18

CHAPTER 2

REVIEW OF LITERATURE

2.1 GENERAL CONCEPTS

The review of literature is a broad comprehensive in depth

systematic and critical review of scholarly print materials, audiovisual material
and personal communications. The task of reviewing research literature
involves the identification selection critical analysis and written description of
existing information on a topic (Polit 2003).

Literature review is a critical summary of research on a topic of

interest, often prepared to put a research problem in context (Polit & Cheryl
Tatano Beck 2003).

Accidents are common in all ages and everywhere in the world.

Accidents are preventable by following safety measures. It can be managed by
effective first aid measures within hour and it helps to save precious human
life. Literature of accident and first aid training are discussed under the
following headings.

The Related Review of Literature has been Organized under the

Following Headings:

 Literature related to general aspects of first aid

 Literature related to wounds and hemorrhage
 Literature related to fracture, sprain and dislocation
 Literature related to epistaxis
 Literature related to epilepsy
 Literature related to knowledge and attitude regarding first aid
management
 19

2.2 STUDIES ON SELECTED ASPECTS OF FIRST AID

EMERGENCIES OF SCHOOL CHILDREN

2.2.1 Literature Related to General Aspects of First Aid

First aid is the temporary and immediate care given the person who
is injured or suddenly become ill” (Gupta, 2004). In 2005 California code of
regulation defined, first aid as “First aid is any one- time treatment and any
follow up visit for the purpose of observation of minor injuries, which do not
ordinarily require medical care” (Kirby and Mather, 2005).

The 2010 guidelines for first aid, stated by American heart

association and American red cross defined first as the assessment and
intervention that can be performed by a bystander or by the victim with
minimal or no medical tools” (Markesan et al. 2010).

American academy of paediatrics (2012) stated that first aid is

define as the initial medical care that you give to a child who is injured or
suddenly become sick. after that American heart association and American red
cross updated their definition in 2015 and stated that first aid is assisting
activities and immediate care obtained for serving illness or sudden injury with
the purpose of life’s preservation, suffering alleviation or injury deterrence and
recovery promotion (Singletary et al. 2015).

First aid is complex and specific situation, hence better trained first
aider are more eligible to deal with unexpected illness or sudden injury.
The first aid will be obtained by everybody and comprises selfcare, so that first
aider can be any person exist in that situation of emergency (Piazza, 2014).

There are three main objectives for the first aid, firstly to preserve life,
not merely victim’s life and also the first aider’s life. Second objective is to avoid
worsening of condition. The third aim of first aid is to encourage recovery, which
 20

means first aider actions should assist injured person toward improvement,
certainly after preventing situation from getting worse (Barrowclough, 2015).

Baser et al. (2012) conducted a study to assess the knowledge and

attitude on first aid among primary school teachers in Turkish. 300 primary
school teachers were selected as a sample for this study. A structured
questionnaire was prepared for assessing the knowledge of the teachers. The
researcher concluded that the primary school teachers had inadequate
knowledge regarding first aid.

Shobha Masih et al. (2014) conducted a study to assess the

effectiveness of educational program regarding first aid for minor injuries in
school children among teachers in Uttrakhand. A quasi experimental research
design adopted for this study. 50 teachers were selected by convenience
sampling method. The result concluded that 74% of the teachers had
inadequate knowledge regarding first aid. The study concludes that the
educational program was effective.

2.2.2 Literature Related to Wounds and Hemorrhage

According to WHO fractures are the most common types of child

hood accidents that affect children below 15 years of age and necessitates
hospitalization in developing countries. In addition. Fractures consist about 10
to 25% of juvenile injuries. Besides, about 9-11% of school children are injured
in sport activities during school times (Khadilkar, 2015).

Manish Kumar Balai (2017) conducted a study to assess the

Effectiveness of Planned Teaching Programmeon Knowledge Regarding First
Aid in Selected Conditions among Primary School Teachers Working in
Selected Schools, at Adarsh Nagar, Jaipur. 60 primary school teachers were
selected by non probability convenient sampling techniques. Data was
 21

collected by using structured questionnaire, in first aid on wound and injury

mean score in pretest 4.5 and in posttest. A study concludes that planned
teaching programme was effective in improving the knowledge of primary
school teachers regarding first aid. The planned teaching programme has
enhanced the knowledge of primary school teachers. Therefore, the community
health nurses must constantly focus on effort in improving the knowledge of
primary school teachers regarding first aid, through health education, mass
media and teaching programme.

Magra (2012) described that children around the world become

involved in increasingly competitive and more organized sports activities, the
frequency and severity of both acute and overuse injuries continues to rise.
Over the past year, several important studies have contributed to the knowledge
in the prevention of sports injuries in children. Safety guidelines and protective
equipment are crucial to minimizing pediatric recreational injuries. Protective
headgear, mouth guards, and wrist guards have all been shown to be effective
in preventing injuries.

Jarvien et al. (2012) conducted a study related to muscle injuries and

optimizing recovery. He has suggested the treatment principle of muscle
injuries follows the PRICE (Protect, Rest, Ice, Compression and Elevation).
The rehabilitation programme should be build around trunk stabilization
exercises, stretching and strengthening of injured muscle.

Leilabasire Lachehashery (2013) conducted a study to assess the

knowledge regarding first aid training among schools of Ahvazing, Canada.. The
269 teachers in the schools were selected and asked to fill out the self-report
questionnaires for data collection. The results showed that 15.2 % of primary
school teachers all of them knew the importance of emergency management and
36.4% would look for a fracture for treatment of the cases. The result concluded
that the teachers had inadequate knowledge regarding first aid training.
 22

Pehinka (2014) conducted a study on bystanders regarding practice

on trauma care. It was assessed by five separate measures of trauma care
including scene safety, extrication of the patient, positioning, and control of
hemorrhage and prevention of hypothermia. Correct extrication, control of
hemorrhage and positioning were improved by wide spread first aid training. It
concluded that training will increase the frequency and quality of bystander’s
practice on trauma care.

James (2004) described that the healing of superficial wounds is a

process that normally follows an uneventful course in which the surface of the
wound is re-epithelialized, the epidermis regenerates, and epidermal-dermal
interactions are re-established. At times colonization by pathogenic bacteria,
particularly Staphylococcus aureus and Streptococcus pyogenes, results in
proliferation of organisms followed by a host reaction consisting of an influx of
polymorph nuclear leukocytes that interferes with the healing process. This
host inflammatory response is essential for prevention of deeper tissue
invasion; the inflammation generated interferes with the wound healing
process. Little information exists on the prevalence of colonization and
infection of superficial wounds in various socioeconomic populations except
for studies on infections with Group A streptococci.

Al-Samghan et al. (2015) conducted a cross sectional study to assess

the knowledge first aid among primary school teachers in Abha city, Saudi. 187
teachers were selected for this study. The research concluded that the teachers
had inadequate knowledge about first aid. So that the researcher recommended
that introduce the first aid in the curriculum of school and college.

Abdulrahman Abdullah (2019) conducted a cross-sectional study to

assess the Knowledge and practices of primary school teachers about first aid
management of minor injuries among children in the Qassim region, Saudi
Arabia. A total of 315 subjects participated in the study. The study result
 23

showed that 35% of participants did know what to do after a pupil faints, while
47.7% of the teachers did know what to do in the event bleeding. The study
concluded that Knowledge and practice of school teachers was inadequate on
minor injuries.

2.2.3 Literature Related to Fracture, Sprain and Dislocation

Feldman et al. (2014) conducted a prospective study on school

injuries, incidence, types related factors and initial management. They found
that annual incidence rate of 5.4injury event / 100 children, which appears to be
underestimate of the actual rate of all the injury events 28.7% resulted in
serious injuries. Injuries were significantly more frequent in the elementary as
well of first aid training among school personnel is inadequate. Opposed to the
secondary schools, and boys were injured significantly more often than the
girls. Most of the children with either serious or minor injuries were sent to the
school office or returned to the classroom.

Oscar Martinez (2019) conducted a study to analyze the

epidemiology of sport injuries that occurred during activities performed under
teacher supervision (Physical Education, break and extracurricular activities),
at high school. A questionnaire regarding sport injuries were administered to
1050 students. Out of the 848 sport injuries registered, 319 (172 in boys and
147 in girls) took place during activities performed under teacher supervision.
There was a higher incidence of injury at age 13 and a lower likelihood of
injuries occurring in boys. Sprains and contusions were the type of injury most
frequently observed, especially in areas such as ankles and knees.

Rubin (2015) conducted a study to examine the injury profiles of

UEFs in all mechanisms of injury related to RTAs in the pediatric population.
Motorcycle (18%) and bicycle riders (18%) had a greater risk for UEF
(P <.0001). Of 3666 patients with UEFs, 2047 (56%) had other injuries.
 24

The pedestrians (82%) and the motorcycle riders (78%) had a greater risk for
associated injuries .Most of the injuries were head/face/neck (70%), lower
extremities (36%), and chest (28%) injuries .Twenty-two percent of all cases
had multiple UEFs. The bicycle riders (28%) had a greater risk for multiple
UEFs (P <.0001). Of 3666 patients with UEFs, we found 4612 UEFs. most of
the fractures in the radius (27%), hummers (25%), ulna (18%) and clavicle
(17%). The study concluded that his study contributes the largest database on
reported pediatric UEFs related to all mechanisms of injury in RTAs and finds
the comparative epidemiology of associated injuries, multiple UEFs, and
frequency of UEFs.

Charueapen (2015) conducted a study to assess the prevalence of

sports injuries in adolescent athletes. Athletes in age group of 11-19 years who
play competitive sports were recruited from the stadium and athletic training
centers over a period of one year. 300 students were observed prospectively to
detect the occurrence of injuries, injury rate both previous and new. a
structured questionnaire was developed and given to the athletes to note
injuries and causes for it. 149 (32.3%) athletes had both previous and recent
injuries, 88 (19.1%) had only previous injury and 63 had only recent injury.
boys injured at a more frequency than girls. the study concluded that
prevalence of sports injuries was 65% in this study. injury risk factors found in
this study were male gender, age, psychological and stress related issues,
previous injuries.

Seham A Abd El Hay (2015) conducted a study to assess the Effect

of Training Program Regarding First Aid and Basic Life Support on the
Management of Educational Risk injuries among Students in Industrial
Secondary Schools, at Tanta City. 60 students were selected by a convenient
sample technique. Two tools used for data collection, like an interview
questionnaire to assess student's knowledge regarding first aid and basic life
 25

support and observational check list sheet related to first aid and basic life
support performance. The study result concluded that all students have poor
mean score of knowledge and practice regarding first aid and basic life support.
Post program more than 50% of students had good mean score of knowledge
and 86.7% of them had good mean score of practice.

Wafix (2013) conducted a quasi-experimental study to assess the

effectiveness of a first-aid intervention program applied by undergraduate
nursing students to preparatory school children. 100 school children in
governmental preparatory schools were selected by conveience sampling
techniques. The results showed generally low levels of satisfactory knowledge
and inadequate situational practice among the school students before the
intervention. Statistically-significant improvements were shown at the post-
and follow-up tests.

Rohitash Kumar (2015) conducted a study was to assess the

knowledge of primary school teachers regarding first aid management of minor
accidents among children (5-10 Years) at selected primary schools of Ambala
district Haryana. Descriptive research design was used for the study 40 samples
primary school teachers were chosen from different primary schools.
The results show that most of the primary school teachers (52.5%) had
moderate knowledge score (16- 21), followed by 37.5 % teachers who had
excellent knowledge score (21 -27), 10% of school teachers had poor
knowledge. The study showed that structured teaching program is necessary to
improve knowledge regarding first aid.

Abernethy et al. (2014) conducted a study on immediate care of

school sport injury at UK. The study revealed that school sport is a major cause
of injury in the post primary age group. Random samples of 450 schools
students in Northern Ireland and republic of Ireland was studied using postal
questionnaires. Replies were received from 333 (74%) schools. There was no
 26

physical education teacher with upto date first aid training in 37% schools.
Immediate care in terms of mechanisms and equipment to deal with injury was
present in 35% -81% of school responding. Correct response ranges from 65%
to 90% to four Scenarios, commonly presenting yet potentially serious
management problems. This Study demonstrated that deficiency in sport injury
care. They also highlighted that Current training in first aid and a need for basic
life support training.

2.2.4 Literature Related to Epistaxis

Khalid A Alshehr (2019) conducted a study on awareness of first-

aid management of epistaxis among school students in jeddah, saudi Arabia.
706 students and teachers were selected for the study. Data were obtained using
a paper-based-questionnaire, which was distributed to participants. The level of
knowledge and awareness regarding the first-aid management of epistaxis
among school students and teachers was shown to be satisfactory. However,
more integrated educational materials should be made available to the general
population as well as school students and staff to improve their overall
knowledge.

Sara Alsaad (2019) conducted a study to awareness about first aid

management of epistaxis among medical students in kingdom of Saudi Arabia.
Data were collected from 300 medical students. 75.7% were female and 24.3%
were males. 64% of the respondents think that epistaxis is an emergency
condition that requires early intervention. 71% of the respondents demonstrated
the correct position as first aid measure of epistaxis and only 41.3% of
respondents demonstrated the correct site for pinching the nose.

Ashamed Salim (2018) conducted a study to assess the knowledge

of the first aid management of epistaxis and misconceptions among the general
population in Saudi. A survey questionnaire was developed and was distributed
 27

through text message, E-mail, social networks, various websites Responses

were collected over a period of 2 months There were 1760 individuals who
responded to the survey, 577 (32.8%) were males. There were 828 respondents
(47%) who received information on the first aid management of epistaxis, the
most common source of information was through a relative or a friend (15.7%).
Only 199 respondents (11.3%) will apply pressure to control epistaxis,
99 (5.6%) knows where to correctly press, and 84 (4.78%) will correctly tilt the
head forward. There were 1111 respondents (63.2%) who have poor knowledge
of first aid management of epistaxis. Conclusion: There is poor knowledge of
the first aid management of epistaxis in the surveyed population. Increased
awareness and information dissemination programs on the first-aid
management of epistaxis can improve knowledge and recall among the general
population.

Fatima Al-Shehri et al. (2018) conducted a cross sectional study to

assess the emergency management of epistaxis among the teachers in Saudi
arabhia. 377 teachers were included in this study. A well-structured online
questionnaire was designed in Arabic. The result concluded that the teachers had
low level of awareness about the management of first aid for epistaxis.
Only 25% knew that pressing the lower cartilaginous part of nose can stop the
bleeding and 26% said they do not know.

Tanner & Harney (2015) conducted a cross sectional study and

Quasi experimental design to assess current knowledge of school teachers
regarding epistaxis and its first aid management. The study population included
those presenting to otolaryngology outpatients with epistaxis. 20 patients
participated in this study over a 7 month period. 25% patients did not use
compression. During an episode of epistaxis. 60% of patients that used the
compression Technique failed to compress the lower one-third of the nose.
10% of patients identified their GP researchers as having taught them first aid
 28

for epitasis. Knowledge of epistaxis management is poor. Education regarding

the basic principles of first aid for epistaxis may reduce morbidity and
unnecessary consultations from health professionals.

Moulton (2009) conducted a study regarding the management for

epistaxis can be controlled by applying direct pressure over little’s area.
This ability was assessed in 115 members of the staff in accident and
emergency department. In his study out of 100 cases, 62 cases (70.45%)
responded to nonsurgical methods, anterior nasal packing being the most
common nonsurgical technique 38 cases (43.18%). Among the 26 cases
(29.55%) requiring surgical methods for control of epistaxis, 14cases (15.91%)
responded to cryotherapy. None of the case in this study required arterial
ligation.

McGarry (2011) conducted a prospective study on first aid

management of epistaxis among the primary school teachers in UK. Most nose
bleeds can be controlled by compressing the ala nasi, thus applying direct
pressure over the Little’s area. The aim of the study was to demonstrate the
correct position for this manoeuvre. The sample consisted of 115 teachers of
different primary schools. The results showed that the correct response rate was
33% and even trained teachers achieved less than 50% success rate.
So increased awareness of this sample and effective techniques of first aid
management of epistaxis is recommended

2.2.5 Literature Related to Epilepsy

Eman Al-Hashemi (2016) conducted a cross-sectional study to assess

the Knowledge about Epilepsy and Attitudes toward Students with Epilepsy
among Middle and High School Teachers in Kuwait. 824 school teachers were
selected for this study. Self-administered questionnaire was distributed to
collect the data. Both knowledge and attitude median scores were significantly
 29

higher in senior teachers with longer teaching experience and in respondents

who dealt with a person with epilepsy. There was significant association
between knowledge score and attitude score. School teachers in Kuwait have
relatively poor knowledge about epilepsy, but have positive attitudes toward
students with epilepsy. The researcher recommended to provide an
information about handling seizures in the educational setting through
development and implementation of epilepsy education programs.

Kolahi M. Ghorbanpur‐Valukolaeiet.al (2018) conducted a cross

sectional study on Knowledge, attitudes, and first‐aid measures about epilepsy
among primary school teachers in northern Iran. 342 primary school teachers
were selected by simple random sampling technique. Data were collected
through interviews using a structured questionnaire. The Likert scale was used
for the attitudes section. The level of first‐aid measures score of 8 (7.2)
teachers was very high, 79 (70.5) high, 25 (22.3) low. The research concluded
that the knowledge of teachers about epilepsy was insufficient, attitudes toward
people with epilepsy were generally positive, and first‐aid measures at the last
witnessed seizure were fairly helpful.

Zewdushewangizaw (2015) conducted a community based study to

assess the knowledge, attitude, and practice related to epilepsy from traditional
doctors and religious leadership in Ethiopia. 660 respondents were selected for
the study. The results of this study stated that 59.8% of the respondents
possessed knowledge about epilepsy, 35.6% had a favorable attitude, and
33.5% of them adopted safe practices related to epilepsy.

Goel et al. (2013) conducted a study to Knowledge, Attitude and

Practices (KAP) of students regarding first-aid management of epilepsy
seizures in government schools of Chandigarh. Total of 177 students were
taken as a sample. 71% of the students had either heard or read about epilepsy.
 30

Half of the students believed epilepsy as a hindrance to education. The research

concluded that the knowledge about various aspects of epilepsy was average
among school students in Chandigarh. However, there was no significant
difference in knowledge, attitude and practice between students who lived in
urban, urban slum and rural areas. It is recommended that first-aid management
of seizures in epilepsy should be a part of school curriculum.

Singh (2013) conducted a study to evaluate the impact of

comprehensive epilepsy education programme for school teachers in
Chandigarh city. A total of 85 teachers participated in the study. Data were
collected by using the semi-structured questionnaire on the first-aid
management of epileptic seizures. 90% of the teachers had previously either
heard or read about epilepsy. 50% of the teachers said that books and
magazines were the most common source of their information, followed by the
internet. The research concluded that the epilepsy intervention educational
package provided a positive, short term, impact on the knowledge and skills of
teachers about epilepsy

Ebuehi et al. (2015) conducted a study to evaluate health education

on the knowledge, attitudes, and first aid management of epilepsy on trainee
teachers in Nigeria. 226 trainee teachers were selected by random
method. Self-administered questionnaires were administered to collect the
data. Largest proportion (44.2%) of respondents had negative attitudes and
poor knowledge of epilepsy. The proportion of respondents with poor
knowledge and negative attitudes dropped by 15.5% (p<0.0001) and 16.4%
(p<0.0001) respectively. Epilepsy health education could increase trainee
teachers' knowledge and attitudes towards epilepsy and facilitate correct first
aid management. This emphasizes the potential benefit of incorporating an
epilepsy tailored intervention programme into teachers' training curricula.
 31

Shah (2009) conducted a study to evaluate the prevalence of

epilepsy in school going children (6-18 years) in Kashmir valley of North West
India, 2009. Epilepsy is a common neurological disorder which predominantly
affects pediatric and young adolescent population. 49 cases of epilepsy were
detected after screening 15218 school going children. It included 55.1%
(prevalence of 3.74/1000) males and 44.9% (prevalence of 3.13/1000) females.
Rural –urban specification revealed a prevalence of 3.49/1000 and 2.96/1000
respectively. Age specific prevalence was found to be 3.82/1000 (6-10 years),
3.44/1000 (11-14 years) and 2.33/1000 (15-18 years). Highest prevalence of
epilepsy was found in upper lower class (prevalence of 3.89/1000) and lowest
in lower middle class (prevalence of 2.78 per 1000).

Akpan (2013) conducted a study to assess the teachers' knowledge

and attitudes towards seizure disorder: a comparative study of urban and rural
school teachers in Akwa Ibom State, Nigeria. A self-administered questionnaire
on knowledge and attitudes to seizure disorder were prepared to collect the
data. Majority of the respondents from both urban and rural schools (68.2%
and 63.6% respectively) believed that the foam from the mouth of a convulsing
child with seizure disorder is the infecting agent. School teachers in both urban
and rural schools exhibited poor knowledge and negative attitudes towards
children with seizure disorder. Massive health education on seizure disorder is
therefore advocated for teachers in both urban and rural schools.

2.2.6 Literature Related to Knowledge Expressed and Expressed

Attitude Regarding First Aid Management

Sofiya Mohan (2017) conducted a study to assess the effectiveness

of video assisted teaching on first aid for minor injuries among NCC Students
in a selected school, Secunderabad. 50 NCC Students were selected by using
simple random sampling. By using structured knowledge questionnaire the
datas were collected. He difference between pre-test and post-test level of
 32

knowledge was found through paired ‘t’ test. It revealed that calculated value
15.76 was higher than tabulated ‘t’ value 2.02. It shows that video assisted
teaching was found to be effective at 0.05 levels as there was significant
increase in the level of knowledge on post-test.

Margadham (2014) conducted a study to evaluate the knowledge of

high school students and teachers on the principles of First Aid. The objective
of the study was to evaluate the level of knowledge about First Aid among
secondary school students and teachers. The sample consists of 227 secondary
school students (34 males and 193 females) and 79 secondary school teachers
(28 males and 51 females). The result showed that 7 of students achieved an
excellent result, 57 a good result and 163 represented inadequate level of
knowledge. None of teachers achieved an excellent result, 11 achieved a good
result and 63 represented inadequate level of knowledge. At the time of
accidents, disasters, mass casualties etc. volunteer groups like National Cadet
Corps has significant role in rescue services.

Nawaf Rn Amro (2017) conducted a study to assess the General

Knowledge & Attitude of First Aid among Schoolteacher's in Palestine.
150 school teachers were selected by simple random sampling techniques. The
total mean score of knowledge on general first aid is 71.41%. The study
concluded that the school teachers' knowledge of first aid concerning
external bleeding and fractures and trauma, dealing with epilepsy, diabetes
and burn is high and the knowledge of CPR is medium. Hence the study was
concluded that the school teacher need more training in First Aid.

Sumatra (2017) conducted a study to assess the effectiveness of

programmed teaching on levels of knowledge and expressed practices
regarding first aid management among primary school teachers at selected
schools, Vellore. 30 primary school teachers were selected by convenient
sampling technique. Analysis of knowledge about first aid management in
 33

select condition found that 21% (32/152) had poor knowledge regarding first
aid management for bleeding and 20.4% (31/152) for epistaxis and foreign
body in eyes. The level of knowledge and practices about first aid was good
among majority of the primary school teachers. The study also identified the
key areas in which first aid knowledge was improved.

Mohammed Saad et al. (2011) conducted a study to evaluate the

effect of educational program on first aid for teachers of primary schools at
Ismailia city. A quasi experimental design was used in this study. Systematic
random sample was used in this study. Interviewing questionnaire was used to
assess the knowledge of primary school teachers regarding first aid. After
pretest the educational programme was delivered. The knowledge and practice
of primary school teachers about first aid were improved post and follow up
implementation of the program compared to pre implementation of the
program.

Aparajita Dasgupta1 et al. (2014) conducted a study on effectiveness

of health education in terms of knowledge acquisition on first-aid measures
among school students of a rural area of west Bengal. 105 students were
selected as a samples. A self-administered questionnaire was administered to
assess their baseline knowledge about selected first-aid skills, followed by on-
the-spot demonstration of the skills. Post intervention evaluation of their
knowledge acquisition was done after 2 weeks with same questionnaire. The
result shows that the baseline knowledge of the study subjects was found to be
inadequate, correct responses being provided by less than 50% of the subjects
for most of the questions. The lowest percentage of correct response was
obtained regarding the management of choking (8.6%).

Nitin Joseph (2015) conducted a cross-sectional to assess the

awareness, attitudes and practices of first aid among school teachers in
Mangalore. Sample size for this study was 146 teachers. The majority of school
 34

teachers in this study had moderate knowledge about first aid management.
The willingness to undergo training and readiness to train others and administer
first aid services in real-life situations, as reported by a majority of participants,
indicated positive attitudes to first aid provision

Xing ming Jin, (2012) conducted a cross-sectional study was carried

out among the primary school teachers. A stratified random sampling method
was used to identify the samples. Data were obtained using a multiple-choice
questionnaire. The results showed that 1067 subjects completed the
questionnaire. None of the surveyed teachers answered all questions correctly;
only 39 individuals (3.7%) achieved passing scores. the relative number of
correct answers to specific questions ranged from 16.5% to 90.2%. in
particular, subjects lacked knowledge regarding first aid for bleeding (only
16.5% answered correctly), chemical injuries to the eye (23%), inhaled poison
(27.6%), and choking and coughing (30.1%). The study concluded that the
level of first-aid knowledge among preschool teachers in Shanghai was low.
There is an urgent need to educate school teachers regarding first aid practices.

2.3 CONCEPTUAL FRAMEWORK

A concept is thought, idea or mental image framed in the mind in

response to learning something new.

The present study aims at preparing, administering and evaluating a

structured teaching programme (STP) for B.Ed. students regarding selected
types of first aid emergencies and management. The framework of the study is
based on the General System Theory developed by Von Bertalanffy in 1968.
A system is a set of interrelated elements which are considered to be human
beings and their environments. As a living system and energy field, the
individual is capable of taking energy and information from the environment
and releasing them to the environment. Because of this exchange, the
 35

individual is an open system. System model consists of three phases input,

process and output.

Input

It is the process by which the system receives energy and

information from the environment. Here it refers to B.Ed. students with their
characteristics and level of knowledge and attitude. In this study the
influencing factors recognized as input are demographic factors.

Process

Process is the use of input ie, Energy and information for the
maintenance of homeostasis of the system. It refers to the different operational
procedures in the overall programme implementation and includes factors that
facilitate or block implementation at various stages of structured teaching
programme. The present study process includes two phases. The first phase
was determining existing knowledge on selected type of first aid emergencies
and its management which serve as a guideline for the development of
structured teaching programme. The second phase consists of preparation and
administration of structured teaching programme to improve the knowledge
regarding the first aid emergencies and its management.

Output

After processing the input, the system returns the input (energy and
information) to the environment. Change is a feature of the process that is
observable and measurable as output, which should be different from that
which is entered into the system. In this study, output consists of evaluation of
target group for change in knowledge and attitude regarding selected types of
first aid emergencies and its management after administering structured
teaching programme.
 36

Feedback

The feedback is the process whereby the output of the system is

redirected as part of the input of the same system. If there is no improvement in
the knowledge, it is reassessed and redirected and process is continued. Thus it
is a continuous process which takes place. But feedback was not included in
this study.
 37

INPUT PROCESS OUTPUT

Adequate
gain in
DEMOGRAPHIC PHASE - I
knowledge
VARIABLES Assessment of and attitude
knowledge and of first aid
Age of B.Ed. students,
attitude of B.Ed.
sex, religion, Evaluation of
students regarding
qualification, years of effectiveness of
selected aspects of first
experience, source of Structured Teaching
aid management
information and Programme
presence of first aid PHASE - II Inadequate
box Preparation and gain
administration of knowledge
Structured Teaching and attitude
Programme of first aid

FEED
BACK

Figure 2.1. Modified Conceptual Framework Based on Modified Von Bertalanffy’s General System Theory (1968)