Abstract |
Background
Basic life support (BLS) includes the early recognition of the emergency at the scene and the
immediate application of resuscitation techniques with a structured approach of updated
algorithms. BLS also focuses on cardiopulmonary resuscitation (CPR) in conjunction with the
use of an external automatic defibrillator. Advanced life support (ALS) includes advanced
interventions and treatments applied in a hospital, using special equipment and drugs, as a
continuation of basic support. The above practices follow the severe illness, severe trauma
and cardiac arrest algorithms given through the guidelines of the European Resuscitation
Council – ERC which are renewed every 5 years. The latest guidelines were issued in 2021 and
incorporate the latest knowledge about Covid-19 and its transmissibility. The health workers
who staff the departments of immediate treatment and emergency management are called
to be the first to apply the best possible care to patients, adults and children, according to the
above guidelines.
It is vital that healthcare workers on the frontline of emergency response are well versed in
both basic and advanced life support algorithms. The provision of quality health services is
linked to lifelong training and the implementation of practical simulations at regular intervals
of health professionals, especially those working in emergency medicine and first aid
structures.
Objective
The purpose of the study is : 1) The recording of the training, experience and knowledge of
the health personnel of the National Emergency Center (NEC), the Emergency Department
(ED) and clinics of the General Hospital of Rethymnon, the Local Health Unit (LHU) and Health
Centers of Regional of Rethymnon, regarding the implementation of protocols governing the
treatment of emergencies of serious illness and serious trauma in children and adults. 2) The
comparison of the staff’s choices with the recommended structured contemporary approach
of basic up-to-date algorithms regarding emergency response in their workplace. 3) The
parallel recording of the self-assessment of the level of knowledge and suggestions of doctors,
nurses and rescuers regarding continuing education in emergency medicine, in order to
highlight the necessity of continuing education.
Methods
It is a modern descriptive study (cross sectional study) using multiple-choice questionnaires
that doctors, nurses, and rescue workers who work at the E.D. are asked to answer and in the
Clinics of the General Hospital of Rethymnon, in the LHU, in Health Centers and in the NEC.
The questionnaires were collected from June to November 2022. The questionnaire is divided
into three main parts: In the first part demographic data and level of education of the
respondents are recorded, in the second part there is a report on their training on basic and
specialized life support and followed by a shelf-assessment of their level of knowledge as well
as the desire or non-continuing education. In the third part, participants are asked to mark the correct answer to multiple-choice questions on managing life support, resuscitation and
treatment emergencies in adults and children with serious innless or trauma.
Results
Out of a total of 280 questionnaires that were given to doctors and nurses of the Clinics, Health
Centers, and LHU, 177 were completed. Of the 177 questionnaires that were finally analyzed,
106 (59,9%) were collected from General Hospital of Rethymnon clinic staff, 46(26%) from
Health Centers of the prefecture of Rethymnon, 18(10,2%) from NEC and 7 (4,0%) from LHU
of Rethymnon, 60,5% of the participants were female and 39,5% were male and their average
age was 40±11 years. The average duration of work in the department was 78±93 months, but
the rescuers had more experience compared to the doctors and nurses (p<0,001). The
resuscitation of patients in damage of life with the use of different technical skills differed
between the different structures, with lower percentages recorded in LHU or other clinics and
higher in ED, ICU and NEC. The use of intraosseous by the health professionals who
participated was nil in the study. In all participants the correct answers ranged at low levels,
varying on average in ½ of the total of 40 questions, rescuers (25,8±2,6) and doctors (21,2±5,7)
answered correctly more than half of the questions (20/40) compared to nurses (18,4±5,6),the
percentages of correct answers also differed significantly by workplace structure, with higher
percentages >60% being recorder only in the NEC and ICU, and percentages >50% in the
pediatric, surgical Eds and LHU and the lowest rates of correct responses in pathological EDs
and surgery or other clinics (p<0,001). APLS (62,5%vs49,4%, p=0.002) and PLS (57,8%vs49,3%,
p=0.01) training was related to higher percentages of correct answers, only training on the
APLS (Beta 0,257, p=0.001) and the frequency of applying resuscitation skills in the last year
(Beta 0.335, p<0.001) were independently related to a high percentage of correct answers.
Training in various basic or specialized adult life support courses was reported by 75.5%
(n=134) of participants with significantly higher rates among rescuers (100%, p<0.001).
Training rates in basic life support ranged low (33.3%) and did not differ between groups, as
did rates in pediatric life support (12.4%). The period since last BLS training was close to 10
years and varied widely between departments (p<0.001). A refresher course was reported by
100% of rescuers but much lower percentages in pediatrics (0%), pathology clinic (4%), surgery
(11%), and ICU (25%). Most employees of all structures (95.8-100%) stated that they wish to
receive lifelong continuing education regardless of workplace. Higher percentages of doctors
(8.1%) and nurses (32,3%) characterize their knowledge of adult BLS as average or below
average compared to rescuers (5.3%, p<0.001). The corresponding percentages of deficient
knowledge for children’s BLS also differ significantly (p<0.001) and are several times higher
for both doctors (37.1%) and nurses (62,5%) than for rescuers (26,3%).
Conclusion
In the present study, the insufficient knowledge of health professionals in emergency
response algorithms is highlighted, as the rates of training in basic and specialized life support
fluctuated at low levels, with the period since the last BLS seminar reaching ten years. The
refresher courses ranged at very low levels for doctors and nurses, a fact that justifies both
their low self-evaluation and their strong desire for training at regular intervals. In conclusion, there is a real need for training in the field of emergency resuscitation, of health professionals
per professional team and per emergency support center.
|