Basic first aid and life support: are the schools prepared? a descriptive study

INTRODUCTION

When a disaster strikes, no responder can respond as quickly as a neighbour or a family member. However only when that person knows first aid, crisis can be averted and lives can be saved.

By definition, first aid is the immediate assistance provided to a sick or injured person until professional help arrives. First aid interventions seek to preserve life, alleviate suffering, prevent further illness or injury and promote recovery.¹ Properly administered first aid can be the difference between life and death, rapid versus prolonged recovery and temporary versus permanent disability.² Studies conducted by British red cross in 2016 revealed that 45-59% of deaths can be prevented by first aid alone. In certain self-limiting medical conditions, it may obviate the need to visit a hospital or clinic, lessening demand on medical facilities.³ According to national first aid science advisory board, first aid should be learned by every person.⁴

Children spend most of their daytime in schools and are at greater risk of accidents and injuries. Overall, majority of the injuries among children are directly related to outdoor physical activities, of which 20% occurs during school hours.⁴

National disaster management guidelines, school safety policy of India 2016 recommend that school teachers and students be trained in first aid and BLS.⁵ First aid training has been a mandatory part of the school curriculum in countries such as Norway since the early 1960s. Since then, there has been widespread call for other countries to adopt similar policies.⁶ However in India it is still not a part of formal education.

The advantage of teaching first aid and BLS to school children lies in building a reserve of trained persons in the society. It is advantageous to catch them young because skills learned at a young age remain with an individual for a long time. This study was undertaken in schools of New Delhi cantonment to assess the awareness of high school students and teachers about first aid in common medical emergencies and BLS, accompanied by demonstration and hands-on training on BLS and first aid skills.

Aim and objectives

The aim of this study was to assess the awareness of high school students and teachers about basic first aid and BLS, to impart knowledge and skills about first aid and BLS to school students and teachers through lecture, demonstration and hands-on training and to create trainers and equip them with necessary knowledge and training material for further reinforcement.

METHODS

The study was conducted to assess the existing knowledge of first aid and BLS in three schools in New Delhi cantonment followed by lecture cum demonstration on first aid and BLS designed specifically for schools.

Type of study

The type of study done was descriptive cross sectional.

Duration of study

The study was conducted from 15 March 2019 to 15 April 2019.

Inclusion criteria

The targeted population included for this study were the school students of class 11th and 12th and the school teachers.

Sample size

All students of class 11th and 12th of three cantonment schools in New Delhi and all school teachers were included in the study. Total 393 students and teachers participated in the study. 377 questionnaires were analyzed as 16 forms were incomplete.

Questionnaire

Knowledge was assessed using a questionnaire comprising 20 multiple choice questions covering basic knowledge about standard first aid procedures in common conditions and BLS. One point was awarded for each correct response and zero for each incorrect response. Maximum and minimum achievable scores were 20 and 0, respectively. 5 questions were focused on BLS. Scores were divided in good (75% or more), average (75%-50%) and poor (<50%). Questionnaire was tested for standardization and validation on 30 children. Since there were no major changes, these 30 children were included in the total sample.

Analysis

Descriptive statistical analysis was done using microsoft excel 2013 and SPSS version 20.

Ethical approval

Ethical approval was taken from O/o Director General Medical Services (Air).

RESULTS

It was an anonymous study and participants were not asked to reveal their personal details like age, sex, class and socioeconomic status.

Mean knowledge score was 10.96 with a standard deviation of 2.87. Highest knowledge score was 16/20 (80%) scored by 4 participants and lowest was 1/20 (5%) scored by 4 participants. Most common score was 12, scored by 62 (16.4%) participants. More than two thirds, 67.6% participants had a score ≤12 (60%) (Table 1).

Knowledge about specific conditions

Knowledge about BLS (Table 2). None of the participants were able to answer all 5 questions about BLS correctly and only 3 (0.8%) of them answered 4 questions correctly. While 315 (83.55%) participants knew that carotid pulse is checked at the side of neck, only 18 (4.77%) knew the correct rate of chest compressions is 100-120/min.

Knowledge about first aid in common medical conditions

Table 3 shows that almost all, 362 (96.02%) participants, knew that first aid means onsite care and it can be given by anyone. Knowledge about management of bleeding wound, electric shock and fever was also very common. 91.78%, 90.19% and 88.86% participants knew about First aid in bleeding wound, electric shock and fever, respectively. Apart from BLS, knowledge was poor about management of epistaxis and snake bite. While only 41 (10.89%) participants knew about management of epistaxis and 69 (18.30%) participants knew about first aid of snake bite.

DISCUSSION

This study was done in three schools in New Delhi cantonment among 377 participants. Study done by Mobarak et al about first aid knowledge and attitude of secondary school students in Saudi Arabia in 2015 revealed that first aid preparedness was inadequate.¹³ A study conducted in Sri Lanka in 2015 found similar results among senior school prefects in schools.¹⁴ Only 17% had complete knowledge of first aid and partial knowledge was found in 33.3% of students in a study done in a public school in Dehradun by Semwal et al.⁴ The results were comparable in this study, where only 7.7% participants had good knowledge (score >75%).

While 96.02% students were aware that first aid is providing immediate onsite care, awareness about BLS was very poor in our study. Aims of first aid were known to 36.66% students in study done by Rachna Kapoor et al.² However, Deepak and Nayak in 2012 report that 62% had good knowledge and 38% had average knowledge of BLS among self-help groups.¹⁰

The maximum and minimum percentage of correct response was obtained for management of fracture (63.33%) and for management of wound (7.66%) respectively in a comparable study done by Rachna Kapoor et al in school students of Ahmedabad.² In our study, knowledge about management of fracture and wound was 84.35% and 91.78% respectively. Study done by Priyangika et al found different results for fracture (50%), however results were comparable for burns. For burns, 52.56% participants had knowledge in our study and 50% in the study done in Sri Lanka.¹⁴

In contrast to study findings of Semwal et al where only 3.7% students had knowledge of first aid in epileptic seizures, 42% of participants responded correctly in study conducted by Priyangika et al 44.82% participants knew about first aid in seizures in our study.

While Priyangika et al reported that none of the participants had correct knowledge about choking, in study done by Semwal et al 5.7% had complete knowledge and 31.3% had partial knowledge. In our study, 30.77% participants knew first aid of choking in a child. Thein et al in 2005 found primary caregivers in Singapore had good knowledge about first aid in choking.¹⁵

In a study done in general population in Myanmar by Mahmood et al in 2018, 39% knew about the correct first aid in snake bite case.¹⁶ In our study, 18.30% participants knew the correct first aid for snake bite. Agravval et al found in study done in rural health care center in India that 42.4% relied on household treatments like putting chilli on wound in dog bite.¹⁷ 69.23% participants in our study were aware that dog bite should be washed with soap and water and nothing should be applied. The difference may be due to the fact that our study was done in urban setup.

Jose Antonio et al reported that a small proportion showed satisfactory knowledge about BLS.¹⁸ In our study, no participant could answer all 5 questions about BLS, and only 10.9% participants answered 3 out of 5 questions correctly. Amoura Soliman Behairy conducted a study on BLS in egyptian schools in 2016 and found that no participant had any baseline knowledge about basic life support.¹⁹

Limitations of the study

As the above study was conducted in a limited time period (1.5 hour each session), it was not possible to give hands-on training to every participant.

CONCLUSION

It was found in the study that not only there was low level of awareness about correct first aid and BLS, but incorrect information was also prevalent. There is a definite need for strengthening knowledge among students by regular training programs on first-aid in schools. First aid training should be incorporated as a part of school curriculum. Repeated reinforcement of knowledge and skills is essential to bring a long term positive change.

Recommendations

On the basis of the observations made in the study, a few short term and long term recommendations are being made. The short term recommendation was to enable efficient first aid management of medical emergencies occurring in schools and all school teachers and students must be trained in first aid and BLS to be able to handle medical emergencies occurring in schools. The long term recommendation was to make schools self-reliant in sustaining a basic first aid and BLS training. First Aid and BLS must be included in the school curriculum, with a defined number of hours dedicated to practical skills which require repeated reinforcement. Certain voluntary teachers can be made trainers who will train subsequent batches of voluntary students. Initial training of these teachers can be taken up by local medical authorities. Certain training aids, equipment and material to be developed so that training of first aid is interesting and educative.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was taken from O/o director general medical services (air)

REFERENCES

1. 1. International Federation of Red Cross and Red Crescent Societies, International First Aid and Resuscitation Guidelines 2016. https://www.ifrc.org/Global/Publications/Health/First-Aid-2016-Guidelines_EN.pdf. Last accessed on 20^th October, 2020.
2. 2. Kapoor R, Vyas S, Mashru P, Mehta A, Mehta A, Mehta S et al. Impact of Training on Knowledge and Attitude Regarding First Aid among Students of Schools of Ahmedabad. Natl J Community Med. 2017;8(7):380-4.
3. 3. Prehospital deaths from trauma and accidental injury preventable? a summary report. British red cross, 2016. Available at: https://www.redcross.org.uk/about-us/what-we-do/research-publications. Accessed on 16 April 2019.
4. 4. Semwal J, Bakshi RK, Juyal R, Deepshikha, Vyas S, Kandpal SD. Study of knowledge and attitudes to First Aid among school children of Doiwala block, Dehradun. Int J Community Med Public Health. 2017;4(8):2934-8.
5. 5. National disaster management guidelines school safety program 2016. New Delhi. https://www.ksndmc.org/NDMA%20Guidelines/School%20Safety%20Policy.pdf. 20^th October, 2020.
6. 6. Lenson S, Mills J. First aid knowledge retention in school children: a review of the literature. Austral J Paramed. 2016;13(1).
7. 7. First aid: from witchdoctors and religious knights to modern doctors. Available at: https://www.medicinenet.com/first_aid_witchdoctors_and_religious_knights/views.htm. Accessed on 10 April 2019.
8. 8. Qureshi FM, Khalid N, Nigah-e-Mumtaz S, Assad T, Noreen K. First Aid facilities in the school settings: Are schools able to manage adequately? Pak J Med Sci. 2018;34(2):272-6.
9. 9. Glendon AI, McKenna SP, Blaylock SS, Hunt K. Evaluating mass training in cardiopulmonary resuscitation. Brit Med J. 1987;294(6581):1182–3.
10. 10. Deepak M, Nayak S. A study on knowledge on assessment of knowledge on practices regarding first aid measures among self-help groups in mangalore with a view to develop information module. Nitte University J Health Sci. 2012;2(3):6871.
11. 11. Metin I, Mutlu C. Level of knowledge about first aid of the university students. Trakia J Sci. 2010;8(2):262-5.
12. 12. Shanthikrishna C, Rekha P. First aid education for safety of students. IOSR J Humanities Soc Sci. 2018;23(7):26-9.
13. 13. Mobarak AS, Afifi RM, Qulali A. First aid knowledge and attitude of secondary school students in Saudi Arabia. Health. 2015;7(10):1366-78.
14. 14. Priyangika KGG, Hettiarachchi M. Knowledge, attitudes and practices on first aid measures among senior school prefects in galle education division, Sri Lanka. KDU Library. 2015.
15. 15. Thein MM, Lee BW, Bun PY. Knowledge, attitude and practices of childhood injuries and their prevention by primary caregivers in Singapore. Singapore Med J. 2005;46(3):122-6.
16. 16. Mahmood MA, Halliday D, Cumming R, Thwin KT, Myitzu M, White J, et al. Inadequate knowledge about snakebite envenoming symptoms and application of harmful First Aid methods in the community in high snakebite incidence areas of Myanmar. PLoS Negl Trop Dis. 2019;13(2):e0007171.
17. 17. Agarvval N, Reddaiah VP. knowledge, attitude and practice following dog bite: a community based epidemiological study. Health Population. 2002;26(4):154-61.
18. 18. Neto JAC, Brum IV, Pereira DR, Santos LG, Moraes SL. basic life support knowledge and interest among laypeople. Int J Cardiovas Sci. 2016;29(6):443-52.
19. 19. Behairy AS, Ahamed M, Al-Batanony. Effectiveness of first-aid and basic life support intervention program on school health advisors. J Health Med Nurs. 2016;24:136-44.