Proficiency, Prospects, and Barriers Regarding Basic and Comprehensive Cardiovascular Life Support Skills Among Dental Professionals in India: A Mixed-Method Study

ABSTRACT

Objective:

Out-of-hospital cardiac arrest is a major public health concern in India, with survival rates below 10%. Dental professionals, interacting with patients in diverse settings, represent an underutilized segment of the health system for emergency preparedness. This study aimed to assess knowledge, perceived barriers, and opportunities related to basic and advanced cardiovascular life support (BLS/ACLS) among dental professionals in India through a mixed-methods approach.

Methods:

A convergent parallel mixed-method study was conducted between February and July 2025. Quantitative data were collected from 330 registered dental professionals using a validated questionnaire (Item-Content Validity Index = 0.82; Cronbach α = 0.86). The primary outcome was the mean knowledge score. Data were analyzed using descriptive statistics, t tests, analysis of variance, and multivariate linear regression with reporting of 95% confidence intervals (CIs). Multicollinearity was assessed using variance inflation factors. Qualitative data were obtained through two focus group discussions (n = 18) and analyzed using thematic analysis.

Results:

While 64.5% of participants had received BLS training, only 21.5% had ACLS exposure. The mean knowledge score was critically low at 35.59% (95% CI: 33.77–37.41). Multivariate regression (model fit: R² = 0.188) identified prior BLS training (B = 6.93, P < 0.001; CI: 3.10–10.76) and higher qualification (e.g., Doctor of Philosophy (PhD) vs. Bachelor of Dental Surgery: B = −14.72, P = 0.011; 95% CI: −26.01 to −3.43) as significant predictors of knowledge. An attitude-based regression (model fit: R² = 0.173) found that disagreement with mandatory automated external defibrillators (B = −19.37, P = 0.016; 95% CI: −35.08 to −3.65) and neutrality on the importance of compression-only life support (B = −10.20, P = 0.015; 95% CI: −18.33 to −2.06) were significantly associated with lower scores. Qualitative analysis yielded five major themes: training, medical emergencies, needs and role of dentists, barriers, and areas for improvement. These themes elucidated factors such as low confidence, significant infrastructure deficits, and systemic obstacles to training, especially in small towns.

Conclusion:

This study highlights critical deficiencies and quantitatively low knowledge scores in cardiovascular life support preparedness among dental professionals. The findings underscore a missed opportunity to expand India’s emergency response capacity, pointing to an urgent need for mandatory, standardized training and systemic infrastructure improvements.

INTRODUCTION

With sudden cardiac arrest (SCA) emerging as a significant public health challenge in India, particularly among younger adults, strengthening early recognition and response capacity has become a critical priority. Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, with out-of-hospital cardiac arrest (OHCA) contributing to nearly 10% of global deaths and almost half of cardiovascular-related mortality.[1,2] In India, the burden is compounded by rapid urbanization, lifestyle changes, and persistently low bystander-initiated cardiopulmonary resuscitation (CPR) rates, which range between 1.3% and 9.8%.[3] With survival outcomes remaining below 10%, OHCA continues to represent a major public health emergency.[1,4]

Cardiopulmonary arrest represents a life-threatening medical emergency that requires immediate and skilled intervention.[3,5] Such emergencies may arise without warning and in any setting—whether in healthcare facilities or in the community.[6]

Despite their critical nature, these events can often be effectively managed when healthcare providers are equipped with appropriate knowledge and receive regular resuscitation training.[7,8] Proficiency in basic life support (BLS), particularly the timely initiation of CPR, can significantly enhance survival chances during the critical pre-hospital phase.[9,10]

Evidence shows that survival decreases by an estimated 7%–10% for every minute of delay in initiating CPR, highlighting the urgency of immediate action. This time-sensitive nature underscores the need to equip potential first responders—including healthcare trainees and laypersons—with both the skills and the confidence to act decisively.[10,11]

Globally, regulatory frameworks ensure such preparedness. For example, in the United States, completion of a certified BLS course is a mandatory prerequisite for dental practice.[12]

The American Heart Association (AHA) consistently advocates for evidence-based approaches to reduce mortality and morbidity related to cardiac and cerebrovascular emergencies. The unpredictable nature of medical emergencies also extends to the dental settings, where patients may experience sudden systemic complications.[13]

Reports from the United Kingdom indicate that nearly one in every 500 dentists has managed a case of SCA annually over the past two decades. In contrast, an Indian study (2011) reported a markedly higher incidence, with almost 10% of surveyed dentists encountering such emergencies during practice.[14] This discrepancy highlights both the greater likelihood of encountering such events in India and the urgent need for structured workforce preparedness. This study, therefore, aims to examine the extent of proficiency in BLS and advanced cardiovascular life support (ACLS) among dental professionals, explore factors influencing their preparedness, and analyze how training exposure and professional attitudes relate to knowledge and confidence.

MATERIALS AND METHODS

STUDY DESIGN AND SETTING

The study used a convergent parallel mixed-methods design, integrating both qualitative and quantitative components. The qualitative strand followed a descriptive exploratory approach, while the quantitative strand employed a cross-sectional survey. Both components were implemented concurrently between February and July 2025, with equal weighting to facilitate triangulation and a comprehensive interpretation of findings.

STUDY SETTING AND POPULATION

The participant pool included registered dentists across different specialties (both general dentists and specialists) from academic, government, and private clinical settings, thereby capturing a diverse range of professional perspectives.

ETHICAL CONSIDERATIONS

Ethical clearance was obtained from the Institutional Ethics Committee. All participants provided informed consent before involvement. Ethical principles related to autonomy, confidentiality, and voluntary participation were upheld throughout the study.

INCLUSION CRITERIA

Participants included registered dental professionals holding a Bachelor’s, Master’s, or Doctoral (PhD) degree. For those with dual qualifications (e.g., Master of Dental Surgery [MDS] and PhD), the highest qualification was recorded (PhD). Since all MDS students had completed a Bachelor of Dental Surgery (BDS) and were registered dental professionals, their inclusion was consistent with the eligibility criteria. No exclusions were applied based on years of experience or place of practice.

SAMPLING AND SAMPLE SIZE

Quantitative phase

An enumerative sampling approach was applied, inviting all eligible dental professionals reachable during the study period to participate. Recruitment occurred through professional mailing lists, institutional networks, and online platforms (WhatsApp, LinkedIn, and email) associated with national and regional dental associations. As an official denominator of actively practicing dentists was unavailable, the total coverage could not be precisely quantified. This limitation was mitigated by employing wide dissemination across sectors and regions to reduce coverage bias and enhance representativeness.

Qualitative phase

A purposive sampling strategy identified participants capable of offering rich, experience-based insights. Two focus group discussions (FGDs) were conducted at different institutions, each including nine participants selected to reflect diversity in professional role, workplace type, and experience level.

MEASURES AND VARIABLES

Quantitative component

The primary outcome was knowledge of BLS and ACLS, assessed through a 28-item structured questionnaire developed specifically for this study. The instrument covered four domains: demographic details, knowledge of emergency protocols (15 items), prospects and attitude-based (eight items), and training exposure (six items). The knowledge section tested BLS and ACLS knowledge using mutiple choice questions and single-best-answer items, with one point for each correct response, yielding a total score of 0–15. The ACLS-related knowledge items assessed conceptual understanding of advanced life support principles.

Training exposure section recorded prior participation in BLS and ACLS training programs; responses were captured in binary (yes/no) or categorical formats (e.g., “within past 1 year,” “1–3 years,” “>5 years”). The prospects and attitudes section assessed perceptions on emergency preparedness, retraining, dentists’ roles in cardiac emergencies, and automated external defibrillator (AED) use. Five items were measured on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree), and two items used categorical options reflecting recommended training intervals. These items were subjected to principal component analysis (PCA) to identify latent constructs underlying attitudes and perceptions. The extracted components were subsequently used as predictors in regression models.

STUDY TOOLS

Quantitative phase

A self-designed, closed-ended questionnaire was developed to assess dental professionals’ knowledge and perspectives regarding BLS and ACLS. Initially consisting of 35 items, the questionnaire underwent content validation and reliability testing by five domain experts.

The questionnaire was face-validated by subject experts. It was developed specifically for this study and has not been published previously. Content validity was acceptable (Item-Content Validity Index = 0.82), and internal consistency was high (Cronbach α = 0.86). Of the initial 35 items, seven were removed after pilot testing due to redundancy, ambiguity, or low content validity, resulting in a final tool comprising 28 items.

Qualitative phase

An in-depth semi-structured interview guide was designed to explore participant perceptions. It was pre-validated through iterative discussions with the research team, a subject expert, and a practicing dental professional. A pretest was conducted, and necessary modifications were incorporated based on feedback.

DATA COLLECTION PROCEDURES

Quantitative phase

The validated questionnaire was disseminated digitally via Google Forms through professional networks, including email, WhatsApp, and LinkedIn. Online dissemination strategy aimed at maximizing geographic and professional diversity, while acknowledging the limitations of self-selection bias. To enhance response rates, reminder messages were sent once per week for 3 weeks, with a 1-week interval between reminders to reduce participant fatigue and response bias. Upon reaching the target of 330 responses, data collection was concluded.

Qualitative phase

The principal investigator (PI) led the data collection process and conducted training sessions to calibrate a four-member qualitative research team, which included: one moderator (PI); two note-keepers, trained to document both verbal and non-verbal cues; and one sociogram recorder, who mapped conversational flow and interaction dynamics. A pilot FGD involving nine dental professionals was carried out to assess procedural feasibility. Minor refinements were applied based on field observations.

Thereafter, two FGDs were conducted at distinct dental institutions in separate cities. Each group comprised nine participants, including two senior professors, two government-employed dental professionals, two private practitioners, and three postgraduate students. Participants were purposively selected based on their relevance to the study theme and ability to articulate informed, candid views. This composition captured perspectives across academic, public, and private dental care sectors. Written informed consent was obtained before participation. Each session lasted approximately 40 min and was audio recorded with permission. The PI transcribed the recordings verbatim on the same day to ensure fidelity and minimize recall bias.

Coding was conducted manually using color-coding and analytic memoing to trace decisions and interpretations. Codes were inductively derived from participant narratives and iteratively clustered into subthemes and major themes. Data saturation was achieved when no new codes emerged after the second FGD. The final coding tree and thematic structure are illustrated in Figure 1, depicting five overarching themes—training, medical emergencies, role of dentists, barriers, and areas for improvement—each with associated categories and subthemes. Verbatim quotations were included to illustrate typical and divergent viewpoints. Credibility was maintained through investigator triangulation, peer debriefing, and convergence with quantitative findings in the mixed-methods phase.

Figure 1.

Themes and subthemes identified from qualitative focus group discussions among dental professionals

Data management and confidentiality

All data were stored securely in encrypted, password-protected systems accessible only to authorized research personnel. Participant identities were anonymized using unique alphanumeric codes during transcription and analysis. Ethical principles related to privacy, data protection, and confidentiality were rigorously maintained throughout the study.

Quantitative data analysis

Data were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA).

A significance threshold of P < 0.05 was adopted for all statistical tests. First, descriptive statistics—including frequencies, percentages, means, and standard deviations—were calculated to summarize demographic characteristics, training exposure, awareness levels, and knowledge performance. Prevalence estimates were presented with 95% confidence intervals calculated using binomial approximation. To assess group-wise differences in knowledge scores, inferential tests were applied: Student’s t test was used for comparisons between two groups (e.g., gender, training status), while one-way analysis of variance (ANOVA) was used for comparisons across three or more categories (e.g., qualification, time since last training). Where applicable, post hoc tests were conducted. Effect sizes were reported using Cohen’s d for t tests and η² for ANOVA to evaluate the magnitude of observed differences.

To explore latent constructs underlying participants’ attitudes and perceptions, PCA was performed on Likert-scale items to reduce dimensionality or to extract latent constructs. Furthermore, multiple linear regression analysis was conducted to control for confounding and to identify predictors of knowledge scores. Multicollinearity among independent variables was assessed using variance inflation factors, and no evidence of problematic collinearity was observed in the final models. Two models were constructed: The first included demographic and training-related variables, and the second assessed attitudinal and perceptual predictors. Regression coefficients (B), standard errors, t statistics, P values, and effect sizes were reported for each variable. The normality of quantitative data was tested by using the Kolmogorov–Smirnov test. There was no missing data in the collection. Effect sizes were calculated using Cohen’s d for independent group comparisons and η² for ANOVA, where applicable. Effect size estimates are primarily reported for multivariable models to reflect the magnitude of associations beyond statistical significance.

Qualitative data analysis

Qualitative data from FGDs were analyzed by manual thematic analysis. Transcripts were coded inductively, and emergent codes were organized into themes aligned with study objectives. Thematic saturation was considered achieved when no new codes or concepts emerged in the second FGD. Findings from qualitative and quantitative strands were compared for convergence and complementarity, allowing insights from both to reinforce and expand the overall interpretation.

The qualitative strand of this mixed-methods study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist to ensure transparency, reflexivity, and methodological rigor.

RESULTS

QUANTITATIVE

A total of 330 dental professionals participated in the study, predominantly aged between 30 and 35 years (41.2%), with females comprising 64.2% of the sample. Most were postgraduates (MDS: 56.4%), while 40.9% held BDS degrees and 2.7% were PhD-qualified. Nearly two-thirds (64.5%) had previously undergone BLS training, with 48.4% reporting such training in the past 1–3 years. In contrast, only 21.5% had attended ACLS training, primarily within the last 1–3 years (54.9%).

Knowledge regarding specific life-saving procedures was limited. Only 31.8% were familiar with authorized BLS courses, and just 28.5% knew of the nearest emergency response system. Furthermore, only 12.4% had witnessed a CPR event, while 28.8% had seen an AED in use; notably, 12.7% were unfamiliar with the term “AED.” No significant differences in knowledge were observed across age (P = 0.673) or gender (P = 0.346). However, educational qualification was strongly associated (P < 0.001), with PhD and MDS participants scoring significantly higher than BDS graduates. Prior BLS training (P < 0.001) and the recency of that training (P < 0.001) were significantly associated with better knowledge scores. ACLS training also showed a significant association (P = 0.026), particularly among those trained within the past year (P = 0.017) [Table 1]. While several associations reached statistical significance, the magnitude of effect was interpreted primarily using regression-based effect size estimates [Tables 2 and 3].

Table 1.

Demographic characteristics and their association with knowledge scores (n = 330)

Variable	Category	n (%)	Mean ± SD	Test statistic	95% CI (%)	P value
Age (years)	20–25	22 (6.7)	34.50 ± 15.03	F = 0.59	4.0–9.4	0.673
	25–30	107 (32.4)	35.16 ± 16.25		27.4–37.4
	30–35	136 (41.2)	35.34 ± 13.80		35.9–46.5
	35–40	39 (11.8)	35.20 ± 20.45		8.3–15.3
	40–45	26 (7.9)	43.08 ± 23.20		5.0–10.8
Gender	Male	118 (35.8)	34.42 ± 18.34	t = 0.94	30.6–41.0	0.346
	Female	212 (64.2)	36.25 ± 16.01		59.0–69.4
Qualification	BDS	135 (40.9)	28.49 ± 12.72	F = 23.28	35.6–46.2	<0.001*
	MDS	186 (56.4)	40.32 ± 17.61		51.1–61.7
	PhD	9 (2.7)	44.44 ± 19.15		1.0–4.4
BLS training	No	117 (35.5)	29.65 ± 16.76	t = 4.95	59.4–69.6	<0.001*
	Yes	213 (64.5)	38.86 ± 16.06
Year of BLS training	<1 year	65 (30.5)	46.39 ± 12.75	F = 11.39	24.3–36.7	<0.001*
	1–3 years	103 (48.4)	35.18 ± 16.29		41.7–55.1
	>5 years	45 (21.1)	36.41 ± 16.43		15.6–26.6
ACLS training	No	259 (78.5)	34.51 ± 16.73	t = 2.24	17.1–25.9	0.026*
	Yes	71 (21.5)	39.54 ± 16.92
Year of ACLS training	<1 year	25 (35.2)	40.92 ± 13.27	F = 4.30	24.1–46.3	0.017*
	1–3 years	39 (54.9)	31.36 ± 13.01		43.4–66.4
	>5 years	7 (9.9)	39.56 ± 15.01		3.0–16.8
Aware of the authorized BLS course	Yes	105 (31.8)	41.02 ± 16.18	t = 4.53	26.8–36.8	<0.001*
	No	225 (68.2)	32.87 ± 15.98
Aware of the nearest emergency response system	Yes	94 (28.5)	40.11 ± 16.27	t = 3.41	23.6–33.4	<0.001*
	No	236 (71.5)	33.61 ± 16.49
Ever witnessed CPR	Yes	41 (12.4)	41.95 ± 15.84	t = 2.73	8.9–15.9	0.002*
	No	289 (87.6)	34.68 ± 16.82
Ever witnessed AED use	Yes	95 (28.8)	40.87 ± 16.10	F = 7.62	23.9–33.7	0.001*
	No	193 (58.5)	33.72 ± 16.41		53.2–63.8
	Not familiar	42 (12.7)	30.24 ± 15.67		9.1–16.3

BDS = Bachelor of Dental Surgery, MDS = Master of Dental Surgery, PhD = Doctor of Philosophy, BLS = basic life support, ACLS = advanced cardiovascular life support, CPR = cardiopulmonary resuscitation, AED = automated external defibrillator

Source: Original (authors’ own data); P < 0.05 = statistically significant; *statistical significance (effect size estimates [Cohen’s d/η²] are reported for multivariable analyses [Tables 2 and 3] to avoid redundancy in descriptive comparisons)

Table 2.

Multivariate analysis of predictors of knowledge

Parameter	B	SE	t	P value	95% CIL	95% CIU	Effect size
Dependent: Knowledge (%)
Intercept	41.75	5.46	7.64	0.000	31.04	52.46	0.154
20–25 years	1.49	4.76	0.31	0.755	−7.85	10.82	0.000
25–30 years	−2.02	3.68	−0.55	0.583	−9.23	5.19	0.001
30–35 years	−2.36	3.57	−0.66	0.509	−9.35	4.63	0.001
35–40 years	−3.68	4.09	−0.90	0.369	−11.69	4.34	0.003
40–45 years	Ref
Male	−3.64	1.84	−1.98	0.048	−7.24	−0.04	0.012
Female	Ref
BDS	−14.72	5.76	−2.56	0.011	−26.01	−3.43	0.020
MDS	−3.14	5.67	−0.55	0.581	−14.24	7.97	0.001
PhD	Ref
Attended training for BLS	6.93	1.95	3.55	<0.001	3.10	10.76	0.038
Attended training for ACLS	1.98	2.26	0.87	0.383	−2.46	6.41	0.002

BDS = Bachelor of Dental Surgery, MDS = Master of Dental Surgery, PhD = Doctor of Philosophy, BLS = basic life support, ACLS = advanced cardiovascular life support

Source: Original (authors’ own data); P < 0.05 = significant; Bold values indicate statistically significant results; model fit: R² = 0.188

Table 3.

Attitude-based regression analysis predicting knowledge scores

Influencing variable	Response	B	SE	t	P value	95% CIL	95% CIU	Effect size
Dependent: Knowledge (%)
Intercept		41.44	3.76	11.02	0.000	34.07	48.81	0.285
Basic and advanced cardiovascular life support training should be repeated	3–4 months	−12.54	3.92	−3.20	0.002	−20.24	−4.85	0.033
	4–6 months	−6.96	2.98	−2.34	0.020	−12.81	−1.12	0.018
	Once every year	−6.70	2.94	−2.28	0.023	−12.47	−0.93	0.017
	Every two years	Ref.
Every dental professional should be skilled and confident enough to provide ACLS	Strongly disagree	3.08	7.21	0.43	0.670	−11.06	17.21	0.001
	Disagree	5.92	12.76	0.46	0.643	−19.08	30.93	0.001
	Neutral	−7.59	6.40	−1.19	0.236	−20.14	4.95	0.005
	Agree	−1.22	2.63	−0.46	0.643	−6.37	3.93	0.001
	Strongly agree	Ref.
Think basic life support procedure should be done only in hospital settings	No	2.66	2.46	1.08	0.280	−2.16	7.48	0.004
	Yes	Ref.
AED should be made mandatory to be kept in clinical settings as a first aid	Strongly disagree	−11.27	6.77	−1.66	0.097	−24.55	2.00	0.009
	Disagree	−19.37	8.02	−2.41	0.016	−35.08	−3.65	0.019
	Neutral	−3.25	3.29	−0.99	0.323	−9.69	3.19	0.003
	Agree	−0.72	2.40	−0.30	0.766	−5.43	3.99	0.000
	Strongly agree	Ref.
Use of an AED with high-quality CPR can double or triple the chances of survival	Strongly disagree	1.62	8.03	0.20	0.841	−14.13	17.36	0.000
	Disagree	14.84	13.57	1.09	0.275	−11.75	41.43	0.004
	Neutral	−8.45	3.46	−2.44	0.015	−15.23	−1.68	0.019
	Agree	−3.36	2.62	−1.28	0.200	−8.49	1.77	0.005
	Strongly agree	Ref.
ACLS can occur in both out-of-hospital and in-hospital settings	Strongly disagree	21.46	9.07	2.37	0.019	3.69	39.23	0.018
	Disagree	5.42	4.51	1.20	0.231	−3.42	14.26	0.005
	Neutral	9.08	3.40	2.67	0.008	2.42	15.74	0.023
	Agree	3.79	2.67	1.42	0.158	−1.45	9.02	0.007
	Strongly agree	Ref.
COLS should be known to every citizen of India to resuscitate the victim in cases of out-of-hospital cardiac arrest	Strongly disagree	−18.85	12.18	−1.55	0.123	−42.73	5.03	0.008
	Disagree	−2.86	9.18	−0.31	0.756	−20.86	15.14	0.000
	Neutral	−10.20	4.15	−2.46	0.015	−18.33	−2.06	0.019
	Agree	−0.31	2.26	−0.14	0.891	−4.74	4.12	0.000
	Strongly agree	Ref.

ACLS = advanced cardiovascular life support, AED = automated external defibrillator, CPR = cardiopulmonary resuscitation, COLS = compression-only life support

Source: Original (authors’ own data); P < 0.05 = statistically significant (Bold values indicate statistically significant results); model fit: R² = 0.173

The PCA revealed two dominant components. Component 1 reflected strong positive attitudes toward CPR/ACLS utility and preparedness, while Component 2 was related to training frequency preferences.

A majority (79.7%) agreed or strongly agreed that AEDs should be mandatory in clinics, and 80% endorsed their role in improving survival outcomes with high-quality CPR (these response trends are illustrated in Figure 2). Similarly, 78.2% believed ACLS should be delivered both in-hospital and out-of-hospital, and 89.4% supported public training in compression-only life support (COLS). Most participants (92.8%) agreed that dental professionals should be skilled in ACLS, with the belief aligning strongly with Component 1 (loading = 0.751) [Table 4].

Figure 2.

Heatmap of attitudes and perceptions regarding advanced cardiovascular life support/basic life support among dental professionals in India (n = 330)

Table 4.

Attitude and perception: principal component analysis

Attitude and perception	No.	%	Principal component
			1	2
Basic and advanced cardiovascular life support training should be repeated
3–4 months	31	9.4	−0.078	0.939
4–6 months	120	36.4
Once every year	137	41.5
Every two years	42	12.7
Every dental professional should be skilled and confident enough to provide ACLS
Strongly disagree	14	4.2	0.751	−0.007
Disagree	2	0.6
Neutral	8	2.4
Agree	58	17.6
Strongly agree	248	75.2
Think basic life support procedure should be done only in hospital settings
No	270	81.8	−0.235	0.279
Yes	60	18.2
AED should be made mandatory to be kept in clinical settings as a first aid
Strongly disagree	15	4.5	0.772	0.091
Disagree	8	2.4
Neutral	44	13.3
Agree	126	38.2
Strongly agree	137	41.5
Use of AED with high-quality CPR can double or triple the chances of survival
Strongly disagree	12	3.6	0.823	0.124
Disagree	3	0.9
Neutral	51	15.5
Agree	126	38.2
Strongly agree	138	41.8
ACLS can occur in both out-of-hospital and in-hospital settings
Strongly disagree	10	3.0	0.654	−0.182
Disagree	17	5.2
Neutral	45	13.6
Agree	164	49.7
Strongly agree	94	28.5
COLS should be known to every citizen of India to resuscitate the victim in cases of out-of-hospital cardiac arrest
Strongly disagree	7	2.1	0.786	0.115
Disagree	5	1.5
Neutral	23	7.0
Agree	123	37.4
Strongly agree	171	52.0

ACLS = advanced cardiovascular life support, AED = automated external defibrillator, COLS = compression-only life support, CPR = cardiopulmonary resuscitation

The overall mean knowledge score was 35.59% (±16.87), indicating low awareness. The most poorly answered items were K17 and K16, with incorrect response rates of 89.7% and 88.5%, respectively. The highest correct responses were observed for K20 (65.5%) and K22 (62.1%), reflecting selective but inadequate knowledge distribution [Table 5].

Table 5.

Knowledge of basic life support/advanced cardiovascular life support

Knowledge item	Incorrect		Correct
	No.	%	No.	%	95% CI of correct knowledge
Early recognition of cardiac arrest	292	88.5	38	11.5	7.65%–15.35%
Areas to improve the quality of services during medical emergencies	296	89.7	34	10.3	7.02%–13.58%
The most common cause of cardiac arrest	271	82.1	59	17.9	13.74%–22.01%
Time taken to perform a pulse check	193	58.5	137	41.5	36.20%–46.83%
Management of a patient with no pulse	114	34.5	216	65.5	60.32%–70.59%
Compression-to-ventilation ratio	136	41.2	194	58.8	53.48%–64.10%
Rate of chest compressions	125	37.9	205	62.1	56.89%–67.36%
Depth of chest compressions	233	70.6	97	29.4	24.48%–34.31%
T-CPR	156	47.3	174	52.7	47.34%–58.11%
Steps of high-quality CPR	176	53.3	154	46.7	41.28%–52.05%
Symptoms of cardiac arrest	235	71.2	95	28.8	23.90%–33.67%
Effective ACLS	285	86.4	45	13.6	9.93%–17.34%
Equipments for ventilation	251	76.1	79	23.9	19.34%–28.54%
Overall (%) mean ± SD	35.59 ± 16.87 (33.77–37.41)

CPR = cardiopulmonary resuscitation, ACLS = advanced cardiovascular life support

Source: Original (authors’ own data)

Significant associations were found between knowledge scores and several attitudinal factors. Participants who agreed that AEDs should be mandatory in clinics (P = 0.007) and that AED use with CPR enhances survival (P = 0.001) had higher knowledge scores. A strong association was also observed between knowledge and the belief that COLS should be universally known (P = 0.002). Notably, a statistically significant association was observed where those preferring less frequent CPR/ACLS training (e.g., every 2 years) had higher knowledge scores, suggesting a possible overcompensation in training preference among those less informed [Table 6]. However, these findings represent an association rather than an effect.

Table 6.

Association of knowledge with attitudes and perceptions

Variable	Overall, knowledge (%)		Significance
	Mean	S	t/F value	P value
Basic and advanced cardiovascular life support training should be repeated
3–4 months	29.53	15.52	F = 4.12	<0.001
4–6 months	34.87	18.68
Once every year	35.37	14.07
Every two years	42.86	18.85
Every dental professional should be skilled and confident enough to provide ACLS
Strongly disagree	34.62	17.53	F = 1.93	0.105
Disagree	30.77	21.76
Neutral	23.08	11.63
Agree	32.63	14.79
Strongly agree	36.79	17.26
Think basic life support procedure should be done only in hospital settings
No	36.21	17.06	t = 1.41	0.160
Yes	32.82	15.83
AED should be made mandatory to be kept in clinical settings as a first aid
Strongly disagree	29.74	19.47	F = 3.55	0.007
Disagree	23.08	11.63
Neutral	30.42	17.79
Agree	36.02	14.94
Strongly agree	38.24	17.57
Use of AED with high-quality CPR can double or triple the chances of survival
Strongly disagree	33.97	18.69	F = 4.60	0.001
Disagree	30.77	0.00
Neutral	27.00	17.57
Agree	36.26	14.75
Strongly agree	38.41	17.55
ACLS can occur in both out-of-hospital and in-hospital settings
Strongly disagree	36.92	16.93	F = 0.46	0.766
Disagree	38.46	13.60
Neutral	37.78	17.50
Agree	35.32	15.91
Strongly agree	34.37	18.80
COLS should be known to every citizen of India to resuscitate the victim in cases of out-of-hospital cardiac arrest
Strongly disagree	29.67	18.00	F = 4.42	0.002
Disagree	29.23	8.43
Neutral	22.74	13.22
Agree	35.90	16.11
Strongly agree	37.43	17.28

ACLS = advanced cardiovascular life support, CPR = cardiopulmonary resuscitation, AED = automated external defibrillator, COLS = compression-only life support.

Source: Original (authors’ own data); P < 0.05 = statistically significant (Bold values indicate statistically significant results)

In multivariate linear regression [Table 2], significant predictors of higher knowledge included female gender (B = −3.64, P = 0.048), higher qualification (BDS vs. PhD: B = −14.72, P = 0.011), and prior BLS training (B = 6.93, P < 0.001). ACLS training, however, was not a significant independent predictor.

In attitude-based regression [Table 3], a statistically significant inverse association was observed between preference for more frequent training (every 3–4 months) and knowledge scores (B = −12.54, P = 0.002). Disagreement or neutrality on key life-saving beliefs (e.g., AED usage, COLS importance) was also associated with lower knowledge scores.

QUALITATIVE RESULTS

Thematic analysis of the FGDs revealed five overarching themes: training, medical emergencies, needs and role of dentists, barriers, and areas of improvement (an overview of the identified themes and subthemes is shown in Figure 1). Each theme encompassed relevant subthemes, highlighting participants’ knowledge, experiences, and perceptions toward BLS/ACLS.

Theme 1: Training

Explored participants’ awareness, experiences, and accessibility of BLS/ACLS training.

CATEGORY 1: KNOWLEDGE ABOUT BASIC LIFE SUPPORT AND ADVANCED CARDIOVASCULAR LIFE SUPPORT TRAINING

Participants demonstrated awareness of the life-saving potential of BLS but perceived ACLS as more technical and restricted to trained healthcare professionals.

“Basic life support is about saving lives after cardiac arrest.”—Respondent A.

“BLS maintains ABC of the patient who collapse.”—Respondent B.

“ACLS is for trained professionals and not for layman, BLS is something which everyone can learn.”—Respondent C.

CATEGORY 2: EXPERIENCES DURING THE TRAINING

The training sessions were viewed as confidence-boosting and essential for applying theoretical knowledge. Hands-on practice was particularly valued.

“The hands-on training provided during the course was extremely helpful in understanding the theoretical knowledge.”—Respondent A.

“While in dental clinic, if there is any emergency, I felt a sense of confidence about being able to manage it.”—Respondent B.

“Earlier I did not know about the correct sequence of BLS.”—Respondent C.

CATEGORY 3: AUTHORIZED BASIC LIFE SUPPORT/ADVANCED CARDIOVASCULAR LIFE SUPPORT COURSE PROVIDERS IN INDIA

The respondents were not very well aware of the course providers in India.

“I am not aware of organizations providing courses in India but I know some of the course providers outside India like AHA.”—Respondent A.

“Courses are provided individually either at college level like in AIIMS or at department level according to interest of each department.”—Respondent B.

Theme 2: Medical Emergencies

Captured personal encounters with cardiac emergencies and perceptions of rising sudden deaths.

CATEGORY 4: INDIVIDUAL EXPERIENCES

Participants recalled witnessing or hearing about cardiac arrest incidents, both in clinical and public settings, which influenced their perceived need for CPR training.

“I have encountered a case of cardiac arrest at airport, some person collapsed suddenly, CPR was given to him by some other person and not me. However, if I had to provide CPR at that point of time, I am not sure I would be able to do it. This is before the training I took.”—Respondent A.

“I have seen my grandfather suffering from cardiac arrest, I was too young to understand at that point of time, all I remember was that the doctor provided him with CPR and medications which lead to his survival”—Respondent B.

CATEGORY 5: REASONS OF INCREASED CASES OF SUDDEN DEATH IN INDIA

Participants commonly cited cardiac arrest as a key contributor to the increasing rate of sudden deaths in India. Sedentary lifestyle and post-COVID complications were highlighted as possible drivers.

“Cases of about sudden death due to cardiac arrest have been increased a lot lately, the reason for it could be sedentary lifestyle may be”—Respondent A.

“Recently post-COVID complications may also be the reason”—Respondent B.

Theme 3: Needs and Role of dentists

Examined perceived responsibility and benefits of BLS/ACLS competency among dentists.

CATEGORY 6: IMPORTANCE OF LEARNING BASIC LIFE SUPPORT AND ADVANCED CARDIOVASCULAR LIFE SUPPORT

Participants collectively emphasized the necessity for dental professionals to be trained in BLS and ACLS, not only for clinical practice but also for community-level preparedness. In addition to performing CPR, participants highlighted the role of dentists in spreading awareness.

“Emergency can occur anywhere anytime, so I should be prepared at all times be it in dental clinic or out of clinic situation of cardiac arrest”—Respondent A.

“While we go in any community settings to treat the population, in case of any emergency during such programs, we should be able to manage it and that is only possible if we are skilled and are confident enough at our skills.”—Respondent B.

“I can also educate the general public about importance of compression-only CPR, and how it should be given until any professional help arrives.”—Respondent C.

“Apart from in hospital or out hospital cardiac arrest cases, knowing applied skills of BLS and ACLS can help me in holding onto dear lives.”—Respondent D.

CATEGORY 7: NECESSARY MEASURES NEEDED TO ACQUIRE BASIC LIFE SUPPORT AND ADVANCED CARDIOVASCULAR LIFE SUPPORT SKILLS

Respondents stressed that acquiring life support skills should be viewed as a professional responsibility.

“Should know at least the basics to save lives, it is mandatory to rescue the patient in case of emergency be it anywhere.”—Respondent A.

“We dentist are also considered as doctors, and if I encounter any case of cardiac arrest at any point of time, I cannot justify that oh I am a dentist! I cannot manage it, call any medical doctor.” I should be able to provide timely initiation.”—Respondent B.

“Incorporate and mandate the skillful training of BLS and ACLS in UG Curriculum”—Respondent C.

“Regular CDE Program for dentists training can motivate dentists to be trained”—Respondent D.

CATEGORY 8: BENEFIT TO A DENTIST AS WELL AS THE PUBLIC

Training dentists in BLS and ACLS was perceived as mutually beneficial—enhancing employability and public health outcomes. The participants highlighted that incorporating dentists into medical emergency services can boost employment and reduce the mortality rate.

“Employment can be increased if the DCI makes it mandatory for all dentists to learn BLS and ACLS.”—Respondent A.

“Number of professionals who are trained and equipped to manage medical emergencies will be increased. This will eventually increase the manpower.”—Respondent B.

“Dentists will be more audible to the normal public; we will also be able to say that we can also save lives.”—Respondent C.

“Accessibility to the healthcare sector will be enhanced”—Respondent D.

“By an interdisciplinary approach we can help in reducing overall mortality rate of cardiac arrest”—Respondent E.

Theme 4: Barriers

Identified obstacles in implementing emergency management in dental practice.

CATEGORY 9: MAJOR CHAOS

Participants described real-world challenges faced during emergencies in dental clinics, often marked by panic, confusion, and a lack of coordinated response.

As one respondent, A explained, “The panic and crowd gathered during such situations hinders immediate action”—Respondent B.

Confidence was a recurring concern: “Lack of confidence to manage such emergency is the major problem,” noted another—Respondent C.

Contributing factors included “delayed call for help, unskilled compressions, and improper time management.”—Respondent D.

Additionally, limited infrastructure was cited: “We don’t have access to emergency equipment like AED.”—Respondent E.

CATEGORY 10: CRITICAL CARE EMERGENCIES IN SMALL TOWNS

The participants highlighted various problems like limited resources and support available. This paints a picture of systemic gaps in both training and infrastructure, making it challenging to manage critical care in these areas.

“They are not very well managed in small cities, there are improper transportation facilities, lack of basic equipment and even lack of doctors in small towns because mostly they do not want to get posted in small towns due to lack of facilities provided to them.”—Respondent A.

“I belong to a small town and I think that there is lack of knowledge and awareness among dental professionals, population and basically everyone because there is all over lack acknowledgment, emphasis is not given to teach and tell us about critical care emergency”—Respondent B.

Theme 5: Areas of improvement

Highlighted recommendations to strengthen emergency preparedness and training.

CATEGORY 11: NEED FOR LOCAL TRAINING AND REDUCED REFERRAL TIME

The participants highlighted the urgency of addressing the gaps in local emergency response and training to save lives.

“There is a loss of time and mostly the health of patient deteriorate during transportation”—Respondent A.

“If skilled people are available, it can be managed in small towns as well.”—Respondent B.

“Training at PHC level should be made mandatory this would help us in providing timely first aid management and reducing mortality rate.”—Respondent C.

CATEGORY 12: STRENGTHENING BASIC LIFE SUPPORT/ADVANCED CARDIOVASCULAR LIFE SUPPORT TRAINING THROUGH SYSTEMIC REFORMS

The participants highlighted the need for structured education and government involvement to strengthen emergency response training in dentistry.

“There is a general lack of awareness and responsibility when it comes about managing such situations.”—Respondent A.

“Educating and training the general public through outreach programs can be beneficial in improving awareness in layman about importance of compression-only CPR.”—Respondent B.

“There should be strong government initiatives to strengthen BLS and ACLS skills among dentists as well, this will help out in decreasing mortality rate.”—Respondent C.

“Generally, there is a casual approach among UG students as well as staff, while they are posted in general medicine and general surgery department.”—Respondent D.

“There should be mandatory departmental postings in emergency wards for training dentists as well, both in UG as well as PG.”—Respondent E.

DISCUSSION

This mixed-methods study revealed gaps in knowledge of life support preparedness among dental professionals. Although awareness of BLS was high, ACLS training remained limited. Quantitative and qualitative findings converged to show that hands-on exposure strongly improved knowledge and confidence, yet systemic barriers such as low awareness of training providers, limited infrastructure, and poor emergency accessibility persist.

Triangulation of quantitative and qualitative findings

Findings from the qualitative strand were used to explain and contextualize quantitative patterns, consistent with the principles of a convergent parallel mixed-methods design.

TRAINING: GAPS IN KNOWLEDGE, EXPERIENCE, AND EXPOSURE

The quantitative findings of the present study highlight a substantial disparity in both the uptake and visibility of formal life support training, particularly in relation to ACLS. This pattern was echoed in the qualitative data, where participants consistently described BLS as a foundational and accessible skill, but perceived ACLS as more advanced and restricted to medical professionals. One respondent summarized this distinction by stating, “ACLS is for trained professionals and not for layman, BLS is something which everyone can learn.” Others reinforced basic understanding, with comments such as, “BLS is about saving lives after cardiac arrest.” Beyond triangulated findings, these findings align with international evidence. Previous studies reported that resident dentists demonstrated suboptimal skills despite prior CPR training, underscoring a lack of confidence in real-world emergencies.[2,15,16,17,18]

The emergence of training initiatives that provide AHA-based ACLS training for dental professionals reflects evolving recognition of the issue, yet participation remains largely elective. To ensure better preparedness, BLS and ACLS training must transition from optional to mandatory.[19,20,21]

The importance of experiential learning emerged strongly in both data strands, which also coincides with previous studies that suggest simulation-based training.[6,16,22,23,24] Quantitative analysis revealed that recent BLS training—particularly within the past year—was significantly associated with higher knowledge scores (mean = 46.39%, P < 0.001). This was echoed in FGDs, where participants emphasized the value of hands-on sessions. One shared, “The hands-on training provided during the course was extremely helpful in understanding the theoretical knowledge,” while another stated, “While in dental clinic, if there is any emergency, I felt a sense of confidence about being able to manage it.”

Despite the presence of nationally coordinated resuscitation initiatives, awareness of authorized life support training providers remained low (31.8%).[25] This finding was consistent with focus group statements like, “I am not aware of organizations providing courses in India but I know some of the course providers outside India like AHA.” Another participant explained, “Courses are provided individually either at college level like in AIIMS or at department level according to interest of each department.” These findings mirror evidence from questionnaire-based regional surveys reporting limited awareness of formal medical services and BLS activation pathways, even in states with established emergency medical services infrastructure.[26]

MEDICAL EMERGENCIES: REAL-WORLD ENCOUNTERS AND SYSTEMIC GAPS

Emergency preparedness gaps are not confined to training exposure. Shivakumar et al.[11] reported that readiness for medical emergencies among dental professionals in India remains inadequate despite growing demand. Our findings confirm this, with only 28.5% of participants aware of the nearest emergency response system, 28.8% having witnessed an AED in use, and 12.7% unfamiliar with the term “AED.” Qualitative data echoed this, with participants recalling instances of uncertainty and hesitation in real emergencies. For instance, one shared, “I have encountered a case of cardiac arrest at airport… CPR was given to him by some other person and not me. However, if I had to provide CPR… I am not sure I would be able to do it.” Another recalled, “I have seen my grandfather suffering from cardiac arrest… all I remember was that the doctor provided him with CPR and medications which lead to his survival.” Access to emergency equipment was a major concern: “We don’t have access to emergency equipment like AED.” Similar observations have been reported in studies examining emergency preparedness across healthcare cadres, which underscores that improving emergency preparedness requires not only formal training but also regular drills, AED accessibility, and system-level integration within both academic and routine clinical practice.[27,28,29,30,31,32]

NEEDS AND ROLE OF DENTISTS: FROM CLINICAL READINESS TO PUBLIC HEALTH RESPONSIBILITY

The study also demonstrated that dentists themselves recognize their evolving professional role in emergency preparedness. A large majority (75.2%) agreed that every dental professional should be skilled in ACLS, while 89.4% endorsed universal training in COLS. FGDs showed that participants viewed preparedness as a professional and civic responsibility. “Emergency can occur anywhere anytime, so I should be prepared at all times be it in dental clinic or out of clinic situation”; “In community settings… we should be able to manage it… only possible if we are skilled and confident.”

Dentists’ public health potential was also highlighted: “I can also educate the general public about importance of compression-only CPR” (Respondent C) and “Knowing applied skills of BLS and ACLS can help me in holding onto dear life” (Respondent D). Participants who supported AEDs in clinics and AED + CPR efficacy scored significantly higher (P = 0.007, P = 0.001, respectively), as did those endorsing universal COLS training (P = 0.002). These findings reaffirm the dentist’s evolving role in emergency preparedness and patient education. These findings align with the study of Gangakhedkar,[10] where COLS is described as a culturally adaptive public health strategy for India’s diverse context. Such insights reaffirm that dental professionals, though primarily oral health providers, represent an untapped workforce capable of contributing to India’s chain of survival.

BARRIERS: CONFIDENCE, INFRASTRUCTURE, AND CONTEXTUAL CONSTRAINTS

Barriers to preparedness emerged clearly across both data strands. Despite the willingness to learn, panic, lack of confidence, and infrastructural deficits were reported as recurring challenges. Although 75.2% endorsed ACLS competency, only 28.5% knew of local emergency services. Focus group narratives highlighted systemic weaknesses: “The panic and crowd gathered… hinders immediate action”; “Lack of confidence… is the major problem”; “Delayed call for help, unskilled compressions, and improper time management.”

Participants from smaller towns described additional difficulties: “I belong to a small town… lack of knowledge and awareness among dental professionals, population and basically everyone”; “They are not very well managed in small cities… lack of basic equipment and even lack of doctors.” Together, these findings reflect broader systemic inequities in emergency care access and training between urban and rural settings.

AREAS OF IMPROVEMENT: TOWARD SYSTEMIC REFORM AND LOCAL EMPOWERMENT

In terms of improvement strategies, both quantitative and qualitative findings pointed to urgent reforms. The mean knowledge score was 35.59% (±16.87); knowledge gaps were particularly evident in early cardiac arrest recognition (88.5% incorrect) and emergency service improvement (89.7% incorrect). Similarly, Mamgain et al.[33] assessed BLS awareness among healthcare workers in a tertiary hospital in northern India and reported deficits in recognizing unresponsiveness, pulse check, and the sequence of chest compressions. Regression analysis demonstrated an inverse association between preference for more frequent retraining and knowledge scores (B = −12.54, P = 0.002). This pattern may reflect reverse causation, confidence—knowledge mismatch, or over-reporting of training needs among individuals with perceived inadequacy, rather than a true effect of training frequency. An association was observed wherein participants who strongly disagreed that ACLS can occur in both in-hospital and out-of-hospital settings demonstrated higher knowledge scores (B = 21.46, P = 0.019), possibly due to differential item interpretation or response bias.

Participants themselves highlighted systemic solutions: “There is a loss of time… patient deteriorate during transportation”; “Training at PHC level should be made mandatory”; “There should be strong Government initiatives to strengthen BLS & ACLS skills among dentists.” Educational reforms were also highlighted: “Mandatory departmental postings in emergency wards … both in UG and PG.” These findings align with previous study recommendations that call for integrating BLS/ACLS into the curricula of healthcare cadres in India.[34,35]

Given the Indian context of this study, the findings carry direct implications for dental education governance. These results support the integration of structured BLS, with appropriate introductory components of ACLS, into the undergraduate dental curriculum by the DCI and related regulatory bodies. Embedding competency-based training with periodic reinforcement within the BDS curriculum could ensure uniform preparedness and strengthen dentists’ contribution to India’s emergency response capacity.

A major strength of this study is its mixed-methods design, which enabled triangulation of quantitative patterns with qualitative insights. This approach allowed us to capture not only measurable gaps in knowledge and training but also the lived experiences and contextual barriers faced, thereby generating a more comprehensive understanding of workforce preparedness. The inclusion of participants from academic institutions, government facilities, and private practices enhanced representativeness and provided perspectives across different levels of healthcare delivery. Rigorous tool development, including expert validation and reliability testing, strengthened internal consistency. The qualitative component further enriched findings by revealing systemic and behavioral challenges that might not be apparent in survey-based research, thereby enhancing the policy relevance of the study.

However, certain limitations must be acknowledged. The cross-sectional nature of the quantitative component restricts the ability to draw causal inferences between training exposure and knowledge outcomes. Accordingly, counterintuitive associations observed should not be interpreted as causal relationships but as exploratory patterns requiring confirmation in longitudinal or interventional studies. Several variables were self-reported, including prior training and emergency encounters; the findings may be subject to recall bias and social desirability bias, particularly in relation to attitudes and perceived professional responsibility. Selection bias cannot be ruled out, especially in the qualitative strand, where voluntary participation may have favored more motivated professionals.

Online dissemination of the questionnaire, although practical for achieving national reach, may have excluded dentists practicing in remote or underserved areas with limited internet access. Additionally, the time constraints of the FGDs (restricted to approximately 40 min) may have limited deeper exploration of certain nuanced perspectives. Finally, although the questionnaire demonstrated acceptable validity and internal consistency, the absence of a nationally standardized tool for assessing life support knowledge among dental professionals restricts comparability with other healthcare disciplines and international benchmarks.

By combining quantitative data with qualitative narratives, this mixed-methods study highlights critical gaps in India’s health workforce preparedness for cardiac emergencies. Although awareness exists, consistent training, confidence to act, and systemic reinforcement remain inadequate. Dentists, owing to their accessibility and frequent patient contact, represent an underutilized yet potentially valuable segment of the health workforce.

CONCLUSION

This study serves as a portal to connect the healthcare workforce to better serve the public. Quantitative findings demonstrated low overall knowledge scores, limited exposure to ACLS training, and significant associations between knowledge levels and factors such as prior BLS training, educational qualification, and selected attitudinal variables. The qualitative findings, reflecting real-world experiences, form the heart of this study by highlighting low confidence in managing cardiac emergencies, inconsistent access to training opportunities, infrastructural limitations, and contextual challenges, particularly in smaller towns and non-tertiary settings. Together, the findings indicate that while awareness of the importance of life support exists, knowledge levels and practical readiness remain insufficient.

RECOMMENDATIONS

Acting upon them can guide policymakers and health systems, as these findings suggest that strengthening the workforce can reduce mortality from SCA, both in-hospital and out-of-hospital settings. In light of these findings, the study supports the need for structured and ongoing life support training, alongside measures to build confidence and strengthen system-level preparedness. The role of dental professionals in initiatives such as COLS extends preparedness well beyond the dental chair. The message is clear: expanding the pool of trained responders is essential to reduce preventable mortality, and embedding these measures into health policy and curricula is critical to strengthen India’s chain of survival and reduce avoidable deaths from SCA. With commitment from educators, policymakers, and healthcare professionals, dentistry can rise to this challenge, not as passive bystanders, but as active lifesavers.

CONFLICTS OF INTEREST

There are no conflicts of interest.

ETHICAL POLICY AND INSTITUTIONAL REVIEW BOARD STATEMENT

All the procedures have been performed as per the ethical guidelines laid down by the Declaration of Helsinki (WMA, 2013) to be mentioned. Ethics Committee’s name: Institutional Ethics Committee of King George’s Medical University. Date: February 13, 2025. Number of clearance: Approval No: XXX-PGTSC-IIA/P13. The ethical approval number is 2945/Ethics/2025 as issued by the Institutional Ethics Committee.

AUTHOR CONTRIBUTIONS

Conceptualization: Dr. SD, Dr. SK, Dr. RG. Methodology: Dr. SD, Dr. SK, Dr. GM, Dr. RG. Data collection: Dr. SD, Dr. SG, Dr. AA, Dr. MKK, Dr. RN. Data analysis: Dr. SK, Dr. GM, Dr. VKG, Dr. NK. Manuscript drafting: Dr. SD, Dr. SG, Dr. AA, Dr. MKK, Dr. RN. Critical review and editing: Dr. SK, Dr. GM, Dr. VKG, Dr. RG, Dr. NK. Final approval of manuscript: all authors.

DECLARATION OF PATIENT CONSENT

Informed written consent from all participants in the study was obtained.

DATA AVAILABILITY STATEMENT

Data are available on reasonable request from the corresponding author; no DOI or repository link is applicable at this stage. Individual participant data are de-identified to protect confidentiality (Contact: Dr. Sifpsa Diwakar; email: sifpsa.diwakar@kgmcindia.edu).

LIST OF ABBREVIATIONS

• ACLS Advanced cardiovascular life support

• AED Automated external defibrillator

• AHA American Heart Association

• ANOVA Analysis of variance

• BDS Bachelor of Dental Surgery

• BLS Basic life support

• CI Confidence interval

• COLS Compression-only life support

• CPR Cardiopulmonary resuscitation

• DCI Dental Council of India

• FGDs Focus group discussions

• I-CVI Item-Content Validity Index

• IRC Indian Resuscitation Council

• MDS Master of Dental Surgery

• OHCA Out-of-hospital cardiac arrest

• PCA Principal component analysis

• PhD Doctor of Philosophy

• PI Principal investigator

• PHC Primary health center

• SD Standard deviation

• SCA Sudden cardiac arrest

• SPSS Statistical Package for the Social Sciences

• UG Undergraduate

SUPPLEMENTARY MATERIAL

DEMOGRAPHIC DETAILS:

Age

Gender:

• □Male
• □Female
• □Prefer not to say

Highest qualification:

• □BDS
• □MDS
• □PhD

PROSPECTS:

• 1.Have you ever attended a training program for basic life support/cardiopulmonary resuscitation (CPR)?
  • □Yes
  • □No
• 2.If yes, mention the approximate date/year you received the training?

  • ———

• 3.Have you ever attended any training program for comprehensive/advanced cardiopulmonary life support (ACLS)?
  • □Yes
  • □No
• 4.If yes, mention the approximate date/year you received the training?

  • ———

• 5.Do you know of any authorized BLS and comprehensive/advanced cardiopulmonary life support (ACLS) course providers in India?
  • □Yes
  • □No

If yes, please mention the name of the authorized basic and comprehensive cardiovascular life support course provider in India that you know?

————————————

• 6.In your opinion, to be confident and skilled enough, how often do you think the basic and comprehensive cardiopulmonary life support training should be repeated?
  • □3–4 months
  • □4–6 months
  • □Once every year
  • □Every two Years
• 7.Every dental professional should be skilled and confident enough to provide basic and comprehensive cardiopulmonary life support in cases of emergency?
  • □Strongly disagree
  • □Disagree
  • □Neutral
  • □Agree
  • □Strongly agree
• 8.Do you know about your nearest emergency response system?
  • □Yes
  • □No

If yes, please mention your nearest emergency response system that you know?

—— ——— ——— ——— —— ——— ——

• 9.Do you think basic cardiopulmonary life support procedure should be done only in hospital settings?
  • □Yes
  • □No
• 10.Have you ever seen a CPR being done in a hospital or out-of-hospital setting?
  • □Yes
  • □No
• 11.Automated external defibrillator (AED) should be made mandatory to be kept in clinical settings as a first aid.
  • □Strongly disagree
  • □Disagree
  • □Neutral
  • □Agree
  • □Strongly agree
• 12.Have you ever seen an AED being used?
  • □Yes
  • □No
  • □I am not familiar with the term
• 13.Use of an AED with high-quality CPR can double or triple the chances of survival.
  • □Strongly disagree
  • □Disagree
  • □Neutral
  • □Agree
  • □Strongly agree
• 14.Comprehensive/Advanced cardiopulmonary life support (ACLS) can occur in both out-of-hospital and in-hospital settings.
  • □Strongly disagree
  • □Disagree
  • □Neutral
  • □Agree
  • □Strongly agree
• 15.Compression-only life support (COLS) should be known to every citizen of India to resuscitate the victim in cases of out-of-hospital cardiac arrest?
  • □Strongly disagree
  • □Disagree
  • □Neutral
  • □Agree
  • □Strongly agree

PROFICIENCY:

• 16.What is the foundation of early recognition of cardiac arrest?
  • □Activating the emergency response system
  • □Prevention and preparedness
  • □High-quality CPR
  • □All of the above
• 17.Which area should be focused/strengthened to improve the quality of services provided during medical emergencies?
  • □Rapid response team
  • □Code blue team
  • □Critical care team
  • □All of the above
• 18.What is the most common cause of cardiac arrest in children?
  • □Cardiovascular issue
  • □Congenital heart defects
  • □Infection and sepsis
  • □Respiratory failure or shock
• 19.Which best describes the length of time it should take to perform a pulse check during the BLS assessment?
  • □1–4 s
  • □11–15 s
  • □5–10 s
  • □16–20 s
• 20.When unsure if the patient has a pulse or not. What should be done?
  • □Begin cycles of compression and ventilation
  • □Wait for the expert
  • □Look for pulse again
  • □Not sure
• 21.What is the recommended compression-to-ventilation ratio while performing CPR on an adult individual?
  • □15:2
  • □30:1
  • □30:2
  • □15:1
• 22.While giving CPR, what is the rate of compression?
  • □80–100/min
  • □100–120/min
  • □120–140/min
  • □120/min
• 23.What is the minimum and maximum depth of compression for adults?
  • □3 cm–4 cm
  • □4 cm–5 cm
  • □5 cm–6 cm
  • □6 cm–7 cm
• 24.What is T-CPR?
  • □Telecommunicator-assisted CPR
  • □Team-based CPR
  • □Transporting the patients during the CPR procedure
  • □All of the above
• 25.Which are not the steps of high-quality CPR?
  • □Start compressions within 10 s of recognition
  • □Push hard, push fast
  • □Allow chest recoil
  • □Interruptions in compressions to assess pulse rhythm
• 26.Which is not a symptom of cardiac arrest?
  • □Unresponsiveness
  • □No breathing
  • □Chest pain
  • □No pulse
• 27.What does an effective comprehensive/advanced cardiopulmonary life support (ACLS) mean?
  • □Initiate CPR immediately
  • □Give medications
  • □Recognize and treat reversible causes of cardiac arrest
  • □All of the above
• 28.As a first aid measure, what do you think should be used?
  • □Pocket mask
  • □Bag mask device
  • □Both
  • □I don’t know

Funding Statement

Nil.