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European Journal of Education Studies
ISSN: 2501 - 1111
ISSN-L: 2501 - 1111
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Copyright © The Author(s). All Rights Reserved. 133
DOI: 10.46827/ejes.v10i3.4712
Volume 10 │ Issue 3 │ 2023
FIRST AID TRAINING AT EARLY CHILDHOOD:
A REVIEW OF LITERATURE
Eleana Tse1
i
,
Katerina Plakitsi2,
Spyridon Voulgaris1,
George A. Alexiou1
1Department of Neurosurgery,
University of Ioannina,
School of Medicine,
Greece
2Department of Early Childhood Education,
School of Education,
University of Ioannina,
Greece
Abstract:
By teaching first aid at school, the number of bystanders can be increased. Researchers
are attempting to identify effective educational methods to teach first aid to children. The
literature review examines published studies to provide information on the content of
kindergarten first aid training. MEDLINE, Scopus, and ERIC were the major databases
searched for related literature published between January 2003 and November 2022. The
first aid interventions were varied in content and aimed to improve students' first aid
knowledge, skills, and attitude. Combining both theoretical and 'hands-on' training
components into the education process was discovered to be a critical factor in delivering
material. More research is needed to determine the role of first aid education in
kindergarten, as well as interventions for knowledge and skill retention.
Keywords: first aid, program, early childhood education, children
1. Introduction
Every day, severe and minor accidents occur all over the world. In many cases, it is critical
to provide immediate first aid assistance. A quick response can mean the difference
between life and death, or it can simply reduce the severity of an injury. Responders
(namely bystanders) must have the necessary knowledge and skills in order to provide
an immediate and efficient response in these cases. Nonetheless, many bystanders do not
know how to react, owing to a lack of first aid knowledge, skills, and confidence (Cheng
i
Correspondence: email e.tse@uoi.gr
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 134
et al., 2021). As a result, increasing the number of properly educated bystanders is a key
challenge for improving the effectiveness of first aid (Eisenburger & Safar, 1999). The
implementation of a first aid culture in society and the expansion of first aid educational
channels are two options for addressing this challenge. Today, the primary channels of
first aid education are primarily private and Red Cross, which can make education
prohibitively expensive for those who cannot afford it. According to research, school can
play a positive role in this direction (Kuvaki, 2018; Ammirati, 2014; Eisenburger & Safar,
1999).
By teaching first aid at school, the number of bystanders can be increased
(Berthelot et al., 2013; Fleischhackl et al., 2009; Jones et al., 2007; Connolly et al., 2007;
Frederick et al., 2000). Individuals who receive first aid education at a young age are more
likely to retain this knowledge and skills as they grow older (Cheng et al., 2021; Kuvaki,
2018). Furthermore, children can be bystanders; thus, first aid education may improve
their effectiveness in responding to accidents. For example, many accidents occur on the
playground, during school breaks, and at home (Jaffe et al., 2021). Finally, schools can
expand free first aid educational channels so that more people have access to first aid
training. The International Scientific Community is conducting research on the education
of children in first aid (Böttiger et al., 2017; Beck et al., 2016; Böttiget & Van Aken, 2015;
Bohn et al., 2013). Evidence suggests that after receiving an appropriate education,
children may be able to provide first aid (Perkins et al., 2021; Lukas et al., 2016; Cave et
al., 2011). Their education includes both resuscitative and non-resuscitative programs;
however, resuscitation is usually the primary focus of this education (Semeraro et al.,
2018; He et al., 2014; Hill et al., 2009).
Researchers are attempting to identify effective educational methods based on
children's age groups, teaching methodologies, and trainer characteristics (i.e., first
aiders, doctors, or school teachers). Another area of interest is evaluating the effectiveness
of educational programs using the following criteria: study design, program duration,
facilitator, content, methods of outcome measurement, material, potential outcome, and
limitations. The current paper examines six previously published studies on first aid
training for young children at kindergarten in order to provide information about the
focused areas and methods used in first aid education in accordance with the criteria
mentioned above. More specifically, the purpose of this paper is to provide information
on which criteria are at the center of current research and which criteria have been less
addressed or ignored. Researchers can use the findings of this literature review to plan
and conduct studies in specific areas, allowing them to optimize their research strategy
for filling existing research gaps.
2. Material and methods
A thorough literature search was carried out in several relevant major databases,
including MEDLINE, Scopus, and ERIC. We conducted a search using the keywords "first
aid training OR first aid program." The search was carried out in December 2022. Based
on the inclusion and exclusion criteria presented in Table 1, two independent researchers
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 135
(ET, GA) reviewed the obtained studies. Differences of opinion between the first two
researchers were resolved by consensus. The inclusion criteria were met by a total of six
peer-reviewed articles.
Table 1: Inclusion and exclusion criteria
Criteria
Inclusion
Exclusion
Language
English
Other languages
Children
4-6 years old
Over 7 years old
Type of articles
Original research
Review, Survey
Types of schools
Kindergarten, preschool
Primary school
Database
PubMed, Scopus, ERIC
Grey literature, another database
4. Results
The current literature review investigates first aid programs in early childhood
education. We found only five studies. Bollig et al. (2011) collected data using a mixed-
methods approach that included both quantitative and qualitative methods. It was a
small pilot study with only ten kindergarten students. An observational cohort study was
used in this study. The first aid course consisted of six lessons (30-40 minutes per week)
taught by a first aid instructor and a kindergarten teacher. The teaching program's
curriculum included basic first aid knowledge and cardiopulmonary resuscitation, which
included mouth-to-mouth/mouth-to-nose breathing. Chest compressions and
defibrillation were not included in the program. A poster and a glove puppet were
important teaching tools. A test scenario was used to measure outcomes two months after
the training intervention, and observation was used after seven months. When
schoolchildren demonstrated first aid knowledge and skills in everyday situations,
teachers take notes. According to the findings of the pilot study, 4-5-year-old children can
learn and apply basic first aid. First aid courses could begin at this age, according to Bollig
et al. (2011), even though their study had major limitations, such as a small number of
participants and no control group to compare the outcomes.
Ammirati et al. (2014) performed their study by conducting a comparative study
with trained and untrained students (N=285 students). The course had no set duration,
and it was taught by a teacher. Before teaching first aid in the classroom, the teachers
completed a six-hour first aid training program. The teaching program's curriculum
consisted solely of calling an ambulance. There was no mention of teaching methods.
They used photographs to evaluate the program two months after it was implemented.
The images were unfamiliar to trained students and thus could not have been planned in
time. Ammirati et al. (2014) discovered that trained students were better than the control
group at describing an emergency and raising the alert. The authors suggested that first
aid courses should be integrated into the school curriculum, beginning at the age of four,
and taught by schoolteachers. Many biases favored the trained group in this study, such
as a significant drop in untrained children from follow-up.
Banfai et al. (2018) used a longitudinal cohort study for their intervention. A
paramedic provided the first aid course, which consisted of three 45-minute sessions per
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 136
week. Knowledge and skills were transferred in small groups (8-10 children per group).
The teaching program's curriculum included calling an ambulance, basic life support
(BLS), automated external defibrillator (AED), handling an unconscious patient, and
managing severe bleeding. The authors used an open-ended questionnaire as well as
observations to evaluate the program. The study was conducted before, immediately
after, four, and fifteen months after the program. The findings revealed a significant
improvement in knowledge, skills, attitudes, and information retention up to 15 months
after the intervention. It was the only study that taught cardiopulmonary resuscitation
(CPR) to children of these ages. They advised that, while young children cannot perform
proper CPR, it is beneficial to learn some aspects of resuscitation because this knowledge
is essential in the event of a true emergency. Because this study was conducted in only
one kindergarten, there is no representative sample. Furthermore, it is unknown how
preschool students would react in an actual emergency.
Plischewski et al. (2021) carried out an experiment. They assessed Norwegian
kindergarten teachers' attitudes toward 'Henry first aid training,' as well as the impact on
3-6-year-olds' understanding of first aid. Henry is a first-aid program for young children
that has been distributed for free to 5,200 kindergartens in Norway. The program
included a puppet, a small first-aid kit, a memory stick containing three Henry songs,
and a set of posters. The teaching program's curriculum included calling for assistance,
recognizing an emergency, staying safe, and alerting adults. Henry is taught to the
students by the teacher. Participants were chosen based on the fact that they had never
used Henry in kindergarten. Researchers interviewed a small group of children, and
follow-up interviews were conducted three months later. According to the findings of
this study, children's understanding of first aid improved after participating in the
program. There is no control group and no random assignment in this study.
Mohajervatan et al. (2020) conducted an observational study. Training consisted
of ten sessions (45 minutes each) over five weeks, with two sessions per week transferring
theoretical knowledge and scenario-based practical first aid skills. Experienced nurses
instructed the first aid course. The curriculum of the teaching program included how to
deal with an accident scene and knowing emergency phone numbers, airway
management, assessment of the condition of consciousness, victim position recovery,
control of nose bleeding, and control of hands or feet bleeding. The authors of this study
created a questionnaire to assess each child's performance in a scenario through
observation. The evaluation was carried out both before and three weeks after the
training. They indicate that children can learn basic first aid skills such as calling an
ambulance, handling an unconscious patient, and dealing with severe bleeding. This
study lacked a representative sample, and the authors did not conduct long-term follow-
up with the participants.
Tse et al. (2022) conducted a randomized controlled trial. Researchers randomly
picked 24 children aged 4-5 years from one kindergarten and assigned them to one of two
groups: training or control. There were three lessons in the training program. The
children in the training group were given a questionnaire one day before, one day after,
two and six months after the training, and once to those in the control group. Prior to the
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 137
training, there was no significant difference in the questionnaire scores between the two
groups. The children in the training group outperformed the children in the control
group on the questionnaire after the lessons. The scores of the children in the training
group had decreased but remained higher than before the training and higher than those
of the control group two and six months later. The study's limitations included the small
sample size and the fact that the control group was not tested over time, so there could
have been changes if they were all in the same school. Finally, because the survey was
not validated, it may not be applicable to other kindergarten populations.
5. Discussion
The studies examined in this paper yielded interesting conclusions about the content of
the interventions, the instructors (facilitators), and the study's limitations in terms of
several methodological issues (e.g. sample, study design).
5.1 Content
The interventions had a mixed content. Studies have shown that both resuscitative and
non-resuscitative programs can provide early childhood children with first aid training
(Tse et al., 2022; Plischewski et al., 2021; Mohajervatan et al., 2020; Bánfai et al., 2018;
Ammirati et al., 2014; Bollig et al., 2011). Furthermore, all of the studies reviewed
included training on how to call an ambulance. The research was limited to teaching basic
life support skills, and some programs included injury-related issues. It was discovered
that incorporating both theoretical and 'hands-on' training components into the
education process was an important factor in delivering material (Reveruzzi, Buckley &
Sheehan, 2016). It is worth noting that one study investigated head injuries, despite the
fact that the head is the most injured part of the body at this age (Jaffe et al., 2021).
Furthermore, no study found that first aid training had a negative effect on students.
Overall, the intervention content differed between studies (He, Wynn & Kendrick, 2014).
As a result, it is impossible to say which type of training is more effective.
5.2 Educators
Studies had different facilitators to teach first aid to young children and it was indicated
that both first aid instructors and teachers had positive outcomes on students' first aid
knowledge, skills, and attitude. It is encouraging that the first aid instruction could be
provided by teachers themselves in case they have the proper first aid education (Lukas
et al., 2016). Teachers as facilitators may result in reduced cost, since it is a cost-effective
method to increase the number of bystanders (i.e. no extra cost for external facilitators).
However, no study assessed students’ outcomes based on the type of facilitators. Hence,
it cannot be concluded which type of educators may be more effective.
5.3 Limitations
There were several limitations in terms of population, study design, knowledge and skill
retention, and comparison groups. Population limitations included small groups that
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 138
were not representative of the kindergarten population (Tse et al., 2022; Mohajervatan et
al., 2020; Bánfai et al., 2018; Bollig et al., 2011). Four of the studies found no evidence of
knowledge or skill retention. Ammirati et al. (2014) conducted an insufficient program
information study. Bollig et al. (2011), Plischewski et al. (2021), and Mohajervatan et al.
(2020) did not use a control group in their pilot study. The control group and follow-up
rates differ significantly in the comparative study conducted by Ammirati et al. (2014).
The studies by Banfai et al. (2018) and Tse et al. (2022) are the only ones that assessed
students' prior first aid knowledge and skills. Finally, no study included a power analysis
to ensure statistically significant results.
6. Conclusions
This article conducted a literature review that investigated first aid programs in early
childhood education. Many researchers have concentrated on teaching older students
first aid (Cheng et al, 2021; Tse & Alexiou, 2021; Tse et al., 2022; Tse et al., 2023). Children
in early childhood education, on the other hand, can learn basic safety behavior, attitude,
skills, and knowledge that will serve them well in adulthood (Tse & Alexiou, 2021). Even
though the studies reviewed show that teaching first aid should begin at a young age,
several research questions remain unanswered, including the time period for which first
aid training knowledge is retained in children's memories, which instructor is more
effective (first aid experts or teachers), when the program should be repeated, and
whether the intervention program is actually effective in improving students' knowledge,
skills, and attitudes toward first aid.
One more important aspect that must be carefully considered when investigating
teaching first aid in early childhood is students' reactions in real-life first aid situations
after participating in educational programs. As a result, there is a need to assess how the
children would react in real-life scenarios and what aspects of training should be
prioritized and intensified in order to improve students' effective reactions in real-life
situations. As a result, research should concentrate on real-world scenarios to provide
data that will aid in making early childhood first aid training more effective.
To summarize, the current study found that kindergarten first aid programs
improve students' knowledge and skills. However, several aspects have not been
investigated, making it impossible to produce scientific and robust results. Given the
small number of studies that have been conducted in this research area, as well as the
limitations discussed above, there is a need for additional research in this area.
Acknowledgements
Author Contributions: Conceptualization, GA and ET.; methodology, GA, ET, KP; formal
analysis, GA, ET.; investigation, ET, GA.; data curation, GA, SV, ET, KP, writing—
original draft preparation, ET, GA; writing—review and editing, ET, GA, SV, KP,
supervision, GA. All authors have read and agreed to the published version of the
manuscript.
Eleana Tse, Katerina Plakitsi, Spyridon Voulgaris, George A. Alexiou
FIRST AID TRAINING AT EARLY CHILDHOOD: A REVIEW OF LITERATURE
European Journal of Education Studies - Volume 10 │ Issue 3 │ 2023 139
Funding Statement
This research received no external funding
Conflicts of Interest Statement
The authors declare no conflict of interest.
About the Authors
Eleana Tse, PhD student, Department of Neurosurgery, School of Medicine, University
of Ioannina, Greece.
Katerina Plakitsi, Professor, Department of Early Childhood Education, School of
Education, University of Ioannina, Greece.
Spyridon Voulgaris, Professor, Department of Neurosurgery, School of Medicine,
University of Ioannina, Greece.
George Alexiou, Associate Professor, Department of Neurosurgery, School of Medicine,
University of Ioannina, Greece.
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