COMPARISON OF THE RELUCTANCE OF HOUSE STAFF OF METROPOLITAN AND SUBURBAN HOSPITALS TO PERFORM MOUTH-TO-MOUTH RESUSCITATION

Background: Although performing mouth-to-mouth resuscitation (MMR) dur ing cardiopulmonary resuscitation (CPR) is an effective lifesaving pro cedure, both the general public and physicians are often unwilling to perform CPR. Fear of contracting infectious diseases, especially AIDS, is often stated as the reason for this reluctance. However, the likel ihood of saving a life usually outweighs the chance of contracting an infectious disease, especially when victims are considered to be at lo w risk for being HIV+ and are in communities with low incidences of HI V antibodies. Methods: The entire housestaff(58 residents) in the Depa rtment of Internal Medicine of a suburban hospital responded to a ques tionnaire of hypothetical cardiac arrest scenarios in both inpatient a nd outpatient settings. Their responses were compared to those previou sly obtained from the housestaff (82 residents) of a hospital in a lar ge metropolitan area with a high incidence of HIV positive patients. R esults: The willingness of the suburban housestaff (residents) to perf orm MMR in the inpatient scenario of a patient with an unknown risk fo r communicable infections was 43%, with trauma was 12%, with a perceiv ed high risk for being HIV+ was 14%, and in the elderly was 29%, compa red to 45, 16, 7 and 39%, respectively of the house staff of the metro politan hospital. In outpatient scenarios, the willingness of the subu rban housestaff to perform MMR on a victim with an unknown risk for co mmunicable infections was 50%, with trauma was 33%, with a perceived h igh risk for being HIV+ was 34%, in the elderly was 26%, and in a chil d was 86%, compared to 54, 36, 21, 65, and 99%, respectively, of the m etropolitan residents. Overall, the suburban male residents were more likely to be willing to perform MMR than the female ones, as were resi dents actively practising a religion or having graduated from medical schools in the United States. Suburban residents under 30 years of age seemed more willing to perform MMR in the majority of the scenarios t han those over 30 years of age. Of the 31 suburban residents that stat ed they would be unwilling to perform MMR in at least one of the given scenarios, all stated that their unwillingness was due to fear of bec oming infected with HIV or other infectious agents. In 1994, the perce ntage of known HIV positive individuals admitted to the suburban hospi tal was approximately five times less than that of the metropolitan ho spital whose house staff was interviewed (P < 0.001). Conclusions: Pat ients perceived to be at high risk for HIV were less likely to receive MMR than those at low risk. The reluctance of house staff to perform MMR in a suburban community hospital with a low incidence of HIV+ pati ents is similar to that of house staff in a large metropolitan communi ty with a much higher incidence of infected patients. This reluctance, which was largely due to fear of contracting HIV infections, is not i nfluenced by frequent contact with patients infected with HIV but is b ased on perceived rather than actual risks of contracting HIV. To incr ease the willingness of physicians, other medical personnel, and the l ay public to perform MMR on victims of cardiac and respiratory arrests , the negligible risk of contracting infectious diseases while perform ing MMR should be emphasized. Use of portable barrier masks while perf orming MMR and an increase in their availability would decrease the mi nimal risks even further, and is recommended by the authors.