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���������+++++����???8w��?M>hDK!K!K!K!b"b"b"�=�=�=�=�=�=�=$�?�WBB�=-+b"b"b"b"b"�=++K!K!>.(.(.(b"B+K!+K!�=.(b"�=.(.(�6�b7K!����O��I�?�&��6�=>0M>�6��B.(�B(b7b7r�B+�<�b"b".(b"b"b"b"b"�=�=.(b"b"b"M>b"b"b"b"���������������������������������������������������������������������Bb"b"b"b"b"b"b"b"b"�	�:	AWARENESS AND KNOWLEDGE ABOUT BASIC LIFE SUPPORT AMONG DOCTORS IN GOVERNMENT SECTOR, IN CAPITAL CITY OF DELHI

















INTRODUCTION

Poor awareness among medical graduates about basic life support (BLS) is a matter of great concern. The presence of a trained rescuer is the key determinant of ultimate survival from life-threatening emergencies. The most important determinant of survival from sudden cardiac arrest is the presence of a self-motivated trained rescuer ready to perform BLS perfectly. BLS does not require any resources. Proper knowledge, practice, and self-motivation can enable a person to effectively resuscitate a victim. Effective BLS provided immediately after cardiac arrest can increase the chances of survival of cardiac arrest victims (HYPERLINK "file:///D:\\bls%20articles\\ARTICLES%20_%20Advances%20in%20Physiology%20Education.htm" \l "ref-13"1). Doctors, nurses, and paramedics must be able to resuscitate cardiac arrest victim, as they are most likely to face such events. A substantial amount of research has revealed poor awareness of BLS among doctors, interns, medical/dental students, and paramedics (1�6). A study (HYPERLINK "file:///D:\\bls%20articles\\ARTICLES%20_%20Advances%20in%20Physiology%20Education.htm" \l "ref-8"7) has also revealed poor self-perception among faculty about their qualifications in BLS.
 Thus, this study was designed with the aim at finding out the awareness and knowledge about BLS among doctors working in government setup. We conducted a study among doctors of all categories working in government hospitals and dispensaries in capital city of Delhi regarding awareness and knowledge of BLS. It was also an attempt to know if the doctors are aware of recent guidelines of BLS (2015). Resuscitation guidelines are revised every five years and have been revised in November 2015. No study has been done till  date as regards awareness of 2015 guidelines and very few studies  have been done to find out awareness of BLS  in doctors working in government setup.






                                                      Materials and Methods

This descriptive�cross-sectional�study was conducted in a tertiary care government hospital in Delhi. The study was conducted in a questionairre format containing 17 questions pertaining to demographic details, awareness and knowledge about BLS. The protocol was approved by the institutional ethics committee of the institute. Answers were generated using Basic Life Support Manual from American Heart Association, 2015.
One hundred and twenty six doctors working in government setup in capital city Delhi were included in the study. An informed consent was obtained from each participant. The participants not willing to take part in the study were excluded and the ones who participated were assessed according to their responses to the questionnaire.
Results were calculated in percentage format. 











                                                                RESULTS
One hundred and twenty six participants were included in the study and out of these seventy two were males and fifty four were females. All the participants were in the age group 21 to 50 years, their age distribution is described in table 1.
None of our participants had complete knowledge about BLS. Eighty seven point five per cent of the participants knew that BLS stands for basic life support. Thirty four percent of participants knew the correct sequence of steps to be followed in BLS. Eighty five percent of participants knew methods of delivering breaths and ninty two point five percent knew the methods of airway control. Surprisingly, 81.1% of responders knew which pulse is to be checked (carotid), but only 35.5% knew that the pulse check is to repeated after 5 cycles of CPCR. Sixty eight point two percent of the responders knew the correct rate of chest compressions to breath, and 78% knew the correct rate of chest compressions (at least 100 per min), but only 39.5% of the responders knew the correct location of chest compression.  Sixty two point five percent of the participants knew that defibrillator is a part of BLS, but only 37.5% knew that AED stands for automated external defibrillator. Table 2, 3 and 4 
Only eighteen percent of participants were aware about the latest guidelines and only thirty two percent knew that they were revised in 2015.
To our surprise among all our participants 96% of them have actually performed BLS on patients.







                                                  Discussion
As per Medical Council of India guidelines all doctors should have basic knowledge about BLS and ACLS (advanced cardiac life support). In our study not even a single doctor scored 100% marks.  Our study shows that majority of doctors have inadequate and outdated knowledge of BLS. The same was observed by Chandrasekaran et al. [3] and Chaudhary et al. [4] who conducted a study among medical, dental, and nursing students in India. Zaheer et al. [6] studied the awareness of BLS of medical students in Pakistan using a questionnaire only. They concluded a lack of awareness regarding BLS among medical students and suggested that resuscitation skills to become a part of the undergraduate curriculum.�
Chaudhary et al. [4] reported that a simulation-based intervention offered a positively evaluated possibility to enhance skills in recognizing and handling emergencies. Ruesseler et al. [12] also advocated that practicing BLS on mannequins enhanced students' skills in recognizing and handling emergencies. Studies [5,8] have also stressed the importance of reinforcement to attain adequate cardiopulmonary resuscitation (CPR) skills and maintain continued competency in the technique. Moreover, the need for reinforcement is apt due to the revision of guidelines for BLS from time to time [9].�
Zaheer et al. [HYPERLINK "file:///D:\\bls%20articles\\ARTICLES%20_%20Advances%20in%20Physiology%20Education.htm" \l "ref-17"10] also concluded that the inclusion of a BLS course will increase awareness and application of this valuable life-saving maneuver. Therefore, BLS and advanced cardiovascular life support training programs should be mandatory for all medical and paramedical staff. Educating medical undergraduates about BLS may turn out to be an excellent strategy to reach the community at large if students share the acquired knowledge with their families and friends.
A recent study conducted in Pakistan revealed that though the knowledge of trained students was higher than the untrained students; reinforcement and refreshing courses are necessary for better level of answering.[11] Healthcare professionals need to have hands-on practice regularly in order to retain the skills.[12,HYPERLINK "file:///D:\\bls%20articles\\Awareness%20about%20basic%20life%20support%20and%20emergency%20medical%20services%20and%20its%20associated%20factors%20among%20students%20in%20a%20tertiary%20care%20hospital%20in%20South%20India.htm" \l "ref7"13] Abbas�et al.,[14] showed that knowledge of trained student was found to be better than untrained student. The permanent training program in BLS and ACLS resulted in important increment in the level of knowledge of nursing professionals.[15] Another study from Malaysia which studied the knowledge, attitude, and confidence of adult CPR among junior doctors in which about 2/3rd�(68.8%) participants had undergone BLS training showed that junior doctors lacked the much needed confidence when it comes to an actual resuscitation case.[HYPERLINK "file:///D:\\bls%20articles\\Awareness%20about%20basic%20life%20support%20and%20emergency%20medical%20services%20and%20its%20associated%20factors%20among%20students%20in%20a%20tertiary%20care%20hospital%20in%20South%20India.htm" \l "ref10"16] Despite obvious enthusiasm and self-declared adequate knowledge, 45.7% of the audited students were not familiar with the guidelines and answered wrongly to more than 6 of 12 questions in the questionnaire and vast majority of the first year medical students were not familiar with the algorithms.[17]
Only 18% doctors were aware of changes in 2015 guidelines and only 32% doctors were aware that BLS guidelines have been revised in 2015.Till date NO study has analysed the knowledge of doctors regarding 2015 guidelines. As a doctor employed in government hospital in capital city of India it is their duty to be abreast with latest changes and guidelines of resuscitation. We recommend frequent training sessions and their timely validation to make the doctors aware of latest guidelines.  












Table 1. Age distribution
Age groupNumber of participantsMale: Female21-30years4224:1831-40years4830:1841-50years3618:18
Table 2. Awareness of BLS
ParametersNumber of participantsKnows fullform of BLS87.5%Awareness about latest guidelines18%Awareness about in which year they were revised32%
Table 3. Knowledge of BLS (knowledge was evaluated on following parameters)
1.Sequence of steps to be followed in BLS34%2.Breaths-Methods of delivering breaths85%Methods of airway control92.5%3.Pulse-Which pulse is checked during pulse check81.1%Pulse check is done after how many cycles of chest compression & breathing 35.5%4.Chest compression-Ratio of chest compression to breaths68.2%Location of delivery of chest compression39.5%Rate of chest compression78%5.Defibrillator-Is defibrillator part of BLS training62.5%What is defibrillator called in BLS 37.5%
Table 4. Scores
Scores( in percentage)Number of participants0-24%3425-49%5850-74%2875-100%6











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