Med. J. Cairo Univ., Vol. 83, No.

1, June: 541-547, 2015

www.medicaljournalofcairouniversity.net

Primary School Teachers' Knowledge about First-Aid

AWAD S. AL-SAMGHAN, S.B.F.M.*; FAISAL M. AL-SHAHRANI, S.B.F.M.** and
FATIMAH H. AL-SHAHRANI, D.I.P.N.***
The Departments of Family & Community Medicine, King Khalid College of Medicine*, Family Medicine Department,
Armed Forces Hospital, Southern Region** and Ministry of Health, Assir Directorate of Health Affairs***, Saudi Arabia

Abstract

Schoolchildren are vulnerable to a number of

risks due to their still maturing physical and mental
abilities. They are more exposed to the risks of
accidents and injuries and hence require first-aid
more often than do adults [3,4] . Such injuries relating
to physical activity can take place during sporting
events at school, and while engaging in extracurricular activities organized by the school as
bicycle riding, swimming, and playing games [5,6] .

Objectives: To explore primary school teachers' knowledge

regarding first aid.
Subjects and Methods: A cross-sectional descriptive study
design was applied among primary school teachers at governmental primary schools for boys in Abha City, Kingdom of
Saudi Arabia. A self-administered questionnaire was designed
by the researchers, which included socio-demographic data
and knowledge about first-aid measures for the most common
incidents among school children.

Schoolchildren are at a particularly higher risk

to sustain accidents and injuries at school. A study
revealed that in a cohort of schoolchildren, the
majority of injuries (88%) were directly related to
physical activity. Moreover, almost 20% of all
physical activity-related injuries occurred during
school hours [7] .

Results: The study included 187 teachers. Their age ranged

between 25 and 58 years with a mean of 41.5 7.4 years. Fiftythree teachers (28.3%) attended a course on first-aid. Of them,
33 (62.3%) reported that these courses included practical
training. About half of the teachers (52.4%) had satisfactory
knowledge about bleeding, and 3 1 % had satisfactory knowledge about poisoning.
Conclusions: Knowledge about first aid is not satisfactory
among teachers of primary schools for boys in Abha, KSA.
First aid educational and training programs should be introduced at school and college levels for early management of
injuries and emergencies. Moreover, knowledge about firstaid should be incorporated in educational curricula. Future
studies may be conducted to assess knowledge about first aid
among teachers of other grades (e.g., secondary) and teachers
of girls' schools.

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 disasters or emergencies. They must be
able to deal properly with health emergencies both
in normal children, and those children with special
health care needs [3] .

Key Words: First aid School health Teachers Hemorrhage

Poisoning Epilepsy Diabetes.

According to the National First-aid Science

Advisory Board [8] , everyone can and should learn
first-aid, i.e. education and training in first-aid
should be universal. This is endorsed by the fact
that properly administered first-aid can mean the
difference between life and death, prompt versus
delayed recovery, and temporary versus permanent
disability [9] .

Introduction
SCHOOL life is an important part of children's
life, which has a direct impact on their physical
and mental health [1] . In many countries school
health services are often neglected. This is reflected
into lack of awareness and education about common
illnesses and first-aid care [2] .

Teachers certainly have an important role in

the protection of the health and safety of schoolchildren. However, this role can only be properly
achieved if teachers are equipped with the needed
skills. Therefore, appropriate in-service training

Correspondence to: Dr. Awad S. Al-Samghan, The Department

of Family & Community Medicine, King Khalid College of
Medicine, Saudi Arabia

541

542

Primary School Teachers' Knowledge about First-Aid

for teachers in child protection is of major importance. Consequently, the assessment of school
teachers' knowledge regarding first-aid measures
is crucial to provide the health personnel with
proper information about the educational needs,
which can help them to plan and organize health
education training programs to enhance teachers'
awareness [10] .

Based on review of relevant literature, a selfadministered questionnaire was designed by the

researchers. It included three parts, as follows:
Socio-demographic data of the teacher (e.g., age,
nationality, qualification, and special habits).
Work history: Job experience and training related
to first-aid.
Knowledge about first-aid measures for the most
common incidents and emergencies among school
children (e.g., injuries, bleeding, burns, hypoglycemia, epileptic fits). A correctly known item
was assigned a score of (1), while an incorrectly
known one was assigned a score of (0). Total
scores were added and teachers who obtained
less than 50% of the total knowledge scores were
considered as having "unsatisfactory" knowledge,
while those who had 50% or more were considered as having a "satisfactory" knowledge.

In USA [11] , it was found that only 5.4% of the

schools had their teachers having first-aid training,
where in many other schools none of the members
of staff had updated first-aid training. Meanwhile,
improved training of physical education teachers
was claimed to decrease the rates of accidental
injuries [12] .
The most common cause of death among children from age 7-14 is trauma and accidents. The
prognosis of any injuries subsequent to accidents
largely depends of the management provided to
the victim in the first minutes immediately following the incident. This reflects the major importance
of the first-aid provided to the victim, which may
sometimes be life-saving [7] .
The importance of first-aid measures is particularly evident when the victim is a child. The
differences between adults and children are not
only limited to anatomical, physiological, and
psychological development, but extend to the differences in exposure to various injures and illnesses.
The mental and physical abilities of children are
not developed enough to allow them to protect and
defend themselves [2] .
The aim of this study is to explore primary
school teachers' knowledge regarding first aid.
Subjects and Methods
This study followed a cross-sectional descriptive research design. The study population consisted of governmental male primary school teachers in Abha City, Kingdom of Saudi Arabia (KSA).
The choice of primary schools for boys in this
study was based on the Saudi Ministry of Education annual statistics that clearly indicated that
the highest incidence rates for injuries were reported from primary schools for boys. Within
Abha City, there are 549 male teachers in a total
of 22 schools [13] .
Following a simple random sample, 10 primary
schools for boys were selected. All teachers within
these 10 schools (n=187) were included in this
study.

A pilot study was carried out on 25 school

teachers in a school other than the selected ones.
Its purpose was to assess the applicability of the
tool and the time needed for filling the forms. The
data collection tool was finalized according to
results of the pilot study. The sample of teachers
within the pilot study was not included in the main
study. Data collection was carried out during October 2011.
Results
Table (1) shows that age of participant teachers
ranged between 25 and 58 years with a mean SD
of 41.5 7.4 years. The majority of them (84.5%)
had Bachelor degree or higher. Their experience
ranged between one year and 37 years with a mean
of 19.3 years and standard deviation of 8.2 years.
As shown in (Table 2), almost all teachers were
aware of first aid (99.5%). Most of the teachers
reported that they obtained their information from
mass media (76.3%) while only 24.2% reported
that the source of their information was physicians,
and school books were the source for first aid
information among 19.4% of teachers. Fifty-three
(28.3%) attended a course on first aid, 62.3% of
them reported that these courses included practical
training, while 69.8% claimed that they were beneficial.
Table (3) shows that 50.8% of participant teachers had personal experience with children's incidents at school that necessitated fist aid. Wounds,
fits and burning were the most common reported
school incidents by teachers (67.4%, 38.9% and
12.6%, respectively). Most of the teachers, who
had experience with incidents at school provided
first aid to incident cases (72.6%).

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Awad S. Al-Samghan, et al.

Table (4) shows that 43.3% of teachers knew

correctly how to care for a case of epistaxis, 14.4%
knew correctly how to care for a bleeding wound,
63.1% knew how to care for scald burns while
70.1% knew correctly how to care for dry burn
wounds, 76.5% knew correctly how to deal with
a child after regaining consciousness, 68.4% knew
correctly how to manage loss of consciousness,
67.9% knew correctly how to manage a case with
foreign body in the ear, 68.4% knew correctly how
to manage a case of asphyxia due to a swallowed
foreign body, while only 39% and 24% of them
knew correctly how to manage a case with foreign
body in the eye and nose, respectively. Most of
the teachers knew correctly how to deal with cases
of sports injury (80.7%) and cut wound (79.1%)
while only 43.3% and 37.4% knew how to deal
with cases of sprains and dental injuries, respectively. Less than two-thirds of them (61.5%) knew
correctly how to manage a case of fall with suspected fractures. Poor teacher s knowledge has
been observed regarding dealing correctly with
cases of poisoning, as only 17.6% knew how to
manage correctly a case with insect sting and 26.2%
knew properly how to take care of a case of swallowing toxic materials.
Table (5) shows, regarding teachers' knowledge
about first aid for diabetic children, the majority
of the teachers knew correctly the importance of
a balanced diet (93.6%), importance of snacks
(93%) and route of insulin intake (87.7%). Approximately two-thirds of them (65.2%) knew correctly
the importance of candies, 61% knew correctly
symptoms of hyperglycemia. Less than half of
them knew correctly symptoms of hypoglycemia
(47.1%) and management of hypoglycemia at
school (46.5%). Almost one-third of them knew
correctly how to manage a case of hyperglycemia
at school (35.8%) and knew correctly the low level
of blood sugar if treatment was neglected (33.7%).
Only 23.5% knew correctly the effect of insulin.
On the other hand, as regard first aid for epileptic
cases, most of the teachers knew correctly that the
child with epilepsy should have a normal life
(90.4%), during epileptic fit, it is necessary to open
the mouth of the child in order that the child does
not bite the tongue (89.3%), and a child with
epilepsy may have learning difficulties if he is not
receiving appropriate treatment (81.8%). Precipitating factors for epilepsy and the importance of
watching a child during fit were known correctly
by 74.3% of them. Only 8%, 13.4%, 19.8% and
25.7% of the teachers knew correctly that epilepsy
is not a communicable disease, needs medical
treatment, not a psychotic disease and it needs
daily treatment, respectively.

Table (1): Personal characteristics of teachers in the study

sample.
Personal
characteristics

Frequency

Percent

66
92
29

35.3
49.2
15.5

Age:
<40
40
50+
Range
Mean SD
Qualification:
Diploma
Bachelor or higher
Experience (years):
<10
10
20+
Range
Mean SD

25.0-58.0
41.5 7.4
29
158

15.5
84.5

21
74
92

11.2
39.6
49.2
1.0-37.0
19.3 8.2

Table (2): Teachers' awareness and previous training on first

aid and their sources of information.
Variables

Frequency

Percent

Heard about first-aid:

Yes
No

186
1

99.5
0.5

Sources of information (n=186):

School books
Doctors
Nurses
Media
Other (courses, internet)

36
45
19
142
19

19.4
24.2
10.2
76.3
10.2

Previously attended
training on first aid:
Yes
No

53
134

28.3
71.7

Training courses (n=53):

Were practical
Were beneficial

33
37

62.3
69.8

Table (3): Teachers' experience with personal incidents that

necessitated first aid at school.
Variables

No.

Teachers' history of having a personal

experience with incidents at school:
No
Yes

92
95

49.2
50.8

Types of incidents (n=95) ( 1) :

Wounds
Fits
Burns
Drowning
Poisoning
Insect sting/animal bite
Others

82
37
12
6
4
2
10

86.4
38.9
12.6
6.3
4.2
2.1
10.5

69

72.6

History of providing first aid by

teachers to incident cases

(1) : Personal experience of more than one incident was possible.

544

Primary School Teachers' Knowledge about First-Aid

Table (4): Teachers' knowledge about first aid for various

incidents at school.
Knowledge items

Correct knowledge
No.

Bleeding:
Care of bleeding wound
Care of epistaxis

27
81

14.4
43.3

Burns:
Care of scald
Care of child on fire

118
131

63.1
70.1

143

76.5

128

68.4

Foreign body:
Eye
Nose
Ear
Swallowed and asphyxiating

73
46
127
128

39.0
24.6
67.9
68.4

Accidents/injuries:
Sports injury
Sprains
Loss of tooth
Cut wound
Fall with suspected fracture

151
81
70
148
115

80.7
43.3
37.4
79.1
61.5

Poisoning:
Swallowing poisonous material
Insect sting

49
33

26.2
17.6

Loss of consciousness:
Dealing with child after
regaining consciousness
Managing loss of consciousness

Table (5): Teachers' knowledge about first aid for diabetes

and epilepsy.
Knowledge items
Diabetes:
Blood sugar when treatment is neglected
Effect of insulin
Route of insulin intake
Symptoms of hyperglycemia
Management of hyperglycemia at school
Symptoms of hypoglycemia
Management of hypoglycemia at school
Importance of balanced diet
Importance of snacks
Importance of candies
Epilepsy:
Etiology: Not spiritual
Etiology: Not genetic
Epilepsy and mental retardation
Not communicable
Not a psychotic disease
Needs medical treatment
Needs daily treatment
Never stop medication
Relation to food
Relation to psychological state
Precipitating factors
A child with epilepsy should have
a normal life
Fits
Management of fits to avoid tongue injury
Exercise
Learning difficulties
Management of fits to calm child
Management of fits to stop it
Watching child during fit

Correct
knowledge

Discussion
Educating even a few people in first aid improves the safety of everyone they come in contact
with. Also, a person trained in first aid is more
motivated to avoid personal injury, because their
first aid training gives them a greater appreciation
of the potential serious consequences. Moreover,
some trained in first aid can be taught to appreciate
the importance of safety, prevention and risk reduction, making them ideal advocates for spreading
safety awareness [14] .
In the present study, 28.3% of primary school
teachers in Abha, KSA had previous training in
first aid and only 62.3% of them reported that these
courses included practical training. This reflects
deficient interest among teachers toward the importance of receiving training on first aid. The
findings highlight the lack of the practical training
component in more than one third of the attended
courses.
In a study conducted in Turkey15, 61.9% of
participant teachers had a previous training in firstaid, for which 54.2% of the courses was only
theoretical. Therefore, 84.7% of these teachers had
the feeling of being inadequate in first-aid and
85.6% reported a need for attending practical
training on first-aid.

No.

63
44
164
114
67
88
87
175
174
122

33.7
23.5
87.7
61.0
35.8
47.1
46.5
93.6
93.0
65.2

54
91
77
15
37
25
48
119
50
100
139
169

28.9
48.7
41.2
8.0
19.8
13.4
25.7
63.6
26.7
53.5
74.3
90.4

Therefore, it seems a pressing necessity to

strengthen school health services through involving
teachers and educators, providing them with training programs and interacting with them. The current
concept of the school health programs brings together parents, the community, experts and professionals from the education, health and allied sectors
to provide a comprehensive primary health care
service to children [17] .

114
167
64
153
73
103
139

61.0
89.3
34.2
81.8
39.0
55.1
74.3

In the present research, only 43.3% of the

teachers knew correctly how to manage a case of
epistaxis. Moreover, satisfactory knowledge about
first-aid of poisoning was reported among 31% of
participant teachers.

On the same line, a study in Egypt assessed

the effect of an educational program on the knowledge of newly graduated nursery teachers regarding common accidents and emergencies among
preschoolers and their first-aid management, indicated that most of the teachers had inadequate
knowledge and performance. This was attributed
to the lack of effective practical emergency care
training in the curriculum of the Faculty of Specific
Education [16] .

545

Awad S. A l-Samghan, et al.

Nonetheless, a recent study in Turkey [18] revealed that most teachers had accurate knowledge
about the first-aid actions to be taken when faced
with epistaxis. This knowledge was better among
younger teachers, which would indicate more emphasis on teaching first-aid principles to among
newly graduated teachers, compared to older ones.
Moreover, satisfactory knowledge about first-aid
of poisoning was reported among 3 1 % of teachers.
Though the majority of participant teachers in
the present study knew correctly the importance
of a balanced diet and route of insulin intake, only
about two-thirds of them knew correctly the importance of candies while 61% knew correctly
symptoms of hyperglycemia, less than half of them
knew correctly symptoms of hypoglycemia and
management of hypoglycemia at school and only
33.7% knew correctly how to manage a case of
hyperglycemia at school and knew correctly the
level of blood sugar when treatment is neglected.

Chmiel-Perzy nska,
et al. [19] noted that not all
schools employ medical staff full time, which
transfers responsibility for administering first-aid
for diabetic students to the teachers. This gains a
special importance regarding the problem of hypoglycemia, which was found to affect about threefourth of diabetic schoolchildren. Hence the responsibility for administering first-aid remains
mainly with the teachers [20] .
In Poland [19] , 26% of primary school teachers
reported having had diabetic schoolchildren in
their classes, and 8% had witnessed schoolchildren
with hypoglycemia, 46% reported that they knew
how to operate a glucose meter, while 32.7% were
not familiar with the symptoms of hypoglycemia,
and 76.9% did not know the blood glucose levels
indicating hypoglycemia. More importantly, 42.3%
of the teachers did not know how to help a hypoglycemic child. Similarly, in Bahrain [21] , a study
among school teachers demonstrated their deficient
knowledge about diabetes among school children.
In the present study, most of the teachers knew
correctly that during epileptic fits, it is necessary
to open the mouth of the child in order that he does
not bite his tongue, and a child with epilepsy may
present learning difficulties if he is not receiving
appropriate treatment. Precipitating factors for
epilepsy were known correctly by 74.3% of them.
However, only 13.4%, 19.8% and 25.7% of the
teachers knew correctly that epilepsy needs medical
treatment, not a psychotic disease and it needs
daily treatment, respectively.

A KAP study among schoolteachers in Pakistan

revealed that the most frequently reported firstaid measure for an epileptic child was laying the
child on bed, while about one-fifth advised putting
a spoon in the mouth. However, about one-third
were uncertain of the effectiveness of treatment.
In Thailand, 15% of school teachers believed that
children with epilepsy should have a special classroom [23] , while the majority of teachers in Zimbabwe agreed to teach children with epilepsy with
others [24] .
[22]

Many studies demonstrated deficient knowledge

about epilepsy among teachers, both in developing
and developed countries [25] . Teachers also may
have misconceptions regarding first-aid for seizures,
and few of them had attended related training
programs. The misconception that epilepsy is a
contagious disease was found to be still prevalent
among teachers [26,27] . In accordance with that, in
the present research, only 8% of the surveyed
teachers knew correctly that epilepsy is not a
communicable disease.
The deficient knowledge about epilepsy may
contribute to the stigma related to negative attitudes
[28] . The more accurate information regarding its
causes and treatments, the less likely are these
negative perceptions [29,30] . Better knowledge and
awareness of first-aid for epileptic fits can help
improving attitudes towards the affected child
[31,32] .
In conclusion, knowledge about first aid is not
satisfactory among teachers of primary schools for
boys in Abha, KSA. This is largely due to a lack
of information and training. So, first aid educational
and training programs should be introduced at
school and college levels for early management of
injuries and emergencies. Moreover, knowledge
about first-aid should be incorporated in educational
curricula.
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