When someone collapses in cardiac arrest, every minute without bystander cardiopulmonary resuscitation lowers the odds of survival. Yet across India, fewer than one in ten victims of out-of-hospital cardiac arrest receives help from a bystander in many urban settings, and only an estimated two to five percent of the population has ever received formal CPR training. A new cross-sectional study from Banaras Hindu University in Varanasi offers a detailed snapshot of why that gap persists even among highly educated young people, and what might close it. Surveying 134 undergraduate and postgraduate students from the Faculty of Education, researchers led by Abhishek Verma and colleagues measured awareness, confidence, symptom recognition, and perceived barriers to performing first aid and CPR in the wake of the COVID-19 health emergency.
The choice of population was deliberate. Students training to become teachers occupy a unique position in the public health landscape: they are future educators who can disseminate life-saving knowledge through schools and communities, multiplying the impact of any single training program. By assessing their preparedness, the researchers hoped to gauge the potential for a self-renewing generation of first responders in a country where sudden cardiac arrest remains one of the most urgent and under-recognized public health crises. The study, published in the Journal of Emergency and Disaster Medicine, was conducted between April and May 2024 using a convenience sample with a calculated minimum requirement of 128 participants, ultimately enrolling 134 students with no missing data.
Demographically, the cohort was dominated by 23-year-olds, who made up 41 percent of respondents, followed by 22-, 24-, and 25-year-olds. Slightly more than half of the participants, 56.7 percent, were male, and nearly two-thirds were postgraduate students. Data were collected through a structured, self-administered questionnaire covering demographic variables, CPR awareness, self-rated ability, prior training, and barriers to intervention. Researchers scored five domains: confidence in performing specific skills such as checking responsiveness, assessing breathing, delivering chest compressions, using an automated external defibrillator, and providing wound care; recognition of situations indicating CPR, including unconsciousness, drowning, burns, and choking; correct response actions; symptom recognition during resuscitation; and overall perceptions of CPR’s importance.
The psychometric properties of the instrument were examined in detail. The confidence domain showed strong internal consistency, with a Cronbach’s alpha of 0.808 across its five items, while the indication, support, and symptom recognition domains demonstrated moderate reliability suitable for exploratory research, with alphas of 0.640, 0.649, and 0.630 respectively. The perception domain, by contrast, showed low internal consistency at 0.201, prompting the authors to analyze those items individually and interpret them cautiously. The overall instrument achieved an acceptable alpha of 0.645. Descriptive statistics revealed that confidence was the most variable measure, ranging from 0 to 17 with a mean of 9.22 and a standard deviation of 3.70, while perception scores were the most tightly clustered.
Attitudes toward CPR were overwhelmingly positive. A striking 70.1 percent of participants considered first aid and CPR more important in light of recent health emergencies, and 71.6 percent strongly agreed with the importance of these skills overall. Yet actual exposure was limited: 20.1 percent had never witnessed a first aid or CPR event, only 9 percent had ever provided CPR, 40.3 percent reported lacking training, and 23.9 percent cited fear of infection as a deterrent. When asked why they might hesitate, 44 percent pointed to safety protocols, 25.4 percent to needed training modifications, and only 17.9 percent reported no hesitation at all. Confidence itself was uneven, with 29.1 percent very confident in performing CPR but 11.9 percent reporting no confidence at all in basic first aid.
The statistical core of the study produced its most important insight. One-way analysis of variance showed a significant relationship between exposure to real first aid or CPR events and total preparedness scores, with F equal to 3.466 and a p-value of 0.010. Students who had actually provided CPR scored dramatically higher, averaging 27.4 points against 20.4 for those with no prior exposure, a gap that dwarfed differences attributable to perception or self-reported barriers. Neither perceived impact of CPR on health emergencies nor reasons for hesitation showed significant score differences, suggesting that nothing substitutes for hands-on experience when it comes to building genuine readiness to act.
Gender emerged as a persistent fault line. Male students scored significantly higher than female students on overall CPR preparedness, with means of 23.8 versus 20.5 and a t-statistic of 3.319 with p equal to 0.002. Chi-square analysis reinforced the pattern, showing that 56.6 percent of males fell into the high-preparedness category compared with 36.2 percent of females, a difference that was statistically significant. In univariate logistic regression, sex was a significant predictor, with female students showing odds of high preparedness less than half those of their male counterparts. However, the association lost significance in the multivariable model, hinting that the disparity may stem from differences in training exposure and experience rather than inherent capability, echoing prior research showing that women often underestimate their skills despite performing comparably.
Age and training status also mattered. Participants aged 22 showed a disproportionate concentration in the low-preparedness group, and trained students were significantly more likely to demonstrate high preparedness, at 59.4 percent versus 35.4 percent for the untrained. Formal training showed a marginal positive association with high preparedness in the multivariable logistic regression, with an odds ratio of 2.21 and p equal to 0.051, while the overall model was statistically significant and passed the Hosmer–Lemeshow goodness-of-fit test. Notably, undergraduate students scored slightly higher than postgraduates, a marginally non-significant difference suggesting that academic progression alone does not translate into emergency readiness, and that practical skill-based education must be embedded deliberately within university life.
The barriers identified by the study extend beyond knowledge. Fear of causing harm, anxiety, and uncertainty have long been documented as psychological obstacles to bystander CPR, and the COVID-19 pandemic added infection risk to the calculus, particularly around mouth-to-mouth ventilation. International resuscitation bodies responded by promoting compression-only CPR and protective equipment, and evidence has since shown that trained laypersons can use automated external defibrillators safely and effectively within structured response systems. In India, cultural discomfort with physical contact with strangers and limited public awareness of the Good Samaritan law, which legally protects emergency helpers, compound the hesitation. The authors argue that training programs must therefore address emotional preparedness and confidence-building alongside technical instruction, using simulation-based learning and periodic refresher sessions to sustain competence over time.
The study’s authors conclude that universities should implement regular, hands-on CPR and first aid programs paired with targeted interventions to dismantle psychological barriers, with particular attention to groups reporting lower confidence. They envision Varanasi, with its massive student population, becoming a model city for bystander CPR readiness, generating scalable lessons for cardiac arrest response across urban and semi-urban India. The findings come with caveats: the cross-sectional design precludes causal claims, the convenience sample of education students from a single faculty limits generalizability, and self-reported questionnaires may not reflect actual CPR competency. Still, the central message is clear and actionable, aligning with expert calls to embed CPR and defibrillator training in schools and colleges nationwide. Communities with high bystander CPR rates see substantially better survival after out-of-hospital cardiac arrest, and young people, armed with practical experience rather than theory alone, are best positioned to become the life-saving bridge between collapse and definitive care.
Subject of Research: First aid and CPR confidence, training gaps, and preparedness among university students in Varanasi, India
Article Title: The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi
Article References: The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi. (n.d.). https://doi.org/10.1007/s44467-026-00016-x
Image Credits: AI Generated
DOI: 10.1007/s44467-026-00016-x
Keywords: cardiopulmonary resuscitation, first aid, bystander CPR, cardiac arrest, health emergency preparedness, CPR training, university students, gender disparity, basic life support, COVID-19, India, Banaras Hindu University
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Ophelia Keating. (September 12, 2026). Hands-On Experience Holds the Key to CPR Confidence Among Indian University Students. Scienmag. https://scienmag.com/hands-on-experience-holds-the-key-to-cpr-confidence-among-indian-university-students/
Ophelia Keating. “Hands-On Experience Holds the Key to CPR Confidence Among Indian University Students.” Scienmag, 12 September 2026, https://scienmag.com/hands-on-experience-holds-the-key-to-cpr-confidence-among-indian-university-students/. Accessed 12 September 2026.
Ophelia Keating. “Hands-On Experience Holds the Key to CPR Confidence Among Indian University Students.” Scienmag. September 12, 2026. https://scienmag.com/hands-on-experience-holds-the-key-to-cpr-confidence-among-indian-university-students/
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