First aid is “ the difference between a life saved and a life lost .” Thousands of lives in Malaysia – 2,500 lives by asphyxiation from choking or 29,000 lives from heart attacks – could be saved annually if the general public is trained to recognise signs of an emergency and provide first aid (“ A comparative evaluation of first aid knowledge and attitude among medical , dental and pharmacy students in AIMST University , Malaysia ”, Gupta et al ., International Journal of Applied Dental Sciences , Vol . 5 , Issue 3 , 2019 ).

Around 59 per cent of deaths from injuries during emergencies could be saved had first aid been administered (“ Mapping the public first-aid training landscape : a scoping review ”, Heard et al ., Disasters , Vol . 44 , Issue 1 , 2020 ).

A cardiac arrest ( where the heart suddenly stops pumping ) is the most frequent out-of-hospital medical emergency (“ First Aid Training in Malaysia and Reality We Face ”, Alphat Training , Sept 10 , 2017 ).

INCREASING AWARENESS NECESSARY

Cardiopulmonary resuscitation ( CPR ) which includes chest compressions and sometimes manual ventilation to increase blood flow is the typical first-aid response . The initial stage is crucial – the probability of survival decreases by seven to nine per cent every minute CPR is not administered (“ How frequent is bystander cardiopulmonary resuscitation performed in the community of Kota Bharu , Malaysia ?”, Chew et al ., Singapore Med J , Vol . 49 , Issue 8 , 2008 ).

Nine of 10 out-of-hospital cardiac arrest cases result in deaths – because of lack of external intervention , the ambulance response time in Malaysia can be well over 15 minutes . This points to the necessity of increasing awareness and exposure to first-aid training and capability , including not least in CPR .

The estimated survival rate for an outof-hospital cardiac arrest in Kuala Lumpur was 22.5 per cent in 2011 (“ Knowledge of and willingness to perform hands-only cardiopulmonary resuscitation among college students in Malaysia ”, Karuthan et al ., Medicine , Vol . 98 , Issue 51 , 2019 ). Providing CPR within the first few minutes can double or triple survival chances (“ Three Things You May Not Know About CPR ”, CDC , October 22 , 2021 ).

Like cardiac arrests , first aid is critical in the case of burn injuries – first aid decreases injury severity , chances of death and length of hospitalisation and improves healing process (“ Awareness of first aids in

BY JASON LOH

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JUHI TODI

burn injuries : A survey in the population of east coast and central of Malaysia ”, Seow Sul Na ).

The instances of requiring first aid are only increasing over time . As it is , heart attacks are one of the most common causes of death in Malaysia .

In 2007 , 8,700 people ( 24 per day ) died of coronary heart disease ( CHD ) which increased to 13,500 people ( 37 per day ) in 2017 . Malaysia has the lowest average age of onset for CHD in the region at 58 years compared to 65 in Thailand and higher obesity rates (“ Young age no barrier for heart disease ”, New Straits Times , Nov 29 , 2019 ).

FREQUENCY OF FIRST AID

Despite its life-saving importance , knowledge and occurrence of first aid is worryingly low . A study of IIUM Kuantan students in 2017 found that although 90.8 per cent had awareness and a positive attitude towards first aid , only 42.8 per cent had moderate knowledge and 55.4 per cent had little knowledge regarding first aid .

In 2018 , 222 final-year medical , dental and pharmacy students at the Asian Institute of Medicine , Science and Technology ( AIMST , Malaysia ) were surveyed as to their knowledge about first aid . Not one of the participants was able to answer all the questions correctly . For instance , only 21.1 per cent of students answered correctly on a question related to choking . Likewise , only 26 per cent responded correctly when asked what to do when a chemical ( foreign element ) enters the eye .

A Melaka study found that in 2019 only two of the 1780 ( 0.11 per cent ) out-ofhospital heart attacks were given CPR by the general public and that households performed CPR successfully only in one per cent of the cases (“ The Prevalence of Cardiopulmonary Resuscitation for Outof-Hospital Cardiac Arrest in Melaka State , Malaysia ”, Yasin et al ., Advances in Health Sciences Research , 39 , 2021 ).

A study on the Burn Unit of Hospital Universiti Sains Malaysia involving 485 burn patients showed that 222 patients ( 45.8 per cent ) received no first aid , and of the 261 patients ( 53.8 per cent ) that did practice , only 24 patients ( five per cent ) performed it correctly ( running under cool water for more than 20 minutes ).

BYSTANDER EFFECT

The bystander effect is a psychological phenomenon wherein the presence of other individuals discourages people from intervening in an emergency situation . The more bystanders are present during an emergency , the less personally responsible one feels to act – this is known as the diffusion of responsibility . As such , no one takes the initiative to intervene .

Furthermore , as other individuals ’ behaviour socially influences humans to guide their own actions , lack of intervention from others reinforces their own inaction (“ Bystander Effect ”, Psychology Today ). As a result ,

individuals in an emergency situation are unknowingly influenced by the bystander effect .

GOOD SAMARITAN LAWS

A primary concern for the public is the fear of facing legal consequences for performing first aid wrongly and harming the person more by mistake . Good Samaritan Laws ( GSLs ) are designed to protect first aiders from litigation of any form and thus , encourage individuals to perform first aid without fear of repercussions and any inhibition . Unfortunately , the public is usually unaware of the existence of GSLs .

A study in Hong Kong found that only 12.1 per cent were aware of what GSLs were . When informed about GSLs , 95.2 per cent of respondents supported enacting GSLs of which 57 per cent said that implementing GSLs would change their willingness to perform bystander CPR (“ Good Samaritan Law and bystander cardiopulmonary resuscitation : Cross-sectional study of 1223 first-aid learners in Hong Kong ”, Hung et al ., Hong Kong Journal of Emergency Medicine , Vol . 28 , Issue 1 , 2019 ).

Numerous countries , such as the USA , Canada , Australia , Finland , and China , have implemented GSLs . There are currently no GSLs in Malaysia .

Hence , EMIR Research recommends that Parliament enact a Good Samaritan Bill – to provide a “ conducive ” and first-aid friendly environment and eco-system for first responders . In addition , EMIR Research also recommends the following policy proposals :

• Workplaces to hold mandatory first aid workshops once a year – which should be claimable via the Human Resource Development Fund ( HRDF ). In addition , every workplace should have a specially designated first responder who would attend and participate in refresher courses ( and related programmes on , e . g ., emergency response planning ,