Assessment of Awareness on Basic Life Support among Healthcare Workers in a Tertiary Care Teaching Hospital in Northern Region of India: a Cross-Sectional Study

Assessment of Awareness on Basic Life Support among Healthcare Workers in a Tertiary Care Teaching Hospital in Northern Region of India: a Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Awareness on Basic Life Support among Healthcare Workers in a Tertiary Care Teaching Hospital in Northern Region of India: a Cross-Sectional Study Himadri Mamgain, Omkarnath Sivarchaka, Sundar Lal Jethani, Vaibhav Badoni This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5614239/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Aug, 2025 Read the published version in Discover Public Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background Basic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population. Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Hence it is crucial for healthcare workers (HCW) to have substantial knowledge and awareness of BLS to help patients when they need it the most. This study aimed to assess the awareness on BLS among HCWs in a tertiary care teaching hospital. Methods A cross-sectional study was conducted among HCWs in a tertiary care teaching hospital. A self-administered questionnaire was developed to assess knowledge on key BLS components, including cardiopulmonary resuscitation (CPR) techniques, use of an automated external defibrillator (AED), and the chain of survival. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 206 responders, 60 were doctors, 122 were nursing staff and 24 were technicians. None of the responders have complete knowledge of basic life support, 58.8% mean percentage of knowledge. There was a significant difference in BLS knowledge between different professional groups, with doctors scoring higher than nurses and paramedics (p < 0.001). Conclusion Even though healthcare professionals receive BLS training at a high rate, there remains a knowledge and retention gap in BLS abilities. Regular skills practice and updated training is recommended to enhance BLS proficiency. Automated External Defibrillator Cardiopulmonary Resuscitation Healthcare Worker Ischemic Heart Disease Medical Emergency Mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Basic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population. 1 Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Cardiovascular diseases (CVD) remain a leading cause of mortality worldwide. As of the most recent data, ischemic heart disease is the primary cause of CVD mortality globally, with an age-standardized rate of 108.8 deaths per 100,000 people. Following closely are conditions like Intra-Cerebral Hemorrhage and Ischemic Stroke. High systolic blood pressure is a significant contributor to CVD-related disability-adjusted life years (DALYs), accounting for 2,564.9 per 100,000 globally. 2 India has seen a rise in CVD incidence, with ischemic heart disease and stroke being major contributors. The age-standardized CVD mortality rate and DALYs continue to highlight the urgent need for effective public health strategies and interventions to manage and reduce the burden of these diseases. Based on 2021 data, ischemic heart disease significantly impacts health in India. It contributes to a high number of DALYs, with almost 2900 years of healthy life lost per 100,000 people due to disability caused by this condition. While tertiary care teaching hospitals manage critically ill patients and their healthcare workers (HCWs) are on the frontline of emergency response, BLS knowledge extends beyond these settings. Early intervention by bystanders with CPR and AEDs is crucial for improving Outside Hospital Cardiac Arrest (OHCA) survival rates. HCWs with a strong foundation in BLS can not only initiate life-saving interventions in the hospital but also serve as educators and advocates for bystander CPR training in the community. Hence it is crucial for healthcare workers to have substantial knowledge of BLS to help patients when they need it the most. 2 Healthcare workers should be aware of cardiopulmonary resuscitation (CPR), competence in operating automated defibrillators (AED), and the ability to address airway obstructions caused by foreign bodies. In addition, it includes the first assessment, rescue breathing methods such mouth-to-mouth ventilation, chest compressions, and airway management. 3 Studies show that healthcare workers knowledge and competence levels vary even though BLS is widely accepted as being important 34 . Furthermore, there may be gaps in knowledge regarding specific CPR techniques and proper use of AED, which can potentially delay effective response during emergencies. Several barriers to effective BLS training were identified in previous studies, including limited access to training programs, time constraints, and lack of institutional support. Additionally, HCWs may experience a decline in BLS skills and knowledge over time if they do not regularly practice these skills. Therefore, ongoing education and practical training are essential to maintain a high level of readiness among HCWs. 4 This study aimed to assess BLS knowledge among healthcare workers in a tertiary care teaching hospital to identify gaps, evaluate training effectiveness, and highlight areas for improvement. Methodology Study Design and Participants A cross-sectional observational study conducted at Tertiary Care Teaching Hospital of North India. The study period was from May, 2024 to September, 2024. The sample size was calculated based on the proportion of healthcare workers (HCWs) aware of Basic Life Support (BLS), assuming a prevalence (P %) of 50%, an error margin of 10%, and a confidence interval (CI) of 99%. Using these parameters, the required sample size was determined to be 170 participants. However, to ensure adequate representation across different categories, the sample size was increased to 200 participants. This included 60 doctors, 120 nurses, and 20 technicians. Ethical clearance was obtained from the hospital’s ethics committee (Ethical Approval No: HIMS/E-1/2024/77). Prior to the involvement in the study, written informed consent was obtained from all participants. Inclusion & Exclusion Criteria The study included those Healthcare workers (doctors, nurses, and paramedics) employed at the hospital for at least six months and who provided written informed consent. Exclusion criteria encompassed healthcare workers on leave during the study period, participants who never had experienced BLS training, incomplete or partially filled forms and individuals who did not consent to participate. Out of 250 healthcare workers approached, 206 were included in the study, and 44 were excluded based on the exclusion criteria. Study tool The modified study tool consisted of a structured pre-validated close ended questionnaire with three sections will be used as a study tool for this study. Section 1 includes the informed consent form, while Section 2 comprises the socio-demographic profile. Section 3 is dedicated to questions related to knowledge of Basic Life Support (BLS) questions, totaling 25 in number. The tool was designed on a basis of review of existing literature and in accordance with the latest American Heart Association (AHA) guidelines for Basic Life Support (BLS). The questionnaire underwent expert panel review, comprising three senior clinicians and two BLS trainers, to ensure content validity. Additionally, pilot testing was conducted with 15 healthcare workers to evaluate clarity, reliability, and consistency before the final survey was administered. The socio-demographic section gathered essential information about the participants, including: age, gender, profession, experience and BLS Training History. The knowledge section evaluated participants' BLS knowledge through multiple-choice questions, grouped into categories: Chest compressions, Rescue breathing, AED usage, and Choking management. Each knowledge-related question was scored on a dichotomous scale, where the correct answer was awarded one point and incorrect answers received zero. This ensured that the total score for each question was one. Hence, each domain was assigned a maximum possible score of 20. Individual knowledge scores were calculated based on this and categorized into three levels: (i) Poor Knowledge: Total scores ranging from 0 to 8. (ii) Average Knowledge: Total scores ranging from 9 to 13. (iii) Good Knowledge: Total scores ranging from 14 to 20. Data Collection A 'universal sampling technique was used to collect the data as all eligible participants were included from the hospital's workforce, including doctors, nurses and paramedics. Questionnaire was explained to the participants before collecting the data. Each participant was informed about the importance of the research, the procedures involved, and how the data would be used. Printed questionnaires were distributed to participants, taking approximately 15 minutes to complete. Statistical Analysis Data were entered into IBM SPSS Statistics for Windows, version 20 for analysis. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were used to summarize demographic data. Inferential statistics were applied for categorical variables, such as Chi-square tests and the Kolmogorov–Smirnov test was used to assess the normality of the data distribution. Since the data did not follow a normal distribution, when comparing more than two groups, the Kruskal–Wallis test was applied and the Mann–Whitney U test was used for comparing the scores between two groups. Statistical significance was considered when the p-value was less than <0.05. Additionally, Multivariate logistic regression was performed to analyze the factors associated with adequate BLS knowledge, providing insights into the influence of various demographic and training-related variables on the outcomes. Results The demographic profile of the participants showcases a varied composition across different categories. A significant portion of respondents falls within the age range of 25-35 years (52%), followed by those aged 35-45 years (41%), with a smaller percentage of participants aged 45 and above (7%). The gender distribution reveals a higher number of females (55%) compared to males (45%). Regarding occupation, nurses constitute the largest group at 59%, while doctors and paramedics account for 29% and 12%, respectively. Furthermore, more than half of the participants graduated within the past five years (53%), and a notable majority received their training through internal programs (67%) instead of from the American Heart Association (AHA) (33%). [Table 1] Table 1: Socio-demographic characteristics of Participants Characteristics Frequency Percentage Age 25-35 108 52% 35-45 84 41% 45 or older 14 7% Gender Female 114 55% Male 92 45% Occupation Doctor 60 29% Nurse 122 59% Paramedic 24 12% Years of Experience Less than 5 years 110 53% More than 5 years 96 47% Source of training AHA 68 33% Hospital designed internal training 138 67% *AHA: American Heart Association The overall definitive knowledge of Basic Life Support (BLS) among healthcare workers stands at about 58.8%. Doctors had the highest knowledge at 68%, while nurses scored 56%, reflecting a good understanding of essential concepts. Paramedics showed the lowest knowledge at 42%, highlighting the need for additional training. Participants generally performed well on key questions, with 82% correctly identifying the compression-to-ventilation ratio and 84% recognizing the meaning of AED, although only 23% accurately responded regarding the recommended chest compression rate. [Figure 1-5] The combined results from the Mann-Whitney U Test and the Kruskal-Wallis Test highlight significant differences in Basic Life Support (BLS) knowledge among healthcare professionals. In the Mann-Whitney U Test, doctors demonstrated a higher mean rank (122.71) compared to nurses (76.15) and paramedics (12.92), with U statistics indicating significant differences (U = 1721.500, p = 0.000 for doctors vs. nurses; U = 5.000, p = 0.000 for doctors vs. paramedics; U = 287.500, p = 0.000 for nurses vs. paramedics). The Kruskal-Wallis Test confirmed these findings, with an overall Chi-Square of 78.95 (df = 2, p = 0.000) indicating significant differences in knowledge levels among doctors, nurses, and paramedics across a total of 206 participants. [Table 3] Table 3: Comparison of Basic Life Support Knowledge Among Healthcare Professionals Test Comparison N Mean Rank U Statistic Asymptotic Sig. (p-value) Mann-Whitney U Test Doctors vs. Nurses 182 Doctors: 122.71, Nurses: 76.15 U = 1721.500 p<0.001 Doctors vs. Paramedics 84 Doctors: 54.33, Paramedics: 12.92 U = 5.000 p<0.001 Nurses vs. Paramedics 146 Nurses: 83.82, Paramedics: 21.04 U = 287.500 p<0.001 Kruskal-Wallis Test Overall Comparison (Doctors, Nurses, Paramedics) 206 Chi-Square = 78.95 df= 2 p<0.001 Doctors 60 Mean Rank: 146.54 Nurses 122 Mean Rank: 98.47 Paramedics 24 Mean Rank: 21.46 p<0.05 is statically significant; df: degree of freedom Healthcare workers with less than five years of experience, have a mean knowledge score of 11.6 (SD = 2.3), while those with more than five years averaged 12.8 (SD = 2.4). However, p-value of 0.173 indicates that there is no statistical difference between these groups. Additionally, knowledge scores for various training periods did not show significant differences, with all p-values exceeding 0.05; for instance, the period 2019-2020 had a p-value of 0.284. In contrast, a significant difference was noted regarding the source of training; healthcare workers trained by the American Heart Association (AHA) achieved an average score of 13.37 (SD = 2.06), which was significantly higher than the 10.98 (SD = 2.15) recorded by those who received internal training (p = 0.000). This highlights the effectiveness of AHA training in enhancing BLS knowledge among healthcare professionals. [Table 4] Table 4: Factors Influencing Knowledge of Basic Life Support Among Healthcare Workers Factor N Mean SD p-value Years of Experience less than 5 Years 134 11.6 2.3 p= 0.173 More than 5 years 72 12.8 2.4 Period of Training 2019-2020 26 11.81 3.16 p=0.284 2020-2021 70 12.19 1.94 2021-2022 64 11.58 2.61 2022-2023 46 11.37 2.20 Source of training AHA 68 13.37 2.06 p=0.000 Internal 138 10.98 2.15 *N: Number of participants; SD: Standard Deviation; AHA: American Heart association When examining gender and age in the multivariate logistic regression analysis, no statistically significant differences were observed in knowledge levels across gender or age groups. However, female participants and those over 45 years old had slightly higher knowledge, though the odds ratio did not indicate significant differences. [Table 5] Table 5: Multivariate Logistic Regression across Scoring Categories by Gender and Age Group Category Score Range Adjusted OR (Exp(B)) P-value 95% CI for Adjusted OR 50% score n % n % Gender female 26 24.1% 88 81.5% 1.00 0.18 0.4-2.5 Male 31 36.9% 61 72.6% - - Age 25-35 31 28.7% 77 71.3% - 0.47 - 35-45 24 28.6% 60 71.4% 1.08 0.5-2.2 45 and older 2 14.3% 12 85.7% 0.83 0.4-1.3 Total 57 27.7% 149 72.3% - - - *OR: Odds Ratio; CI: Confidence Interval Discussion This study's main goal is to assess healthcare professionals' current knowledge of Basic Life Support (BLS) in a tertiary care teaching hospital. It attempts provide insights into the efficacy of current training programs and identify areas for development by evaluating BLS competency and finding factors that contribute to proficiency. The results provide a framework for improving life-saving abilities through focused interventions and uniform training for all healthcare professions. With a mean score of 58.8%, this study indicated that healthcare personnel in an academic medical center had low knowledge of BLS. The results align with a study conducted out in Pakistan, which indicated that healthcare workers had a comparable knowledge level of BLS at 58.3%. The study also revealed that a number of Healthcare Professions, including physicians and supporting staff, lacked sufficient BLS knowledge, highlighting the necessity of formal training programs to close these knowledge gaps. 5 Poudel et al.'s similar study from 2023 discovered that healthcare personnel typically lack knowledge enough about BLS, despite it being essential for efficient emergency response. 6 Among medical professionals, doctors had the highest knowledge level at 68%, much exceeding that of nurses (56%), and paramedics (42%). This discrepancy emphasizes the importance it is to provide specific training for various professional groups. Other research revealed similar results, emphasizing that physicians generally have greater knowledge of emergency procedures than other healthcare professionals. 7 8 9 10 11 Another influential element was experience, however p = 0.173 indicates that it had no statistically significant effect on knowledge levels. The mean score for professionals with more than five years of experience was 12.8; the score for those with less experience was 11.6. This result is in opposition to Aroor et al. (2020) research, which found a correlation between higher BLS knowledge and more clinical experience. The findings of research by Chaudhary et al. (2018), however, which showed that healthcare personnel frequently experience a deterioration in BLS knowledge and skills without regular retraining, emphasize the significance of ongoing education and refreshers for preserving BLS skills. 12 13 The results of the study show that healthcare professionals' knowledge and proficiency in Basic Life Support (BLS) are significantly influenced by the training program they received. 9 10 11 12 With mean scores of 13.37 vs. 10.98 (p = 0.000), participants trained by the American Heart Association (AHA) showed considerably greater understanding than those instructed internally. This supports other research that indicates the development of life-saving abilities requires structured, excellent training programs such as those provided by the American Heart Association. Standardized training ensures a higher retention of BLS skills than informal internal training, according to other research 9 10 11 12 . This underscores the need for continuous assessment and improvement of internal training programs to meet these criteria. Research has indicated that although medical professionals tend to have greater knowledge, many healthcare personnel still do not possess the necessary BLS skill. Our study shows similar findings with Chandrasekaran S. et al and Matsuura H et al, indicating that many healthcare workers exhibit low knowledge of essential BLS skills such as performing chest compressions and responding quickly in emergency situations. Despite their medical background they lack confidence when it comes to executing basic life support (BLS) techniques like chest compressions and using automated external defibrillators (AEDs). 4 14 The findings of this study highlight significant gaps in the healthcare personnel’ knowledge and proficiency in Basic Life Support (BLS) in a tertiary care teaching hospital. It was evident that across different occupational groups, with paramedics showing the lowest level of knowledge. This disparity emphasizes the necessity of focused educational initiatives. The study revealed a noteworthy observation, as 67% of the participants had to count on internal training programs. The results indicate that competency levels are directly influenced by the quality and structure of training, as evidenced by the considerable difference in knowledge scores (mean scores of 13.37 vs. 10.98, p < 0.001) between participants who received internal training and those trained by the American Heart Association (AHA). Our study supports previous research, including Chandrasekaran S et al. 4 , which emphasized that healthcare personnel's knowledge of BLS is significantly improved by ongoing, systematic training, reinforcing the need for comprehensive training programs with defined curricula and best practices, such as those offered by the AHA. The implementation of thorough training programs that place a high priority on practical experience and frequent updates is necessary in order to solve these weaknesses. It is believed that repeated training greatly improves knowledge retention and practical abilities is supported by research 15 . Moreover, BLS instruction can be standardized across healthcare professions by incorporating AHA standards into training courses, guaranteeing a consistent degree of skill 16 17 . In order to improve outcomes, training in BLS should be required in the curricula of Indian teaching hospitals, as many resident physicians lack comprehensive knowledge of the subject. Furthermore, requiring BLS certification for all healthcare personnel and holding retraining sessions every two years might greatly increase the general level of readiness to respond appropriately in an emergency 18 19 . Healthcare organizations can promote a culture of safety and preparedness by implementing such measures, which will eventually improve patient outcomes in emergency circumstances. Conclusion The study highlights a concerning low level of Basic Life Support (BLS) knowledge among healthcare workers in a tertiary care teaching hospital, with the mean score of 58.8%. Significant discrepancies in knowledge were observed across different occupational groups, highlighting the need for modified training interventions. The source of training played a crucial role, participants received American Heart Association (AHA) training exhibits higher knowledge compared to those received Hospital design internal training. The findings emphasize the importance of standardized high quality training programs, such as those offered by the AHA and the need to strengthen and modify the internally design training programs to match the effectiveness of accredited external programs. Additionally, to ensure greater competency BLS training should be made a mandatory part of foundation courses for all healthcare workers. Limitations The study's limitations include the lack of follow-up assessments to gauge long-term BLS knowledge retention and its focus on a single tertiary care hospital, limiting generalizability. Excluding unavailable healthcare workers may have affected sample representativeness. Additionally, the study assessed only knowledge, not practical skills. Declarations Author Contribution Himadri M: proposed the study, Himadri M and Omkarnath S: drafted the manuscript, conducted data interpretation, Jethani SL: conceived the idea of study and reviewed the manuscript, Vaibhav B: contributed in data collection and literature review. Acknowledgement Dr. Sonika Agarwal, Professor and Head of Critical Care Medicine, HIMS, Uttarakhand, Dr. R.S. Saini, Professor and Head of Hospital Administration, HIMS, Uttarakhand and Dr. Rajesh Sharma, Coordinator of the Skill Lab, HIMS, Uttarakhand and all the participants for their valuable support and guidance throughout the project. Data Availability The data generated and analyzed in this study are not publicly available due to the confidentiality of the participants, however they can be made available upon reasonable request. Conflicts of interest : NIL Source of Funding : NIL References Rao S, Rao S. Cardiac Disease among South Asians: A Silent Epidemic [Internet]. [cited 2024 Jan 9]. Available from: https://indianheartassociation.org/wp-content/uploads/2023/05/Indian-Heart-Association-presentation-1.pdf. World Health Organization. Global health estimates: Leading causes of DALYs [Internet]. World Health Organization. 2022. 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Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2025 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 12 May, 2025 Editor assigned by journal 23 Apr, 2025 Reviews received at journal 19 Apr, 2025 Reviewers agreed at journal 19 Apr, 2025 Reviews received at journal 16 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviewers invited by journal 14 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 29 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Ventilation\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614239/v1/cd0291cbd212aaaaa5578f7c.jpg"},{"id":80784459,"identity":"96b06ebe-5a46-4e05-87ae-f6c0843f3cfc","added_by":"auto","created_at":"2025-04-17 05:35:55","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":139967,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge on Skills of BLS\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614239/v1/7638037c7e1db9bea809b62b.jpg"},{"id":80784457,"identity":"88194da6-db57-47d9-ac8e-c557c9616650","added_by":"auto","created_at":"2025-04-17 05:35:55","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":68176,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge on use of AED and Stroke\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614239/v1/a59cb5c28923bffc9b09709a.jpg"},{"id":80784466,"identity":"d67c694a-a2da-4fd8-96d2-4b280bdc8b6a","added_by":"auto","created_at":"2025-04-17 05:35:55","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":89232,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge on Choking \u0026amp; Special Scenarios\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614239/v1/477652470282be46df9e1f6a.jpg"},{"id":90345597,"identity":"e64c0edb-8ce1-45f1-8eb2-446e3c1b5a64","added_by":"auto","created_at":"2025-09-01 16:10:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1154852,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5614239/v1/ff935e9a-f9cc-40d5-a86f-2c570a4f433b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Awareness on Basic Life Support among Healthcare Workers in a Tertiary Care Teaching Hospital in Northern Region of India: a Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eBasic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population.\u003csup\u003e1\u003c/sup\u003e Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Cardiovascular diseases (CVD) remain a leading cause of mortality worldwide. As of the most recent data, ischemic heart disease is the primary cause of CVD mortality globally, with an age-standardized rate of 108.8 deaths per 100,000 people. Following closely are conditions like Intra-Cerebral Hemorrhage and Ischemic Stroke. High systolic blood pressure is a significant contributor to CVD-related disability-adjusted life years (DALYs), accounting for 2,564.9 per 100,000 globally.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndia has seen a rise in CVD incidence, with ischemic heart disease and stroke being major contributors. The age-standardized CVD mortality rate and DALYs continue to highlight the urgent need for effective public health strategies and interventions to manage and reduce the burden of these diseases. Based on 2021 data, ischemic heart disease significantly impacts health in India. It contributes to a high number of DALYs, with almost 2900 years of healthy life lost per 100,000 people due to disability caused by this condition.\u003c/p\u003e \u003cp\u003eWhile tertiary care teaching hospitals manage critically ill patients and their healthcare workers (HCWs) are on the frontline of emergency response, BLS knowledge extends beyond these settings. Early intervention by bystanders with CPR and AEDs is crucial for improving Outside Hospital Cardiac Arrest (OHCA) survival rates. HCWs with a strong foundation in BLS can not only initiate life-saving interventions in the hospital but also serve as educators and advocates for bystander CPR training in the community. Hence it is crucial for healthcare workers to have substantial knowledge of BLS to help patients when they need it the most.\u003csup\u003e2\u003c/sup\u003e Healthcare workers should be aware of cardiopulmonary resuscitation (CPR), competence in operating automated defibrillators (AED), and the ability to address airway obstructions caused by foreign bodies. In addition, it includes the first assessment, rescue breathing methods such mouth-to-mouth ventilation, chest compressions, and airway management.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies show that healthcare workers knowledge and competence levels vary even though BLS is widely accepted as being important \u003csup\u003e34\u003c/sup\u003e. Furthermore, there may be gaps in knowledge regarding specific CPR techniques and proper use of AED, which can potentially delay effective response during emergencies. Several barriers to effective BLS training were identified in previous studies, including limited access to training programs, time constraints, and lack of institutional support. Additionally, HCWs may experience a decline in BLS skills and knowledge over time if they do not regularly practice these skills. Therefore, ongoing education and practical training are essential to maintain a high level of readiness among HCWs.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to assess BLS knowledge among healthcare workers in a tertiary care teaching hospital to identify gaps, evaluate training effectiveness, and highlight areas for improvement.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional observational study conducted at Tertiary Care Teaching Hospital of North India. The study period was from May, 2024 to September, 2024. The sample size was calculated based on the proportion of healthcare workers (HCWs) aware of Basic Life Support (BLS), assuming a prevalence (P %) of 50%, an error margin of 10%, and a confidence interval (CI) of 99%. Using these parameters, the required sample size was determined to be 170 participants. However, to ensure adequate representation across different categories, the sample size was increased to 200 participants. This included 60 doctors, 120 nurses, and 20 technicians.\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the hospital\u0026rsquo;s ethics committee (Ethical Approval No: HIMS/E-1/2024/77). Prior to the involvement in the study, written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eInclusion \u0026amp; Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eThe study included those Healthcare workers (doctors, nurses, and paramedics) employed at the hospital for at least six months and who provided written informed consent. Exclusion criteria encompassed healthcare workers on leave during the study period, participants who never had experienced BLS training, incomplete or partially filled forms and individuals who did not consent to participate. Out of 250 healthcare workers approached, 206 were included in the study, and 44 were excluded based on the exclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe modified study tool consisted of a structured pre-validated close ended questionnaire with three sections will be used as a study tool for this study. Section 1 includes the informed consent form, while Section 2 comprises the socio-demographic profile. Section 3 is dedicated to questions related to knowledge of Basic Life Support (BLS) questions, totaling 25 in number. The tool was designed on a basis of review of existing literature and in accordance with the latest American Heart Association (AHA) guidelines for Basic Life Support (BLS). The questionnaire underwent expert panel review, comprising three senior clinicians and two BLS trainers, to ensure content validity. Additionally, pilot testing was conducted with 15 healthcare workers to evaluate clarity, reliability, and consistency before the final survey was administered. The socio-demographic section gathered essential information about the participants, including: age, gender, profession, experience and BLS Training History. The knowledge section evaluated participants\u0026apos; BLS knowledge through multiple-choice questions, grouped into categories: Chest compressions, Rescue breathing, AED usage, and Choking management. Each knowledge-related question was scored on a dichotomous scale, where the correct answer was awarded one point and incorrect answers received zero. This ensured that the total score for each question was one. Hence, each domain was assigned a maximum possible score of 20. Individual knowledge scores were calculated based on this and categorized into three levels:\u003c/p\u003e\n\u003cp\u003e(i) Poor Knowledge: Total scores ranging from 0 to 8.\u003c/p\u003e\n\u003cp\u003e(ii) Average Knowledge: Total scores ranging from 9 to 13.\u003c/p\u003e\n\u003cp\u003e(iii) Good Knowledge: Total scores ranging from 14 to 20.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA \u0026apos;universal sampling technique was used to collect the data as all eligible participants were included from the hospital\u0026apos;s workforce, including doctors, nurses and paramedics. \u0026nbsp;Questionnaire was explained to the participants before collecting the data. Each participant was informed about the importance of the research, the procedures involved, and how the data would be used. Printed questionnaires were distributed to participants, taking approximately 15 minutes to complete.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered into IBM SPSS Statistics for Windows, version 20 for analysis. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were used to summarize demographic data. Inferential statistics were applied for categorical variables, such as Chi-square tests and the Kolmogorov\u0026ndash;Smirnov test was used to assess the normality of the data distribution. Since the data did not follow a normal distribution, when comparing more than two groups, the Kruskal\u0026ndash;Wallis test was applied and the Mann\u0026ndash;Whitney U test was used for comparing the scores between two groups. Statistical significance was considered when the p-value was less than \u0026lt;0.05. Additionally, Multivariate logistic regression was performed to analyze the factors associated with adequate BLS knowledge, providing insights into the influence of various demographic and training-related variables on the outcomes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic profile of the participants showcases a varied composition across different categories. A significant portion of respondents falls within the age range of 25-35 years (52%), followed by those aged 35-45 years (41%), with a smaller percentage of participants aged 45 and above (7%). The gender distribution reveals a higher number of females (55%) compared to males (45%). Regarding occupation, nurses constitute the largest group at 59%, while doctors and paramedics account for 29% and 12%, respectively. Furthermore, more than half of the participants graduated within the past five years (53%), and a notable majority received their training through internal programs (67%) instead of from the American Heart Association (AHA) (33%). [Table 1]\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eTable 1: Socio-demographic characteristics of Participants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003e25-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003e35-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003e45 or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eParamedic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eYears of Experience\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eLess than 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e53%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003e\u0026nbsp;More than 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003eSource of training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eAHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 316px;\"\u003e\n \u003cp\u003eHospital designed internal training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 179px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 662px;\"\u003e\n \u003cp\u003e*AHA: American Heart Association\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe overall definitive knowledge of Basic Life Support (BLS) among healthcare workers stands at about 58.8%. Doctors had the highest knowledge at 68%, while nurses scored 56%, reflecting a good understanding of essential concepts. Paramedics showed the lowest knowledge at 42%, highlighting the need for additional training. Participants generally performed well on key questions, with 82% correctly identifying the compression-to-ventilation ratio and 84% recognizing the meaning of AED, although only 23% accurately responded regarding the recommended chest compression rate. [Figure 1-5]\u003c/p\u003e\n\u003cp\u003eThe combined results from the Mann-Whitney U Test and the Kruskal-Wallis Test highlight significant differences in Basic Life Support (BLS) knowledge \u0026nbsp;among healthcare professionals. In the Mann-Whitney U Test, doctors demonstrated a higher mean rank (122.71) compared to nurses (76.15) and paramedics (12.92), with U statistics indicating significant differences (U = 1721.500, p = 0.000 for doctors vs. nurses; U = 5.000, p = 0.000 for doctors vs. paramedics; U = 287.500, p = 0.000 for nurses vs. paramedics). The Kruskal-Wallis Test confirmed these findings, with an overall Chi-Square of 78.95 (df = 2, p = 0.000) indicating significant differences in knowledge \u0026nbsp;levels among doctors, nurses, and paramedics across a total of 206 participants. [Table 3]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"713\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 713px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Comparison of Basic Life Support Knowledge \u0026nbsp; \u0026nbsp; Among Healthcare Professionals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eComparison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMean Rank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eU Statistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eAsymptotic Sig. (p-value)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMann-Whitney\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eU Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eDoctors vs. Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDoctors: 122.71, Nurses: 76.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eU = 1721.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eDoctors vs. Paramedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDoctors: 54.33, Paramedics: 12.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eU = 5.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNurses vs. Paramedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNurses: 83.82, Paramedics: 21.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eU = 287.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eKruskal-Wallis Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOverall Comparison (Doctors, Nurses, Paramedics)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 88px;\"\u003e\n \u003cp\u003eChi-Square = 78.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 46px;\"\u003e\n \u003cp\u003edf= 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 103px;\"\u003e\n \u003cp\u003ep\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eDoctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMean Rank: 146.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMean Rank: 98.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eParamedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMean Rank: 21.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 713px;\"\u003e\n \u003cp\u003ep\u0026lt;0.05 is statically significant; df: degree of freedom\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHealthcare workers with less than five years of experience, have a mean knowledge score of 11.6 (SD = 2.3), while those with more than five years averaged 12.8 (SD = 2.4). However, p-value of 0.173 indicates that there is no statistical difference between these groups. Additionally, knowledge scores for various training periods did not show significant differences, with all p-values exceeding 0.05; for instance, the period 2019-2020 had a p-value of 0.284. In contrast, a significant difference was noted regarding the source of training; healthcare workers trained by the American Heart Association (AHA) achieved an average score of 13.37 (SD = 2.06), which was significantly higher than the 10.98 (SD = 2.15) recorded by those who received internal training (p = 0.000). This highlights the effectiveness of AHA training in enhancing BLS knowledge among healthcare professionals. [Table 4]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" rowspan=\"2\" style=\"width: 641px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4: Factors Influencing Knowledge \u0026nbsp;of Basic Life Support Among Healthcare Workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYears of Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eless than 5 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003ep= 0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eMore than 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePeriod of Training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2019-2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003ep=0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2020-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2021-2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2022-2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSource of training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eAHA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e13.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003ep=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eInternal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e10.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003e*N: Number of participants; SD: Standard Deviation; AHA: American Heart association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"2\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen examining gender and age in the multivariate logistic regression analysis, no statistically significant differences were observed in knowledge levels across gender or age groups. However, female participants and those over 45 years old had slightly higher knowledge, though the odds ratio did not indicate significant differences. [Table 5]\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 641px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5: Multivariate Logistic Regression across Scoring Categories by Gender and Age Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eScore Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAdjusted OR (Exp(B))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e95% CI for Adjusted OR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026lt;50% score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026gt;50% score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e24.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e81.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.4-2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e36.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e72.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e25-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e28.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e71.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e35-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e28.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e71.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.5-2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e45 and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.4-1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e72.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 641px;\"\u003e\n \u003cp\u003e*OR: Odds Ratio; CI: Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study's main goal is to assess healthcare professionals' current knowledge of Basic Life Support (BLS) in a tertiary care teaching hospital. It attempts provide insights into the efficacy of current training programs and identify areas for development by evaluating BLS competency and finding factors that contribute to proficiency. The results provide a framework for improving life-saving abilities through focused interventions and uniform training for all healthcare professions.\u003c/p\u003e \u003cp\u003eWith a mean score of 58.8%, this study indicated that healthcare personnel in an academic medical center had low knowledge of BLS. The results align with a study conducted out in Pakistan, which indicated that healthcare workers had a comparable knowledge level of BLS at 58.3%. The study also revealed that a number of Healthcare Professions, including physicians and supporting staff, lacked sufficient BLS knowledge, highlighting the necessity of formal training programs to close these knowledge gaps.\u003csup\u003e5\u003c/sup\u003e Poudel et al.'s similar study from 2023 discovered that healthcare personnel typically lack knowledge enough about BLS, despite it being essential for efficient emergency response.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAmong medical professionals, doctors had the highest knowledge level at 68%, much exceeding that of nurses (56%), and paramedics (42%). This discrepancy emphasizes the importance it is to provide specific training for various professional groups. Other research revealed similar results, emphasizing that physicians generally have greater knowledge of emergency procedures than other healthcare professionals.\u003csup\u003e7 8 9 10 11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother influential element was experience, however p\u0026thinsp;=\u0026thinsp;0.173 indicates that it had no statistically significant effect on knowledge levels. The mean score for professionals with more than five years of experience was 12.8; the score for those with less experience was 11.6. This result is in opposition to Aroor et al. (2020) research, which found a correlation between higher BLS knowledge and more clinical experience. The findings of research by Chaudhary et al. (2018), however, which showed that healthcare personnel frequently experience a deterioration in BLS knowledge and skills without regular retraining, emphasize the significance of ongoing education and refreshers for preserving BLS skills.\u003csup\u003e12 13\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe results of the study show that healthcare professionals' knowledge and proficiency in Basic Life Support (BLS) are significantly influenced by the training program they received.\u003csup\u003e9 10 11 12\u003c/sup\u003e With mean scores of 13.37 vs. 10.98 (p\u0026thinsp;=\u0026thinsp;0.000), participants trained by the American Heart Association (AHA) showed considerably greater understanding than those instructed internally. This supports other research that indicates the development of life-saving abilities requires structured, excellent training programs such as those provided by the American Heart Association. Standardized training ensures a higher retention of BLS skills than informal internal training, according to other research\u003csup\u003e9 10 11 12\u003c/sup\u003e. This underscores the need for continuous assessment and improvement of internal training programs to meet these criteria.\u003c/p\u003e \u003cp\u003eResearch has indicated that although medical professionals tend to have greater knowledge, many healthcare personnel still do not possess the necessary BLS skill. Our study shows similar findings with Chandrasekaran S. et al and Matsuura H et al, indicating that many healthcare workers exhibit low knowledge of essential BLS skills such as performing chest compressions and responding quickly in emergency situations. Despite their medical background they lack confidence when it comes to executing basic life support (BLS) techniques like chest compressions and using automated external defibrillators (AEDs).\u003csup\u003e4 14\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe findings of this study highlight significant gaps in the healthcare personnel\u0026rsquo; knowledge and proficiency in Basic Life Support (BLS) in a tertiary care teaching hospital. It was evident that across different occupational groups, with paramedics showing the lowest level of knowledge. This disparity emphasizes the necessity of focused educational initiatives. The study revealed a noteworthy observation, as 67% of the participants had to count on internal training programs. The results indicate that competency levels are directly influenced by the quality and structure of training, as evidenced by the considerable difference in knowledge scores (mean scores of 13.37 vs. 10.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) between participants who received internal training and those trained by the American Heart Association (AHA). Our study supports previous research, including Chandrasekaran S et al. \u003csup\u003e4\u003c/sup\u003e, which emphasized that healthcare personnel's knowledge of BLS is significantly improved by ongoing, systematic training, reinforcing the need for comprehensive training programs with defined curricula and best practices, such as those offered by the AHA.\u003c/p\u003e \u003cp\u003eThe implementation of thorough training programs that place a high priority on practical experience and frequent updates is necessary in order to solve these weaknesses. It is believed that repeated training greatly improves knowledge retention and practical abilities is supported by research \u003csup\u003e15\u003c/sup\u003e. Moreover, BLS instruction can be standardized across healthcare professions by incorporating AHA standards into training courses, guaranteeing a consistent degree of skill \u003csup\u003e16 17\u003c/sup\u003e. In order to improve outcomes, training in BLS should be required in the curricula of Indian teaching hospitals, as many resident physicians lack comprehensive knowledge of the subject.\u003c/p\u003e \u003cp\u003eFurthermore, requiring BLS certification for all healthcare personnel and holding retraining sessions every two years might greatly increase the general level of readiness to respond appropriately in an emergency\u003csup\u003e18 19\u003c/sup\u003e. Healthcare organizations can promote a culture of safety and preparedness by implementing such measures, which will eventually improve patient outcomes in emergency circumstances.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study highlights a concerning low level of Basic Life Support (BLS) knowledge among healthcare workers in a tertiary care teaching hospital, with the mean score of 58.8%. Significant discrepancies in knowledge were observed across different occupational groups, highlighting the need for modified training interventions. The source of training played a crucial role, participants received American Heart Association (AHA) training exhibits higher knowledge compared to those received Hospital design internal training. The findings emphasize the importance of standardized high quality training programs, such as those offered by the AHA and the need to strengthen and modify the internally design training programs to match the effectiveness of accredited external programs. Additionally, to ensure greater competency BLS training should be made a mandatory part of foundation courses for all healthcare workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eLimitations\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study's limitations include the lack of follow-up assessments to gauge long-term BLS knowledge retention and its focus on a single tertiary care hospital, limiting generalizability. Excluding unavailable healthcare workers may have affected sample representativeness. Additionally, the study assessed only knowledge, not practical skills.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHimadri M: proposed the study, Himadri M and Omkarnath S: drafted the manuscript, conducted data interpretation, Jethani SL: conceived the idea of study and reviewed the manuscript, Vaibhav B: contributed in data collection and literature review.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e Dr. Sonika Agarwal, Professor and Head of Critical Care Medicine, HIMS, Uttarakhand, Dr. R.S. Saini, Professor and Head of Hospital Administration, HIMS, Uttarakhand and Dr. Rajesh Sharma, Coordinator of the Skill Lab, HIMS, Uttarakhand and all the participants for their valuable support and guidance throughout the project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data generated and analyzed in this study are not publicly available due to the confidentiality of the participants, however they can be made available upon reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e: NIL\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e: NIL\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRao S, Rao S. Cardiac Disease among South Asians: A Silent Epidemic [Internet]. [cited 2024 Jan 9]. Available from: https://indianheartassociation.org/wp-content/uploads/2023/05/Indian-Heart-Association-presentation-1.pdf.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global health estimates: Leading causes of DALYs [Internet]. World Health Organization. 2022. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys\u003c/li\u003e\n\u003cli\u003eRuesseler M, Weinlich M, M\u0026uuml;ller MP, Byhahn C, Marzi I, Walcher F. Simulation training improves ability to manage medical emergencies. Emerg Med J. 2010 Oct;27(10):734-8. doi: 10.1136/emj.2009.074518. PMID: 20852280.\u003c/li\u003e\n\u003cli\u003eChandrasekaran S, Kumar S, Bhat S, Saravanakumar, Shabbir M, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian Journal of Anaesthesia [Internet]. 2010 [cited 2019 Jun 20];54(2):121. 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J Healthc Eng [Internet]. 2023;2023:9936114. Available from: http://dx.doi.org/10.1155/2023/9936114\u003c/li\u003e\n\u003cli\u003eNemat A, Nedaie MH, Essar MY, Ashworth H, Aminpoor H, Sediqi AW, et al. Basic life support knowledge among healthcare providers in Afghanistan: a cross-sectional study of current competencies and areas for improvement. Ann Med Surg (Lond) [Internet]. 2023 [cited 2024 Oct 14];85(4):684\u0026ndash;8. Available from: https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/04000/basic_life_support_knowledge_among_healthcare.10.aspx\u003c/li\u003e\n\u003cli\u003eNambiar M, Nedungalaparambil NM, Aslesh OP. Is current training in basic and advanced cardiac life support (BLS \u0026amp; ACLS) effective? A study of BLS \u0026amp; ACLS knowledge amongst healthcare professionals of North-Kerala. World J Emerg Med [Internet]. 2016;7(4):263\u0026ndash;9. Available from: http://dx.doi.org/10.5847/wjem.j.1920-8642.2016.04.004\u003c/li\u003e\n\u003cli\u003eMpotos N, Vekeman E, Monsieurs K, Derese A, Valcke M. Knowledge and willingness to teach cardiopulmonary resuscitation: a survey amongst 4273 teachers. Resuscitation [Internet]. 2013;84(4):496\u0026ndash;500. Available from: http://dx.doi.org/10.1016/j.resuscitation.2013.01.023\u003c/li\u003e\n\u003cli\u003ePatel H, Mahtani AU, Mehta LS, Kalra A, Prabhakaran D, Yadav R, et al. Outcomes of out of hospital sudden cardiac arrest in India: A review and proposed reforms. Indian Heart Journal [Internet]. 2023 Sep 1 [cited 2024 Jan 9];75(5):321\u0026ndash;6. Available from: https://www.sciencedirect.com/science/article/pii/S0019483223001402#:~:text=With%20an%20estimated%20survival%20of\u003c/li\u003e\n\u003cli\u003eAroor AR, Saya RP, Attar NR, Saya GK, Ravinanthanan M. Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India. J Emerg Trauma Shock 2014;7:166-9.\u003c/li\u003e\n\u003cli\u003eChaudhary GP, Sah K, Malla J, Das N, Chaudhary S, Chaudhary I, et al. Knowledge regarding Basic Life Support among Health Care Workers of the Hospital of Nepal. Jakovljevic M, editor. Journal of Healthcare Engineering. 2023 Jan 5;2023:1\u0026ndash;6\u003c/li\u003e\n\u003cli\u003eMatsuura H, Sakai T, Katayama Y, Kitamura T, Hirose T, Matsumoto H, et al. A follow-up report on the effect of a simplified basic life support training program for non-medical staff working at a university hospital: changes in attitude toward cardiopulmonary resuscitation and automated external defibrillator use through repeat training. Acute Med Surg [Internet]. 2020;7(1):e548. Available from: http://dx.doi.org/10.1002/ams2.548\u003c/li\u003e\n\u003cli\u003eChaskar V, Thakkar A, Zadkar S, Gite J. Prospective study to assess knowledge about basic life support in college students and evaluate the effectiveness of basic life support training. J Pract Cardiovasc Sci [Internet]. 2024 [cited 2024 Oct 14];10(1):30\u0026ndash;5. Available from: https://journals.lww.com/jpcs/fulltext/2024/10010/prospective_study_to_assess_knowledge_about_basic.5.aspx\u003c/li\u003e\n\u003cli\u003eAl Shoshan F, Al Harbi A. Evaluation of the effectiveness of basic life support courses among health care professionals at the ministry of national guard health affairs [Internet]. Ijmrhs.com. [cited 2024 Oct 14]. Available from: https://www.ijmrhs.com/medical-research/evaluation-of-the-effectiveness-of-basic-life-support-courses-among-health-care-professionals-at-the-ministry-of-nationa.pdf\u003c/li\u003e\n\u003cli\u003eShaheen N, Shaheen A, Diab RA, Mohmmed A, Ramadan A, Swed S, et al. Basic Life Support (BLS) knowledge among general population; A multinational study in nine Arab countries. Arch Acad Emerg Med [Internet]. 2023;11(1):e47. Available from: http://dx.doi.org/10.22037/aaem.v11i1.1975\u003c/li\u003e\n\u003cli\u003eTipa RO, Bobirnac G. Importance of basic life support training for first and second year medical students--a personal statement. Journal of medicine and life [Internet]. 2010;3(4):465\u0026ndash;7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019063/\u003c/li\u003e\n\u003cli\u003eAlghamdi Y, Alghamdi T, Alghamdi F, Alghamdi A. Awareness and attitude about basic life support among medical school students in Jeddah University, 2019: A cross-sectional study. Journal of Family Medicine and Primary Care. 2021;10(7):2684.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Automated External Defibrillator, Cardiopulmonary Resuscitation, Healthcare Worker, Ischemic Heart Disease, Medical Emergency, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-5614239/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5614239/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBasic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population. Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Hence it is crucial for healthcare workers (HCW) to have substantial knowledge and awareness of BLS to help patients when they need it the most. This study aimed to assess the awareness on BLS among HCWs in a tertiary care teaching hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among HCWs in a tertiary care teaching hospital. A self-administered questionnaire was developed to assess knowledge on key BLS components, including cardiopulmonary resuscitation (CPR) techniques, use of an automated external defibrillator (AED), and the chain of survival. Data were analyzed using descriptive statistics and chi-square tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 206 responders, 60 were doctors, 122 were nursing staff and 24 were technicians. None of the responders have complete knowledge of basic life support, 58.8% mean percentage of knowledge. There was a significant difference in BLS knowledge between different professional groups, with doctors scoring higher than nurses and paramedics (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEven though healthcare professionals receive BLS training at a high rate, there remains a knowledge and retention gap in BLS abilities. Regular skills practice and updated training is recommended to enhance BLS proficiency.\u003c/p\u003e","manuscriptTitle":"Assessment of Awareness on Basic Life Support among Healthcare Workers in a Tertiary Care Teaching Hospital in Northern Region of India: a Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 05:35:50","doi":"10.21203/rs.3.rs-5614239/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T15:37:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T15:49:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-19T13:15:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166356232007355158880911288814549758136","date":"2025-04-19T12:52:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-16T04:03:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71969927278963091219173905407821453751","date":"2025-04-16T03:28:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T18:46:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52657078556502156138476891195261919087","date":"2025-04-14T18:39:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T16:17:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229345231932991459183480479769469691333","date":"2025-04-14T16:09:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T10:57:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T09:08:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-03-29T04:38:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f4579a0-d012-4b9d-ac7a-216c065efa8b","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:09:14+00:00","versionOfRecord":{"articleIdentity":"rs-5614239","link":"https://doi.org/10.1186/s12982-025-00913-y","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-08-30 15:57:45","publishedOnDateReadable":"August 30th, 2025"},"versionCreatedAt":"2025-04-17 05:35:50","video":"","vorDoi":"10.1186/s12982-025-00913-y","vorDoiUrl":"https://doi.org/10.1186/s12982-025-00913-y","workflowStages":[]},"version":"v1","identity":"rs-5614239","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5614239","identity":"rs-5614239","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}