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ARE SCHOOLS AND TEACHERS PREPARED TO RESPOND TO HEALTH EMERGENCIES IN CHILDREN? A QUESTIONNAIRE STUDY IN MANGALORE, INDIA

Authors:
Arathi Rao at Manipal Academy of Higher Education
Arathi Rao
Ashwini Rao at Manipal Academy of Higher Education
Ashwini Rao
Ramya Shenoy at Manipal Academy of Higher Education
Ramya Shenoy
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Abstract

Objective: To evaluate the preparedness of the schools and teachers to respond to medical and dental emergencies in children. Materials & method: A questionnaire was administered to teachers and heads of schools. Results: About 92% of them reported that they were not confident in dealing with the situation. None of the schools had a written protocol for emergency management. Conclusion: This study shows that teachers as well as schools are not prepared to deal with health emergencies.
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ISSN 2320-5407 International Journal of Advanced Research (2014), Volume 2, Issue 11, 1123-1126
1123
Journal homepage: http://www.journalijar.com INTERNATIONAL JOURNAL
OF ADVANCED RESEARCH
RESEARCH ARTICLE
ARE SCHOOLS AND TEACHERS PREPARED TO RESPOND TO HEALTH
EMERGENCIES IN CHILDREN? A QUESTIONNAIRE STUDY IN MANGALORE,
INDIA
Dr. Arathi Rao1, Dr. Ashwini Rao2*, Dr. Ramya Shenoy3
1. Professor & Head of Paedodontics
2. Professor & Head of Public Health Dentistry
3. Associate Professor in Public Health Dentistry
Manipal College of Dental Sciences, Mangalore, Manipal University
Manuscript Info Abstract
Manuscript History:
Received: 19 September 2014
Final Accepted: 28 October 2014
Published Online: November 2014
Key words:
Medical emergencies, school
teachers, school children
*Corresponding Author
Dr. Ashwini Rao
Objective: To evaluate the preparedness of the schools and teachers to
respond to medical and dental emergencies in children. Materials &
method: A questionnaire was administered to teachers and heads of schools.
Results: About 92% of them reported that they were not confident in dealing
with the situation. None of the schools had a written protocol for emergency
management. Conclusion: This study shows that teachers as well as schools
are not prepared to deal with health emergencies.
Copy Right, IJAR, 2014,. All rights reserved
Introduction
Teachers in schools have a responsibility to ensure that students gain the knowledge and skills they require to
become effective learners and ultimately effective and responsible citizens and understand and appreciate the values
and beliefs. It is important that every school and teacher actively participate in the protection, safety and welfare of
students, thus helping to create the foundation for an effective learning environment. An average school aged child
spends 28% of the day and 14% of his or her annual hours in school1. During school hours, in addition to minor
injuries; children might experience health emergencies in the form of status asthmaticus, diabetic crises, status
epilepticus, cardiac crisis, tooth avulsion, fractures of teeth or jaw and so on.2,3 Schools need to be ready to identify
these medical and dental emergencies and should have a protocol in place to handle any untoward incidences. The
objective of the present study was to evaluate the preparedness of the schools and teachers in Mangalore, India to
respond to medical and dental emergencies in children.
MATERIALS AND METHOD
A self - administered questionnaire comprising of 9 items was administered to teachers and a 7 item interview
schedule was administered to the heads of the school. Demographic details regarding age, sex, years of teaching
experience and total hours spent in school were also obtained.
A total of 22 primary schools with 1000 teachers were selected by random sampling and questionnaires were
distributed to the teachers, with a response rate of 75%. The interview schedules were answered by all heads of the
22 schools. Data was analyzed using the statistical package for social sciences (SPSS) version 11.
RESULTS
A total of 750 teachers and 22 schools took part in the study. Among the teachers, 300 were male, 450 were female,
75% of them belonged to the 30-40 year age group and the average teaching experience was 13 + 3 years.
ISSN 2320-5407 International Journal of Advanced Research (2014), Volume 2, Issue 11, 1123-1126
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Preparedness of teachers:
It was astonishing to know that almost 90% of the teachers had not received any formal training in the management
of health emergencies. (Fig 1)
We found that 89% of the teachers could not identify symptoms of head injury and dehydration. With respect to
allergies, although about 80% of the teachers knew that children may be allergic to certain food items and insect
bites, very few of them knew that smelling flowers (40%) and sweeping floors (23%) could also cause allergy in
children. (Table 1)
Regarding awareness about contact sports related injuries, only 2% of the teachers knew that being unable to bite
his/her upper and lower teeth properly after trauma might be a sign of jaw fracture whereas only 15% of the teachers
knew that a tooth should be stored in milk or water before being re-implanted back into the socket. The study also
showed that in spite of 67% of the teachers reporting encountering medical or dental emergencies in their teaching
experience, 92% of them reported that they were not confident in dealing with the situation. (Table 1)
Preparedness of Schools:
When we conducted interviews of the heads of the schools, we found that although all schools maintained medical
records pertaining to immunization / illness of children, only 22% of the schools reported maintaining records of the
emergency events at school. None of the schools recommended any specific precaution during contact sports such as
helmets or mouth guards, but 90% of the heads of the schools reported that they advocated safe playground and
class rooms. All the schools reported that in the event of any medical or dental emergency, the child would be taken
to hospital and the parents informed. Almost half of the schools which participated in our study reported to have a
full fledged hospital within a radius of 5 kms, but none of the schools had a written protocol for emergency
management nor a pre identified doctor on call in case of an emergency. (Table 2)
TABLE 1: PREPAREDNESS OF TEACHERS IN HANDLING HEALTH EMERGENCIES
Item
Right answer
Wrong answer
If a child falls while on a balancing bar and is conscious
but is not able to move his/her head, the child is probably
suffering from...
83 (11%)
667 (89%)
If a child is made to stand out in the hot sun for long
periods and he / she collapses, the child is probably….
82 (11%)
668 (89%)
Can you please tick the actions to which you feel a child
may develop allergic reaction…..
83 (11%)
667 (89%)
During contact sports if a permanent tooth falls out due
to injury, the action to be taken immediately….
113 (15%)
637 (85%)
Following playground injury to the face, if the child is
not able to bite his/her upper and lower teeth properly, it
means that….
15 (2%)
735 (98%)
Are you confident in handling medical / dental
emergencies in a child
60 (8%)
690 (92%)
Have you encountered any medical / dental emergencies
in your teaching experience
503 (67%)
247(33%)
ISSN 2320-5407 International Journal of Advanced Research (2014), Volume 2, Issue 11, 1123-1126
1125
TABLE 2: PREPAREDNESS OF SCHOOLS IN HANDLING HEALTH EMERGENCIES
Item
Yes
No
Schools which make note of children with medical
illness
22 (100%)
0
Schools which maintain records of medical / dental
emergencies during school hours
5 (23%)
17(77%)
Schools which advocate safe play ground and class
rooms
20 (91%)
2 (9%)
Schools where parents are informed following medical /
dental emergencies during school hours
22 (100%)
0
Schools where there are written protocols to handle
medical / dental emergencies
0
22 (100%)
Schools which have pre-identified a doctor on call in
case of medical / dental emergencies
0
22 (100%)
Schools which have a well - equipped hospital within 5
Kms from school
12 (55%)
10 (45%)
DISCUSSION
It is estimated that 10% to 25% of injuries to children occur while they are in school2. Pediatric emergencies such as
the exacerbation of medical conditions, behavioral crises, and accidental/intentional injuries are therefore likely to
occur more often during school hours.2,3 In addition, the increase in the number of children with special health care
needs and chronic medical conditions can present with a gamut of emergencies that may require special equipment,
preparation and training of personnel, medications and supplies, and/or transport decisions and arrangements3. It is
thus the responsibility of the school to provide safety and first aid in the school premises.
The American academy of Paediatrics and the American Heart Association have published guidelines for emergency
medical care in schools stressing the need for school teachers to establish emergency response plans to deal with life
threatening emergencies in school1. Despite its critical importance, school emergency preparedness is frequently
inadequate in Indian schools because of non existence of proper guidelines for management of such emergencies
coupled with barriers such as lack of physical facility, staffing, education and training, and inadequate financial
resources4.
This study was carried out to evaluate the level at which the schools and the teachers of Mangalore city are ready to
respond to medical and dental emergencies in children. It is very necessary for the schools to provide education and
training to teachers in identifying and managing emergencies in school. The training also need to be reinforced at
regular intervals. Sapien et al5 demonstrated improvement in school teachers' confidence level in recognizing
respiratory distress in asthmatic children and knowledge of asthma medications after attending educational sessions
consisting of video footage and didactic teaching. In the present study we found that majority of the teachers were
not able to identify common injuries that a child may face in school. Children tend to play continuously in sunlight
forgetting to drink water and this may lead to severe dehydration. Teachers need to know and understand to provide
drinking water and identify symptoms of dehydration. It is important that teachers recognize the symptoms, provide
first aid and identify the need to hospitalize the child as and when needed.
In our study, only 23% of the teachers could correctly identify all the causes for allergy. Teachers need to be trained
in identifying cases of allergy and its prevention. From the dental health point of view, avulsion of tooth following
injury is very common, and many teachers were not aware that the avulsed permanent tooth could be placed back in
the socket. Fracture of the jaws or any other bones needs stabilization through first aid. Education seems to be the
need of the hour, when it comes to medical and dental emergency management in schools. Teachers need to be
trained to identify health emergencies like allergic reactions, chocking, fractures and asthamatic attacks.
According to Sapien and Allen1, 67% of the schools in New Mexico report emergencies yearly and Knight et al7
reported that injuries account for a majority of school-based emergency calls. Olympia and Wan6 reported that four
of the six most commonly reported school emergencies were related to trauma (extremity sprain, extremity fracture,
head/neck injury, laceration), whereas shortness of breath and seizures were the most common medical complaints.
In the present study many teachers had encountered dental emergencies in schools and although the schools have a
system of recording health related issues, the documentation of the actual event and follow up is absent. In the
ISSN 2320-5407 International Journal of Advanced Research (2014), Volume 2, Issue 11, 1123-1126
1126
present study all the schools were concerned about play ground and class room safety but they did not have a written
plan for management of emergencies nor did they recommend mouth guards and helmets.
According to the study by Olympia et al8 in Pennsylvania, seventy percent of schools had a Written Emergency Plan
(WEP), but almost 36% of them do not practice the plan.
Since athletic trainers or physical educators are present during all athletic events, they can be made the one point
contact for such emergency management in schools. Children with special health care needs need special attention
with regards to prevention and management of emergencies.
CONCLUSION
The results of the study shows that teachers as well as schools are not prepared to deal with health emergencies
arising during school hours. Presence of children with special needs in schools necessitates the need for specific
protocol and ready resources to handle emergencies. It is time that the National Council for Teacher Education
(NCTE, India) take up the issue and provide training to teachers in identification and management of medical and
dental emergencies as well as issue guidelines and make it mandatory for all the schools to have an written
emergency management protocol and to strictly follow them.
RECOMMENDATIONS
Identify the existing medical problems in children and obtain more information about their condition.
Adequate record keeping.
Develop written emergency management protocol and a point of contact in school.
Regular training of the teachers in identification and management of medical and dental emergencies.
REFERENCES
1. Sapien RE, Allen A. Emergency preparation in schools: a snapshot of a rural state. Pediatr Emerg Care.
2001;17(5):329–333.
2. Loyacono TR. Responding to school emergencies. Emerg Med Serv. 2005; 34(4):43–44.
3. Olympia R P, Wan E, Avner JR. The Preparedness of Schools to Respond to Emergencies in Children: A
National Survey of School Nurses. Pediatrics 2005;116 (6): e738-e745.
4. Karande N, Shah P, Bhatia M, Lakade L, Bijle MN, Arora N, Bhalla M. Assessment of awareness amongst
school teachers regarding prevention and emergency management of dentoalveolar traumatic injuries in
school children in Pune City, before and 3 months after dental educational program. J Contemp Dent
Pract. 2012 Nov 1;13(6):873-7.
5. Sapien RE, Fullerton-Gleason L, Allen N. Teaching school teachers to recognize respiratory distress in
asthmatic children. J Asthma. 2004;41 :739 –743.
6. Olympia RP, Wan E. The preparedness of schools to respond to emergencies in children: A national survey
of school nurses. Pediatrics 2005: Vol. 116 No. 6; e738-e745.
7. Knight S, Vernon DD, Fines RJ, Dean JM. Prehospital emergency care for children at school and
nonschool locations. Pediatrics. 1999;103 (6):e81
8. Olympia RP, Dixon T, Brady J. Emergency Planning in School-Based Athletics: A national survey of
athletic trainers. Pediatric Emergency Care: 2007; Volume 23 (10):703-708.
... To authors' knowledge, there is yet an established conceptual framework which links the concept of infrastructure, knowledge and skill to represent the preparedness of ECCE educators. However, based on past studies (Alshehri, Alluwaim, & Alyahya, 2018;Bashir & Bakarman, 2014;Elaziz & Bakr, 2009;Ezeonu, Okike, Anyansi, & Ojukwu, 2017;Olympia, Weber, Brady, & Ho, 2017;Rao, Rao, & Shenoy, 2014), safety infrastructure, teachers' knowledge and skills towards safety and health related emergencies were repeatedly investigated to measure the preparedness of schools. ...
... In parallel, the preparedness of school staff towards health related issues was measured based on the knowledge and practice in first aid of the staff (Bashir & Bakarman, 2014). Another set of research further bolstered the need to incorporate knowledge as a construct in the health and safety preparedness framework when they revealed that majority of teachers and head of schools answered wrongly when questioned about health and safety issues (Rao, et al., 2014). On regards to the infrastructure, the availability of fire extinguisher, school clinic, school safety monitoring, and first aid box was considered as the primary indicators of preparedness towards health and emergency (Ezeonu, et al., 2017). ...
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Prehospital Emergency Care for Children at School and Nonschool Locations
Article
The purpose of this study was to ascertain whether school-based emergency medical services (EMS) incidents are different from nonschool-based EMS incidents for school-aged children. We examined South Dakota EMS incident reports involving children ages 5 to 18 years old from 1994 through 1996 (n = 12603). Patient characteristics, dispatch reason, primary medical complaint, injury type, contributing factor of injury, and performed interventions were analyzed. During the study period, there were 140455 total EMS incident reports, of which 12603 (9.0%) were for school-aged children. EMS dispatches to a school represented 755 (6.0%) of all EMS incidents for school-aged children. The number of school-based EMS incidents was highest at the beginning of the school year, whereas the number of nonschool-based EMS incidents was highest during the summer months. School-based EMS incidents peaked at noon, whereas nonschool-based EMS incidents peaked after school. For both locations, the average age of the patient was 14 years old. The dispatch reason for school-based EMS incidents differed from those for nonschool-based EMS incidents. The top three school-based EMS dispatch reasons were falls (36.2%), other trauma (27.0%), and medical illness (24.5%). Motor vehicle crashes (30.8%), medical illness (26.2%), and other trauma (11.4%) were the leading nonschool-based EMS dispatch reasons. Injuries accounted for a significantly greater proportion of school-based than nonschool-based EMS incidents (70.7% vs 62.6%). Excluding pain, the most frequent type of injury was a fracture or dislocation in school-based EMS incidents and open soft-tissue injury in nonschool-based EMS incidents. A total of 11 students sustained an injury resulting in paralysis. The body region that was most commonly injured was a lower extremity (23%) in school-based incidents, whereas the head was the most commonly injured body region in nonschool-based incidents (20%). Sports were the largest contributing factor in school-based incidents, whereas alcohol/drug use was the largest contributing factor in nonschool-based EMS incidents among school-aged children. A medical illness was the primary complaint for 206 (27.3%) of the school-based incidents and 3599 (30.4%) of the nonschool-based incidents. The chief medical complaints were breathing difficulty (18.4%), seizure (16%), and other illness (12.3%) for school-based EMS incidents. Other illness (20.0%), breathing difficulty (13.7%), and abdominal pain (12.0%) were the chief complaints for nonschool-based EMS incidents. Treatment was rendered by the EMS provider in 11 753 (93.3%) of the incidents. Frequency of EMS intervention was the same for school-based incidents and nonschool-based incidents. Transportation to a medical facility was more frequent in school-based incidents than nonschool-based incidents. Compared with nonschool-based EMS incidents, school-based EMS incidents are more often attributable to injury, more often related to a sports activity, and more often result in transport to a medical facility. Understanding the characteristics of school emergencies resulting in an EMS dispatch may help emergency medical providers be better prepared for school-based incidents. School personnel may benefit from increased knowledge about the EMS system and EMS programs. In addition, EMS incident data may provide useful information about school-based injuries and may provide a means for injury surveillance.
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Emergency preparation in schools: A snapshot of a rural state
Article
  • Nov 2001
To study emergency preparedness in public schools in a rural state. Questionnaires were mailed to school nurses registered with the State Department of Education. Data collected included school nurse and staff training, school location, emergency equipment available, and Emergency Medical Service (EMS) access. Seventy-two percent of the surveys were returned after one or two mailings. They report little emergency training for both school nurses and school staff. Emergency equipment available varies widely: oxygen 20%, artificial airways 30%, cervical collars 22%, splints 69%. Equipment was more likely to be available in communities with populations of less than 200,000. Sixty-seven percent of schools activate EMS for a student and 37% for an adult annually. Eighty-four percent of schools have a less than 10-minute EMS response time. EMS activation to schools is a common occurrence. Schools are ill prepared to care for this acuity of student or staff as assessed by equipment and emergency training. Schools in smaller communities, however, are better prepared for emergencies.
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Teaching School Teachers to Recognize Respiratory Distress in Asthmatic Children
Article
  • Oct 2004
To demonstrate that school teachers can be taught to recognize respiratory distress in asthmatic children. Forty-five school teachers received a one-hour educational session on childhood asthma. Each education session consisted of two portions, video footage of asthmatic children exhibiting respiratory distress and didactic. Pre- and posttests on general asthma knowledge, signs of respiratory distress on video footage and comfort level with asthma knowledge and medications were administered. General asthma knowledge median scores increased significantly, pre = 60% correct, post = 70% (p < 0.0001). The ability to visually recognize respiratory distress also significantly improved (pre-median = 66.7% correct, post = 88.9% [p < 0.0001]). Teachers' comfort level with asthma knowledge and medications improved. Using video footage, school teachers can be taught to visually recognize respiratory distress in asthmatic children. Improvement in visual recognition of respiratory distress was greater than improvement in didactic asthma information.
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Emergency Planning in School-Based Athletics: A National Survey of Athletic Trainers
Article
  • Nov 2007
  • PEDIATR EMERG CARE
To use nationally published guidelines to examine the preparedness of schools in the United States to respond to emergencies associated with school-based athletics. A questionnaire, mailed to 1000 randomly selected members of the National Athletic Trainers' Association, included questions on the clinical background of the athletic trainer, the demographic features of their school, the preparedness of their school to manage life-threatening athletic emergencies, the presence of preventative measures to avoid potential sport-related emergencies, and the immediate availability of emergency equipment. Of the 944 questionnaires delivered, 643 (68%) were returned; of these, 521 (81%) were eligible for analysis (55% usable response rate). Seventy percent (95% confidence interval [CI], 66-74) of schools have a Written Emergency Plan (WEP), although 36% (95% CI, 30-40) of schools with a WEP do not practice the plan. Thirty-four percent (95% CI, 30-38) of schools have an athletic trainer present during all athletic events. Sports previously noted to have higher rates of fatalities/injuries based on published literature, such as ice hockey and gymnastics, had, according to our data, less coverage by athletic trainers compared with other sports with lower rates of fatalities/injuries. Athletic trainers reported the immediate availability of the following during athletic events: cervical spine collar (62%, 95% CI, 58-66), automatic electronic defibrillator (61%, 95% CI, 57-65), epinephrine autoinjector (37%, 95% CI, 33-41), bronchodilator metered-dose inhaler (36%, 95% CI, 32-40). Although schools are in compliance with many of the recommendations for school-based athletic emergency preparedness, specific areas for improvement include practicing the WEP several times a year, linking all areas of the school directly with emergency medical services, increasing the presence of athletic trainers at athletic events (especially sports with a higher rate of fatalities/injuries), regulating the care of and inspection of school facilities and fields, requiring the use of safety equipment (such as mouth guards and protective eye equipment), and increasing the availability of automatic electronic defibrillator in schools.
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