From spectator to lifesaver: a six-month evaluation of bystander training in CPR and bleeding control

Objective: Low- and middle-income countries (LMICs) continue to bear the major burden of morbidity and mortality associated with out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding post-trauma. While bystander cardiopulmonary resuscitation (CPR) and bleeding control trainings in developed countries have assessed their impact on bystanders’ knowledge and ability to act during an emergency, limited studies have been conducted in low-resource settings, specifically in the context of bystanders’ self-efficacy and confidence after training. Therefore, this study aimed to determine the impact of a novel bystander training program by assessing the change in knowledge, confidence, and self-efficacy of laypeople in performing CPR and bleeding control before and after training. Methods: A prospective study was implemented at a healthcare facility in a South Asian LMIC to determine the impact of a national initiative aimed at providing CPR and bleeding control skills to its citizens. Adult (≥ 18 years), non-medical employees of the institution were included. Data on participants’ demographics, knowledge, confidence, and self-efficacy in performing CPR and bleeding control were collected before (Time 1), immediately post-training (Time 2), and six-months post-training (Time 3). These responses were compared to ascertain the change in identified parameters using percentages and paired t-tests, with a p-value < 0.05 considered statistically significant. Results: Of 200 respondents, 89.0% (n = 178) had no prior training in CPR or bleeding control. A significant increase in knowledge and self-efficacy was noted for both the skills from time 1 to 2 and from time 1 to 3 (all p-values < 0.001), without any association noted with their educational status. However, a decrease was noted in both these parameters from time 2 to 3, indicating the need for timely refresher trainings. A considerable increase was seen in both short- and long-term confidence of participants in performing CPR and bleeding control, with a notable decrease in fears/concerns about injuring themselves/victims or getting sued. Conclusion: The empowerment of bystanders as first responders can play a pivotal role in saving lives. Conducting biannual refresher trainings, encouraging bystander protection at a policy level, and expanding the program regardless of the participants’ education can make such training effective and sustainable in low-resource settings.