Abstract
BackgroundOutbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown.MethodsA cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals’ attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed.ResultsAmong 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP.ConclusionsOutbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions.
Highlights
Bystander cardiopulmonary resuscitation (BCPR) is vital to improve the survival of patients experiencing out-of-hospital cardiac arrest [1, 2]
Taiwan is a developed island country with a 23.59 million population spread across a total land area of 36,197 km2, which was expected to have the second highest number of COVID-19 cases owing to its proximity to and number of flights to and from China [21]; it has had a low incidence of confirmed COVID-19 cases [22]
We developed a structured questionnaire that was reviewed and modified under the consensus reached by three emergency physicians who are qualified as emergency medical service (EMS) medical directors with over 5-year EMS experiences, two experienced paramedics, two CPR-trained nonmedical laypersons, and one survey expert and statistician to improve clarity and brevity
Summary
Bystander cardiopulmonary resuscitation (BCPR) is vital to improve the survival of patients experiencing out-of-hospital cardiac arrest [1, 2]. The epidemic outbreak of an emerging infectious disease (EID), such as COVID19, may have a more negative impact on the BCPR rate for patients experiencing out-of-hospital cardiac arrest [7,8,9,10] because of the fear of getting infected while breaking social distancing rules [11, 12] and helping such patients by coming in close proximity. Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use.
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