Assessment of Knowledge, Attitude, and Practice of Medical Emergency among Different Healthcare Professionals: A Survey Based Cross Sectional Study

INTRODUCTION

A medical emergency refers to a sudden and unforeseen situation that requires immediate care and treatment.^[1] Prompt action in such emergencies can significantly impact a patient’s suffering and chances of survival.^[2] These urgent medical situations necessitate intervention within one hour, commonly referred to as the “Resuscitative hour.”^[3]

The primary objective in handling all emergencies is to safeguard life.^[4]

Identifying a medical emergency promptly and managing it effectively can be crucial in saving a patient’s life and avoiding irreversible consequences. Frequent medical emergencies include acute asthma attacks, heart attacks, anaphylactic shock, hypoglycemic comas, seizures, head injuries, and trauma.^[5]

Healthcare professionals need to recognize the indications and potential complications of common emergencies, along with the effects and interactions of different medications.^[6]

Alternatively, some factors can reduce the vulnerability of medical emergencies, such as thorough evaluation of the patient’s medical history, physical examination, and preparedness for possible changes in the treatment plan in case of an emergency.^[7]

Nurses are often the first to respond to emergencies since they spend a significant amount of time with patients and are usually the first to recognize an in-hospital medical crisis, such as cardiac arrest. Therefore, nursing students need to acquire both knowledge and confidence in CPR to enhance their competencies in handling medical emergencies. Nurses must be adept, prepared, and well-informed about life-saving techniques, which may necessitate ongoing CPR training. The willingness of nurses and nursing students to perform CPR plays a crucial role in the swift and effective management of cardiac emergencies.^[8]

Medical emergencies can happen at any point during dental procedures. In the UK, around 70% of general dental practitioners have dealt with at least one medical emergency. A graduate from dental school should be proficient in handling such emergencies.^[9]

During the administration of local anaesthesia and other drugs, dental material and the anxiety of operative and surgical procedures in day-to-day dental practice, have been found to trigger medical emergencies to be specific syncope, hyperventilation, and cardiac arrest. A statewide survey carried out in Saxony, Germany, found that 57% of dentists experienced at least three medical emergencies within a 12-month timeframe. Vasovagal syncope was noted as the most frequently reported incident.^[10]

The extent of knowledge and attitude of health care professionals is inconsistent, as revealed by several surveys conducted in various parts of the world. There is an increase in the requirement for BLS courses in developed countries. In spite of that, training is not practiced in the underdeveloped and developing countries. Medical and paramedical professionals’ deficient in adequate knowledge, as analyzed by a survey conducted in a hospital in Nepal.^[11]

MATERIAL AND METHODS

A descriptive cross-sectional study was conducted from October 2024 to December 2024 in the Public Health Dentistry department at Maharana Pratap College of Dentistry and Research Centre, Gwalior.

The study participants were chosen using a convenience sampling approach. A self-administered questionnaire was utilized to assess the knowledge, attitude, and practices regarding medical emergencies among healthcare professionals, and it was designed with open-ended questions as well as yes or no response options.

RESULTS

The knowledge-related part of Table 1 shows that more than half of dental (68.8%), ayurvedic (74%), and nursing (82%) healthcare professionals were very well known to diagnose between medical urgencies (P=0.0912) and medical emergencies [Figure 1]. Additionally. 54.4% of dental, 60% of ayurvedic, and 84% of nursing students were able to perform basic life support (BLS), while 60% of dental students (P=0.0004), 96% of ayurvedic students, 90% nursing students were known to be well equipped regarding artificial manual breathing unit (AMBU) bag (P=0.0000) [Figures 2 and 3]. Dental students were more aware regarding management of syncope than ayurvedic and nursing students (84.4%, 52%, and 38% respectively), showing statistically significant differences between all three professions (P=0.0000) [Figure 4].

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Figure 1:

Participants knows diagnose urgency and emergency.

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Figure 2:

Number of participants who know how to perform basic life support (BLS).

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Figure 3:

Number of participants who know how to use the artificial manual breathing unit (AMBU) bag.

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Figure 4:

Number of participants who know how to manage syncope.

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The attitude-related part of Table 1 shows that almost every participant of all three professions was confident in obtaining vital signs (dental=86.6%, ayurveda=98%, nursing=98%) (P=0.0028), while 97.7% of dental, 98% of ayurvedic, and 98% of nursing participants felt that obtaining vital signs is important during clinical practice (P=0.294). Moreover, 45.5% of dental, 80% of ayurvedic, and 40% of nursing respondents were competent in injecting IM injections, while those were confident in IV injections administration in dental, nursing, and ayurveda (47.8%, 74%, and 62%, respectively) (P=0.0021) [Figures 5-8].

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Figure 5:

Number of participants were confident in obtaining vital signs.

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Figure 6:

Number of participants who know the importance of obtaining vital signs.

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Figure 7:

The number of participants who were at the IV injection administration.

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Figure 8:

The number of participants who were competent at IV injection administration.

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The practice-related section of Table 1 shows that the maximum percentage of dental (94.4%), ayurvedic (98%), and nursing (92%) healthcare professionals record medical history and any drug allergy-related history (P=1.139). In relation to a question related to attending the workshop, 94.4% of dental, 92% of nursing, and 98% of ayurvedic attended a previous workshop on BLS (P=0.0000) [Figures 9 and 10].

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Figure 9:

Number of participants who enquired about medical history, including medication and allergy.

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Figure 10:

Number of participants who attended the previous workshop on emergency training.

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The knowledge part of Table 2 shows that the majority of participants knew the correct rate of chest compression, showing a similar percentage between dental, ayurvedic, and nursing participants (80%, 74%, and 90%, respectively) with a significant difference (P=0.0383). Syncope was the most commonly reported medical emergency among dental students (47.7%), heart attack among ayurvedic students (44%), as well as the most serious (28%), while angina was the most common, and cardiac arrest was the most serious medical emergency among nursing students (P=0.0000) [Figures 11-13].

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Figure 11:

The number of participants who answered 100-120 chest compressions.

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Figure 12:

Most common medical emergency.

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Figure 13:

Most common medical emergency.

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Table 2 shows that nitrates were considered as the primary drug for the management of angina among all three healthcare professionals, i.e., dental, ayurveda, and nursing (56.6%, 30%, and 74% respectively), with a significant difference (P value=0.0000) [Figure 14].

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Figure 14:

The number of participants who answered nitrates as management of angina.

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DISCUSSION

Health-associated urgencies and emergencies can arise in anyone, at any moment, and location. In the present study, 68.8% of dental, 74% of ayurvedic, and 82% of nursing participants claimed to diagnose between medical emergency and urgency can be compared with the study by Stafuzza TC et al. (94%).^[12]

Every effort should be made to avert a medical emergency, with prevention starting at the moment the patient is questioned about their medical history.^[13] In the present study, a maximum number of participants of healthcare professionals record medical history as well as drug allergies.

A study conducted by Kumarswami et al. concluded that very few participants can give IV (6.6%) and IM (34%) injections, although according to the current study, 45.5% of dental, 80% of ayurvedic, and 40% of nursing participants were competent at the administration of IM injections, while those who were competent at IV injections administration 47.8%, 74%, and 62%, respectively.^[14]

According to the present study syncope (47.7%) is considered as the most common dental professional, heart attack (44%) among ayurvedic professionals and angina among nursing professionals (52%) whereas a study by Jodalli P et al. mentioned Syncope or fainting was reported by 40.9% of the participants, 37.1% experienced hypoglycemic episodes, allergic reactions were noted by 17.1%, epileptic seizures occurred in 7.6%, asthmatic episodes were observed in 4.5%, and angina was reported by 0.9%.^[15]

A current study indicates that heart attacks represent the most critical medical emergency to be reported among dental (43.3%) and ayurvedic healthcare professionals, while cardiac arrest (58%) was among nursing healthcare professionals. Cardiovascular diseases, along with SCA, are the leading cause of death both in Poland and globally. Additionally, 80% of SCA incidents happen outside of hospital environments, and by European study indicates that “sudden cardiac arrest” impacts approximately 350,000 to 700,000 people each year.^[16,17]

BLS serves as the essential basis for preserving life irrespective of an event of cardiac arrest. Key components of BLS involve promptly identifying SCA and initiating the emergency response system.^[18]

Individuals trained in BLS can intervene promptly to reduce related complications and fatalities. In the present study, 51.6% of dental, 46% of ayurvedic, and 84% of nursing students claimed to have a previous workshop on BLS (basic life support). Whereas, a study in Saudi Arabia by Saquib SA et al. shows that 91.5% of dental and 86% of nursing interns attended previous workshops.^[11]

A recent study shows 54.4% dental, 60% ayurvedic and 84% nursing respondents were aware of performing BLS (basic life support) and well equipped with instruments required for BLS such as an AMBU bag (artificial manual breathing unit) with a good percentage of 60% dental, 96% ayurvedic and 90% of nursing whereas according to study of Jodalli PS et al. only 36.2% participants were good at using AMBU bag.^[15]

Vital signs serve as indicators of a person’s health status and reflect the proper functioning of circulatory, respiratory, neural, and endocrine systems. They provide a standardized way to convey a patient’s condition and the seriousness of any illness.^[19] Maximum number of dental (86.6%), ayurvedic (98%), and nursing (98%) participants were confident in measuring vital signs and almost all participants of all three healthcare professions think obtaining vital signs is important while according to the research of Albelaihi HF et al. 29.4% measure vital signs and 50.3% felt the importance of vital signs.^[13]

Present study 84.4% of dental, 52% of ayurvedic, and 38% of nursing participants affirmed that managing syncope can be synonymous with the study of Fernandes Anabelle, where 49.2% chose the Trendelenburg position as early management of syncope.^[20]

About 56.6% of dental, 30% of ayurvedic, and 74% of nursing participants chose sublingual nitrate as immediate management of angina, although a study by Hashim et al. 68.9% of participants affirmed sublingual nitrates as a drug of choice for angina.^[10]

Clinical significance: Training in BLS should be a part of the curriculum of the healthcare profession so that associated vulnerability can be reduced.

CONCLUSION

The overall knowledge of medical emergencies was moderate; there is a need to gain knowledge regarding BLS and handling of medical emergencies. There is a need to develop a positive attitude towards injection administration, as sometimes it is required during medical emergencies, irrespective of healthcare professionals, and a lack of practice. Training in BLS should be a part of the curriculum of the healthcare profession.