Ewa Kwiatkowska, Dariusz Kosson
Department of Anesthesiology and Intensive Therapy Teaching, Faculty of Health Sciences, Warsaw Medical University, Warsaw, Poland
Introduction: Cardiovascular diseases and related with them sudden cardiac arrest states are the main cause of death in Poland as well as worldwide. The quick start of rescue activities by witnesses of the incident increases chances of saving the victim.
Aim: the aim of the study was to assess the knowledge and skills of patients in different ages on providing the first aid. High school students were the control group.
Material and methods: A diagnostic survey was the research method used in the study. Among techniques assigned to this method, the anonymous questionnaire technique was chosen. The study was conducted from February to April 2018 among patients in one selected Warsaw hospital. Students in one selected Warsaw high school were the control group.
Results: More frequently high school students than patients confirmed the participation in the first aid course, 74% and 60%, respectively. Patients usually gained the knowledge on the first aid in the workplace, at school, and also during the driving license course. The school was the main source of knowledge for high school students. In the study group, both male and female patients presented a lower level of knowledge than male and female high school students. Patients with higher education characterized the highest level of knowledge on the first aid.
Conclusions: One should strive to change the system of knowledge transfer by putting more emphasis on simulation exercises referring to specific situations in everyday life. The higher level of knowledge of high school students may result from including in the curriculum issues related to the premedical first aid. It is necessary to deepen and broaden the knowledge at further stages of education and professional life. Education regarding the basic first aid should be adapted to the age of the recipient and widely propagated in the society.
Cardiovascular diseases and associated with them sudden cardiac arrest states are the primary cause of deaths in Poland and worldwide. The quick start of rescue activities by witnesses of the event increases chances of saving the injured and reduces the risk of complications caused by temporary hypoxia of the central nervous system (CNS) and other organs. Standards for the premedical first aid delivery change every few years and are included in the guidelines of the European Resuscitation Council (ERC), which are called recommendations. The latest recommendations come from 2015.
Everyone should know rules of providing first aid in order to be able to use them in everyday life, be able to take care of a sick person or someone whose life is threatened even in unexpected situations, before the arrival of an ambulance and providing professional medical care. The ability to provide the first aid is most often used by health care professionals because they face situations in which they have to use them. The knowledge of the first aid principles increases the chances of saving a person’s life or health.
PREMEDICAL FIRST AID – DEFINITION, LEGAL ACTS
The premedical first aid is the help provided to the injured person in case of a sudden deterioration of health or life-threatening condition . Any person who is a witness to a sudden threat to one’s life is obliged to provide the first aid. Failure to provide help to an injured person without exposing oneself or another person to a danger of loss of life or a serious body injury can be punished by imprisonment of up to 3 years .
SELECTED CASES REQUIRING THE FIRST AID
Cardiopulmonary resuscitation (CPR)
Sudden cardiac arrest is the cessation of the mechanical heart work, which is accompanied by the loss of consciousness, the lack of muscle tension, the lack of response to external stimuli and the lack of perceived heart rate in the patient .
Resuscitation is the restoration of circulation and breathing through indirect heart massage and artificial respiration. The purpose of resuscitation is to maintain oxygen transport to the brain as well as to regain the spontaneous respiration and heart function. The brain is the most sensitive organ to hypoxia. The brain will react to the total interruption of oxygen supply by the loss of consciousness in a dozen or so seconds, the reversible clinical death lasts about 3 minutes. The biological death occurs after 3 minutes, during which irreversible changes occur in the brain, so the chances of regaining the heart and breathing decrease .
Basic resuscitation can be interrupted only when the victim begins to react, breathe or move or the rescue action is taken over by paramedics from the EMS team or other medical services. When the person performing resuscitation is tired, it is recommended to assist in resuscitation by other witnesses of the event .
In the recovery position (the safe position) one can place an unconscious person only when he breathes on his own. It protects against the collapse of the tongue, and the aspiration of saliva or stomach contents. This position allows one to control breathing .
The cause of chest pain may indicate one of many diseases, including ischemic heart disease, the digestive system disease, musculoskeletal system disease, neurosis as well as lung disease. The blood flow decrease through coronary arteries may lead to ischemia of various areas of the myocardium or total damage, i.e. the necrosis known colloquially as “infarction”. The pain is usually described as “stinging”, “crushing”, “burning” or “tightening”. It is located near the sternum but may radiate to shoulders and the neck .
The aim of the study was to assess the knowledge and skills of patients in different ages on providing the first aid. High school students were the control group. The knowledge of principles of the premedical first aid was the subject of the study. The work hypothesis: The knowledge of patients is smaller than the knowledge of high school students.
MATERIALS AND METHODS
A diagnostic survey was the research method used in the study. Among techniques assigned to this method, the anonymous questionnaire technique was chosen. The research tool was an original questionnaire containing 21 questions, including 11 questions regarding the basic knowledge on the first aid. The questions were closed, with the possibility of indicating only one correct answer. Among them there was only one multiple-choice question.
The control group consisted of students in one selected Warsaw high school. 200 patients and 100 students were enrolled. The choice of respondents was random and participation in the research was voluntary.
The statistical analysis was carried out using the STATISTICA version 7.0 software from StatSoft Poland. The following methods of quantitative data analysis were used: the differences between the compared groups were assessed on the basis of the significance test for categorical variables with chi-square statistics; the Pearson correlation coefficient was also used (a measure based on chi-square values of associations between categorical variables; indicates the strength of the relationship). Statistically significant results were those fulfilling the condition of P below 0.05.
Into the study there were enrolled 200 patients (the study group). There were 114 women (57%) and 86 men (43%) among respondents. The age structure of the respondents was as follows: 20 – 30 years – 15%, 30 – 40 years – 13%, 40 – 50 years – 20%, 50 – 60 years – 18%, 60 – 70 years – 21%, 70 – 80 years – 10%, 80 – 90 years – 3% (Figure 2). Due to a very low percentage of people aged 80 – 90 years, a group of respondents aged over 70 years (13%) was formed for further analysis.
The control group consisted of 100 high school students, 58 women and 42 men, living in cities over 100,000 inhabitants (72%) or smaller urban centers (13%) and rural areas (9%).
Question 1: Do you know the first aid principles? The knowledge of principles of the first aid was more often confirmed by high school students than patients, 92% and 75%, respectively.
Question 2: Did you participate in the first aid course? More often high-school students than patients confirmed participation in the first-aid course, 74% and 60%, respectively. However, the difference was not statistically significant.
Question 3: Where did you learn the first aid principles? (the question was multiple choice). Patients most often acquired first aid principles in the workplace (37%) and at school (34%) as well as during a driving license course (24%), during studies (19%), on television (17%), from the internet (7%), and at a picnic (6%). For high school students, the main source of knowledge was: school (96%), the internet (23%), a picnic (23%) and television (15%) (Fig 1).
Question 4: Is the ability to provide the first aid needed? Both patients and high school students confirmed the usefulness of first aid skills, 97% and 99%, respectively. No differences were found to be statistically significant.
Question 5: Would you take part in the free of charge first aid course if it were organized in your area of residence? Patients (80%) significantly more frequently than high school students declared the willingness to participate in the free of charge first aid course.
Question 6: Do you know emergency telephone numbers? Both patients and high school students confirmed the knowledge of emergency telephone numbers, 96% and 95%, respectively. No differences were found to be statistically significant.
Question 7: What is the telephone number of the Emergency Notification Center? 88% of patients and 91% of high school students were aware of the 112 number as the number of the Emergency Notification Center. No differences were found to be statistically significant.
Question 8: What is the first aid? 91% of studied patients correctly determined that the first aid is a set of rescue procedures performed by people at the scene. The correct definition of the first aid was indicated by 100% of high school students. It was found that the level of knowledge of high school students was significantly higher than in case of 91% patients.
Question 9: What would you do if you saw a person lying on the street? The study revealed that in the situation of a person lying on the street, high school students would act correctly more frequently than patients, getting information about the situation, 57% and 50% respectively. Patients more often than high school students would make a phone call to the EMS without taking any steps on their own, 47% and 38%, respectively. No differences were found to be statistically significant.
Question 10: How would you check the presence of breath in the victim? The presence of breath in the victim can be checked sensitively, audibly, visually. The variant “all answers are correct” was chosen by 74% of the studied population, including 81% of high school student and 69% of patients. No differences were found to be statistically significant.
Question 11: According to your opinion, the currently recommended number of air breaths and chest compressions during cardiopulmonary resuscitation (CPR) in an adult is …? The correct answer (30 compressions and 2 breaths) was indicated by 91% of high school students and 57% of patients. Patients also indicated as correct the answer: 30 compressions and 5 breaths (17%) as well as indicated that they did not have any knowledge on the subject (17%). No differences were found to be statistically significant.
Question 12: According to your opinion how deep should be the chest compressed during cardiopulmonary resuscitation (CPR) in an adult? The correct answer (the recommended depth of chest compression during adult CPR is 4 – 5 cm) was indicated by 74% high school students and by only 30% patients. Patients chose incorrect answers as follows: 3 cm (15%), 7 cm (7%), the depth of compressions is not important (20%), and also indicated a lack of knowledge on the subject (28%). It was found that the knowledge of high school students on the value of chest compressions depth during CPR was significantly higher than in case of patients participating in the study.
Question 13: How long do you think you should continue cardiopulmonary resuscitation (CPR)? High school students more often than patients marked that all answers were correct, 62% and 43%, respectively. CPR should be carried out until the victim’s response, exhaustion of one’s own strength or arrival of the EMS team. No differences were found to be statistically significant.
Question 14: How do you think in which position the unconscious victim should be placed? High school students more often than patients knew the correct position of the unconscious victim [on the side, with the hand under the cheek, the upper leg bent in the knee and the head slightly tilted back (recovery position)], 94% and 80%, respectively.
Question 15: In which position would you put a conscious person with suspected myocardial infarction? High school students more often than patients knew the correct position in a conscious person with a suspicion of a heart attack: half-sitting, 42% and 36%, respectively. In both groups, every third person marked “I do not know the right answer”. No differences were found to be statistically significant.
Question 16: What would you do with the victim with nosebleed? In case of nosebleed, the correct procedure more frequently (lean forward, apply cold compresses on the neck and forehead) was chosen by high school students than patients, 80% and 49%, respectively. No differences were found to be statistically significant.
Question 17: Who in Poland is obliged to provide the first aid? 88% of high school students and 82% of patients were aware of the obligation to provide the first aid. No differences were found to be statistically significant.
For the test of knowledge on the first aid, questions 7 – 17 were selected. If a correct answer was given, 1 point was awarded. In the test of knowledge one could get 11 points. The following knowledge level assessment system was applied:
• 81−100% correct answers – grade: 5 (10−11 points) – level: very good
• 61−80% correct answers – grade: 4 (8−9 points) – level: good
• 41−60% correct answers – grade: 3 (6−7 points) – level: satisfactory
• 21−40% correct answers – grade: 2 (4−5 points) – level: low
• up to 20% correct answers – grade: 1 (≤ 3 points) – level: insufficient
In the knowledge test, the mean value for patients was 6.83 (± 2.56) points, which was assessed as a sufficient level, when in case of high school students it was – 8.60 (± 1.59) points, which was assessed as a good level. Among patients there were people who obtained 0 points (0.5%), i.e. all answers they gave were wrong as well as there were people with the maximum number of points (5.0%). Nevertheless, among high school students the percent of maximum results was almost two times higher (9.0%). The value of the lower quartile indicated that 25% of the studied patients did not get more than 5 points (low level), when according to the upper quartile, only 25% achieved a score of at least 9 points, which was good and very good. Referring to the control group, according to the value of the lower quartile, 75% of high school students obtained at least 8 points in the test, which was good and very good (Table 1).
According to the adopted grading scale, the level of knowledge presented by patients was insufficient in 11%, low – in 18%, satisfactory – in 26%, good – in 31%, and very good – in 14%. The results obtained by high school students were significantly higher: insufficient – 0%, low – 4%, satisfactory – 18%, good – 47%, very good – 31%. It was found that the level of knowledge of high school students on the first aid was significantly higher than among the studied patients (Fig. 2).
Analysis of the knowledge level and sex
In the studied group both male and female patients presented the lower knowledge level than male and female high school students. However, no statistically significant differences were revealed (Fig. 3).
Analysis of the knowledge level
and the place of residence
Among inhabitants of rural areas high school students presented a significantly higher knowledge level than patients, 44% and 30%, respectively. In case of people living in cities with < 100 000 inhabitants very good and good gradings received 82% of high school students and only 39% of patients. Also, in people living in cities with > 100 000 inhabitants this difference marked significantly, 79% and 47%, respectively. Authors concluded that the place of residence significantly differentiated the knowledge level of patients as well as high school students (Fig. 4).
Analysis of the knowledge level and the education level
The highest level of knowledge on the first aid was found in patients with higher education: insufficient – 2%, low – 13%, satisfactory – 23%, good – 44%, and very good – 18%. Among respondents with secondary and vocational education, over 60% did not receive a grade higher than sufficient. In the group of patients with primary or vocational education, the level of knowledge in 29% was assessed as insufficient, when in the group with secondary education this percentage was 15%. A very good result was obtained by 8% of respondents with primary/vocational education and 11% with secondary education. It was found that the level of education significantly differentiated the level of knowledge of patients and high school students (Fig. 5).
Analysis of the knowledge level and age
The knowledge level of the first aid was significantly dependent on the patient’s age. Authors revealed that the higher patient’s age was, the higher rate of persons with insufficient and low levels of knowledge were. Additionally, the percent of persons with good and very good knowledge decreased. One must stress that the percent of good and very good gradings in the age group 20 – 30 years was 84%, 30 – 40 years – 69%, and 40 – 50 years – 57%. Whereas, the insufficient and low levels were observed in 67% of patients aged 70 – 80 years, 37% of patients aged 60 – 70 years, and 42% of patients aged 50 – 60 years. Authors concluded that the age significantly differentiated the level of knowledge of patients and high school students (Fig. 6).
The patient’s knowledge is insufficient to provide premedical first aid and decreases with age. Patients think that they have a lot of knowledge on the basic first aid, but the results from our own study are not satisfactory. Most often, the knowledge was acquired at school, at work or on a driving license course. However, patients were more likely to participate in the first aid course than high school students used as a control group.
In the study on the analysis of the state of knowledge in the field of first aid among pre-school teachers, it showed that respondents in 84% participated in first aid trainings, teachers from Szczecin – in 84%, from Gryfice – in 62%, and patients – only in 60%. Teachers of high schools in West Pomeranian (Szczecin, Gryfice) as well as patients and high school students from their own study unanimously stated that learning the first aid principles was needed (98%, 100%, 97% and 99%) [7, 8].
The drivers from the Lublin province in 92% knew that every citizen is obliged to provide the first aid, whereas the rate in patients group was 82%. Drivers in 68% cases would put an unconscious breathing person in the recovery position, whereas in the patients group the rate was 80%. Considering cardiopulmonary resuscitation, 66% of drivers knew that the ratio of the number of chest compressions to the number of rescue breaths is 30: 2. This was known to 52% of patients .
The study by Latos et al. indicated that the highest level of knowledge occurred in anesthesia nurses with higher education. The obtained results are similar to those presented in that paper. In summary, knowledge about the first aid is dependent on education level .
1. One should strive to change the knowledge transfer system by placing more emphasis on simulation exercises referring to specific situations in everyday life.
2. A higher level of knowledge of high school students may result from including in the curriculum issues related to the premedical first aid. It is necessary to strive to deepen and broaden the knowledge at further educational and professional stages.
3. In middle-aged and active people, the first aid program should be enforced in health and safety trainings.
4. A separate training unit should be formed for the elderly. Similarly to other educational activities for patients in the advanced age, such training would activate this population and would lead to increase in their health safety.
5. Education regarding basic first aid should be adapted to the age of the recipient and widely promoted in the society.
The article was created as a part of the master’s thesis on Nursing at the Faculty of Health Sciences of the Medical University of Warsaw
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Conflict of interest
All authors state that there is no conflict of interest.
Address for correspondence:
Department of Anesthesiology and Intensive Therapy
Teaching, Faculty of Health Sciences,
Warsaw Medical University
Lindleya 4, 02-005 Warszawa
Fig. 1. Sources of knowledge on the first aid among patients and high school students.
Table 1. Distribution of knowledge test results among patients and high school students.
High school students
Fig. 2. Assessment of the knowledge test results among patients and high school students.
Fig. 3. Assessment of knowledge level according to sex.
Fig. 4. Assessment of the knowledge test results according to the place of residence.
Fig. 5. Assessment of the knowledge test results according to the education level
Fig. 6. Assessment of the knowledge test results according to age.