Knowledge and Attitude of Dental Students and Staffs towards Basic life Support(BLS)

Introduction:The present study was aimed to assess the awareness, knowledge, and attitude towards basic life support (BLS) among the dental students and faculty of Al Azhar dental college. Materials and Methods:A descriptive study was conducted by using a Questionnaire comprising of 20 questions to collect the data pertaining to awareness and knowledge of BLS, attitude towards BLS among the 3rd, final year dental students and the faculty members. After excluding the incomplete response sheets which were none in the present study, the data from 212 members were subjected to the analysis. The Main outcome measure was the over all score in the BLS knowledge. Knowledge of BLS was assessed as per the data contained in the Basic life support manual from American Heart Association. Results: Out of 212 members 109 were 3rd year students and 85 were final year students and 18 faculty members. The overall knowledge score was 33.7%. Overall results were poor with less than minimum knowledge on the topic BLS. A score of less than 50% was evident in the study indicating a poor knowledge of BLS among both the students and the faculty.The range of correct answers were 3-11 among students and 4-6 among the staffs. A significant difference (p


INTRODUCTION
Basic life support (BLS) is a simple life saving protocol following a cardiac arrest. It is an integral part of emergency resuscitative care that aims to retain sufficient ventilation and circulation until the cause of the arrest is detected and eliminated. 1 As health care professionals, dental practitioners encounter life-threatening medical emergencies. A study by Muller et al 2 , found that medical emergencies are no rare in dental practise, as about twothirds of dentist faced at least one emergency during the 12 month study period. Early initiation of cardiopulmonary resuscitation by witnesses increases survival after cardiac arrest. In turkey 3 it is rare that basic life support is initiated by a layperson in the contest of medical emergencies, provision of a competent BLS carries a potential impact on lives. It is recommended that all dental students and staffs, who are exposed to patients, must be trained to offer basic life support. Data from previous studies suggest that more than 3 million sudden cardiac death occur worldwide every year and survival is lower than 8%. [4][5][6] It has also been estimated that by the end of present decade, 60% of world's heart disease is expected to occur in India and proportionately the incidence and prevalence is expected to rise 4 . It is very important for every medical/dental professionals to know about CPR to save life and improve overall quality of the community health. But low confidence among dental students in performing CPR has been reported from Europe 1 . Different reports have described the knowledge of BSL among health care professionals 2-4 . Chandrasekaran et al, 7 evaluated the knowledge of BLS among healthcare students and professionals and found that the study subjects were severely lacking in BLS knowledge. The American Heart Association (AHA) resuscitation guidelines recommend that all under graduated students who are in contact with the patients should have regular resuscitation training 3 . Reddy et al 8 assessed the knowledge of BLS among bachelor of dental surgery clinical students, dental interns, postgraduate students and dental faculty in dental school in India. The study concluded that postgraduate students and faculty had significantly poorer knowledge when CPR is controlled by guidelines developed by certain associations such as American heart association 11 and some other associations in Europe 12 Singapore 13 Australia, and New Zealand. 14 These guidelines are updated regularly to cope with new advances in this field. In India, the undergraduate curriculum as proposed by the Dental Council of India (DCI) includes medical emergency management under the subjects of general medicine and oral and maxillofacial surgery. 15 Keeping this in mind, only III, IV, V years (clinical dental students) along with the faculty were included in the study. Nevertheless, there is no detailed information regarding BLS knowledge and attitude among dental students and staff in dental schools in Kerala.
The aim of the present study is to assess and compare the level of knowledge and attitude toward BLS among bachelor of dental clinical students, staffs at Al-Azhar dental college Thodupuzha.

II. MATERIALS AND METHOD
A Cross sectional survey was conducted in Al Azhar dental college (during Feb 2018) among 212participants including dental students and the faculty members to assess the knowledge and attitude towards basic life support. The sample size of 212 which includes 66 males and 146 females. Ethical approval was obtained from the Institutional review board. The sample is divided into two sections 3 rd ,4 th year students and faculty which includes 194 students and 18 faculty members. The questionnaire was adapted from the survey used by Shantachandrashekaran7 in a previous study with some modification. Data collection was done by distributing questionnaires among the students and staffs during the clinical and lecture time with prior permission. Questionnaire included 20 closed questions each to evaluate the knowledge and attitude of BLS respectively. Participants had four different options to answer the knowledge questions. For every correct answer a score of 1 was assigned and a score of 0 for every incorrect. The questions were incorporated after going through various literature related to that, which consisted of self-prepared 20 basic questions regarding adult and child BLS, including the experience and attitude of the participants to BLS, theoretical and practical knowledge of the participant to BLS and previous experience and exposure to BLS. The questionnaire prepared was then assessed by carrying out a pilot study among the experienced medical fraternity, and the necessary corrections were made accordingly. The answers were received on the next day of the survey and analyzed. Incomplete responses were excluded from the study. The professional qualifications of the participants were considered. Statistical analysis was performed using SPSS software 20.0.Significance level was kept at 5%.  Out of 212 responders 109were third year dental students, 85 were final year students and 18 faculty members. Ninty four percentage(94%) of the responders knew the abbreviation of BLS as Basic life support. More than half of the participants (62%) failed to insist on looking for safety as the first step in BLS. Majority of the participants (80%) failed to insist on activating EMS immediately after confirming the unresponsiveness in an adult.Around 70%responders did not know that the correct location of chest compression in an infant was one finger breadth just below the nipple line. Majority (77.5%) the responders did not know alternative techniques of resuscitation when mouth-to-mouth ventilation was not opted. Almost all of the participants (99.5%) of the responders failed to select mouth-to-mouth and nose technique as the rescue breathing for infants. Forty nine percentage participants did not know that the depth of chest compression in an adult was 1.5 to 2 inches. Lack of knowledge regarding the depth of chest compression in a child was one-third to onehalf the depth of the chest was 72%. Eighty percentage did not know that the chest compression in an infant was onethird to one-half the depth of the chest. Only 18% of the responders answered the rate of chest compression as 100/minute in adults and children CPR.Only 33% of the responders had correctly answered that the compression ventilation ratio in a child and adult single rescuer CPR was 30:2. Only 20% knew that the ratio of compression ventilation in a new born was 3:1. Responders did not know that the abbreviation of AED was 'automated external defibrillator' was 80 % and only 25% cent knew that the abbreviation of EMS was 'Emergency Medical Service'. Fourty five (45%) % did not know that the first step in helping a suspected foreign body obstruction victim is to confirm the severity of obstruction by talking to him. Only 31.5% of the responders did not know the early signs of stroke and only 14% per cent knew how to recognise and help a patient with acute coronary syndrome.The overall knowledge score was 33.7%. No participants had complete knowledge on BLS. Table 2

IV.
DISCUSSION The present study assessed knowledge of students and faculty regarding BLS in a private dental college in southern Kerala.The study showed that dental students and faculty in the study group were lacking in the awareness of BLS. Awareness of BLS was poor in all the students. This study emphasized the cognitive approach to the general perception and skills of Basic Life Support, early recognition of stroke and acute coronary syndrome. The practising and teaching doctors in this study scored less this explained why many dental doctors were not good in carrying out effective CPR. 16 It is now essential to standardise training in advanced life support and make it a mandatory component of all dental school undergraduate curricula. It is also equally important that teachers, school children, public and all lay persons from the community be taught the facts of basic life support and first. Study population with positive knowledge score was 33.7%.A similar finding was observed in studies conducted by Shanthachandrashekaret al 7 and inadequate knowledge on BLS. A different and positive finding was reported by the study conducted by Malford TPet al. 17 The range of correct answers given by students was 6-11, whereas it is surprising and alarming that the same with faculties were in range of 4-6. Although the mean knowledge score is significantly differ from the student's, the negligible number of staff population must not be a representative population. The present study report that the students have a negative attitude ie mere 33.7% responded positively to the attitude and practical based questions. Lack of professional training of BLS was regarded as the most common hindering factor responsible for poor BLS knowledge by dental students. [18][19][20] Baduni N et al 21 reported score of 9.2 ±1.2 among dental practitioners which is better than the present study where mean score was 6.5. The majority of the study participants of the present study reported that BLS training should be a part of the dental curriculum and raised the point that there was no professional training available. A recommendation to  24 reported that a considerable portion of the study population in the respective studies had knowledge scores below average and recommended that proper strategies should be devised to bridge the lacunae in the knowledge.

V. CONCLUSION
The findings of the present study demonstrates poor knowledge (33.7%) among dental students regarding BLS and showed the urgent need for continuous refreshing courses for this critical topic.

VI.
ACKNOWLEDGMENT Authors would like to acknowledge all the survey participants.

VII. LIMITATIONS AND RECOMMENDATIONS
This study has some limitations that should be taken into consideration. One possible limitation is the likelihood of selection bias given that dental students who chose to participate in the survey may be keener interested or concerned with CPR than those who did not participate. Therefore, the results are likely not generalizable to nonrespondents. In addition, a general limiting characteristic of self-reporting survey is the probability of socially acceptable responding, Nonetheless, despite these limitations, the study provides some important information about Al Azhardental students, Kerala knowledge and attitude regarding principles of BLS.