Local medical students can be instructors for life-saving first aid-courses for lay people despite severe stress from siege and military attacks: A descriptive study from Gaza

Background People in Gaza suffer acute, time-critical medical emergencies like other populations: out-of-hospital cardiac arrest (OHCA), myocardial infarction (MI), stroke, septicemia and breathing difficulties. Thousands of trauma casualties from repetitious Israeli attacks on Gaza add to the everyday accidents and trauma patients. Emergency patients need an efficient ‘chain of survival’: lay bystanders able to recognize emergencies, call for help and capable of providing basic life support (BLS) and cardio-pulmonary resuscitation (CPR) as needed. Gaza’s population has little if any access to systematic BLS- and CPR-training. Hospital staff report that many medical and trauma emergency patients reach hospitals without active BLS/CPR, often with blocked airways and ongoing bleeding. We wanted to see if we could recruit local medical students as instructors to train 3000 lay people BLS and CPR in Gaza. Methods We selected 53 5th and 6th year medical student volunteers from Al Azahr University in Gaza to train as BLS- and CPR-instructors. Training included 12 hours BLS/CPR-skills and four hours of didactical skills to enable efficient 1-2 hours basic training. We designed a written questionnaire to explore the student’s demographics, prior training experience, motivation and the expectations they had as to the effects of the training on patient’s outcomes. After completing the instructor course, the students started training lay people. We developed teaching material based on the European Resuscitation Council guidelines and experience from similar training (The Arctic University of Norway). Results The instructors: Fifty-three medical students completed training, 53 % females, 47 % males, all in their early twenties. Response rate to the questionnaire was 92,5 % (49/53). Eight percent had lost family members during Israeli attacks and more than ¼ had lost house or property. Nine out of ten students had no previous experience in training lay people, 70 % had never taken a first aid training course themselves. One third (n=18, 34 %) were afraid of situation where they would need to give first aid. The majority (85,6 %) wanted to increase personal capacity and skills in BLS/CPR. Nearly half of the students wished to contribute to achieve training 3.000 lay people. Nearly ¾ described a sense of belonging and duty to the community as their most important inspiration (n=38, 71,7 %). Forty students (75 %) hoped the training would contribute to increased capacity and skills in the community’s response to emergencies, especially during attacks. The training sessions: Nine training sessions with 246 lay participants are so far completed: six school sessions, two in sporting clubs and one family development center. Twenty-five student instructors have instructed so far, yielding a ratio of 5,8 lay trainees pr. student instructor. The majority of lay trainees have been school students aged 13-20 years (n= 178, 72,4 %). The male/female-ratio of trainees was 1,3:1 Interpretation: We have shown that local medical students are willing and able to train as volunteer instructors for BLS/CPR-courses targeting lay people in communities under severe stress from siege and military attacks. The effects of such training on local resilience and patient mortality need further studies.