This article explains the proposed teaching-learning method for psychomotor skills of basic life support which is the demonstration-observation-assistance-performance (DOAP) technique as per Competency-Based Medical Education (CBME).

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Sudden cardiac death (SCD) is the leading cause of mortality worldwide, with the incidence in western countries being approximately 50 to 100 per 100,000 in the general population. SCD accounts for 10.30% of all the deaths in South India and the victims are 5-8 years younger than their western counterparts. Bystander cardiopulmonary resuscitation (CPR) improves the outcome of BLS especially when the initiation of advanced life support is delayed.

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Sequence of BLS

The sequence of BLS may be summarised by the pneumonic: DRSCAB

D - Danger (Scene safety)

R - Response (Assess response)

S - Seek help

C - Circulation (Chest compression)

A - Airway

B - Breathing

If the victim is not responsive but has a pulse and breathing spontaneously, he/she is put in a recovery position (on one side).

Danger

1. Whenever we see a collapsed victim, the rescuer should ensure that the scene is safe for him to go and rescue.
2. If a person is hit and run by a vehicle, the victim should be brought to a corner of the road before resuscitation is attempted or else the rescuer runs the risk of getting injured by another vehicle.
3. The scene should be made safer for the victim, rescuer and others before resuscitation is started.

Response

1. The victim should be assessed for thr response by asking "Are you alright" in the language the victim might understand along with tapping on both shoulders.
2. If the victim is responding, he should be watched for any deterioration.
3. Else, an ambulance is called immediately by giving all the details including the number of victims (if mass casualty) and details of the place.

Seek help

A call for help is performed by mobilising the bystanders and the emergency response team (ambulance) mentioning all possible details.

Circulation

Sudden cardiac arrest (SCA) should be recognized as soon as possible by checking unresponsiveness or absent/gasping breathing (often described as breathing that does not look normal)

The victim is assessed for a pulse by feeling the Carotids (Brachial artery in infants) for 5-10 seconds along with any possible spontaneous breathing efforts by the victim. If breathing is not normal but the pulse is felt, provide rescue breathing:1 breath every 6 secs or 10 breaths/min Check pulse every 2 minutes. If no pulse, start CPR. If you suspect a possible opioid overdose, administer naloxone if available as per protocol. If no pulse could be felt, CPR is initiated with 30 chest compressions at the rate of 120 compressions per minute followed by 2 breaths. This sequence has been repeated a total of five times. This takes two minutes. Use AED as soon as it is available

 Airway

The airway is opened with a head tilt (extending the head using a non-dominant hand) and chin lift (using the index and middle fingers of the dominant hand). If the cervical injury is present or suspected, only jaw thrust is done.

Breathing

Two normal breaths are given as mouth to mouth or mouth to barrier device (like a mask) after 30 Chest compressions. In children with two rescuers, the ratio is 15:2. Give each ventilation over no more than one second

Endpoints

• Patient becomes responsive
• Advanced medical help arrives

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Impact

Bystander CPR improves the chance of a victim's Return of Spontaneous Circulation (ROSC) by 100%. Even if one cannot perform the whole sequence, Chest compressions alone (Compression-Only Life Support - COLS) can improve the chances of return of patient cardiac activity to a great extent. So, the Indian Resuscitation Council (IRC), under the aegis of the Indian Society of Anaesthesiologists (ISA) promotes the slogan "Two hands can save lives!!!"

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Current status

Incorporation of a BLS course, including CPR learning procedures in the university curriculum, with regular reassessments, would increase the knowledge and application of CPR skills among students for saving people's life [1-2]. The revised curriculum for undergraduate medical trainees in India now includes BLS training as an integral part of the foundation course for first-year medical students [3]. The curriculum to teach resuscitation in the foundation course is the one advocated by the IRC [4].

The proposed teaching-learning method for psychomotor skills of BLS is the demonstration-observation-assistance-performance (DOAP) technique as per Competency-Based Medical Education (CBME). This is the system proposed by National Medical Commission (NMC – the erstwhile MCI) for the MBBS students now. According to this, BLSis taught in a simulated environment where the student watches videos to create interest and then has interactive lectures on BLS.

The student then observes the skills on a mannequin which the trainer deconstructs, describes the steps and demonstrates the skill. The students are then assisted to perform on a mannequin to acquire these skills and then practised and perform individually on a mannequin, and finally, perform as a part of a team to attain this competency.

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The author is a cardiac anesthesiologist and is the Associate Professor in Andaman & Nicobar Islands Institute of Medical Sciences, Port Blair.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.