INTRODUCTION:

Sudden cardiac arrest is a situation in which the heartbeat stops abruptly and without any warning signs, which results in no blood being pumped into the rest of the body leaving the person in a fatal condition.

Sudden cardiac death is defined as natural death due to cardiac causes, heralded by abrupt loss of consciousness within 1 hour of the onset of acute symptoms¹. Basic Life Support (BLS) is a set of emergency procedures used to maintain vital functions in individuals experiencing cardiac arrest, respiratory distress, or other life-threatening conditions until advanced medical care arrives. It is performed to support the person’s circulation and respiration through the use of cardiopulmonary resuscitation (CPR). Victims who have had early and correct BLS intervention will be better oxygenated and are more likely to respond to advanced techniques to revive them, thereby increasing their chance of survival. BLS includes recognition of signs of sudden cardiac arrest, heart attack, stroke, and foreign body airway obstruction, and the performance of cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator².

Choking, also known as foreign body airway obstruction is a phenomenon that happens when an object lodges in the throat or windpipe blocking the flow of air. It cuts off oxygen to the lungs and brain. Lack of oxygen to the brain for more than 5 minutes may cause brain damage or death³. For a conscious choking victim, first-aid protocol is encouraging the victim to cough, followed by hard back slaps. If these attempts are not effective, the procedure continues with abdominal thrusts (Heimlich maneuver) or chest thrusts if the victim cannot receive abdominal pressure. In scenarios when the first aid procedures are not resolving the choking, it is necessary to call to emergency medical services (911), but first aid measures should be continued until they arrive⁴.

According to 2022 analysis, 3,71,506 coronary heart disease deaths occur out of hospital or in-hospital emergencies department annually. Sudden cardiac deaths account for more than 40 to 45% of cardiovascular deaths in India⁵. Around 4,500 - 5,000 choking-related deaths occur in the United States every year. Deaths from choking most often occur in the very young children under three years old and in the elderly adults over 75 years⁶.

In Kerala, heart attacks are a leading cause of death, with statistics showing a significant percentage of registered deaths attributed to cardiac arrest. While the percentage of deaths due to heart attacks has been declining in recent years, it still remains a major public health concern. In 2021, heart attacks accounted for 21.39% of all registered deaths⁷.

A quasi-experimental study was conducted in Pakistan in September 2024 among 80 intermediate students to assess the effectiveness of Basic Life Support (BLS) training on the students’ knowledge levels. Non-probability purposive sampling technique was used to select samples. At the start of the study, 95% of the participants had a low level of BLS knowledge. After the training, 30% of the students achieved a moderate level and 37.5% reached a high level of BLS knowledge, showing significant improvement due to the intervention. The study found that while BLS training is effective in improving knowledge in the short term, it is not sufficient on its own for long-term retention. Therefore, the study recommends that regular reinforcement and refresher training are essential to maintain and strengthen BLS knowledge over time⁸.

In India, approximately 32,457 people died from heart attacks in 2022, according to the National Crime Records Bureau (NCRB). This figure represents a 12.5% increase compared to the 28,413 deaths reported in the previous year. Overall, sudden deaths in India reached 56,450 in 2022, 10.1% increases from the previous year⁹.

A retrospective observation study conducted about survival trends of cardiopulmonary resuscitation efforts at King Abdullah University Hospital in Northern Jordan revealed that 4.3% of people survived from receiving CPR in outpatient basis, while 14.88% people survived from receiving CPR in inpatient basis¹⁰.

Cardiovascular diseases, especially coronary heart disease (CHD), are epidemic in India. The Registrar General of India reported that CHD led to 17% of total deaths and 26% of adult deaths in 2001-2003, which increased to 23% of total and 32% of adult deaths in 2010-2013. The World Health Organization (WHO) and Global Burden of Disease Study also have highlighted increasing trends in years of life lost (YLLs) and disability-adjusted life years (DALYs) from CHD in India. In India, studies have reported increasing CHD prevalence over the last 60 years, from 1% to 9%-10% in urban populations and <1% to 4%-6% in rural populations¹¹.

Cardiac arrests and choking can occur anywhere. It can happen in schools, homes or public places and immediate response is critical. Inadequate knowledge of BLS can lead to delayed or ineffective response, resulting in poor outcomes.

The present study was initiated to assess the knowledge regarding BLS among higher classes’ students in selected school in Pathanamthitta. The study will help to identify knowledge gaps and the findings will help to develop educational strategies to improve BLS knowledge and life saving skills among higher class students.

STATEMENT OF THE PROBLEM:

A descriptive study to assess the knowledge regarding Basic Life Support (BLS) among higher class students in selected school at Pathanamthitta

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding basic life support among higher class students.

2. To find out the association between the level of knowledge with selected demographic variable.

3. To provide informative session on BLS

HYPOTHESIS:

H0: There is no significant association between level of knowledge of higher class students with selected demographic variables.

H1: There is a significant association between level of knowledge of higher class students with selected demographic variables.

MATERIALS AND METHODS:

A quantitative research approach was used in this study. Non-experimental descriptive research design was adopted to assess the knowledge regarding basic life support among higher class students in selected school in Pathanamthitta. The samples size was 40 and non-probability convenient sampling technique was used to select samples on the basis of inclusion and exclusion criteria. A self-structured knowledge questionnaire was the tool used which consists of 30 multiple choice questions to assess level of knowledge regarding BLS includes CPR, AED and choking management among higher class students. The maximum possible score was 30.The content validity of the tool was obtained from the experts. The suggestions from the experts were incorporated in the tool. After obtaining formal permission, the pilot study was conducted among 6 higher class students. Reliability of the tool was ascertained by the split half method and the tool was found to be reliable (r=0.92)

The data was collected after obtaining prior permission from the concerned authorities of the selected school. The researchers introduced themselves with samples and explained the purpose of the study to them and confidentiality was assured to all samples. An informed consent was taken from the samples and a self-structured knowledge questionnaire was given for collecting demographic data and assessing the knowledge level about BLS.

A small informative session was also conducted to the students regarding BLS after data collection and given informative leaflets to them which provide information about cardio pulmonary resuscitation, breathing techniques, automated external defibrillator and emergency choking management.

RESULTS:

Section A: Distribution of samples according to their demographic data.

Out of 40 samples, 60% belongs to 14–15-year age group, while the remaining 40% belong to the 16–17-year age group. Females constitute 60% of the total sample size of 40, while males account for 40%. Among the 40 samples, majority of them 65% were resides in urban area and 35% resides in rural area. Majority of student’s father and mother have Postgraduate educational qualification (42.5% and 50% respectively), graduate level were 40% and 35% respectively, and pre degree level were 17.5% and 15% respectively. 70% of students father working in private sector, 10% were in government job and 20% belongs to others category. 45 % of student’s mothers were working in private sector, 5 % were in government job category and 50% belongs to house wife. 70% of the 40 samples did not have any prior knowledge about BLS, but 30% had the previous knowledge regarding BLS where social media stands out as the leading source of knowledge for 60%; 30% from peers, and 10% from other training programs.

Table 1: Frequency and percentage distribution of samples based on demographic variables

Sl. No

Demographic variables

Age

14-15 years

16-17 years

60%

40%

Gender

Male

female

40%

60%

Residence

Urban

Rural

65%

35%

Father’s education

SSLC

Pre degree

UG/Diploma

PG/Others

17.5%

40%

42.5%

Mother’s education

SSLC

Pre degree

UG/Diploma

PG/Others

15%

35%

50%

Father’s occupation

Daily Wage Worker

Private job

Government job

Others

70%

10%

20%

Mother’s occupation

Daily Wage Worker

Private job

Government job

Housewife

45%

50%

Previous knowledge regarding BLS

Yes

30%

70%

Section B: Description of Sample Based On Knowledge Score:

Among 40 samples 92.5% (37 students) are having good knowledge, 7.5% (3 students) are having average knowledge and no one had poor knowledge and excellent knowledge.

Table 2: Frequency, percentage distribution, mean and standard deviation of samples based on their knowledge score on BLS

Si No	Level of knowledge	f	%	Mean	SD
1	Poor knowledge	0	0	18.9	2.11
2	Moderate knowledge	3	7.5
3	Good knowledge	37	92.5
4	Excellent knowledge	0	0

Section C: Association of Knowledge Score and Selected Demographic Variables:

By using chi square test, it proved that there is no significant association between knowledge score and selected demographic variables. Since there is no association between the selected demographic variables, research hypothesis H1 is rejected and null hypothesis H0 is accepted.

DISCUSSION:

The findings of the present study were discussed in relation to the objectives.

The study reveals that the majority (92.5%) of the higher class students (37 students) have good knowledge, 7.5% (3 students) are having moderate knowledge and no student had poor knowledge about BLS. The present study shows that there is no significant association between knowledge score and selected demographic variables such as residence, education of father and mother, occupation of father and mother.

NURSING IMPLICATIONS:

The findings of the study suggested that nurses at all levels can be act as supporting group to enhance the quality of life. They can create awareness about BLS and promote safe practices in community for saving lives in emergency situation. Nurses can collaborate with educational institutions to integrate BLS training into the school curriculum. Nurse administrators should organize regular educational programs eminars, and workshops to update the knowledge of students regarding Basic Life Support (BLS). Ensure that educational resources and teaching aids are available and accessible. The findings of this study open avenues for further research on the awareness and acceptability of Basic Life Support.

LIMITATIONS:

· The study was limited to 10th, 11th and 12th class students from a single institution.

· The sample size was small-40; hence the conclusion from the study cannot be generalized.

· The study did not include long-term follow up to assess retention of knowledge.

· The time duration of the study was less.

RECOMMENDATIONS:

· Conduct similar studies with larger and more diverse samples.

· Implement long term updating and follow up of knowledge level.

· Assess the effectiveness of different training methods such as hands on training, video based training.

· Develop evidence based training program for basic life support on timely basis.

· Integrate basic life support training into the curriculum.

CONCLUSION:

The present study was conducted to assess the knowledge regarding the basic life support among higher class students of selected school in Pathanamthitta. The overall experience of conducting the study was indeed valuable. It was a great learning opportunity for the student researchers in this. The study reveals that most of the higher classes’ students had adequate knowledge regarding BLS and they can handle an emergent situation skillfully. Informative session with leaflet and hands on practice was very helpful to all the students and they were happy and satisfied with the updated knowledge regarding the topic they have received. Proper identification of the cardiac arrest and timeless prompt action can save a life by any one.

REFERENCES:

1. Myerburg RJ, Castellanos A. Cardiac arrest and sudden cardiac death. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. p. 1100–13.

2. American Heart Association. Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. Circulation. 2020; 142 (16_suppl_2) :S337–57. doi:10.1161/CIR.0000000000000916.

3. Noffsinger D. Choking and airway obstruction. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020. p. 1535-7.

4. National Health Service (NHS). Choking: first aid advice. 2022. Available from: https://www.nhs.uk/conditions/choking/

5. Rao BH, Sastry BK, Chugh SS, Kalavakolanu S, Christopher J, Shangula D, et al. Contribution of sudden cardiac death to total mortality in India – a population based study. Int J Cardiol. 2012; 154(2):163–7.DOI: 10.1016/j.ijcard.2010.09.016.

6. Duckett SA, Bartman M, Roten RA. StatPearls. Choking. Treasure Island (FL): StatPearls Publishing; 2023.

7. Jayanth AS. Percentage of deaths caused by heart attack declining in Kerala. The Hindu. Kozhikode; 10 Jun 2023

8. Pandey A, Parate VR, Meshram VP, Giri PA. Awareness and knowledge of basic life support among undergraduate medical students at a tertiary care teaching hospital. Int J Health Sci Res [Internet]. 2014 Mar [cited 2025 Jul 31]; 4(3):28–32.

9. Clarance D. Deaths due to heart attacks up by 12.5 % in 2022: government data. India Today. New Delhi; 4 Dec 2023.

10. Sharieh W, Khader Y, Jaddou H, Badran E, Yousef M. Incidence, characteristics, and survival trend of cardiopulmonary resuscitation following in-hospital compared to out-of-hospital cardiac arrest in Northern Jordan: a retrospective observational study at King Abdullah University Hospital. BMC Emerg Med. 2017; 17:50

11. Gupta R. Coronary heart disease epidemiology in India: Global burden, risk factors, and prevention. Circ Res. 2018; 122(3):362-74.

Received on 15.09.2025 Revised on 21.10.2025

Accepted on 22.11.2025 Published on 21.02.2026

Available online from February 23, 2026

Asian J. Nursing Education and Research. 2026;16(1):29-32.

DOI: 10.52711/2349-2996.2026.00007

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

S. No.	Demographic Variable	Chi-Square value (X2)	Table Value	Significant or Non-Significant
1.	Residence	1.745	3.841	Not Significant
2.	Education of Father of Samples	0.563	5.991	Not Significant
3.	Education of Mother of Samples	0.906	5.991	Not Significant
4.	Occupation of Father of Samples	1.38	5.991	Not Significant
5.	Occupation of Mother of Samples	2.91	5.991	Not Significant