Background
Methods
Selection of first aid topics
Systematic literature searches and study selection
Data extraction, data synthesis and quality assessment
Making a first draft of the educational pathway
Consensus meeting and finalizing the educational pathway, based on the best available evidence
Development of teaching materials
Results
Study identification and study characteristics
Best available evidence on the effectiveness of first aid training to children
Author, year, Country | Study design | Population | Comparison | Outcomes |
---|---|---|---|---|
Campbell, 2001, USA [25] | Experimental: randomised controlled trial | Nr. of participants: 660 students (51% males, 49% females) Age range: 11–16 years | Intervention: Programme: First aid and home safety training Control: Programme: Tobacco and alcohol prevention programme | Measured before, immediately after and 1 year after training: Knowledge: Emergency response procedures (check-call-care); First aid kit Skills: Responses to two audio-recorded scenarios (glass wound, burn injury). Type and order of responses were scored: Check the scene and victim; Call 911; Care for the victim Attitude: First aid confidence |
Frederick, 2000, UK [26] | Experimental: controlled before after study | Nr. of participants: 1096 students (gender not reported) Age range: 10–11 years | Intervention: Programme: Injury Minimization Program for Schools (IMPS) Control: No intervention | Outcomes were measured before and 5 months after training: Knowledge: Self-developed quiz Skills: Performance on a basic life support scenario. [only measured post intervention] Attitude: Record observations of dangerous behavior in a video |
Heard, 2013, USA [27] | Observational: cohort study | Nr. of participants: 2747 students (gender not reported) Age range: 10–15 years | Intervention: Programme: Burn care and prevention | Outcomes were measured before (2012) and 11 months after training (2012 resurvey): Knowledge: 10-item survey on burn first aid |
Uray, 2003, Austria [28] | Observational: before after study | Nr. of participants: 47 students (20 males, 27 females) Age range: 6–7 years | Intervention: Programme: First aid training | Outcomes were measured before and immediately after training: Knowledge: Questionnaire in which students had to place three cartoon-like illustrations in the correct sequence |
Wafik, 2014, Egypt [30] | Observational: before after study | Nr. of participants: 100 students (gender not reported) Age range: 11–16 years | Intervention: Programme: First aid training | Outcomes were measured before, immediately after and 2 months after training: Knowledge: 32 item questionnaire. Skills: Performance on five first aid scenarios (choking, burns, poisoning, and fractures) |
Wilks, 2016, Australia [29] | Observational: before after study | Nr. of participants: 107 students (51 males, 56 females) Age range: 11–12 years | Intervention: Programme: First aid, CPR and beach safety training | Outcomes were measured before, 1 week after, and 8 weeks after training: Knowledge: 50-item quiz on emergency services and life-supporting first aid |
Outcome | Comparison | Effect Size | #studies, # participants, age | Reference |
---|---|---|---|---|
A. Burns | ||||
Knowledge: Burns FA | FA training vs no intervention | Statistically significant: 1.5±1.0 vs 1.3±1.0 MD: 0.2, 95% CI [0.08;0.32] (p < 0.001)a in favour of first aid training | 1, 542 vs 554, 10-11 years | Frederick, 2000 [26] |
Knowledge: what to do when clothes catch fire | Pre vs 11 month follow-up | Statistically significant: 1873 (85%) vs 179 (57%) OR: 0·41 b,d (p < 0.01) in favour of first aid training | 1, 2197 vs 312, 10-15 years | Heard, 2013 [27] |
Knowledge: Burns FA | Pre vs 11 month follow-up | Statistically significant: 1820 (83%) vs 258 (83%) OR: 1.83 b,d (p = 0.03) in favour of first aid training | 1, 2197 vs 312, 10-15 years | Heard, 2013 [27] |
Knowledge: Burns FA (score >60%) | Pre vs post | Statistically significant: 5 (5%) vs 99 (99%) e RR: 19.80a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Knowledge: Burns FA (score >60%) | Pre vs 2 month follow-up | Statistically significant: 5 (5%) vs 100 (100%) e RR: 20.00a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Skills: Burns practice (score >60%) | Pre vs post | Statistically significant: 0 (0%) vs 94 (94%) e RR: 189.00a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Skills: Burns practice (score >60%) | Pre vs 2 month follow-up | Statistically significant: 0 (0%) vs 74 (74%) e RR: 149.00a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Skills: Order of FA response | FA training vs sham intervention | Scenario (severe burn injury) Not statistically significant: 5 (3%) vs 1 (0·5%) e RR: 7.52, 95% CI [0.89;63.69]a c (p = 0.06) | 1, 147 vs 221, 11-16 years | Campbell, 2001 [25] |
Skills: Correct procedures listed | FA training vs sham intervention | Scenario (severe burn injury) Not statistically significant: 104 (73%) vs 149 (69%) e RR: 1.05, 95% CI [0.91;1.21]a c (p = 0.49) | 1, 147 vs 221, 11-16 years | Campbell, 2001 [25] |
B. Bleeding | ||||
Knowledge: cuts and bleeding FA | Pre vs 1 week post | Statistically significant: 74 (69%) vs 94 (90%) e RR: 1.33a b (p < 0.001- overall p) in favour of first aid training | 1, 107 vs 102, 11-12 years | Wilks, 2015 [29] |
Knowledge: cuts and bleeding FA | Pre vs 8 week follow-up | Statistically significant: 74 (69%) vs 93 (82%) e RR: 1.28a b (p < 0.001- overall p) in favour of first aid training | 1, 107 vs 105, 11-12 years | Wilks, 2015 [29] |
Knowledge: Haemorrhage FA (score >60%) | Pre vs post | Statistically significant: 34 (34%) vs 97 (97%) e RR: 2.85a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Knowledge: Haemorrhage FA (score >60%) | Pre vs 2 month follow-up | Statistically significant: 34 (34%) vs 92 (92%) e RR: 2.71a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Skills: Order of FA response | FA training vs sham intervention | Scenario (severe glass wound) Statistically significant: 21 (14%) vs 10 (5%) e RR: 3.16, 95% CI [1.53;6.51]a (p < 0.001) in favour of first aid training | 1, 147 vs 221, 11-15 years | Campbell, 2001 [25] |
Skills: Correct procedures listed | FA training vs sham intervention | Scenario (severe glass wound) Not statistically significant: 75 (52%) vs 125 (57%) e RR: 0.90, 95% CI [0.74;1.10]a c (p = 0.41) | 1, 147 vs 221, 11-15 years | Campbell, 2001 [25] |
C. Skin wounds | ||||
Knowledge: cuts and bleeding FA | Pre vs 1 week post | Statistically significant: 74 (69%) vs 94 (90%) e RR: 1·33a b (p < 0.001- overall p) in favour of first aid training | 1, 107 vs 102, 11-12 years | Wilks, 2016 [29] |
Knowledge: cuts and bleeding FA | Pre vs 8 week follow-up | Statistically significant: 74 (69%) vs 93 (82%) e RR: 1.28a b (p < 0.001- overall p) in favour of first aid training | 1, 107 vs 105, 11-12 years | Wilks, 2016 [29] |
Knowledge: Wounds FA (score >60%) | Pre vs post | Statistically significant: 47 (47%) vs 96 (96%) e RR: 2.04a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Knowledge: Wounds FA (score >60%) | Pre vs 2 month follow-up | Statistically significant: 47 (47%) vs 90 (90%) e RR: 1.91a b (p < 0.001) in favour of first aid training | 1, 100, 11-15 years | Wafik, 2014 [30] |
Skills: Order of FA response | FA training vs sham intervention | Scenario (severe glass wound) Statistically significant: 21 (14%) vs 10 (5%) e RR: 3.16, 95% CI [1.53;6.51]a (p < 0.001) in favour of first aid training | 1, 147 vs 221, 11-16 years | Campbell, 2001 [25] |
Skills: Correct procedures listed | FA training vs sham intervention | Scenario (severe glass wound) Not statistically significant: 75 (52%) vs 125 (57%) e RR: 0.90, 95% CI [0.74;1.10]a c (p = 0.41) | 1, 147 vs 221, 11-16 years | Campbell, 2001 [25] |
Best available evidence on the effectiveness of educational interventions in LMIC
Outcome | Comparison | Effect Size | # effect sizes, # studies | Reference |
---|---|---|---|---|
Composite test scores (SMD±SE) | Provision of instructional materials vs no intervention (business as usual) | Not statistically significant: SMD: 0.01±0.01, 95% CI [-0.01;0.02] (p = 0.23) a | 5 effect sizes from 3 studies b | Snilstveit, 2015 [23] |
Language arts test scores (SMD±SE) | Provision of instructional materials vs no intervention (business as usual) | Not statistically significant: SMD: 0.00±0.01, 95% CI [-0.02;0.02] (p = 0.78) a | 5 effect sizes from 4 studies b | Snilstveit, 2015 [23] |
Maths test scores (SMD±SE) | Provision of instructional materials vs no intervention (business as usual) | Not statistically significant: SMD: -0.02±0.02, 95% CI [-0.06;0.02] (p = 0.26) a | 5 effect sizes from 4 studies b | Snilstveit, 2015 [23] |
Learning/testing outcomes (Cohen’s d ± SE) | Use of alternative pedagogical methods vs conventional teaching methods | Statistically significant: Cohen’s d: 0.918±0.314, 95% CI [0.25;1.59] (p<0.05) | 41 effect sizes from 17 studies b | Conn, 2014 [24] |
Cognitive test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Not statistically significant: SMD: 0.01±0.03, 95% CI [-0.04;0.07] (p = 0.66) a | 2 effect sizes from 2 studies b | Snilstveit, 2015 [23] |
Composite test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Statistically significant: SMD: 0.06±0.01, 95% CI [0.03;0.08] (p < 0.0001) | 3 effect sizes from 3 studies b | Snilstveit, 2015 [23] |
Composite test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 1-3 sub-group: Statistically significant: SMD: 0.09±0.02, 95% CI [0.05;0.13] (p < 0.0001) | 2 effect sizes from 2 studies b | Snilstveit, 2015 [23] |
Composite test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 4-5 sub-group: Statistically significant: SMD: 0.08±0.02, 95% CI [0.04;0.12] (p < 0.0001) | 2 effect sizes from 2 studies b | Snilstveit, 2015 [23] |
Language arts test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Statistically significant: SMD: 0.23±0.05, 95% CI [0.13;0.34] (p < 0.001) | 67 effect sizes from 17 studies b | Snilstveit, 2015 [23] |
Language arts test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 1-3 sub-group: Statistically significant: SMD: 0.23±0.06, 95% CI [0.11;0.35] (p < 0.01) | 63 effect sizes from 14 studies b | Snilstveit, 2015 [23] |
Language arts test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 4-6 sub-group: Not statistically significant: SMD: 0.21±0.13, 95% CI [-0.04;0.47] (p = 0.10) a | 4 effect sizes from 4 studies b | Snilstveit, 2015 [23] |
Maths test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Statistically significant: SMD: 0.14±0.03, 95% CI [0.08;0.20] (p < 0.001) | 24 effect sizes from 14 studies b | Snilstveit, 2015 [23] |
Maths test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 1-3 sub-group: Statistically significant: SMD: 0.08±0.03, 95% CI [0.03;0.13] (p < 0.01) | 9 effect sizes from 9 studies b | Snilstveit, 2015 [23] |
Maths test scores (SMD±SE) | Structured pedagogy interventionsvs no intervention or other small educational intervention | Grades 4-6 sub-group: Statistically significant: SMD: 0.21±0.08, 95% CI [0.04;0.37] (p < 0.05) | 4 effect sizes from 4 studies b | Snilstveit, 2015 [23] |
Educational pathway on first aid for sub-Saharan Africa
E: Encourage K: Know/Know How R: Repeat | 5–6 yrs | 7–8 yrs | 9–10 yrs | 11–12 yrs | 13–14 yrs | 15–16 yrs | 17–18 yrs |
---|---|---|---|---|---|---|---|
BURNS | |||||||
Knowledge | |||||||
The children: • recognise a burn | E | K | R | R | R | ||
• know how to provide first aid for a burn (regardless of the degree of the burn) | E | K | R | R | R | ||
• know when to seek medical help for a burn | E | K | R | R | R | ||
• know the difference between a superficial, intermediate and deep burn | E | K | R | R | |||
• know what commonly causes burns (hot water, flames, fire) | K | R | R | R | |||
• know what can cause a burn (heat, chemicals, radiation...) | E | E | E | E | K | R | R |
Skills | |||||||
The children can: • correctly provide first aid for a burn | E | K | R | R | R | ||
• seek medical help if the burn is serious | K | R | R | R | |||
Attitudes | |||||||
The children recognise the importance of: • continuously applying water to a burn | E | K | R | R | R | ||
BLEEDING | |||||||
Knowledge | |||||||
The children know: • what they have to do in the event of a nosebleed | E | K | R | R | R | ||
• when to seek medical help for a nosebleed | E | K | R | R | |||
• how to correctly stop (severe) bleeding | E | K | R | R | |||
• that medical help must always be sought in the event of severe bleeding | E | K | R | R | |||
Skills | |||||||
The children can: • correctly stop a nosebleed | E | K | R | R | R | ||
• apply a bandage to stop (severe) bleeding | K | R | R | ||||
Attitudes | |||||||
The children recognise the importance of • stopping a bleeding as quickly as possible | E | K | R | R | |||
SKIN WOUNDS | |||||||
Knowledge | |||||||
The children: • recognise a skin wound | E | K | R | R | |||
• know which equipment is needed to provide first aid for a skin wound | E | K | R | R | |||
• know when the injured person should seek medical help for a skin wound | K | R | R | R | |||
• know the importance of tetanus vaccinations, and know why tetanus is dangerous and linked with skin wounds | K | R | R | R | |||
• know that an injured person with a skin wound in which a foreign object is embedded should always seek medical help | K | R | R | R | |||
Skills | |||||||
The children can: • correctly provide first aid for a skin wound if clean water is available | E | K | R | R | R | ||
• stop the bleeding of a wound that does not stop bleeding by itself | E | K | R | R | R | ||
• correctly provide first aid for a skin wound in which a foreign object is embedded | K | R | R | ||||
Attitude | |||||||
The children recognise the importance of: • correctly providing first aid for a skin wound in which a foreign object is embedded | E | K | R | R |
Teaching materials for first aid training to children in sub-Saharan Africa
Educational method | Appropriate age groups | Strengths | Limitations | Additional panel remarks | ||
---|---|---|---|---|---|---|
5–8 yrs | 9–12 yrs | 13–18 yrs | ||||
Song | x | x | x | Easy to motivate children; Enables memorization | Passive way of receiving information; Possible lack of knowledge or understanding of the lyrics | |
Quiz | x | x | x | Interactive; Engages all children at the same time | Language and comprehension may be a challenge, particularly for non-first language speakers | Should be adapted to the language spoken by and environment of the children; Local contextually appropriate questions should be created |
Colouring | x | Enables practical rehearsal of the content; Active learning | Children may not have the necessary hand motor skills | 8–12-year-olds could colour, whereas 9–12-year-olds can draw themselves | ||
Poem | x | x | x | Allows for repetition, which enables memorization | Difficult wording might interfere with understanding; Can only be used for key messages | 5–8-year-olds can recite a poem taught to them, whereas at a later age, children may be able to write their own poems |
Puppetry | x | Very visual; Can be engaging, particularly with younger age groups | Difficult to pin content to it; Trainers should be confident with it (time-consuming) | |||
Drawing | x | Some children might not succeed in drawing; Can be time-consuming | The act of drawing should not interfere with learning | |||
Case study | x | x | x | Can come from the learners themselves; Easy to adapt according to age | Not easy to find a case study that fits the content and the context; When analyzing a case study from a learner, must include and manage children’s emotional reactions to the case; Trainers should be taught to run a case study | 5–8-year-olds: incorporate visual elements such as photos 9–12-year-olds: work with a story |
Group work | x | x | x | Peer to peer narration and active involvement; Children can speak in their own language | Some children are quiet when in groups and might not say anything | The social aspect of group work can be initiated at 5–8 years, but group work can only really occur from 9 years of age onwards |
Storytelling | x | x | x | Engaging and entertaining; A story can be adapted to the content and age of the child | If the content is not adjusted to the age group, children may listen without understanding | |
Self-discovery | x | x | x | Experiential learning; May include take-home exercises | Need for clear guidelines before and after activity to ensure that the right lessons are learnt | |
Drama and simulation | x | x | x | Engaging and entertaining | Challenges with group work and holding attention | |
Demonstration | x | x | x | Focus on practical skills (key for First Aid training) | Depending on the size of the group, teachers may not be able to engage everyone; Demonstration needs to be done properly, so teachers need training; Skills may need to be broken down into components, to ensure that learners are able to understand and gain the practical skill | |
Quotes | x | x | Can be used for big groups; − Children have to think independently whether or not they agree with the quote, and will have to take a position |