In Europe, cardiovascular diseases account for 40% of deaths among patients below the age of 75; sudden cardiac arrest is responsible for 60% of deaths in cardiac ischaemic disease [1], which is the leading cause of death worldwide [2]. Early and accurate recognition of sudden cardiac arrest  symptoms as well as prompt institution of pre-medical rescue procedures increase considerably the chances of survival of victims [3], which emphasizes the importance of resuscitation-related education.

Cardiopulmonary resuscitation classes for the students of Collegium Medicum of Jagiellonian University involve: first aid (1st year), rescue medicine with elements of disaster medicine (part 1 – 4th year and part 2 – 5th year) plus anaesthesiology and intensive therapy (6th year). They include both theoretical courses and practical training. Repeated classes are to assimilate and consolidate the students` knowledge on first aid and provide them with the newest guidelines.

The aim of the study was to assess the knowledge of the basic life support-automated external defibrillation (BLS-AED) algorithm among medical students participating or otherwise in the course on basic resuscitation procedures as well as their awareness of the need and efficacy of first aid and motivation for active administration of rescue procedures.

METHODS

The questionnaire study involved students of individual years of the Medical Faculty. Six groups of students were randomly formed, including 5 groups with those who took part in the BLS-AED course during studies at least one time and one group of first-year students who did not participate in such courses. Questionnaires were completed anonymously, “in a class” setting, assuming the respondents knew the meaning of the BLS-AED abbreviation.

The questionnaire, designed according to the available literature [3, 4, 5, 6, 7] consisted of three parts. The first part contained information concerning the respondents` past experience related to BLS-AED courses. The second part included 4 multiple choice questions assessing the motivation for undertaking resuscitation procedures. The final part consisted of 12 questions checking the knowledge of BLS-AED algorithm; each correct answer was scored 1 and each wrong one – 0.

The results were analysed using descriptive statistics and the Kruskal-Wallis test. Two null hypotheses were assumed: 1 – () – no differences among the populations of 1-6-year students, 2 – () – no differences among the populations of the 2-6-year students.

RESULTS

The study included 165 respondents. The sizes of groups according to individual years of studies were presented in Table 1.

Among the students who completed the BLS-AED course:

• 88.55% thought that the course improved their first aid skills;

• 93.89% believed that the course should be repeated several times during the studies;

• 38.17% stated that the course should be repeated ≤4 times, whereas 41.22% >4 times during the studies;

• 37.40% respondents wanted the course to be repeated 6 times during the studies;

• 91.60% expressed the willingness to re-attend the BLS-AED course.

The factors inclining the respondents to participate again in the course were compiled in Table 2. Among the participants of the BLS-AED course, 10 respondents did not want to re-attend the course, and motivated their decision as follows “I believe that I assimilated the knowledge and skills related to BLS-AED to the extent that retaking the course is not necessary”. One student gave another reason.

Among all the respondents, 76.97% claimed they knew the BLS-AED algorithm. Nonetheless, 45.67% of them gave wrong answers to 6 or more questions. The majority of students (89.7%) believed that the knowledge of BLS-AED algorithm could be useful some time (Table 3).

Three respondents answered that the knowledge of BLS-AED algorithm is useless, including 1, stating that the reason is poor availability of AED (3rd year), 1 – that it might do more harm than good (3rd year) and 1 – that he had no intension of helping anyone as someone would call an ambulance after all (1st year of study).

In the population studied, 37 respondents declared they had participated earlier in first aid and resuscitation courses; 30 of them claimed they followed the BLS-AED algorithm, 7 – stated otherwise as they did not know it.

As far as the question “Would you decide to undertake rescue procedures if you were again in the situation requiring the administration of first aid?” is concerned, 86% of respondents declared they would undertake rescue procedures trying to follow the algorithm (Table 4).

Positive answers were given by 79% of respondents to the question “Would you decide to use AED if available at the site of administering first aid to an unconscious person?”.

Analysis of the results using the Kruskal-Wallis test enabled to reject the hypothesis about the lack of differences among the populations of 1-6-year students (H=45.707; p=0.000). Based on the same test, the hypothesis assuming no differences among the populations of 2-6-year students was confirmed (H=3.288; p=0.511).

DISCUSSION

The questionnaire study concerning resuscitation provided by physicians and nurses of a paediatric hospital showed that about half of respondents critically assessed their skills [8]. In our study the majority of students, despite good self-assessment of the knowledge of BLS-AED algorithm, made numerous factual mistakes. Almost half of respondents declaring satisfactory BLS-AED knowledge gave wrong answers to 6 or more of the 12 questions. In the entire population studied, only 40% could recognize the clinical signs of  correct circulation. 

The majority of respondents are aware of the benefits of the BLS-AED algorithm in cases of sudden cardiac arrest. There is still a proportion unaware of usefulness of the algorithm and not willing to follow it in their rescue activities. This is alarming considering poor involvement of random witnesses in resuscitation procedures in the out-hospital setting [9].

Furthermore, the majority of respondents are motivated to undertake resuscitation according to the BLS-AED algorithm; still not all participants of the course express readiness to administer resuscitation procedures in fear of harming the victim, due to shyness or ignorance.

The findings demonstrated a substantial difference in the level of knowledge concerning the BLS-AED algorithm use between the group of respondents who completed the first aid course and otherwise. The level of knowledge was much higher after the first course; yet such a tendency was not observed during the successive years of training.

A high proportion of respondents expressed their willingness to re-attend the BLS-AED course; their main motivation was the need to revise suitable management algorithms in cases of sudden cardiac arrest. According to the majority of students, courses should be organized more frequently.

CONCLUSIONS

1. The knowledge of BLS-AED algorithm among medical students of all years of studies is not satisfactory.

2. BLS-AED trainings, particularly practical classes, should be repeated regularly.

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REFERENCES

1.     Specjalistyczne zabiegi resuscytacyjne. Polska Rada Resuscytacji, Kraków 2007: 1-4.

2.     Sokołowska-Kozub T, Trybus-Gałuszka H, Nowak J, Koźbiał P, Drab E: Pierwsza pomoc i resuscytacja krążeniowo-oddechowa, podręcznik dla studentów (Red.: Andres J), Polska Rada Resuscytacji, Kraków 2006: 30-41.

3.     Wytyczne 2005 resuscytacji krążeniowo-oddechowej: Europejska Rada Resuscytacji we współpracy z Polską Radą Resuscytacji, Kraków 2005: 11-28.

4.     Campbell JE: Basic trauma life suport. Medycyna Praktyczna, Kraków 2006.

5.     McLean B, Zimmerman JL: Fundamental critical care support. Society of Critical Care Medicine, Mount Prospect 2007.

6.     Larsen R: Anestezjologia. Urban&Partner,  Wrocław 2003: 893-944.

7.     Szczeklik A: Choroby wewnętrzne. Medycyna Praktycznam, Kraków 2005: 115-122.

8.     Grześkowiak M, Bartkowska-Śniatkowska A, Rosada-Urasińska J, Paklińska K: Personel medyczny szpitala pediatrycznego nie ma wystarczających umiejętności prowadzenia resuscytacji krążeniowo-oddechowej. Anaesthesiol Intensive Ther 2009; 41: 234-237.

9.    Rudner R, Jałowiecki P, Dziurdzik P, Karpel E, Kawecki P, Dudek-Dyczkowska D, Welland M: Wyniki postępowania resuscytacyjnego w pozaszpitalnych zatrzymaniach krążenia o etiologii kardiologicznej. Anaesthesiol Intensive Ther 2004; 36: 267-275.

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address:

*Anna Kołodziej
ul. Armii Krajowej 7/1, 30-150 Kraków
tel.: 0-604 824 081
e-mail: medicus84@o2.pl

received: 17.01.2010
accepted: 01.12.2010