Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis

doi:10.5847/wjem.j.1920-8642.2020.03.001

Abstract

Abstract:

BACKGROUND: The number of lay people willing to attempt cardiopulmonary resuscitation (CPR) in real life is increased by effective education in basic life support (BLS). However, little is known about access of general public to BLS training across the globe. This study aimed to investigate availability and key features of BLS courses proposed for lay people in India, Nigeria and the United Kingdom (UK).

METHODS: A Google search was done in December 2018, using English keywords relevant for community resuscitation training. Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis. On-site training courses were limited to those provided within the country’s territory.

RESULTS: A total of 53, 29 and 208 eligible courses were found for India, Nigeria and the UK, respectively. In the UK, the number of courses per 10 million population (31.5) is 79 and 21 times higher than that in India (0.4) and Nigeria (1.5). Course geography is limited to 28% states and one union territory in India, 30% states and the Federal Capital Territory in Nigeria. In the UK, the training is offered in all constituent countries, with the highest prevalence in England. Courses are predominantly classroom-based, highly variable in duration, group size and instructors’ qualifications. For India and Nigeria, mean cost of participation is exceeding the monthly minimum wage.

CONCLUSION: In contrast to the UK, the availability and accessibility of BLS courses are critically limited in India and Nigeria, necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates.

Key words: Basic life support, Cardiopulmonary resuscitation, Courses, Training, India, Nigeria, United Kingdom

Alexei Birkun, Fatima Trunkwala, Adhish Gautam, Miriam Okoroanyanwu, Adesokan Oyewumi. Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis[J]. World Journal of Emergency Medicine, 2020, 11(3): 133-139.

Figures/Tables 8

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Parameters	India	Nigeria	United Kingdom
BLS courses, n	53	29	208
First aid courses, n (%) ^a	29 (55)	24 (83)	141 (68)
BLS-devoted courses, n (%)	24 (45)	5 (17)	67 (32)
Course organizers, n	33	20	95
Non-profit organizations, n (%)	6 (18)	0 (0)	11 (12)
Limited companies/corporations, n (%)	16 (48)	17 (85)	58 (61)
NS, n (%)	11 (33)	3 (15)	26 (27)
Learning method ^b
Classroom, n (%)	33 (62)	22 (71)	191 (92)
Distance, n (%)	20 (38)	4 (13)	7 (3)
Blended, n (%)	0 (0)	3 (10)	10 (5)
NS, n (%)	0 (0)	2 (6)	0 (0)
AED included, n (%)	31 (58)	15 (52)	112 (54)
Knowledge/skills assessment included, n (%)	26 (49)	18 (62)	114 (55)
Certificate awarded, n (%)	39 (74)	24 (83)	161 (77)
Course duration
First aid courses (classroom/blended), range	3 hours - 9 days	3 hours - 5 days	2 hours - 4 days
First aid courses (distance), range	25 minutes - 90 minutes	3 days	1 hour - 3 hours
BLS-devoted courses (classroom/blended), range	2 hours - 1 day	NS	1 hour - 6 hours
BLS-devoted courses (distance), range	19 minutes - 2 hours	30 minutes - 90 minutes	NS
NS, n (%)	13 (25)	7 (24)	22 (11)
Maximum group size, mean (range)	25 (10-30)	10 (9-10)	12 (6-15)
NS, n (%)	42 (79)	26 (90)	153 (74)
Cost per trainee (US dollar)
First aid courses (classroom/blended), mean (range)	85 (8-282)	91 (36-193)	137 (31-905)
First aid courses (distance), mean (range)	61 (35-139)	110 (NA)	27 (19-31)
BLS-devoted courses (classroom/blended), mean (range)	42 (28-56)	111 (83-138)	66 (31-157)
BLS-devoted courses (distance), mean (range)	36 (10-95)	35 (25-50)	24 (23-25)
Free classroom/blended courses, n (%)	0 (0)	0 (0)	10 (5)
Free distance courses, n (%)	7 (35)	0 (0)	1 (0.5)
NS, n (%)	24 (45)	6 (21)	67 (32)

Guidelines concordance (as declared in the course description) ^a	India (n=65)	Nigeria (n=29)	United Kingdom (n=211)
Not specified	21	22	157
American Heart Association, 2010	3	1	-
American Heart Association, 2015	3	3	-
American Heart Association, year not specified	17	3	1
American Red Cross, year not specified	1	-	-
European Resuscitation Council, 2010	-	-	2
European Resuscitation Council, 2015	-	-	3
European Resuscitation Council, year not specified	5	-	4
International Liaison Committee on Resuscitation, 2010	2	-	-
International Liaison Committee on Resuscitation, year not specified	1	-	1
Red Cross, year not specified	4	-	-
Resuscitation Council (UK), 2010	-	-	3
Resuscitation Council (UK), 2015	-	-	9
Resuscitation Council (UK), year not specified	5	-	31
Society Consensus Guidelines for Resuscitation in India, 2011	3	-	-

Instructors (as declared in the course description)	India (n=53)	Nigeria (n=29)	United Kingdom (n=208)
Not specified	49	19	149
American Heart Association instructors	-	3	-
Certified first aid trainers	-	-	5
Certified/accredited instructors, trainers, tutors	-	4	2
Consultants	-	1	-
Doctors	1	-	2
Emergency medicine doctors	1	-	-
Firefighters and paramedics	-	-	1
First aid trainers, instructors	-	-	9
Heartstart instructors	-	-	1
Instructors, trainers	1	1	14
Medical and emergency services professionals	-	-	2
Paediatric specialists	-	-	1
Paediatric trained paramedics	-	-	2
Professional adult educators	-	-	4
Professional trainers	-	-	2
Professionals	1	1	5
Qualified academics	-	-	1
Resuscitation Council accredited/qualified instructors	-	-	5
Specialists in paediatric first aid	-	-	2
Teachers	-	-	1

Characteristics	India	Nigeria	United Kingdom
Population, total (millions)	1,339.18	190.89	66.02
Surface area (sq.km) (thousands)	3,287.3	923.8	243.6
Population density (people per sq.km of land area)	450.4	209.6	272.9
Income group	Lower middle income	Lower middle income	High income
Minimum wage, monthly (US dollars)	58	50	1,732
Living wage, monthly (US dollars)	90	66	861
Life expectancy at birth, total (years)	69	53	81
Individuals using the Internet (% of population)	29.5	25.7	94.8

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