[01] Lim Yi Ern, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [02] Liew Teck Vui, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [03] Sangkari Ramesh, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [04] Kalaivani Rajan, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [05] Thavisha Archani Arangala, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia.

Up to 2020 June 09, Coronavirus disease 2019 (COVID-19), a novel pneumonia disease originated from Wuhan, has affected 8,329 people in Malaysia including 325 healthcare staffs. While it is a healthcare professional’s duty to save people from this deadly infectious disease, it could be very intimidating to know that this highly infectious disease can be transmitted easily to themselves through droplets and close contact especially when they are performing Basic Life Support (BLS) which includes chest compression and mouth-to-mouth ventilation. Therefore, the aim of this research is to determine the perceived risk and willingness to perform Basic Life Support among medical students of Melaka-Manipal Medical College (MMMC) following the 2019 Coronavirus pandemic. A cross sectional study was conducted during May 2020 in MMMC. Purposive sampling was used to enrol students into this study and they were asked to respond to the validated online questionnaires designed to examine student’s confidence in BLS skills, their perceptions of the risks associated with performing BLS and their willingness to perform BLS in varying situations. The analysis included frequency, percentages, mean, standard deviation, unpaired T-test, ANOVA, chi-square test and logistic regression. A total of 172 participants answered the questionnaire, including 119 fourth year students and 53 fifth year students. All of them underwent BLS training during 3^rd year. 73.9% of the students were concerned about disease transmission during BLS and 83.8% of them stated that the risk of infection transmission was greater now than it was before the COVID-19 pandemic. Students seemed to be more willing to perform chest compressions only for both family members and strangers but were less willing to perform mouth-to-mouth ventilation in strangers although they were mostly willing to do so for their family members. The fear of COVID-19 was found to be the most important reason that would stop our respondents from performing mouth-to-mouth ventilation. There was a significant association between gender and perception of risk to the rescuer from performing BLS. It has also been found out that the more confident students felt about their skills in BLS, the more willing they were to perform chest compressions and mouth-to-mouth ventilation during an out-of-hospital cardiac arrest. In conclusion, COVID-19 pandemic had affected the risk perception of our medical student to perform BLS but had not much effect on our medical students’ willingness to perform BLS.

Perception, Willingness, Basic Life Support, COVID-19, Medical Students, Cross-sectional

[01] Sangamesh NC, Vidya KC, Pathi J, Singh A. Awareness, Attitude, and Knowledge of Basic Life Support among Medical, Dental, and Nursing Faculties and Students in the University Hospital. J Int Soc Prev Community Dent. 2017 Jul-Aug; 7 (4): 161-167. doi: 10.4103/jispcd.JISPCD_240_17. Epub 2017 Jul 31. PMID: 28852630; PMCID: PMC5558248. [02] Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010 Oct; 81 (10): 1277-92. [03] Narayan DP, Biradar SV, Reddy MT, Bk S. Assessment of knowledge and attitude about basic life support among dental interns and postgraduate students in Bangalore city, India. World J Emerg Med. 2015; 6 (2): 118-22. doi: 10.5847/wjem.j.1920-8642.2015.02.006. PMID: 26056542; PMCID: PMC4458471. [04] Roshana S, Kh B, Rm P, Mw S. Basic life support: knowledge and attitude of medical/paramedical professionals. World J Emerg Med. 2012; 3 (2): 141-5. doi: 10.5847/wjem.j.issn.1920-8642.2012.02.011. PMID: 25215053; PMCID: PMC4129799. [05] Infection control strategies for specific procedures in health-care facilities: a quick reference guide: epidemic-prone and pandemic-prone acute respiratory diseases. World Health Organization [Internet]. 2008 [cited 2020 May 25]. Available from: https://apps.who.int/iris/handle/10665/69792. [06] Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings [Internet]. Centers for Disease control and Prevention; 2020 [cited 2020 May 25]. Available from: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html. [07] Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7 (4): e35797. doi: 10.1371/journal.pone.0035797. Epub 2012 Apr 26. PMID: 22563403; PMCID: PMC3338532. [08] Caves ND, Irwin MG. Attitudes to basic life support among medical students following the 2003 SARS outbreak in Hong Kong. Resuscitation. 2006 Jan; 68 (1): 93-100. doi: 10.1016/j.resuscitation.2005.05.014. Epub 2005 Oct 10. PMID: 16219408; PMCID: PMC7116926. [09] Giammaria M, Frittelli W, Belli R, Chinaglia A, De Michelis B, Ierna S, Imazio M, Vacca R, Manno E, Trinchero R. Esiste la riluttanza a praticare la rianimazione con ventilazione bocca a bocca senza mezzi di barriera tra gli operatori sanitari intervenuti come first responders? [Does reluctance to perform mouth-to-mouth ventilation exist among emergency healthcare providers as first responders?]. Ital Heart J Suppl. 2005 Feb; 6 (2): 90-104. Italian. PMID: 15822733. [10] Mackenzie JS, Smith DW. COVID-19: a novel zoonotic disease caused by a coronavirus from China: what we know and what we don't. Microbiol Aust. 2020; MA20013. PubMed PMID: 32226946. [11] Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of Advanced Research. July 2020; 24: 91-8. [12] Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). The Indian Journal of pediatrics. 2020; 87: 281–6. [13] Lee A. Wuhan novel coronavirus (COVID-19): why global control is challenging? Public Health. 2020; 179: A1–A2. PubMed PMID: 32111295. [14] Coronavirus disease (COVID-19) pandemic [Internet]. World Health Organization; 2019 [cited 2020 May 25]. Available from: http://www.who.int/emergencies/diseases/novel-coronavirus-2019. [15] Coronavirus disease (COVID-19) [Internet]. 2020 [cited 2020 Jun 8]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200518-covid-19-sitrep-119.pdf?sfvrsn=4bd9de25_4. [16] Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020; E1–6. [17] Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, Li P, Zhou Y, Lin YF, Duan Q, Luo G, Fan S, Lu Y, Feng A, Zhan Y, Liang B, Cai W, Zhang L, Du X, Li L, Shu Y, Zou H. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020 Jun; 80 (6): 656-665. doi: 10.1016/j.jinf.2020.03.041. Epub 2020 Apr 10. PMID: 32283155; PMCID: PMC7151416. [18] Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020 May; 115 (5): 766-773. doi: 10.14309/ajg.0000000000000620. PMID: 32287140; PMCID: PMC7172492. [19] Cascella M, Rajnik M, Cuomo A, Dulebohn, S. and Di Napoli, R. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan [cited 2020 May 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554776/. [20] Q&A on coronaviruses (COVID-19) [Internet]. World Health Organization; 2020 [cited 2020 May 25]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses. [21] Dawn Chan. 37 new Covid-19 cases, 1 additional death [Internet]. New Straits Times; 2020 [cited 2020 May 19]. Available from: https://www.nst.com.my/news/nation/2020/05/593881/37-new-covid-19-cases-1-additional-death. [22] Lab, Kini News [Internet]. Covid-19 in Malaysia. 2020 [cited 2020 May 19]. Available from: https://newslab.malaysiakini.com/covid-19/en. [23] Arumugam, Tharanya, and Rahmat Khairulrjijal. 325 Medical Workers Test Positive for Covid-19 [Internet]. New Straits Times; 2020 [cited 2020 May 19]. Available from: https://www.nst.com.my/news/nation/2020/04/586972/325-medical-workers-test-positive-covid-19. [24] Cha AE. Hospitals consider universal do-not-resuscitate orders for coronavirus patients [Internet]. The Washington Post; 2020 [cited 2020 May 26]. Available from: https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/. [25] Wilder-Smith A, Chiew CJ, Lee VJ. Can we contain the COVID-19 outbreak with the same measures as for SARS?[Internet]. 2020 May [cited 2020 May 19]; 20 (5): e102-7. Available from: https://doi.org/10.1016/s1473-3099(20)30129-8. [26] Tomlinson B, Cockram C. SARS: experience at Prince of Wales Hospital, Hong Kong. The Lancet [Internet]. 2003 [cited 2020 May 19]; 361 (9368): 1486-7. Available from: https://doi.org/10.1016/S0140-6736(03)13218-7. [27] Lam KK, Lau FL, Chan WK, Wong WN. Effect of severe acute respiratory syndrome on bystander willingness to perform cardiopulmonary resuscitation (CPR)--is compression-only preferred to standard CPR?. Prehosp Disaster Med [Internet]. 2007 [cited 2020 May 19]; 22 (4): 325-329. Available from: https://doi.org/: 10.1017/s1049023x00004957. [28] Ahorsu, D. K., Lin, C., Imani, V. et al. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addiction [Internet]; 2020 [cited 2020 May 19]. Available from: https://doi.org/10.1007/s11469-020-00270-8. [29] Urooj, U., Ansari, A., Siraj, A., Khan, S., & Tariq, H. Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic. Pakistan Journal of Medical Sciences, 36 (COVID19-S4) [Internet]; 2020 [cited 2020 May 18]. Available from: https://doi.org/10.12669/pjms.36.COVID19-S4.2643. [30] Taghrir MH, Borazjani R, Shiraly R. COVID-19 and Iranian Medical Students; A Survey on Their Related-Knowledge, Preventive Behaviors and Risk Perception. Arch Iran Med. 2020 Apr 1; 23 (4): 249-254. doi: 10.34172/aim.2020.06. PMID: 32271598. [31] Herman B, Rosychuk RJ, Bailey T, Lake R, Yonge O, Marrie TJ. Medical students and pandemic influenza. Emerg Infect Dis. 2007 Nov; 13 (11): 1781-3. doi: 10.3201/eid1311.070279. PMID: 18217571; PMCID: PMC3375803. [32] Huang EP-C, Chiang W-C, Hsieh M-J, Wang H-C, Yang C-W, Lu T-C, et al. Public knowledge, attitudes and willingness regarding bystander cardiopulmonary resuscitation: A nationwide survey in Taiwan. J Formos Med Assoc. 2019; 118: 572–81. [33] Kanstad BK, Nilsen SA, Fredriksen K. CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway. Resuscitation. 2011 Aug; 82 (8): 1053–9. https://doi.org/10.1016/j.resuscitation.2011.03.033. [34] Johnston TC, Clark MJ, Dingle GA, FitzGerald G. Factors influencing Queenslanders’ willingness to perform bystander cardiopulmonary resuscitation. Resuscitation [Internet]. 2003 Jan [cited 2020 Jun 07]; 56 (1): 67–75. Available from: https://doi.org/10.1016/S0300-9572(02)00277-0. [35] Axelsson A, Herlitz J, Fridlund B. How bystanders perceive their cardiopulmonary resuscitation intervention; a qualitative study. Resuscitation [Internet]. 2000 Sept [cited 2020 Jun 7]; 47 (1): 71–81. Available from: https://doi.org/10.1016/S0300-9572(00)00209-4. [36] Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S. CPR training and CPR performance: do CPR-trained bystanders perform CPR? Acad Emerg Med [Internet]. 2006 Jun [cited 2020 Jun 07]; 13 (6): 596–601. Available from: https://doi.org/10.1197/j.aem.2005.12.021. [37] Ismail R, Doi S, Naganathna N. HIV infection in Malaysia: a report of cases seen at the University Hospital, Kuala Lumpur. Med J Malaysia. 1995 Dec; 50 (4): 298-301. [38] Ghanem E, Elgazar M, Oweda K, Tarek H, Assaf F, Ahmed El-Husseny MW, Elgebaly A, Abushouk AI. Awareness of Basic Life Support among Egyptian Medical Students; a Cross-Sectional Study. Emerg (Tehran). 2018; 6 (1): e36. [39] Saquib SA, Al-Harthi HM, Khoshhal AA, Shaher AA, Al-Shammari AB, Khan A, Al-Qahtani TA, Khalid I. Knowledge and Attitude about Basic Life Support and Emergency Medical Services amongst Healthcare Interns in University Hospitals: A Cross-Sectional Study. Emerg Med Int. 2019 Mar 3; 2019: 9342892. [40] Taniguchi T, Omi W, Inaba H. Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan. Resuscitation. 2007; 75: 82–7. [41] Cho GC, Sohn YD, Kang KH, Lee WW, Lim KS, Kim W, et al. The effect of basic life support education on laypersons’ willingness in performing bystander hands only cardiopulmonary resuscitation. Resuscitation. 2010; 81: 691–4. [42] Chew KS, Yazid MNA. The willingness of final year medical and dental students to perform bystander cardiopulmonary resuscitation in an Asian community. Int J Emerg Med. 2008; 1: 301–9. [43] Pillow MT, Stader D, Nguyen M, Cao D, McArthur R, Hoxhaj S. Perceptions of basic, advanced, and pediatric life support training in a United States medical school. J Emerg Med. 2014 May; 46 (5): 695-700. doi: 10.1016/j.jemermed.2013.08.055. Epub 2013 Oct 22. PMID: 24161229. [44] Hamasu S, Morimoto T, Kuramoto N, Horiguchi M, Iwami T, Nishiyama C, Takada K, Kubota Y, Seki S, Maeda Y, Sakai Y, Hiraide A. Effects of BLS training on factors associated with attitude toward CPR in college students. Resuscitation. 2009 Mar; 80 (3): 359-64. doi: 10.1016/j.resuscitation.2008.11.023. Epub 2009 Jan 31. PMID: 19181430.