European Resuscitation Council Guidelines 2021: First aid

Water Versus Electrolyte Rehydration on Vocal Fold Osmotic and Oxidative Stress Gene Expression

OBJECTIVES

Systemic dehydration may induce osmotic and oxidative stress in the vocal folds, but our knowledge of the biology and mitigation with rehydration is limited. The purpose of this experiment was to evaluate whether systemic dehydration induces vocal fold oxidative and osmotic stress and to compare the impact of rehydration by water intake versus electrolyte intake on osmotic and oxidative stress-related gene expression.

METHODS

Four-month-old male Sprague-Dawley rats (N = 32) underwent water restriction. Rehydration was achieved with ad libitum access to water or electrolytes for 24 hours. Rats were divided into four groups: euhydration control, dehydration-only, dehydration followed by either water or electrolyte rehydration (n = 8/group). Gene expression was assessed via RT2 Gene Expression Profiler arrays.

RESULTS

With respect to oxidative stress, 10 genes were upregulated and 2 were downregulated after vocal fold dehydration compared with the euhydrated control. Concerning osmotic stress, six genes were upregulated with dehydration only, six genes were upregulated following rehydration with water, whereas a single gene was upregulated with electrolyte rehydration. All genes with significantly different expression between the rehydration groups showed lower expression with electrolytes compared with water.

CONCLUSIONS

The results support a potential role of oxidative and osmotic stresses in vocal folds related to systemic dehydration. The differences in stress-related gene expression in vocal fold tissue between rehydration with electrolytes or water, albeit modest, suggest that both rehydration options offer clinical utility to subjects experiencing vocal fold dehydration with preliminary evidence that electrolytes may be more effective than water in resolving osmotic stress.

LEVELS OF EVIDENCE

NA (prospective animal study) Laryngoscope, 2024.

Using generative artificial intelligence in bibliometric analysis: 10 years of research trends from the European Resuscitation Congresses

Aims

The aim of this study is to use generative artificial intelligence to perform bibliometric analysis on abstracts published at European Resuscitation Council (ERC) annual scientific congress and define trends in ERC guidelines topics over the last decade.

Methods

In this bibliometric analysis, the WebHarvy software (SysNucleus, India) was used to download data from the Resuscitation journal's website through the technique of web scraping. Next, the Chat Generative Pre-trained Transformer 4 (ChatGPT-4) application programming interface (Open AI, USA) was used to implement the multinomial classification of abstract titles following the ERC 2021 guidelines topics.

Results

From 2012 to 2022 a total of 2491 abstracts have been published at ERC congresses. Published abstracts ranged from 88 (in 2020) to 368 (in 2015). On average, the most common ERC guidelines topics were Adult basic life support (50.1%), followed by Adult advanced life support (41.5%), while Newborn resuscitation and support of transition of infants at birth (2.1%) was the least common topic. The findings also highlight that the Basic Life Support and Adult Advanced Life Support ERC guidelines topics have the strongest co-occurrence to all ERC guidelines topics, where the Newborn resuscitation and support of transition of infants at birth (2.1%; 52/2491) ERC guidelines topic has the weakest co-occurrence.

Conclusion

This study demonstrates the capabilities of generative artificial intelligence in the bibliometric analysis of abstract titles using the example of resuscitation medicine research over the last decade at ERC conferences using large language models.

An Online-Based Survey to Assess Knowledge, Attitudes, and Barriers to Perform First Aid after Road Accidents Conducted among Adult Jordanians

(1) Background: First aid administered during road accidents can save millions of lives. However, the knowledge and attitudes of the Jordanian population towards first aid are lacking. This study aimed to examine the knowledge, attitudes, and barriers to performing first aid among the Jordanian population during road accidents. (2) Methods: An online questionnaire was developed and distributed using various Jordanian social media platforms. The questionnaire collected the participants' sociodemographic details and assessed their first aid knowledge, attitudes toward first aid, and barriers preventing the participants from performing first aid in emergencies. (3) Results: 732 participants participated in this study. The median knowledge score regarding first aid items was 9 (7-10) out of the maximum possible score of 15. The median first aid attitude score was 24 (22-27) out of a maximum possible score of 30. The most commonly reported barrier to performing first aid among the participants was "lack of first aid training" (76.78%), followed by "lack of knowledge about first aid" (75.81%) and "fear of performing first aid" (57.51%). The participants with lower income levels exhibited more negative attitudes towards first aid (4). Conclusions: This study underscores the urgent need for enhanced first aid training and awareness in Jordan. The participants' first-aid knowledge overall was limited, although positive attitudes toward first-aid delivery were observed. The findings emphasize the need for regular and structured first-aid training courses, addressing barriers such as fear and misinformation and ensuring accessibility across all socioeconomic levels to improve preparedness for road traffic accidents and other emergencies. This comprehensive approach can better equip the Jordanian population to effectively manage emergencies and improve public health outcomes.

Public first aid education model design study based on user experience

Background

Presently, China's first aid penetration rate remains relatively low, leaving ample room for improvement in the existing first aid education model. Given its role as a service for the general public, public first aid education must thoroughly consider the learning needs and experiences of the public when designing the teaching mode.

Methods

Semi-structured interviews were employed to gather detailed insights into participants' experiences in the first aid learning process. Subsequently, NVivo was utilized to analyze the interviews and identify specific design strategies. Additionally, a 7-point scale questionnaire was employed to assess the intervention effects of music familiarity and the simulation of teaching aids on users' willingness and confidence in learning. Building upon the design strategy, a "feedback device + app" approach was proposed. Finally, user satisfaction was evaluated through a scale questionnaire.

Results

The use of familiar music had a significant positive effect on participants' willingness and confidence to learn, while users' fear of teaching aids had no effect on willingness and confidence. The user experience-based first aid education model can better meet the public's learning needs for first aid knowledge and skills.

Conclusion

This study proposes a first aid education model based on user experience design methodology, which optimizes the public's self-learning experience by evoking positive emotions while circumventing negative emotions. The educational model was recognized by users in terms of design concepts and is expected to help increase first aid prevalence in the future.

Evaluation of a newly developed first aid training programme adapted for older people

BACKGROUND

Older people need to acquire knowledge and skills at first aid (FA) training tailored to them. Our research aimed to evaluate an FA training programme adapted for older people. We assumed that satisfaction with FA training, as well as knowledge of FA, would be higher among older people who received training according to an adapted programme compared to those who received training according to the existing programme for the general public.

METHODS

We trained older people according to the existing FA programme for the general public and according to a new FA training programme adapted for older people. The new training program is shorter and focuses on FA contents that are more relevant for older people. We evaluated participants with a general assessment questionnaire (consisting of items regarding satisfaction, comprehensibility, length, and physical difficulty), a test on theoretical FA knowledge, and a test on practical cardiopulmonary resuscitation (CPR) knowledge. To ensure the homogeneity of the groups and to verify the impact on the results of the test of practical CPR knowledge, we also tested the participants regarding their psychophysical capabilities.

RESULTS

A total of 120 people completed the free FA training sessions. The general assessment questionnaire score of participants who were trained based on the new FA training program was 19.3 (out of 20), which was statistically significantly (p < 0.05) higher than that of those trained based on the old program (general assessment score of 17.1). Participants who were trained based on the new program scored an average of 8.6 points on the theoretical FA knowledge test, while those who were trained based on the old program scored an average of 7.1 points, which was statistically significantly (p < 0.05) lower. In both programs, the same average scores (7.5 out of 10 points) on the practical CPR knowledge test was achieved. However, participants who participated in the FA course adapted for the older people gained practical CPR knowledge in a shorter time. Older people with a greater psychophysical capacity were more successful in performing CPR, regardless of which FA training programme they received.

CONCLUSIONS

The effectiveness of FA training is greater if older people are trained in accordance with a targeted programme adapted to the psychophysical limitations of the older people.

Assessing Parental Competence and Self-Ratings in Management of Pediatric Type 1 Diabetes and Emergency Glucagon Administration-An Exploratory Observational Study

BACKGROUND

Parents of pediatric patients with type I diabetes require competence in hypoglycemia management and skills in glucagon administration to deal with potentially life-threatening severe hypoglycemia. We aimed to compare parents' subjective self-ratings to an objective expert assessment of competences and skills in dealing with severe hypoglycemia.

METHODS

We interviewed 140 participants to assess their subjective self-ratings. The objective expert assessments used a standardized clinical case scenario of severe hypoglycemia and a practical demonstration of glucagon administration.

RESULTS

The participants self-rated their competence in hypoglycemia management as good (5) or very good (6), and their skills in administering glucagon as acceptable (3) [Scale: very poor (1) to very good (6)]. In the standardized clinical case scenario, 1.4% (2/140) of participants named all relevant steps of severe hypoglycemia management. In the practical demonstration of glucagon administration, 92.9% (130/140) of participants committed at least one drug handling error; 52.1% (73/140) committed at least one drug handling error rated with high clinical risk.

CONCLUSIONS

We found discrepancies regarding participants' subjective self-ratings compared to their performance in the respective objective expert assessments. These discrepancies indicate a lack of error awareness and the need for intervention studies to improve competence in hypoglycemia management and glucagon administration.

Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system

BACKGROUND

Bristol Medical School has adopted a near peer-led teaching approach to deliver Basic Life Support training to first year undergraduate medical students. Challenges arose when trying to identify early in the course which candidates were struggling with their learning, in sessions delivered to large cohorts. We developed and piloted a novel, online performance scoring system to better track and highlight candidate progress.

METHODS

During this pilot, a 10-point scale was used to evaluate candidate performance at six time-points during their training. The scores were collated and entered on an anonymised secure spreadsheet, which was conditionally formatted to provide a visual representation of the score. A One-Way ANOVA was performed on the scores and trends analysed during each course to review candidate trajectory. Descriptive statistics were assessed. Values are presented as mean scores with standard deviation (x̄±SD).

RESULTS

A significant linear trend was demonstrated (P < 0.001) for the progression of candidates over the course. The average session score increased from 4.61 ± 1.78 at the start to 7.92 ± 1.22 at the end of the final session. A threshold of less than 1SD below the mean was used to identify struggling candidates at any of the six given timepoints. This threshold enabled efficient highlighting of struggling candidates in real time.

CONCLUSIONS

Although the system will be subject to further validation, our pilot has shown the use of a simple 10-point scoring system in combination with a visual representation of performance helps to identify struggling candidates earlier across large cohorts of students undertaking skills training such as Basic Life Support. This early identification enables effective and efficient remedial support.

Teacher Preparedness for Medical Emergencies in Belgian Classrooms: Studying Objective and Subjective First-Aid Knowledge

About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers’ objective first-aid knowledge—particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career.

Prehospital clinical practice guidelines for unintentional injuries: a scoping review and prioritisation process

BACKGROUND

Globally, millions of people die and many more develop disabilities resulting from injuries each year. Most people who die from injuries do so before they are transported to hospital. Thus, reliable, pragmatic, and evidence-based prehospital guidance for various injuries is essential. We systematically mapped and described prehospital clinical practice guidelines (CPGs) for injuries in the global context, as well as prioritised injury topics for guidance development and adolopment.

METHODS

This study was sequentially conducted in three phases: a scoping review for CPGs (Phase I), identification and refinement of gaps in CPGs (Phase II), and ranking and prioritisation of gaps in CPGs (Phase III). For Phase I, we searched PubMed, SCOPUS, and Trip Database; guideline repositories and websites up to 23^rd May 2021. Two authors in duplicate independently screened titles and abstract, and full-text as well as extracted data of eligible CPGs. Guidelines had to meet 60% minimum methodological quality according to rigour of development domain in AGREE II. The second and third phases involved 17 participants from 9 African countries and 1 from Europe who participated in a virtual stakeholder engagement workshop held on 5 April 2022, and followed by an online ranking process.

RESULTS

Fifty-eight CPGs were included out of 3,427 guidance documents obtained and screened. 39/58 (67%) were developed de novo compared to 19 that were developed using alternative approaches. Twenty-five out of 58 guidelines (43%) were developed by bodies in countries within the WHO European Region, while only one guideline was targeted to the African context. Twenty-five (43%) CPGs targeted emergency medical service providers, while 13 (22%) targeted first aid providers (laypeople). Forty-three CPGs (74%) targeted people of all ages. The 58 guidance documents contained 32 injury topics. Injuries linked to road traffic accidents such as traumatic brain injuries and chest injuries were among the top prioritised topics for future guideline development by the workshop participants.

CONCLUSION

This study highlights the availability, gaps and priority injury topics for future guideline development/adolopment, especially for the African context. Further research is needed to evaluate the recommendations in the 58 included CPGs for possible adaptation to the African context.

2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care

INTRODUCTION

Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel.

OBJECTIVES

We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel.

METHODS

We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

RESULTS

We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing.

CONCLUSIONS

This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.

Brief Training of Technical Bleeding Control Skills-A Pilot Study with Security Forces

Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical-practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical-practical training.

How to evaluate first aid skills after training: a systematic review

Background

To be able to help and save lives, laypersons are recommended to undergo first aid trainings. The aim of this review was to explore the variety of the elements of the measuring systems to assess the effects of first aid trainings on different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.

Methods

This systematic literature review used Scopus and PubMed databases and searched for studies published between January, 2000, and December, 2020. Out of 2,162 studies meeting the search criteria, 15 studies with quantitative and repeatable evaluation methods to assess first aid skills after first aid training for adults were included in the final analysis.

Results

Practical skills, especially on the ability to perform cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator, were the most studied first aid skills after first aid training. This evaluation was based on several standardized measurements and assessed often with the help of a combination of resuscitation manikin and observer. Evaluation methods of performance in other emergency situations are not well standardized. Questionnaires used to assess knowledge of first aid, though seemingly based on guidelines, were also not standardized, either. Emotional aspects of first aid (willingness or self-confidence) were evaluated by highly simplified questionnaires, and answers were graded by five-point Likert scale.

Conclusion

According to our review, the focus of evaluation methods after first aid training has been on practical skills and especially on CPR. Though the evaluation of first-aid knowledge seems to be straightforward, it is not performed systematically. Evaluation methods for emotional aspects are highly simplified. Overall, standardized measurements and evaluation methods to assess all aspects of first aid skills are needed.

Rescue Blankets as Multifunctional Rescue Equipment in Alpine and Wilderness Emergencies-A Narrative Review and Clinical Implications

The utilization of rescue blankets in pre-hospital emergency medicine exceeds protection from hypothermia and enhanced visibility by far. In this narrative review, we focus on emphasizing the alternative applications of these fascinating multifunctional tools in the pre-hospital setting. A literature search in PubMed^® and Web of Science^TM yielded 100 results (last update was on 8 July 2022), a total number of 26 of which were included in this narrative review. Nine articles assessing alternative functions of rescue blanket were further evaluated and described in more detail. In addition, we performed various experimental and observational trials to test the functionality of rescue practice in mountain emergency medicine. Newly fabricated rescue blankets proved to possess impressive robustness. We evaluated rescue blankets in their applicability to not only protect from hypothermia, but also as practical tools to treat catastrophic hemorrhage and bleeding limbs, to perform open pneumothorax chest seals in sucking chest wounds, to prevent damage to unprotected eyes on the glacier and as alternative instruments for transportation in the inaccessible areas. Rescue blankets are important rescue equipment in alpine and wilderness emergencies with multifunctional applications, and must be part of every personal medical kit.

Telenotarztsysteme im deutschen Rettungsdienst: eine nationale Sachstandserhebung

Hintergrund und Fragestellung

Bislang liegen nur wenige Daten über den aktuellen Ausbaustand von Telenotarzt(TNA)-Systemen im deutschen Rettungsdienst vor. In einer nationalen Befragung wurde der Sachstand zu Ausbau und Nutzung von TNA-Systemen erhoben.

Material und Methode

Durchführung einer Online-Befragung unter aktiv im deutschen Rettungsdienst tätigen Personen zum Vorhandensein eines TNA-Systems und dessen Ausgestaltung, zu Standardarbeitsanweisungen (SAA) für Rettungsfachpersonal in ausgewählten Einsatzszenarien sowie zu persönlichen Einschätzungen zum Themenkomplex TNA.

Ergebnisse

1023 Teilnehmer aus 77,1 % (n = 299) aller deutschen Rettungsdienstbereiche nahmen teil. 90,3 % (n = 270) der Bereiche hatten kein TNA-System, ein mindestens teilweiser Betrieb war in 9,3 % (n = 29) etabliert. Die Ausgestaltung ist heterogen, die SAA für Rettungsfachpersonal unterscheiden sich auch innerhalb einzelner Bundesländer und zwischen Bereichen mit und ohne TNA erheblich. Regionen mit TNA verfügen zu einem größeren Anteil über SAA und führen einzelne Maßnahmen häufiger durch. So ist eine intravenöse Analgesie durch den Rettungswagen (RTW) bei 0,8 % vs. 8,9 % (n = 1 vs. n = 76) der Teilnehmenden nicht vorgesehen, die Gabe von Acetylsalicylsäure bei akutem Koronarsyndrom ohne ST-Hebung erfolgt in 3,1 % vs. 23,1 % (n = 4 vs. n = 198) nicht. Bei der persönlichen Einschätzung zum Thema TNA besteht ein signifikanter Unterschied zwischen Bereichen mit und ohne vorhandenes TNA-System.

Schlussfolgerungen

Im deutschen Rettungsdienst sind in weniger als einem Zehntel der Bereiche TNA-Systeme in Betrieb und die vorhandenen Systeme sind sehr heterogen gestaltet. Gleiches gilt für das Vorhandensein von Standardarbeitsanweisungen. Dies legt nahe, dass bei nationaler Betrachtung relevante Unterschiede in der notfallmedizinischen Versorgungsqualität der Bevölkerung bestehen.

Graphic abstract

Impact of the Use of Simulated Patients in Basic First Aid Training on Laypeople Knowledge, Skills, and Self-efficacy: A Controlled Experimental Study

BACKGROUND

First aid training is a cost-effective way to improve public health, but the most effective methods to teach first aid are currently unclear. The aim of this research was to investigate the added value of simulated patients during first aid certification trainings.

METHODS

Occupational first aid trainings organized by the Belgian Red Cross between September 2018 and August 2019 were allocated to either training with a simulated patient or regular training, for the topics "stroke" and "burns." Participants' knowledge and self-efficacy related to these topics were assessed at baseline, directly after training and after 1 year. First aid skills for "stroke" and "burns" and participant satisfaction were assessed after training. Knowledge and self-efficacy were measured via a questionnaire, and skills were assessed during a practical skills test. Data were analyzed using generalized linear mixed model analyses.

RESULTS

A total of 1113 participants were enrolled, 403 in the simulated patient group and 710 in the control group. First aid knowledge and self-efficacy increased strongly immediately after training. These increases did not differ between groups, nor did the level of practical skills. The simulated patient group had a significantly increased retention in first aid knowledge after 1 year, compared with control, while retention in self-efficacy did not differ. Participant satisfaction with training was similar between groups.

CONCLUSIONS

Using simulated patients during occupational first aid trainings for laypeople did not improve outcomes immediately after training but did improve retention of first aid knowledge after 1 year. These results support the use of simulated patients during first aid training.

Effectiveness of Early Warning Scores for Early Severity Assessment in Outpatient Emergency Care: A Systematic Review

Background and Objectives

Patient assessment and possible deterioration prediction are a healthcare priority. Increasing demand for outpatient emergency care services requires the implementation of simple, quick, and effective systems of patient evaluation and stratification. The purpose of this review is to identify the most effective Early Warning Score (EWS) for the early detection of the risk of complications when screening emergency outpatients for a potentially serious condition.

Materials and Methods

Systematic review of the bibliography made in 2022. Scientific articles in Spanish and English were collected from the databases and search engines of Pubmed, Cochrane, and Dialnet, which were published between 2017 and 2021 about EWSs and their capacity to predict complications.

Results

For analysis eleven articles were selected. Eight dealt with the application of different early warning scores in outpatient situations, concluding that all the scoring systems they studied were applicable. Three evaluated the predictive ability of various scoring systems and found no significant differences in their results. The eight articles evaluated the suitability of NEWS/NEWS2 to outpatient conditions and concluded it was the most suitable in pre-hospital emergency settings.

Conclusions

The early warning scores that were studied can be applied at the pre-hospital level, as they can predict patient mortality in the short term (24 or 48 h) and support clinical patient evaluation and medical decision making. Among them, NEWS2 is the most suitable for screening potentially deteriorating medical emergency outpatients.

Awareness, attitude and perceived knowledge regarding First Aid in Kinshasa, Democratic Republic of Congo: A cross-sectional household survey

•

Prehospital emergency care systems in Africa need to be developed to address a growing burden of disease and improve outcomes.

•

Minimal data exist on First Aid (FA) in the low socioeconomic setting of Sub-Saharan Africa and the Democratic Republic of Congo (DRC) in particular.

•

A community-based evaluation can provide a better understanding of the nature and level of the gaps as perceived by community members in Kinshasa, DRC.

•

This evaluation offers a basis from which country-specific layperson FA training programmes could be developed and rolled out to equip Kinshasa's communities with lifesaving skills.

Introduction

Emergency care can potentially address half of deaths and one-third of disability in low-and-middle income countries. First Aid (FA) is at the core of out-of-hospital emergency care and is crucial to empower laypersons to preserve life, alleviate suffering and improve emergency response and outcomes. This study aimed to gauge FA awareness, the attitude and perceived knowledge in households in the low socioeconomic setting of Kinshasa, Democratic Republic of Congo (DRC).

Methods

We undertook a cross-sectional community-based household survey in twelve health zones in Kinshasa. A three-stage randomised cluster sampling was used to identify 1217 households. The head of each household or an adult representative answered on behalf of himself/herself and the household. The primary outcome was FA awareness, attitude and perceived knowledge.

Results

Most households had a poor socio-economic background, with 70.0% living on <US$100 per person per month. Most respondents received formal education (98.4%), with 37.6% reaching the tertiary level. The majority (77.6%) believed that an emergency requiring FA was likely to happen in their household. There was a noticeable contrast between awareness (90.0% asserted that FA knowledge is a necessity) and positive attitude regarding FA (91.3% believed that FA increases wellbeing and survival) on one hand, and the insignificant rate of FA training (0.2%) on the other. Most (83.6%) acknowledged they did not think they had the required basic FA knowledge and skills for five selected common life-threatening emergencies. The age, area of residence and level of education of participants played a variable role regarding FA awareness, attitude and knowledge.

Conclusion

Most participants reported inadequate knowledge of FA despite awareness and a positive attitude. Context-appropriate training programs are greatly needed to empower Kinshasa's communities and equip them with lifesaving skills.

How to improve public health literacy based on polycentric public goods theory: preferences of the Chinese general population

Background

In the current era of big data, it is critical to address people’s demand for health literacy. At present, the traditional mode of communicating scientific health knowledge and information technology is interchangeable, resulting in the emergence of a new mode of communicating health literacy. To publicize health education and health literacy in a targeted way, to meet the public’s needs, and to understand how the public’s demand for subjects, contents, and forms of health literacy service has changed in the era of COVID-19, the investigation of public’s demand for health information and health literacy was conducted.

Objective

This study aims to understand the differences in demand for health literacy service providers, contents, channels, forms, and facilities among Chinese citizens with different genders, ages, education levels, economic conditions, and living environments, and to provide reasonable recommendations for developing public health literacy.

Methods

Questionnaire Star was used to conduct a large sample of random online surveys. In Wuhan, Hubei Province, 2184 questionnaires were issued, 8 invalid questionnaires were eliminated, and 2176 were recovered, with an effective rate of 99.6%. IBM SPSS Statistics 20 was utilized to analyze the survey data.

Results

(1) In health literacy service providers selected by the public, the proportion of government departments or government collaboration with other institutions exceeded 73%, indicating that health literacy services are public goods; (2) access to health literacy services was lower in township areas than in urban areas (P < 0.001, 3) internet media and communicating with acquaintances, which have the highest popularity rate, were also the two channels that were least trusted by the public; and (4) the differences in contents and service channels of health literacy among residents with different genders, ages, education levels, economic status, and living environments were statistically significant.

Conclusions

(1) It is recommended to establish an integrated health literacy service model with multi-center supply. Government departments, medical institutions, and media should cooperate effectively to provide health literacy services. (2) The government should pay attention to the fairness of health education and strengthen the supply of health literacy services in township areas. (3) It is critical to strengthen the public’s ability to discriminate network information and pay attention to scientific thinking cultivation. (4) Health literacy service providers must focus on the differences between public demands and improve the connotation of health literacy services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13272-z.

Rescue blankets as multifunctional rescue equipment in alpine and wilderness emergencies: a commentary

Emergency applications of rescue blankets go far beyond protection from hypothermia. In this review alternative applicabilities of these remarkable multifunctional tools were highlighted. Newly fabricated rescue blankets prove impressive robustness. The high tensile strength along with its low weight enable further applications, e.g. immobilization of injured extremities, splinting, wound dressing, a makeshift chest seal in sucking chest wounds, amongst others. Furthermore, the foil can be used as a vapour barrier, as eye protection and it can even be used to construct a stopgap bivouac sack, as alternative tool for transportation in the remote area and a wind shield or a water reservoir in the wilderness. During search-and-rescue missions the light reflection from the gold surface enhances visibility and increases the chance to be found. Rescue blankets are essential parts of first aid kits and backpacks in alpine and wilderness environment with multifunctional applicabilities. In this commentary to a review we want to evaluate the numerous applicabilities of rescue blankets in the treatment of emergencies by wilderness medicine and pre-hospital EMS.

Resuscitation highlights in 2021

BACKGROUND

This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021.

METHODS

Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes.

RESULTS

98 papers were selected for brief mention.

CONCLUSIONS

Resuscitation science continues to evolve and incorporates all links in the chain of survival.

[ERC guidelines 2021 on cardiopulmonary resuscitation]

The current European guidelines on cardiopulmonary resuscitation were published in 2021. The guidelines, which are structured in 12 chapters, were supplemented with the chapters on epidemiology and life-saving systems. In the following article, the recommendations on basic life support, advanced measures for resuscitation in adults and postresuscitation treatment are discussed.

Rescue blanket as a provisional seal for penetrating chest wounds in a new ex vivo porcine model

BACKGROUND

Open pneumothorax after a penetrating thorax trauma is a life-threatening disease with high mortality. Emergency application of a chest seal allowing the release of trapped air is the optimum initial therapy until surgical chest drainage is available.

METHODS

In a newly developed experimental porcine model of open pneumothorax we tested three different materials regarding their applicability for acute treatment of sucking chest wounds in pre-hospital emergency care, namely a commonly used rescue blanket (RB), plastic foil from a gauze package (packaging material, PM) and a commercial chest seal (CS).

RESULTS

An ex vivo open pneumothorax model using a porcine chest wall and a vacuum-assisted drainage system was successfully established. Rescue blanket segments sized 70 x 100 mm achieved significantly higher rates of successful sealing than did plastic foils from a gauze package sized 100 x 100 mm when the devices were applied to the moistened chest wall and fixed on three sides (5/5 (100%) vs. 0/5 (0%), p=0.002). Loosely fixed rescue blankets efficiently released injected air (10/10, 100%) and consequently sealed the wound in all cases (10/10).

CONCLUSIONS

Rescue blankets, applied wet, are appropriate chest seals with good occlusive and adherence properties. Fixation on two sides of the dressing is sufficient to allow trapped air to exit and sufficient sealing of the chest wound. Rescue blankets were superior to plastic foils from a gauze package and were seen to function as a potent makeshift chest seal when no commercial chest seal is available.

[Pharmacological therapy of circulatory shock]

Circulatory shock requires treatment of the underlying pathology in addition to supportive pharmacological therapy that is guided by hemodynamic monitoring. Based on the evaluation of the patient's volume, perfusion and cardiac status, the following therapeutic goals should be achieved: (1) Normalization of the intra- and extravascular fluid volume. (2) Provision of sufficient perfusion pressure and organ perfusion. (3) Optimization of cardiac function including protecting an ischemic and exhausted myocardium from overload. The most important therapeutic substances are balanced electrolyte solutions and the vasopressor noradrenaline. Because there is little scientific evidence for the use of alternative drugs, these should only be given if there is a good pathophysiologic rationale and if their effect is continuously monitored and re-evaluated.