THE SURVEY REPORT ON THE AVAILABILITY OF FIRST AID AT A CORPORATION SCHOOL IN CHENNAI

POLICY:

Schools must have facilities to allow provision of basic first aid care as well as first aid treatment such as minor cuts, scratches, bruising and for bodily injury.

ABSTRACT:

Children are the most vulnerable beings and they tend to fall ill so easily. They spend as much as 70-80 percent of their waking hours in school. Though schools include first aid facilities in their curriculum, they do not practise school-based emergency response plan. According to the Education Department, certain guidelines have to be followed to issue certificate for a school. To check whether the guidelines are strictly carried out in corporation schools, our group visited a corporation school in Chennai. We decided to know the preparation and maintenance of first aid kit.

INTRODUCTION:

Many parents send their children to schools charging heavy fees combined with better student discipline and high learning environment. For them, sending children to one of the high status schools is a prestige issue. Thus parents find a standardized testing criterion to rank the schools in the city. They seldom pay attention to the child’s safety measures and first aid facilities. A well stocked first aid kit is compulsory for every school because nobody can predict when an emergency arises.

METHODOLOGY:

We decided to do a questionnaire mode survey. Also to infotain and give proper awareness to students on first aid, we made powerpoints and performed a Tamil skit. 

A BRIEF NOTE ON OUR VISIT TO THE SCHOOL:

As it was an official and formal visit, we had to get an authorization letter from our NGO to visit the school. Unfortunately, to get the letter sanctioned by the Principal of the Corporation school was a tedious task. Later, we got it done.

We visited the school on 28th February 2018. Intentionally, we reached there at half past 1PM as it would be lunch break for the students. Many students were playing football, cricket, and thumb games and so on. Some were idly sitting and chatting. We randomly called some students and started conversing with them. We enquired them the availability of first aid facilities in their school. Many of them know first aid only as having medication and lying in sick room the whole day. They were not aware of the clear implication of what first-aid is. Like we had preplanned, we did a skit emphasizing on the need of first aid and the crucial role of it in our daily lives. The central idea of the first aid skit was saving an asphyxiated student’s life in school. Thus we taught the students ‘what first aid’ can be given in such a threatening situation. We showed them the treatment process through our skit as follows:

1. Place individual in comfortable position, usually sitting, leaning forward. 

2. Remain calm. 

3. If individual is known to school personnel as having pre-existing asthma, refer to the written emergency action plan on file and proceed with physician's recommendations. 

4. If any of the following conditions exist, take him/her to the nearest hospital:

• Difficulty breathing (significant use of neck and chest muscles for breathing or poor air movement). 

• Shortness of breath or inability to speak more than 3-5 word sentences. 

• Breathing rate of less than 12 or greater than 30 times a minute. 

• Individual with decreased level of consciousness. 

• Bluish lips or nail beds

Thus, students got a brief idea of first aid and its uses. We then distributed the questionnaire to some adult students for getting first hand information about first aid in their school.  Later, we stroke in conversation with the nurse and the secretary to the school principal. The details of the conversation are as follows:

CONSOLIDATED DATA:

MAJOR FIRST AID CONTENTS:

According to Tamilnadu State Government School Policy Advisory Guide:

Schools must:

1. Maintain at least one major first aid kit located in the sick bay

2. Store any medications separately from the first aid kit including any prescribed or non-prescribed medication provided by a student’s parent/carer or adult/independent student.

Note: Thermometers are not necessary for first aid.

TYPE OF EQUIPMENT	CONTENT INCLUDES
Current first aid manual	First Aid Emergency Handbook from: - Tamilnadu State Government Products - Local suppliers
Wound cleaning equipment	-Gauze swabs: 100 of 7.5 cm x 7.5 cm divided into small individual packets of five sterile saline ampoules: 12 x 15 ml and 12 x 30 ml -Disposable towels for cleaning dirt from skin surrounding a wound
Wound dressing equipment	Sterile, non-adhesive dressings, individually packed: - eight 5 cm x 5 cm - four 7.5 m x 7.5 m - four 10 cm x 10 cm for larger wounds Combine pads: twelve 10 cm x 10 cm for bleeding wounds Non-allergenic plain adhesive strips (‘band aids”), without antiseptic on the dressing, for smaller cuts and grazes Steri-strips/wound closures for holding deep cuts together in preparation for stitching Non-allergenic paper/adhesive type tape, width 2.5 cm–5 cm, for attaching dressings Conforming bandages for attaching dressings in the absence of tape or in the case of very sensitive skin Six sterile eye pads, individually packed
Bandages	Six triangular bandages for: - slings - pads for bleeding - attaching dressings - immobilising injured limbs - splints etc Conforming bandages to hold dressings in place: - two of 2.5 cm - two of 5 cm - six of 7.5 cm - two of 10 cm Crepe bandages (“hospital weight”) to secure a pad to control bleeding, to support soft tissue injuries (sprains & strains) and for ‘Pressure Immobilisation Bandaging technique’ for snake bite: - two of 2.5 cm - two of 5 cm - six of 7.5 cm - two of 10 cm - two 15 cm Heavy elastic bandages; two 15cm. These are ideal to use for ‘Pressure Immobilisation Bandaging technique’ for snake bite or severe allergic reaction to other bites and stings.
Injury Treatment Equipment	One pair of: - stainless steel scissors (medium size) - trauma shears (heavy duty scissors for cutting clothing, bandages, shoelaces etc. if required) Disposable splinter probes and a sharps container for waste Disposable tweezers for sprains, strains and bruises, two: - gel packs, kept in the refrigerator, or - disposable ice packs for portable kits made from small zip-Lock plastic bags filled with water, frozen and wrapped in a cloth/bandage/disposable towel before being application Flexible ‘sam’ splints for fractured limbs (in case of ambulance delay) Additional 7.5 m crepe bandages and safety pins to attach splints Ice packs.
Lotions and Ointments	Sun screen, ideally a low allergenic/sensitive skin type, with a sun protection factor of between 15+ and 30+ Single use sterile saline ampoules for the irrigation of eyes Notes: Creams and lotions, other than those in aqueous or gel form, are not recommended in the first aid treatment of wounds or burns. Antiseptics are not recommended. Cuts and abrasions should be cleaned initially under running water followed by deeper and more serious wounds being cleaned with sterile saline prior to dressing.
Hygiene and Cleaning Equipments	Single use nitrile gloves in various sizes such as small, medium and large Note: Some people are allergic to latex gloves. Blood and vomit spill kits Disposable hand towels Adhesive sanitary pads, as a backup for personal supplies Antiseptic hand wash/germicidal soap and nail brush for hand-cleaning before and after treatment only Single use antiseptic wipes for hand cleaning when water is not readily available One box of paper tissues Paper towel for wiping up blood spills in conjunction with blood spill kit Single use plastic rubbish bags that can be sealed, for used swabs  A waste disposal bin suitable for taking biohazard waste Note: Biohazard waste should be burnt. There are several companies that will handle bulk biohazard waste. Ice cream containers or emesis bags for vomit.
Other Equipments	Resuscitation face mask such as “pocket mask” type that can be cleaned/reused One medicine measure for use with prescribed medications disposable cups One teaspoon Pen-like torch, to measure eye-pupil reaction Blanket and sheet, including a thermal accident blanket for portable kits

FIRST AID ROOM IN CORPORATION SCHOOL:

According to the Tamilnadu State government, schools must have a separate room for first-aid.

The corporation school colloquially name it as ‘sick room.’ 

FACILITIES FOR FIRST AID:

-Precautions against infection see: Infectious Diseases within Related policies

-Reassurance and comfort with a safe level of privacy, dignity, comfort and independence.

-Employee and volunteer health, safety and welfare

-Associated record keeping in accordance with privacy and confidentiality

SUPERVISION IN FIRST AID ROOM:

The level of supervision in the first aid room varies depending on the case. For example, supervision:

-Should be required for a student who has had a blow to the head and is feeling dizzy

-May not be required for a student with a slight headache, who needs a lie down.

SCHOOL NURSE IN CORPORATION SCHOOL:

School nurses or first aid health coordinators are mandatory in every school, according to the Tamilnadu Education Department.

The responsibilities of school nurse of Corporation School:

-Taking a lead role in supporting teachers and principals in health support planning

Having knowledge of:

-All students with a support or management plan

-The first aid response noted in the plans

-Ensuring that student’s emergency contact details are up to date

-Ensuring all medications supplied by the student are within their use-by date

-Working with staff to conduct regular:

-Reviews of management strategies

-Risk assessments

-Develop strategies to raise awareness in the school community about health and safety issues.

STANDARD PRECAUTIONS UNDERTAKEN BY THE NURSE:

-Anticipating potential contact with infectious materials in routine and emergency situations is the 

most important step in preventing exposure to and transmission of infections. 

-Use Standard Precautions and infection control techniques in all situations that may present the 

hazard of infection. 

-Precautions observed and appropriate protection used when caring for bleeding injuries 

or handling other body fluids in emergency situations. Body fluids include blood, drainage from cuts, scabs, skin lesions, urine, feces, vomitus, nasal discharge, and saliva. The body fluids of all persons should be considered to be potentially hazardous. 

-Avoiding direct contact with body fluids. Assisting in first aid when body fluids are present (e.g., cleaning cuts and scrapes, treating a bloody nose) should use disposable 

gloves. 

-Using protective eye wear and masks in certain situations. 

-If unanticipated skin contact occurs, hands and all other affected skin should be washed with soap 

and running water as soon as possible. The local procedures for blood and body fluid exposure 

should be followed. 

-Diligent and proper hand washing, the use of barriers (e.g., gloves), appropriate disposal of waste 

products and needles, and proper care of spills are essential techniques of infection control. 

-If it is necessary to perform CPR, a one-way mask or other infection control barrier should be 

used. However, CPR should not be delayed while such a device is located.

OTHER HEALTH SERVICES:

Visiting health services

The school has visiting health care professionals, such as nurses, physiotherapists, etc, a facility must be available for provision of the health service.

STANDARD FIRST AID PROCEDURES UNDERTAKEN BY THE CORPORATION SCHOOL SO FAR:

ISSUE	FIRST-AID PROCEDURES
Fever	1. Took temperature. If fever is present (100 °F or greater), check for other symptoms of illness. 2. Allowed individual to lie down. 3. Applied cool compress to forehead. 4. Isolated individual for the benefit of others.
Faint	1. Positioned individual on back on a flat surface. 2. Elevated legs 8-12 inches. 3. Loosened clothing around neck and waist. 4. Applied cool, damp cloth to head. 5. Continued to observe carefully.
Minor Injury	1. Determined cause of the injury. 2. As it was minor trauma, applied ice/cold pack for 15 minutes to eye. 3. Patched both eyes to minimize eye movement, and referred for immediate medical care.
Headache	1. Individual was made to lie down for 20-30 minutes in darkened area. 2. Checked temperature. 3. Placed a cool cloth on the forehead to promote relaxation.
Animal bite	1. Wore gloves to treat the victim. 2. Removed rings and bracelets from bitten extremity. 3. Cleansed wound thoroughly with soap and water for 5 minutes. 4. Covered wound with clean bandage (preferably sterile). 5. Determined individual's tetanus immunization status.
Fracture	1. Determined cause of injury. 2. Kept individual quiet, still, and warm. 3. Controlled bleeding by placing a clean cloth (preferably sterile) over the wound and applying pressure on a nearby artery. 4. As there was no danger to life the victim can be moved. Orelse, do not move from place of accident until affected limb has been properly supported or immobilized. 5. Immobilized extremity to reduce pain. Supported with pillows, blankets, broomstick, uninjured limb etc. 6. Applied ice/cold pack for 15 minutes
Electric burn	1. Do not attempt to remove individual from the source of electricity. Never go near an individual who may have been injured by electricity until you are sure power source has been turned off. 2. Wear gloves 3. If necessary, and only after contact is broken with electrical source, one should go near to the victim. 4. Cover the burned area with a dry (preferably sterile) non-stick dressing. 5. Look for a second burned area where the electricity left the body.
Chest pain	1. Remain with individual until emergency personnel arrive. 2. Place the individual in a comfortable position, usually sitting up, particularly if there is shortness of breath. 3. Loosen tight clothing. 4. Provide reassurance. 5. If individual has "heart medicine" with him in the clinic, assist him take it. (For a child, consult written emergency action plan on file and proceed with the physician's recommendations.) 6. Do not give food, drink, or "pills" to an unconscious individual. 7. Do not attempt to transport individual. This will add additional strain.
Insect in Ear	1. Place a few drops of oil in the ear to quiet the insect.
Head Injury	1. Keep individual lying down and quiet. 2. If individual is unconscious and neck injury is not suspected, support head and gently turn entire body to one side (log roll) so secretions drain from mouth. Do not turn head if neck injury is suspected. 3. Loosen clothing around neck. 5. Check for airway obstruction. If necessary, certified personnel start CPR (see CPR). 6. Do not insert anything into the individual's mouth. 7. Wear gloves. Use Standard Precautions (see Standard Precautions). 8. Control extensive bleeding by applying direct pressure to injury site. 9. Do not wash head wounds if suspect skull fracture. 10. Small cuts on face or scalp may bleed extensively. Control bleeding of this kind by applying clean dressings (preferably sterile) directly on the wound. 11. If dressings become blood soaked, add more dressings. Do not remove original dressing. 12. For blows to the head not accompanied by any of the above symptoms, treat for headache.
Nose Bleeding	1. Wear gloves. 2. If bleeding is from trauma, see Head Injury. 3. If bleeding is not related to trauma, keep individual slightly leaning forward and breathing through the mouth. 4. Loosen anything tight around the neck. 5. Pinch the sides of the nose against the septum (bone in centre of nose) for at least 5-10 minutes to allow a clot to form. 6. Tell individual not to blow nose or sniff for 1-2 hours in order to prevent dislodging the clot. 7. If bleeding does not stop in 5-10 minutes or individual has frequent episodes, repeat pressure to Septum.

ANALYSIS:

We found out that the school is providing basic life support aids in case of an emergency. The teachers and health practitioner are experts at the treatments of first aid. It seems it is not the certificate in first aid or medical profession that matter but the courage to face the situation and take it as a challenge to save life. We have recommended the school authority to share their first aid knowledge to their students. It should be a standard component of educational programs at all teacher training schools and should also be updated at regular intervals throughout their careers, as part of teacher’s continuous professional development. 

RECOMMENDATIONS:

Emergency Do’s and Don’ts

Fever	The usual medication for fever is paracetamol, but may vary for every individual. If you are travelling and your child catches a fever, it is advisable that you keep tracking his/her temperature. Make sure the child is kept warm enough. Always talk to your doctor and pack the medicine he/she recommends for your children.
Burns	If your child has scalded his/her hand, the first point of action is to put the hand undercold running water for a few minutes before applying any lotion or anti-burn cream like Burnol. If the burn starts wrinkling and drying, it is advisable to keep it open. It is necessary that you dry out the burn with a piece of sterilised gauze before you apply any antiseptic or anti-burn cream. Dab at the burn and do not wipe it. In case you do not have a burn-healing ointment, the white of an egg or honey can be used to cover the scald till you see a doctor.
Wounds	A bleeding wound has to be cleaned with water first and then with an antiseptic solution like Dettol or Savlon. Wipe the wound with a sterilised gauzepad. If the wound needs to be covered, use sterilised bandages and gauze tape. It is necessary that you make sure the wound is clean and dry before you apply an antiseptic cream on it. Betnovate and Soframycin are the commonly used creams, but check with your doctor before you pack them in your first-aid kit.
Nasal Blockage	Nasal blockages usually occur when a child has a cold. The only remedy is to make your child drink hot or warm water, steaming as described by the pediatrician or hot water fomentations. Applications of a vaporubmay also help, if your child is not allergic to it.
Sprains	Sprains can be bad if they are not attended to immediately. If your child suffers a sprained ankleor a sprained wrist, it is important that you massage the injured ankle or wrist with anice pack. Tie a bandage securely around the injury. If there is a break anywhere, it is always useful to hold the broken bone in place by tying a splint on either side of the injured area and holding it there with the help of a bandage till you reach the doctor.
Splinters	In order to remove a splinter, you need a pair of tweezers, some gauze and an antiseptic liquid. Usually splinters go under the skin or nails by piercing through the skin. You must ensure that the splinter has not pierced the skin too deep before trying to remove it. If you do not see the end ofthe splinter, do not attempt to squeeze the spot where the splinter is set. Trying to remove the splinter forcibly will cause it to break inside the body. In such cases, it's best you let a doctor check it out. After removing the splinter, apply an antiseptic liquid. Do not keep the wound open as this can lead to infection when the wound comes in contact with the bacteria in the surrounding air.

CONCLUSION:

Dr. Kshitija Rao, Mumbai has some important instructions regarding providing first aid:

"First aid should strictly be aid that is given only till a doctor arrives. Moreover, the first aid provider should make sure he or she is safe while giving the first aid. For example, if you are helping a fire victim, make sure that you are not in the line of fire. Also call for help. Do not attempt to do everything alone." 

The time between any injury and immediate medical care is known as golden window period. That is, first aid plays a significant role during that crucial stage.  

Hence a first aid kit in every school or household is very important so that when a problem occurs, precious time is not lost in assembling material.