Pediatric first aid knowledge and attitudes among staff in the preschools of Shanghai, China

Abstract

Unintentional injury remains the leading cause of morbidity and mortality among children worldwide. The aims of this study were to assess a baseline level of first aid knowledge and overall attitudes regarding first aid among staff members in Shanghai preschools.
A cross-sectional study was carried out among the staff members at selected preschools. A stratified random sampling method was first used to identify suitable subjects. Data were obtained using a multiple-choice questionnaire. A standardized collection of demographics was performed and participants were given the aforementioned questionnaire to indicate knowledge of and attitudes toward first aid.
1067 subjects completed the questionnaire. None of the surveyed employees answered all questions correctly; only 39 individuals (3.7%) achieved passing scores. The relative number of correct answers to specific questions ranged from 16.5% to 90.2%. In particular, subjects lacked knowledge regarding first aid for convulsive seizures (only 16.5% answered correctly), chemical injuries to the eye (23%), inhaled poison (27.6%), and choking and coughing (30.1%). A multiple linear regression analysis showed scores were significantly higher among staff members with more education, those who had received first aid training before or were already healthcare providers, younger employees, and staff members from rural districts. Most employees agreed that giving first aid was helpful; the vast majority felt that it was important and useful for them to learn pediatric first aid.
The level of first-aid knowledge among preschool staffs in Shanghai was low. There is an urgent need to educate staff members regarding first aid practices and the various risk factors relating to specific injuries.

Full text

R E S E A R C H A R T I C L E Open Access
Pediatric first aid knowledge and attitudes among
staff in the preschools of Shanghai, China
Feng Li
1,2
, Fan Jiang
1*
, Xingming Jin
1
, Yulan Qiu
3
and Xiaoming Shen
4*
Abstract
Background: Unintentional injury remains the leading cause of morbidity and mortality among children
worldwide. The aims of this study were to assess a baseline level of first aid knowledge and overall attitudes
regarding first aid among staff members in Shanghai preschools.
Methods: A cross-sectional study was carried out among the staff members at selected preschools. A stratified
random sampling method was first used to identify suitable subjects. Data were obtained using a multiple-choice
questionnaire. A standardized collection of demographics was performed and participants were given the
aforementioned questionnaire to indicate knowledge of and attitudes toward first aid.
Results: 1067 subjects completed the questionnaire. None of the surveyed employees answered all questions
correctly; only 39 individuals (3.7%) achieved passing scores. The relative number of correct answers to specific
questions ranged from 16.5% to 90.2%. In particular, subjects lacked knowledge regarding first aid for convulsive
seizures (only 16.5% answered correctly), chemical injuries to the eye (23%), inhaled poison (27.6%), and choking
and coughing (30.1%). A multiple linear regression analysis showed scores were significantly higher among staff
members with more education, those who had received first aid training before or were already healthcare
providers, younger employees, and staff members from rural districts. Most employees agreed that giving first aid
was helpful; the vast majority felt that it was important and useful for them to learn pediatric first aid.
Conclusions: The level of first-aid knowledge among preschool staffs in Shanghai was low. There is an urgent need
to educate staff members regarding first aid practices and the various risk factors relating to specific injuries.
Keywords: First aid, Preschool staff, Knowledge
Background
Injuries and accidents are the leading causes of death in
children worldwide [1]. Children are prone to uninten-
tional injuries [2] and are at a higher risk of experiencing
injuries, because their bodies are developing and they
have not yet learned to be aware both of themselves and
various environmental dangers. Because children spend
a significant portion of their day in child-care centers,
pediatric emergencies such as the exacerbation of exist-
ing medical conditions or accidental physical injuries are
more likely to occur in those settings [3]. Unintentional
injuries, such as falls, bruises, and bumps likewise occur
in child-care programs. Schools and playgrounds are the
most common location for falls (40.4%), and approxi-
mately 39% of reported injuries in child-care settings in-
volve bites [4]. In the United States, annual injury rates
range from 0.7 to 5.1 injuries per child [5]. Injury alone
accounts for almost one half of all deaths in preschool-
aged children in the USA [6,7]. In China, injury accounts
for a third of all deaths in children aged 1 to 4 years,
and one half of all deaths in children between 5 to
9 years of age [8]. The rate of accidental injury was
10.94% among preschool children in Shanghai; the most
* Correspondence: fanjiang@shsmu.edu.cn;xmshen@online.sh.cn
1
Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric
Translational Research Institute, Shanghai Children's Medical Center affiliated
Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory
of Children’s Environmental Health, MOE-Shanghai Key Laboratory of
Children's Environmental Health, Ministry of Education, China, 1678
Dongfang Rd, Shanghai 200127, China
4
Shanghai Institute for Pediatric Research, Xinhua Hospital affiliated Shanghai
Jiaotong University School of Medicine, Shanghai Key Laboratory of
Children's Environmental Health, MOE-Shanghai Key Laboratory of Children's
Environmental Health, Ministry of Education, China, 1665 Kongjiang Rd,
Shanghai 200092, China
Full list of author information is available at the end of the article
© 2012 Li et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Li et al. BMC Pediatrics 2012, 12:121
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common injuries included falls, collisions and extru-
sions, and sprains [9]. Compared to non-school-based
emergency medical service (EMS) incidents, school-
based EMS incidents are more often attributable to in-
jury, more often related to a sports activity, and more
often result in transport to a medical facility [10]. Most
injuries in preschools are require only first aid treatment
[11]; therefore, preschools are important locations to
focus on the prevention of injuries and diseases in chil-
dren, because situations requiring first aid are often
encountered there. Leila et al. described the first aid
used and resulting clinical outcomes of all patients who
arrived at a children’s hospital with an acute burn injur-
ies [12]. They found that correct first aid was associated
with significantly reduced re-epithelialization time for
children with contact injuries; likewise, some positive
clinical outcomes were associated with correct first-aid
use. This shows there is a need for a higher public
awareness of correct first-aid treatments. Administering
correct and timely first aid to patients after accidents is
vital and can potentially save lives [13,14]. In schools,
staffs are often first-aid providers it has become import-
ant to determine the current perceptions held by school
staff concerning children’s accidents [15].
Trained individuals who are closest to the scene of the
accident should administer first aid, first aid training for
regulated day care providers may contribute to children's
health and safety [16]. A pediatric first aid training pro-
gram for the staff members at Shanghai preschools has
already begun. This program will equip all 35,000 current
preschool employees in Shanghai with medical first aid
knowledge and skills. Concurrent with the training pro-
gram, a baseline survey was conducted on the preschool
staff members. The goal of the current study was therefore
to use questionnaires to evaluate preschool employees'
knowledge of and attitudes toward first aid measures for
the management of ill and injured children.
Methods
Subjects
This study included employees working in preschools in
Shanghai, China. In China, no distinction is made between
preschools and day care centers. Preschools in China op-
erate on a full-day basis and thus serve as both an educa-
tional and childcare institutions. There are a total of 1193
preschools in Shanghai, employing 35,000 teachers,
healthcare providers (persons with some medical know-
ledge; they are generally not doctors), and directors.
Shanghai has 18 districts and one county; a stratified ran-
dom sampling method was used to obtain 1282 subjects.
The number of staff members in each district or county
was selected based on the proportion of staffs in the dis-
trict or county. Of the total 35,000 preschool employees in
Shanghai, 54.2% work at public schools, 29.1% at private
schools, and 16.7% at other types of schools. In each dis-
trict or county, preschools are classified as public, private,
or other. In the district or county, the employees from
each preschool category were selected according to the
proportion of the types of schools present in the district
or county. A local children’s hospital undertook the strati-
fied sampling process. The selected 1282 employees were
invitedtomeetatthechildren’shospitalwithhelpfrom
the local education authorities. Finally, 1067 of 1282
volunteers participated in this study. A cross-sectional sur-
vey was conducted to assess subjects for the first aid man-
agement of ill or injured children using a self-filled
questionnaire. The participants were not allowed to check
any reference materials. All participants provided written
informed consent. The institutional review board of
Shanghai Children's Medical Center approved this study,
and the research was carried out in compliance with the
Helsinki Declaration.
Procedures
The data were collected by questionnaire, which was
divided into three sections. Section A focused on demo-
graphic information of the participants. Section B was
comprised of 37 simple-choice questions on the know-
ledge of the treatment of common children’s emergen-
cies. The questions were written using a PedFACTs
textbook [17] and an instructor's resource manual pub-
lished by American Academy of Pediatrics [18]. Partici-
pants were instructed to select the best answer from a
choice of four options. One point was awarded for each
correct answer, with no credit given for unanswered
questions or an answer of “Not Sure”. Total scores were
computed as a sum of each item score and then standar-
dized to a range of 0–100. A score of 80% or greater was
required to pass, in accordance with examination guide-
lines from the American Academy of Pediatrics. Section
C addressed attitudes toward first aid, including three
questions apiece on attitudes towards learning and also
administering first aid. Participants responded using a
five-point scale ranging from disagreement to agreement
(1 –Completely Disagree; 2 –Partly Disagree; 3 –Neutral;
4–Partly Agree; and 5 –Completely Agree.). These
questions were taken from another first-aid training
study [19]. For the percentages of those who agreed,
codes 4 and 5 were combined; for percentages of those
who disagreed, codes 1 and 2 were combined.
Data analysis
All data were entered into the Statistical Package for the
Social Sciences for Windows (Version 11.0, Chicago, IL,
U.S.) for statistical analysis. The results of the question-
naire are expressed as frequency distributions and were
computed in percentages. A comparison of the scores
based on groups was performed with an analysis of
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variance or Student's ttest as needed. A multiple linear
regression analysis was performed to assess the inde-
pendent contributions of factors associated with the
knowledge scores: age, district (urban/rural), type of
school (public/other), highest level of education (high
school and below/college and above), staff category
(healthcare providers/teachers), and previous first aid
training (received/not). P< 0.05 was considered statisti-
cally significant for all analyses.
Results
Section A: demographic information
A total of 1067 subjects participated in and completed this
study. Of the sample group, 0.3% of the subjects were male
and 99.7% were female. In our samples, 66.7% of partici-
pants were employees at public schools, 21.8% at private
schools, and 10.5% at other types of schools. There was no
statistically significant difference between our sample and
the total preschool staff in Shanghai (χ2=3.848,P=0.146).
A total of 69.2% of the group had not taken any first-aid
training courses before. The demographic characteristics
of the participants are listed in Table 1.
Section B: Knowledge
The average scores differed significantly across staff
categories. Healthcare providers had higher scores
(Table 1). Subjects who had received first-aid training be-
fore had a higher level of knowledge than those who had
not. The average scores were significantly different among
participants from different districts, participants of differ-
ent ages, participants from different preschools, and parti-
cipants who had different levels of education (Table 1).
None of participants surveyed answered all questions
correctly. An average score of 56.7 ± 12.4 was documen-
ted. Only 39 individuals (3.7%) achieved passing scores.
Accurate answers to each specific question ranged from
16.5% to 90.2% (Table 2). Subjects especially lacked
knowledge regarding first aid for convulsive seizures
(only 16.5% aware), chemical injuries to the eye (only
23% aware), inhaled poison (only 27.6% aware), choking
and coughing (only 30.1% aware), and bites to the
tongue (only 38.8% aware). Only 21% knew to first sur-
vey the scene when dealing with an accident. Correct
responses regarding first-aid for fainting (41.2% in total,
44.1% of healthcare providers, 36.5% of teachers) and
heatstroke (42.1% in total, 41.7% of healthcare providers,
42.7% of teachers) were also low. When faced with cases
of inhaled poison, only 27.6% of staff described appropri-
ate first aid. Accurate responses to first aid on other
common emergencies are shown in Table 2.
Results of the multiple linear regression analysis
showed the knowledge score to be significantly higher
among staff who had higher education levels (t= 2.069,
P= 0.039), who were from rural districts (t=−3.785,
P< 0.001), who had received first aid training before
(t= 2.506, P= 0.012), those who were already healthcare
providers (t= 4.546, P< 0.001), and younger personnel
(t=−4.185, P< 0.001) (Table 3).
Table 1 Demographic characteristic of the staff and average scores of subgroups
Characteristics N (%) Mean ± SD t/F P
District (N = 1067) 18.031 <0.001
Urban 591 (55.4%) 55.3± 12.1
Rural 476 (44.6%) 58.5± 12.6
Age (years) (N = 1067) 19.091 <0.001
≤30 304 (28.5%) 59.4± 12.1
31–40 369 (34.6%) 57.5 ± 12.1
≥41 394 (36.9%) 53.8± 12.3
Highest education level (N = 1064) 17.643 <0.001
High school or below 278 (26.1%) 54.1± 11.6
College or above 786 (73.7%) 57.7± 12.5
Staff categories (N = 1067) 25.582 <0.001
Healthcare providers 662 (62.0%) 58.2± 12.4
Teachers 405 (38.0%) 54.3± 12.1
Received first aid training
*
(N = 1065) 14.521 <0.001
No 738 (69.2%) 55.8± 12.5
Yes 327 (30.6%) 58.9± 11.9
Types of school (N = 1067) 9.562 0.002
Public 722 (67.7%) 57.5 ± 12.5
Others 345 (32.3%) 55.0± 12.1
*
Those with unknown data for the specified characteristics are excluded from this table.
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Table 2 Relative number of correct responses to study questions
First aid knowledge Healthcare providers No. (%)
(N = 66)
Teachers No. (%)
(N = 405)
Total, No. (%)
(N = 1067)
Percentage of correct responses from <30%
Convulsive seizures——position the child on
his left side first
119 (18.0) 57 (14.1) 176 (16.5)
Survey the scene first in the accidents 143 (21.6) 81 (20.0) 224 (21.0)
Inhaled poison——remove the child from
the toxic area first
203 (30.7) 91 (22.5) 294 (27.6)
Chemical injury to eye——put on disposable
gloves and flush the chemical from the eye
with lukewarm water
158 (23.9) 87 (21.5) 245 (23.0)
Percentage of correct responses from 30% to 60%
Choking and coughing child——do nothing,
except reassure the child and observe the
child closely
202 (30.5) 116 (28.6) 318 (30.1)
Caring for a choking child, call EMS after 2 minutes
of performing first aid care
253 (38.2) 142 (35.1) 395 (37.0)
Bites to the tongue ——apply pressure with
a piece of gauze or cloth to stop the bleeding
296 (44.7) 118 (29.1) 414 (38.8)
Fainting——lay the child on his or her back
and loosen any tight clothing
292 (44.1) 148 (36.5) 440 (41.2)
Heatstroke——cool the child immediately
and call EMS
276 (41.7) 173 (42.7) 449 (42.1)
reduce infection by flushing the injured area
with running water;
289 (43.7) 169 (41.7) 458 (42.9)
before CPR, determine that breathing and
coughing are absent
346 (52.3) 211 (52.1) 557 (52.2)
Insect stings——move the child to a safe area
and remove any stingers
387 (58.5) 212 (52.3) 599 (56.1)
Nosebleeds——pinch the soft parts of the nose
and press against the bones of the face
423 (63.9) 211 (52.1) 634 (59.4)
Penetrating injury to eye——call EMS 408 (61.6) 230 (56.8) 638 (59.8)
Percentage of correct responses >60%
Punctures——Soak the wound in clean water 455 (61.2) 250 (61.7) 655 (61.4)
Swallowed poison——remove traces of
the poisonous from the child’s mouth first
and then call EMS
444 (67.1) 270 (66.7) 714 (66.9)
Bleeding——place firm, direct pressure on
the wound
472 (71.3) 250 (61.7) 722 (67.7)
Dog bites——care for the wound and
check with animal control officer
496 (74.9) 248 (61.2) 744 (69.7)
Spinal injury——avoid moving the child at all,
and keep the neck and back aligned
524 (79.2) 327 (80.7) 851 (79.8)
Burns——place the burned area in cool water 552 (83.4) 318 (78.5) 870 (81.5)
Electrical burns——turn off the power
source if possible and call EMS
554 (82.2) 335 (82.7) 879 (82.4)
Bone injury——rest and call EMS 562 (84.9) 341 (84.2) 903 (84.6)
Keeping dangerous materials in
an inaccessible place and locked up
605 (91.4) 353 (87.2) 958 (89.8)
Swelling——apply cold, then wrap
and elevate the injured body part
614 (92.7) 348 (85.9) 962 (90.2)
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Section C: Attitudes
For attitudes towards administering first aid, the majority
felt positive toward providing first aid. Regarding attitudes
towards learning first aid, the vast majority felt that it was
important and useful skill for them to learn (Table 4).
Discussion
The results of our study indicate overall staff knowledge
of first aid to be lacking, evidenced by the low but visible
frequency of incorrect responses to common illnesses
and injuries. The American Academy of Pediatrics has
set 80% as the passing level in its written knowledge
exam of pediatric first aid training for caregivers and
teachers. According to that criterion, only 3.7% of the
surveyed teachers had an adequate knowledge of first
aid. Questions related to splinters (incorrect rate: 61.4%),
nosebleeds (59.4%), Insect stings (56.1%), fainting
(41.2%), reducing infection by flushing the injured area
with running water (42.9%), heatstroke (42.1%), bites to
the tongue (38.8%), inhaled poison (27.6%), and chemical
injury to the eye (23.0%) were most often answered in-
correctly. With regard to a child swallowing poison, if
the victim vomits, the insulting substance may cause
more damage as it passes through the esophagus a sec-
ond time. Induction of emesis is wrong and harmful
[20], but many of the study participants thought it ap-
propriate. In cases of poisoning, 33% of the staff mem-
bers in our study would not take both the child and the
poison bottle directly to the hospital. In the present
study, the rate of correct answers to questions about
convulsive seizures was lowest; only 16.5% of responders
would act to first protect the head. Similarly, Dantas in
Brazil demonstrated that teachers’knowledge about the
clinical characteristics and initial procedures to attend a
person during a seizure was also unsatisfactory [21].
Fewer than 13% of them knew to protect the head.
Childhood encounters with bees, wasps, yellow jackets,
hornets, and fire ants can be a natural consequence of
children's curiosity and exploration. In most cases, insect
stings do not require medical attention. However, a se-
vere allergic reaction to an insect sting can occur very
quickly, without warning, and can be life-threatening.
Insect bites, especially bee stings, can be fatal in short
periods of time if the injured person has an extreme sen-
sitivity and is not given first aid immediately [17]. Mild
allergic reactions include hives and swelling, but death
can occur from edema of the respiratory system [22,23].
This study determined that 43.9% employees did not
know to remove bee stingers immediately, and only
56.1% of employees in the study knew to move the child
to a safe area and remove any stingers. With regard to
heatstroke, 42.1% of responders knew to cool the child
immediately and call EMS. Heatstroke can develop sud-
denly, and an infant or child with heatstroke will have a
body temperature of 106 °F or higher. Once the sweat
glands' ability to produce sweat is exhausted, the skin
may be dry and hot. If the body temperature does not go
down, brain damage and death can occur [17]. In cases
of choking and coughing, the number of incorrect
responses was disturbing (30.1%). The course of action
for dealing with a casualty who is choking but also
breathing is to allow him or her to continue coughing,
because they still have a clear airway [22,24]. An infant
or child with a partially blocked airway continues to
breathe, but will usually be coughing. Coughing is the
body's way of removing what feels like a foreign object.
When there is an object in the airway, forceful coughing
is more effective than anything anyone else can do to
get the object to move up and out of airway [17]. But
most responders indicated that they would clap the
child's back. Prior studies regarding the knowledge of
Table 4 Pediatric first aid attitudes of staff
Statement (figures are expressed in percentages) N
*
Disagree Neutral Agree
Attitudes towards giving first aid
That I should give first aid is fair 1037 2.1 3.8 94.1
That I should give first aid is unpleasant 1027 86.7 4.9 8.4
That I should give first aid is very good 1028 5.4 7.4 87.2
Attitudes towards learning first aid
It is good for me to learn first aid 1039 0.6 1.2 98.2
It is useful for me to learn first aid 1040 0.4 0.3 99.3
It is important for me to learn first aid 1043 0.5 0.7 98.8
*
N denotes the number with valid answers (i.e. excludes those who left blanks or indecipherable answers).
Table 3 Multiple regression analysis of factors associated
with score of knowledge
Beta Standard error tP-value
College education or above 0.766 0.370 2.069 0.039
Urban districts −1.054 0.278 −3.785 <0.001
Received first aid training before 0.790 0.315 2.506 0.012
Working at a public school 0.287 0.311 0.921 0.357
Age −0.781 0.187 −4.185 <0.001
Healthcare providers 1.382 0.304 4.546 <0.001
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first aid knowledge among preschool staffs have been
scarce. In the U.S., Gagliardi et al. has indicated that
most teachers are deficient in knowledge of emergency
care and basic life support modalities [25]. A study con-
ducted in Turkey evaluating the first aid knowledge and
attitudes of 312 primary school teachers showed that
most of the teachers lacked accurate knowledge about
first aid [22]. Physical education teachers at schools in
Ireland also showed poor knowledge of how to treat
children during emergencies [23].
Injury is a common cause of morbidity and mortality
in children. Prompt, appropriate treatment can help de-
crease this morbidity and mortality. Because children
spend the majority of their day in school, teachers
should be proficient in basic first-aid skills. In this study,
only 30.6% of the study participants had ever received
first-aid training before; however, they only had been
trained in cardiopulmonary resuscitation and not in the
treatment of common children’s injuries. The results of
a study carried out by Gagliardi on the extent of training
and emergency care knowledge of public school teachers
in the U.S. indicated that one-third of surveyed teachers
had no specific training in first aid, and 40% had never
been trained in cardiopulmonary resuscitation [25]. This
is also in keeping with other studies from North Amer-
ica, which found that 30% of teachers had no specific
training in first aid, and 40% had never been trained in
CPR [26,27]. One U.S. study found that only 75% of
child care center administrators surveyed reported that
first aid training was required for their staff, and only
15% of child care centers serving children with special
care needs required its staff to be CPR-certified [3]. In
the U.S., approximately half of all child care centers do
not have specific written procedures for urgent medical
emergencies, such as severe bleeding, unresponsiveness,
poisoning, shock, heart or circulation failure, seizures,
head injuries, anaphylaxis, or allergic reactions [3]. The
American Academy of Pediatrics recommends that at
least one staff member who has successfully completed
training in pediatric first aid be in attendance at all times
and in all places where children are present. Injury stud-
ies conducted at childcare centers have demonstrated
that the most common injuries are minor and that se-
vere injuries requiring medical attention comprise only
1% to 7% of the total injuries [28,29]. The most common
injuries in childcare centers reported in the literature in-
clude fractures, lacerations, contusions, and dental injur-
ies [30,31]. One study reported that 84% of injuries
occurring in the child care settings required first aid
treatment [11]. More effort should be made to increase
first aid and CPR training for childcare center staff
members, because many emergencies can be managed
with these lifesaving skills. Our results clearly demon-
strate there are grave deficiencies in the provision of first
aid for children among preschool staffs in Shanghai. The
lack of formal and effective emergency care training in
teacher preparation programs coupled with a lack of
continuing education requirements is one possible ex-
planation for these results [25]. Using data from the
present study, a comprehensive campaign should be
planned for Shanghai.
The current findings show that healthcare providers
scored very high on the questionnaire, which is likely
related to the fact that healthcare providers by definition
have pre-existing medical knowledge. Younger employ-
ees also scored higher, which may be due to younger
employees frequently possessing higher educational
levels and having already been exposed to newer know-
ledge regarding first aid. Performing proper first aid is a
fairly complex set of tasks. Knowledge is necessary but
not sufficient. While the attitudes towards giving first
aid is assumed to be of direct importance to perform-
ance in first-aid situations, the attitudes towards learning
first aid may be of greater, if indirect importance [19].
Our survey showed that most teachers’attitudes towards
giving or learning first aid were positive, but it remains
necessary to increase their actual first aid knowledge
and skills. Improvement in child care centers' prepared-
ness to respond to emergencies and disasters should in-
clude maintaining the immediate availability of
potentially life-saving medications and ensuring that all
child care center employees are trained in first aid and,
where appropriate, CPR [3]. Pediatricians should take an
active role in training first responders in pediatric as-
sessment and CPR, and assist preschools in developing
disaster plans. Teaching first aid offers an opportunity to
educate childcare providers and teachers about risk fac-
tors for specific injuries. Identification and actions taken
to reduce risk delivered alongside first aid training may
reduce the overall rate of child injury.
This study has several limitations. The primary limita-
tion is that the investigation of 1067 employees in
Shanghai is not representative of other parts of China,
largely because there are significant socio-economic dis-
parities between China’s western and eastern provinces;
Shanghai is one of the most developed cities in China.
Similar studies conducted throughout the country are
necessary. Our study was also limited in that it did not
evaluate staff members' skills in implementing first aid.
This was because most of our participants had none.
First aid knowledge alone does not ensure proper con-
duct during an emergency.
Conclusions
Although this study shows that the level of first aid
knowledge among personnel who care for children was
low, it also shows that they are interested in obtaining
proper training. There is an urgent need to educate
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preschool staffs about first aid practices and the risk fac-
tors related to specific injuries. We would recommend
that pediatric first aid training be made more widely
available to the preschool staffs.
Abbreviations
EMS: Emergency medical services; PedFACTs: Pediatric first aid for caregivers
and teachers; SD: Standard deviation; No: Number.
Competing interests
The authors have no conflicts of interest.
Authors' contributions
FJ and XMS conceived and designed the study, coordinated data collection
and reviewed the manuscript. FL carried out the study, collected data,
analyzed the data, and drafted the manuscript. FJ and XMJ conducted the
field work. All authors read and approved the final manuscript for
publication.
Acknowledgements
The authors would like to thank the study participants. Assistance was given
by the American Academy of Pediatrics and Shanghai Local Education
Authority. The study was supported by Ministry of Science and Technology
of China (2010CB535000); Chinese National Natural Science Foundation
(81172685); Shanghai Science and Technology Commission (10QA1404800),
and Shanghai Municipal Committee of Education (11SG19,HJTY-2010-A09).
Author details
1
Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric
Translational Research Institute, Shanghai Children's Medical Center affiliated
Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory
of Children’s Environmental Health, MOE-Shanghai Key Laboratory of
Children's Environmental Health, Ministry of Education, China, 1678
Dongfang Rd, Shanghai 200127, China.
2
Department of Children and
Adolescents Health Care, Xin Hua Hospital affiliated Shanghai Jiaotong
University School of Medicine, Shanghai Key Laboratory of Children's
Environmental Health, MOE-Shanghai Key Laboratory of Children's
Environmental Health, Ministry of Education, China, 1665 Kongjiang Rd,
Shanghai 200092, China.
3
School of Public Health affiliated Shanghai
Jiaotong University School of Medicine, 227 South Chongqing Rd, Shanghai
200025, China.
4
Shanghai Institute for Pediatric Research, Xinhua Hospital
affiliated Shanghai Jiaotong University School of Medicine, Shanghai Key
Laboratory of Children's Environmental Health, MOE-Shanghai Key
Laboratory of Children's Environmental Health, Ministry of Education, China,
1665 Kongjiang Rd, Shanghai 200092, China.
Received: 18 January 2012 Accepted: 3 August 2012
Published: 14 August 2012
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doi:10.1186/1471-2431-12-121
Cite this article as: Li et al.:Pediatric first aid knowledge and attitudes
among staff in the preschools of Shanghai, China. BMC Pediatrics 2012
12:121.
Li et al. BMC Pediatrics 2012, 12:121 Page 7 of 7
http://www.biomedcentral.com/1471-2431/12/121