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You are driving along a quiet road. Suddenly a car comes into sight – wheels up in the air, by the side of the road. The occupants are injured. What do you do? Stop and help, of course. But how? This is a crucial issue because: Nearly two thirds of all European car drivers feel confident enough to give first aid, but only some 18 percent know exactly what to do when they are the first to arrive at the scene of an accident. In other words, motorists tend to largely overestimate their first-aid skills. This is the central finding of the survey which ADAC and its EuroTest partner clubs conducted together with the Red Cross in 14 European countries.

The emergency response chain
First of all, there is the emergency response chain which the first to arrive at the scene of an accident must be able to perform. Just slightly more than one third of the motorists interviewed knew that they should ensure their own safety first, and less than 50% of the interviewees replied that the accident scene had to be secured. About the same number would have determined the condition of the injured person(s) or provided first aid right away. Just over two thirds would have made an emergency call. This is good, but not good enough considering that a little more than 50% indicated the correct European emergency number, 112. Some 40% of the participants indicated a national emergency number, and around 11% did not even know an emergency number at all.

Shocking: More than 71% of the car drivers interviewed were not sure how to check the victim’s condition correctly. Almost 75% answered that they would talk to the injured person to check the victim’s level of consciousness/responsiveness. Only about 50% of the participants would have checked for breathing. Just 45% would have checked the victim for severe bleeding or injuries.

Life-saving measures

What is the right thing to do if the victim is unconscious and no longer breathing? Some 71% did not know exactly. While 75% of the motorists asked did mention Cardiopulmonary Resuscitation (CPR), only about one third remembered that the victim had to be laid down on his/her back first. So much for theory. In practice, more than 80% were unable to perform proper CPR.

It is also essential to place a victim with a severely bleeding arm on his/her back. However, only 30% of the interviewees remembered this measure. As many as 80% would have applied a pressure bandage. Still, the bottom line is: Around three-quarters had no accurate knowledge.

The victim is unconscious, but breathing normally. How do I place the victim in the recovery position? The answer is simple: lay the victim on the ground and roll the person onto his/her side – which almost 70% of the interviewees carried out correctly in practice. However, only about 42% remembered to make sure to check and maintain an open airway. Consequently, only 36.5% correctly performed both measures together.

Regular refresher courses necessary

The findings of the survey are not really surprising considering that nearly one-third of the motorists interviewed said they had never attended a first aid course. Some 22% had last attended a first aid course more than ten years ago. Only about one-third had attended a first aid course as a mandatory prerequisite for obtaining their driving license. At this point, a first look at a few countries seems worthwhile. In Portugal, Italy, Spain and Belgium, the number of motorists who had never attended a first aid course was much higher than the European average. The number was also remarkably high in France and Finland. These are all countries with no statutory obligation to attend a first aid course.

However, mandatory attendance is by no means a guarantee for first aid skills put into practice with confidence and competence, especially when the course took place quite some time ago. On the contrary: As the survey shows, motorists generally have certain fundamental skills. However, many of them are not sure how to carry out such complex life-saving measures as CPR. Consequently, we strongly recommend regular refresher courses.

Anyone can save lives

Even the best-trained, quickest rescuers may not be able to save the victim’s life if, for instance, severe bleeding is not stopped immediately. After all, applying a pressure bandage is no rocket science – if you remember how to do it. Anyone who does may gain valuable time until the arrival of the rescue services and may help to mitigate the consequences of an accident or even save someone’s life.

More than 50% of European road fatalities die within the first few minutes after an accident. This number could be drastically reduced if everyone knew how to provide adequate first aid during these crucial first minutes. So, how good is the first aid knowledge of European car drivers? Is it sufficient for quick and competent intervention? ADAC and its European partner clubs wanted to find out and launched a PISA first aid knowledge survey in 14 countries together with the Red Cross as part of the EuroTest programme.
200 car drivers each in 14 European countries

The survey involved interviews with car drivers only (200 each) in Belgium, Denmark, Germany, Finland, France, Italy, Croatia, Austria, Portugal, Switzerland, Serbia, Slovenia, Spain, and the Czech Republic. The interviewees were divided up into three age groups (18 to 25; 26 to 59; 60 years and older) with approximately equal proportions of men and women. They had to answer a total of ten questions, including two with practical exercises. There were no pre-defined answers, as in a multiple choice method. Rather, most questions required more than just one answer.

Interviews in busy places

The interviewers conducted their interviews with car drivers in the street between May and August 2012. Each national partner chose three different locations in their country with a very high traffic volume, e.g. motorway service areas or car parks at shopping centres. A balanced geographical distribution of the interview locations was essential. At least two representatives of each national automobile club and of the Red Cross conducted the survey in these locations, setting up their own booths. The practical exercises were carried out on dummies or volunteers behind a screen to prevent potential further test subjects from gaining an advantage by watching.

Our journey through countries whose results were conspicuous in one way or another begins in the deep south, i.e. in Portugal which had a surprise in store for us: Almost 75% of the motorists interviewed – substantially more than in any of the other European countries – said they had never attended a first aid course. Nevertheless, asked how to check for the condition of a victim, the Portuguese gave the most competent answers. More than half of them mentioned all the essential points. When it came to checking for severe bleeding/injuries, nearly three quarters gave the correct answer. More than half of the interviewees knew how to handle an unconscious victim who had stopped breathing, many of them even saying they would lay the victim on the ground. The Portuguese participants of the survey only flunked on the subject of the pressure bandage: A mere 58% remembered this measure.

Spanish lacked confidence

The scenario in neighbouring Spain was quite different. More than one-third of the Spanish car drivers said they did not feel confident at all to provide first aid. What is even worse is that only about 43% would have made an emergency call. Not even 50% would have spoken to the injured person to check the victim’s level of consciousness/responsiveness Even worse, only around 9% would have checked the victim for severe bleeding/injuries. In the practical exercise, some 40% did not know how to place the victim in the recovery position. Finally, while some 45% remembered to mention CPR, hardly any of them were able to perform it correctly.

French acquire first aid skills out of their own motivation

Moving north a bit, some 46% of the French participants said they had attended a first aid course out of their own motivation – the highest rate in Europe. With a total of 38% answering correctly, the French also knew best how to deal with a severely bleeding wound, close to 44% even remembering to lay the injured person on his/her back. We move on to Belgium. Around 88% of the Belgian participants would have spoken to the injured person to check the victim’s level of consciousness/responsiveness. On the other hand, a mere 28% knew exactly where to apply CPR.

Germans best on “emergency response chain”; Austrians did not know 112

Of all Europeans surveyed, the Germans had the best knowledge of the emergency response chain: About one third mentioned all its elements. More than 50% would have ensured their own safety, while about 75% would have secured the accident scene – top results in both cases. Across the Alps in Austria, the situation was as follows: About one fourth of the participants had attended a first aid course no more than ten years before. Almost 85% mentioned first aid as an element of the emergency response chain. Shocking: 93% did not know the European emergency number 112. About the same percentage failed to indicate exactly what to do with an injured person who had stopped breathing. In practice, more than 85% were unable to perform proper CPR. Only 1 in 100 knew all the steps required in tending to a severely bleeding wound.

Czechs excel in CPR; Croatians best on recovery position

About one third of the Czech participants were not sure if they felt confident enough to give first aid or not. Only some 10% answered with a definite no. Just some 17% would have ensured their own safety. The Czechs did much better in the practical exercises though: Around 39% – the highest rate in Europe – performed all necessary CPR measures correctly. A stunning 75% even made sure to continue with CPR until the arrival of the rescue services. In Slovenia, our next stop, only 40% of the interviewees felt confident enough to provide first aid. Still, close to 75% would have checked and maintained an open airway in a victim placed in the recovery position. Nearly two thirds compressed the victim’s chest 30 times when performing CPR. Just across the border, in Croatia, almost all the car drivers interviewed said they had attended a first aid course. However, exactly 50% did so more than 10 years ago. For the vast majority, attendance was a mandatory prerequisite for obtaining their driving license. As many as 95% would have made an emergency call. An impressive 63% knew every detail of the recovery position. Slightly more than 72% placed their hands correctly while performing CPR, but only some 8% knew how to carry out all the necessary steps.

Italians flunked several times

A giant leap across the Adriatic takes us to Italy where virtually none of the interviewees were able to name all the elements of the emergency response chain. In particular, only about 14% said it was essential to secure the accident scene and just 17% mentioned first aid. The Italian participants failed in this category. Their performance was equally dismal when it came to checking a victim’s condition. Approximately 93% failed to name all the important elements; merely about 22% mentioned breathing. An unconscious victim breathing normally would have been even worse off: Although about 60% would have placed the victim on the ground and rolled him/her onto his/her side, only some 17% would have checked and maintained an open airway. As little as 8% knew that both measures are necessary.

Fins attended courses for professional reasons

The final leg of our trip takes us way up north, where the Fins have interesting news for us: While only about 2% of the interviewees in Finland attended a first aid course as part of their driving license training, 75% had professional reasons for doing so. The Fins were also far more sure of themselves than their fellow Europeans. Some 85% felt confident to give adequate first aid. Moreover, nearly all of them would have called the 112 emergency number for help. When it came to checking a victim’s condition, 91% remembered to check the victim’s breathing as well. Just as many indicated CPR as a rescue measure for an unconscious victim who had stopped breathing. About 96% would have applied a pressure bandage to a severely bleeding arm wound. The Fins took the “European crown” in all of these questions.

Finally, Denmark, Switzerland and Serbia performed neither extremely well nor extremely poorly.

Improving first aid knowledge across Europe

The results of the European first aid survey differed considerably from country to country. However, it should not make any difference whether a motorist is injured in a road accident in Spain, Germany or the Czech Republic. A life-threatening condition knows no nationality. Therefore, massive improvements in first aid knowledge will be required across Europe.