Numerous child-related medical emergencies requiring instant intervention can occur at schools or homes (1). In such circumstances, teachers and parents share the responsibility of ensuring the safety and well-being of young children as they are frequently the first responders (2). Nevertheless, many teachers and parents lack the necessary training to respond effectively to emergencies, potentially increasing risks for children in critical situations (3, 4).

Basic life support (BLS) is provided by the first responders to assist individuals experiencing cardiac or respiratory arrest, and therefore it is crucial for preserving a child’s life. The emergency procedures provided in BLS include calling local emergency medical services, confirming cardiac arrest, and initiating cardiopulmonary resuscitation (CPR), besides the use of an automated external defibrillator (AED) (5).

It is imperative that non-health professionals, especially school guardians, receive BLS training to ensure the safety of the children. Training more people in CPR is a key part of strategies that improve community response to out-of-hospital cardiac arrests (OHCA). In this context, It has been reported that effective CPR and defibrillation can save half of OHCA (6).

Numerous studies from Greece (7), Belgium (8), Spain (9), and Columbus (3) have found that knowledge levels of BLS among school teachers and community members are inadequate. In addition, studies from Saudi Arabia involving school teachers and public individuals residing in Al-Qassim (10), Al-Khobar (11), Riyadh (12), and Taif (13) cities also documented unsatisfactory levels of knowledge regarding first aid and BLS.

Given the absence of prior studies on this issue in Tabuk City, it is essential to assess the current levels of awareness among teachers and parents regarding BLS. This step is essential to identify gaps in training and barriers to acquiring BLS skills as well as areas for improvement. Subsequently, a structured professional development program for teachers and community awareness initiatives for parents can be established. Therefore, this study aimed to evaluate the knowledge, skills, and attitudes concerning BLS among kindergarten and primary school teachers and parents in Tabuk City, Saudi Arabia.

Table 1 demonstrates that most participants (70.3%) were parents, while 29.7% were teachers. The participants’ ages ranged from 18 to 70 years, with a mean age of 35.1 ± 10.91 years, and female participants (59.7%) outnumbered males. Most participants were Saudi citizens (95.1%). A great proportion of the participants were married (72.1%), while 23.8% were single and a few were divorced or widowed (2.1% each). More than half of the participants (54.6%) were graduates, and a smaller proportion had secondary (19.5%), middle (7.2%), or primary (2.8%) education. The educational field (37.9%) was the main employment sector, followed by non-employed participants (26.4%), and those in other fields (24.1%).

Regarding CPR training status, more than half (53.3%) of the participants lack previous CPR training. Among those who received training (N = 182), the place of training was either the schools (37.4%), the Red Cross (33.5%), or a private organization (16.5%). Strikingly, nearly half (46.7%) had received training more than 2 years ago, while 61 (33.5%) within the past 6 months. Queries about resuscitation experiences revealed that direct exposure to real-life resuscitation is relatively limited among participants where 55.6% had never observed CPR being performed, and only 14.4% of participants had actively participated in performing CPR (Table 2).

Table 3 shows the responses to the knowledge and skills questions. The majority of participants (71.8%) correctly identified 997 as the emergency contact number in Saudi Arabia. When asked about the response to finding a lifeless adult, only 57.9% correctly reported the initial need to check for consciousness, secure the airway, and assess breathing before starting chest compressions. About two-thirds of participants (64.9%) correctly knew that a breathing but unresponsive person should be placed in the recovery position and contact the emergency services. When asked about the correct CPR technique, the correct placement of hands one above the other with palms downward was identified by 70.5, and 68.5% correctly answered that one must kneel next to the torso. Furthermore, 52.8% identified the correct ratio of 30:2 (30 chest compressions to 2 rescue breaths), while only 18.7% correctly answered that compressions should be at least 5 cm deep and at a rate of 100–120 compressions per minute, and only 16.4% properly recognized the recommended frequency of two compressions per second. When asked about AED use, only 44.1% had the correct knowledge that the purpose of AED is to analyze the heart rhythm and deliver an electric shock if necessary. However, only 6.9% correctly answered that any citizen is allowed to use an AED.

Figure 1 illustrates the distribution of participants’ knowledge and skill levels in BLS. About half (50.3%) showed a fair level, while poor levels constituted 44.6% and only a few participants (5.1%) exhibited good levels.

The analysis of the relationships between knowledge and skill levels in BLS and the participants’ sociodemographic characteristics including age, gender, nationality, education level, and job sector revealed the absence of statistically significant associations (All p values >0.05). Alternatively, previous CPR training showed a significant association with knowledge and skill levels (p < 0.001). Most (80%) participants classified as having good BLS knowledge and skills reported having prior CPR training, while 69.0% of those with poor knowledge and skills had never received CPR training as shown in Table 4.

Table 5 provides intuition into the participants’ barriers and attitudes toward CPR training and BLS application. The participants who had never received CPR training reported different reasons such as not knowing where to attend a course (27.7%), lack of time (22.6%) or interest (14.1%), or financial costs (5.9%). Asking about the concerns that prevent the participants from performing BLS revealed fear of causing harm to the victim (37.2%) or lack of knowledge and skills (34.1%), besides infection risks (12.8%) and legal concerns (9.0%). Most (81.0%) participants expressed interest in receiving more CPR training, and this frequency was increased to 85.4% if a free CPR course was offered. The main motivation for CPR training was to prevent unnecessary deaths (35.1%). High percentages supported mandatory CPR training either in schools (40.5%), or for all jobs (37.9%). Furthermore, 59.5% supported requiring CPR training for teacher certification, while 40.5% showed a divergent response. More than half (57.2%) believed every school should have an AED, while 42.8% disagreed.

This study revealed critical gaps in awareness and training in BLS among kindergarten and primary school teachers and parents in Tabuk City, Saudi Arabia. The majority of participants had either an average level of awareness (50.3%) or lacked the adequate levels necessary for emergencies (44.6%). Only a very small percentage (5.1%) demonstrated a good level. Specific gaps in essential CPR details were identified including the correct compression-to-breath ratio, compression depth and frequency, and the purpose and the person who can use the AED. These findings suggest insufficient or inaccessible current training programs. Moreover, the fact that half (50.3%) of the participants exhibited a “fair” level of knowledge denotes that the current knowledge level may not be strong enough to ensure confident and effective intervention in emergencies. Exploration of the current training status of the participants revealed limited training opportunities where more than half of (53.3%) the participants have never received any formal CPR training, and nearly half (46.7%) of the trained participants had received their CPR training more than 2 years ago. Up-to-date training within the past 6 months was reported by only 33.5% of the respondents. Additionally, the current survey documented limited real-life exposure and hands-on experience in CPR. A substantial number of participants (55.6%) had never observed CPR being performed, and only 14.4% had actively participated in performing CPR.

In agreement with these findings, teachers working in Al-Madinah City (14) and Al-Qassim Region (10), Saudi Arabia exhibited comparable inadequate knowledge of BLS, particularly low knowledge regarding CPR skills and AED use. The majority of teachers also reported having no previous CPR training and most of them had training more than 2 years ago. Another study in Taif City involved 248 teachers and 400 parents established poor knowledge levels about CPR skills among more than 75% of the respondents, with no significant difference between teachers and parents (13). Likewise, studies from Riyadh (12) and Buraidah (15), Saudi Arabia explored the limited availability of CPR courses for school teachers as well as mothers. Internationally, earlier studies from the United Kingdom and the United States also showed low knowledge levels about CPR among teachers (16–18).

The present study also found that BLS knowledge and skill levels are primarily determined by training rather than demographic factors. This underlines the importance of increasing access to CPR training programs to improve overall awareness and skills in BLS. Regular refresher courses are essential as they affect the retention of knowledge and the ability to perform CPR effectively. Organizations and policymakers should prioritize structured CPR training, as well as refresher courses, to ensure a greater number of individuals achieve satisfactory responses in emergencies. Various studies documented a significant association between previous CPR training courses and knowledge levels (2, 19, 20). The necessity of regular CPR training to improve knowledge and skills has been also reported by Nori et al. (21) who also suggested the implementation of BLS courses in the educational curriculum. Furthermore, López et al. (9) and Khademian et al. (22) conducted interventional studies and concluded a positive impact of BLS training on the knowledge and skills of teachers and public individuals with improvement in CPR sequence and quality of chest compression after training. The detected deficiency in knowledge about the AED use in this study should be considered while preparing for the training programs as both high-quality CPR and rapid defibrillation are essential for good outcomes of out-of-hospital cardiac arrest (23, 24).

The present study investigated the key barriers preventing participants from receiving CPR training and performing BLS. Participants stated that they did not attend CPR training because they had no information about the places of the CPR courses. The same reason was reported in previous Saudi studies (10, 14), and a study from Palestine (25). Alternatively, an earlier study from the United States highlighted the financial cost of CPR training as the main barrier (3). In addition, lack of knowledge and skills and fear of causing harm to the victim were the most common reasons for their hesitation in performing BLS measures. This emphasizes the necessity for increasing awareness and hands-on training to boost their confidence.

Most participants in this study showed positive attitudes and strong support for CPR training. Most of them want to learn CPR skills and the main motive for learning was to avoid unnecessary deaths. Similar findings were reported in the previous studies from different countries (8, 10, 14, 20). Many participants believed in the need for early education and supported making CPR training mandatory in schools, and to be as a requirement for teacher certification. Some suggested extending CPR training to be a prerequisite for all jobs. Despite more than half favoring the presence of AEDs in schools, there were some concerns probably due to the cost, maintenance, or usability. It is worth mentioning that many American states, Canada, and several European countries have legislated CPR training in schools to ensure that individuals acquire this crucial skill at a young age, increasing the likelihood that they will retain it into adulthood, enhancing confidence and reducing fear (26, 27). The implementation of AED programs in schools has shown a high survival rate for individuals experiencing sudden cardiac arrest in high schools across the United States (28). To effectively implement CPR training in schools, clear guidelines should be established on the required proficiency level for students, along with training programs for teachers. It is also essential to emphasize that advanced skills are not necessary to perform CPR. Additionally, familiarizing teachers with CPR training kits can help enhance the learning process. A multicenter study concluded that effective CPR training implementation in schools dictates establishing clear guidelines for the required proficiency level for both the students and the teachers. It also emphasized the importance of familiarizing teachers with CPR training kits (29).

The cross-sectional study design, besides the reliance on self-reported data, may introduce bias or inaccuracy into the results. In addition, the use of a non-random sampling method may limit the ability to generalize the results to the entire population.

This study highlights substantial gaps in BLS awareness and training among kindergarten and primary school teachers and parents in Tabuk City, Saudi Arabia. Most participants demonstrated either average or inadequate levels of knowledge, with critical deficiencies in fundamental CPR skills, particularly concerning compression techniques and the effective utilization of AEDs. Training exposure emerged as the only factor influencing knowledge and skill levels. A lack of awareness regarding available CPR training opportunities was the most frequently cited barrier to participation. Despite these gaps, participants exhibited a predominantly positive attitude toward acquiring BLS skills, with a strong willingness to engage in further training. These findings underscore the urgent need to improve the awareness of teachers and the public about BLS by increasing access to structured CPR training programs and incorporating practical, hands-on components to foster confidence and preparedness in emergency situations.