European Journal of Cardiovascular Medicine

Basic Life Support (BLS) is a critical set of emergency procedures that can be administered by both healthcare professionals and laypersons to ensure the immediate preservation of life in situations where a person's airway, breathing, or circulation (the ABCs of resuscitation) are compromised. These situations often include sudden cardiac arrest, respiratory failure, and choking—emergencies that, if not promptly addressed, can lead to irreversible damage or death within minutes. BLS techniques, which include cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs), are vital for stabilizing individuals until more advanced medical help arrives.^1-4

In densely populated urban areas such as New Delhi, the need for widespread knowledge and proficiency in BLS cannot be overstated. The city's high population density, combined with increasing incidents of lifestyle-related health issues, underscores the importance of equipping as many individuals as possible with the skills necessary to act during emergencies. In India, cardiovascular diseases are a leading cause of mortality, and rapid intervention through BLS could significantly improve survival rates. Despite this, studies suggest that the general public's knowledge of BLS remains inadequate, a situation exacerbated by limited access to training, socio-economic barriers, and variations in educational outreach efforts.^5-9

Moreover, public spaces in New Delhi—such as metro stations, markets, and schools—are areas where sudden cardiac events or accidents are more likely to occur. However, without sufficient knowledge of BLS among the city's residents, the chances of effective bystander intervention are significantly reduced. This situation highlights the urgent need for assessing current BLS awareness levels, identifying gaps in knowledge, and implementing targeted educational programs that can empower individuals to act confidently in life-threatening situations.

Given the critical importance of BLS and the need to enhance community-level preparedness, this study aims to assess the public's awareness and understanding of BLS in New Delhi. By focusing on key aspects such as CPR steps, AED usage, and scenario-based knowledge, the study seeks to provide a comprehensive evaluation of how well-prepared the general public is to handle emergencies. The findings of this study will serve as a foundation for developing strategies to improve BLS training and education across diverse socio-demographic groups within the city.

Objectives

The primary objectives of this study are:

1. To assess the level of knowledge and awareness regarding Basic Life Support (BLS) among adults in New Delhi.
2. To evaluate the public's understanding of key BLS components, including the correct steps for CPR, the use of AEDs, and the recognition of emergencies that require BLS intervention.
3. To identify knowledge gaps and misconceptions about BLS across different socio-demographic groups within New Delhi.
4. To provide recommendations for targeted educational programs and public health initiatives aimed at enhancing BLS knowledge and preparedness among New Delhi residents.

Research Approach: This study employed a descriptive research approach to gather and analyze data on BLS awareness among New Delhi residents.

Research Design: A cross-sectional survey design was used to assess the knowledge and awareness of BLS among the adult population of New Delhi.

Study Area: The study was conducted across various districts of New Delhi, ensuring representation from both urban and semi-urban areas.

Study Duration: The research was carried out over a five-month period, from January 2024 to May 2024.

Study Population: The target population included adults aged 18 and above who have been residents of New Delhi for at least 12 months. This criterion was established to ensure participants had a stable connection to the city and were familiar with its healthcare environment.

Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50%, and a margin of error of 5%. A conservative non-response rate of 5% was also accounted for.

Study Tool: A structured questionnaire comprising 25 multiple-choice questions was developed to assess participants' BCLS knowledge. The questionnaire included the following sections:

• CPR Steps: Evaluating the understanding of the correct sequence of CPR procedures.
• AED Usage: Assessing knowledge of AED operation and scenarios requiring defibrillation.
• Emergency Recognition: Identifying emergencies that necessitate BLS, such as cardiac arrest or choking.
• Scenario-Based Questions: Testing practical application of BLS knowledge through hypothetical situations.

Each question had four options, with one correct answer bolded. The questionnaire was pre-tested on a small sample to ensure clarity and relevance.

Scoring: Participants' scores were categorized as follows:

• Very Good: 80% (20-25 correct answers)
• Good: 60-79% (15-19 correct answers)
• Fair: 41-59% (10-14 correct answers)
• Poor: <40% (0-9 correct answers)

Data Collection: Data were collected using both digital (Google Forms) and physical questionnaires, depending on participants' access to technology. The survey was disseminated through social media platforms like WhatsApp, Facebook, and email. In addition, face-to-face interviews were conducted by trained data collectors to ensure inclusivity, especially for participants with limited digital access.

Data Analysis: The collected data were entered into Microsoft Excel, cleaned for errors, and analyzed using Epi Info V7 software. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Cross-tabulations were conducted to examine the relationships between socio-demographic variables and BLS knowledge.

Ethical Considerations: Ethical standards were strictly adhered to throughout the study. Informed consent was obtained from all participants before they completed the survey. Confidentiality and anonymity were maintained, and the study received ethical approval from the institutional review board prior to data collection.

Table 1 provides a detailed overview of the socio-demographic characteristics of the study participants. The age distribution is relatively balanced, with the largest group being between 18-30 years old (31.8%), followed by those aged 31-40 (23.3%), and the smallest group being over 50 years old (23.5%). Gender distribution is almost equal, with females slightly outnumbering males at 51.0%. In terms of marital status, 57.0% of participants were married, while 40.3% were single, and a small percentage (2.8%) fell into the "Others" category. Educationally, most participants had completed high school (27.8%) or were graduates (34.3%), with fewer having postgraduate qualifications (23.8%) or below high school education (14.3%). Regarding occupation, half of the participants were employed (50.3%), followed by unemployed individuals (26.8%) and students (23.0%). Income distribution shows that 36.5% of participants earned between ₹20,001-₹50,000 monthly, with 27.0% earning ₹50,001-₹1,00,000, and 22.3% earning below ₹20,000.

Table 1: Socio-Demographic Characteristics of Study Participants (N=400)

Table 2 assesses participants' basic knowledge and awareness of BLS. An encouraging 76.8% of participants had heard of BLS, indicating general awareness. However, only 54.8% knew the correct order of steps in BLS (check responsiveness, call for help, CPR, AED). Understanding of CPR techniques is varied, with only 44.3% aware of the correct chest compression-to-breath ratio (30:2) and 42.0% knowing the recommended compression depth (at least 2 inches). Awareness of the correct pace for chest compressions (100-120 compressions per minute) is lower, with just 37.3% responding correctly. These findings highlight some gaps in basic BLS knowledge among the population, particularly in understanding the specifics of CPR and the correct sequence of steps in an emergency.

Table 2: Comprehensive Knowledge and Awareness Questions for Basic Life Support (BLS) (N=400)

Table 3 dives deeper into CPR techniques, revealing some gaps in the public’s knowledge. While 44.8% knew it’s important to keep arms straight during compressions to deliver effective compressions, a lower 48.0% correctly identified how to perform rescue breaths properly. Only 39.3% knew how long to continue CPR before checking for signs of life, showing that many may not be fully prepared to execute CPR correctly. Interestingly, awareness of infant CPR techniques was somewhat higher, with 43.3% answering correctly, indicating slightly better knowledge of CPR for specific groups like infants. When asked about CPR in a drowning situation, 45.5% responded correctly, showing moderate awareness.

Table 3: Knowledge of CPR Techniques (N=400)

Table 4 assesses the knowledge and use of Automated External Defibrillators (AED). Only 40.3% of participants had received training on AED usage, indicating a significant gap in practical life-saving skills. Understanding of when to use an AED was slightly better, with 42.8% answering correctly, but only 38.0% knew the basic steps to operate an AED. Awareness of safety measures, such as ensuring no one is touching the victim during shock delivery, was even lower at 34.8%. This table highlights a critical area for improvement, as AEDs are essential for increasing survival rates in cardiac arrest cases.

Table 4: Knowledge and Use of AED (N=400)

Table 5 presents participants' knowledge of various BLS scenarios. Nearly half of the participants (49.5%) could identify the signs of a heart attack, while 45.5% knew how to perform BLS on a choking victim using the Heimlich maneuver. When it came to administering BLS to an unresponsive child, 42.3% answered correctly, showing room for improvement in pediatric BLS knowledge. For trauma incidents, only 40.5% could correctly outline the steps, and similarly, 37.8% knew when to perform CPR in cases of electrocution. These findings suggest that while there is a basic understanding of BLS, scenario-specific knowledge is often lacking.

Table 5: Knowledge of BLS Scenarios (N=400)

Table 6 categorizes participants based on their overall BLS knowledge scores. The largest group, representing 30.8% of participants, fell into the "Fair" category (11-15 correct answers), indicating that most people have a moderate understanding of BLS. A quarter of participants (24.5%) scored in the "Good" category (16-20 correct answers), while 23.0% demonstrated a "Very Good" understanding (21-25 correct answers). However, 21.8% of participants had "Poor" knowledge (less than 11 correct answers), emphasizing that a significant portion of the population could benefit from targeted BLS education and training initiatives.

Table 6: Overall, Knowledge Score Categories for BLS (N=400)

The results of this study offer a detailed and multifaceted view of the current state of public knowledge and awareness regarding Basic Life Support (BLS) in New Delhi. Given the critical nature of BLS in emergency response, these findings underscore the importance of understanding where the public stands in terms of readiness to act during life-threatening situations, such as cardiac arrest, respiratory failure, or choking incidents.

General Awareness and Knowledge Gaps: The study reveals that while there is a baseline awareness of BLS, with 76.8% of participants having heard of the concept, there remain significant gaps in the understanding of its fundamental components. This is particularly concerning in a densely populated urban environment like New Delhi, where rapid and effective bystander intervention could mean the difference between life and death.

For example, only 54.8% of participants knew the correct order of steps in BLS, which is foundational to providing effective help in emergencies. The correct sequence—checking responsiveness, calling for help, initiating CPR, and then using an AED—is critical for ensuring that appropriate actions are taken in the proper order. The fact that nearly half of the participants did not know this sequence highlights a major area for improvement in public education. This gap can lead to delays in critical interventions, potentially reducing the chances of survival for individuals experiencing sudden cardiac events.^7-11

CPR Techniques: Delving deeper into CPR techniques, the study highlights further areas where knowledge is lacking. Only 44.3% of participants knew the correct chest compression-to-breath ratio (30:2), and even fewer (42.0%) were aware of the recommended compression depth (at least 2 inches). These statistics are concerning because improper CPR technique can severely diminish the effectiveness of resuscitation efforts. For instance, inadequate compression depth may not generate sufficient blood flow to vital organs, while incorrect compression-to-breath ratios can reduce the efficiency of oxygen delivery to the brain and heart.

The relatively low percentage of correct responses regarding the compression rate (100-120 compressions per minute) further indicates that many individuals may not be fully prepared to perform CPR effectively. This is especially significant in light of the American Heart Association's (AHA) emphasis on the importance of high-quality CPR in improving survival rates. The fact that only 37.3% of participants answered this question correctly suggests that more robust training programs are needed to ensure that individuals are not only aware of BLS but are also capable of performing it correctly when needed.

Interestingly, the study shows that knowledge about infant CPR techniques was slightly better, with 43.3% of participants answering correctly. This could be indicative of targeted educational efforts aimed at specific groups, such as parents or caregivers. However, the overall low percentages across the board highlight the need for more comprehensive and universally accessible CPR training that covers all age groups.^10-14

AED Knowledge and Usage: The findings also reveal a significant gap in public knowledge regarding the use of Automated External Defibrillators (AEDs). Only 40.3% of participants reported having received training on AED usage, and a mere 42.8% knew when to use an AED during a cardiac arrest situation. AEDs are critical tools for restoring normal heart rhythms in cases of sudden cardiac arrest, and the fact that such a low percentage of the population is familiar with their use is alarming.

The study also shows that only 38.0% of participants knew the basic steps to operate an AED, which typically involve turning on the device, applying the pads, and following the voice prompts. Additionally, awareness of safety protocols, such as ensuring no one is touching the victim during shock delivery, was even lower, with just 34.8% of participants answering correctly. These findings point to a critical area for intervention, as AEDs, when used correctly and promptly, can dramatically improve survival rates in cardiac arrest cases.^13-17

Scenario-Specific Knowledge: The study's exploration of scenario-specific knowledge further underscores the need for targeted education. For example, while 49.5% of participants could identify the signs of a heart attack, a significant portion of the population remains unaware of the symptoms that require immediate BLS intervention. Similarly, only 45.5% of participants knew how to perform BLS on a choking victim, and just 42.3% were familiar with the steps for managing an unresponsive child. These gaps in scenario-specific knowledge are particularly concerning because they suggest that even individuals who are aware of BLS may not be able to apply it effectively in real-life situations.

The fact that only 40.5% of participants knew how to handle trauma situations requiring BLS, such as car accidents or severe bleeding, further highlights the need for more practical, scenario-based training. Additionally, the low percentage of participants (37.8%) who knew when to perform CPR in cases of electrocution suggests that many individuals may hesitate or make mistakes during critical moments, potentially leading to poor outcomes.

Overall, Knowledge and Implications: When considering the overall knowledge scores, it is evident that while a portion of the population has a moderate understanding of BLS, there is still a significant need for improvement. The largest group of participants (30.8%) fell into the "Fair" category, indicating that while they have some knowledge of BLS, it may not be sufficient to act confidently and effectively in an emergency. The fact that 21.8% of participants were categorized as having "Poor" knowledge is particularly concerning, as this group is likely to be unprepared to provide any meaningful assistance during a cardiac emergency.

These findings have important implications for public health initiatives in New Delhi. The city, with its high population density and increasing prevalence of cardiovascular diseases, requires a well-informed and capable public that can act as first responders in emergencies. The study's results suggest that current educational efforts are not reaching enough people or providing sufficient depth of knowledge. As such, there is a pressing need for more comprehensive and accessible BLS training programs that can equip individuals with the skills necessary to save lives.^14-17

Recommendations for Improvement: Based on the study's findings, several recommendations can be made to enhance BLS knowledge and preparedness in New Delhi. First, public health campaigns should prioritize not only raising awareness about BLS but also providing practical, hands-on training that covers all aspects of CPR and AED usage. These programs should be made widely available across various settings, including schools, workplaces, and community centers, to ensure that as many people as possible have the opportunity to learn and practice BLS.

Additionally, scenario-based training should be emphasized to help individuals apply their knowledge in real-life situations. This could include simulations of common emergencies, such as heart attacks, choking incidents, and trauma situations, to build confidence and competence in BLS procedures.

Finally, efforts should be made to increase the visibility and accessibility of AEDs in public spaces. Public awareness campaigns could focus on educating people about where AEDs are located and how to use them, as well as encouraging businesses and organizations to install AEDs in their facilities.

In conclusion, this study highlights significant gaps in public knowledge and awareness regarding Basic Life Support (BLS) in New Delhi, particularly in areas critical for effective emergency response, such as the correct sequence of CPR steps, the use of AEDs, and scenario-specific applications of BLS techniques. While there is a baseline level of awareness, with some individuals demonstrating a good understanding, a substantial portion of the population remains underprepared to act confidently in life-threatening situations. These findings underscore the urgent need for targeted educational programs, hands-on training, and public health initiatives aimed at enhancing BLS proficiency across diverse socio-demographic groups. By addressing these gaps and increasing accessibility to training resources, New Delhi can significantly improve its community-level preparedness for emergencies, ultimately saving more lives.

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