BASILISK Pre-intervention

According to WHO, cardiovascular diseases (CVDs) are the leading cause of death globally, considering 17.9 million lives died in 2019. Heart attacks and strokes were responsible for 85 percent of these deaths. CVD deaths that occur in low and middle-income countries contributed to over three-quarters of all cases. There is still a plan from WHO between 2010-2025 to lessen the global prevalence of raised blood pressure that causes CVDs by 25% cases.

Meanwhile, In Indonesia,  years of life lost (YLL) caused by the mortality from coronary heart disease (CHD) and cerebrovascular diseases are estimated to be 3,299 and 2,555 YLL/100,000 population, respectively. The absence of a universal healthcare insurance scheme is one possible explanation for the demonstrated inequality in cardiovascular care.

Basic Life Support (BLS) is the foundation for saving lives after cardiac arrest. BLS is a life-saving intervention that can be performed by health workers or laypeople who have been trained for heart attacks, respiratory failure, or obstructive airway breath patients. Basic life support, a vital component of the chain of survival, decreases the cardiopulmonary resuscitation (CPR) interval and increases the hospital discharge rate. Performed systematic reviews for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, a sequence for starting CPR, CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.

BASILISK (Basic Life Support Knowledge) is a community development project held by SCOME CIMSA-BEM KM FK Unand towards medical students from Universitas Andalas. BASILISK aims to improve awareness and knowledge of medical students from Universitas Andalas about the lifesaving CPR and first aid in emergencies measured by increasing pre-test to post-test to a minimum average of 80 in September-October 2021.

On September 10th, 2021, SCOME CIMSA-BEM KM FK Unand held a pre-intervention. The event began with the cadre’s recruitment and re-assessment of knowledge and awareness regarding Basic Life support. This re-assessment was carried out to collect primary data about the importance of the BASILISK program.

BASILISK Intervensi 1

According to The SMARThealth Extend study, High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. The study shows several important findings regarding the treatment received by the respondents with high cardiovascular risk in Indonesia. Only 11% and 1% of them received blood pressure lowering and statins treatment. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.

On September 19th, 2021, SCOME CIMSA-BEM KM FK Unand held intervention 1 of BASILISK. The event was filled with training entitled “Basic Life Support, Handling Trauma, and Indications and Handling Cardiopulmonary Resuscitation (CPR),” given by the experts from IDI West Sumatra, dr. Kino Sp. JP(K), and dr. Rhudy Marseno from PTBMMKI, the selected cadres, presented material that will be useful in the future as a prospective doctor.

In this section, these are some indicators that imply exemplary implementation of Basic Life Support is expected to: cardiac arrest can be prevented and patient transportation can be carried out quickly, Heart and lung function can be improved by using AEDs and compressions, and brain can be preserved because the blood supply is maintained until help arrives.

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies. CPR must only be performed if the person is unconscious. We should not perform CPR if the person is breathing normally. The whole CPR process includes a continuous cycle of 30 chest compressions followed by two rescue breaths. By manually pumping the blood through the body with chest compressions and administering oxygen with the breaths, we act as the victim’s heart.

An AED is a small portable defibrillator  used to restart a person’s heart when they are suffering a sudden cardiac arrest. It starts by analyzing the person’s heart rhythm and then sends an electric shock to the heart to get the heart to beat normally again. They are easy for a layperson to use because all one has to do is turn it on and follow the instructions prompted by the AED.

BASILISK Intervensi 2

On September 24th, 2021, SCOME CIMSA-BEM KM FK Unand held a live simulation of “Basic Life Support, Trauma Treatment, and Indications and Management of Cardiopulmonary Resuscitation (CPR),” which was guided by the student activity unit on our campus who was skilled in this topic. In this simulation, the cadres will practice together to have equal capability.

A splint is a supportive device used to keep in place any suspected fracture in one’s arm or leg. Splinting is often used to stabilize a broken bone during the referral process to the hospital for more advanced treatment. In addition, it could help in treating a severe limb strain or sprain. A splint helps prevent bone protruding through the skin, soft skin and tissue damage, as well as bleeding. 

In emergency cases, anything can be utilized for splinting, yet there are two types of splints: flexible and rigid. There are general principles of splinting: Identify the fracture site, stop the bleeding using bandages, but avoid pressing on the fractured painful and deformed site. In case of bone fractures where the bone ends protrude through the skin, do not push these ends back in place as this will cause inflammation and acute bleeding. Keep the fractured bone motionless, the splint firmly to immobilize the fracture, then check for blood circulation to ensure the splinting is not too tight. 

Meanwhile, Chest compressions are the fundamental component of effective CPR as the widely available means to provide organ perfusion during cardiac arrest. The effectiveness of chest compressions is dependent on correct hand position and chest compression depth, rate, and degree of chest wall recoil. Any pauses in chest compressions mean stopped organ perfusion, and consequently, need to be minimized to prevent ischaemic injury.

There are some indicators of high-quality chest compressions, including starting chest compressions as soon as possible. Deliver compressions on the lower half of the sternum (‘in the center of the chest’).  Compress to a depth of at least 5 cm but not more than 6 cm. Compress the chest at a rate of 100-120 min with as few interruptions as possible. Allow the chest to recoil completely after each compression; do not lean on the chest. Perform chest compressions on a firm surface whenever feasible.

BASILISK Intervensi 3

On September 9th, 2021, SCOME CIMSA-BEM KM FK Unand held a virtual practical exam on “Basic Life Support, Trauma Treatment, and Indications and Management of Cardiopulmonary Resuscitation (CPR),” which is the final intervention for the BASILISK Community Development. In this section, the cadres will be tested based on the views shared in previous interventions by several examiners from PTBMMKI using the Zoom meeting platform. Each cadre will be tested with one examiner.

Currently, about 9 in 10 people who have a cardiac arrest outside the hospital die, and about 350,000 cardiac arrests happen outside of hospitals each year—and about 7 in 10 of those happen at home. Unfortunately, about half of the people who experience cardiac arrests at home don’t get the help they need from bystanders before an ambulance arrives.

Basic cardiac life support aims to restore the circulation of oxygenated blood before professional help arrives. It comprises the basic skills of cardiopulmonary resuscitation (CPR) and combines closed-chest compression with artificial ventilation of the lungs. During cardiac arrest, the heart cannot pump blood to the rest of the body. Death can happen in minutes without treatment. CPR uses chest compressions to mimic how the heart pumps. If performed in the first few minutes of cardiac arrest, CPR can double or triple a person’s chance of survival.

Meanwhile, according to the World Health Organization (WHO), road traffic injuries accounted for 1.25 million deaths in 2014, and trauma is expected to rise to the third leading cause of disability worldwide by 2030. Patients with serious traumatic injuries have a significantly lower likelihood of mortality or morbidity when treated at a designated trauma center.

Splinting plays a major role in managing musculoskeletal injuries, including treating  overuse and soft tissue injuries (e.g., tendonitis and sprains), and traumatic injuries like extremity fractures and joint dislocations. However, preliminary evidence suggests that many splints are misapplied  with the potential for causing unnecessary injury.

Carefully examine the injured extremity before placing the splint. Evaluate pulses, motor function, and sensory function to determine whether emergency intervention or evaluation by a specialist is necessary. Treat skin or soft-tissue injuries appropriately before placing a splint. Routine care after applying  a splint should include extremity elevation, application of ice packs, administration of medications for pain or itching, and appropriate communication of instructions for medical follow-up.