Short communicationNational population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore☆
Introduction
The Cardiac Arrest and Resuscitation Epidemiology study found that only 2.0% of out-of-hospital cardiac arrest (OHCA) victims in Singapore survived to discharge.1 Bystander CPR increases the survival rates of OHCA victims by two to three times2, 3 and is independently associated with “a very good quality of life” for survivors.4 However, the prevalence of bystander cardiopulmonary resuscitation (CPR) in Singapore is only 15.0–22.9%,1, 5, 6 compared to 28–46% in other developed cities.3, 7
In pulseless ventricular tachycardia or ventricular fibrillation, defibrillation to restore cardiac rhythm is the single most important intervention.3, 8 Automated External Defibrillators (AED) have demonstrated survival benefit9, 10 with reasonable health benefit for the cost.11, 12
The prevalence of laypersons trained in first aid, CPR and AED in Singapore is unclear. Among the participants in a mass CPR event a decade ago, 57% had never learnt CPR while 16.3% had never heard of CPR before the event.13
We aimed to assess health knowledge, attitudes and practices among Singapore residents towards life-saving skills and providing emergency assistance in the community using a population representative sample. In this paper, life-saving skills refer to first aid, CPR and AED usage skills. Certifications of respective life-saving skill are defined as standard first aid course, CPR and usage of AED endorsed by the National Resuscitation Council of Singapore; the national accreditation body for all cardiac life support training centres. Such certifications are usually valid for 2 years.
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Study design
An observational cross-sectional population-based study was conducted as part of an annual Omnibus Survey conducted by the Health Promotion Board in Singapore to assess health knowledge, attitudes and practices and to evaluate the effectiveness of various health programmes. A validated national sampling frame was utilized and a random sample of 7840 household addresses was selected. As this was an anonymous survey, it was exempted from ethics committee review.
Interviewers were trained on
Results
Response rate was 65.2% with a total of 4192 respondents. Table 1 shows the socio-demographics of the surveyed population, which is similar to Singapore resident population, as recorded in the population census in 2009.
Table 2 shows the attitudes towards and perceptions of life-saving skills and providing emergency assistance in the community. Fig. 1 shows respondents’ belief about first aid, CPR & AED training and whether they have ever been trained or possess valid certification (CPR/AED/BCLS
Discussion
This study found that although a high proportion of respondents believed that adults should be trained in first aid, CPR and AED, the proportion who had ever been trained in these skills are much lower. This presents a considerable public health opportunity to provide public training to meet this discrepancy. The top three barriers to rendering emergency assistance were all related to lack of training rather than lack of willingness. This reveals in general willingness in this community to
Conclusion
This study found that although a high proportion of respondents believed that adults should be trained in first aid, CPR and AED, the proportion who had ever been trained in these skills are much lower. This is the first population-based investigation into the prevalence of first aid, CPR and AED training in Singapore. This study provides necessary baseline data to assess the effectiveness of ongoing community interventions.
Conflict of interest statement
Dr. MEH Ong has a patent filing related to a method of predicting acute cardiopulmonary events and survivability of a patient (Application Number: 13/047,348). Dr Ong also has a licensing agreement with the ZOLL Medical Corporation for the technology and is the principle investigator of an ongoing industry funded study on mechanical CPR.
The other authors have neither commercial nor personal associations or any sources of support that might pose a conflict of interest in the subject matter or
Acknowledgments
We would like to thank Dr Jes Fergus, Ministry of Health, Singapore; and Health Promotion Board Singapore for the assistance in data analysis.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.05.008.