Background: In medical emergencies such as cardiac arrest, timely bystander intervention through Basic Cardiopulmonary Life Support (BCLS) can significantly enhance survival outcomes. While BCLS is traditionally associated with healthcare professionals, empowering the general public-especially in geographically challenging and semi-urban areas like Shimla-is critical. However, limited training access, persistent myths, and lack of awareness continue to hinder effective community response. Materials and Methods: A descriptive, cross-sectional study was conducted from October to December 2024 in Shimla, Himachal Pradesh, to assess public knowledge and perceptions of BCLS. A total of 400 adults aged 18 and above were selected through mixed purposive and convenience sampling. Excluding healthcare professionals, data were collected using a pre-validated bilingual questionnaire covering socio-demographics, BCLS knowledge (20 multiple-choice questions), and attitudes toward emergency response. Responses were scored and categorized as Very Good (>80%), Good (60-79%), Fair (41-59%), or Poor (<40%). Data were analyzed using SPSS v26.0. Results: Participants were mostly aged 26-35 years (36.8%), with a slight female majority (53.8%) and a rural predominance (54.5%). A strong majority recognized key BCLS components-78.5% correctly defined BCLS, 77.0% identified scene safety as the first step, and 78.0% knew the correct chest compression site. Awareness of AEDs was moderate (66.8%), while 71.0% understood that chest compressions alone can sustain life. In total, 81.1% of respondents demonstrated Good to Very Good knowledge, though 19% fell into Fair or Poor categories, revealing critical gaps in practical readiness and confidence. Conclusion: Shimla’s public demonstrates a commendable theoretical understanding of BCLS, but noticeable gaps persist in advanced application, AED familiarity and response timing. Bridging these gaps through widespread, hands-on training, legal reassurance, and integration of BCLS education into schools, communities, and workplaces is essential to foster a lifesaving culture of action when every second counts.
In critical medical emergencies such as cardiac arrest, choking, or sudden respiratory failure, every second counts. Basic Cardiopulmonary Life Support (BCLS)-a lifesaving skill encompassing chest compressions, rescue breathing and the timely use of automated external defibrillators (AEDs)-can dramatically improve survival outcomes when performed promptly and correctly. While BCLS is often associated with healthcare professionals, global health organizations increasingly emphasize the importance of equipping laypersons with these fundamental skills. Early intervention by bystanders, even before professional medical help arrives, can double or triple survival rates in out-of-hospital cardiac arrests [1-6].
Despite its significance, public awareness and training in BCLS remain alarmingly low in many parts of India, including semi-urban and hilly regions like Shimla. Factors such as limited access to first aid training programs, lack of community-based health education and the misconception that only doctors can perform resuscitation contribute to widespread unpreparedness. Cultural hesitations, fear of legal repercussions and uncertainty about correct techniques often deter individuals from taking action, even when they witness a medical emergency [7-9].
Shimla, the capital of Himachal Pradesh, presents a unique healthcare landscape that blends urban facilities with a large, surrounding rural population. As the region continues to develop its emergency response infrastructure, understanding the public’s current level of knowledge and readiness to perform BCLS is crucial. It is not enough for hospitals and ambulances to be well-equipped-the general population must also be empowered to act swiftly in the golden minutes of a life-threatening event.
This study aims to assess the level of awareness, understanding and confidence related to BCLS among the adult population of Shimla. By identifying knowledge gaps, misconceptions and attitudes toward emergency response, the findings will help guide targeted training programs, community outreach initiatives and policy measures to build a more prepared and life-saving capable public.
Study Design
This study adopted a descriptive, cross-sectional design aimed at evaluating the awareness, knowledge and perceptions related to Basic Cardiopulmonary Life Support (BCLS) among the general adult population of Shimla. The design enabled a snapshot analysis of public preparedness and misconceptions regarding BCLS during the defined data collection period.
Study Area and Population
The research was conducted in Shimla, the capital city of Himachal Pradesh, which encompasses both urban centers and adjacent rural communities. The study population included adults aged 18 years and above who were permanent residents of Shimla. The target demographic represented a broad range of educational, occupational and socio-economic backgrounds to reflect the diversity of the region’s population. Healthcare professionals or individuals formally trained in emergency medicine or BCLS were excluded to focus on lay public understanding.
Study Duration
Data collection was carried out over a three-month period from October to December 2024. This time frame allowed for comprehensive community engagement through both in-person and digital means.
Sample Size and Sampling Technique
A total of 400 participants were recruited for the study. The sample size was calculated using a 95% confidence interval, a 5% margin of error and an expected awareness prevalence of 50%, with a 10% buffer added for non-responses or incomplete submissions. A mixed sampling technique was employed-combining purposive sampling (to ensure representation from various socio-demographic groups) and convenience sampling (to facilitate wider outreach in public spaces, community hubs and online platforms).
Inclusion and Exclusion Criteria
Inclusion Criteria
Participants who provided informed consent
Exclusion Criteria
Data Collection Tool
A structured, pre-validated questionnaire was designed in both English and Hindi. The tool was developed in consultation with emergency medicine specialists, public health professionals and educators to ensure accuracy and relevance. The questionnaire was divided into three main sections:
Scoring and Classification
Each correct response in the knowledge section was awarded one point. Total scores were converted into percentages and categorized into four levels:
Data Collection Procedure
Data were collected through both digital (Google Forms) and in-person (paper-based) questionnaires. The online survey link was circulated via WhatsApp, local Facebook groups and community mailing lists. Paper forms were distributed in areas with limited internet access, including public parks, markets and rural health centers. Informed consent was obtained electronically or in writing prior to survey participation. All responses were anonymous and voluntary.
Data Analysis
Responses were compiled using Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics (frequencies, percentages, means) were used to summarize socio-demographic data and knowledge levels.
Ethical Considerations
Participants were informed of the study’s purpose, assured of confidentiality and informed of their right to withdraw at any stage. No personal identifiers were collected and data were used solely for academic and research purposes.
The study included a diverse sample of 400 participants from Shimla, reflecting a broad demographic spectrum. The age distribution showed that the majority of respondents were between 26-35 years (36.8%), followed by 36-45 years (28.3%), 18-25 years (22.0%) and 46 years and above (13.0%). Females slightly outnumbered males, comprising 53.8% of the sample. Education levels varied, with the highest proportion having an undergraduate degree (35.8%) and secondary school education (31.3%), while 16.0% held postgraduate degrees. A smaller segment had primary education (12.5%) or no formal schooling (4.5%). In terms of occupation, office workers (24.3%) and homemakers (23.8%) were most common, followed by teachers (15.3%), students (14.5%) and healthcare professionals (13.3%). Rural residents made up a slightly higher proportion (54.5%) compared to their urban counterparts (45.5%), underscoring the importance of evaluating BCLS knowledge across diverse residential and educational backgrounds.
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 88 | 22.0% |
26–35 | 147 | 36.8% | |
36–45 | 113 | 28.3% | |
46 and above | 52 | 13.0% | |
Gender | Male | 185 | 46.3% |
Female | 215 | 53.8% | |
Education Level | No formal education | 18 | 4.5% |
Primary school | 50 | 12.5% | |
Secondary school | 125 | 31.3% | |
Undergraduate degree | 143 | 35.8% | |
Postgraduate degree | 64 | 16.0% | |
Occupation | Homemaker | 95 | 23.8% |
Office Worker | 97 | 24.3% | |
Teacher | 61 | 15.3% | |
Healthcare Professional | 53 | 13.3% | |
Student | 58 | 14.5% | |
Other | 36 | 9.0% | |
Residential Setting | Urban | 182 | 45.5% |
Rural | 218 | 54.5% |
Overall, the knowledge and awareness of BCLS among Shimla’s public were encouraging, though key gaps remained. A substantial proportion of respondents accurately defined BCLS (78.5%) and correctly identified essential steps such as ensuring scene safety (77.0%), dialing the emergency number 112 (71.8%) and applying chest compressions at the recommended rate of 100-120 per minute (72.8%). Understanding of core concepts like compression location (78.0%), compression-to-breath ratio (72.3%) and depth (69.0%) was relatively strong. A majority recognized that chest compressions alone can sustain life (71.0%) and that BCLS can be performed by anyone trained (75.3%). Awareness of AEDs was moderate, with 66.8% correctly identifying their role and 69.8% knowing what the acronym stood for. Encouragingly, 80.5% were aware that BCLS training is available to the public and 79.3% recognized the survival benefits of early CPR. However, fewer participants understood the need to reassess after two minutes (66.5%) or the optional nature of mouth-to-mouth resuscitation (69.5%). These findings reflect a promising baseline of public knowledge while highlighting specific areas that require targeted educational reinforcement.
Table 2: Public Knowledge and Awareness of Basic Cardiac Life Support (BCLS)
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What does BCLS stand for? | a) Basic Cardio Lung Safety, b) Basic Cardiac Life Support, c) Basic Clinical Life Safety, d) Breath Circulation Life Skill | 314 | 78.5 |
2 | What is the first step in BCLS? | a) Check pulse, b) Start chest compressions, c) Ensure scene safety, d) Call ambulance | 308 | 77.0 |
3 | What number should be dialed for emergency services in India? | a) 112, b) 108, c) 102, d) 100 | 287 | 71.8 |
4 | What is the correct chest compression rate per minute in adults? | a) 50–60, b) 80–100, c) 100–120, d) 150–170 | 291 | 72.8 |
5 | Where should compressions be applied during CPR? | a) Left chest, b) Right ribs, c) Center of the chest, d) Lower abdomen | 312 | 78.0 |
6 | What is the ratio of compressions to breaths in CPR for adults? | a) 10:2, b) 30:1, c) 30:2, d) 15:5 | 289 | 72.3 |
7 | Which device delivers electric shock during cardiac arrest? | a) Pacemaker, b) AED, c) Ventilator, d) Defogger | 267 | 66.8 |
8 | What does AED stand for? | a) Automated Energy Device, b) Automated External Defibrillator, c) Airway Emergency Defibrillator, d) Advanced External Device | 279 | 69.8 |
9 | Can chest compressions alone save a life? | a) No, b) Yes, c) Only with oxygen, d) Only in hospitals | 284 | 71.0 |
10 | How deep should adult chest compressions be? | a) 1 inch, b) At least 2 inches, c) 4 inches, d) Just touch the chest | 276 | 69.0 |
11 | Who can perform BCLS? | a) Only doctors, b) Anyone trained, c) Paramedics only, d) Only adults | 301 | 75.3 |
12 | When should you stop CPR? | a) After 5 minutes, b) When help arrives or signs of life return, c) After 20 compressions, d) If the patient doesn’t wake up | 274 | 68.5 |
13 | What does CAB stand for in BCLS? | a) Compression, Alert, Breathing, b) Compression, Airway, Breathing, c) Circulation, Alert, Breathing, d) CPR, AED, Breathing | 270 | 67.5 |
14 | What is the first thing to check in an unconscious person? | a) Eyes, b) Blood pressure, c) Responsiveness, d) Heartbeat | 295 | 73.8 |
15 | Can CPR cause injury? | a) Never, b) Sometimes, c) Always, d) Only in elderly | 263 | 65.8 |
16 | What is the benefit of early CPR? | a) Nothing, b) Increases survival chances, c) Avoids oxygen, d) Avoids AED | 317 | 79.3 |
17 | Is mouth-to-mouth required in all CPR cases? | a) Yes, b) Not always, c) Only with family, d) Only in adults | 278 | 69.5 |
18 | How long should you perform CPR before reassessing? | a) 30 seconds, b) 2 minutes, c) 5 minutes, d) 10 seconds | 266 | 66.5 |
19 | What should you do if an AED is available? | a) Ignore it, b) Wait for a doctor, c) Use it immediately, d) Only touch it with gloves | 288 | 72.0 |
20 | Is BCLS training available for the general public? | a) No, b) Yes, c) Only for students, d) Only in metro cities | 322 | 80.5 |
The classification of knowledge scores revealed a relatively well-informed public. Out of 400 participants, 161 individuals (40.3%) demonstrated Very Good knowledge (>80% correct), while another 163 (40.8%) fell within the Good category (60-79%), indicating that over 81% of respondents had a sound understanding of BCLS principles. A smaller portion, 59 participants (14.8%), exhibited Fair knowledge (41-59%), while only 17 individuals (4.3%) had Poor knowledge (<40%). This distribution reflects a strong general grasp of BCLS among the community, but also underscores the importance of extending training opportunities and awareness campaigns to reach the 19% of individuals with limited or incorrect knowledge-particularly in rural areas and among those with lower educational attainment.
Table 3: Knowledge Score Classification on BCLS Awareness
Knowledge Level | Score Range (% Correct) | Number of Respondents (n) | Percentage (%) |
Very Good Knowledge | ≥80% | 161 | 40.3% |
Good Knowledge | 60–79% | 163 | 40.8% |
Fair Knowledge | 41–59% | 59 | 14.8% |
Poor Knowledge | <40% | 17 | 4.3% |
This study provides a comprehensive insight into the level of public awareness, understanding and attitudes regarding Basic Cardiopulmonary Life Support (BCLS) among adults in Shimla-a region where topographical and infrastructural challenges often impede timely access to emergency medical care. In a setting where minutes can be the deciding factor between life and death during events like cardiac arrest, the role of an informed and responsive bystander becomes not just supplementary but potentially lifesaving. The findings of this study, therefore, are of great significance in shaping local public health strategies, emergency preparedness frameworks and community-level interventions.
The socio-demographic analysis (Table 1) paints a picture of a relatively young and educated population. The highest number of participants belonged to the 26-35 age group (36.8%), followed by 36-45 years (28.3%) and 18-25 years (22.0%), collectively constituting nearly 87% of the total sample. This suggests that a large proportion of the surveyed population are in the active working-age group-often the first to witness emergencies in households, workplaces and public spaces. Encouragingly, 35.8% held undergraduate degrees and an additional 31.3% had completed secondary schooling, indicating a fairly literate audience that is likely capable of understanding and retaining BCLS training if provided. The representation from both rural (54.5%) and urban (45.5%) areas also ensured that regional variations in knowledge and accessibility were adequately captured. The inclusion of participants from varied professions, including homemakers, office workers, teachers and students, further contributed to a robust dataset reflective of Shimla's general populace.
The core of the research lies in the assessment of BCLS-related knowledge (Table 2), where the results were both promising and revealing. An overwhelming majority of respondents could correctly identify what compression rate of 100-120 per minute (72.8%) and the correct compression-to-breath ratio (30:2) (72.3%)-demonstrates that many in the public are aware of the mechanics of effective resuscitation.
Nevertheless, several findings underscore the need for deeper and more practical training. While 69.8% of respondents correctly expanded the acronym AED (Automated External Defibrillator), only 66.8% knew that it is the device used to deliver a shock during cardiac arrest. This slight discrepancy points to a surface-level familiarity with terminology without comprehensive understanding of device usage or context. Furthermore, misconceptions linger regarding critical procedural aspects-only 66.5% knew CPR should be reassessed every two minutes and just 69.5% recognized that mouth-to-mouth breathing is not mandatory in all CPR situations. These gaps could potentially delay or deter immediate intervention in emergencies, especially if bystanders believe they are unqualified to act due to incomplete knowledge.
Public perception surrounding who can perform BCLS also revealed room for optimism: 75.3% correctly stated that anyone trained-regardless of profession-can perform BCLS. This marks an important shift away from the outdated belief that life-saving procedures are strictly within the purview of doctors or paramedics. It also aligns with global health policy shifts that now advocate for mass BCLS literacy, especially in regions with delayed emergency medical response. Encouragingly, 79.3% of respondents were aware of the survival advantage conferred by early CPR and 80.5% affirmed that BCLS training is available to the general public. These results are particularly relevant in advocating for expanded access to community-based first aid and CPR certification programs.
Injuries associated with CPR, a common concern among the untrained public, were acknowledged with 65.8% correctly noting that CPR can sometimes cause injury. This awareness, if balanced with training on risk versus benefit, could mitigate fear-driven hesitations. Similarly, the fact that 71.0% believed chest compressions alone could help save a life is indicative of growing familiarity with hands-only CPR campaigns promoted by global health bodies like the American Heart Association and WHO.
The knowledge classification (Table 3) reflects a strong overall performance. A combined 81.1% of respondents scored in the “Very Good” (40.3%) or “Good” (40.8%) knowledge categories. This is encouraging and suggests a promising baseline upon which training initiatives can be built. However, the fact that 14.8% scored in the “Fair” range and 4.3% in the “Poor” range cannot be overlooked. This 19.1% represents nearly one in five individuals who are likely unprepared to respond effectively in a cardiac emergency-either due to misinformation, lack of exposure, or confidence issues. Targeted interventions, especially in rural or less-educated populations, must be prioritized to ensure inclusivity in emergency response readiness.
Comparatively, these results align with findings from similar studies in both Indian and global contexts. Research conducted in Maharashtra and Tamil Nadu revealed comparable knowledge gaps, especially concerning AED usage, compression techniques and public confidence in initiating CPR. International studies from the UK, Turkey and Nigeria have similarly documented high awareness of CPR's value but low confidence or practical readiness to perform it-often due to lack of hands-on training or legal fears. The Shimla data add to this global narrative while highlighting local nuances-such as the effect of geographic terrain, rural inaccessibility and mixed educational levels-which influence public health preparedness.
The implications of this study are manifold. First, there is an urgent need to introduce structured, multilingual BCLS training modules at the community level-leveraging schools, workplaces, panchayats and primary healthcare centers as delivery platforms. Second, digital platforms and social media can be harnessed to share short, high-impact CPR videos that reinforce key concepts in a visually engaging way. Third, collaborations between local NGOs, health departments and emergency response teams can facilitate low-cost certification camps, mock drills and refresher workshops. Fourth, the curriculum of upper secondary schools and colleges should include mandatory first aid and BCLS training, particularly since the majority of the population surveyed falls within the young adult bracket [10-13].
Moreover, building public trust through legal awareness-such as promoting India’s Good Samaritan Law-can reduce hesitations associated with intervening in emergencies. Anecdotal fears of being blamed, harassed, or entangled in medico-legal processes remain powerful deterrents in India’s cultural landscape and must be actively addressed through public information campaigns.
This study highlights a promising level of public awareness and foundational knowledge regarding Basic Cardiopulmonary Life Support (BCLS) among adults in Shimla, with over 80% of participants demonstrating good to very good understanding of core concepts. However, critical gaps persist-particularly around practical application, AED usage, reassessment timing and the nuances of CPR delivery. These findings underscore the urgent need for widespread, hands-on BCLS training, especially in rural and lower-education populations. Strengthening public confidence through structured community programs, legal awareness campaigns and integration of BCLS into school and workplace curricula will be essential to transform theoretical knowledge into lifesaving action when every second truly counts.
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