Access to first aid facilities as a means of combating occupational accidents and diseases

in institutions
Abstract
Background and Objective: Children spend most of their time in schools and are vulnerable
to injuries and mild ailments, hence requiring first-aid care. School teacher can provide
immediate first-aid care in the absence of any health professional. This study assesses first-
aid facilities within school premises and assessment of teachers on first aid training.

Methods: The article review was a narrative review type. This was based on areas related to
the research topic. First aid in schools, materials and qualification of first aider was revealed
based on existing views, existing theories and ideology. Results are based on a qualitative
rather than a quantitative level.

Results: The review adds value to existing knowledge on first aid in schools. The reviews
were undertaken through keywords and related topics. In the literature, First Aid, First aid
materials, equipment and first aid facilities, Selection of First Aiders, Contacting first aid
personnel, Qualifications and Training, The necessity of First aid , Preserving life, Promoting
recovery, Promotes the sense of safety, Quick treatment, Prevents victim’s condition from
becoming worse, Helps preserve life, Makes people feel secure, The basic first aid knowledge
helps in treating were discussed. The necessity of first aid in school settings has been
overlooked and been undermined in many researches.

Conclusion: It is beyond doubt that knowledge of first aid promotes a safer and healthier
environment. Having staff and students who are well equipped with first aid skills contribute
to enhancing the safety of the schools. Many students experience accidents while they are at
schools. The accidents might lead to simple injuries, serious wounds or fractures. However,
the victim can be given initial assistance until the doctor arrives. It is important to have
trained staff and students who can utilize their skills and take quick action to treat the affected
person.

KEYWORDS: First-aiders, First aid training, Schools teachers.

1.0 INTRODUCTION
First aid is applied to injured or ill persons in any health threatening setting in order to save
life, prevent degradation 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
First aid is the assistance given to any person suffering a sudden illness or injury (Kindersley,
2009) with care provided to preserve life, prevent the condition from worsening, and/or
promote recovery. It is the provision of limited care for an illness or injury, which could be
provided, usually by a lay person, to a sick or injured patient until definitive medical
treatment can be accessed, or until the illness or injury is dealt with (as not all illnesses or
injuries will require a higher level of treatment). It generally consists of series of simple,
sometimes life saving, medical techniques, which an individual, either with or without formal
medical background can be trained to perform with minimal equipment.

First aid applies to a broad range of medical situations and consists both of specific
knowledge and skills (e.g., what to do for each type of injury or illness) and the ability to
assess a situation and make appropriate decisions, (such as when to call for emergency
medical assistance)( St.John Ambulance, 2006). First Aid can save lives and prevent minor
injuries becoming major ones. Under health & safety legislation employers have to ensure
that there are adequate and appropriate equipment and facilities for providing first aid in the
workplace (Dempsey, 2003). First aid is generally performed by the layperson, with many
people trained in providing basic levels of first aid, and others willing to do so from acquired
knowledge. It is concerned not only with physical injury or illness but also with other initial
care which includes psychosocial support for people suffering emotional distress caused by
experiencing or witnessing a traumatic event (European First Aid Guidelines, 2007).

The immediate assistance provided by first aider helps a lot. Undoubtedly, this assistance
given during the first few minutes after a crash often is of great importance for those who are
injured, especially in terms of future health and quality of life. A considerable amount of time
may pass before an ambulance and professional rescue personnel arrives. Thus, it is
imperative that first aid materials or facilities are found and used correctly administer first
aid to the victims. Without prompt life-saving assistance, an injured person may die for a
number of reasons, such as airway obstruction or other causes correlated to pre-hospital death
following trauma (Henriksson et al., 2001).

1.1 Problem Statement

First Aid is important for every individual at every age, including school children. 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 first aid procedures (Olympia et al., 2005) Given that most institutions may
not have any trained healthcare providers on-site, it will be some of the workers who provide
first aid to students. In the developed countries, people are learned to call specific numbers,
e.g., 911 in the USA, however the situation is different in many developing countries like
Ghana where awareness of the community is not as appropriate. Because children spend
considerable time at institutions when they are not with their families, situations requiring
First Aid often are encountered out there. During sporting activities where the risk of injury is
very high students become victims of serious injuries which could have been controlled by
administering first aid. In the school, a pupil may become ill or get injured and the situation
would require some first aid before the person is taken to the clinic or hospital. Sometimes
schools organise field trips for their students and in most cases they do not make any
adequate arrangement for the provision of first aid. Some of the pupils in the may have some
medical conditions where there is the need for special attention when they are at school.
These are few among many reasons that makes provision of first aid facilities in schools an
essential part of school planning. Schools are low risk environments, but authorities must
consider the needs of specific times, places and activities in deciding on their provision. This
research is therefore meant to investigate access to first aid facilities as a means of combating
occupational accidents and diseases in educational institutions.

1.2 Objectives of the study

The main objective of the study is to access to first aid facilities as a means of combating
occupational accidents and diseases in educational institutions.
Specific objectives were
1. To access the appropriate first aid materials in a first aid box
2. To find out the necessity of first aid in institutions
3. To determine factors that influences the selection of first aiders.
1.3 Research questions
1. What are the appropriate first aid materials in a first aid box?
2. How necessary is first aid in institutions?
3. What factors influences the selection of first aiders?

2.0 Methodology

The article review was a narrative review type. This was based on areas related to the
research topic. First aid in schools, materials and qualification of first aider was revealed
based on existing views, existing theories and ideology. Results are based on a qualitative
rather than a quantitative level.

2.1 Method of review

The issue review method was used in this studied by investigating the first aid facilities as a
means of combating occupational accidents and diseases in educational institutions in terms
First aid in schools, materials, qualification of first aider and benefits of first aid.  

2.2 How it was conducted

The steps and stages involved in the preparation of this review involves the following 

The introduction was written based on the subject background i.e. the general topic, issue,
area of concern was also given to illustrate the context i.e. the first aid in educational
institutions. The Problems were also highlighted i.e. Trends, new perspectives, gaps, contrary
ideas.

Full preparation of article was done through narrowing of the topic; defining a few research
questions like: what appropriate materials must be found in first aid box?, what are the
benefits of first aid? The search for literature sources was done using specific key words, the
topic and research questions during the search read.

A chronological outline structure was developed and headings for the sections in the text
body were made find headings for the sections in the text body.

The planning of the content of the paragraphs was made in the sections.

 The final drafting of the abstract, introduction, results sections, conclusion, and references
were made.

2.3 Keywords used in the search

1. First aid

2. First aider

3. occupational accident

2.5 Addressing the knowledge gap

The method of analysis of the information was done qualitative.

3.1 First Aid

First aid is the assistance given to any person suffering a sudden illness or injury (Kindersley,
2009) with care provided to preserve life, prevent the condition from worsening, and/or
promote recovery. It is the provision of limited care for an illness or injury, which could be
provided, usually by a lay person, to a sick or injured patient until definitive medical
treatment can be accessed, or until the illness or injury is dealt with (as not all illnesses or
injuries will require a higher level of treatment). It is also the provision of immediate care to a
victim with an injury of illness, usually effected by a lay person, and performed within a
limited skill range. First aid is normally performed until the injury or illness is satisfactorily
dealt with (such as in the case of small cuts, minor bruises, and blisters) or until the next level
of care, such as an ambulance or doctor, arrives. Many times, death results because of delay
in reaching the casualty to appropriate medical care, and/or lack of knowledge regarding
treatment. On the contrary, if help is provided to casualty as soon as possible following the
accident or injury, a life could be saved. This helps lower mortality and morbidity rates,
complications due to injury or delay in the treatment and a lesser monetary burden on the
casualty (http:/ / en. wikibooks. org/ w/ index. php? title=First_ Aid/ What_ Is_ First_ Aid?
&oldid=1322976)

3.2 First aid materials, equipment and first aid facilities

Employers must provide proper materials, equipment and facilities at all times. First aid
equipment must be clearly labelled and easily accessible. Every employer should provide at
least one fully stocked first aid container for each site. The assessment of a school's first aid
needs should include the number of first aid containers. Additional first aid containers will be
needed for split sites/levels, distant sports fields or playgrounds, and any other high risk areas
and any off site activities. All first aid containers must be marked with a white cross on a
green background. The siting of first aid boxes is a crucial element in the school's policy and
should be given careful consideration. If possible, first aid containers should be kept near to
hand washing facilities. There is no mandatory list of items for a first aid kit (Dempsey,
2003). However, the HSE recommend that where there is no special risk identified, a
minimum provision of first aid items would be:
1. A leaflet giving general advice on first aid
2. 20 individually wrapped sterile adhesive dressings
3. 2 sterile eye pads
4. 4 individually wrapped (sterile) triangular bandages
5. 6 safety pins
6. 6 medium sized individually wrapped sterile wound dressings
7. 2 large sterile individually wrapped sterile dressing
8. one pair of disposal gloves equivalent or additional items are acceptable
A school's first aid procedures should identify the person responsible for examining the
contents of first aid containers. These should be checked frequently and restocked as soon as
possible after use. There should be extra stock in the school. Items should be discarded safely
after the expiry date has passed. Before undertaking any off site activities, the head teacher
should assess what level of first aid provision is needed. The HSE recommend that , where
there is no special risk identified, a minimum stock of first aid items for travelling first aid
containers is:
1. a leaflet giving general advice on first aid
2. 6 individually wrapped sterile adhesive dressings
3. 1 large sterile unmedicated wound dressing (approx. 18 cm x 18cm)
4. 2 triangular bandages
5. 2 safety pins
6. individually wrapped moist cleaning wipes
7. one pair of disposable gloves equivalent items are acceptable, additional items may
be necessary for specialised activities
Transport regulations require that all minibuses and public service vehicles used either as an
express carriage or contract carriage have on board a first aid container with the following
items.
1. 10 antiseptic wipes (foil packaged)
2. one confirming disposable bandage (not less than 7.5 cm wide)
3. 2 triangular bandages  one packet of 24 assorted adhesive dressings
4. 3 large sterile unmedicated ambulance dressings (not less than 15 x 20 cm)
5. 2 sterile eye dressings
6. 12 assorted safety pins
7. one pair of rustless blunt ended scissors
This first aid container shall be: Maintained in good condition Suitable for the purpose of
keeping the items referred to in good condition Readily available for use Prominently marked
as a first aid container (Dempsey, 2003).

3.3 Selection of First Aiders

Unless first aid cover is part of a member of staff's contract of employment, people who agree
to become First Aiders do so on a voluntary basis. When selecting first aiders, governing
bodies and head teachers should consider the individual's:  Reliability and communication
skills  Aptitude and ability to absorb new knowledge and learn new skills  Ability to
cope with stressful and physically demanding emergency procedures  Normal duties. Will
they be able to leave immediately to go to an emergency. Certain skills are considered
essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of
first aid, which focus on critical life-saving intervention, must be rendered before treatment
of less serious injuries. ABC stands for Airway, Breathing, and Circulation. The same
mnemonic is used by all emergency health professionals. Attention must first be brought to
the airway to ensure it is clear. Obstruction (choking) is a life-threatening emergency.
Following evaluation of the airway, a first aid attendant would determine adequacy of
breathing and provide rescue breathing if necessary. Assessment of circulation is now not
usually carried out for patients who are not breathing, with first aiders now trained to go
straight to chest compressions (and thus providing artificial circulation) but pulse checks may
be done on less serious patients (http://en.wikipedia.org/wiki/First_aid#Aims). Some
organizations add a fourth step of "D" for Deadly bleeding or Defibrillation, while others
consider this as part of the Circulation step. Variations on techniques to evaluate and
maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured,
first aiders can begin additional treatments, as required. Some organizations teach the same
order of priority using the "3Bs": Breathing, Bleeding, and Bones (or "4Bs": Breathing,
Bleeding, Brain, and Bones). While the ABCs and 3Bs are taught to be performed
sequentially, certain conditions may require the consideration of two steps simultaneously.
This includes the provision of both artificial respiration and chest compressions to someone
who is not breathing and has no pulse, and the consideration of cervical spine injuries when
ensuring an open airway (http://en.wikipedia.org/wiki/First_aid#Aims).

3.3.1 Contacting first aid personnel

Do all school staff know how to contact a first aider? Are there agreed procedures in place if
an emergency occurs in an isolated area e.g. on the playing field? Governing bodies/head
teachers should consider how best to let everyone know the school's first aid arrangements.
Procedures need to be in place that are known, understood and accepted by all. Information
should be given about the location of first aid equipment, facilities and personnel. First aid
notices should be displayed which are clear and easily understood by all. The governing
body or head teacher may decide on the basis of risk assessment of their first aid needs, that a
first aider is not necessary, although this is unusual. The minimum requirement is that an
appointed person must take charge if the first aid arrangements. The school's assessment
should identify the number of appointed persons needed. Arrangements should be made to
ensure that this cover is available at all times while people are on the school premises. First
aid is as easy as ABC – airway, breathing and CPR (cardiopulmonary resuscitation). In any
situation, apply the DRSABCD Action Plan. DRSABCD stands for:

1. Danger – always check the danger to you, any bystanders and then the injured or ill
person. Make sure you do not put yourself in danger when going to the assistance of another
person.
2. Response – is the person conscious? Do they respond when you talk to them, touch
their hands or squeeze their shoulder?
3. Send for help – call triple zero (000). Don’t forget to answer the questions asked by
the operator.
4. Airway – Is the person’s airway clear? Is the person breathing?
5. If the person is responding, they are conscious and their airway is clear, assess how
you can help them with any injury.
6. If the person is not responding and they are unconscious, you need to check their
airway by opening their mouth and having a look inside. If their mouth is clear, tilt their head
gently back (by lifting their chin) and check for breathing. If the mouth is not clear, place the
person on their side, open their mouth and clear the contents, then tilt the head back and
check for breathing.
7. Breathing – check for breathing by looking for chest movements (up and down).
Listen by putting your ear near to their mouth and nose. Feel for breathing by putting your
hand on the lower part of their chest. If the person is unconscious but breathing, turn them
onto their side, carefully ensuring that you keep their head, neck and spine in alignment.
Monitor their breathing until you hand over to the ambulance officers.
8. CPR (cardiopulmonary resuscitation) – if an adult is unconscious and not breathing,
make sure they are flat on their back and then place the heel of one hand in the centre of their
chest and your other hand on top. Press down firmly and smoothly (compressing to one third
of their chest depth) 30 times. Give two breaths. To get the breath in, tilt their head back
gently by lifting their chin. Pinch their nostrils closed, place your open mouth firmly over
their open mouth and blow firmly into their mouth. Keep going with the 30 compressions and
two breaths at the speed of approximately five repeats in two minutes until you hand over to
the ambulance officers or another trained person, or until the person you are resuscitating
responds. The method for CPR for children under eight and babies is very similar and you
can learn these skills in a CPR course.

9. Defibrillator – for unconscious adults who are not breathing, apply an automated
external defibrillator (AED) if one is available. They are available in many public places,
clubs and organisations. An AED is a machine that delivers an electrical shock to cancel any
irregular heart beat (arrhythmia), in an effort get the normal heart beating to re-establish
itself. The devices are very simple to operate. Just follow the instructions and pictures on the
machine, and on the package of the pads, as well as the voice prompts. If the person responds
to defibrillation, turn them onto their side and tilt their head to maintain their airway. Some
AEDs may not be suitable for children
(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/first_aid_basics?open).

3.3.2 Qualifications and Training

A first aider must hold a valid certificate of competence, issued by an organisation whose
training and qualifications are approved by the Health & Safety Executive. Training courses
cover a range of first aid competencies, standard first aid at work training courses do not
include resuscitation procedures for children. The employer should arrange appropriate
training for first aid personnel, Training courses can be tailored to suit the needs of the
school. Personnel working with children under 7 years of age and babies should receive
specific training for this age group. First aid at work certificates are valid for three years.
Employers should arrange refresher training and re testing of competence before certificates
expire. If a certificate expires, the individual will have to undertake another full course of
training to become a first aider. However, employers can arrange for first aiders to attend
refresher training up to three months before the expiry date of their certificate. The new
certificate takes effect from the date of expiry. Schools should keep a record of first aiders
and certification details.

3.4 The necessity of First aid

The key aims of first aid can be summarized in three key points, sometimes known as 'the
three P's'(NHS Direct, 2008)

1. Preserve life: the overriding aim of all medical care, including first aid, is to save lives
and minimize the threat of death.
2. Prevent further harm: also sometimes called prevent the condition from worsening, or
danger of further injury, this covers both external factors, such as moving a patient
away from any cause of harm, and applying first aid techniques to prevent worsening
of the condition, such as applying pressure to stop a bleed becoming dangerous.
3. Promote recovery: first aid also involves trying to start the recovery process from the
illness or injury, and in some cases might involve completing a treatment, such as in
the case of applying a plaster to a small wound.

3.4.1 Preserving life

In order to stay alive, all persons need to have an open airway—a clear passage where air can
move in through the mouth or nose through the pharynx and down into the lungs, without
obstruction. Conscious people will maintain their own airway automatically, but those who
are unconscious (with a GCS of less than 8) may be unable to maintain a patent airway, as the
part of the brain which automatically controls breathing in normal situations may not be
functioning((NHS Direct, 2008). If the patient was breathing, a first aider would normally
then place them in the recovery position, with the patient leant over on their side, which also
has the effect of clearing the tongue from the pharynx. It also avoids a common cause of
death in unconscious patients, which is choking on regurgitated stomach contents. The airway
can also become blocked through a foreign object becoming lodged in the pharynx or larynx,
commonly called choking. The first aider will be taught to deal with this through a
combination of ‘back slaps’ and ‘abdominal thrusts’((NHS Direct, 2008). Once the airway
has been opened, the first aider would assess to see if the patient is breathing. If there is no
breathing, or the patient is not breathing normally, such as agonal breathing, the first aider
would undertake what is probably the most recognized first aid procedure—cardiopulmonary
resuscitation or CPR, which involves breathing for the patient, and manually massaging the
heart to promote blood flow around the body((NHS Direct, 2008). Emergency re-admission
(unplanned readmission within 28 days of leaving hospital) is a key risk for older people,
with the rate for those over the age of 75 having increased from 11.35 per cent in 2000/01 to
15.3 per cent in 2010/11 (Department of Health, 2013). Emergency re-admission may occur
for a number of reasons, including falls, malnutrition or incontinence (Brantervik et al.,
2005), complications related to medication (Foust et al., 2005) or complications associated
with depression and other mental health issues. Older people recently discharged from
hospital are also susceptible to weight loss (Alibhai et al., 2005) and to functional decline
(Hughes et al., 2008). Support at Home service users are more likely to live alone. Those
living alone are more likely to experience higher rates of mortality, to be lonely, and to have
increased blood pressure, poor self- rated physical health, and depression (Windle et al.,
2011)Social isolation is also one of the factors (alongside factors such as anxiety, depression,
and sensory and cognitive impairments) identified by Preyde and Chapman (2007) that can
prevent older people from effectively accessing services that are of potential benefit to them.

3.4.2 Promoting recovery

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone
fracture. They may be able to deal with the situation in its entirety (a small adhesive bandage
on a paper cut), or may be required to maintain the condition of something like a broken
bone, until the next stage of definitive care (usually an ambulance) arrives (NHS Direct,
2008). The period following hospital discharge can be a vulnerable time for some older
patients. One Canadian study, for example, assessed a sample of elderly patients as they were
discharged from acute care medical and surgical units and found that almost 40 per cent of
the older people were considered at risk of adverse outcomes; that 11 per cent indicated
depression; that 45 per cent indicated psychological distress; that 13 per cent showed
cognitive impairment; and that just over 62 per cent had at least one nutritional concern
(Preyde and Chapman, 2007).

3.4.3 Promotes the sense of safety

Teachers and students with good knowledge of the first aid are likely to be more alert and
active. They make sure they are not vulnerable to any accident or injuries. First aid promotes
the sense of safety. It makes them capable of managing incidents and assessing casualties.
The more they are aware of the accidents, illness and treatments, the more they become
conscious.

3.4.4 Quick treatment

First aid is the initial treatment given to a victim. Some injuries do not require professional
assistance. They can be treated with simple methods such as applying an ice pack etc. First
aiders can help the affected person feel better and relieve pain by performing simple
procedures.

3.4.5 Prevents victim’s condition from becoming worse

Although first aid is a temporary treatment, it still plays a great role in preventing the
situation from getting serious or worse. Well-trained first aiders apply the right methods to
keep the situation under control. They put every effort to help victim cope with the illness or
pain until professional help arrives.

3.4.6 Helps preserve life

People equipped with first aid skills can handle emergencies in an efficient manner. Their
quick response and right methods of treatment can help save lives. A trained person is more
composed and confident in critical situations. He/she knows the best possible ways to help
the victims regain their consciousness.

3.4.7 Makes people feel secure

People who get first aid training to learn the treatment methods are likely to feel secure. They
are aware of the fact that they can treatment themselves easily in case an accident occurs.
Moreover, they are also trusted by their friends or loved ones. Having a well-trained first
aider around help them relax and stay calm in the event of an emergency.

3.5 The basic first aid knowledge helps in treating:

 Bleeding
 Burns
 Heatstroke
 Unresponsiveness or unconsciousness
 Head injuries
 Bone injuries
 Muscle injuries
 Joint injuries
 Choking
 Fainting
 Chest pains
 Asthma
 Allergic reactions (https://www.firstaidforschools.com/first-aid-in-schools/)

4.0 Conclusion

It is beyond doubt that knowledge of first aid promotes a safer and healthier environment.
Having staff and students who are well equipped with first aid skills contribute to enhancing
the safety of the schools. Many students experience accidents while they are at schools. The
accidents might lead to simple injuries, serious wounds or fractures. However, the victim can
be given initial assistance until the doctor arrives. It is important to have trained staff and
students who can utilise their skills and take quick action to treat the affected person. They
can apply the right procedures to prevent more damage.As first aid offers a range of benefits,
therefore, it is a must for the teachers and students to get a proper first aid training so that
they can contribute to preserving lives. Without an initial medical assistance, a mild injury
might turn into a serious one. Moreover, serious injuries when not treated on time can be
fatal. To ensure the safety of all the staff members and students, it is important to have first
aid in the schools. It is vital to make everyone aware of the basic methods they should apply
after an accident occurs.

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(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/first_aid_basics?open
Accessed on 5 February, 20120)

Guidance on First Aid For Schools

(https://www.gov.uk/...data/.../guidance_on_first_aid_for_schools.pdf Accessed on 2
February, 2020)

First aid at work - wsps

(http://www.wsps.ca/WSPS/media/Site/Resources/Downloads/First_Aid_at_Work_final.pdf?
ext=.pdf Accessed on 4 February, 2020)