysis

Number Cruncher Statistical System 2007 (Kaysville, Utah,USA) program was used for statistical analysis.Descriptive statistical methods (mean, standard deviation, median, frequency,rate, minimum, maximum) were used while evaluating the study data.McNemar test and Wilcoxon Signed Ranks test were used to evaluate the applied test questions’ results before and after the training.The significance level of this study was set at α=0.05.

3.Results

A total of 168 students completed the pre-and post-training test.A statistically significant increase of correct rate in all questions was noted.The results are presented in Table 1.

Table 1.Evaluation of post-training test results compared to pre-training.

While 21.4% (n=36) of the students gave correct answers to the 2nd question (How many times should CPR per minute be applied to adults?) before the training, 81.0% (n=136) gave the correct answer after the training; Only 11.9% (n=20) of the students gave correct answers to the 9th question (Which of the following statements about the CPR that the first aider will apply when encountering an elderly victim is correct?) before the training,64.3% (n=108) gave the correct answer after the training; 34.5%(n=58) of the students gave correct answers to the 12th question(In which area is the Heimlich’s Maneuver applied in adults?)before the training, whereas 81.5% (n=137) gave the correct answer after the training; 35.7% (n=60) of the students gave correct answers to the test’s 14th question (Which of the following first aid information is incorrect?) before the training, and 88.1%(n=148) gave the correct answer after the training; 34.5% (n=58)of the students gave correct answers to the 15th question (Which of the following is not one of the maneuvers used in the case of foreign body aspiration?) before the training, 85.1% (n=143) gave the correct answer after the training.It was determined that an increase in the number of correct answers given to the questions about CPR and application method (Questions 2, 9, 12, 14),foreign body aspiration after the training was higher than the other questions, and it was found to be statistically significant (P=0.001 and P＜0.01, respectively).

While the pre-training total test scores of the students were 5.56±1.88.The post-training average was 12.44±1.87.The increase in the total post-training test results compared to pre-training was statistically significant (Z=11.275, P=0.001).

4.Discussion

The quality of cardiopulmonary resuscitation performed is of vital importance, and it has been found that even among healthcare professionals, an efficient resuscitation cannot always be performed[2].It was learned that all but one of the studentsparticipating in our study had not received first aid training before,and their current knowledge was based on films and social media.

In a review by Suarez et al.basic life support, training methods were mentioned, and it was stated that the most frequently used method was in the form of pretest-training-posttest as in our study[5].The rate of correct post-test answers increased significantly in all questions, and it was determined that the increase in number of correct answers given to the especially questions about cardiopulmonary resuscitation practical application.Aspiration was higher than the other questions.Itwas noteworthy that these questions’ common feature was those related to issues supported by the practical application (CPR and application method, foreign body aspiration).

The students participating in our study consisted of a group representing the young segment of the population who have just graduated from high school, and our findings revealed their knowledge and experience level in first aid interventions are low.It was observed that they mostly gained this information from social media, news programs and high school classes.Our study revealed that it is possible to raise a significant level of awareness, even with one day of theoretical and practical training.In a similar study.the rate of people who knew where the cardiac compressions should be located was 44.2%, while in our study similar rates were found.Nevertheless.it was observed that the answers were given about the interventions to be performed on the patient with epilepsy, and the basic first aid steps included similar mistakes known in the society, such as making someone smell cologne or onion[6].

Heat stroke and frostbite are called environmental injuries, and they are more common in homeless people, drug addicts and those working in the field.Frostbite and heat stroke can progress rapidly from simple symptoms to life-threatening situations, and outstanding results can be obtained with early intervention[7.8].Correct answers in the pretest to the question about heat stroke were 36.2%.The rate of those who answered the question about epilepsy correctly was 73.2%.We think that this is due to the more frequent encounters with situations such as epileptic seizures.sudden cardiac arrest, and the information transmitted by hearsays and information learned through social media.

In our study, we showed the positive effect of education on strengthening first aid awareness, which is similar to other studies.In a study[9], it shows that the necessity of first aid training given in the adolescent age group and the information is significantly preserved after 12 months in this age group, similar to our article.In another study conducted with medical school and first year nursing students, it examined the results of face-to-face education and co-education with an online instructor, and showed that there were no significant results.It has been shown that repeating the blended training shortly after the course and 6 months later increases the permanence of the information[10.11].We also think that the trainings should be repeated at certain intervals in order to increase the permanence of the level of knowledge achieved through training.

Learning first aid is the easiest way of early diagnosis and effective intervention of cardiopulmonary arrest.It has been shown that even short-term training in the posttest performed after the 8-hour course significantly increases the knowledge and skills regarding first aid interventions.The increase in the number of correct answers observed in the posttest for the questions related to the subjects with practical applications was determined more than the ones explained only theoretically and showed the importance of practical applications in training.We suggest adding first aid practical courses to the first-year curriculum and raising awareness by adding courses that may play an essential role in medical education.

Conflict of interest statement

The authors report no conflict of interest.

Authors’ contributions

Design and data collection: E.A., N.A.and O.G.; Data analysis and interpretation: A.E.and O.G.; Writing the article: E.A.and N.A.;Critical revision and final submission: O.G..

Effect of basic life support training on the knowledge and skills of first aid of first year medical students

Esra Karaman, Nazire Avcu, Ozlem Guneysel*

Department of Emergency Medicine, Faculty of Medicine, Maltepe University, Istanbul, Turkey

Supplementary material.Questions.

1.What is the drug-free intervention performed to provide oxygen to the lungs with artificial respiration and blood pumping from the heart with external CPR after the airway opening is provided to save a life to the people whose respiration and/or heart is stopped?

A.Advanced life support

B.Critical care

C.Basic life support

D.Immediate aid

2.How many times should CPR per minute be applied to adults?

A.60/min

B.80/min

C.30/min

D.100-120/min

3.Which of the following should be the first aid given to a person with airway obstruction,coughing, and difficulty in talking and seeking help?

A.Sniffing position

B.Rentek's Maneuver

C.Shock position

D.Encouraging to coughing

4.Which of the following is not one of the cooling methods applied to heat emergencies?

A.Placing ice packs in the neck, groin, and armpit of the patient

B.Spraying water on his/her body and evaporating it with a fan

C.Intervention with antipyretic drugs

D.Using a cooler blanket

5.Which is not one of the mildest conditions associated with heat?

A.Heat edema

B.Heat exhaustion

C.Heat rash

D.Heat cramps

6.Which of the following is correct?

A.Epileptic seizures last about 5-6 minutes

B.Making the patient smell materials such as onions and cologne during the seizure has no therapeutic effect

C.A triggering factor is absolutely required for a seizure

D.During the seizure, should be tried to switch to the rescue position

7.Which is incorrect about first aid in case of drowning?

A.In case of drowning in the sea, if the patient is not breathing, CPR should be started in water, if possible

B.The order is A, B, C in resuscitation

C.Clothes should not be removed when the person is taken out of the water to prevent heat loss

D.100% oxygen support should be started as soon as possible

8.Which of the following is not seen in heat exhaustion?

A.Headache

B.Muscle cramps

C.Nausea and vomiting

D.Seizure

9.Which of the following statements about the CPR that the first aider will apply when encountering an elderly victim is correct?

A.Using one hand, lowering the sternum 1-1.5 cm

B.Using the middle and ring finger of a hand, lowering the sternum 1-1.5 cm

C.Using two hands, compression with the half of the thorax

D.Using one hand, lowering the sternum 5 cm

10.Which of the following is not seen during an epileptic attack?

A.Urine or stool incontinence

B.Abnormal behaviors such as licking oneself, swallowing, searching for objects

C.Abnormal arm and leg movements without loss of consciousness

D.Petrification, resting on

11.Which one is not among the first aid rules to be applied during the seizure?

A.In order to open the patient's respiratory tract and prevent him/her from biting his/her tongue, the mouth should be opened by force, and materials such as a spoon can be used if necessary.

B.112 should be called

C.During contractions, no pressure should be applied to the arms and legs

D.After the seizure stops, the patient should be taken to the recovery position

12.In which area is the Heimlich's Maneuver applied in adults?

A.Just below the belly button

B.The upper part of the stomach, below the sternum

C.To the middle part of the pelvis

D.To the middle part of the thoracic wall

13.Which of the following is not one of the symptoms of heatstroke?

A.Abdominal cramp, nausea, vomiting

B.Muscle cramps, fatigue, tiredness

C.Shiny, fresh and cold skin

D.Dizziness, behavioral disorder, nervousness

14.Which of the following first aid information is incorrect?

A.The look-listen-feel method should be performed for 10 seconds.

B.The rate of heart pressure is adjusted to 100-120 compressions per minute.

C.The pressure to be applied in CPR should be 1/3 of the chest height when viewed from the side.

D.Basic life support should be stopped after five rounds of at most 30/2 heart compression.

15.Which of the following is not one of the maneuvers used in the case of foreign body aspiration?

A.Heimlich's Maneuver

B.Oral cleaning

C.Hitting the back

D.Head-tilt/chin-lift Maneuver

16.Which one is incorrect about partial obstruction?

A.There are air intake and outtake, even limited.

B.The patient may speak or cough.

C.Although the inside of the mouth cannot be seen clearly, it should be checked blindly with a finger.

D.Coughing effort, if any, should be supported.

17.Which one is incorrect about drowning?

A.If there is no suspicion of a foreign body, Heimlich creates a risk for aspiration.

B.The state of consciousness, spontaneous breathing, and the presence of circulation upon arrival in the emergency room is ineffective in predicting the outcome.

C.The first thing to do without checking the presence of spontaneous breathing should be to take the patient into the recovery position.

D.Cricoid pressure increases the risk of aspiration.