Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey

1 Introduction

Hellenic Police is a Law Enforcement Agency that accounts for approximately 53.000 police officers (PO) whose role in Greek society is diverse. A role that goes deeper than that of law and order (Law 4249/2014 Article 11), reaching social and humanitarian dimensions and includes the pursuit of preserving and maintaining the human physical and mental integrity of the general population, including the PO [1, 2], whose primary tool is the knowledge on the provision of First Aid (FA) [3]. The necessity of knowledge and training in FA [4] (which is estimated to be established in any occupation, every worker and citizen) [5, 6] to Greek PO is highlighted through two main axes:

Regarding the general population, mainly through road accidents [7], cardiovascular disease [8–10], anthropogenic and natural disasters (for example, in 2018 Attica wildfires) [11].

POs, in the course of performing their duty, often come into contact with blood or body fluids by means a needle-stick accident with a drug syringe, the bite of an arrested person, or blood from the captured person getting into the officer’s eyes, mouth, or open wound [13]. If an arrested person carries hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV), and if an exposure accident occurs, the PO is at risk of becoming exposed to (one of) these viruses [13]. In one study of POs in San Diego, almost 30% of all POs recalled at least one needle-stick accident during their work [14]. Moreover, in New York, the incidence of needle-sticks and human bites among Pos is estimated at 39 per 10,000 per year [15].

Moreover, according to Hawkins et al. [16], POs were the first responders in emergency cases requiring FA such as cardiac arrest and vehicle accidents due to the nature of their duties and work. Specifically, POs responded to medical emergencies in 80% of the cases of the incidents they were called upon to address, in 88% of cases they arrived faster than emergency medical services (EMS) and in 60% provided early medical care before EMS arrived. There is a similar situation observed in Tanzania where regardless of whether an ambulance is available for evacuation, Pos have arrived at the crash scene first, effectively becoming the first responders to those who have suffered from road traffic injuries (RTIs) [17].

The profession of PO due to high exposure to stressful and health-threatening situations, related to health risk factors and mainly: blood pressure, metabolic syndrome and cardiovascular diseases. Predisposing factors are: rotational shiftwork, sleep deprivation, poor diet, smoking, alcohol consumption, inactivity, exposure to noise and infectious agents, obesity, stress, and post-traumatic stress [18, 19]. For this reason, the education on FA is paramount of importance.

In the current literature, there is no other study that provides information regarding practices and educational needs of POs on FA/ Cardiopulmonary Resuscitation (CPR). Thus, the purpose of this study was to provide a description of practices and educational needs of Hellenic POs in providing FA/CPR in case of medical emergencies and description of the available equipment of professionalFA kit.

2 Methods

3 Results

3.2 Questions regarding first aid, cardiopulmonary resuscitation and defibrillation [12]

The distribution of the number of correct answers regarding FA, CRP, and Defibrillation questions is presented in Fig. 1. Regarding the nine questions about knowledge in FA, 481 of the 520 participants (92.5%) answered correctly at least one of the nine questions, and none of the responders answered correctly to all nine questions, while 15.2% answered correctly to more than 50% of questions. No factors were significantly associated with the percentage of participants answering correctly to more than 50% of questions.

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Fig. 1

Distribution of the number of correct answers for (FA), Cardiopulmonary Resuscitation (CPR) and Defibrillation questions.

On the other hand, concerning the eight questions about CPR and Defibrillation, 454 of the 520 participants (87.3%) answered correctly at least one of the eight questions, and one of the responders answered correctly to all eight questions. It should be noted that only 11.7% of participants answered correctly to more than 50% of questions for CRP/Defibrillation. It was found that the percentage of participants who answered correctly to more than 50% of questions was statistically significantly higher among those mentioning that they had training for FA (19.0%) compared to those not having training (7.1%, p < 0.001), among those aged more than 35 years old (20%) compared to those aged less than 35 years old (10.0%, p = 0.038) and among those having more than 15 years of work experience (18.5%) compared to those having less (10.5%, p = 0.025).

To the best of our knowledge, this is the first Greek study describing the practices and educational needs of Hellenic POs in providing FA/CPR in case of medical emergencies. Our study underlines that most Hellenic POs did not know what they should do when they experienced FA/CPR needs, indicating the necessity of educating and training POs in Greece in an organized and compulsory manner. A recent Spanish study found that 24.1% of PO had performed at least once FA/CPR in an actual situation which is higher than Greek POs’ response (18.2 %) [20].

The previous finding is in line with a similar Greek study in a sample of Athens population investigating the knowledge about the National Center for Emergency Care (EKAB, tel. number: 166) and knowledge of Basic Life Support (BLS) [24]. In this study it was found that 60% of the respondents did not know what BLS is and only 16.6% were aware of the symptoms of a serious cardiac event [24].

An interesting finding was that the percentage of POs who had experienced FA/CPR needs but did not know what they should do was statistically significantly higher among POs who mentioned that they had never attended a training program in the past to their counterparts. This finding is in line with two previous studies [20, 25]. Specifically, in a Spanish study published in 2017, it was found that knowledge and disposition were significantly associated with having received training with a periodicity of less than two years [20]. In addition, another Malaysian study indicated that the respondents would be willing to handle or render help during any medical emergencies if they had received the proper FA/CPR training [25].

PO education in FA/CPR and the use of Automatic External Defibrillator (AED) may also improve the poor return of spontaneous circulation (ROSC) rate (below 10%) observed in Greece in a recent European study regarding out-of-hospital cardiac arrest (OHCA) [26]. Furthermore, in a study conducted in Sweden [21], it was found that dispatch of first responders (firefighters and/or POs) in addition to emergency medical services in people who experienced Out-of-Hospital Cardiac Arrest (OHCA) was associated with a moderate, but significant, increase in 30-day survival (from 7.7% pre-intervention to 9.5% after intervention). What is more, in a recent review, it was shown that time the weighted mean survival rate of the study groups was higher than that of the control groups (p < 0.001), as was the weighted mean survival rate of the group first shocked by police compared to those first shocked by EMS (39.4% vs. 28.6%, p < 0.001) [27].

One more interesting finding is that only 18.1% (94/520) of the POs had FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%). Expect proper and continuous theoretical and hands-on training in FA/CPR; it is crucial for POs to have the appropriate Professional FA Kit, to provide high-quality services in medical emergencies. This finding is in line with those of three previous studies [17, 29]. Specifically, according to an American study, hemostatic gauze can be effective for treating junctional wounds following brief training, which is important for troops and non-military providers [28]. In another study conducted in Tanzania, in which the purpose was to determine what factors facilitate or hinder the use of trained first aid skills by POs at work, all POs reported lack of equipment as a barrier to using their skills [29]. Additionally, POs highlighted the lack of gloves for self-protection and boards for lifting and carrying injured victims as significant challenges [29]. As a result, it was common for them to find themselves in difficult situations, especially when dealing with bleeding victims [29]. In a qualitative study published in 2019, POs proposed that patrol cars and police posts be stocked with first-aid materials. Bystanders could even assist with rescuing injured victims if first-aid materials were available, as opposed to what is currently happening since no one is ready to work without protection[17].

This questionnaire could be used in high-income countries and in countries with a lifestyle and culture similar to Greece, with only minor adjustments for demographic characteristics. What is more, this questionnaire would be more effective in security force personnel such as police, coast guard and fire service, because its design concerns this kind ofpopulation.

5 Conclusions

There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs. Moreover, the POs should also possess the necessary first aid equipment to render high-quality first aid when on duty.

Further studies need to be conducted on national level with a nationally representative sample in order to determine the educational needs and the level of knowledge of the POs on FA/CPR in all over the country and to determine the differences between rural and urban areas. This crucial to design an effective intervention. Lastly, personnel from all of the security forces such as fire service and coast guard should take part in future studies to investigate the differences between them.

Ethical approval

Ethical approval was obtained from the Ethics Committee of a Greek University (Doc. Ref: 2206/2015) and the Administrative Support and Human Resources (H.R.) Approval from the branch of the Hellenic Police (Doc. Ref: 1821/15/107886) was obtained prior to data collection.

Informed consent

Informed consent form was obtained from all participants prior to their enrollment. All participants were given adequate time to read, understand and perform questions regarding the study protocol and procedures. Study publication procedures did not require participants’ approval.