Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance

Abstract

IntroductionSurvival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting.MethodsA descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills.ResultsOverall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training.ConclusionOverall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

“…Multiple surveys in SSA have demonstrated that even clinicians including physicians do not have adequate basic life support (BLS) and advanced cardiac life support (ACLS) training (about half of those surveyed), and the majority are unable to operate an automated external defibrillator (AED) [13,97,98]. In South Africa where EMS services are available, overall knowledge and skill performance of CPR is still well below standard by EMS personal with only 25% of the required standards met [99]. In addition to lack of optimal resuscitative measures, quality improvement schemes are also deficient in SSA.…”

Relationship between knowledge and skill for basic life support in personnel of emergency medical services, Islamic Republic of Iran

“…In-hospital survival is relatively higher (22.3-25.5%) than the out-of-hospital setting (10.8%). One of the main reasons for the disparity in survival rate is that rescuers are often performing cardiopulmonary resuscitation (CPR) at sub-optimal standards (5). Therefore, the skill of emergency medical personnel in resuscitation as the first line of assistance is an essential factor in the outcome of cardiac arrest (6).…”

Impact of Age and Sex on Bystander Cardiopulmonary Resuscitation Knowledge

“…39 In South Africa, age was one of the demographic factors that influenced the knowledge and skills of cardiopulmonary resuscitation. 41 Jaafar et al 42 reported that females were significantly faster than males in carrying out the chest compressions while participants with less BMI than the study mean were providing more correct chest compressions depth than those with BMI more than the study mean. An earlier Nigerian study showed that while age had statistically significant influence on attitude of some Nigerian students to cardiopulmonary resuscitation, gender did not.…”