Assessment of Knowledge of Polish University Technical Students on Using an Automated External Defibrillator (AED) – Survey Results

Purpose: The article presents the results of a survey, which assessed the knowledge of technical university studentson the use of AED (Automated External Defibrillator). The authors put forward two research hypotheses. The first one assumes that the respondents do not have sufficient knowledge about the use of AED. According to the second, the respondents assess their knowledge on using AED at a higher level than it actually is. Project and methods: The survey method was used to assess the knowledge about the location and proper use of the AED. Authors have conducted surveys with 133 respondents (42% women and 58% men) aged 20-24 (average 21.56 ± 0.95 years). Of all subjects, 91% had not previously performed any basic life support before. The questionnaire contained a number of questions that verify both the theoretical knowledge of the respondents and detailed practical knowledge regarding the proper use of the defibrillator. Results: The research results indicate that the level of knowledge about cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) among the surveyed students of technical universities is limited. As many as 92% of respondents declared that they know what a defibrillator is used, but only 5% of respondents actually know what defibrillation is. Only 23% of respondents claimed to know the location of the defibrillator at their university, but in fact only 7% of them were able to pinpoint it. As many as 87% of students were not familiar with the location of the defibrillator in their area of residence. Furthermore, only 32% of the respondents answered the question correctly when the defibrillator should be used. Conclusions: The results of the survey indicate an important need for education – not only in terms of general knowledge and skills related to CPR and AED, but especially in practical information about the location of the nearest AED in the workplace, as well as place of residence. Information on the AED location should be included in the first aid training program. It is also important to instruct the audience where such data can be obtained. The authors would like to emphasize that efforts to increase the level of knowledge of lay people are necessary to improve the effectiveness of CPR and AED, and thus the survival of people during sudden life-threatening situations.


Introduction
The authors' intention was to carry out preliminary assessment of the level of knowledge of construction students of a selected technical university on the functioning, operation and use of the Automated External Defibrillator (AED). For this purpose, two research hypotheses were formulated and were verified on the basis of the results of the survey. The first assumes that the respondents do not have sufficient knowledge on the use of AED, while the second one assumes that the respondents evaluate their knowledge about the use of AED at a higher level than it actually is. In the study, the authors also took into account the issue of knowing the closest location of the location of AED to the place of study, work and residance.
University students represent a large social group, and thus many of them find themselves in a situation where it is necessary to provide assistance to the victim. Moreover, the surveyed group of respondents are people who may be responsible for safety on construction sites in the future as site managers. Data from the Central Statistical Office indicates that the accident rate in the construction sector is 6.01 per 1,000 employees. This places the sector in the 8th place in terms of accident rates in Poland [compared to sectors ranked as 1st: mining and quarrying (14.73/1000), 2nd: water supply; sewage and waste management (14.25/1000) and 3rd: industrial processing (10.14/1000)] [1]. In 2017, there were 5,390 accidents in the Polish construction sector, including 58 fatal and 102 serious accidents. In 2015, in the EU-28 counties, the construction, manufacturing, transportation and storage sectors, as well as agriculture, forestry and fishing sectors together accounted for slightly more than two-thirds (67.8%) of all fatal accidents at work, and slightly less than half (44.9%) of all non-fatal accidents. In the same year, more than one in five (21.0%) fatal accidents at work in the EU-28 took place in the construction sector [2]. w krajach UE-28 sektory budownictwa, produkcji, transportu i magazynowania oraz rolnictwa, leśnictwa i rybołówstwa łącznie odpowiadały za nieco ponad dwie trzecie (67,8%) wszystkich wypadków śmiertelnych przy pracy, a niewiele mniej niż połowę (44,9%) stanowiły wypadki przy pracy bez ofiar śmiertelnych. W tym samym roku więcej niż jeden na pięć (21,0%) wypadków śmiertelnych przy pracy w UE-28 miał miejsce w sektorze budowlanym [2]. SFT VOL. 56 ISSUE 2, 2020, PP. 62-75 Schools and higher education institutions play a special role to play in teaching basic life-saving procedures. Hence, the students' knowledge regarding the ability to use automated external defibrillators has been assessed at various universities in the entire world. Students' awareness of the possibility of using AED should also be built through its physical presence in the public space of schools and higher education institutions. In the state of Michigan (US), for example, more than 70% of schools are equipped with AEDs [3]. In comparison to the US, the availability of this device in Polish schools and universities requires significant improvement.

Wstęp
Research conducted among students at higher education institutions indicates that the implementation of knowledge on the use of AED, in particular, the location of these devices is a common problem. In a study conducted at the University of Illinois, 88.4% of surveyed students correctly identified AED in the picture, but only 17.6% knew about the existence of such a device at their institution, and 2% were able to indicate its exact location [4]. Interestingly, 66.3% of respondents would look for AEDs in places where fire extinguishers are located and 19.6% near the entrance to the building.
Polish studies conducted among students of non-medical faculties indicate that the level of knowledge on the use of AED is low. Only slightly more than half (51%) of the respondents know the correct placement of the electrodes, and only 38% of respondents know what defibrillation is [5]. Even a short, one-minute training session reduces the time needed to operate the AED (from the moment of providing assistance to the moment of delivering a shock). It should be emphasized that this time is extended again 6 months after the short training [6].

Survey outline
The questionnaire contains a number of questions verifying both the theoretical knowledge of the respondents and detailed practical knowledge regarding the proper use of the AED. When preparing the questionnaire, the content included in the manual for the course "Basic Resuscitationwith Automated External Defibrillator " (based upon the 2015 European Resuscitation Council Guidelines) was taken into account. Moreover, before respondents completed the survey, questions were consulted with basic life support instructors and paramedics. Additionally, prior to the survey, in order to avoid misinterpretations the questionnaire was verified by a small random sample. The order of the questions has been designed in such a manner as not to create a suggestion or a clue to further questions.

Survey composition
The survey consists of 28 questions. The first two questions concerned basic data: age and gender. The next four questions related to: participation in occupational health and safety (OHS) training at the higher education institution; discussing the operation and application of AED in OHS training; practical exercises with the use of AED in OHS training; participation in other first aid courses with practical exercises using AED. Questions 7 and Szczególną rolę w nauczaniu podstawowych zabiegów ratujących życie mają szkoły i uczelnie wyższe. Stąd też wiedzę studentów na temat umiejętności użycia automatycznych defibrylatorów zewnętrznych oceniano na różnorodnych uniwersytetach na całym świecie. Świadomość studentów w zakresie możliwości wykorzystania AED należy budować także przez jego fizyczną obecność w przestrzeni publicznej szkół i uczelni. Przykładowo w Stanie Michigan (USA) ponad 70% szkół wyposażonych jest w AED [3]. W porównaniu do USA dostępność tego urządzenia w polskich szkołach i uniwersytetach wymaga znacznej poprawy.

Participant profile
The group of 133 respondents participating in the survey was not selected randomly. It was created by second and third year students of engineering studies, majoring in construction. After graduation and obtaining their building qualifications, these people will be responsible for safety at the construction site. Moreover, as part of their studies, they are required to complete several months of industrial internship at a construction site.
The respondents answered the questions anonymously, giving prior consent to participate in the survey. Before receiving the questionnaire, the participants were informed about the purpose and form of the questionnaire. The students took an average of 8 minutes to complete the form. Among respondents, 58% were men and 42% women. Age distribution of respondents ranged from 20 to 24 years (age median Me = 21, mean M = 21, 56 and standard deviation SD = 0,95). Only 9% of the respondents provided first aid in real conditions (question 9), while 99% had not previously used AED (question 10). A vast majority of people, namely 92%, participated in OHS training at their higher education institution (question 3), but only half, 48% to be exact, said that the issues of using a defibrillator were discussed (20% of people said it had not been raised, 32% did not know -question 4. Almost all respondents (93%) said that no practical exercises with the use of AED were carried out during this training (question 5). 33% of the respondents attended a first aid course with practical exercises and the use of a defibrillator other than OHS training at higher education institutions (question 6). The content of the survey is attached as Appendix A.

Results
A vast majority of respondents (91.7%) declare that they know what a defibrillator is for (question 7). The ability to use the AED in a correct manner was declared by 24% of respondents, 50% do not know if they could use it correctly, and 26% said they could not (question 8). 77% of students did not know where the AED defibrillator was located closest to their location at the university -the place of weekly classes and completing the survey (question 11). The remaining people who declared that they knew the nearest AED location were asked in question 12 to indicate the exact location. Only 7% of them precisely indicated the nearest location of the defibrillator. Question 13 related to the knowledge of the AED location in the place of residence. 87% of the respondents did not know the location of the AED in their place of residence, and 70% did not know where to find information on the AED location (Question 14, 15). Przeważająca liczba osób -92% brała udział w szkoleniu BHP na swojej uczelni (pytanie 3), jednak tylko połowa, a dokładnie 48%, stwierdziła, że poruszano na nim kwestie zastosowania defibrylatora (20% osób twierdziło, że nie poruszano, 32% nie widziało -pytanie 4). Prawie wszyscy respondenci (93%) byli zgodni, że podczas owego szkolenia nie przeprowadzono ćwiczeń praktycznych z zastosowaniem AED (pytanie 5). 33% ankietowanych brało udział w kursie pierwszej pomocy z ćwiczeniami praktycznymi wraz z użyciem defibrylatora -innym niż szkolenie BHP na uczelni (pytanie 6). Treść ankiety stanowi załącznik A.

Odpowiedź
[%] • The process of strengthening the effect of chest compressions by providing an electrical shock / Proces polegający na wzmocnieniu efektu uciśnięć klatki piersiowej poprzez dostarczenie wyładowania elektrycznego 13 9.8% • The process of delivering a shock to the myocardium in order to stop abnormal heart rhythm / Proces dostarczenia prądu do mięśnia sercowego mający na celu zatrzymanie nieprawidłowego rytmu serca • The process of delivering a shock to the myocardium in order to stimulate the heart to work /  In question 20, respondents were asked when the defibrillator should be used. Only 32% of the students gave the correct answer: "immediately after it is delivered", while 21% of the respondents were convinced that 2 minutes after starting the CPR and 6% that after 5 minutes (see Figure 2) Only 39.8% of the respondents answered correctly, i.e. they would continue chest compressions. The majority of the students would interrupt chest compressions, and 8% admitted that they did not know the answer to this question (see Figure 3).     In question 26, the respondents were asked to refer to a situation where the victim has a wet chest and there is a need to use the AED. 72% of the students will dry the victim's chest before applying the pads, which is the correct answer. 16% will use the defibrillator as instructed by the audio instructions, and