Appendix I, III, IIII



CPR Attitudes Questionnaire Survey

Name:

0I. Basic Information

1. Subject’s code：□□□□（skip this item）

2. Age：＿＿＿

3. Highest education：□Illiterate □Elementary school □Junior high school（middle school） □High school（vocational school） □College Gender：□Male □Female

4. Marital status：□Single □Married □Divorced □Widow/Widower

5. Religion：

□None □Buddhism □Folk religion □Christianity □Catholic □Muslim □Other

6. Occupation：

□Military/Government employee □Agriculture/Fishery/Stock farming □Industry □Business □Self-employed □Service industry □Housekeeper □ Student □Retired □Healthcare

7. Do you have any experience working in a medical institution/hospital (including clinics and long-term care facilities):

□Yes □No

8. Do you have any chronic disease: □Yes □No

9. Do you have the IC Card for Severe Illness: □Yes □No

10. Do you live with a family member over the age of 65: □Yes □No

11. Have you received the CPR training before: □Yes □No

（Please skip to Q15 if the answer is no）

12. If the answer to Q12 is yes, when was the latest training conducted:

□Within 1 year □1-2 years □2-5 years □more than 5 years ago □not sure

13. If the answer to Q12 is yes, what is the content of the training?

□Conventional CPR（including mouth-to-mouth resuscitation）

□New CPR（pure chest compressions）

14. If the answer to Q12 is yes, do you clearly know the accurate operating procedures for CPR:

□very clear □clear □fair □not clear □very unclear

15. Have you ever performed PCR in an emergency situation?

□Yes □No

II. Content of the Questionnaire (Pre-Test)

When someone is unconscious and has no spontaneous breathing or heartbeat and has been reported to 911, CPR should be performed immediately according to the recommendations of American Heart Association (AHA).

Please assist in answering the following questions：

1. If this person were a stranger, would you be willing to perform conventional CPR (mouth-to-mouth resuscitation) on her (him) immediately?

□ Yes □ No

2. If you are not willing to perform CPR on a stranger, what is the reason(s)? (select all that apply)

□ (1) Concern about doing more harm to the person

□ (2) Concern that CPR cannot be performed correctly

□ (3) Concern about legal issues

□ (4) Not willing to perform mouth-to-mouth resuscitation

□ (5) Do not want to perform CPR

□ (6) Other, please specify the reason(s):

3. From the reasons listed above, select the 搊ption?that is the most important reason that you do not want to perform CPR.

□(1) □(2) □(3) □(4) □(5) □(6)

4. If you select Option (4) in Q2 and you are not required to perform mouth-to-mouth resuscitation, would you be willing to perform chest compression on a stranger?

□ Yes □ No

5. If this person were a family member or an acquaintance, would you be willing to perform conventional CPR on her (him) immediately?

□ Yes □ No

6. If you are not willing to perform CPR on a family member or an acquaintance, what is the reason(s)? (select all that apply)

□ (1) Concern about doing more harm to the person

□ (2) Concern that CPR cannot be performed correctly

□ (3) Concern about legal issues

□ (4) Not willing to perform mouth-to-mouth resuscitation

□ (5) Do not want to perform CPR

□ (6) Other, please specify the reason(s):

7. From the reasons listed above, select the 搊ption?that is the most important reason that you do not want to perform CPR.

□(1) □(2) □(3) □(4) □(5) □(6)

8. If you select Option (4) in Q2 and you are not required to perform mouth-to-mouth resuscitation, would you be willing to perform chest compression on a family member or an acquaintance?

□ Yes □ No

III. Content of the Questionnaire (post-test)

When someone is unconscious and has no spontaneous breathing or heartbeat and has been reported to 911, CPR should be performed immediately according to the recommendations of American Heart Association (AHA). Please answer the following questions:

9. If this person were a stranger, would you be willing to perform conventional CPR (mouth-to-mouth resuscitation) on her (him) immediately?

□ Yes □ No

10. If you are not willing to perform CPR on a stranger, what is the reason(s)? (select all that apply)

□ (1) Concern about doing more harm to the person

□ (2) Concern that CPR cannot be performed correctly

□ (3) Concern about legal issues

□ (4) Not willing to perform mouth-to-mouth resuscitation

□ (5) Do not want to perform CPR

□ (6) Other, please specify the reason(s):

11. From the reasons listed above, select the 搊ption?that is the most important reason that you do not want to perform CPR.

□(1) □(2) □(3) □(4) □(5) □(6)

12. If you select Option (4) in Q2 and you are not required to perform mouth-to-mouth resuscitation, would you be willing to perform chest compression, new CPR, on a stranger?

□ Yes □ No

13. If this person were a family member or an acquaintance, would you be willing to perform conventional CPR (mouth-to-mouth resuscitation) on her (him) immediately?

□ Yes □ No

14. If you are not willing to perform CPR on a family member or an acquaintance, what is the reason(s)? (select all that apply)

□ (1) Concern about doing more harm to the person

□ (2) Concern that CPR cannot be performed correctly

□ (3) Concern about legal issues

□ (4) Not willing to perform mouth-to-mouth resuscitation

□ (5) Do not want to perform CPR

□ (6) Other, please specify the reason(s):

15. From the reasons listed in Q14, select the 搊ption?that is the most important reason that you do not want to perform CPR.

□(1) □(2) □(3) □(4) □(5) □(6)

16. If you select Option (4) in Q6 and you are not required to perform mouth-to-mouth resuscitation, would you be willing to perform chest compression on a family member or acquaintance?

□ Yes □ No

IV. Follow-up on the CPR+AED Course

1. Have you had an opportunity to perform CPR on someone after receiving the 揕ove More, Save More?CPR+AED Training Course provided by Chang Gung Memorial Hospital few months ago?

□ Yes □ No (If ΡNo, please skip to Q 4)

2. During the process of CPR, did you give an electric shock to the patient?

□ Yes □ No

3. Did the patient resume spontaneous breathing and heart rhythm on scene?

□ Yes □ No

4. After receiving the CPR+AED training course provided by Chang Gung Memorial Hospital, did you participate in any other first aid training course conducted by other institutions?

□ Yes □ No

(If ΡNo, stop right here)

5. Continued from previous question, how many first aid training courses have you taken during this period?

□ 1 □ 2 □ 3 □ 4

6. Continued from previous question, how many tests for first aid training courses have you successfully passed?

□ 1 □ 2 □ 3 □ 4

~~Thank you for your assistance~~

Chang Gung Basic CPR + AED Course Evaluation Form

≤Pre-test / ≤Post-test

Name of Student:

Age:

Gender: ≤Male ≤Female

Affiliation:

Date of Test： (MM/DD/YYYY)

Native Language:≤Mandarin ≤Taiwanese ≤Hakka ≤Other

Course Subject Evaluation Form (to be filled by the examiner)

|Step |Item |Yes |No | |

|1 |Verbally confirm that the scene is safe | | | |

|2.1 |Confirm response: tap the patient | | | |

|2.2 |Confirm response: call the patient’s name loudly | | | |

|3.1 |Check for breathing | | | |

|3.2 |Confirm that the patient has not breathed for 5-10 seconds | | | |

|4.1 |Call for help | | | |

|4.2 |Ask someone to Call 911 | | | |

|4.3 |Ask someone to get an AED | | | |

|5.1 |After asking for assistance, begin CPR | | | |

|5.2 |After asking for assistance, begin CPR within 10 seconds | | | |

|6.1 |Place the heel of your hand in the right place for chest compression: in the inter-nipple | | | |

| |line | | | |

|6.2 |Place your other hand on top of the first hand | | | |

|7.1 |Keep the CPR arm straight | | | |

|7.2 |Keep the CPR arm perpendicular to the body | | | |

|8 |Allow the student to continue chest compressions for 1 minute | |

| |（the examiner will measure the time by using a stopwatch） | |

|The examiner says: “The AED arrives on scene.” | |

|9 |After arrival of the AED, turn on the AED’s power | | | |

|10 |Attach the pads | | | |

|11 |Confirm that the pads are placed in the correct place | | | |

|12 |Before pushing the “shock” button, shout “keep clear” | | | |

|13 |After the protocol for AED, shock or analysis, has been | | | |

| |completed, the emergency medical resumes CPR | | | |

|End the Test | |

|14 |Fluency |Poor |Fair |Good |

|15 |Operating procedures |Poor |Fair |Good |

Examiner’s Signature:

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Dear Participants:

Thank you for participating in the study of “Evaluation of the Public’s Resuscitation Attitudes and Efficacy of CPR Training.” To understand your attitudes toward CPR training, please take a few minutes to complete the following questionnaire. The content of this questionnaire is for research use only and all information will be stored and kept confidential by relevant staff of this study.

We wish you good health and happiness.

Sincerely,

Principal Investigators

Zheng-Wei Zhan & Zhen-Yu Jan

Fill in only your name, leave the rest in blank

Ｓｋｉｐ　Ｓｅｃｔｉｏｎ　ＩＩ　ａｎｄ　ｓｔａｒｔ　ｆｒｏｍ　Ｓｅｃｔｉｏｎ　ＩＩＩ．

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2012/11/9 Version 1.0 CPR Attitudes Questionnaire survey

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