Adult Basic Life Support (BLS) Awareness and Knowledge Among Medical and Dental Interns Completing Internship from Deemed University

Introduction

Cardiac arrest is an important acute emergency situation both with in and out side the hospital set ups and carries a high level of mortality risk. However if early Basic life support (BLS) -cardio pulmonary resuscitation (CPR) is initiated; the survival rate can be substantially improved¹ The knowledge of BLS (CPR) is a major determinant in the success of resuscitation and plays a vital role in the final outcome of acute emergency situations. Knowledge of BLS is an absolute necessity for medical professionals to face acute medical emergencies. In the present study we aimed to assess the awareness, knowledge, attitude about adult BLS among interns completing their internship in both medical and dental streams from Nitte University (a deemed university).

Relevance and need for the present study

Chandrasekaran S and group studied the awareness of BLS among students, doctors, and nurses of medical, dental, homeopathy & nursing colleges and found it to be very poor which needed improvement²

S Raghavan and group from resuscitation council of southern Africa analyzed the level of knowledge & skill in basic resuscitation among medical practitioners (full time employed doctors) and tried to determine the differences in characteristics between those with and without knowledge and skills. In this cross sectional study they also found poor knowledge and skills of basic resuscitation among medical practitioners as less than 25 % of them scored more than 50 % marks³

Hassan Zaheer & group from Karachi, Pakistan analyzed under graduate medical students and found around 60 % of them had no knowledge of BLS and concluded that inclusion of BLS course will increase awareness and application of this valuable life saving maneuver⁴.

PS Phillips and group from Royal hospital Bath (UK) analyzed the junior doctors in medical schools of U K and found many junior doctors were not competent in carrying out effective resuscitation even though medical schools in U K provided them some form of life support training⁵.

Ji Ung Na and group from Korea investigated the level of BLS skill retention of Medical Doctors six and twelve months after BLS education and analyzed the correlation between Clinical experience of resuscitation and BLS skill retention. They found well Preserved Compression skills but poor retention of non compression skills⁶.

The above literatures indicate that BLS studies have been conducted in various Countries on specific sub groups like under graduate medical and dental students, medical doctors in medical colleges, full time employed doctors in government hospitals, junior doctors in medical schools.

HOWEVER THERE ARE NO STUDIES TO KNOW THE BLS PREPAREDNESS AMONG MEDICAL AND DENTAL INTERNS RIGHT AT THE TIME OF COMPLETING THEIR INTERNSHIP, A CRUCIAL TIME PERIOD JUST BEFORE THEY REACH OUT TO THE COMMUNITY AS HEALTH CARE PROVIDERS.

Hence the present study aims to know the level of BLS preparedness among this particular sub group and secondly it shall also help the administrators to streamline necessary modalities to make our future health care providers full fledged.

Methods And Methodology

The present descriptive study was conducted in a Questionnaire format by using a Questionnaire containing 19 questions pertaining to the demographic details, awareness, knowledge, attitude towards BLS. The protocol was approved by the central ethics committee of Nitte University. Whole batch of medical interns (n=84) and dental interns (n=78) who were Completing their internship were included in the study to avoid any selection bias.

After obtaining the informed consent from each participant, each one was asked to fill up the provided questionnaire (Appendix II) in front of the investigator to avoid any malpractice while answering the questionnaire. The answer keys for the core questions on knowledge of BLS were generated using Basic life support manual from American Heart Association. Incomplete response sheets (none in the present study) were excluded from data capturing and analysis. The data from 162 interns so captured were subjected to both descriptive and inferential statistical analysis. STATISTICAL ANALYSIS: The statistical analysis was performed with the statistical Package for the social sciences, Windows version 11.0 (SPSS Inc, Chicago, US). As the whole batches of interns completing internship were included (none excluded) the Sample thus constituted represented the Population, eliminating the scope for Standard error. Associations with in the medical & dental streams and comparisons between medical and dental streams were drawn using chi square and z test. The results with a P value of < 0.05 were considered significant. The conclusions were drawn based on the results of the analysis.

Results

Summary of Results

The summary of the results drawn from the above tables were as follows:

1. The present study encompassed 84 interns from medical stream and 78 interns from Dental stream. (Table -1)

2. Female interns out numbered male interns in both medical and dental streams (Table - 1)

3. There was no significant age difference between male & female medical and dental interns. (Table - 1)

4. All the interns (100 %) from both medical and dental streams were aware of the BLS thus demonstrating a high level of awareness. (Table - 2)

5. All the interns (100 %) from both medical and dental streams were aware of the need and usefulness of possessing BLS knowledge. (Table - 2)

6. All the interns (100 %) from medical and dental streams favored inclusion of BLS in their academic curriculum, thus stressing the need for a structured BLS training. (Table - 2)

7. Majority of interns (87 % medical, 81 % dental) correctly knew that BLS could be performed at both with in and out side the hospital set ups. (Table - 3)

8. 98 % of medical interns and 53 % of dental interns had observed BLS being performed, suggesting medical interns were more fortunate than dental interns. (Table-3)

9. 85 % medical interns had actually administered BLS in a real life situation while none (0 %) of the dental interns had performed the same, indicating poor hands-on BLS experience among dental interns. (Table - 3)

10.85 % of medical interns had received BLS training through BLS workshops while it was only 8 % among dental interns, thus suggesting poor exposure to BLS training among dental interns. (Table -3)

11. Level of BLS knowledge was better among medical interns as they scored better than dental interns as evidenced by 37 (44 %) of medical interns, 69 (88 %) of dental interns had scored less than 50 % of scores.(Table - 5)

12. 62 % medical and 50 % dental interns self graded themselves to have average knowledge of BLS in a five level grading system. On comparing the scores scored by interns (on knowledge of BLS) and their own self grading of BLS knowledge, it was evident that interns demonstrated realistic assessment of themselves. (Table-5)

13. Non availability of professional training was quoted as the main reason for lack of BLS knowledge by maximum interns (67 % medical & 75 % dental interns). A small percentage of interns (11 % medical & 9 % dental) quoted lack of interest also as the cause for the same. This shows an astonishingly similar trend in the perception of both medical & dental streams of interns for not having an adequate BLS knowledge. (Table - 5) 14. Inferential statistical analysis reveled a clear association (P < 0.05) of better BLS Knowledge score & individual BLS knowledge components among the interns who had attended the BLS work shop and who had performed BLS. This makes it evident that the resuscitation experience (performing BLS) and training (attending BLS Work shop) would boost the confidence among interns. Table- 4, 6,7,8,9, 10)

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Figure 1

FOR FIGURES - 1 & 2 :

A = Knowledge of Rate of cardiac compression during BLS delivery.

B = Knowledge of Ratio of cardiac compressions to breath during BLS delivery.

C = Knowledge of Location for cardiac compression during BLS Delivery.

D = Knowledge of Sequence of BLS components during BLS delivery.

K = Knows

DK =Does not know.

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Figure 2

FOR FIGURES - 1 & 2 :

A = Knowledge of Rate of cardiac compression during BLS delivery.

B = Knowledge of Ratio of cardiac compressions to breath during BLS delivery.

C = Knowledge of Location for cardiac compression during BLS Delivery.

D = Knowledge of Sequence of BLS components during BLS delivery.

K = Knows

DK =Does not know.

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Figure 3

FOR FIGURE - 3 :

E = BLS score of 50 % and above.

F = BLS score of below 50 %.

MD = Medical interns.

DN = Dental interns.

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Discussion

The present study being an unique study analyzed the knowledge, awareness and attitude towards BLS among both medical and dental interns right at the point of completion of their internship. The results from the present study revealed the following :

1. It was most common to note Average knowledge of BLS among both medical and dental interns.

2. Medical interns were better than dental interns with respect to BLS knowledge.

3. Level of BLS knowledge was not satisfactory especially in those who had not received any prior training(BLS work shop).

4. Lack of professional training of BLS was regarded as the most common hindering factor responsible for poor BLS knowledge by interns.

5. Both medical and dental interns demonstrated realistic assesment of themselves while grading themselves about their knowledge of BLS.

6. Structured training of BLS was strongly favoured by all interns.

Conclusions

From the present study we conclude the following :

1. Performing BLS and Attending BLS work shop plays a vital role in attaining BLS knowledge by both medical and dental interns.

2. There is an absolute clear need for review of Basic Life Support (BLS) education for

3. There is a need for structured training of BLS and BLS must be included in the Medical and Dental academic curriculum. This will go a long way in improving the outcome of BLS delivery by interns (the future health care providers), thus immensely benefitting the society and also boosting the morale of the interns. Interns from both Medical and Dental streams.

(Questionnaire)

ADULT BASIC LIFE SUPPORT AWARENESS AND KNOWLEDGE IN INTERNS COMPLETING INTERNSHIP FROM DEEMED UNIVERSITY

SL NO. :

AGE    :

GENDER: Male / Female COURSE : MBBS/BDS

1.    Have you heard about BLS?

Yes/ No

2. Expand BLS.........................................

3. Do you think that all interns need to know about BLS?

Yes/No

4. Do you think BLS training should be part of your medical curriculum?

Yes/No

5. Do you think BLS should be done only in hospital settings?

Yes/No

6. Please indicate the reason for lack of knowledge about BLS?

a. Busy curriculum

b. Lack of interest

c. No professional training available

7. Have you heard about BTLS

Yes/No

If yes, Expand

8. Have you ever seen a BLS (CPR) being done?

Yes/No

9. Have you ever done a BLS (CPR) on a patient?

Yes/No

10. Have you ever attended a workshop on BLS?

Yes/No

11. Indicate the number of compressions to be done in one minute in an adult?

a. 100

b. 200

c. 50

d. 30

12. Mark the ratio of chest compression to breath in adults?

a. 15:2

b. 3:2

c. 30:2

d. 100:2

13. Please indicate the location for chest compressions?

a. Left side of the chest

b. Right side of the chest

c. Mid chest

d. Xiphisternum

14. Arrange them in orderly sequence.

a. Head tilt

b. Chin lift

c. Check pulse

15. Expand AED.........................

16. Have you heard of Heimlich maneuver?

Yes/No

17. Please indicate the dialing number for help in case of a medical emergency in your setup?

a. 911

b. 102

c. 104

d. 108

18. Please rate yourself on BLS knowledge?

a. Poor

b. Below average

c. Average

d. Good

e. Excellent

19. Is it useful to know about BLS?

Yes/No