Elsevier

Resuscitation

Volume 51, Issue 3, December 2001, Pages 239-246
Resuscitation

Community attitudes towards performing cardiopulmonary resuscitation in Western Australia

https://doi.org/10.1016/S0300-9572(01)00411-7Get rights and content

Abstract

Objective: to determine the attitudes of the Western Australian community towards performing cardiopulmonary resuscitation, and the factors affecting these attitudes. Methods: telephone survey of a randomly selected sample of people from suburban Perth and rural Western Australia; practical assessment of a sub-sample of volunteers from those surveyed, to correlate survey answers with practical skills. Results: of 803 people surveyed, the majority (90.7%) definitely would give mouth-to-mouth ventilation to a friend or relative, but less than half (47.2%) would to a stranger. The reluctance was mostly (56%) because of health and safety concerns, particularly related to HIV infection. Higher percentages of people would definitely provide cardiac massage for a friend or relative (91.4%) or stranger (78.1%). People were more likely to give mouth-to-mouth and cardiac massage if they had been trained in cardiopulmonary resuscitation (CPR), trained several times, trained recently, and used their CPR skills in real life. There were no significant differences between city and country people in whether they would provide CPR, but older people were less willing to provide mouth-to-mouth or cardiac massage. On practical assessment of 100 volunteers, there were significant errors and omissions in airway assessment, mouth-to-mouth resuscitation and cardiac massage. Volunteers with better practical scores were more prepared to provide CPR. Discussion: our results indicate a significant reluctance of the Western Australia public to perform mouth-to-mouth, except to a friend or relative. Earlier CPR training, practice and use seemed to diminish this reluctance. Practical CPR skills were not well executed. Those with better skills were less reluctant to use them. We recommend increasing CPR training in the community, greater frequency of refresher courses and public education on the risks of CPR to improve rates of bystander CPR.

Introduction

Cardiopulmonary resuscitation (CPR) has been widely taught to lay communities since the American Heart Association endorsed CPR training for the public [1]. However, as little as 30% or less of out-of-hospital arrests have CPR initiated by lay bystanders [2]. Little research has been done on attitudes to performing CPR in this situation. A small number of studies have shown that attitudes towards and willingness to perform CPR, particularly mouth-to-mouth ventilation, vary widely between different populations. Shibata et al. for example showed that very few Japanese (from 2 to 3% of high school students, teachers and nurses, to 26% of emergency medical technicians) would definitely perform mouth-to-mouth ventilation on a stranger if faced with the situation [3]. In contrast Axelsson et al. showed that trained Swedish lay people were much more likely to perform CPR despite over 90% being concerned about the risk of disease transmission [4]. Only 17% of those surveyed would not start CPR on a young drug addict and 7% on an unkempt man.

There is some evidence that the low incidence of out-of-hospital CPR by lay bystanders may be the result of fear of infectious disease transmission by mouth-to-mouth ventilation [5], although this evidence has been described as unconvincing [6]. This, along with doubts about the added benefit of mouth-to-mouth ventilation over cardiac massage alone, has led to the recommendation that clinical trials be undertaken to determine whether mouth-to-mouth is really necessary in CPR [5].

For the community to derive significant benefit from large scale teaching of CPR, people must be prepared to use their skills in emergency situations. We were interested in the attitudes of the lay public in Western Australia to performing CPR, whether the community was likely to use acquired skills in an emergency, and what factors may have influenced such a decision.

Section snippets

Subjects

Subjects were selected using a stratified random sample approach. There were eight strata consisting of males and females by urban and rural place of residence. The response rate for the telephone survey was 55%, giving a total of 803 responses. This was a favourably high rate as response rates of only 30–40% have been achieved in earlier health telephone interviews.

Theoretical knowledge

A questionnaire was designed to assess theoretical knowledge. All interview staff were instructed in obtaining appropriate

CPR training

The total number of survey participants was 803; 100 also completed the practical assessment (51 female and 49 male). The gender distribution of respondents to the survey was even with 49.9% female and 50.1% male participants. There was a similar distribution of female and male participants in rural (49.4 and 50.1%) and urban (50.1 and 49.9%) areas.

Of the 803 participants in the survey, 515 (64.1%) had received CPR training (that is mouth-to-mouth ventilation and cardiac massage) at least once.

Discussion

The penetrance of CPR training into the community in Western Australia is relatively high. Around two-thirds of adults have been trained in CPR, two thirds of these more than once, and a third have completed a senior first aid certificate. There are, however, several disturbing findings in our results. Despite the high level of training in the community, there was a reluctance to perform important, potentially life-saving procedures, particularly mouth-to-mouth ventilation. The vast majority of

Acknowledgements

The authors would like to thank those taking part in the survey, particularly those who volunteered to have their practical skills assessed. This study was funded by the Australian Rotary Health Research Fund.

Portuguese Abstract and Keywords

Objectivo: Determinar a atitude da comunidade da Western Australia face ao SBV e factores que influenciam essa atitude. Método: Inquérito por telefone a uma amostra seleccionada de forma randomizada de pessoas provenientes de uma zona suburbana de Perth e rural de Western Australia; avaliação prática de uma sub-amostra de voluntários daqueles questionados, para correlacionar as questões com as capacidades práticas. Resultados: Das 803 pessoas inquiridas, a

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    In order to increase the number of individuals among the public trained in CPR, introducing CPR training into schools has been widely recommended as a long-term strategy to educate the wider community. However, the ultimate aim of any basic life support (BLS) training course is not just to equip the health care providers (Brenner et al., 1997; Jelinek et al., 2001; Shibata et al., 2000) and lay rescuers (Johnston et al., 2003; Shibata et al., 2000) with the knowledge and skills to perform CPR, but to actually have people who are willing to perform bystander CPR in real emergency situations (Jelinek et al., 2001; Spooner et al., 2007). Having people with positive attitudes toward bystander CPR so reducing time lost by hesitation to initiate bystander CPR in real emergency situations is significantly important because the time taken from the activation of the emergency medical services to the time when they arrive at the scene is longer than the critical first 5 min (Eisenberg et al., 1990).

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Portuguese Abstract and Keywords

Objectivo: Determinar a atitude da comunidade da Western Australia face ao SBV e factores que influenciam essa atitude. Método: Inquérito por telefone a uma amostra seleccionada de forma randomizada de pessoas provenientes de uma zona suburbana de Perth e rural de Western Australia; avaliação prática de uma sub-amostra de voluntários daqueles questionados, para correlacionar as questões com as capacidades práticas. Resultados: Das 803 pessoas inquiridas, a maioria (90.7%) realizaria ventilação boca-a-boca a um amigo ou familiar, mas menos de metade (47.2%) a realizaria a um estranho. A relutância é devida principalmente (56%) a preocupações com a segurança e a saúde, particularmente relacionadas com a infecção HIV. Uma percentagem mais elevada de indivı́duos realizaria massagem cardı́aca a um amigo ou familiar (91.4%) ou estranho (78.1%). As pessoas que mais fácilmente realizariam ventilação boca-a-boca e massagem cardı́aca são aquelas que estão treinadas SBV, treinadas várias vezes, treinadas recentemente e que usaram as suas competências na vida real. Não havia diferenças significativas entre pessoas da cidade e do campo relativamente à questão de realizarem SBV, mas as pessoas mais idosas tinham menos vontade de realizar ventilação boca-a-boca ou massagem cardı́aca. Na avaliação prática de 100 voluntários, foram detectados erros significativos e omissões na avaliação da via aérea, reanimação boca-a-boca e compressão cardı́aca externa. Os voluntários com melhor desempenho prático estavam melhor preparados para fazer SBV. Discussão: Os resultados dos autores revelam que existe uma relutância significativa do público da Western Australia em realizar ventilação boca-a-boca excepto se se tratar de um familiar ou amigo. O treino precoce em SBV e a sua prática parecem diminuir esta relutância. As competências práticas em SBV não foram bem executadas. Aqueles que têm melhores competências foram menos relutantes em as usar. Recomendamos que o treino de SBV na comunidade seja incrementado, que existam cursos de actualização com maior frequência e educação do público sobre os riscos relacionados com o SBV, de forma a melhorar as taxas de SBV realizadas por quem presencia a paragem.

Palavras chave: Compressão cardı́aca externa; Reanimação Cardio-pulmonar (RCP); Educação para a RCP; Ventilação boca-a-boca

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