Verbal and visual information exchange in EMS-to-ED patient handovers: An observational and attitudinal study.

Death on Arrival (DOA) is a critical issue in emergency care, reflecting delays in early response, limited access to health services, and inadequate emergency preparedness at the community level. Patients who have undergone percutaneous coronary intervention (PCI), particularly those with a history of ST-elevation myocardial infarction (STEMI), remain at high risk for recurrent cardiac events, including sudden cardiac arrest. Limited family knowledge regarding basic life support (BLS) may contribute to delayed first aid and increased mortality. Therefore, this study aimed to improve BLS knowledge among families of post-PCI patients diagnosed with Anterior STEMI. This study employed a descriptive case study design conducted in the Merak Ward of Dr. M. Salamun Air Force Hospital from December 6 to December 8, 2025. The participant was the family of a post-PCI patient with a medical diagnosis of Anterior STEMI. Data were collected using basic life support standard operating procedures and structured observation sheets. The results indicated an improvement in the family’s knowledge of basic life support following the educational intervention. The family demonstrated better understanding and ability to recognize and respond to emergency situations related to cardiac and respiratory arrest. In conclusion, basic life support education effectively enhances the knowledge and preparedness of families of post-PCI patients. Improved family readiness may play a crucial role in early emergency response and potentially reduce the risk of Death on Arrival in patients with high-risk cardiac conditions.

Background: The incidence of cardiac arrest or Sudden Cardiac Arrest (SCA) in the community that cannot be saved increases every year. This is because they do not get the right and fast action due to the community's ignorance and inability to assist. Objective: This study aimed to evaluate health education on increasing knowledge and readiness of respondents in helping cardiac arrest victims. Methods: This study used a pre-experimental design with a one-group pre-post test approach to 52 respondents, namely the general public. The research sample was recruited using convenience sampling techniques. The sample was given health education on basic life support (BLS) and cardiac arrest management directly with several interactive sessions using visual aids such as posters and presentation slides. Data collection used a valid and reliable questionnaire (Knowledge and Readiness to Help). Data were analyzed univariately through frequency distribution, central tendency, mean difference, and bivariate tests using paired sample t-tests. Results: There was an increase in respondents' BLS knowledge from 6.87 to 11 (p<0.001) and readiness to help, with an average score increasing from 60.4 to 63.3 (p=0.002). These results indicate that health education can increase knowledge about BLS and readiness to help respondents. Research results show that readiness to act in emergencies depends on more than theoretical understanding; it also requires practical training, self-confidence, and direct experience. Conclusion: Health education significantly improved public knowledge and readiness to provide first aid for cardiac arrest victims. These findings indicate that structured Basic Life Support (BLS) education is effective in strengthening community preparedness and timely emergency response. Integrating regular and practical BLS training into community health programs may further enhance public capacity to respond to cardiac arrest events.

Proper basic life support (BLS) skills are crucial for laypeople and health care professionals to increase the survival of cardiac arrest patients. A practical examination at the end of a BLS course may be beneficial for prolonging skill retention. We aimed to investigate the efficacy of our BLS training and the effect of BLS practical examinations on skill retention among fifth-year medical students compared with the effect of additional practice and continuous assessment. In this randomized, assessor-blinded, parallel group study, fifth-year medical students took a practical BLS examination ("practical examination" group) or participated in an additional 30-minute practice with continuous assessment ("additional practice" group) two weeks after a 90-minute intrahospital COVID-19 BLS training. BLS skill retention was assessed two weeks, two months and one year later, and the results of the two groups were compared. Fourteen elements of BLS were evaluated during the skill retention assessments. Descriptive statistics and Mann‒Whitney and Fisher's exact tests were used for statistical analysis. Thirty-two voluntary students were included (practical examination: n = 17, additional practice: n = 15), with no significant differences in basic characteristics (age: p = 0.891; gender: p = 0.999; previous BLS education: p = 0.469; previous participation in BLS: p = 0.678; planning to work in emergency medicine or critical care: p = 0.471). BLS skills were satisfactory during all skill retention assessments, except for the application of protective equipment and depth of chest compressions. More students placed surgical masks on patients' faces in the additional practice group during the first skill retention assessment (p = 0.005). However, this difference disappeared over time, and both groups performed poorly in the application of protective equipment. The activation of the chain of survival and high-quality chest compressions were acceptable during all the skill retention assessments. There was no significant difference in overall BLS skill retention between the two groups (total score after two weeks: p = 0.764; after two months: p = 0.542; after one year: p = 0.791). The BLS course provided by our department was effective; however, the BLS practical examination did not offer a significant advantage in terms of skill retention compared to additional practice and continuous assessment in our student population. Not applicable.

Drowning and suicide are interconnected complex phenomena and represent significant Public Health issues. The aim of this paper was to identify and describe the characteristics and factors associated with intentional drownings in Galicia (Spain), analyzing a retrospective cohort of twenty-one years. A descriptive, retrospective, and longitudinal study (2001-2021) was conducted analyzing a cohort of patients aged 0 to 100 years who were treated by Basic and Advanced Life Support (BLS/ALS) units of the FPUS 061 and by hospitals within the Galician Health Service (SERGAS). Records coded with a diagnosis of drowning or near-drowning were included and were recoded as fatal or non-fatal drowning according to international recommendations. Additionally, records containing the terms suicide, self-harm, or suicide attempt in prehospital or hospital documentation were also included. Ninety-nine cases were documented, representing 9% of all drownings in Galicia and 14% of individuals aged over sixty five who drowned. Eighty-two percent of the victims were residents of the municipality where the incident occurred, and 60% were women. Ninety-nine percent had a prior diagnosis of mental health disorder. Individuals over sixty five accounted for 53% of the cases, with a mortality rate of 50%. The presence of witnesses was associated with lower mortality. There is a relationship between intentional drownings and mental health disorders. In these events, the presence of witnesses is a protective factor, while advanced age is a risk factor for mortality. Intentional drowning is a complex and understudied health issue, so prevention and Public Health strategies should be implemented to reduce these preventable deaths.

ABSTRACT OBJECTIVES Pediatric patients represent a high-risk, low frequency population in emergency medical services (EMS) systems. Quality improvement (QI) is the backbone of high-quality care delivered in EMS and engagement in pediatric-specific QI work is a core domain of the National Prehospital Pediatric Readiness Project (PPRP). There is no widely accepted set of quality measures that focus on the full scope of pediatric prehospital care. Our objective was to establish core PPRP Quality Measures for a National EMS Information System (NEMSIS)-derived pediatric prehospital dashboard to support pediatric QI initiatives. METHODS We convened a 16-member technical expert panel (TEP) from national professional societies and federal entities. The TEP included physicians, nurses, EMS clinicians, federal partners, state EMS officials, and NEMSIS staff. Candidate measures were identified through a review of national resources and a survey of TEP members. The TEP employed a modified Delphi process to establish consensus priorities and scored measures based on the National Quality Forum Measure Evaluation Criteria. Candidate measures were prioritized based on scientific acceptability, importance to patient outcomes, utility in driving improvements, and feasibility of collection. Candidate measures were scored on a scale of 1 (lowest priority) to 5 (highest priority). Consensus was defined as 75% of the TEP rating a measure ≥ 4. RESULTS The TEP identified 65 candidate measures. After three rounds of voting, consensus was achieved on 24 measures addressing a range of common pediatric prehospital conditions, including airway management (5 measures), trauma (4), pain control (3), respiratory emergencies (3), cardiac arrest (2), anaphylaxis (1), shock (1), seizures (1), hypoglycemia (1), newborn emergencies (1), non-transport (1), and safe transport (1). Thirteen (54%) of these measures apply to basic life support (BLS) teams. Common reasons for excluding measures included: limited scientific evidence, measure complexity, and redundancy. CONCLUSIONS A TEP identified 24 quality measures in pediatric EMS that emphasize foundational practice and relevance across a range of volumes and service models. Future validation of these measures with NEMSIS data are needed to establish benchmarks of care across variably resourced EMS agencies and develop effective strategies to support adherence to high-quality pediatric prehospital emergency care.

Abstract Background In‐hospital cardiac arrests present significant challenges for healthcare facilities. Basic life support (BLS) training for nonphysician employees is crucial to strengthening the in‐hospital chain of survival, yet this high‐stakes, infrequently used skill has received limited research attention. Objectives This study evaluated the learning effectiveness and learner experiences during a renewal of the institutional BLS course for nonphysician employees. Methods A 2‐year prospective, comparative, mixed‐methods study was conducted at a tertiary medical center in Taiwan. Participants included nurses, nonclinical healthcare providers, administrative staff, and research assistants. The renewed course incorporated flipped learning, team‐based practice, technology‐enhanced learning, and real‐time feedback. Follow‐up assessments at 3 months included written and skills tests, and participants also completed one‐on‐one interviews. Quantitative results were analyzed statistically, and qualitative data were thematically analyzed. Results From April 2021 to July 2023, 68 BLS courses trained 2052 participants. Follow‐up results showed a significant decline in knowledge and skills, but the renewed course improved retention in specific skills, including pulse check ( p = 0.03), chest compression location ( p = 0.04), and rechecking pulse after compressions ( p = 0.004). Interview themes highlighted factors facilitating learning, such as interactive methods and real‐time feedback, and revealed prevalent emotions including worry, nervousness, and hesitation. Conclusions Integrating evidence‐based teaching strategies can enhance skills’ retention in BLS training for nonphysician hospital staff. Given the emotional stress reported, future courses should address both technical competencies and emotional preparedness to improve confidence and performance in real emergencies.

Blended learning versus virtual reality and traditional methods in cardiopulmonary resuscitation training: a randomized trial in university students

Despite evidence demonstrating that severely injured patients treated at trauma centers have improved outcomes relative to those treated at nontrauma centers, rates of undertriage (transportation of severely injured patients to nontrauma centers) remain high. While national expert panels have developed field trauma triage (FTT) guidelines to aid in the triage of injured patients, the impact of the implementation of these guidelines on existing triage patterns is unknown. To examine the association between the 2015 update to FTT guidelines and trends in trauma triage in a mature trauma system in Ontario, Canada. This retrospective, population-based cohort study was conducted from April 1, 2009, to March 31, 2020, among individuals aged at least 16 years who presented to hospital with a traumatic injury in Ontario, Canada. Statistical analysis was conducted from October 2023 to October 2025. Implementation of the 2015 update to the FTT guidelines as specified in version 2.1 of the Ontario Basic Life Support Patient Care Standards. The exposure was divided into 3 timeframes: pre-FTT (April 1, 2009, to June 30, 2014), implementation (July 1, 2014, to May 2 31, 2015), and postimplementation (June 1, 2015, to March 31, 2020). Patients were categorized as undertriaged, overtriaged, or appropriately triaged based on hospital of presentation and presence of a severe injury (defined as Injury Severity Score [ISS] ≥16 or death within 24 hours of injury). Interrupted time series analysis was used to estimate temporal trends in triage rates and variations in these rates associated with the updated FTT guidelines, adjusting for differences in sociodemographic and injury characteristics. Of 281 268 patients with traumatic injury (mean [SD] age, 62.4 [22.5] years; 141 450 [50.3%] female; median [IQR] ISS, 4 [4-9]) included, 53 870 (19.2%) presented directly to a trauma center. Among patients who presented to a trauma center, 28 494 (52.9%) had a minor injury. Population-level rates of undertriage and overtriage were 63.5% and 12.3%, respectively. At the population level, the implementation of updated FTT guidelines was associated with a 15.2% instantaneous decrease in undertriage (rate ratio [RR], 0.85; 95% CI, 0.77-0.94). Conversely, there was no instantaneous change in overtriage (RR, 0.90; 95% CI, 0.79-1.04). During the 5 years after implementation, rates of undertriage increased by 2.4% per year (RR, 1.02; 95% CI, 1.02-1.03) while overtriage decreased by 3.8% annually (RR, 0.96; 95% CI, 0.95-0.97). Across trauma centers, the updated FTT guidelines were associated with a 14.4% instantaneous decrease in the proportion of patients with minor injuries presenting to a trauma center (RR, 0.86; 95% CI, 0.77-0.95). During 5 years after implementation, the rate at which patients with minor injuries presented directly to a trauma center remained constant (RR, 1.00; 95% CI, 0.99-1.01). In this cohort study, the implementation of updated FTT guidelines was immediately associated with a 15% decrease in undertriage without an increase in overtriage. After the implementation of these guidelines, rates of undertriage increased by 2% each year. These findings suggest that FTT is effective in decreasing undertriage; however, ongoing monitoring is required to ensure that these benefits are maintained.

Cardiac Arrest Care in Resource-Limited Settings.

BackgroundHealth care professionals must stay updated with the latest guidelines for basic life support (BLS) and advanced cardiac life support (ACLS) to effectively assist patients during cardiac emergencies. Since its launch in 2018, the Ghana Heart Initiative has significantly enhanced the skills and knowledge of health care professionals in managing cardiovascular diseases, including cardiac emergencies.ObjectiveThis study aims to assess the knowledge and skills of BLS and ACLS among health care professionals immediately after training in Ghana.MethodsThis cross-sectional, training-based study involved 541 and 302 health care professionals trained in BLS and ACLS, respectively. Among them, 229 BLS and 124 ACLS-trained participants completed the questionnaires immediately after the training, and their data were included in the final analysis. Knowledge was assessed using a standardized questionnaire and an instructor-led skills evaluation based on the updated 2018 and 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.ResultsThis study shows that 74.6% (171/229) of the health care professionals had adequate knowledge and skills in BLS. Those working in tertiary health care facilities were 80% less likely (adjusted odds ratio [AOR] 0.20, 95% CI 0.07-0.59; P=.003) to have adequate BLS knowledge and skills than those in primary health care facilities. Health care professionals from regions such as Volta and Oti were 4.94 times more likely to have adequate BLS knowledge and skills compared to those from Bono East (AOR 4.94, 95% CI 1.17-20.80; P=.03). Over 73.3% (91/124) of health care professionals had adequate knowledge and skills in ACLS. Males were 7.05 times more likely (AOR 7.05, 95% CI 2.69-18.46; P<.001) than females to possess adequate ACLS knowledge and skills.ConclusionsGiven an opportunity to learn and practice, health care professionals in Ghana attain adequate knowledge and skills in BLS and ACLS.

Surgical site infections(SSIs) represent a significant healthcare concern, contributing to increased morbidity, mortality, and costs. This study examined perioperative infection control practices among operating room nurses in Rinconada hospitals, analyzing the relationship between demographic profiles and infection prevention practices across all surgical phases. A descriptive research design was employed using a structured questionnaire administered to 53 operating room staff nurses through total enumeration. Data were analyzed using percentage technique, weighted mean, and chi square test to determine associations between demographic variables (age, sex, task performed, length of service, and training) and infection control practices during pre operative, intraoperative, and post-operative phases.The respondent were predominantly female (81.13%), aged 18-24 years (28.30%), with 1-5 years of service (47.17%). Most performed ward nurse duties (48.78%) and possessed basic life support training (47.17%). All perioperative phases demonstrated high adherence to infection control practices: pre-operative (weighted mean=4.19), intraoperative (weighted mean=4.14), and post-operative (weighted mean=4.18).

Automated External Defibrillators (AEDs) are critically important for rapid intervention in cases of sudden cardiac arrest. For this reason, their presence in crowded places such as shopping malls and airports has become a legal requirement in some developed countries. However, for effective use, trained individuals must also be available. Considering that first aid may be needed at any moment, promoting the use of AEDs is highly significant. In this context, it is essential to provide hands-on basic life support training and ensure access to the necessary equipment during the training process. Most current training devices offer only voice commands, which creates accessibility barriers for individuals with hearing impairments. In this study, a microcontroller-based AED training device prototype has been developed. Compared to existing devices, it offers improved features such as visual instructions via an LCD screen, color-coded LED alerts for each step, and remote control through an Android application.

Comparing the blend of manikin based simulation and virtual reality based training with mixed reality based training for basic life support: a randomized control trial

Hypertension is a chronic condition that often remains asymptomatic but is associated with a high risk of perioperative complications. In adults, hypertension is classified as essential or secondary, while in pregnancy it presents as gestational hypertension or preeclampsia, which may progress to HELLP syndrome. Patients with hypertension undergoing surgical procedures are at increased risk of complications, including stroke, arrhythmias, and mortality, particularly when blood pressure is poorly controlled. Certain anesthetic agents, such as sevoflurane and propofol, may induce significant hypotension, highlighting the importance of comprehensive pre-anesthetic assessment. The AMPLE approach (Allergy, Medication, Past Medical History, Last Meal, Environment/Event) serves as a systematic method to identify perioperative risks and support safe anesthesia planning.Preliminary observations at Bangli Regional Hospital reported 20–30 surgical cases with comorbid hypertension per month, including 10–20 cases of gestational hypertension. To address this issue, a community service program was conducted to provide education on pre-anesthetic assessment using AMPLE and Basic Life Support (BLS) training for patients’ families. The program was positively received, with participants demonstrating appropriate BLS techniques and actively engaging during counseling sessions. These findings suggest that routine implementation of AMPLE education and BLS training may enhance family preparedness and patient safety in perioperative and emergency situations.

This study examined public attitudes and experiences in using the Internet for first aid guidance in real-life medical emergencies. The study involved: (1) an analysis of YouTube comments (n = 6,786) on first aid videos using latent Dirichlet allocation topic modeling; (2) a survey of completers of an online Basic Life Support course (n = 731). Topic modeling of social media comments revealed users' frustration with unskippable advertisements, reflecting a collective perception of online videos as a source of immediate advice on first aid in real-life emergencies. According to the survey data, 14.6% of respondents sought online first-aid instructions during a real-life emergency. An additional 8.9% reported similar experiences among friends or relatives. Of those who searched for advice, 90.7% found and implemented instructions. Most respondents showed readiness to attempt this in future as they believe it could be lifesaving. The existing public demand for, and continued use of, the Internet as a source of advice on first aid, the risks arising from laypeople's reliance on information of questionable quality, and the potential usefulness of authoritative digital guidance for instances where other means of assistance are unavailable constitute an intricate public health issue that requires attention and comprehensive solutions.

Codeveloped by the American Heart Association and the American Academy of Pediatrics, this publication presents the 2025 guidelines for basic life support during cardiopulmonary resuscitation and emergency cardiovascular care of the pediatric patient, excluding the newborn infant, and represents the first comprehensive update of treatment recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines are for lay rescuers and health care professionals with recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. Existing guidelines remain relevant unless specifically updated in this publication. Topics reviewed include the initiation of cardiopulmonary resuscitation; pulse check; components of high-quality cardiopulmonary resuscitation; chest compression technique; support surfaces for cardiopulmonary resuscitation; opening the airway; coordination of shock and cardiopulmonary resuscitation; types of defibrillators or automated external defibrillators; defibrillator paddle or pad size, type, position; treatment of inadequate breathing with a pulse; and foreign-body airway obstruction. Key topics that are new, are substantially revised, or have significant new literature include the elimination of 2-finger chest compressions in infants due to ineffectiveness of achieving proper depth with a recommendation of 1-hand or 2 thumb-encircling hands technique; the immediate application and use of an automated external defibrillator with a pediatric attenuator if available for cardiac arrest; and in infants with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 chest thrusts (no abdominal thrusts), and in children with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 abdominal thrusts. Key Words: AHA Scientific Statements • cardiopulmonary resuscitation • chest compressions • defibrillator • foreign body airway obstruction • heart arrest • shockable rhythm • ventilation.

Between 1/15,000–1/50,000 passengers suffer in-flight medical emergencies (IFME) with cardiac arrest accounting for 0.3 %. Confined space can have a negative impact on quality of chest compressions during cardiopulmonary resuscitation (CPR), thus we have conducted a randomized controlled study to find the most effective approach of performing CPR in a one – vs. two-rescuer method in a simulated airliner cabin. We randomized 20 healthcare professionals to perform a set of 10 min Basic Life Support (BLS, chest compressions and bag-mask-ventilation) in a one- vs. two-rescuer scenario and in confined space vs. open space in a randomized order using a full-body manikin. The primary outcome was compression depth as sensitive marker for differences in CPR-quality. The study was registered on clinicaltrials.gov (NCT02002481). Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that one- vs. two-rescuer method showed differences in no-flow-time (confined: 8.05 ± 0.17 vs. 24.25 ± 1.05 s/2min and open space: 7.51 ± 0.02 vs. 21.31 ± 0.43 s/2min; p < 0.001) and missing releases (confined: 27.09 ± 5.55 vs. 46.64 ± 9.66 number/10 minutes and open space: 27.09 ± 2.44 vs. 43.36 ± 6.4 number/10minutes; p < 0.001). A confined space significantly elevated no-flow-time in the two-rescuer-method vs. the one-rescuer-method (24.24 ± 1.06 s/2min vs. 21.26 ± 0.44 s/2min; p < 0.001), whereas compression frequency and compression depth were different but still within the current recommendations of ERC/AHA in both methods per condition. Limited space in an airliner cabin has significant impact on no-flow-time in a two-rescuer-method. In case of CPR and limited access to the patient, we recommend a one-rescuer-method as first approach to ensure early and high-quality CPR for experienced personnel.

ABSTRACTObjectivesTo evaluate the effectiveness of short-duration self-learning (SSL) and mastery learning (ML) strategies on the acquisition and 6-month retention of cardiopulmonary resuscitation (CPR) skills and basic life support (BLS) knowledge among hospital administrative staff in Thailand.DesignComparative assessment of two CPR training strategies.SettingTertiary-level academic institution in Thailand.ParticipantsA total of 163 hospital administrative staff aged ≥18 years without prior BLS certification were enrolled and randomly allocated to either the SSL group (n=82) or the ML group (n=81). Participants with previous CPR certification, medical limitations preventing chest compressions or those unwilling to attend the 6-month retention test were excluded. 71 participants in each group completed the 6-month follow-up.InterventionsAll participants viewed an 8 min self-directed instructional video on BLS and subsequently performed CPR practice using real-time feedback manikins. The SSL group practised independently for up to five 1 min sessions, while the ML group practised until achieving a predefined mastery threshold (QCPR (Quality Cardiopulmonary Resuscitation) score >90%).Primary and secondary outcome measuresThe primary outcome was CPR skill retention at 6 months, measured by QCPR overall performance score. Secondary outcomes included observational BLS performance (scene safety, responsiveness, emergency activation, breathing assessment and correct hand placement), knowledge retention scores and the number of attempts required to achieve mastery in the ML group.ResultsBoth SSL and ML groups demonstrated significant improvement in CPR performance and BLS knowledge immediately after training (p<0.001). At 6 months, no statistically significant differences were found between groups in CPR skill retention (mean difference 0.7%, 95% CI −1.9% to 3.3%, p=0.62) or BLS knowledge retention (mean difference 0.2, 95% CI −0.4 to 0.8, p=0.51). Female participants required more attempts to achieve mastery compared with males (mean 3.0 vs 2.1, p=0.007).ConclusionsBoth SSL and ML effectively enhanced CPR performance and knowledge retention among non-medical hospital staff. SSL offers a practical, resource-efficient and scalable approach for CPR training in large-scale community or institutional settings. Future studies should investigate the cost-effectiveness and optimal refresher frequency for sustaining CPR competency.Trial registration numberTCTR20210521003.

Manual bag-valve-mask ventilation during out-of-hospital cardiopulmonary resuscitation: a prospective observational study.