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Original Research (Original Article) 


Ali E. Mansour et al, 2019;3(11):941–946.

International Journal of Medicine in Developing Countries

Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia

Ali E. Mansour1,2, Ahmad Hamad Alsager1, Abdulrahman Abdullah Alasqah1*, Abdulaziz Abdullah Alsuhaibani1, Abdullah Ibrahim Aldughaim1, Abdulaziz Abdullah Alayed1, Abdulmalik Abdullah Aljlali1, Hassan Abdullah Almogbel3, Ibrahim Musaad Aljuraifani1, Abdullah Saleh Altamimi1

Correspondence to: Abdulrahman Abdullah Alasqah

*Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia.

Email: al3mer95 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 04 September 2019 | Accepted: 10 September 2019


ABSTRACT

Background:

While teachers have an abundant responsibility for teaching and guiding children in their academic and overall growth, previous studies have found out that the prevalence of first aid training among teachers is still low. Even though teachers act as the first line of defense in any health emergency. The present study aims at investigating the prevalence of knowledge among teachers on how to handle first aid procedures for basic and usual accidents and chronic diseases such as diabetes and epilepsy.


Methodology:

Quantitative observational cross-sectional study was carried out targeting the primary schools at Unaizah city, Qassim region, Saudi Arabia. The sample included exclusively teachers enrolled in a systematic approach. A total of 315 subjects participated in the study.


Results:

Majority of the research participants were aged between 26 years and 50 years, 291 (93.9%), with only 2.6% being aged 50 years or more. Most of the participants had bachelor degree as the highest education level 239 (77.3%), while there was only one participant with a Ph.D. While 44.2% of the teachers knew first aid education, 22.3% of the participants could confidently carry out first aid procedures. Three-quarters of the 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.


Conclusion:

Knowledge and education of what to do in an emergency that requires first aid appears to be not a problem in the primary schools surrounding Unaizah city, Qassim region, Saudi Arabia. However, the present study still warrants practical training for the teachers on first aid procedures.


Keywords:

KAP, first aid, Saudi Arabia, Unaizah.


Introduction

Being in primary school, pupils are arguably at their most vulnerable at school given that they may need healthcare help but due to their tender age, they may not know how to ask for it or appropriately take care of each other in the event of a medical emergency. The primary support for pupils in primary school upon unusual situations in school that may not necessarily involve medical attention is the teachers who are the adults in a school setting. Teachers act as counselors and direct the activities of the pupils and as such, they are seen as a role model by pupils and or rather the first people to be contacted by the pupils [1]. Unfortunately, interventions such as technological communication in a school setting may not be legal. This is in addition to communication in a school setting being mainly top– down where pupils receive instructions and direction from teachers and not vice-versa. From a medical emergency standpoint, the first line of intervention involves the first aid which acts as the primary medical assistance. While older pupils would be likely to help younger pupils in such cases, the primary authority and source of courage in such situations are the teachers [2]. Additionally, because of the National First-aid Science Advisory Board's assertion that anyone can and should have some basic form of first-aid knowledge, but the recent study states only about 6% of teachers in the United States to have first aid skills [3]. This is despite the fact that in some instances first aid can mean the difference between life and death, especially in blocked air-passage which is common in children aged between 0 and 10 years [3]. The research shows that while other diseases are a cause of death for children, lives of individuals aged between 7 and 14 years is likely to be brought to a stop due to trauma or accidents [4]. A good proportion of the trauma and accidents can be taken care of by proper first aid preventing further complications and the most dreaded cause of death [5]. Children, especially at younger ages, are at increased risk of physical trauma due to their inability to defend themselves table 1.

First-aid procedures range from simple steps, such as applying wrapping bandages to an open wound to the rather more complicated procedures, such as performing cardiopulmonary resuscitation (CPR). For the latter, training is required given the risk of introducing further damage to the patient if wrongfully taken [6]. The majority of the teachers and personnel within a school community are not conversant with performing the rather complex first-aid procedures [7]. Yet, again, while first aids may not always provide a cure, they go a long way in preventing further complication before actual medical assistance is gotten. Cardiac arrest could be prevented through CPR procedure and increase chances of survival by an approximate of 2–3 times [8]. Such knowledge could be found in training for basic life support first aid, which could be trained upon even children aged 9 years and above [9]. An important aspect of first aid is particular attention required for individuals with special types of medical conditions, such as diabetes, epileptic condition, and asthma attacks among other conditions. For patients with epilepsy attacks, one of the major hurdles in getting adults or individuals with good knowledge for first aid is getting rid of the negative attitude toward people with epilepsy [10]. In a study by Eze et al. [10], where a random sample of 226 trainee teachers was considered, 61.9% of the participants had poor knowledge and negative attitudes toward people with epilepsy [11]. Such attitudes not only hinder first aid procedure by teachers to students but have also been observed to affect academic performance, social skills, and general growth and development of the affected students [12]. On the other hand, a study conducted in Liverpool Britain to establish knowledge of teachers on diabetics and how to handle diabetic students, it was found then only 24% of the teachers had knowledge of diabetes and how to handle patients suffering from diabetes [12]. Given the huge responsibility of teachers in taking care and being overall role models for their students, it seems it becomes a responsibility of teachers and school management to have basic knowledge in first aid and lifesaving skills. Previous study data already suggests that the knowledge gap for first aid is highly needed in the teaching and education fraternity. The present study paper aims at investigating and establishing the knowledge and attitudes of teachers in Unaizah City in the Kingdom of Saudi Arabia.

Table 1. Demographic information.

Variable N %
Age
<25 11 3.5
26–50 291 93.9
50> 8 2.6
Qualifications
Diploma 60 19.4
Bachelor 239 77.3
Master 9 2.9
Ph. D 1 0.3
Heard about First Aids
Yes 309 99.0
No 3 1.0
Years of teaching
<10 137 44.2
10–20 105 33.9
20–30 62 20.0
30–40 6 1.9
First-Aid source of information
Books 38 12.1
Doctors 28 8.9
Nurses 30 9.6
Social Media 162 51.6
Other 56 17.8
Attendance of FATraining
Yes 138 44.2
No 174 55.8
Need for FA education
Yes 305 97.1
No 9 2.9
FA confidence
Confident 70 22.3
Not sure 173 55.1
Not confident 71 22.6
Need for training for FA
Yes 273 86.7
No 39 12.4

Subjects and Methods

A quantitative observational cross-sectional study was carried out in the Qassim region, Saudi Arabia targeting primary schools at Unaizah city, Qassim region. The sample exclusively consisted of primary school teachers as study subjects who were sampled using a systematic sampling technique. Data were collected using pretested, semi-structured questionnaire, developed, and interrogated by experts. The main items in the questionnaire included demographic information, knowledge, and attitudes toward first aid. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24 after being stored in excel sheets.


Results

Majority of the research participants were aged between 26 and 50 years 291 (93.9%), with only 2.6% being aged 50 years or more. Most of the participants had a bachelor degree as the highest education level 239 (77.3%), while there was only one participant with a Ph.D. Among the total, 99% of the participants had heard about first aid, while 105 (33.9%) of the participants had between 10 and 20 years of teaching. Furthermore, 44.2% of the participants had less than 10 years’ experience in teaching, while 62 (20.0%) had between 20 years and 30-years of experience in teaching. Practical experiences in first aid were found very rare where more than half (51.6%) of the participants reported their source of information as social media websites and applications. Participants who reported their source of information for first aid as doctors, nurses or books were represented by respective proportions 8.9%, 9.6%, and 12.1%, respectively. The bigger proportion of (55.8%) teachers reported that they had no training in first aid, while the rest reported that they had attended some form of first aid training. However, 97.1% of the teachers agree that there is a need for first aid education. When asked how confident they are in administering first aid procedure, only 22.3% reported they are confident, 55.1% reported that they are not sure while the rest said they were not at all confident table 2.

Table 2. Care for common accidents.

Questions N %
The pupil who just fainted in a match should return
Immediately After Regaining consciousness 12 3.9
If there are no signs of head injury 29 9.4
After examination and go-ahead by a doctor 237 76.7
If the student feels like continuing 31 9.8
FA to a sprained ankle should not include
Ice 74 24.6
Knocking the ankle by hand 95 31.6
Compress 62 20.6
Elevate 70 23.3
First Step in taking care of bleeding wounds
Use a clean cloth or sterile gauze to gently press until bleeding stops 148 47.7
Apply firm pressure directly to the bleeding site 53 17.1
Apply more bandages to enhance old ones already soaked in blood 45 14.5
Rise the wound above heart level 64 20.6
The first action is taken when approaching injured or unconscious student
Carried off the pitch 25 8.1
Check for awareness 39 12.7
Check for breath 141 45.9
Check for pulse 102 33.2

Common accidents and FA procedures

Despite the low number of teachers with actual training on first aid, 237 of them (76.7%) thought that a pupil who just fainted in a match should return to the match only after being cleared by a qualified doctor. Almost half (47.7%) of the participants think that the first step in taking care of bleeding wounds is by use of clean cloth or sterile gauze to gently press until bleeding stops, while the non-effective method of raising the wound above the heart was backed by 20.6% of the teachers. 141 (45.9%) of the participants think that the first step action is taken when approaching injured or unconscious student is to check for breath, as opposed to check for awareness (12.7%) and check for pulse 33.2%.

Care for diabetics

On whether insulin increases blood sugar, 75 (42.2%) of the participants thought that indeed insulin increases blood sugar while those who were right (107) 58.8% thought it does not increase blood sugar levels. Among the total, 85.7% of the teachers knew that insulin is administered through injections, while the rest knew otherwise. Knowledge for the care of diabetics is in terms of complaints of thirst, stomach pains, and vomiting from diabetics was also posed to the participants. On this question, 72.3% responded that it is likely that blood sugar levels are high for diabetics, as opposed to 27.7% who answered no. Furthermore, 42.9% thought that these symptoms can easily be treated at schools, with 57.1% who thought the symptoms might need more than school treatment. Among the study subjects, 92.9% of the teachers responded by agreeing that diabetics must have a snack in the middle of the morning, as compared to only 7.1% who felt otherwise table 3.

Care for epileptics

Among the study subjects, 79.8% of them responded that epilepsy is not a spiritual problem, as just less than half of respondents thought that epilepsy is a genetic problem (153) 49.5%. About three quarters (73.9%) of the respondents responded that epilepsy could lead to mental retardation, as 87.1% of the respondents were of the opinion that epilepsy does not require medical treatment. Furthermore, 194 (61.6%) of the teachers agreed that emotional issues on an epileptic cause may trigger epileptic seizures, as 94.4% agreed that epileptic seizures do not require rushing the patient to the hospital table 4.

Table 3. Care for diabetics

N %
Diabetics who do not take their medication have a low blood sugar level
Yes 120 38.8
No 189 61.2
Insulin causes high Blood sugar
Yes 75 42.2%
No 107 58.8%
Insulin is given by injection
Yes 270 85.7
No 36 11.4
Complaints of
Thirst
Vomiting
Stomach pain
Is likely that blood sugar levels are high
Yes 222 72.3
No 85 27.7
The above situation can be treated at school
Yes 132 42.9
No 176 57.1
It is necessary for a diabetic to have a balanced diet
Yes 289 93.2
No 21 6.7
It is necessary for a diabetic to have a snack in the middle of the morning
Yes 288 92.9
No 22 7.1

Discussion

The National First-aid Science Advisory Board described knowledge about fist aid for American Teachers in 2002 to be about 6%. For the present study, knowledge of first aid education stood at 44.2% despite the fact that only about 22.3% of sampled teachers were confident in carrying out first aid. The present study percentage is quite low given that most teachers (33.9%) had more than 10 years of experience in teaching yet 97.1% of the teacher's claims that there is a need for first aid education. Common accidents in schools received were well responded to by participants. For instance, more than three-quarters of the study participants would only allow a pupil who just fainted from a sports action after approval by a qualified medical doctor as compared to responses such as student shows no signs of head injury (9.4%), or immediately after regaining consciousness (3.9%). However, the subject of first aid on sprained ankle-which did top the list of playground injuries-received scattered responses such as 24.6% said ice should be applied, 31.6% responding that the injured ankle should be knocked by hand, while 20.6% responding that the injured ankle should be compressed. This suggests the lack of first aid training for teachers in usual injuries. Most teachers (54%) did not know the correct measure to do when a pupil faint. This suggests the potential importance of faulty first aid procedure in trying to administer CPR as mentioned by Uray et al. [6]. Knowledge about the critical importance of insulin for diabetics is still limited even among teachers who were very likely to encounter students who are diabetic. The primary role of insulin is to regulate blood sugar levels by lowering it if it is too high or increasing its triggering mechanisms for lowering it when the levels are too low. Among the study, subjects, 11.4% of the teachers were not aware that insulin is taken through injections, while 42.2% of the participants thought that insulin lowers blood sugar level. However, a decent proportion (72.3%) of the teachers was quite aware of what to do when the diabetics begin to show symptoms such as thirst, vomiting, or stomach pains which are signs of increased blood sugar levels. This is also the case for an overwhelming majority of teachers (92.9%) with the knowledge that diabetics ought to have at least a snack in the middle of the morning. While the majority of teachers believe that epilepsy is not a spiritual condition, still 20.2% of the participants were of opinion that the disorder is due to spiritual conditions indicating negative attitude and ignorance about the condition [9]. This is underscored by the fact that half of the teachers (50.5%) were not aware that the disorder is genetically linked. However, that epileptic seizures do not require rushing to the hospital is a well-known fact as signified by 94.4% of teachers who knew about this. The study was a cross-sectional descriptive study that utilized a systematic model of sampling. While the sampling procedure could prove robust in the external validity of the study results, the fact that the results are confined to descriptive results limit the generalization of the results.

Table 4. Care for epileptics.

Question N %
Epilepsy is a spiritual problem
Yes 62 20.2
No 245 79.8
Epilepsy is a genetic problem
Yes 153 49.5
No 156 50.5
Epilepsy can lead to mental retardation
Yes 80 26.1
No 226 73.9
Epilepsy does not require medical treatment
Yes 40 12.9
No 270 87.1
Emotional problems may be the cause of epilepsy
Yes 194 61.6
No 111 35.2
Epileptic seizures do not require to rush to the hospital of the patient
Yes 289 94.4
No 17 5.6

Conclusion

In conclusion, knowledge and education of what to do in an emergency that requires first aid appear to be not a problem in the primary schools surrounding Unaizah city, Qassim region, Saudi Arabia, However, what appears to be lacking is the practical training for the basic procedures. This requires government or policy intervention to increase the number of individuals acquiring actual training for first-aid procedures.


List of Abbreviations

SPSS Statistical Package for Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The study was approved by UMC-IRB, Qassim Unviversity, dated: 2018-03-04.


Author details

Ali E. Mansour1,2, Ahmad Hamad Alsager1, Abdulrahman Abdullah Alasqah1, Abdulaziz Abdullah Alsuhaibani1, Abdullah Ibrahim Aldughaim1, Abdulaziz Abdullah Alayed1, Abdulmalik Abdullah Aljlali1, Hassan Abdullah Almogbel3, Ibrahim Musaad Aljuraifani1, Abdullah Saleh Altamimi1

  1. Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia
  2. Damietta Faculty of Medicine, Al Azhar University, Egypt
  3. King Fahad Specialist Hospital, Qassim, Saudi Arabia

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How to Cite this Article
Pubmed Style

Mansour AE, Alsager AH, Alasqah AA, Alsuhaibani AA, Aldughaim AI, Alayed AA, Aljlali AA, Almogbel HA, Aljuraifani IM, Altamimi AS. Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. IJMDC. 2019; 3(11): 941-946. doi:10.24911/IJMDC.51-1567545145


Web Style

Mansour AE, Alsager AH, Alasqah AA, Alsuhaibani AA, Aldughaim AI, Alayed AA, Aljlali AA, Almogbel HA, Aljuraifani IM, Altamimi AS. Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. https://www.ijmdc.com/?mno=64061 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1567545145


AMA (American Medical Association) Style

Mansour AE, Alsager AH, Alasqah AA, Alsuhaibani AA, Aldughaim AI, Alayed AA, Aljlali AA, Almogbel HA, Aljuraifani IM, Altamimi AS. Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. IJMDC. 2019; 3(11): 941-946. doi:10.24911/IJMDC.51-1567545145



Vancouver/ICMJE Style

Mansour AE, Alsager AH, Alasqah AA, Alsuhaibani AA, Aldughaim AI, Alayed AA, Aljlali AA, Almogbel HA, Aljuraifani IM, Altamimi AS. Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. IJMDC. (2019), [cited October 15, 2021]; 3(11): 941-946. doi:10.24911/IJMDC.51-1567545145



Harvard Style

Mansour, A. E., Alsager, . A. H., Alasqah, . A. A., Alsuhaibani, . A. A., Aldughaim, . A. I., Alayed, . A. A., Aljlali, . A. A., Almogbel, . H. A., Aljuraifani, . I. M. & Altamimi, . A. S. (2019) Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. IJMDC, 3 (11), 941-946. doi:10.24911/IJMDC.51-1567545145



Turabian Style

Mansour, Ali E, Ahmad Hamad Alsager, Abdulrahman Abdullah Alasqah, Abdulaziz Abdullah Alsuhaibani, Abdullah Ibrahim Aldughaim, Abdulaziz Abdullah Alayed, Abdulmalik Abdullah Aljlali, Hassan Abdullah Almogbel, Ibrahim Musaad Aljuraifani, and Abdullah Saleh Altamimi. 2019. Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (11), 941-946. doi:10.24911/IJMDC.51-1567545145



Chicago Style

Mansour, Ali E, Ahmad Hamad Alsager, Abdulrahman Abdullah Alasqah, Abdulaziz Abdullah Alsuhaibani, Abdullah Ibrahim Aldughaim, Abdulaziz Abdullah Alayed, Abdulmalik Abdullah Aljlali, Hassan Abdullah Almogbel, Ibrahim Musaad Aljuraifani, and Abdullah Saleh Altamimi. "Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 941-946. doi:10.24911/IJMDC.51-1567545145



MLA (The Modern Language Association) Style

Mansour, Ali E, Ahmad Hamad Alsager, Abdulrahman Abdullah Alasqah, Abdulaziz Abdullah Alsuhaibani, Abdullah Ibrahim Aldughaim, Abdulaziz Abdullah Alayed, Abdulmalik Abdullah Aljlali, Hassan Abdullah Almogbel, Ibrahim Musaad Aljuraifani, and Abdullah Saleh Altamimi. "Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia." International Journal of Medicine in Developing Countries 3.11 (2019), 941-946. Print. doi:10.24911/IJMDC.51-1567545145



APA (American Psychological Association) Style

Mansour, A. E., Alsager, . A. H., Alasqah, . A. A., Alsuhaibani, . A. A., Aldughaim, . A. I., Alayed, . A. A., Aljlali, . A. A., Almogbel, . H. A., Aljuraifani, . I. M. & Altamimi, . A. S. (2019) Knowledge and practices of primary school teachers about first aid management of minor injuries among children in the Qassim region, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (11), 941-946. doi:10.24911/IJMDC.51-1567545145