Fallo e basta!!
Massaggia, massaggia, massaggia e defibrilla il primo possibile.
E’ con estrema soddisfazione che posso tramite questo sito annunciare che il lavoro del “mio” laureando Francesco Adami, laureando in Medicina, e’ stato appena pubblicato sulla’ “Italian Journal of Emergency Medicine”.
Francesco ha seguito circa 300 laureandi in medicina che hanno seguito i miei corsi BLSD all’ UNiversita’ degli Studi di Pisa: li ha monitorati prima del corso, immediatamente dopo il corso e poi a distanza di mesi, per capire quante informazioni essi avessero recepito e compreso, anche a distanza di mesi. Lo ha fatto con questionari diretti e via mail, con cruciverba, puzzles….
I risultati vi saranno chiari dopo ver letto l’articolo appena pubblicato.
La mia idea dunque , che e’ meglio informare 100 persone laiche all’uso del DAE e della RCP pare funzionare. In quelle tre ore avrei potuto formare 5 perfette “macchine da guerra” per la RCP e uso del defibrillatori, oppure informare 300 persone.
Questo deve essere lo scopo di questi corsi: informare sul perché’ si può’ morire, informare sul perché’ si può’ sopravvivere ad un arresto cardiaco, ed informare COME sopravvivere ad un arresto cardiaco.
Non ho inventato niente di nuovo, ma la comunicazione e’ importante, e per poter comunicare efficacemente occorre sapere.
Niente di più’ semplice, niente di più’ difficile.
Bravo Francesco, complimenti.
Clicca su “read More” per visualizzare l’articolo
Informed or Trained: Just Do It.
A Pre-Course Assessment of Principles of Cardiopulmonary Resuscitation (CPR) for Medical Students
Francesco Adami*, Maurizio Cecchini**
* Final year medical student, Faculty of Medicine, University of Pisa, Italy
** Cardiology Consultant, University Emergency Medicine Department, University Hospital of Pisa, Italy
Abstract
Objective. The aim of this study was to examine medical students’ level of theoretical knowledge of principles of cardiopulmonary resuscitation before a CPR course.
Methods. There were 265 medical students (in the second to final academic year), who attended the optional course on CPR and Early Defibrillation. Participants completed a questionnaire, with 15 questions, concerning themes of Early Recognition and Call for Help, Early CPR, and Early Defibrillation. The questionnaire was filled out before the course. We tested the influence of gender, year of academic study, and previous participation in a BLS course.
Results. Medical students (n =265) have shown insufficient knowledge about the contents of the BLS algorithm (median =9, interquartile range =4) in the pre-course questionnaire.
Early CPR tends to be weaker (only 30.6% of students know the correct compression rate, 26.4% know the correct depth, 60.4% know the correct position of hands on the chest, 51.7% know the correct ventilation/compression ratio, 62.3% know the different ventilation methods, and 41.4% know the correct C-A-B sequence).
Students who attended a BLS course had better results on the pre-course questionnaire (median =11, interquartile range =3, p < 0.001, Spearman Rho =0.40). The level of study and gender did not influence the results of the pre-course questionnaire.
Conclusions. Medical students have significant gaps in their understanding of CPR and BLS. A previous parte- cipation in the past in a BLS course demonstrates an improved acquisition of CPR techniques.
Keywords: Basic Life Support (BLS), Automated External Defibrillators (AED), Cardiopulmonary Resuscitation (CPR), CPR Training, CPR Knowledge, CPR Questionnaire.
Introduzione
The survival chain consists of four rings: Early Recognition and Call for Help, Early CPR, Early Defibrillation and Post-Resuscitation Care. The correct execution of these four steps increases the chances of survival for a person suffering from cardiac arrest. Knowledge and efficient execution of the first three steps should be extended to all personnel in the community (not just medical staff), as they can increase patient survival rate.
It is also widely recognized by the community that hospital staff should know CPR principles and perform them with skill [1,2]. In many professions (healthcare and non-healthcare professions), CPR and BLS should be required in the curriculum.
However, medical students are introduced to the principles of resuscitation in school; unfortunately, the theoretical and practical knowledge of BLS and CPR remain optional in the students’ background [3].
Methods and data collection
A questionnaire of 15 questions was used to collect student information regarding knowledge of CPR and BLS. The participants in the questionnaire were medical students (in the second academic year to the sixth academic year) at the University of Pisa, who were enrolled in an elective course on CPR and Early Defibrillation.
The course consisted of two sessions that were held on two consecutive days. Each group consisted of a maximum of 100 students.
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The questionnaires were filled out at the beginning of each session, consisting of 15 closed questions (with four pos- sible alternatives, only one being correct). Each correct answer counted as 1 point, so 15 points was the maximum score. The contents of the questionnaire (and its evaluation) adhered to guidelines of the European Resuscitation Council 2010. The questionnaire was pre-tested to ensure both its content and validity.
Results
We distributed 350 questionnaires to students, with 75.7% (265) completed and returned.
The questionnaire was completed by 48 second-year students, 49 third-year students, 49 fourth-year students, 22 fifth-year students, and 82 sixth-year students (final year). There were 96 (36.2%) males and 169 (63.8%) females. Among participants, 182 (68.7%) had never previously attended a course for either CPR or BLS, while 83 (31.3%) had attended one.
Knowledge of the principles of BLS and Cardiopulmonary Resuscitation
A descriptive analysis of the pre-course questionnaire results showed a median of nine correct answers (Q1 =7, Q3 =13, mean 8.96, SD =2.41), out of a total score of 15.
There was a strong positive correlation between students who had previously attended a BLS course and their test results (Spearman’s Rho 0.40, p <0.01); the median of the group (n =83) for the BLS course was 11 (Q1 =9, Q2 =12, mean 10.36 SD =2.31), while the group (n =182) that never attended a BLS course had a median =8 (Q1 =7, Q2 =10, mean 8.32 SD =2.17), represented in the Box Plots (Picture 1, 2). We found no other significance in the comparisons made between different years of study or gender.
NO Previous Course Attended Group (Picture 1)
Figure 1.
Mean Line
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Figure 2.
Assessment of Early Recognition and Call for Help
The first ring in the survival chain concerns Early Recognition and Call for Help, with 77.7% of students calling for a ground check (regarding safety of the scenario), and 70.9% of them knowing whether a patient was unconscious or unable to breathe (or having abnormal breathing). In this case, emergency services were called, and they identi- fied the correct emergency telephone number (99.2%), and the sequence of links in the chain of rescue (Picture 3).
Assessment of Early CPR
After the Early Recognition and Call for Help, a group of questions evaluated the Early CPR ring. There were 72.5% of students correctly placing the victim on the ground in the supine position with the chest exposed, while 60.4% of them correctly placed their hands on the chest; however, only 30.6% knew the correct compression rate, and only 26.4% knew the correct compression depth. The ratio of compressions/ventilations was known by 51.7% of students, as well as different ways of ventilation to help a patient on the ground (including the ability to perform hands-only CPR): this was understood by 62.3% of students, with 43.4% knowing the proper sequence of compression-opening techniques in the airway (see Picture 3).
Assessment of the Early Defibrillation
This is a group of questions that have not been thoroughly explored, although 63.8% of the students correctly knew the acronym AED; it is interesting that 35.8% of them did not ask about being at the scene, or ask for automated external defibrillators (AEDs) and only 32,5% knew the right paddle defibrillator placement (see Picture 3).
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Previous CPR Course Attended Group (Picture 2)
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Figure 3.
Discussion/Recommendations
In the introduction, we argued that all healthcare workers should have a solid knowledge of CPR, but this study reports how that is insufficient for a medical student’s understanding of CPR (median 9, Q1 =7, Q3 =11 in the pre-course questionnaire).
Given the data, we demonstrated the correct approach to an unconscious patient: in the absence of breathing (or abnormal breathing) on the ground, we also found how more than 70% of all answers about Early Recognition and the Call for Help ring were correct; this is a fundamental step to start the chain of survival. However, we also noted that the demand for an AED was not part of the emergency call (only 35.8% required it on the scene) [4,5]. Other areas of the survival chain, more specifically those of Early CPR and Early Defibrillation (although the latter was less analyzed in this study) show an insufficient knowledge of the BLS algorithm before the course. It is preci- sely in these two areas, which are the heart of the survival chain, that the attendance course makes a difference. This allows us not only to suggest solutions, such as the inclusion of additional theoretical and practical courses on CPR and Early Defibrillation in the core curriculum for medical students, but to plan frequent retraining sessions and information sessions [6,7].
Limitations
In the study, we poorly evaluated the chain’s ring in terms of Early Defibrillation. In addition, we have not fully analyzed previous CPR training, or the length of time it took to learn.
Another limitation of this study is not having data from CPR performed on the ground, in order to yield a more comprehensive look at this research topic [8].
Regarding the sample group of students, we did not have the opportunity to study those enrolled in the first aca- demic year.
These students, however, gave us the opportunity to evaluate their knowledge (from the second academic year to the sixth academic year); however, we cannot yet determine if these results are transferable to students in other health professions.
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Conclusions
The study had one purpose: to assess medical students’ knowledge of CPR before a BLS course.
The results demonstrated that BLS and CPR knowledge before the course is insufficient, in particular the gap is in the knowledge about Early CPR and Early Defibrillation, fundamental pillars in the chain of survival.
This study also confirmed significantly better performance in the pre-course test of those who had experience with a BLS course vs. those who never took it.
In conclusion, we see how a BLS course or a correct information about CPR principles can improve these skills, especially in the theoretical knowledge of the chain of survival.
References
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- Kozlowski D et al. The knowledge of public access to defibrillation in selected cities in Poland. Arch Med Sci 2013; 9(1): 27-33.
- Freund Y et al. Self-perception of knowledge and confidence in performing basic life support among medical stu- dents. Eur J Emerg Med 2013; 20(3): 193-6.
- Jordan T, Bradley P. A survey of basic life support training in various undergraduate health care professions. Resus- citation 2000; 47(3): 321-3.
- Perkins GD et al. Basic life support training for health care students. Resuscitation 1999; 41(1): 19-23.
- Chandrasekaran S et al. Awareness of basic life support among medical, dental, nursing students and doctors.Indian J Anaesth 2010; 54(2): 121-6.
- Secher N et al. Direct mail improves knowledge of basic life support guidelines in general practice: a randomisedstudy. Scand J Trauma Resusc Emerg Med 2012; 20: 72.
- Ruesseler M et al. Simulation training improves ability to manage medical emergencies. Emerg Med J 2010; 27(10):734-8.
