Paper presented at the British Educational Research Association Annual Conference, Heriot-Watt University, Edinburgh, 3-6 September 2008

Title: What are the Beliefs / Views of Teaching Staff in UK Senior Schools about Their Role in the Event of a Pupil Requiring Emergency First Aid?

Author: Carolyn M Crouchman MSc., BSc. Hons., R.N., R.N.T. Senior Lecturer

Faculty of Health and Human Sciences,Thames Valley UniversityWellington StreetSlough SL1 1YG

e-mail carolyn.crouchman@tvu.ac.uk

Telephone 01753 697588

With thanks to Professor Di Marks-Maranand Hazel Rogan

1

Abstract

This paper reports data surrounding the views of teachers in state sector senior

schools across 2 counties in the South of England. The term “senior schools” is

defined as those attended by pupils aged 11 – 18 years. Survey method was

used in the study and a convenience sample of 20 teachers completed a short

questionnaire. The majority of respondents were accompanying year 10 students

to “taster sessions” at a University campus and all were qualified teachers.

The objective of the study was to ascertain the views of teachers in senior

schools about their roles and skills in the event of a pupil requiring first aid and/or

cardio pulmonary resuscitation, and whether they would participate in training if

offered. A literature review indicated 3 key areas related to first aid in schools:

government guidelines and legislation, studies originating from the healthcare

sector, and studies originating from the education sector.

4 Key themes emerged from the data. These were: the role of schools in

providing first aid: concerns about litigation: compulsory first aid training:

voluntary first aid training. From this small survey it is clear that despite some

interesting differences across the pupil range teachers recognise the need for

good emergency first aid provision in their schools. Whether this is mandatory for

all, voluntary for a named set of first aiders, or whether different emergency

response preparation is required is a matter for debate. Further study is planned

in order to gain more detail, and to establish whether these results are

generalisable.

2

Background

First aid is defined as the actions of a first responder in an emergency and/or

accident situation. The United Kingdom Resuscitation Council (2005) recently

reviewed the first responder guidelines and has simplified them in an attempt to

make them easier for the lay public to use. This training has been widely

available for many years and public awareness and training has increased

significantly in recent years (Resuscitation Council UK 2005).

Currently it is not mandatory for schools in the UK to have teaching staff trained

in the first aid of children. It is pertinent to consider the increase in the numbers

of children in schools with identified health needs / risks (DfEE 1998). Almost

400,000 children were the victims of accidents / injuries on school premises in

2002 (The Royal Society for Prevention of Accidents 2002). Conclusive evidence

indicates that teaching basic first aid / resuscitation skills to the general public

confers significant benefits to survival rates (Berg et al. 1999; Dorph et al. 2002;

Resuscitation Council UK 2005). In 1992 the European Resuscitation Council

(ERC) stated that all European schools should include basic life support (BLS) in

their curriculum (ERC BLS Working Party 1992).

The British Red Cross, British Medical Association, The Resuscitation Council

(UK), and The Royal National Lifeboat Institution are among a number of key

bodies supporting the need for compulsory first aid education for school children

(British Red Cross 2006b).

3

The evidence examined suggests that first aid skills for staff in schools is on the

agenda but is unclear about what is appropriate. It is therefore important to seek

the views of teachers as so little is known about their opinions on this subject.

Significant work from the British Heart Foundation (BHF) (2005) and British Red

Cross (2006a) targets the training of school children (Lester et al 1994).

However, this would seem inextricably linked to the training of teachers.

Literature review

The review of the literature surrounds the research question about the beliefs,

attitude and understanding of senior school teachers working in the UK about

their role and skills in the event of a pupil requiring first aid and/or cardio

pulmonary resuscitation.

The literature review is divided into 3 parts. The first section concentrates on

government reports, guidance and legislation, in order to set the study in context

and to review the current situation. The second section examines work

originating from the healthcare sector, and the third section explores literature

with origins in the education sector. The literature review goes back as far as the

1970s as there is little relevant work linking first aid and schools before that time.

Literature from the healthcare sector is reviewed in terms of the effectiveness of

first aid / resuscitation training in the school context.

Government reports and legislation

4

Schools must meet the Health and Safety regulations to have at least one first

aider in each building. There is a difference in what is understood by the term

“first aider”. This role is primarily focussed on adults in the workplace.

Resuscitation is part of the course but does not specifically focus on children

(Health & Safety Executive 1981).

There is no obligation for teaching staff, including physical education (P.E.) staff

to do any first aid training. Anecdotal evidence suggests that good practice would

make head teachers feel that all P.E. staff ought to have some relevant training.

In contrast to the current situation in schools, there is a significantly greater

amount of regulation for off-site school activity (DfES 1998). This has largely

been as a result of some tragic (and much reported by the media) accidents /

events on school trips and the resulting effect on parents confidence in the safety

of such activities.

The Department of Health (DoH) and the then Department for Education and

Employment (DfEE) (1998) produced guidance on first aid provision in schools,

focussing on the accountability of staff and head teachers, and addressed a

variety of practical questions about children’s medication, common conditions and

developing policies and procedures. However, the over arching theme of this

document is about the legal position of teaching staff.

“Teachers’ conditions of employment do not include giving first aid “.

(DfEE 1998, p. 4)

5

It is confusing to understand how this statement fits with the concept of “in loco

parentis” and the rest of the document. The paper goes on to say,

“Teachers and other staff in charge of pupils are expected to use their

best endeavours at all times, particularly in emergencies to secure the

welfare of the pupils in the same way that parents might be expected to act

towards their children. In general the consequences of taking no action

are likely to be more serious than those of assisting in an emergency”

(DfEE 1998), p. 4)

The term “assisting in an emergency,” is vague and has a number of

interpretations.

The Resuscitation Council UK (2000) make clear the legal position of teachers.

They specify that whilst the lay public do not have a duty to respond, there are a

limited number of relationships where a duty of care exists, and teachers in

compulsory education fall into this category. This would fit with the concept of “in

loco parentis” mentioned previously.

In 2004 the Department for Education and Skills (DfES) suggested 5 core themes

for the wellbeing of children in school. These are: to be healthy, to enjoy and

achieve, make a positive contribution, achieve economic well being, and to stay

safe. The document goes on to say that children need to be cared for and safe

from accidental injury and death (DfES 2004). It could be argued that this adds to

6

the increasing profile of the needs of the child in school. It is also pertinent to

consider the increase in numbers of children in schools with identified health

risks/needs such as asthma, seizures, severe allergies and heart conditions

(DfEE 1998). It would seem logical that the recommendations in DfES (2004)

paper can only be sustainably achieved by working closely with parents, carers,

and teachers.

The DfES (2005) developed a common set of skills and knowledge that is

designed for use by everyone working with children and young people (Lee

2006). It includes skills for first aid in emergencies, and appears multi-disciplinary

in it’s approach. This seems to be targeting healthcare professionals but it is

unclear whether teachers would fit in here on some sort of skills ladder.

Health Sector

It is not unusual now for supermarket, airline and train station staff to be trained in

resuscitation techniques including community defibrillator provision (Cummins et

al. 1995). This is of particular note as approximately 70% of cardiac arrests

happen out of hospital with 30% of these dying before they reach hospital (British

Heart Foundation 2005). The cardiac arrest out of hospital survival rate in

London has doubled in the last 6 years (London Ambulance Service (LAS) Audit

2007). LAS (2007) state that the survival rate to discharge from hospital for those

resuscitated by bystanders has risen from 4.2% to 11% since 1999. They cite

“effective bystander resuscitation” as a key factor in this improvement. In Seattle

in the US, where a large public training programme was in place with bystanders

starting resuscitation within 4 minutes of collapse, there was a 40% survival rate

7

compared with no attempt – no survivors (Thompson et al. 1979). Other benefits

are that those who use these emergency skills may feel that they have helped to

maximise the likelihood of a good outcome.

The high death rate from ischaemic heart disease was recognised in Wales in

1991 (Osmond & Baker, Welsh Health Planning Forum 1991) and targets were

set to address the concerns. One of the targets was to increase community

knowledge of cardio-pulmonary resuscitation (CPR) to 25% of adults in Wales by

2002. They went on to implement the BHF Heartstart Programme. This was

followed by the Heartstart in Schools programme which became a national

initiative spearheaded by the BHF (Lester 1994). This is a whole school

approach to emergency life support for children from 5 years up, with age

appropriate teaching methods, materials and outcomes. It has been running for

approximately 14 years and evaluations from both teachers and pupils have been

extremely positive (BHF 2005). Evaluations have been by teacher and pupil

feedback in the form of questionnaires, interviews, recounting situations where

the skills learned were used and external school inspector reports. The

Heartstart Programme has been taken up by over 2000 primary and senior

schools across the UK and links with national curriculum themes in science,

citizenship, and personal, social, health education (PSHE)(BHF 2005). In 1992

the European Resuscitation Council (ERC) stated that all European schools

should include basic life support (BLS) in their curriculum (ERC BLS Working

Party 1992).

8

In the UK there has been some reluctance to teach BLS to children in schools

(British Red Cross 2006a) in comparison to other countries such as Norway,

where the teaching of rescue breathing has been part of the school curriculum

since 1961 (Lind et al 1963). Whilst there are enthusiastic teachers, there

remains no mandatory requirement. However, in 1993 the Scottish Health

Service Advisory Council stated that CPR training in schools would be the most

significant factor in achieving improved survival from heart attack (Scottish Health

Service Advisory Group 1993).

There was some suggestion that children would not have the physical strength to

carry out CPR, but this has been refuted. Vanderschmidt et al. (1976) evaluated

a course for 200 students aged 12 – 13 years and 200 aged 15 – 16 years in

Boston, USA. Effective performance of CPR had no correlation with age or

gender, and lighter weight students scored higher on some skills. The Welsh

Heartstart pilot study confirmed this with the use of the Laerdal skillmeter which

measures effectiveness of ventilation on a manikin (Lester et al. 1994). In 2007,

a study showed that 45% of 13/14 year olds could perform adequate continuous

chest compressions (Maconochie et al. 2007). Maconochie et al. (2007) also

suggested that nurses could teach CPR to children in schools.

St John Ambulance run first aid courses for schools. These include the Young

Lifesaver Awards Scheme which has also been been adopted by the Duke of

Edinburgh’s Award Scheme (St John Ambulance 2006). St John Ambulance

have recently, in September 2007, launched a new resource to replace the

9

Young Lifesaver Award (St John Ambulance 2006) and are currently evaluating

this.

A recent survey of 1000 people, carried out for Asthma UK showed that the

majority knew that asthma could be fatal but only half of those questioned knew

what to do if they witnessed an attack (Asthma UK 2006a). This prompted

Asthma UK to launch its Deadly Serious campaign to raise awareness that

asthma can be fatal and what first aid resources are required (Asthma UK

2006b)..

The recent addition to the National Service Framework for Coronary Heart

Disease of a section on “Arrhythmias and Sudden Cardiac Death” (DOH 2005)

indicates a rise in the diagnosis of some otherwise undetected life threatening

cardiac abnormalities. There is a particular risk in the teenage years when

growth spurts and risk-taking (for example recreational drugs) may increase the

risk of a cardiac event. This is highlighted by charity Cardiac Risk in the Young

(CRY) who estimate that approximately 8 young people (under 25 years old) die

suddenly from Sudden Arrhythmic Death Syndrome (SADS) every week in the

UK. CRY (2005) are asking for all children starting senior school to be given

ECG screening in year 7/8 (aged 11-12). This campaign, “an ECG with the

BCG,” is already current practice in Italian schools (CRY 2005). Swartz (2006)

called for Europe-wide neonatal ECG screening as there was growing evidence

of children with undiagnosed life threatening cardiac arrhythmias which could be

treated.

10

The British Red Cross (2006b) gives a clear and persuasive argument supporting

the mandatory inclusion of first aid training in UK schools to

“…enable the next generation to keep safe, stay healthy, and make a

contribution to our communities as active citizens”,

(British Red Cross 2006b. p. 5).

Research by Ipsos MORI (2006) indicates overwhelming support for first aid

training for children aged 11 years and over, with 93% of respondents supporting

such a proposal. The value of year six children having first aid training by

bringing them into Accident/Emergency departments for teaching sessions as

part of the injury minimisation programme (IMPs) was highlighted in The

Guardian (2007) (impsweb.co.uk).

11

Education Sector

Little research is available originating from the education sector. Tunnicliffe

(1986) described how first aid was incorporated into the curriculum in a London

school. She noted that whilst health education topics such as “My Body” and

other health specific projects were undertaken, first aid was neglected. She went

on to say that first aid was not only a valuable skill but was relevant to teaching

science, in particular human biology and went on to show how it related to a

number of areas in the science curriculum.

Armstrong (2004) reported on the increasing role of the school nurse in Australia.

A number of school nurses have carried out valuable work in the context of first

aid. Shaw (1991) set up a school first aid club and commented that she believed

that this should be a part of the curriculum. Redheffer (1988) reported on a

survey of 20 teachers in a US school. She had surveyed them before and 2

years after a training programme on how to deal with emergencies with

favourable results. Rutledge carried out a similar programme in the UK in 1992

with positive feedback from the teachers involved (Rutledge 1992). The British

Red Cross (2006a) carried out interviews and visits to 18 primary and secondary

schools in the UK to explore teachers’ views about first aid training for children.

The research highlighted the paradox between the “high importance” rating of first

aid education but identified very low levels of provision. The main reason for this

was cited as little curriculum time and a lack of good interactive resources. It was

recognised that there was opportunities within the PSHE curriculum in both

primary and secondary schools for first aid training. Handcock (2006) suggests

that for the 11-19 age range learning first aid is a key part of personal safety.

12

Maunder (2004) chronicled her day as a school nurse and briefly included the

importance of the first aid provision in her role. The Royal College of Nursing

(2006) have acknowledged the need for school staff to be prepared to consider

first aid/resuscitation training. Clearly there are significant issues in the private

sector where many children are weekly or term time boarders.

In its White Paper, Choosing Health (DH 2004) the government proposed a

significant increase in the number of school nurses by 2010. The Chief Nursing

Officer for England and Wales highlighted the issues for head teachers (DfES

2005) outlining how school nurses can help schools to reach “Healthy School

Status” by 2009. It remains to be seen how the school nurse provision will

develop.

In the USA guidelines have recently been introduced for the management of

cardiac arrest during school athletics (Lie 2007). These guidelines are

comprehensive and have clear training implications for both teachers and

students.

In summary, from all three areas of the literature the evidence examined seems

to suggest that first aid/resuscitation skills for staff in schools is on the agenda but

it is unclear about what is, or should be, expected. There is some government

guidance and reporting, but little imperative in the form of legislation, although it

remains uncertain whether such legislation is appropriate. There is significant

evidence to suggest that children in senior schools are a medium – high risk

13

group with regard to a variety of medical conditions, and risk of injury (DfEE 1998;

RoSPA 2006). Therefore, some uniformity of training input for pupils and

teachers would seem sensible.

The primary work in the healthcare sector with regard to first aid is the BHF’s

Heartstart Programme which is proving very successful. School nurses have

made a significant contribution and possibly look set to expand their role and

influence.

One of the criticisms of the Heartstart Programme is that some of the terminology

seems confusing. For example, BLS (Basic Life Support) is the same as ELS

(Emergency Life Support). First aid does not make everyone think of

resuscitation, and the word “resuscitation” can be unnerving for many people.

CPR (Cardio Pulmonary Resuscitation) may also confuse further. This confusion

is unhelpful to the non-medical person. The concept and language of

resuscitation may result in the lay public being put off the idea of first aid in

emergencies as it may seem complicated and daunting.

The recent recommendations from the British Red Cross (2006b) are perhaps the

most significant development about the issue of first aid training in schools. The

Times newspaper launched its Christmas appeal in December 2006 with an

article supporting first aid training for schoolchildren with a British Red Cross

fundraising appeal (The Times 2006). Significant work from the BHF (2005) and

British Red Cross (2006b) targets the training of school children. However, this

14

would seem inextricably linked to the training of teachers in schools and is

therefore relevant to this review.

The study

Methodology and research questions

Survey method ((Moser & Kalton 1985) was selected for this study. Four

research questions were identified as follows.

1. Should school teachers be trained in emergency first aid for children in

schools

2. If such training was offered, how would teachers’ respond

3. Any other comments or views about emergency first aid training for

teachers

4. Demographic information from respondents regarding their status as a

teacher (qualified/unqualified) and the age group(s) they teach

Data collection

A survey questionnaire was developed to answer the four research questions.

The survey was conducted using a convenience sample of teachers. Local

senior schools bring groups of pupils to the University to visit the skills laboratory

at one campus. While the pupils were engaged in activities, the teachers were

invited to complete a simple questionnaire. A total of 20 questionnaires were

completed.

15

Data analysis

Simple content analysis was used to analyse the data from the surveys. The

completed respondent questionnaires were grouped by the age groups which the

teachers taught. Therefore, findings are presented as follows:

Teachers who teach aged 11 – 16 (n = 12)

Teachers who teach a mix of 11 – 16 year olds and 16+ (n = 4)

Teachers who only teach 16 + (n = 4)

Two teachers indicated that they taught ages 13 – 16 or 14 – 16 and these

teachers were assigned to the 11 – 16 age group. The majority of the respondent

teachers (n = 12) solely taught under 16 pupils. The number of respondents for

the other teacher groups was 4 and 4. All respondents were qualified teachers.

Findings

Those who taught 11 – 16 year olds (n = 12)

The findings show that 8 out 12 teachers (66.6%) in this group were positive

about teachers needing to be trained in emergency first aid. Three respondents

were unsure and 1 answered negatively, citing being too busy to participate in

such training. The response from teachers who taught this age group was

largely positive, with 8 respondents (66.6%) indicating that they would welcome

the opportunity, 1 respondent indicating that she/he would not wish to be trained 16

in first aid and 2 respondents unsure/undecided. One respondent did not answer

this question.

Those who taught a mix of 11 – 16 year olds and 16+ (n = 4)

All 4 respondents in this group indicated that school teachers should be trained in

emergency first aid. Additionally, all 4 respondents in this group indicated that

they would welcome the opportunity to train in emergency first aid

Those who taught 16 – 18 year olds only (n = 4)

All 4 respondents in this group indicated that school teachers should be trained in

emergency first aid. Additionally, all 4 respondents in this group indicated that

they would welcome the opportunity to train in emergency first aid.

Any other comments or views about emergency first aid training for

teachers

Not all respondents answered this question but for those who did, there was no

pattern across the different age groups that they taught. Fewer teachers in the

11 – 16 group made comments than from the other two groups of teachers. The

majority of comments were made by respondents who taught 16 + pupils only.

However, analysis of the comments was undertaken using a modified Framework

Method of Analysis (Ritchie & Spencer 1994), and the comments related to this

question across all the respondents indicated four themes:

17

Theme 1: Role of schools in providing first aid

Three of the 20 respondents indicated that all schools should have a certain

number of first aiders. One respondent indicated that lunchtime/after school; first

aid training sessions were offered in her school. Two commented on/questioned

the cost of providing such training. One respondent indicated that it was important

for schools to provide first aid services as there are a significant number of

children with medical conditions. One respondent described current first aiders in

her/his school as “slow and not very competent.”

Theme 2: Concerns about litigation

Two respondents raised the issue of litigation for teachers who are trained to give

first aid indicating that litigation is a small concern for the teachers in this survey.

Theme 3: First aid training should be compulsory for all teachers

This theme emerged from three comments made by the respondents

Theme 4: First aid training should be voluntary only

18

Two comments emerged within this theme. One specified that first aid training

should be voluntary only. The other indicated that each school needs to have a

designated number of named and trained first aiders.

From this small and simple survey it is clear that despite some differences across

the pupil age-range, the majority of teachers appear to recognise the need for

good emergency first aid provision in their schools, whether this is compulsory for

all teachers or voluntary for a named set of first aiders.

19

Discussion

The majority of senior school teachers in this survey recognised the need for

emergency first aid provision in schools, and were open to undertaking some

training in emergency first aid for children. However, there were a number whose

responses were negative and these can be examined in the themes identified.

Fear of adverse litigation was a small but significant concern. There is perhaps

an unfounded fear of litigation which may be fuelled by inaccurate and

sensationalist media stories. The facts in relation to this are clear. There is no

case to date where legal action has been taken as a result of a teacher (or any

other) applying first aid measures in an emergency. The Resuscitation Council

(UK) cites overwhelming and conclusive evidence that prompt bystander

resuscitation improves outcome significantly and that it is always better to do

something rather than nothing (Weaver et al 1986, Eisenberg et al 1980)

(Resuscitation Council 2006).

The law does not expect perfection in relation to technique as it is not an

everyday occurrence for most people and therefore if someone chose to help the

expectation is only what would be considered reasonable (Resuscitation Council

UK 2006).

There appear to be clear financial perceived constraints if teachers are to be

released for first aid training, in terms of cost of training and replacement teaching

cover. Perhaps “whole day” training is inappropriate. One suggestion is to

include “first response to collapse” training as part of inset days along with other

20

medical information such as epi-pen administration and response to seizures as

is already the case.

There was some concern expressed by respondents in this study regarding the

effectiveness of existing first aiders in schools. This may be a separate issue in

relation to training and/or speed of response. More investigation would be useful

in this area. The view that first aid training should be voluntary seems

reasonable.

Post-16 and 11 – 18 age group teachers were all positive about the need for

emergency first aid training and their willingness to undertake such training.

There has been some evidence that people are reluctant to do chest

compressions on children for fear of harming them. Despite this concern being

wholly unfounded (Resuscitation Council UK 2006), it may explain the response

in the post 16 age group as more positive because their students are more likely

to be adult size.

The current climate with a full curriculum and the working life of teachers already

being very full it is understandable that they may feel that this is not a role they

wish to undertake. But perhaps there is a misconception about what constitutes

emergency first aid as opposed to comprehensive first aid training. It is

impractical for teachers to be able to cover all aspects of first aid. Emergency

first aid is likely to be a very infrequent but life saving event.

21

Recognition of the needs of children with medical conditions and health and

safety legislation means that schools must have a system to inform and direct

staff. In light of the duty of care as applied to teaching staff should they be asking

for/provided with further training input? The Bolam test (1957) may need to

become part of the discussion about what would be reasonable actions in an

emergency first-aid situation for those with a “duty of care”.

Limitations of the Study

Such a small sample means that it is not possible to generalize the findings.

There are also some small but possibly significant differences in approach to the

subject in different parts of the UK. It could also be suggested that the

convenience sample are self-selecting to some degree as perhaps those who

have chosen to come with their students to “taster sessions” are already

desensitized. The questionnaire had to be very brief and therefore limited the

amount of data that could be collected.

The Future

The number of children in mainstream schools with medical issues is likely to

increase as a result of improved diagnosis of conditions, increases in health and

genetic screening and stricter implementation of inclusion policies. Significant

developments in general education to include first aid education to support the

science and the PSHE curriculum (Bizzo 2006, Handcock 2007, Rowlands 2007,

Tunnicliffe 1986, 2007) mean that there may be a further need for teacher

22

preparation to support these initiatives. Maconochie et al. (2007) and Jones et al.

(2007) suggest that nurses could teach resuscitation skills to children in schools.

The Injury Minimisation Programme (impsweb.co.uk) has been piloted in six cities

across the UK and includes emergency response skills (Frederick et al 2000).

The way forward may need to include demystifying the concept of first aid,

perhaps changing it to “emergency response”. First aid implies a number of

responses from cuts to cardiac arrest. The law requires a certain number of first

aiders, but knowing what to do in an emergency before anyone else arrives

should perhaps become part of every employee’s role. An exploration of the

concept of citizenship may be useful in determining how society in general views

the scope of the helping role.

Conclusion

This small study has examined the views of 20 senior school teachers about

emergency first aid provision in schools. The responses were largely positive

about the contribution they want to provide. A small but significant number of

concerns were highlighted and discussed. Suggestions for future planning

include the inclusion of “emergency response” becoming part of inset days along

with existing emergency response training. The findings of this study indicate a

need for more extensive research to be undertaken. Clearly teachers’ views are

crucial to the development of the debate.

Key words: First Aid, Schools, Teachers, Emergency, Children.

23

References

Armstrong F. (2004) More Than Just Bandaids. The Emerging Role of School

Nurses. Australian Journal of Nursing; May 11, (10): 18-21.

Asthma UK (2006a) Press release, available at

http://www.asthma.org.uk/news_media/news/people_ignorant.html, accessed 9

June 2008.

Asthma UK (2006b) Deadly Serious Campaign, at www. Asthma.org.uk.

Basic Life Support Working Party of the European Resuscitation Council.

Guidelines for basic life support (1992) Resuscitation, 24: 103-110.

Berg R.A. Hilwig R.W. Kern K.B. Babar I. Ewy G.A. (1999) Simulated mouth-

to-mouth ventilation and chest compressions (bystander cardiopulmonary

resuscitation) improves outcome in a swine model of pre-hospital paediatric

asphyxial cardiac arrest. Crit Care Med; 27; 1893-1899

Berg R.A. Hilwig R.W. Kern K.B. Babar I. Ewy G.A. (1999) “Bystander” Chest

Compressions and Assisted Ventilation Independently Improve Outcome from

Piglet Asphyxial Pulseless “cardiac arrest”. Circulation; 101; 1743 - 1748.

Bizzo N. (2006). Science Education Saves Lives. IOSTE Newsletter. 9(2) 6 -7.

24

Bolam v Friern Hospital Management Committee [1957] 2 All ER 118

British Heart Foundation (2005). ABC, Issue 19. Winter. Schools Section: 21.

British Red Cross (2006a). Research on Engaging Teachers, London: British

Red Cross. www.redcross.org.uk

British Red Cross (2006b) Life-Live It. The Case for First Aid Education in UK

Schools. September, London: British Red Cross.

Cardiac Risk in the Young (2005) www.c-r-y.org.uk.

Cumming R.O., Eisenburg M.S., Hallstrom A.P. (1985) Survival of out of hospital

cardiac arrest with early initiation of cardiopulmonary resuscitation. American

Journal of Emergency Medicine: 3(2): 114-19.

DfEE (1998) Supporting Pupils with Medical Needs – A Good Practice Guide.

www.teachernet.gov.uk/_doc/4422/med.pdf

Department for Education and Skills (1998) Guidance on First Aid for

Schools. .London: DfES

Department for Education and Skills (2004) Every Child Matters, Change for

Children. . Looking for a School Nurse? London: DfES.

.

25

Department for Education and Skills (2005). Common Core of Skills and

Knowledge for the Children’s Workforce. London: DfES.

Department of Health (2004b) Choosing Health. London: DH

Department of Health (2005) National Service Framework. Coronary Heart

Disease. Chptr. 8, Arrhythmias and Sudden Cardiac Death. London: DH

Dorph E. Wik L. Steen P.A. (2002) Effectiveness of ventilation-compression

ratios 1:5 and 2:15 in simulated single rescuer paediatric resuscitation.

Resuscitation: 54: 259-64.

Eisenberg M.S., Copass M.K., Hallstrom A.P., et al. (1980) Treatment of out-of-

hospital cardiac arrests with rapid defibrillation by emergency medical

technicians. New England Journal of Medicine 302: 1379-1383.

Eisenburger P., Safar P. (1999) Life supporting first aid training of the public –

review and recommendations. Resuscitation 41: 3-18.

European Resuscitation Council. (2000). Introduction to the International

Guidelines for CPR and ECC, Resuscitation, 46: 3-15.

Frederick, K., Bixby, E., Orzel, M-N., Stewart-Brown, S. & Wellett, K. (2000) An

evaluation of the effectiveness of the Injury Minimization Programme for Schools

(IMPS), Injury Prevention, 6: 92-95.

26

Guardian Newspaper (2007) Safety First, 1st May, 2007: 12.

Handcock J. (2007). Creating a Generation of Lifesavers. Learning for Life.

Issue 9, June 2007; 3.

Health and Safety Executive (1981) Health and Safety (First Aid) Regulations.

London: HSE

Ipsos MORI (2006) August. Face to face interviews with British public in

respondents homes (1960 adults) using computer assisted personal interviews.

London: Ipsos Mori.

Jones I., Whitfield R. et al (2007) At what age can school children provide

effective chest compressions? An observational study from the Heartstart UK

schools training programme. British Medical Journal, April, online. www.bmj.com

Lee P. (2006) Using the “Getting it Right” Tool for Children and Young People.

Nursing Times, 102, 21: 21 -22.

Lester C. et al. (1994) The Heartstart Programme: Teaching Cardio-pulmonary

Resuscitation to Schoolchildren. Health Education Journal, 53: 454-61.

27

Lie D. (2007) New Guidelines for Managing Sudden Cardiac Arrest during School

Athletics, Medscape Medical News, April 10, 2007, at

www.medscape.com/viewarticle/554918

Lind B., Stovner J. (1963) Mouth to mouth resuscitation in Norway. Journal of the

American Medical Association, 185: 933.

London Ambulance Service (2007), Audit, 2007, Nursing Times 103, 6: 7.

Maconochie I., Simpson S. & Bingham,B . (2007). Teaching children basic life

support skills. British Medical Journal, 334: 1174 (9 June)

Marsden A.K. (1988) Save a Life – A campaign for mass education in emergency

first aid. Health Trends, 47: 53-5.

Maternal and Child Health Bureau (1999). Basic emergency lifesaving skills

(BELS): a framework for teaching emergency lifesaving skills to children and

adolescents. Newton M.A.: Children’s Safety Network, Education Development

Center.

Maunder Y. (2004) My Day as a School Nurse. Education and Health. 22, 1:

8-10.

Moser, CA & Kalton, G (1985) Survey Methods in Social Investigation. 2nd edition.

Aldershot: Dartmouth

28

Osmond C. & Barker, D. (1991). Welsh Health Planning Forum. Ischaemic Heart

Disease in England and Wales Around the Year 2000. Journal of Epidemiology

and Community Health, 45: 71-2.

Redheffer G. (1988). Preparing Teachers to Deal with Emergencies, Journal of

Emergency Nursing. 14, (2): 132-33.

Resuscitation Council (UK) (2005) Paediatric Basic Life Support . London:

Resuscitation Council. www.resus.org.uk

Resuscitation Council UK (2000) The Legal Status of Those who Attempt

Resuscitation, p. 3. London: Resuscitation Council. www.resus.org.uk

Resuscitation Council UK (2006). Resuscitation for the Citizen, 7th Ed: 6.

Ritchie J. & Spencer L. (1994) Qualitative data analysis for applied policy

research. In Bryman A & Burgess R, eds, Analysing Qualitative Data. Routledge:

London

Rowlands G. (2007). Towards a new biology curriculum, Journal of Biological

Education. 41, 3: 99-101.

29

Royal College of Nursing (2006) Workshop, “Basic Life Support in Schools,”

presented at the annual conference of The RCN Independent School Nurses’

Subgroup Annual Conference, “Caring and Sharing.”, 24 August.

Royal Society for the Prevention of Accidents. (2002) Child Victims of Accidents

by Location. London: RoSPA. www.rospa.com

Rutledge M. (1992). Helping Them to Help Each Other. Health Visitor, 65, 11:

412-3.

Schwartz P. (2006). Europe Wide Neo-Natal ECG Screening. European Heart

Journal. On-line Publication. DOI:10.1093/eurheartj/eh115.

Scottish Health Service Advisory Group. (1993). Report of the Working Group on

Cardiopulmonary Resuscitation (CPR). Edinburgh: HMSO.

Shaw H. (1991). Setting Up a School First Aid Club. Health Visitor, 64, 1: 18.

St John Ambulance (2006). Conversation and email with. L. Towse, Education

Liaison Officer. December.

St John Ambulance (2006). Emergency Aid in Schools, First Aid for Teachers and

Those Working with Young People. London: St John’s Ambulance

30

Thompson RG, Hallstrom AP, Cobb LA. (1979) Bystander-initiated

cardiopulmonary resuscitation in the management of ventricular fibrillation.

Annuls of Internal Medicine, 90: 737-740. 

The Child Accident Prevention Trust. Injury Minimisation Programme.

Impsweb.co.uk

The Times (2006). Christmas Appeal, December 20. TT: 29.

Tunnicliffe S.D. (1986). Life Saving Science, Health at School, 2. 3, November:

82-83.

Tunnicliffe S.D. (2006) The Importance of Research to Biological education.

J.B.E. 40,(3): 99-100.

Tunnicliffe S.D. (2007) No Time to Teach Life Saving Skills? Essential First Aid

within Biology Lessons. J.B.E. 42(1): 3-4.

Vanderschmidt H, Burnap T.K., Thwaites J.K. (1976) Evaluation of a

Cardiopulmonary Resuscitation Course for Secondary Schools Retention Study.

Medical Care Vol.14, No.2: 181-184.

Weaver W.D., Cobb L.A., Hallstrom A.P., et al. (1986) Factors influencing

survival after out-of-hospital cardiac arrest. Journal of the American College of

Cardiology 7: 752-757.

31

Welsh Health Planning Forum. (1991) Protocol for investment in health gain:

Cardiovascular disease. Cardiff: Welsh Office.

Wik L., Kramer-Johansen J., Myklebust H., Sorebo H., Svensson L., Fellows B. et

al. (2005). Quality of cardiopulmonary resuscitation during out-of-hospital cardiac

arrest. JAMA 293: 299-304.

32

Statement of Ethical Approval

This study was granted “light touch” ethical approval by the Thames Valley

University Ethics Committee in June 2006.

Contact point – (FHHS) Chair – Heather Loveday. heather.loveday@tvu.ac.uk

This document was added to the Education-line database on 30 January 2009

33