1

CHAPTER 1

INTRODUCTION

“A good teacher is like a candle. It consumes itself to light the way for others”

 Bruke Adams

1.1 BACKGROUND OF THE STUDY

The real joy, fun, lovable movements are not in expressing out to the
external world but in enjoying with each and every movement of our life.
This real joy, fun and favorable moments become more enjoyable if the source
of all these comes from the future pillars and ever green children.

Child is a distinctive individual; he or she is not a miniature of an

adult. The childhood period is an important period because of socialization
process starts by transmission of attitude, customs and behavior through the
effect of family and community. Children are vulnerable to Children are
vulnerable to injuries, but at time.

In world, after, China India is the second most populated country.

In India 16.45 Cr children were in the age group 0-6 years and 37.24 Cr in the
age group 0-14 years which constitute 13.59% and 30.76% of the total
population respectively (Indian sensus,2019).

Every year April 7thwill be celebrated as World Health .WHO stated

that Healthy environment for Children is the rights for the child to grow up in a
healthy home, school and community. The future development the children and
of their world depends on their good health (Brundtland, 2013).
 2

Today’s children are tomorrow’s citizen- take care of them if you wish
to have a strong India, ever ready to meet various challenges. Healthy children are
the good resource and a Nations pride. The Investment in children development is
an investment for the future of the nation (Jawaharlal Nehru, 2002).

School age children are very active at home, in the community and
at the school. This increased activity and time away from parents increases the
risk for unintentional injuries .The death rate in children between 5 to 10 years
of age is less than younger children .Each year, 20% to 25% of all
children sustain an injury to seek medical attention or to miss the school
(Viswanathan, 2007).

Children are unproduced to injuries and accidents, which may range

from minor injuries to severe accidents. This will lead to bleeding and fractures,
hence the first-aid management becomes as supreme as taking a child to a medical
facility. Children pass most of their daytime in schools, and are at greater risk of
accidents and injuries due to involvement in sports and other extracurricular
activities, and hence require first-aid more often than do adults. Overall, majority
of the injuries among children are directly related to outdoor physical activities, of
which 20% occurs during school hours (Farhan Muhammad Qureshi, 2018)

Injuries and sudden illness are major issues in public health and
usually occurring at any time of their life. Besides, schoolchildren injuries
take a major part. Unintentional play ground injuries occurring during school
hours and includes falls, head injures, wound, hemorrhage and others.
(Salmines et al., 2014)

Children spent most of the time in school under the supervision of

teachers. Consequently first aid should be well known by teachers who are the
key personnel to deal with immediate health needs during school hours.
Healthy environment is very important to prevent the hazards besides
 3

competent teachers who can identify any health problem and able render a first
aid for commonly occurring first aid emergencies in school (Masih, 2014).

First Aid has been given to wounded and sick people since ancient
times. The idea of ‘First Aid’ was conceived by General Esmarch, a famous
German surgeon. Formation of St. John ambulance association in 1877 was the
beginning of an organized worldwide effort at giving First Aid. The Red Cross
is a worldwide organization. Red Cross Society of India was established in
1920. It has achieved a great improvement in health and prevention of disease.

First aid is not only just about helping crash victims at the roadside.
But also calming an injured person or as profound as saving a life. Certain
self limiting illnesses or minor injuries may not require further medical care
immediately if first aid is given. It aims to preserve and protect life, prevent
further injury or deterioration of illness and help to promote recovery.
The internationally accepted symbol for first aid is the white cross on a green
background (St John Ambulance 2008).

First aid is the temporary and immediate care given to the person
who is injured or suddenly becomes ill. First aid can save a victim’s life
especially if the victim is bleeding heavily and has stopped breathing. It also
prevents additional medical emergencies that can arise from an injury or illness
(Gupta, 2004).

According to Division Of Occupational Health and Safety (2014)

stated that First aid is emergency care given immediately to an injured person.
The purpose of first aid is to minimize injury and future disability. In serious
cases, first aid may be necessary to keep the victim alive.
 4

The objectives of First Aid is to offer assistance to anyone injured or

ill before expert help from a doctor or nurse is available, or before an
ambulance arrives.

The aims of First Aid are threefold:

 Saving life by prompt and initial action;

 Preventing the injury from becoming worse;
 Helping recovery through reassurance and protection from further
danger.

It follows, then, that First Aid equipment and materials must be

simple, and capable of being used by anyone without risk of exacerbating any
injuries or causing the condition of an injured person to deteriorate.

The first aider will be a common person who may learn the standard
methods of first aid skills. The person can identify the problems and provide
necessary treatment without causing further injuries. First aid can save a person
during emergencies that may arise due to injuries and illness. First aid will be
continued till the qualified medical person research that place (Singhajay, 2008).

Timely administration of first aid in response to injuries and medical

emergencies will help to reduce complications, the cost of treatment and
mortality among children. As schools do not usually have trained health care
providers on site, it is essential for teachers to be trained in first aid procedures.
They also need to be updated periodically in their knowledge and skills to keep
up with current first aid guidelines. Teachers must be willing to assume the
responsibility for competently rendering first aid to students whenever the need
arises. It is equally important for schools to be well equipped with first aid
facilities, in order make appropriate interventions possible (Al-Robaiaay, 2013).
 5

1.2 SIGNIFICANCE OF THE STUDY

Children are more vulnerable to injuries and carry a higher risk

because of developmental and behavioral properties including unawareness
of hazards and being active as well as physical properties including narrower
airways, smaller body mass and thinner and more vulnerable skin
(Sönmez, Uskun, & Pehlivan, 2014). Moreover, children and young adults,
injuries cause more childhood deaths than all other diseases combined, and
also Life-threatening emergencies can happen in any school at any time
(Hazinski et al., 2004).

Injuries do not always indicate neglect. It is a difficult task to watch

children carefully without overprotecting or unnecessarily confining them.
Small falls help children learn the dangers of highest; touching a hot object
once can emphasize to the child the pain of burn. Parents need to remember
that infants and young children cannot anticipate danger or understand where it
is or is not present. It must be remembered that child need to be physically
removed from the situation. Unintentional injuries rank as the number- one
cause of death and a leading cause of hospitalization for the infants and
toddlers. The importance of the mothers role in childhood accident prevention
has long been recognized, although many studies suggests that many mothers
are unsure of that role, feel inadequately prepared for it and recognize
significant constraints on their accident prevention activity. The Health of the
nation suggested that specific accident prevention activities should be
undertaken by the mothers (Sandhya Shrestha, 2014).

According to Sönmez et al. (2015) in injuries that occur as a

result of school accidents. Teachers are the first people who responsible to
help the child and perform first aid practices . First aid practices are vital in
terms of preventing death and further harm with simple interventions.
Therefore, teachers should know the rules of basic first aid practices.
 6

Richard Johnson (2004) conducted a study profile of two hundred

schooler who had met with an accident at school was studied. The most
common type of accident observed was fall 45%. Injuries due to sharp edge
instruments 40% burns /scalds 9% etc. were other type of accidents
encountered. A total of 300 students less than 15 years were contacted and
evaluated to measure the risk of domestic accidents. History of unintentional
injuries (falls burns, animal bite). The fire, electric appliances, household’s
chemicals with reach of the students and material which can fall of the students
was also observed on the day of the survey.

School life is an important part of children’s life, which has a direct

impact on their physical and mental health. Health promotion and prevention
are the most neglected part in both policy and practice. Schools can play a
significant role in health promotion due to two major reasons; first, the schools
offer structured opportunities for learning and second, pupils spend significant
amount of their time in schools during which they are involved in a variety of
activities including sports and physical exercises (Nancy, 2011).

Teachers have an important role to play in child protection.

Their role can only be properly carried out, if teachers are equipped with the
relevant skills. Appropriate in service training in child protection for teachers is
of key importance in both emphasizing child protection issues and in
promoting these skills in teachers. (Rayanna 2001).

Because in colleges give limited emphasis for first aid emergencies

and its management in the educational curriculum plan, in the same time the
school students spend most of their day within a school environment, which is
most likely setting for injuries due to usual work in this school as; bleeding,
asthma attacks, epileptic, fracture etc.. That may require first aid procedures.
Teachers have an important role in providing first aid for the school children.
So it is necessary to conduct our study to train B.ED students who are the
 7

future teachers about first aid and basic life support to be able to deal safely
with these injuries and also update their knowledge and skills in the light of
recent first aid guidelines.

1.3 NEED FOR THE STUDY

Children are more active, competent, and adventitious and are

vulnerable to injuries and accidents that may occur in schools such as sports
injuries, eye injuries, nose bleeding and epilepsy.

Knowler (2015) stated that teaching is the most effective when it

responds to a learners need. There is an important need to impart knowledge to
the needy people about the infant care.

First Aid essentially uses simple techniques involving a basic

knowledge, good practice of the principles of life preservation. It does not
require sophisticated equipment or a great knowledge of medical matters. It is
often as important to know what not to do as it is to know what should be done.
First Aid equipment and materials must be simple, and capable of being used
by anyone without risk of exacerbating any injuries or causing the condition of
an injured person to deteriorate.

It is necessary to train medical and non medical professional about

first aid. If first aid is given appropriately within 2 hours, we can save the
precious human life. Injuries are leading cause of death during the first half of
the life. Recent survey in India indicates that, an estimated injury related death
between 0-18yrs is around 2,43,025 which can be reduced with adequate first
aid training for the teachers and in schools (UNICEF, 2007).

First aid training helps to develop safety awareness. Those with first
aid training are more likely to assist public if they are stricken while the main
 8

benefits are to be trained individuals and family, they extend further usually to
co-workers, acquaintances and strangers (Halverson, 2018).

The common types of accidents among school children involves

falls and the injuries they sustained in school are fractures, bleeding, abrasions
and foreign bodies in eyes, ear and throat. 10-14 yrs aged boys are more prone
for the accidents at school. It is due to the environment, friends, new games,
and other activities. There are nearly 40-50% children prone to get accidents in
schools than all other accidents. It can be reduced by safety education training
and first aid training (Jackwon, 2013).

Taylor (2011) stated that The breakdown of skin and underlying

tissues causing wounds, as well, physical injury or mechanical force may result
in wounds.

According to fundamentals of nursing standards and practice (2011)

wounds can be classified according to various terms but usually described
based on the causes. The classification of wounds is intentional wounds and
unintentional wounds. Unintentional wounds are unanticipated and occur in
unsterile situation, which makes more risk for infection.

Bryant and nix (2015) stated that Proper wound care is necessary to
promote healing that result in intact skin layer. Intact skin is the first line of
defense of the body against the invasion of microorganisms. The skin defends
the body in other ways by serving as s sensory organs for pain, tough and
temperature

Bleeding caused by injury may cause serious threat to the life of the
person. The techniques used to stop the bleeding are direct pressure indirect
compression points and tourniquet (constricting stretchable band that tied strongly
above the wound) used to stop the bleeding. (Uaman and Davidson, 2014).
 9

Minor bleeding episodes are commonly seen among the school

students. It is easy to treat and have no long term consequences. Major
bleeding can be very dangerous and need to care immediately to prevent
complications. Accidental cuts, lacerations or puncture wounds from sharp
objects could cause extensive bleeding. Extensive bleeding can cause a drop in
the blood pressure and decreased organ blood flow, which could lead to shock.
We have to check a person who is bleeding for other related injuries such as
head injury, fracture, cuts and falls from height (Elzi, 2015).

Smeltzer et al. (2010) stated that fracture is an in complete

distribution in the continuity of bone structure and knew to its type and extent
and uaually fracture occurs when the bone is exposed to a great stress more
than its ability to tolerate, fracture is the most common injuries during growing
years 10 to 25% of all pediatric injuries are fracture. The who describes
fracture as the most common category of unintentional injuries suffered by
school going children .Percentage of fracture increased with the increase in the
sports activity in boys from 2 to 5, 6 to 9, 15 to 18 years of age. High level of
sports activity may increase the risk of fracture (Mohammad A Almakie,
2018).

American academy of pediatrics (2012) stated that First aid

intervention for muscular skeletal injuries as fracture, sprains generally
includes the principles of RICE, which means the following R:- refers rest.
I means an ice or cold pack should placed on the site of injury to help in
vasoconstriction of blood vessels and it will help in reducing the swelling.
C refers to compression n and means using an elastic firm bandage to injured
musculoskeletal area. E means the affected area must be elevated to reduce the
swelling specially in joint injury.

Sprains are defined as injuries to ligament, which are band of tissues

that hold bone in position and connect them other bones or the joints. Common
 10

signs and symptoms of sprain are pain tenderness, fast swelling of area,
discoloration and bruising. First aid emergency for sprains includes
immobilization, elevation, application of cool pack and referring to a health
facility (Stephens. 2016).

Ankle sprain is defined as a sudden twist that tenses the structures

around the joint. It can be no more than painful wrenching of soft tissue.
However, ligament rupture may result if a severe force is applied. Inversion of
the planter flexed foot is the most common injury mechanism, which affects
the lateral ligaments of the ankle in more than 90% of the cases. Risk factors
include those involved in jumping sports such as basketball, having history of
ankle sprain. The typical presentation is a history of twisting ankle followed by
pain, tenderness, swelling, and ecchymosis. Ankle sprain is diagnosed through
a history of the incident and physical examination to rule out other conditions
(Chadhuri, 2015).

Kate (2018) stated that dislocation is when two connected bones slip
out of position in a joint. Dislocations are caused by falls and hard impacts,
such as in sports injuries, and are more common in teens than young children.
These injuries require emergency medical care to avoid further damage.

John frust (2015) stated that First aid Management of a dislocation is

after managing all life and limb-threatening conditions. A first-time dislocation
should be considered and treated as a possible fracture. Any splint that is
available should be used to splint the injury in the position found. Splints can
include: the patient supporting the limb in a comfortable position, triangular
bandages and fracture straps and rigid splints such as box splints.

Sundblad (2015) conducted a study about injuries of school children

during physical activities. The outcome of the study showed that sprains and
strains occurred in 49% of children where the wounds made only 14 %.
 11

However the rate of incidence for fracture were 5%, for dislocation 4%.
The study revealed that importance of providing first aid training for teacher
and sports coaches, because the school teachers are the first persons which
confronting child emergencies at school.

Ola baminore (2019) stated that epistaxis is defined as acute

hemorrhage from the nostril, nasal cavity, or nasopharynx. It is a frequent
Emergency Department (ED) complaint and often causes significant anxiety in
patients.

Epistaxis is one of the most common otorhinolaryngology

emergencies occurring in pediatric population due to school injuries and
traumas, predisposing them to require basic yet important first-aid
management. Since teachers are usually the first responders encountering
nosebleeds, it is essential that proper knowledge and awareness of appropriate
first-aid measures with the appropriate management of epistaxis are required
(Yassier et al. 2019).

Recurrent nose bleeding due to unknown causes occurs in about 9%

of children between age 1 and 16 and generally is simple and self limiting but
severe cases referred for professional medical treatment. Epistaxis resulted
from many causes such as trauma, structural alteration or pathological origins
(Ward, 2014).

Robertson (2012) conducted a study to explore epistaxis incidence

rate and management among primary school teachers. 157 teachers were
selected for this study. The study results showed that 25% of secondary school
teachers and 37.5% pf primary school teachers were aware the nose bleeds
management among primary school teachers in Nagpur.
 12

Epilepsy is a disorder of the brain characterized of the brain by an

enduring predisposition to epileptic seizures (Fisher et al., 2055). According to
WHO epilepsy is two or more unprovoked seizures. Epilepsy is a medical
condition that produces seizures affecting a variety of mental and physical
functions. It is also called seizure disorder.

Epilepsy is one of the most common neurological problems of

childhood, with a worldwide prevalence of 5–10 per 1000 people Remarkably,
about 3% of people will be diagnosed with epilepsy at some time in their life
.Studies have revealed that being labeled with epilepsy has a major effect on
children, school children specifically, both academically and psychosocially.
Knowledge about epilepsy is an important issue in determining teachers’
attitudes toward children with epilepsy (Eman Al Hashimi, 2016).

Mustapha et al. (2016) conducted a planned teaching programme

regarding knowledge and attitude on epilepsy and its first aid actions.
60 teachers were selected by purposive sampling technique. A structure
questionnaire and attitude scale was used to collect the data. The result showed
that there was no significant relationship between first aid management
knowledge and attitude towards epilepsy. The study concluded that the planned
teaching program was effective.

Teachers are the main caregivers and the first line of protection for
school children. Their role complements that of parents. During school hours,
school teachers are actually the first respondent in cases of Training on First
Aid. They must be able to deal properly with health emergencies both in
normal children, and those children with special health care needs. However,
this role can only be properly achieved if teachers are equipped with the needed
skills. Therefore, appropriate in service training for teachers in child protection
is of major importance (Awad et al. 2015).
 13

Alicia (2018) did a retrospective analysis on compared injuries

occurring at schools to injuries occurring elsewhere in youth ages 5‐18 years.
school injuries accounted for 21% of unintentional injury‐related ED visits, with
an estimated annual incidence rate of 1385 injuries per 100,000 5‐ to 18‐year‐olds.
Middle school‐aged youth (10‐13 years) had the highest annual incidence rate
(1640 per 100,000 youth) compared with younger and older counterparts. School
injuries were more likely to be due to sports/recreation than nonschool injuries.

Saide Faydalı (2018) conducted a descriptive study to identify

situations in which teachers most frequently encounter the need to administer
first aid to children and whether the teachers performed the correct application
in these events. The study was conducted with 331 teachers. The study also
investigated any accidents and injuries occurring, their causes, and the
teachers’ interventions following the accidents and injuries. It was found that
teachers had information about first aid, but they did not trust themselves
enough to practice it. Conclusion Understanding the causes of accidents and
injuries, finding preventive measures, and updating teachers’ knowledge about
this subject are important to provide a safe educational environment.

Safi Dakhil (209) conducted a cross-sectional descriptive study to

explore the primary school teacher’s knowledge toward first aid at primary
school in Iraq. Out of 200 teachers, majority (83 %) of the total sample were
females while 17 % were males, (76%) were between (30-49) years old, (90%)
of study sample did not participate in any training program. and, majority
(85%) of teachers they have acquired knowledge through T.V or Net. About
half of primary school teachers’ did have low level of knowledge concerning
first aid, most of the primary school teachers not participant in any training
program about first aid, and difference in gender has effect on their knowledge.
 14

Black (1997) stated first aid knowledge is methods and techniques

that used perform practices related to prevention and immediate response to
health emergencies. It can be given in all areas such as household, schools,
workplace, and recreational areas. Beyond health matters, first aid knowledge
also increases the social responsibility of the society and strengthens values.

Teachers have an important role to play in child protection.

Their role can only be properly carried out, if teachers are equipped with the
relevant skills. Appropriate in service training in child protection for teachers is
of key importance in both emphasizing child protection issues and in
promoting these skills in teachers (Rayanna 2001).

As per the experience of Investigator visit to schools during school

health programmes and urban community postings, the teachers had lower
knowledge regarding First Aid for common injuries occurs in school children.
Hence this structure teaching programme can influence the B.Ed students who
are the future schoolteachers in effective first aid skills and managing
emergency situation with positive results. This will reflect in future to train and
guide their junior with confidence on this aspect and also can save many lives
of school children by giving first aid in injuries.

1.4 STATEMENT OF THE PROBLEM

A study to assess the knowledge and attitude on selected aspects of

first aid emergencies and its management of school students among B.Ed.
students in selected colleges, Coimbatore, Tamilnadu.

1.5 OBJECTIVES OF THE STUDY

 To assess the knowledge regarding selected aspects of first aid

emergencies and its management of school students among B.Ed
students.
 15

 To assess the attitude regarding selected aspects of first aid

emergencies and its management of school students among B.Ed
students.
 To deliver a structured teaching programme regarding selected
aspects of first aid emergencies and its management of school
students among B.Ed students.
 To assess the effectiveness of structured teaching programme
regarding selected aspects of first aid emergencies and its
management of school students among B.Ed students.
 To correlate the knowledge and attitude regarding selected first aid
emergencies and its management of school students among B.Ed
students.
 To find out the association between knowledge and attitude score
with selected demographic variables of B.Ed students.

1.6 HYPOTHESIS

 H1: There is a significant difference between pre-test and post-

test score on knowledge of B.Ed students regarding selected
aspects of first aid emergencies and its management of school
students.
 There is a significant difference between pre-test and post-test
score on attitude of B.Ed students regarding selected aspects of
first aid emergencies and its management of school students.
 There is a association between knowledge and attitude score with
selected demographic variables of B.Ed students regarding
selected aspects of first aid emergencies and its management for
of school students.
 16

1.7 OPERATIONAL DEFINITIONS

Assess : It refers to statistical measurement of the knowledge and attitude

scores of the B.Ed students regarding selected aspects of first aid emergencies
in children as observed by using structured questionnaire.

Knowledge: Refers to the amount of information possessed by B.Ed students

regarding selected aspects of first aid emergencies in school children and are
measured by correct responses given by them to the questions in the structured
knowledge questionnaire.

Attitude: it refers to the responses by B.Ed students regarding selected aspects

of first aid emergencies and its management in school children to administer
questionnaire of five degree likert scale with taking into account positive and
negative formed questions.

First Aid

It refers to provision of initial care for an illness or injury. It is

usually performed by non-expert, but trained personnel to a sick or injured
person until definitive medical treatment can be accessed.

Selected aspects of First Aid Emergencies

The selected aspects of first aid emergencies for the present study
are wounds, hemorrhage, sprains and dislocation, fractures, epistaxis, epilepsy.

First aid management

It refers to the assistance given to the victim after a traumatic injury

before actual treatment is given for selected conditions such wounds,
hemorrhage, sprains and dislocation, fractures, epistaxis, epilepsy.
 17

School students

Children who are going to an institution for basic education. In this

study, it refers to children who are studying I-X standard.

B.Ed student

It refers to students those who are studying in bachelor of education.

1.8 ASSUMPTION

 B.Ed students have inadequate knowledge regarding first aid

emergencies and its management for school children.
 Educating B.Ed students regarding first aid emergencies and its
management for school children will help them in future to
manage emergency situations in school.
 B.Ed students may need refreshers courses on first aid
management.
 Programmed teaching may help in imparting knowledge on first
aid management

1.9 DELIMITATION

This study is limited to

 Selected B.Ed students at Coimbatore only

 Sample size was 300 only.