Posted by: tommecrow | October 15, 2015

Would you be willing to give mouth-to-mouth ventilations?

Due to the likelihood of a drowning victim being submerged under water for a significant period of time, resuscitation protocol for drowning victims emphasises the importance of ventilating a casualty (providing ‘air’) alongside chest compressions. In non-submersion related instances of cardiac arrest research suggests that in many cases oxygen levels in the body will still be high enough for compression only CPR to be effective.

In most circumstances drowning events are attended by by-standers unequipped with medical equipment. In low-income countries – where professional first response systems are almost non-existent – there is virtually no opportunity for professional medical assistance during an emergency.

Therefore ventilations for drowning victims will nearly always have to be done using mouth-to-mouth techniques that result in physical contact between the lips of one person and another.

Students in Raigonj, Bangladesh learn CPR on the First Responder program

Students in Raigonj, Bangladesh learn CPR on the First Responder program

There has been a fair amount of research on the willingness of people to do mouth-to-mouth ventilations, yet almost all of the existing literature is based on data from high-income countries where drowning rates are relatively low and first responder services generally arrive within minutes.

In Bangladesh drowning is the leading cause of childhood death. At the IDRC-B we have previously published a paper exploring the feasibility of implementing a large scale CPR programme for drowning prevention in a rural district of Bangladesh. The study examined the learning process and retention of knowledge among course participants. Our findings suggest that implementation may be feasible within certain sub-groups of the population.

But even if implementation were feasible, and course participants could retain their skills, the biggest question remains.. in a conservative society, would people put their lips on someone else’s to give ventilations?

To explore the issue in more detail we conducted a study that described hypothetical scenarios to course participants involving situations where they would have to give ventilations to family members, friends and strangers; and measured their ‘willingness’ to do so.

721 people took part in the study. The results were fascinating. We found that willingness to deliver mouth-to-mouth ventilation was heavily influenced by the sex of a potential recipient and their relationship to the trainee. Although ‘willingness’ was highest if the hypothesised victim was an immediate family member (as you would expected), we found significant differences in a persons willingness to give ventilations to a person of the opposite sex (whether close family or not).

Further qualitative research is needed to explain why willingness to give mouth-to-mouth ventilations varies so significantly. Studies from high-income countries suggest that fear of infection is most likely to put people off, yet in Bangladesh our participants noted cultural values (particularly the notion of ‘respect’ to the elderly) as being key drivers.

The results suggest that significant cultural barriers need to be overcome in order to for a community first responder programme for drowning to be feasible in rural Bangladesh. Community education and sensitisation programmes should be developed to highlight the importance of ventilations for drowning victims and normalise the concept of giving mouth-to-mouth ventilations to someone of the opposite sex.

You can read the full article for free in the journal BMC International Health and Human Rights:

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