The Need for First Aid Awareness among Candidate Teachers

Abstract

Objectives Students at schools may require first aid due to illness, deterioration in their condition, or accidents. Therefore, educators should know first aid procedures and be able to put them into practice. In this study, the objective was to determine the level of first aid knowledge among students at a Faculty of Education and evaluate the efficacy of the first aid training (FAT) provided to them. Methods This study included 88 students at Gazi University, Faculty of Education (Ankara). All students were provided 20 hours of FAT over a period of three months. Participants completed pre- and post-FAT questionnaires and a final examination. Results Sixty-one percent of participants (n=54) had attended FAT within the previous five years. Average pre- and and post-test scores were 47.89±11.29 and 75.28±12.62, respectively. There was a significant increase between the average scores (p<0.001). The proportion of correct responses on basic life support issues was also significantly higher after the training. Significantly more participants felt they had sufficient first aid knowledge and skills after the training (58%) compared to pre-training (8%) levels (p<0.001). Conclusions First aid knowledge among students at a Faculty of Education was considered to be insufficient. FAT should be standard in educational programs at all teacher training schools and the results show such training needs to be updated regularly.

Full text

Türkiye Acil Tıp Dergisi - Tr J Emerg Med 2011;11(4):166-170 doi: 10.5505/1304.7361.2011.50490
Submitted (Geliş tarihi): November 11, 2011 Accepted (Kabul tarihi): December 29, 2011
Correspondence (İletişim): Fikret Bildik, M.D. Gazi Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, Beşevler 06500 Ankara, Turkey
e-mail (e-posta): fbildik@gazi.edu.tr
ORIGINAL ARTICLE KLİNİK ÇALIŞMA
1Department of Emergency Medicine, Gazi University, Faculty of Medicine, Ankara, Türkiye
2Şişli Etfal Training and Research Hospital, İstanbul, Türkiye
Fikret BİLDİK,1 İsa KILIÇASLAN,1 Cumali DOĞRU,2 Ayfer KELEŞ,1 Ahmet DEMİRCAN1
The Need for First Aid Awareness among
Candidate Teachers
Eğitim Fakültesi Öğrencileri için İlk Yardım Eğitiminin Gerekliliği
ÖZET
Amaç
Öğrencler okulda mevcut hastalıklarında kötüleşme veya kaza geçr-
me neden le lk yardıma gereksnm duyablrler. Bu nedenle öğret-
menlern lk yardım grşmlern blmes ve uygulayablmes gerekldr.
Bu çalışmanın amacı, öğretmen adayı olan eğtm fakültes öğrencle-
rnn lk yardım blg düzeyn ve verlen lk yardım eğtmnn etknlğ-
n saptamaktır.
Gereç ve Yöntem
Bu çalışmaya, 88 Gaz Ünverstes Eğtm Fakültes (Ankara) öğrencs
katıldı. Öğrenclere üç aylık dönem çnde 20 saat lk yardım eğtm ve-
rld. Eğtm önces ve sonrası 20 soruluk lk yardım blgler çeren sınav
ve lk yardım eğtm le lgl anket düzenlend.
Bulgular
Bu öğrenclerden 54’ü (%61.4) son 5 yıl çnde lk yardım eğtm al-
mıştı. Ön test not ortalaması 47.89±11.28, son test not ortalama-
sı 75.28±12.62 d ve aralarında statstksel anlamlı artış vardı
(p<0.001). Temel yaşam desteğ le lgl sorulara doğru yanıt verme
oranı eğtm sonrası statstksel anlamlı olarak artış gösterd. “Yeter-
l lk yardım blgs ve becersne sahp olduğunuzu düşünüyor musu-
nuz?” sorusuna verlen “evet” yanıtı eğtm önces %7.0’den, eğtm
sonrası %58.0’e artış gösterd (p<0.001).
Sonuç
Eğtm fakültes öğrenclernn lk yardım blglernn yetersz olduğu,
öğretmen yetştren tüm okullarda lk yardım eğtm verlmes ve öğ-
retmenlern de blglern güncellemesnn gerekl olduğu düşünülmek-
tedr.
Anahtar sözcükler: Temel yaşam desteğ; lk yardım; öğretmen; öğrenc; eğtm.
SUMMARY
Objectves
Students at schools may require rst aid due to illness, deteriora-
tion in their condition, or accidents. Therefore, educators should
know rst aid procedures and be able to put them into practice.
In this study, the objective was to determine the level of rst aid
knowledge among students at a Faculty of Education and evaluate
the ecacy of the rst aid training (FAT) provided to them.
Methods
This study included 88 students at Gazi University, Faculty of Edu-
cation (Ankara). All students were provided 20 hours of FAT over a
period of three months. Participants completed pre- and post-FAT
questionnaires and a nal examination.
Results
Sixty-one percent of participants (n=54) had attended FAT within
the previous ve years. Average pre- and and post-test scores were
47.89±11.29 and 75.28±12.62, respectively. There was a signicant
increase between the average scores (p<0.001). The proportion of
correct responses on basic life support issues was also signicantly
higher after the training. Signicantly more participants felt they
had sucient rst aid knowledge and skills after the training (58%)
compared to pre-training (8%) levels (p<0.001).
Conclusons
First aid knowledge among students at a Faculty of Education was
considered to be insucient. FAT should be standard in educa-
tional programs at all teacher training schools and the results show
such training needs to be updated regularly.
Key words: Basc lfe support; frst ad; school teachers; students; tranng.
166

Introducton
First aid is applied to injured or ill persons in any health
threatening setting in order to save life, prevent degrada-
tion of the situation, or contribute to a treatment process
before professional medical care is available. First aid refers
to assessments and interventions that can be performed by
a bystander (or by the victim) with minimal or no medical
equipment.[1]
Basic life support (BLS), includes maintaining the safety of the
scene where the accident occurs, opening airway, providing
mouth-to-mouth ventilation, and external chest compres-
sion, and represents the most crucial step in rst aid. Cases in
which circulation is arrested for more than ve minutes, can
result in irreversible brain damage or even death. Therefore,
in general, life-saving BLS procedures should immediately
be applied non-professionals, who happen to be nearby at
the time of the incident.[2]
Children and teachers spend most of their time within a
school environment, which is therefore the most likely set-
ting for incidents (e.g., asthma attacks, epileptic seizures,
sports injuries, etc.) that may require rst aid procedures.
[3] Given that schools may not have any trained healthcare
providers on-site, it will be teachers who provide rst aid to
students. Teachers should therefore be trained in rst aid
procedures and be able to put them into practice. Teachers
should be able to convey basic, accurate, and current rst
aid knowledge to their students and others in society. There-
fore, teachers not only need to receive rst aid training (FAT)
during their professional development, but should also up-
date their knowledge and skills in the light of recent rst aid
guidelines.
This study evaluated knowledge of the latest rst aid/BLS
guidelines among students at Gazi University, Faculty of
Education in order to review and determine the eciency of
this particular FAT.
Materals and Methods
The study methodology involved pre- and post-training
questionnaire surveys. The study included rst year students
at Gazi University, Faculty of Education, Department of Spe-
cial Education (The Teaching Mentally Handicapped Chil-
dren Program) between March and June of 2010 and 2011.
The participants were provided oral and written information
prior to study. The study was approved by the institutional
Ethics Committee. Of 105 rst year students, the study in-
cluded 88 who voluntarily agreed to complete question-
naire forms before and after the training and to take tests
related to their rst aid knowledge.
Participating students were provided 20 hours of FAT by
an Assistant Professor at Gazi University, Faculty of Medi-
cine, Department of Emergency Medicine. The course con-
tent comprised: 1 hour of denition and aims of rst aid; 4
hours of basic life support; 2 hours of rst aid in bleeding,
shock, methods and practices of bleeding control; 2 hours
on injuries and organ ruptures; 1 hour on burns and frost
bite; 2 hours on electrical shock and drowning; 2 hours on
dislocation, fractures and sprains; 2 hours on methods of
rescue and transportation of the injured patients; 2 hours
on treating patients with altered levels consciousness; and
2 hours on rst aid cases of poisoning. BLS was explained
theoretically and students also had the opportunity to put
this knowledge into practice through case studies using a
manikin. Bleeding control techniques were also demonstrat-
ed and applied on a student.
Participants completed a multiple-choice pre-test (20 ques-
tions) assessment on their level of knowledge prior to FAT;
and a questionnaire on their overall views of rst aid and
whether they had previously taken a rst aid course. Follow-
ing the training, the same multiple-choice questions were
repeated as a post-test and a revised questionnaire form was
used to obtain feedback about training. Of the 20 multiple
choice questions, 5 were related to BLS. Test scores were
evaluated (score range 0-100). Comparisons were made be-
tween average pre- and post-training test-scores; and be-
tween individuals who had previously received training and
those who had not. Answers to the questions related to BLS
were also evaluated.
All data were analyzed using SPSS (Version 11.0 for Win-
dows®, SPSS Inc., Chicago, USA). Frequency distribution
and descriptive criteria were calculated. The Kolmogorov-
Smirnov test was used to test for normality. Mean ± stan-
dard deviation was used to evaluate average test scores.
A paired-samples t-test was used to compare average test
scores (pre- and post-training) for individuals who had taken
the training before, whereas an independent-samples t-test
was applied to those with no prior FAT. Questionnaire re-
sponses were compared using chi-square, McNemar tests
and Fisher exact tests.. A value of p<0.05 was taken to indi-
cate statistical signicance in all cases.
Results
Of the 88 participants 43 (48.9%) were male and 45 (51.1%)
were female. Fifty four (61.4%) of the students had taken rst
aid courses within the previous 5 years. Forty one (75.8%)
stated that they had taken these training during their el-
ementary education, 7 (13.0%) during primary education,
and 6 (11.2%) during driving courses.
As shown in Figure 1, when the test scores were evalu-
Bildik F et al. The Need for First Aid Awareness among Candidate Teachers 167

ated out of 100, average pre-test score was found to be
47.89±11.29 (minimum 25-, maximum 80) and average post-
test score was signicantly higher, at 75.28±12.62 (minimum
45-, maximum 95), (p<0.001). The average pre-test score
among students with prior FAT (n=54) was 49.07±11.25,
which did not dier signicantly (p=0.220) from average
score of 46.03±11.27 for those (n=34) with no prior FAT.
The average post-training test score among participants
with prior FAT (76.29±12.02) was not signicantly dierent
(p=0.346) to those with no prior FAT (73.68±13.56) (Figure
2). Of 5 BLS questions, 3 showed a signicant increase in the
number of correct answers after the training (Table 1).
Feedback on the training was obtained via a questionnaire
form. Prior to training, 7 (8.0%) of participants respond-
ed ‘yes’ to the question, “Do you think you have enough
knowledge and skills when you are faced with someone
who needs rst aid?” compared with 51 (58.0%) the training
(p<0.001). A majority of the students (89.8%) emphasized
that FAT should be reiterated sometime during their profes-
sional life (Table 2).
Türkiye Acil Tıp Dergisi - Tr J Emerg Med 2011;11(4):166-170
168
30
35
40
45
50
55
60
65
Value of Test Score
Pre-test
47.89
75.28
Post-test
70
75
80
Figure 1. Diagrammatic view of mean value of pre -test and post
test scores.
Figure 2. Diagrammatic view of mean value of pre- and post test
scores of those who had taken rst aid training before and those
who had not.
30
35
40
45
50
55
60
65
Value of Test Score
Students who had taken a rst
aid course before
Students who had not taken a
rst aid course before
70
75
80
49.07
46.03
76.29 73.68
Pre-test
Post-test
Questions Pre- test Final test
True False True False p
n (%) n (%) n (%) n (%)
What is the rate of chest compression/mouth-to-mouth ventilation in an adult? 10 (11.4) 78 (88.6) 83 (94.3) 5 (5.7) <0.001
How is mouth-to-mouth ventilation practice evaluated? 68 (77.3) 20 (22.7) 77 (87.5) 11 (12.5) =0.049
Where exactly is chest compression applied on the body? 23 (26.3) 65 (73.9) 73 (83.0) 15 (17.0) <0.001
What is the leading cause of airway obstruction in an unconscious patient? 82 (93.2) 6 (6.8) 88 (100) – *=0.056
Which of these actions is primarily performed on a person who has respiratory arrest? 27 (30.7) 61 (69.3) 65 (73.9) 23 (26.1) =0.002
Chi-Square and *Fisher Exact tests.
Table 1. Pre-test and post-test answers to basic life support questions
Table 2. Answers to feedback questionnaires after the training
Questions Yes No No idea
n (%) n (%) n (%)
Did the rst aid training meet your expectations? 80 (90.9) 5 (5.7) 3 (3.4)
Do you think it is more useful when rst aid trainings are provided by emergency physicians? 85 (96.6) 1(1.1) 2 (2.3)
Do you think you have enough rst aid knowledge and skills if you ever encounter someone who needs rst aid? 51 (58.0) 7 (8.0) 30 (34.1)
Did you nd the content of the rst aid training satisfying? 74 (84.1) 10 (11.4) 4 (4.5)
Would you like rst aid trainings to reiterate in your professional life? 79 (89.8) 4 (4.5) 5 (5.7)

Dscusson
Children may encounter life-threatening emergency situa-
tions while at school. As they spend most of their time at
schools, this is a highly likely setting for illness, deterioration
or accidents.[3] Trauma and asphyxia are leading causes of
pediatric mortality and, maintaining open airways, support-
ing ventilation, and controlling bleeding may be life-saving.
[4] These rst aid techniques should be initiated by teachers
who happen to be closest to the student at the time of the
incident.
In a study of teachers, 17% reported witnessing a life-threat-
ening incident involving a student at least once during their
career.[5] In a study of 573 school nurses, Olympia et al.[3] re-
ported that 68% had managed life-threatening incidents
requiring emergency medical attention during the previous
school year. In the same study, school nurses also indicated
that they mostly encountered incidents such as extremity
sprains, respiratory disorders, seizures, extremity fractures,
head/neck injuries, and lacerations, respectively. They also
encountered a lower number of life-threatening cases, such
as poisoning, anaphylaxis, airway obstruction, loss of con-
sciousness, and cardiac arrest. Sports injuries also frequently
occur at schools.[6] Uner et al.[7] reported the frequency of in-
juries in school as 10.7% (among 401 high school students)
during the previous three months; in 44.2% of cases, rst aid
was applied at the scene.
A study of teachers in Turkey (n=312) found that they lacked
sucient rst aid knowledge.[8] Abernethy et al.[6] found that
37% of physical education teachers did not have up-to-date
rst aid knowledge. A study conducted in Poland concluded
that neither students nor teachers had sucient rst aid
knowledge.[9] This supports the importance of our present
study on FAT awareness among candidate teachers at the
Faculty of Education.
There are no large-scale studies of rst aid/BLS knowledge
and skills within Turkish society. A study of rst aid knowl-
edge among university students reported that their level of
rst aid was insucient, as they were only exposed to theo-
retical FAT.[10] Another study found that university students
lacked sucient knowledge of spinal injuries and interven-
tions, and it was emphasized that practical classes demon-
strating rst aid techniques would be benecial for students
in other departments besides the health sciences.[11]
According to the 2002 First Aid Regulations, published by
the Ministry of Health in Turkey, requires that workplaces
employ rst-aid providers, depending on the number of
employees and a minimum of 40 hours of FAT must be pro-
vided to those providers.[12] The National Ministry of Educa-
tion requires that FAT be given together with trac lessons
in primary schools during grades 6 to 8. Moreover, the Mo-
tor Vehicles Regulations include a 12-hour rst aid course as
part of the process to obtain a driving license. In our study,
although 61.4% of participants indicated that they received
FAT within the previous 5 years (either during their primary
or secondary education, or during their driving courses),
their relatively low pre-test scores indicate that their rst aid
knowledge was still insucient and that FAT must be reiter-
ated.
Basic life support represents the most crucial step in rst
aid and is the foundation for saving lives following sudden
cardiac and respiratory arrest.[13] In conformity with the con-
cept of “evidence-based medicine”, BLS undergoes continu-
ous progress and changes. During the rst year of study, The
“Cardiopulmonary Resuscitation (CPR) Guidelines” which
was the previous publication in November 2005 by the “In-
ternational Liaison Committee on Resuscitation” was avail-
able at that time. The publication of these revised guideline
prompted updates to practical procedures, For instance,
according to CPR guidelines published in 2000, the rate of
chest compression/mouth-to-mouth ventilation for an adult
was 15/2, this was subsequently revised to 30/2 in the 2005
guidelines, and the importance of uninterrupted, high qual-
ity chest compressions was emphasized.[2]
In another example, an extensive international study re-
viewed all of data supporting resuscitation and new guid-
ance was recently published, in October 2010. There are
signicant changes in this guidance related to BLS and rst
aid. For instance, the order of BLS practice was A (airway), B
(breathing), C (circulation) in the previous 2005 guidelines;
however in the most recent version, the sequence was re-
vised to C-A-B. In addition, the “Look, Listen, and Feel” ap-
proach was removed from the BLS algorithm.[13] Moreover
the current guidelines include various changes to some rst
aid applications, for example control of bleeding.[1] The pub-
lication of this latest guidance has also necessitated updat-
ing BLS knowledge and skills.
In our study, 88.6% of students incorrectly answered the
pre-test question related to the rate of chest compression/
mouth-to-mouth ventilation in an adult (cited as 30/2 in the
2005 and 2010 guidelines). Seventy-three percent of the
students failed to identify the exact position on the chest at
which compression should be performed. However, a major-
ity of the students (93.2%) responded correctly to the ques-
tion measuring classical knowledge, concerning the most
frequent cause of airway obstruction in an unconscious
patient (Table 1). These nding indicate that changes intro-
duced in the 2005 and 2010 CPR guidelines, have still not
been incorporated by non-healthcare providers; therefore,
rst aid/BLS training should be regularly updated. Conse-
Bildik F et al. The Need for First Aid Awareness among Candidate Teachers 169

quently, there is a clear requirement for continual rst aid
training and review.
Limitations
The number of participants is limited, as this particular
study includes only the students at Gazi University, Faculty
of Education, Department of Special Education (“The Teach-
ing Mentally Handicapped Children” Program). The eect of
students’ non-attendance during the training hours was not
considered. There was insucient data concerning the qual-
ity of students’ previous rst aid trainings. Furthermore, skill
performance and long term retention of this knowledge was
not evaluated in the study.
Concluson
First aid knowledge among students at the Faculty of Edu-
cation was considered to be insucient. FAT should be a
standard component of educational programs at all teacher
training schools and should also be updated at regular inter-
vals throughout their careers, as part of teachers’ continuous
professional development.
Acknowledgement
The authors thank Mustafa İlhan, MD, for his recommenda-
tions on statistical analyses.
Conict of interest
None declared.
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