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Year : 2020  |  Volume : 23  |  Issue : 10  |  Page : 1449-1455

The effect of knowledge levels of individuals receiving basic first aid training in Turkey on the applications of first aid

Department of Nursing, Biruni University, Faculty of Health Sciences, Istanbul, Turkey

Date of Submission19-Dec-2019
Date of Acceptance10-Apr-2020
Date of Web Publication12-Oct-2020

Correspondence Address:
Dr. A Karaca
Department of Nursing, Biruni University, Faculty of Health Sciences, Protokol Yolu 10. Yıl Cad. No: 45 34010, Topkapi, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_686_19

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Objectives: To evaluate the knowledge level of individuals who attended a first aid training update program, and to determine the factors affecting their approaches in such cases. Methods: This is a descriptive cross-sectional study. The sample of the research consists of 747 individuals (laypersons) who applied to the first aid training update organized in an institution in Istanbul providing health education between 01.02.2018 and 01.08.2018, and who agreed to participate in the research. These first aid trainings are provided by healthcare professionals who have first aid certificate of authority within the scope of first aid regulation. Data were collected using the “Participant Information Form” and the “Basic First Aid Knowledge Level Evaluation Form”. Results: The participants administered first aid within the three years of time following their basic first aid training course (24.6%). They administered first aid primarily in emergency cases of fainting (29.6%) and the majority of them (95.7%) did not perform cardiopulmonary resuscitation during their basic first aid effort. Of the participants, 73.9% answered incorrectly the question: “The letter 'A' in the abbreviation ABC of basic life support administration stands for airway”. In our study, it was also found that there was a significant relationship between the total knowledge score and the number of trainings update and first aid intervention in the last three years (P < 0.05, P < 0.001, respectively). Conclusions: It was determined that individuals had a high level of knowledge about basic first aid and one-quarter of the participants had administered first aid in the last three years. In order for individuals not to lose their knowledge and skills gained through first aid training; updating training and providing first aid training programs to individuals in society can be a guide for bystanders who provide faster and sufficient first aid in cases of emergency.

Keywords: First aid, life support, training programs

How to cite this article:
Karaca A, Kose S. The effect of knowledge levels of individuals receiving basic first aid training in Turkey on the applications of first aid. Niger J Clin Pract 2020;23:1449-55

How to cite this URL:
Karaca A, Kose S. The effect of knowledge levels of individuals receiving basic first aid training in Turkey on the applications of first aid. Niger J Clin Pract [serial online] 2020 [cited 2022 Dec 8];23:1449-55. Available from:

   Introduction Top

Accidents are a major public health problem worldwide leading to death, injuries, lifelong suffering, and major economic loss.[1] As in all health services, prevention of and protection against accidents are much easier and more important than treatment of casualties.[2] It is important for bystanders to administer basic first aid to themselves or others in cases of accident, injury, or sudden illness because medical help may not be immediately accessible. First aid, judiciously applied by bystanders, can save lives and serve as a bridge to survival until professional assistance arrives.[3] According to the American Heart Association (AHA) data (2018), 356,000 out-of-hospital cardiac arrests (OHCA) occur annually in the USA.[4] The most important measure to achieve good neurologic function following OHCA is the immediate initiation of cardiopulmonary resuscitation (CPR) by bystanders. The lay CPR applied following OHCA can improve survival 2-3 times and together with early defibrillation the “drug of choice” in cases of OHCA.[5],[6],[7]

First aid is a set of practices that all individuals should administer in every situation regardless of their health education levels.[2] A systematic worldwide review study reported that 83.7% of patients were administered first aid incorrectly, and estimated that correct first aid could reduce mortality by 1.8%–4.5%.[8] However, bystanders usually need both courage and the necessary knowledge to give basic first aid correctly.[9] Whether individuals responding to incidents or accidents have received first aid training plays a decisive role in sustaining the life of the person, preventing the deterioration of their health condition, preventing disability, and reducing recovery time.[10]

It is important to evaluate the efficacy of this training on increasing and improving laypersons' first aid skills. In line with these assessments, necessary arrangements for first aid training programs should be made evaluating whether the course participants gain the appropriate approaches, competencies, and behaviors related to first aid practices.[11] The aim of this study was to evaluate the basic first aid knowledge level of individuals who attended first aid training updates in addition to their ability to administer first aid, as well as factors affecting their knowledge and application of skills.

   Materials and Methods Top

Study design, setting and sample

This descriptive cross-sectional study was conducted in Kurtaran Health and Education Services, an institution affiliated with the Ministry of Health and authorized to provide first aid training in Istanbul. The study population consisted of 747 individuals who presented to the first aid training update program between February 1st, 2018, and August 1st, 2018. They had received basic first aid training at least three years ago and agreed to participate in the study. No sample selection was made and the entire study population constituted the study sample.

The first aid training certificate programs offered in the center where the study was conducted are organized within the framework of the First Aid Regulation published by the Ministry of Health. This program is adapted from the European Resuscitation Council. These training sessions are given by individuals certified with a “First Aid Trainer Certificate” approved by the Ministry of Health. The aim of this program is to help both the individual and society gain first aid knowledge and skills, to provide first aiders according to the number of the staff in all public and private organizations, and to reduce the risk of death and disability due to accidents. In addition, these training programs are organized as one trainer for every seven participants and the number of participants is limited to a maximum of 21 people. The first aid training program has two levels.

1. Compulsory first aid training: The training is provided over 16 hours (two days). The educational content consists of theoretical and practical training. The theoretical training consists of lectures, question-answer sessions, short films, and demonstration methods. The practical training includes the implementation of CPR on mannequins. After the training, the participants take a central exam given by the Ministry of Health. Individuals who receive 85 points or more on this exam are considered successful and are entitled to receive the first aid certificate approved by the Health Directorates. The certificate is valid for three years. After three years, the validity period is extended by three years with a training update.

2. Training update: This is compulsory training required for individuals whose three-year certificate validity period has expired. The training takes one day (eight hours). The educational content consists of only theoretical and practical training. The effectiveness of the training is evaluated using a pre- and post-test. In this study, the questionnaire form was applied to the participants before training update, during pre-test.

Data collection and measurements

Data were collected using the Participant Information Form and the Basic First Aid Knowledge Level Evaluation Form (BFAKLEF). The questionnaire forms were provided to the individuals, who had previously received basic first aid training, before they attended the first aid training update. The Participant Information Form consists of 12 questions about individuals' “sociodemographic characteristics” and “basic first aid training and interventions”. The Basic First Aid Knowledge Level Evaluation Form was prepared by the researchers in line with the literature to evaluate the knowledge levels of individuals about basic first aid training. This form has eight dimensions with a total of 39 questions on tthe following: (1) general first aid information, (2) CPR administration, (3) bleeding, (4) trauma, (5) burns, (6) epilepsy, (7) acute myocardial infarction, and (8) fractures, dislocations, and sprains. These questions address the most common emergency cases in daily life. The questions are scored one for correct and zero for incorrect answers. The lowest and highest scores that can be obtained from this form are 0 and 39, respectively. Higher scores indicate higher levels of first aid knowledge.

Eight experts were interviewed for the content validity of the form. The experts were asked to evaluate and score each item in terms of comprehensibility and conformity (1 point = not appropriate, 2 points = slightly appropriate, 3 points = appropriate, 4 points = very appropriate). The expert opinions were evaluated using the Content Validity Index. The content validity of the questionnaire was determined as 89%. A pilot study was carried out to decide the clarity of the items in the scale. Data obtained from the pilot study were applied to a total of 10 participants. After the necessary corrections were made regarding the questions that the participants had difficulty in understanding during the pilot implementation, the main application was started.

Ethical consideration

Before conducting the study, the Non Interventional Research Ethics Committee (Decision No. 2018/13-20) and the institution where the research was conducted gave written permission and approval. In addition, informed consent was obtained from participant who agreed to participate in the study.

Statistical analysis

Data were analyzed using descriptive statistics such as frequency, arithmetic mean, standard deviation, and percentage. The independent sample t-test was used for intra-group comparisons of parameters in quantitative data with two groups. In the comparison of quantitative data with more than two groups, one-way analysis of variance (ANOVA) was used for inter-group comparisons of parameters.

   Results Top

Of the 747 individuals who participated in the study, 78.4% were male, 50.6% were high school graduates, 82.6% were married, and 64.3% were civil servants. The mean age of the participants was 39.56 ± 5.99. More than half of the individuals (56.6%) received the initial training update for the first time, and the majority (85.5%) participated in the first aid training voluntarily. One-quarter (24.6%) of the participants had administered any kind of first aid during the study period. First aid was given at home (34.2%) and to persons who they had not met before (31%). The majority of all participants (95.7%) did not perform lifesaving treatment such as CPR [Table 1]. Fainting was the dominating diagnosis (29.6%), followed by foreign objects in airways (14.5%), epileptic seizures (14.4%), and bleeding (13.4%).
Table 1: Distribution of participants' characteristics in related to first aid application (n=747)

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The mean score on the BFAKLEF was 32.23 ± 2.93 (range, 22–39). The knowledge level scores on the sub-dimensions were shown in [Table 2]. Almost all (99.9%) participants knew “The telephone number to the dispatch central is 112”. Only 26.1% could correctly answer the question of “The letter 'A' in the abbreviation ABC of basic life support administration stands for airway”[Table 3].
Table 2: Distribution of responses to the information form for basic first aid training (n=747)

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Table 3: Distribution of responses to the information form for basic first aid training (n=747)

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A significant difference was found between the participants' first aid knowledge level total mean scores with respect to the number of training updates they received (P < 0.05). The first aid knowledge level total mean score of participants who had two training updates (32.62 ± 3.05) was statistically significantly higher than that of participants who had one training update (32.02 ± 3.18)(P < 0.05).

The first aid knowledge level total mean score of participants who administered first aid in the last three years (33.99 ± 3.18) was statistically significantly higher than that of participants who had not (31.85 ± 2.75) (P < 0.001). A statistically significant difference was found between the first aid knowledge level total mean scores of participants who had administered first aid in the last three years with respect to the sub-dimensions of bleeding, trauma, burns, epilepsy, and fractures, dislocations, and sprains, respectively.

No statistically significant difference was found between the participants' first aid knowledge level total mean scores with respect to age, sex, marital status, educational level, and occupation (P > 0.05).

   Dıscussıon Top

The present study was conducted with individuals with a first aid certificate who had participated in at least one training update program, and it was determined that the basic first aid knowledge level of the participants was high. Also in our study, on the information form, the item that the majority of participants answered correctly was “The telephone number to the dispatch central is 112”. This result suggests that almost all of the participants had information about the first step to be taken in the event of an emergency, which is also very important for maintaining the treatment of casualties by a professional team. However, the item that few participants answered correctly was “The letter 'A' in the abbreviation ABC of basic life support administration stands for airway”. This may be due to the education level of the participants or that they might not be familiar with English language. Alternatively, the participants may have forgotten their previous knowledge. ABC is the international reminder acronym for fundamental steps used by both health care professionals and laypersons while dealing with a patient. Basically, it stands for Airway, Breathing, and Circulation. This reminder does not have a Turkish equivalent used in our country. Therefore, deriving an acronym from the Turkish translation will not make any sense unless it is used at national level. In this regard, it can be recommended to prepare memorable study cards for the participants and to send informative messages at certain times. When similar studies are examined in literature, in a study conducted to determine teachers' level of knowledge on first aid, Erkan and Göz[3] stated that teachers were uninformed mostly on epilepsy, CPR, and shock, and Dinçer et al.[2] reported that the majority of teachers did not have sufficient knowledge of first aid. In our study, it is believed that the knowledge total mean scores of the participants were high due to the fact that they had previously attended a basic first aid training course.

Training updates are very important for individuals to complete the lack of information, to renew, and solidify their knowledge, and to minimize mistakes during the administration of first aid. In addition, training updates can increase self-confidence while performing first aid. The present study found that the participants' first aid knowledge level total mean scores increased in direct proportion to the number of training updates they received. Rea et al.[12] determined that correct first aid administration had positive effects on patients, and that individuals who participated in first aid courses improved the level of their knowledge about correct first aid administration. Another review study[13] also suggested that the format and frequency of first aid training increased the performance and attitude of repeated training. Similarly, in the study of Pelinka et al.,[14] it was stated that in order to be able to effectively manage a critically ill or injured patient, bystanders needed to attend first aid training updates. However, Bakke et al.[15] indicated that the pre-hospital emergency care performed by bystanders on patients in serious conditions was substantially accurate and that the training they previously received improved the first aid quality, but its effect on patient survival should be investigated.

The circumstances of individuals performing first aid interventions were also examined in this study. Most of the cases in which the participants reported administering first aid were fainting (29.6%), followed by foreign objects in the airway (14.5%), and epileptic seizures (14.4%). It was also determined that 24.6% of the participants had administered first aid in the last three years. According to Mauritz et al.,[16] the most frequently required first aid measures were “patient positioning,” “controlling hemorrhage,” and “ensuring accident site safety.” The authors indicated that the majority of the participants did not receive first aid training or only attended a first aid course to obtain a driving license.[16] Considering the different results obtained from the studies, it is thought that these results may have been influenced by many of the factors that affect individuals' first aid interventions.

In our study, it was found that most of the participants (95%) had not performed CPR. In addition, the lowest score obtained from the information form was related to the CPR subscale. In the review study conducted by de Buck et al.[17] in the USA in 2013, it was reported that only 20% of laypersons had knowledge about hands-on CPR, and 75% were willing to perform CPR. In the same study, only 39% of the participants reported that they would start resuscitation when faced with real casualties. Training given to school children in CPR is a possible method of increasing the rate of CPR administered by bystanders at the time of an incident and the OOHCA survival rate.[13],[18] The AHA published a statement entitled “Kids Save Lives” in 2011, indicating that CPR training should be mandatory for school children.[17] These studies indicate the importance of compulsory first aid training in formal education programs in increasing survival rates in life-threatening emergency situations, and also show that relevant laws play a major role in this regard.


This study is limited to the individuals who participated in the study and to the institution where the study was conducted. The shortcoming of the study is that some titles related to first aid training (e.g. stroke, intoxication, drowning) are not included in “BFAKLEF” data collection tool. It would be useful for these subjects to be addressed in further studies.

   Conclusıon Top

According to the findings of this study, the individuals had a high basic first aid knowledge level. Also, more than half of the participants had administered first aid in the last three years, mostly in cases of fainting. The continuity of first aid training programs, the voluntary participation of the majority of the participants in the training, the training program organized in accordance with the standards determined by the Ministry of Health, and the competence of Ministry of Health-approved first aid trainers could also be effective in this result. The findings indicate how important and effective a country's health service policies and laws are in this respect.

Financial support and sponsorship


Conflicts of Interest

There are no conflicts of interest.

   References Top

Larsson EM, Mártensson NL, Alexanderson KAE. First-aid training and bystander actions at traffic crashes-Apopulation study. Prehosp Disaster Med 2002;17:134-41.  Back to cited text no. 1
Dinçer Ç, Atakurt Y, Şimşek I. Okulöncesi eǧitimcilerinin ilk yardım bilgi düzeyleri üzerine bir araştırma. J Ankara Univ Fac Med 2000;53:31-8.  Back to cited text no. 2
Erkan M, Göz F. Öǧretmenlerin ilk yardım konusundaki bilgi düzeylerinin belirlenmesi. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2006;9:63-8. (Turkish)  Back to cited text no. 3
American Heart Disease and Stroke Statistics (2019). AHA Centers for Health Metrics and Evaluation [cited 2019 Dec 14]. Available from:  Back to cited text no. 4
Böttiger BW, Semeraro F, Wingen S. Kids save lives: Educating schoolchildren in cardiopulmonary resuscitation is a civic duty that needs support for implementation. J Am Heart Assoc 2017;6:1-4.  Back to cited text no. 5
Iserbyt P, Theys L, Ward P, Charlier N. The effect of a specialized content knowledge workshop on teaching and learning basic life support in elementary school: A cluster randomized controlled trial. Resuscitation 2017;112:17-21.  Back to cited text no. 6
Lukas RP, Van Aken H, Mölhoff T, Weber T, Rammert M, Wildd E, et al. Kids save lives: A six-year longitudinal study of schoolchildren learning cardiopulmonary resuscitation: Who should do the teaching and will the effects last? Resuscitation 2016;101:35-40.  Back to cited text no. 7
Tannvik TD, Bakke HK, Wisborg T. A systematic literature review on first aid provided by laypeople to trauma victims. Acta Anaesthesiol Scand 2012;56:1222-7.  Back to cited text no. 8
Kitchener BA, Jorm AF. Mental health first aid training for the public: Evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry 2002;2:1-6.  Back to cited text no. 9
İnan HF, Kurt Z, Kubilay İ. İlkyardım ve Acil Saǧlık Hizmetleri Daire Başkanlıǧı temel ilkyardım uygulamaları eǧitim kitabı. Temel Saǧlık Hizmetleri Genel Müdürlüǧü, Ankara, 2011.  Back to cited text no. 10
Van de Velde S, Heselmans A, Roex A, Vandekerckhove P, Ramaekers D, Aertgeerts B. Effectiveness of nonresuscitative first aid training in laypersons: A systematic review. Ann Emerg Med 2009;54:447-57.  Back to cited text no. 11
Rea S, Kuthubutheen J, Fowler B, Wood F. Burn first aid in Western Australia-Do healthcare workers have the knowledge? Burns 2005;31:1029-34.  Back to cited text no. 12
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Pelinka LE, Thierbach AR, Reuter S, Mauritz W. Bystander trauma care-effect of the level of training. Resuscitation 2004;61:289-96.  Back to cited text no. 14
Bakke HK, Steinvik T, Eidissen SI, Gilbert M, Wisborg T. Bystander first aid in trauma-prevalence and quality: A prospective observational study. Acta Anaesthesiologica Scand 2015;59:1187-93.   Back to cited text no. 15
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De Buck E, van Remoortel H, Dieltjens T, Verstraeten H, Clarysse M, Moens O, et al. Evidence-based educational pathway for the integration of first aid training in school curricula. Resuscitation 2015;94:8-22.  Back to cited text no. 17
Malta Hansen C, Zinckernagel L, Kjær Ersbøll A, Tjørnhøj-Thomsen T, Wissenberg M, Lippert FK, et al.. Cardiopulmonary resuscitation training in schools following eight years of mandating legislation in Denmark: A nationwide survey. J Am Heart Assoc 2017;6:1-12.  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3]

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