title: [Does reluctance to perform mouth-to-mouth ventilation exist among emergency healthcare providers as first responders?].
abstract: BACKGROUND
  Only 30% of survivors from out-of-hospital cardiac arrest receive basic life support (BLS) before the arrival of emergency personnel. This is also due to reluctance to perform BLS, especially mouth-to-mouth ventilation without barrier devices in victims who are unknown to the rescuer (either layperson or healthcare provider).
  
  
  METHODS
  To evaluate the incidence of reluctance to perform mouth-to-mouth ventilation without barrier devices and its consequences in a simulated BLS scenario proposed by a questionnaire to healthcare providers of critical area in a public general hospital.
  
  
  RESULTS
  Answers were collected from 128 of 165 (77.5%) interviewed healthcare providers. Physicians were 46 of 128 (35.9%), professional nurses were 78 of 128 (60.9%) and 4 of 128 (3.2%) were other health workers devoted to patient assistance. Seventy-five of 128 (58.6 %) were reluctant to perform mouth-to-mouth ventilation without barrier devices; 68 of 75 (90.6%) would perform BLS only by chest compression. Compared with non-reluctant providers, they would have been available to perform assisted ventilation by non-validated alternative methods (54.2 vs 18.8% respectively, p < 0.001). Seven of 75 (9.6%, no physician among them) would perform no BLS at all. The most significant predictors of reluctance were age < 40 years (p = 0.07) and previous attendance of BLS-BLSD courses (p = 0.07).
  
  
  CONCLUSIONS
  Reluctance to perform mouth-to-mouth ventilation without barrier devices is frequent and may reduce the number of potential BLS providers. Because of the concern about disease transmission between victim and rescuer, rescuers with a duty to respond such as healthcare providers should follow precautions including the use of barrier device also outside their workplace. When barrier devices are unavailable first responders should consider chest compression alone instead of not performing any BLS maneuvers. BLS training should help give a greater emphasis on this topics.
authors.affiliation: Dipartimento di Cardiologia, Ospedale Maria Vittoria, Torino. massimo_giammaria@libero.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Giammaria
authors.forename: Walter
authors.initials: W
authors.lastname: Frittelli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Belli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Chinaglia
authors.forename: Brunella
authors.initials: B
authors.lastname: De Michelis
authors.forename: Salvatore
authors.initials: S
authors.lastname: Ierna
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.forename: Roberto
authors.initials: R
authors.lastname: Vacca
authors.forename: Emilpaolo
authors.initials: E
authors.lastname: Manno
authors.forename: Rita
authors.initials: R
authors.lastname: Trinchero
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009055:Mouth; D016079:Refusal to Treat / Q000331:legislation & jurisprudence; D012107:Research Design; D012119:Respiration; D011795:Surveys and Questionnaires