KNOWLEDGE OF BASIC LIFE SUPPORT AMONG FINAL YEAR DENTAL STUDENTS OF BPKIHS

1* 2 3 3 Anjani Kumar Yadav , Mehul Rajesh Jaisani , Ashok Dongol , Pradeep Acharya Received : 12 Dec., 2020 Accepted : 06 Sep., 2021 Published : 04 Nov. 2021 1432 ISSN: 2542-2758 (Print) 2542-2804 (Online) Birat Journal of Health Sciences Vol.6/No.2/Issue 15/May-Aug., 2021 Original Research Ar cle INTRODUCTION Basic Life Support (BLS) includes iden fica on of signs of sudden cardiac arrest, heart a ack and stroke; early ins tu on of cardiopulmonary resuscita on (CPR) and rapid 1 defibrilla on with an automated external defibrilator. Cardiopulmonary resuscita on is a lifesaving process that improves the survival rates of the pa ents that suffer from 2 cardiac arrest. Similarly, the survival rate a er cardiac arrest is further improved by early ins tu on of good quality CPR and early defibrilla on. The survival rate a er cardiac arrest was found to be 67% if all the interven ons were done immediately a er collapse, but the chances of survival decline by 5.5% for every minute delay in CPR, defibrilla on 3 and defini ve care. Immediate recogni on and ac va on, early CPR, and rapid defibrilla on (when appropriate) are the first three BLS links in the adult Chain of Survival but iden fica on of cardiac arrest is not straight forward and any confusion from rescuer part can result in delay in ins tu on of CPR and thus the precious me is lost that 4 might decrease the chances of survival. All the health care professionals including doctors, nurses and paramedical persons should know how to perform BLS as they encounter such situa on very o en. The students of each and every health science college are the building block of future health care system of any country and hence their knowledge of BLS is crucial. Lack of structured training has been iden fied 5 as the main reason of poor knowledge about BLS. Similarly, BDS (Bachelor of Dental Surgery) students of B. P. Koirala Ins tute of Health Science (BPKIHS) immediately a er passing the final year exam are posted in various district/zonal hospital during their internship and they may encounter a situa on where they have to perform this life saving procedures and they cannot escape just because they are dental doctors. It has been reported that there have been poor training and low level of confidence among 6,7 undergraduate students even in France and UK. No such report has been found in dental undergraduate students in Nepal. The ra onale of this study was to assess the level of knowledge about BLS among dental (BDS) final year students of BPKIHS to gather informa on for the effec ve organiza on of training of BLS before entering internship.


Introduc on
The chance of survival of a vic m a er cardiac arrest/ foreign-body airway obstruc on is doubled by early ins tu on of Basic Life Support (BLS). Besides medical doctors, dental doctors might also encounter the pa ents in emergency situa on requiring BLS, especially during peripheral district teaching hospital pos ng in internship.

Objec ves
The objec ve of this study was to assess the level of knowledge about BLS among final year dental students of BPKIHS.

Methodology
In this cross-sec onal study, structured ques onnaires were distributed to BDS final year students (purposive sampling, sample size = 53). Each ques on responded correctly was awarded as point +1 and total points were calculated by adding all the correct answers. The collected data were entered in Microso excel 2010 and descrip ve analysis was done by SPSS 16.

Result
Out of 53 ques onnaires distributed, 49 were responded and returned (response rate= 92.45%). Twenty par cipants were male and twenty-nine were female. Four par cipants had taken BLS training in the past. Only twenty par cipants scored ≥ 50% and none of the par cipant scored ≥75%. Only one ques on was responded correctly by 100% par cipants. Ten ques ons were responded correctly by ≥50% par cipants. Although 65.3% par cipants were aware about high quality CPR, only 49% knew the exact loca on of chest compression. The chest compression to ven la on ra o for each of single rescuer and two rescuers was known by 20 par cipants (40.8%) and 28 par cipants (57.1%) respec vely.

INTRODUCTION
Basic Life Support (BLS) includes iden fica on of signs of sudden cardiac arrest, heart a ack and stroke; early ins tu on of cardiopulmonary resuscita on (CPR) and rapid 1 defibrilla on with an automated external defibrilator. Cardiopulmonary resuscita on is a lifesaving process that improves the survival rates of the pa ents that suffer from 2 cardiac arrest. Similarly, the survival rate a er cardiac arrest is further improved by early ins tu on of good quality CPR and early defibrilla on. The survival rate a er cardiac arrest was found to be 67% if all the interven ons were done immediately a er collapse, but the chances of survival decline by 5.5% for every minute delay in CPR, defibrilla on 3 and defini ve care. Immediate recogni on and ac va on, early CPR, and rapid defibrilla on (when appropriate) are the first three BLS links in the adult Chain of Survival but iden fica on of cardiac arrest is not straight forward and any confusion from rescuer part can result in delay in ins tu on of CPR and thus the precious me is lost that 4 might decrease the chances of survival. All the health care professionals including doctors, nurses and paramedical persons should know how to perform BLS as they encounter such situa on very o en. The students of each and every health science college are the building block of future health care system of any country and hence their knowledge of BLS is crucial. Lack of structured training has been iden fied 5 as the main reason of poor knowledge about BLS. Similarly, BDS (Bachelor of Dental Surgery) students of B. P. Koirala Ins tute of Health Science (BPKIHS) immediately a er passing the final year exam are posted in various district/zonal hospital during their internship and they may encounter a situa on where they have to perform this life saving procedures and they cannot escape just because they are dental doctors. It has been reported that there have been poor training and low level of confidence among 6,7 undergraduate students even in France and UK. No such report has been found in dental undergraduate students in Nepal. The ra onale of this study was to assess the level of knowledge about BLS among dental (BDS) final year students of BPKIHS to gather informa on for the effec ve organiza on of training of BLS before entering internship.

METHODOLOGY
It was a ques onnaire based cross-sec onal study conducted among the final year dental students of BPKIHS. All the students of BDS final year (2014 batch) giving consent to par cipate in the study were included. Ethical clearance was taken from the Ins tu onal Review Commi ee (IRC) of BPKIHS. Procedures of the research were explained to the par cipants and informed wri en consent was taken from each par cipant. A list of BDS final year students was compiled from the a endance register of BPKIHS (purposive sampling, sample size = 53). Structured ques onnaires were delivered to all on the list by hand on 20/03/2019, one month before appearing the final exam assuming that the students had gained the op mum knowledge at that me. The ques onnaires contained twenty six mul ple choice ques ons and were designed to collect data about age, sex, BLS training in the past and knowledge about BLS. Most of the ques onnaires were returned on the same day of distribu on and for those who did not return, a reminder message was send to each of them via mobile on the fi h day a er distribu on. The ques onnaires were collected over a period of one week and the collected ques onnaires were analyzed. Each ques on responded correctly was awarded as point +1 and total points were calculated by adding all the correct answers. The collected data were entered in Microso excel 2010 and descrip ve analysis was done by SPSS 16. The scores were categorized as very poor (<30%), poor (30-45%), average (46-55%), good (56-65%), 8 very good (66-75%) and excellent (>75%).

RESULTS
Out of fi y three ques onnaires distributed, forty nine were returned to the inves gator and the thus the response rate from the par cipants was 92.45%. Out of 49 par cipants, only 4 (8.2%) par cipants had taken BLS training in the past (Figure 1). The correct response to each ques on is shown in Table 1. Only one ques on (full form of BLS) was responded correctly by 100% par cipants while only three par cipants (6.1%) knew the full form of AED. Ten ques ons were responded correctly by 50% or more par cipants and three ques ons were responded correctly by less than 10% par cipant. Only thirty percent (30.6 %) of the par cipant knew that EMS should be ac vated immediately a er confirma on of unresponsiveness and only six percent were aware that CPR is not aimed to restart the heart. Although Yadav AK et al

DISCUSSION
The aim of Basic life support training is to immediately iden fy the vic ms of cardiac arrest and foreign body airway obstruc on and manage with cardiopulmonar y resuscita on and defibrilla on as early support of ven la on and circula on restores the blood and oxygen supply to vital organs and prevent from being damaged 9 permanently. The theore cal knowledge and prac cal skills of BLS are the main determinant for the successful 8 execu on of CPR in emergency situa on. The procedures of BLS are simple but systema c and it should be known to every layman. Developed countries have already recommended BLS training even for high school students 10 nearly a decade ago. However; it has not been made easily available even for the medical and paramedical persons in Nepal ll date. Many medical/dental and paramedical students might not learn even the basic knowledge of this essen al and life-saving procedures in class with hands-on prac ce during their undergraduate study period and they remain incompetent to perform CPR even a er gradua on. The situa on is same in dental students of BPKIHS but they are expected to perform CPR from the very first day of their internship as they are posted in peripheral district teaching hospital. Similarly, low confidence among medical students 11 in performing CPR has also been reported from Europe. The present study also revealed that the par cipants have inadequate knowledge on BLS. None of the par cipants has scored even 70% and only one ques on (full form of BLS) was responded correctly by all par cipants. Only twenty par cipants scored 50% or more. Ten ques ons were responded correctly by 50% or more par cipants. Although there is a study in which par cipants who have received training in class have fairly higher score of knowledge regarding BLS as compared to non-trained, all four par cipants in the present study who had taken BLS training in the past had 8 scored less than 50%. As per a study conducted by Cooper S et al, those a ending immediate life support had a significantly higher knowledge score in beginning of the course as compared to the group a ending BLS course that indicates that the preparatory course manual had been beneficial. Knowledge did not decline as much as the skill did a er six month of training; however, it remained higher 12 than pre-course level. Further, before conduc ng a BLS training, the level of self-confidence among the students regarding management of cardiac arrest need to be assessed as the self-percep on of qualifica on in BLS is 11 found to be poor. Thus, It is essen al to standardize training in BLS to make it more reten ve and mandatory component students. This study also has limita ons as it is based on a ques onnaire which serves as an indicator of purely theore cal knowledge as the theore cal knowledge does not necessarily indicate that the par cipants can perform well in during CPR in real world. Although a theore cal test cannot replace a prac cal test for the assessment of an individual, it is a viable alterna ve as a tool to es mate and compare the efficacy of psychomotor skills, especially in 14 group training programs.

CONCLUSION
Knowledge of BLS is poor among the BDS final year students. Even the knowledge of par cipants who had taken BLS training in the past ranged from poor to average.

RECOMMENDATION
Mul Centre study should be conducted to assess the knowledge of BLS among the BDS final year students of Nepal.

LIMITATION OF THE STUDY
Being a single Centre study findings of this study cannot be generalized to all the BDS final year students.