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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 4  |  Page : 241-244

Assessment of level of knowledge, awareness, and attitude toward “Basic Life Support” and “Cardiopulmonary Resuscitation” among dental students, interns, and dental practitioners


1 Department of Oral Medicine and Radiology, D. Y. Patil Dental School, Pune, Maharashtra, India
2 Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Dental School, Pune, Maharashtra, India
3 Department of Oral and Maxillofacial Surgery, D. Y. Patil Dental School, Pune, Maharashtra, India

Date of Submission29-Oct-2020
Date of Acceptance30-Jan-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Anagha V Shete
Department of Oral Medicine and Radiology, D. Y. Patil Dental School, Lohegaon, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_192_20

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  Abstract 


Background: Being healthcare professionals, the dentists should be aware of the basic and practical aspects of basic life support (BLS) and cardiopulmonary resuscitation (CPR). This study helps assess the knowledge and awareness of dental professionals toward it. Aim: The aim of the study is to assess the level of knowledge, awareness, and attitude toward “BLS” among dental students, interns, and dental practitioners. Materials and Methods: This survey-based study enrolled 70 students from 3rd-year BDS, 70 students from final-year BDS, 80 interns, and 45 dental academicians/practitioners of the dental college. A semi-structured, validated, peer-reviewed questionnaire was used with three sections – demographic data, qualification, and experience; knowledge of participants regarding BLS (26 multiple-choice questions); and awareness and attitude toward BLS (7 close-ended questions). Results: Surprisingly, none of the 265 participants had complete knowledge of BLS and CPR. They lacked in basic knowledge of this important lifesaving protocol. The students and interns also were unaware of basic and applied knowledge of BLS, which shows the necessity of its inclusion in BDS curriculum. Conclusion: The understanding of lack of knowledge and awareness about BLS and CPR is alarming. Its inclusion in curriculum, training, and periodic re-training of dental undergraduates, interns, postgraduates, academicians, and practitioners is necessary.

Keywords: Basic life support, cardiopulmonary resuscitation, dental practitioners, interns


How to cite this article:
Shete AV, Shete MV, Kulkarni TM, Chinte AD, Nerkar A, Kshirsagar K. Assessment of level of knowledge, awareness, and attitude toward “Basic Life Support” and “Cardiopulmonary Resuscitation” among dental students, interns, and dental practitioners. Indian J Dent Sci 2021;13:241-4

How to cite this URL:
Shete AV, Shete MV, Kulkarni TM, Chinte AD, Nerkar A, Kshirsagar K. Assessment of level of knowledge, awareness, and attitude toward “Basic Life Support” and “Cardiopulmonary Resuscitation” among dental students, interns, and dental practitioners. Indian J Dent Sci [serial online] 2021 [cited 2021 Oct 19];13:241-4. Available from: http://www.ijds.in/text.asp?2021/13/4/241/327812




  Introduction Top


Ronald Regan once said, “Failing to prepare is preparing to fail.” This philosophy is true during a medical crisis when minutes can be the difference between life and death. When a patient experiences a respiratory arrest, cardiac arrest, or obstructed airway, one needs to act swiftly and promptly starting with basic life support (BLS) skills. Cardiopulmonary resuscitation (CPR) is a simple lifesaving protocol following a life-threatening medical emergency, invented in 1960. It includes psychomotor skills for performing high-quality CPR, using an automated external defibrillator (AED), and relieving an obstructed airway for patients of all ages.[1] Resuscitation is the art of restoring life or consciousness of one apparently dead. BLS is a level of medical care, which is used for patients with life-threatening illness until the patient can be given full medical care.[2] As per the American Heart Association, CPR should start within 10 s of recognition of cardiac arrest.[3] This awareness has placed a growing demand on medical personnel for expertise in resuscitation. BLS requires nothing as far as resources are concerned and its importance is undeniable. Proper practice of the techniques and maneuvers enables a person to effectively resuscitate a victim. Ideally, everyone should know BLS and CPR, and especially for medical personnel, it should be a prerequisite for entering into this field. All medical, nursing, and paramedical students are expected to know resuscitation. The ability to diagnose and treat a respiratory or cardiac arrest is a basic medical skill that all doctors are generally assumed to possess.

The number of such studies carried out in Maharashtra assessing the knowledge, awareness, and attitude of dental practitioners toward BLS is less. It is important that every member of our community should be trained in effective BLS technique to save lives. At least doctors, including dental practitioners, and medical and paramedical staff, should be trained in high-quality CPR, as it is a basic medical skill, which can save many lives if implemented timely. Dentistry is a specialized branch and has made an immense progress. To ensure better and safer healthcare, it is essential for all dental practitioners to be well versed with BLS.

Aims

(1) To assess the level of knowledge, awareness, and attitude toward “BLS” among dental students, interns, and dental practitioners. (2) To compare the knowledge score and awareness and attitude of BLS and CPR between students, interns, and practitioners.


  Materials and Methods Top


This survey-based study enrolled 70 students from 3rd-year BDS, 70 students from final-year BDS, 80 interns, and 45 dental academicians/practitioners of the dental college. A semi-structured, validated, and peer-reviewed questionnaire was used. Cronbach's alpha analysis was done after face validity to check the reliability and validity of the questionnaire. It was composed of three sections which included: (1) demographic data, qualification, and experience; (2) knowledge of participants regarding BLS (26 multiple-choice questions [MCQs]); and (3) awareness and attitude toward BLS (7 close-ended questions). In the first section, the respondents had to provide information regarding gender, age, and academic level and total years of clinical/academic experience. The second section comprised 26 MCQs prepared from guidelines for CPR 2015 by the American Heart Association and Handbook for BLS by American Red Cross. An answer key was also prepared for the same. Finally, in the third section, the information was obtained about training, previous experience in CPR, opinion about inclusion in the curriculum, etc., The volunteers were also given the opportunity to explain the reasons why they would feel reluctant, hesitant, or less confident in such emergency scenario.

Participation in the survey was completely voluntary. The participants were advised to answer the questions without resorting to literary material or other professionals. They needed to answer all the three sections of the questionnaire. To avoid any malpractice while answering the questionnaire, the participants were asked to fill up the details in front of the investigator; hence, it was supervised. Every precaution was taken to protect the privacy of the research subject and the confidentiality of their personal information. The knowledge score for every participant was calculated, where 26 was the maximum score possible and 0 was the minimum score. The more the score, the better is the knowledge regarding BLS. Approval from the institutional ethics committee was obtained before the study.

Statistical evaluation

The data were entered into Microsoft Office Excel, and analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0, Brand name- IBM SPSS Statistics, License- Trialware/ SasS, Operating system- Windows, macOS, Linux. One-way ANOVA test was used to determine whether there were any statistically significant differences between the means of independent groups. Chi-square test–post hoc test was done to test relationships between categorical variables. The level of significance was taken at a P < 0.05.


  Results Top


Assessment of knowledge score between four groups and comparison of mean were done by one-way ANOVA. P < 0.001 and the results were significant [Table 1]. The mean score was highest in Group 3 followed by Group 2, Group 1, and Group 4. Subgroup comparison of knowledge scores was done by Benferroni post hoc test [Table 2]. When Group 1 was compared with other groups, the difference was significant with Group 3. When Group 2 was compared with other groups, the difference was significant with Group 4. Similarly, the results of Group 3 were significant with Group 1 and 4 and that of Group 4 with Group 2 and Group 3. All questions were also individually assessed to test the exact areas of presence of knowledge and lack of knowledge. Kruskal–Wallis ANOVA test was done for intragroup comparison while Mann–Whitney test was done for intergroup comparison.
Table 1: Assessment of knowledge score between 4 groups and comparison of Mean by One way ANOVA

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Table 2: Comparison of knowledge scores between groups by Bonferroni post hoc test

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Out of all 26, few most important questions are discussed here. To our surprise, only 17.7% of 3rd-year students, 15.9% of final-year students, 15.8% of practitioners, and 30.3% of interns knew the correct order of performing CPR. Mean score was calculated [[Graph 1] - Question 4]. Rate of chest compression in adults and children during CPR was known by only 27.2% of 3rd-year students, 22.1% of final-year students, 20.3% of practitioners, and 30.6% of interns. Mean score was calculated [[Graph 2] - Question 16]. 25.7% of 3rd-year students, 26.8% of final-year students, 26.9% of practitioners, and 26.4% of interns could tell correct technique to maintain airway in victims. Mean score was calculated [[Graph 3] - Question 7]. 27.5% of 3rd-year students, 26.1% of final-year students, 28.6% of practitioners, and 25.4% of interns knew correct compression–ventilation ratio in adults. Mean score was calculated [[Graph 4] - Question 17]. The questions based on clinical judgment and experience were well answered by practitioners as compared to other groups. Mean score was calculated [[Graph 5] - Question 5 and [Graph 6] - Question 24].



Attitude and awareness of all participants was assessed too. 99.1% of the participants felt that it is necessary for dentists and dental auxiliary to have adequate knowledge of BLS and CPR. Only 13.6% of them had previously attended the workshop or lectures related to BLS and CPR. Out of them, many participants had attended it within the last 5 years. 84.1% of them had never performed CPR nor had seen administering it. If a situation demands, 78.1% of the participants would not feel confident in administering CPR; the common reasons being inadequate theoretical knowledge, inadequate or no training offered in UG/PG curriculum, nonupdated knowledge, fear of causing more harm to patient, and general lack of interest. 99.1% of them felt the necessity of inclusion of BLS in the UG and PG curricula.


  Discussion Top


A study by Müller et al.[4] found that medical emergencies are common in dental practice, as about two-third ofthhe dentists faced at least one emergency during the 12-month study period. The combined findings of surveys by Fast et al. and Malamed[5],[6] showed 30,602 emergencies occurring over a 10-year period in the offices of the 4309 dentists reporting. The gravity of these situations justifies the need for every dental practitioner to be at least able to perform the basics of CPR: chest compression and rescue breath.[7] Indeed, during a cardiac arrest, in the absence of CPR, the chances of survival are reduced by 7%–10% every minute after the event begins.[8] Hence, in the United States, BLS training has been recommended for all healthcare professionals since 1966.[9] Different reports have described the knowledge of BLS among dentists in India, but a little research regarding this has been carried out in Maharashtra. Chandrasekaran et al.[10] evaluated the knowledge of BLS among healthcare students and professionals in Tamil Nadu and found that the study participants were severely lacking in BLS knowledge. Another study by Reddy et al.[11] concluded poor knowledge regarding BLS among dental students in dental school of India. A study by Gonzaga et al.[12] found that 86% of the interviewed dentists had received information about CPR; however, most of them had not received practical training for it. Another study by Raghava and Attar Nazir[13] showed poor knowledge of BLS among dental interns in dental college of Mangalore.

The basic knowledge of practitioners tends to fade over the years due to lack of periodic training and retraining. Interns tend to answer the basic questions better as they tend to attend related lectures or workshops. Overall, the knowledge of dental students, faculty, and practitioners remains poor regarding very important lifesaving protocols.


  Conclusion Top


The understanding of lack of knowledge and awareness of dentists about BLS and CPR is alarming. As they belong to the category of healthcare professionals, training and periodic re-training of dental UGs, interns, PGs, academicians, and practitioners for BLS measures, CPR and management of medical emergencies is necessary. In addition, its inclusion in the UG curriculum is extremely essential.

Drawbacks of the study were that practical skills could not be assessed. The survey can also be repeated once BLS and CPR workshop is taken to assess improvement in the knowledge of participants.

Ethical clearance

The study was approved by the Institutional Ethics Committee of D Y Patil Dental School, Lohegaon, Pune. Approval No.- IECDYPDS/A-101

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Supplementary file 1: Questionnaire

Participation in the survey is voluntary.

If you are participating, kindly answer all the questions.

Kindly do not refer to the literature or discuss with other professionals while answering the questions.

Demographic Data/General Information:

Age of the participant:

Gender of the participant:

Academic level: 3rd-year BDS student/4th-year BDS student/intern/staff member

Tick the appropriate answer

Years of clinical/Academic experience: 1–5 years, 5–10 years, 10–15 years, >15 years.

Knowledge of BLS:

  1. What does the abbreviation “BLS” stand for?


  2. (a) Basic Life Support (b) Best Life Services

    (c) Basic Lung Support (d) Basic Life Standards.

  3. 2. What does the abbreviation “CPR” stand for?


  4. (a) Coronary-pulmonary resuscitation

    (b) Cardiopulmonary resuscitation

    (c) Cardiac-pulse resuscitation

    (d) Coronary-pulmonary regurgitation.

  5. 3. What will be your first step when you find an adult person unresponsive on the road? (Note: If you are alone at that place)


  6. (a) Maintain airway (b) Start chest compression

    (c) Ask for help (d) Start giving breathings.

  7. 4. The correct order of performing CPR for adults, children, and infants is - (A - Airway, B - Breathing, C - Chest compressions).


  8. (a) A-B-C (b) C-A-B (c) B-A-C (d) A-C-B.

  9. 5. If an adult person after accident is not responding to you even after shaking and shouting at him/her, what will be your immediate action plan? (Note – If multiple rescuers are present)


  10. (a) Rapid defibrillation

    (b) Immediate recognition of cardiac arrest and activation of emergency response system

    (c) Put him/her in recovery position

    (d) Observe.

  11. 6. If an adult person after accident is not responding to you even after shaking and shouting at him, for how much time you will try to feel for pulse before moving to start chest compressions?


  12. (a) 5–10 s (b) 10–15 s

    (c) 15–20 s (d) any of the above.

  13. 7. The correct technique to maintain airway in such patients (without spine injuries) is:


  14. (a) Sweep finger in mouth (b) Head lift-chin tilt

    (c) Head tilt-chin lift (d) Blows on the back

  15. 8. The correct technique to maintain airway in patients with cervical spine injuries is:


  16. (a) Jaw thrust (b) Head lift-chin tilt

    (c) Head tilt-chin lift (d) Blows on the back.

  17. 9. What is the location for chest compression in adults?


  18. (a) Right side of the chest

    (b) Left side of the chest

    (c) Center of the chest on breastbone

    (d) Anywhere on chest region.

  19. 10. What is the location for chest compression in infants following two-finger technique?


  20. (a) Two-finger in the center of infant's chest just below the nipple line

    (b) Two-finger breadth above the nipple line

    (c) Two fingers at the intermammary line

    (d) Two fingers at xiphisternum.

  21. 11. Technique to give breaths in infants? (Note - Preferred method)


  22. (a) Mouth-to-mouth only

    (b) Mouth-to-mouth and-nose

    (c) Mouth-to-nose only

    (d) Mouth-to-mouth without nose pinched.

  23. 12. Technique to give breaths in infants? (Note - If you are not able to apply preferred method)


  24. (a) Make a mouth-to-mouth seal only

    (b) Use of some instruments.

    (c) Make a mouth-to-nose seal

    (d) None of the above.

  25. 13. What is depth of compression in adults during CPR?


  26. (a) At least 2 inch

    (b) 2½–3 inch

    (c) <2 inch

    (d) According to your comfortable level.

  27. 14. What is depth of compression in children during CPR?


  28. (a) About 2 inch

    (b) 2½–3 inch

    (c) One-fourth to one-half depth of chest

    (d) About 1 inch

  29. 15. Depth of compression in infants during CPR?


  30. (a) More than 1½– 3 inch

    (b) About 1 and 1/2 inch

    (c) About ½–1 cm

    (d) One-half to one-third depth of chest.

  31. 16. Rate of chest compression in adults and children during CPR?


  32. (a) At least 100/min (b) At least 90/min

    (c) At least 80/min (d) At least 70/min

  33. 17. Compression–ventilation ratio in adults is:


  34. (a) 30:1 (b) 15:2 (c) 30:2 (d) 15:1

  35. 18. In a child, chest compression and ventilation ratio is:


  36. (a) 15:2 (b) 5:1 (c) 30:2 (d) 3:1.

  37. 19. Abbreviation AED stands for?


  38. (a) Automated External Defibrillator

    (b) Automated Electrical Defibrillator

    (c) Advanced Electrical Defibrillator

    (d) Advanced External Defibrillator.

  39. 20. What does abbreviation EMS stand for?


  40. (a) Effective Medical Support

    (b) Emergency Management Services

    (c) Emergency Medical Services

    (d) External Medical Services.

  41. 21. If you and your colleague are eating food and suddenly your colleague starts symptoms of choking and is confirmed by taking to him/her, what will be your first response on the spot?


  42. (a) Give back blows (b) Give chest compression

    (c) Give abdominal thrusts (d) Any of the above.

  43. 22. If you and your colleague are eating food and suddenly your colleague starts symptoms of choking and is confirmed by taking to him/her, what will be your first response? (Note - If your colleague is pregnant/obese)


  44. (a) Give abdominal thrusts (b) Give back blows

    (c) Give chest thrusts (d) None of the above.

  45. 23. Have you heard of Heimlich maneuver?


  46. (a) Yes (b) No.

  47. 24. You notice that your patient during dental treatment suddenly develops slurring of speech and weakness of left upper limb. Which one of the following can be done?


  48. (a) May be hypoglycemia, so give him/her some glucose drinks

    (b) Possibly stroke, get him/her to the nearest hospital

    (c) Possibly stroke, he/she may require thrombolysis and hence activate emergency medical services

    (d) May be due to sleep deprivation, let him/her to sleep.

  49. 25. An elderly patient while doing dental procedure experiences retrosternal chest discomfort, profuse sweating, and vomiting. What should be done?


  50. (a) Probably myocardial infarction, hence activate EMS, give an aspirin tablet/nitroglycerine table, and allow him/her to rest

    (b) Probably acid peptic disease, hence give an antacid/H2 blockers

    (c) Probably indigestion, hence give some water or soda

    (d) Take him/her by walk to the nearest hospital.

  51. 26. A pediatric patient suddenly chokes while he/she is under dental treatment, you have confirmed that he/she is unable to cry (or) cough, what will be your immediate response?


  52. (a) Start CPR immediately

    (b) Try to remove the suspected foreign body by blind finger sweeping technique

    (c) Back blows and chest compression of five cycles each then open the mouth and remove foreign body only when it is visible

    (d) Give water to the infant.


Awareness/Attitude toward BLS:

  1. As a healthcare professional, do you feel it is necessary for the dentists/dental auxiliary to have adequate knowledge and training of BLS?


  2. (a) Yes (b) No.

  3. 2. Have you ever attended BLS workshop?


  4. (a) Yes (b) No.

  5. 3. If yes,


  6. (a) Within the last 5 years (b) More than 5 years ago.

  7. 4. Have you ever performed or seen someone performing CPR for a victim?


  8. (a) Yes (b) No.

  9. 5. If a situation demands, would you feel confident in performing CPR?


  10. (a) Yes (b) No.

  11. 6. If No, the reasons are:


  12. A. Inadequate theoretical knowledge

    B. Inadequate/no training offered during undergraduate (UG)/postgraduate (PG) curriculum

    C. Knowledge not updated enough

    D. Fear of causing more harm to the patient

    E. Fear of contracting infections

    F. General lack of interest due to time constraints, etc.

    G. If others, Please specify……….

  13. 7. Do you think BLS training should be a part of UG/UG and PG curriculum?

    (a) Yes (b) No.






 
  References Top

1.
American Red Cross Basic Life Support for Healthcare Providers Handbook. USA: StayWell; 2015.  Back to cited text no. 1
    
2.
Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63-81.  Back to cited text no. 2
    
3.
American Heart Association-BLS for Health care Providers-Students manual. Part one, p-3 accessed on 12/12/2013.  Back to cited text no. 3
    
4.
Müller MP, Hänsel M, Stehr SN, Weber S, Koch T. A state-wide survey of medical emergency management in dental practices: Incidence of emergencies and training experience. Emerg Med J 2008;25:296-300.  Back to cited text no. 4
    
5.
Fast TB, Martin MD, Ellis TM. Emergency preparedness: A survey of dental practitioners. J Am Dent Assoc 1986;112:499-501.  Back to cited text no. 5
    
6.
Malamed SF. Managing medical emergencies. J Am Dent Assoc 1993;124:40-53.  Back to cited text no. 6
    
7.
Laurent F, Augustin P, Nabet C, Ackers S, Zamaroczy D, Maman L. Managing a cardiac arrest: evaluation of final-year predoctoral dental students. J Dent Educ 2009;73:211-7.  Back to cited text no. 7
    
8.
Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005;67:S7-23.  Back to cited text no. 8
    
9.
CPR. Statement by the ad hoc Committee on CPR of the Division of Medical Sciences. National Academy of Sciences. National Research Council. JAMA 1966;198:372-9.  Back to cited text no. 9
    
10.
Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar, Shabbir PM, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian J Anaesth 2010;54:121-6.  Back to cited text no. 10
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11.
Reddy S, Doshi D, Reddy P, Kulkarni S, Reddy S. Awareness of basic life support among staff and students in a dental school. J Contemp Dent Pract 2013;14:511-7.  Back to cited text no. 11
    
12.
Gonzaga HF, Buso L, Jorge MA, Gonzaga LH, Chaves MD, Almeida OP. Evaluation of knowledge and experience of dentists of São Paulo State, Brazil about cardiopulmonary resuscitation. Braz Dent J 2003;14:220-2.  Back to cited text no. 12
    
13.
Raghava S, Attar Nazir R. Adult basic life support (BLS) awareness and knowledge among medical and dental interns. Nitte Univ J Health Sci 2012;2:6-13.  Back to cited text no. 13
    



 
 
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