Knowledge and attitudes of primary school teachers toward first aid in al najaf al-ashraf city thesis 2016

Ministry of Higher Education
and Scientific Research
University of Kufa
Faculty of Nursing
Knowledge and Attitudes of Primary School Teachers
Toward First Aid in Al-Najaf Al-Ashraf City
A thesis Submitted to the Council of Faculty of Nursing at
University of Kufa in Partial Fulfillment of the Requirements for
the Degree of Master in Nursing Science / Community Health
Nursing Department
By
Hussein Mansour Ali Al-Tameemi
Supervised by
Asst. Prof. Fatima Wanas Khudair
B.Sc., MSc., PhD in Community Health Nursing
September 2016 A.D. Dhu al-Qi'dah 1437 A.H.

ِ‫م‬‫ي‬ِ‫ح‬َّ‫الر‬ ِ‫ن‬َْ‫ْح‬َّ‫الر‬ ِ
‫ه‬‫اّلل‬ ِ‫م‬ْ‫س‬ِ‫ب‬
﴿‫ا‬ً‫يع‬َِ‫َج‬ َ‫َّاس‬‫ن‬‫ال‬ ‫ا‬َ‫ي‬ْ‫َح‬‫أ‬ ‫ا‬ََّ‫َّن‬َ‫أ‬َ‫ك‬َ‫ف‬ ‫ا‬َ‫اه‬َ‫ي‬ْ‫َح‬‫أ‬ ْ‫ن‬َ‫م‬َ‫و‬﴾
‫العظيم‬ ‫العلي‬ ‫هللا‬ ‫صدق‬
/‫املائدة‬ ‫{سورة‬‫اآلية‬ ‫من‬ ‫جزء‬32}
‫الما‬
‫ئدة‬

Supervisor Certification
I certify that this thesis, which entitled (Knowledge and Attitudes
of Primary School Teachers Toward First Aid in Al-Najaf Al-Ashraf City),
was prepared under my supervision at the faculty of Nursing, University of
Kufa in partial fulfillment of the requirements for the degree of Master in
Nursing Science.
Supervisor
Dr. Fatima Wanas Khudair
Asst. Professor and Academic Advisor
Faculty of Nursing
University of Kufa
/ / 2016

Dedication
TO
My father and mother with all love and
respect.
My wife and family with all love and
respect.
My advisor (Dr.Fatima Wanas Khudair)
with all my respect.
My dear friends with my love and
respect.
Primary school teachers who accepted to
participant in the study.
Hussein

I
First of all, great thanks for Allah the most merciful the most
compassionate, and the prayer and peace of Allah be upon our Master
and prophet Muhammad and his divine good family, who guided us to
get out of darkness of nescience.
Numerous people have helped and supported me in my
endeavors. Most especially, I wish to express my deepest and grateful thanks to
my supervisor Ass. Professor Dr. Fatima Wanas Khudair, the head of
Community Health Nursing branch in the Faculty of Nursing, University of
Kufa.
I gratefully acknowledge the endless generosity of the experts who kept
me on the right track for their time and expertise in reviewing and evaluating
of study instrument.
I offer my thanks and appreciation to the Directory of Education of Al-
Najaf Al-Ashraf, school principals and school teachers for their collaboration
during the current study.
Also, I would like to recognize the positive efforts and invaluable
assistance of the library staff in the Faculty of Nursing.
Furthermore, my enduring gratitude goes to my father and mother for
their unfailing encouragement, patience, and love.
Finally, special thanks to my dear wife, who was a great supporter for
me during the most difficult circumstances that I faced, and a great tribute to
my kids who were disturbing me during writing this thesis.
Acknowledgments

II
Abstract
Background: Unintentional injuries as well as sudden sicknesses is
one of the important noteworthy reasons that lead to impairments and
mortality in children, particularly those who are in school age. From this
standpoint, primary school teachers’ knowledge about first aid is necessary
in order to be prepared for providing first aid when needed for children
during school time.
Methodology: a descriptive cross-sectional study was applied on
teachers of governmental primary schools in Al-Najaf city. Furthermore; the
study continued from 1st
November 2015 to 4th
September 2016, in order to
assess participants' knowledge and their attitudes toward first aid, as well as,
to find any significant relation for teachers socio-demographic characteristic
with their knowledge and attitude regarding first aid.
By using a simple random sampling, thirty governmental primary
schools were selected randomly, and then 320 primary school teachers were
selected randomly, through an equation used for determining sample size;
finally, the total number of valid questionnaires for analysis were 302.
A questionnaire composed of three parts was used, the first part
included inquiry regarding socio-demographic characteristic of participants,
and the second part included questions concerning knowledge about first aid
which was divided into six domains, while the last part included questions
regarding teachers' attitudes toward first aid and also it was sub-divided into
three domains.
Results: The result showed that from total 302 school teachers
included in the study, 287 (95%) of them had total fair knowledge and only
15 (5%) of participant teachers had poor knowledge, besides no one of them
had good knowledge. With regard to teachers' attitudes towards first aid, the
results showed that 282 (93.4%) of the teachers commonly had a positive

III
attitude toward first aid, while the number of those who owned the negative
attitudes towards the first aid did not exceed twenty teachers, about (6.6%)
of participants.
With respect to the relation of participants’ socio-demographic data
with their knowledge levels no significant association was determined but
for monthly income, while concerning teachers’ attitudes toward first aid
only residency in urban areas and years of experience demonstrated
significant relation to their socio-demographic data.
Conclusions and Recommendations: the final conclusion and
summary of the study showed unsatisfactory knowledge about first aid
among teachers, while, participants generally expressed positive attitudes
toward first aid. Therefore, the researcher recommended to establish a
compulsory training sessions for teachers at the beginning of each academic
year.

IV
List of Contents
Subject
Page
No.
Acknowledgements І
Abstract ІІ-III
List of Contents IV-V
List of Tables VI
List of Figures VII
List of Abbreviations VIII-IX
Chapter One: Introduction 1-7
1.1 Background 2-3
1.2 Importance of the Study 4-5
1.3 Statement of the Problem 6
1.4 Objectives of the Study 6
1.5 Definition of the Terms 6-7
Chapter Two: Review of Literatures 8-48
2. Summary for Review of Literature 9
2.1. Section A (Historical Overview): 10-12
2.2. Section B (Literatures Regarding General Information about
First Aid):
12-21
2.3. Section C (Literatures Regarding Wounds and Bleeding): 22-27
2.4. Section D (Literatures Regarding Bone and Joint Injuries): 27-32
2.5. Section E (Medical Emergencies and Illnesses): 32-41
2.6. Section F (Literatures Regarding Burns): 41-44
2.7. Section G (Literatures Regarding Bites, Foreign Bodies and
Stings):
44-47
2.8. Section K (Literatures Regarding Attitude): 47-48
Chapter Three: Methodology 49-56
3.1. Study Design: 50
3.2. Administrative Arrangements: 50
3.3. Ethical Consideration: 50
3.4. Setting of the Study: 50
3.5. The Sample of the Study: 51
3.5.1. The Sample Size: 51
3.5.2. The Sampling of the Study: 51-52
3.6. Instrument of the Study: 52
3.7. Current Study Validity: 52
3.8. Pilot Study: 53
3.9. Reliability: 53

V
3.10. Data Collection: 53-54
3.11. The Statistical Analysis: 54-56
Chapter Four: Results of the Study 57-77
Chapter Five: Discussion of the Study 78-92
5.1. Socio-Demographic Characteristic and Educational Level of
Participants:
79-81
5.2. Previous Information on First Aid Among Participants: 81-84
5.3. General Information of Primary School Teachers about First
Aid:
84-85
5.4. Teachers’ Knowledge about First Aid for Wounds and
Bleeding:
85
5.5. Teachers’ Knowledge about First Aid for Bone and Joint
Injuries:
85-86
5.6. Teachers’ Knowledge about First Aid for Medical Conditions: 86-88
5.7. Teachers’ Knowledge about First Aid for Burns: 88
5.8. Teachers’ Knowledge about First Aid for Foreign Bodies
(Eyes & Ears), Dog’s Bite and Stings:
88-89
5.9. Teachers’ Overall Knowledge about First Aid: 89-90
5.10. Primary School Teachers’ Attitude Toward First: 90-91
5.11. The Relationship Between Participants’ Overall Knowledge
and Attitude Toward First Aid and Their Socio-Demographic
Characteristic:
92
Chapter Six: Conclusions and Recommendations 93-96
6.1 Conclusions 94
6.2 Recommendations 94-95
References 96-122
Appendices No.
Panel of Experts A
Administrative Arrangements B
Ethical Considerations C
Linguists Certification D
Questionnaire in Arabic E
Abstract In Arabic

VI
List of Tables
Table
No
Table Title Page
3.1 Reliability of the current study instrument 53
4.1 Socio-demographic characteristics of the studied group 58
4.2 Educational level and years of experience of the studied
group
59
4.3 Distribution of Previous and source of Information about first
aid
60
4.4 Responses of participants regarding the general information
about first aid
61
4.5 Responses of participants regarding the first aid of Wounds
and Bleeding
63
4.6 Responses of participants regarding the first aid of Bone and
joint injuries
65
4.7 Responses of participants regarding the first aid of medical
situations
67
4.8 Responses of participants regarding the first aid of Burns 69
4.9 Responses of participants regarding the first aid of bites,
stings & foreign body
71
4.10 Evaluation of teachers’ overall knowledge about first aid in
school
72
4.11 Relationship between overall knowledge of participants and
their socio-demographic characteristics
73
4.12 Responses of participant teachers to questions on attitude
toward first aid
74
4.13 Frequency distribution of domains and overall attitude toward
first aid of participant teachers
75
4.14 Relationship between attitude of participants toward first aid
in schools and their socio-demographic characteristics
77

VII
List of Figures
Table
No
Title of Figure Page
2.1 Priority of Treatment. 15
2.2 First Aid for Nosebleeds. 26
2.3 Types of fractures. 29
2.4.A Fixing with splint only. 31
2.4.B Fixing with both splint and sling. 31
4.1 Distribution of participant teachers according to their
knowledge on general information on first aid.
62
knowledge on first aids for wounds and bleeding.
64
knowledge on first aids for bone and joints injuries.
66
knowledge on first aids of medical situations.
68
knowledge on first aids of burns.
70
knowledge on first aids for bites, stings & foreign bodies.
72
attitude toward first aids in schools.
75

VIII
List of Abbreviations
Abbreviation Meaning
AAP American Academy of Pediatrics
ACEP American College of Emergency Physicians
AD Anno Domini
AHA American Heart Association
AIDS Auto Immune Deficiency Syndrome
ANRCS American National Red Cross Society
BBB Breathing, Bleeding and Bones
BC Before Christ
BSL Basic Life Support
CD Compact Disk
CDC Centers for Disease Control and Prevention
CPR Cardio Pulmonary Resuscitation
CSO Central Statistical Organization
d Level of Significance or Desired Precision
D.M Diabetes Mellitus
e.g. exempli gratia (Latin Words that Means for example)
IQD Iraqi Dinar
NCPP National Committee for Population Policies
NSC National Safety Council
P Estimated Proportion
P Page
P.P Pages
P.value Probability Value
q One Minus estimated proportion
RICE Rest, Ice, Compression and Evaluation
SPSS Statistical Package for the Social Sciences

IX
TV Television
U.K United Kingdom
USA United States of America
WHO World Health Organization
X, 30 Chapter Number from Bible
Z Level of Confidence

Chapter One: Introduction 2
Chapter One
Introduction
1.1. Background:
Injuries and sudden illnesses are an essential issue in public health and
usually occurring at any times of daily life. Besides, school children injuries
take a major part. Unintentional playground injuries occurring during school
hours and includes falls, head injuries, wound bleeding and others (Salminen
et al., 2014). Accidental injuries are usually categorized based on their
happening, for instance: burns, scalds, poisoning, falls and drowning,…etc.
(WHO, 2010). They are also exposed to numerous kinds of epidemiological
factors in the school which impact their current and upcoming condition of
health (Masih et al., 2014).
The first aid is an urgent attention delivered to victims of sudden
illness or injury until medical helps arrive. So that, early treatment of such
emergencies decreases morbidity and deaths among school aged children
(Singer et al., 2004; Abdella et al., 2015; Khatatbeh, 2016).
A significant part of children’s life is school lifetime, which directly
affect their physical and mental health(Thyer, 1996; Olympia et al., 2005).
Unfortunately, school health services are ignored in some countries
particularly the developing ones. This contributes to shortage in awareness
and knowledge regarding sudden illnesses and first aid measures (Bhatia et
al., 2009). Children's times mostly spend in school under direct supervision
of teachers. Consequently, first-aid should be well-known by teachers who
are the key personnel to deal with urgent health needs during school hours.
Healthy harmless environment is very vital to avoid these hazards besides
competent teachers who can identify any health problem and able to provide
first aid for commonly happening emergencies in school (Masih et al., 2014).
The 2005 guidelines for first aid definition is “the assessment and
interventions that can be performed by a bystander (or by the victim)

immediately with minimal or no medical equipment.” (AHA (American
Heart Association ) and ANRCS (American National Red Cross Society),
2005). Another definition adopted in 2014 by American College of
Emergency Physicians (ACEP), which refers to first aid as the actions taken
in response to somebody who is wounded or has unexpectedly become ill
(Piazza, 2014). The primary purpose of first-aid is to reduce suffering, make
healing process possible and decrease damage. So that, the first action taken
to deal with injuries and sudden illnesses decides the upcoming sequences
of illness and complication rates (Goel and Singh, 2008).
The National First-aid Science Advisory Board clarified, everybody
can and must learn first-aid, i.e. education and training in first-aid should be
worldwide. This is recognized by the fact that correctly directed first-aid
means the difference among life and death, early versus late rescue, and
momentary versus long-lasting disability (Lingard, 2002; Singer et al., 2004;
The National First-Aid Advisory Board, 2005). Therefore, teachers must
know the basic rules for first aid as well as the students must be instructed
on first aid (Uskun et al., 2008; Celik, 2013; Sönmez et al., 2014).
Identification of urgent situation and calling for help is an important
issue in first aid, particularly in case of lack or insufficient basic knowledge
about first aid measures for complex situations to be sure that the child will
have a professional medical help (Mahony et al., 2008; Cowan et al., 2010).
Teachers are almost the first and the main caregiver represented the
first line to protect school children, in addition, teachers’ role complements
the parent’s role. School teachers during the school hours, are the real first-
respondent to emergencies, injuries resulting from school accidents.
Therefore, they have to be capable to act accurately with health emergencies
affected the school children (Barrett, 2001; Uskun et al., 2008; Sönmez et
al., 2014).
Consequently, the current study tried to assess the knowledge and
attitude of group of Iraqi primary school teachers in Al-Najaf city.

1.2. Importance of the Study:
Unintentional injuries encountered in the childhood are a global public
health problem and are to be found as a first order among the causes of
mortality and morbidity. Across the world, at least 875 000 children aged
below 18 years decease due to unintentional injuries yearly and more than
95% of these deaths happen in countries with low and middle income levels
(WHO, 2006; Altunda and Öztürk, 2007; İnanç et al., 2008). For example,
in United States of America each year 200,000 schoolchildren are injured
during playing and 70% of cases requires hospitalization, moreover, in
Europe countries as Poland there were 3274 school accidents reported
among 293,000 primary school student every year (Sosnowska and Kostka,
2003; Al-Robaiaay, 2013).
Not only injuries but, chronic childhood illnesses may become
suddenly an emergency during school period. Schools today contains higher
numbers of children with long-lasting and severe illnesses, suffering from
diseases like epilepsy, asthma and diabetes mellitus which are requiring
special attention and urgent care (Bergren, 2010; Allen et al., 2012).
Asthma considered as very public respiratory disorder distressing
school children. WHO has reported that worldwide, around 235 million
people are asthmatic (Govender and Gray, 2012). Depending on Centers for
Disease Control and Prevention (CDC) ten percent of children at USA
schools having asthma, while in south Africa asthma affects 20% of
schoolchildren (Bergren, 2013; Govender & Gray, 2012). Many researchers
recognized impact of teachers’ knowledge on care for asthmatic children. In
USA, inappropriate actions of schoolteachers maybe had an essential part in
the mortality of school children with asthma between 1990-2003. (Tse, 2002;
Greiling et al., 2005; Ones et al., 2006; Govender and Gray, 2012).
In addition, diabetes mellitus is another chronic disease affecting
children and juveniles, and requires continuous monitoring of affected

children and the teachers can play an important role this case (Aycan et al.,
2012; Bergren, 2013).
Likewise, epilepsy is one of most commonly neurological childhood
problems, mostly observed in first decade of life. Worldwide, there are 33
million child suffering from epilepsy. The intense consequence of having
seizure in school can be very hurtful for any child and requires teachers’ first
aid knowledge to deal with (Jacoby, 2002; Bishop and Boag, 2006; Aydemir,
2008; Karimi and Heidari, 2015).
School children are more susceptible to injuries and carry a greater
risk due to developmental and behavioral characteristic including
unawareness of hazards and being active as well as bodily properties
including narrower airways, smaller body mass and thinner and extra
susceptible skin (Peden, 2008).
Global studies have noted a diverse depiction around readiness among
school teachers to apply first aid. In European studies , for instance, the
current philosophy is tending to learn first aid to primary school teachers and
they will in turn transfer such skills and knowledge to their pupils , besides,
poor knowledge, attitude, practice and awareness among school teachers was
observed by many Asian researchers (Bollig et al., 2009; Al-Robaiaay, 2013;
Devashish et al., 2013; Kumar et al., 2013; Ammirati et al., 2014).
There is a lack in scientifically sound data and only few studies are
concerned with this subject in Iraq, in addition, physicians and health care
providers are not present in the school (Al-Robaiaay, 2013).
Therefore, the assessment of knowledge and attitude of primary
schoolteachers and their information regarding first aid will help in
establishment of educational programs and workshops about the first aid,
that resulting in development of their knowledge and attitude toward first aid
with intern reduction in the risk of injuries and enhance life saving for
primary school aged children.

1.3. Statement of the Problem:
Knowledge and attitudes of primary school teachers toward first aid
at Al-Najaf City.
1.4. Objectives of the Study:
1-To assess the level of knowledge and attitude of primary school
teachers toward first aid at primary schools of Al-Najaf city.
2- To identify the relationship between the level of knowledge and
attitudes of primary school teachers toward first aid and their
sociodemographic characteristic (age, gender, residency, marital status,
number of children, monthly income, educational level, years of experience,
previous information about first aid and sources of previous information).
1.5. Definition of Terms:
1.5.1. Knowledge:
a. Theoretical Definition:
Information gained through experience or education (Muneeswari,
2014).
b. Operational Definition:
In this study, the knowledge refers to the ability of teachers to answer
the questions correctly and will be measured through self-administered
questionnaire.
1.5.2. Attitude:
The 2015 American Psychological Association dictionary of
psychology defined attitude as “a somewhat permanent and overall
evaluation of an object, person, group, issue, or concept on a distance
ranging from negative to positive”. Attitudes delivers synopsis judgments of
target objects which are supposed to be resultant from precise beliefs,
feelings, and previous actions accompanied through those objects
(VandenBos, 2015). In another words, “attitudes are evaluative reactions

(positive or negative) toward objects, events, and other people” (Griggs,
2012).
In this study attitudes recognized in the light of responses of primary
school teachers to self-administered questionnaire of five degree Likert scale
with taking into account positive and negative formed questions.
1.5.3. Primary School Teacher:
Primary school teacher is a person who teaches pupils (children under
13 years of age) at the elementary school (Collins English Dictionary, 2016;
Merriam-Webster’s Learner’s Dictionary, 2016).
Primary school teachers who are existed in primary schools of Al-
Najaf city during the period of the study, which they are graduated from
teachers' preparation institutes and colleges and working in primary schools
in the field of education.
1.5.4. First Aid:
Emergency measures to help an ill or wounded person preceding to
obtaining skillful medical care (Marcovitch, 2009), or in another terms it is
“immediate care given to an injured or suddenly ill person, and includes
providing momentary help while waiting for competent medical attention, if
needed is obtained or until the chance for recovery without medical care is
assured” (Thygerson et al., 2011).
In the current study, first aid means knowing about injuries requiring
initial interventions such as wounds, bleedings, epistaxis, fractures, burns, or
electrical shocks, or about sudden illnesses such as epileptic fits, diabetes
emergency or asthma attack, and other incidental matters such as dog bites
or bug stings, etc.

Chapter Two
Review
of literature

Chapter Two: Review of Literature 9
Chapter two
Review of Literature
Review of literature is an essential step in research process. It refers
to a widespread, exhaustive and systematic examination of different
publications related to study issue.
Review of literature, is originated from many sources such as books,
manuals, previous thesis, dissertation, journal articles, encyclopedias,
reports, internet…etc.(Nieswiadomy, 2012). The most vital aim for
conducting review of the literature is to identifying any topics known
regarding the current study, whereas any former studies are located, and the
conceptual framework of the study is formulated. Besides, review of
literature is beneficial in planning the methodology of study (Nieswiadomy,
2012).
In the current study, review of literature was collected and conducted
according to the following:
2.1. Section A: Historical Overview.
2.2. Section B: Literatures regarding general information about first aid.
2.3. Section C: Literatures regarding wounds and bleeding.
2.4. Section D: literatures regarding bone injuries.
2.5. Section E: literatures regarding other medical emergencies and illnesses.
2.6. Section F: literatures regarding burns.
2.7. Section G: literatures regarding bites, foreign bodies and stings.
2.8. Section K: literatures regarding attitude.
Additionally, each of aforementioned sections contained a brief
historical and epidemiological summary for the relevant subject, besides, a
sufficient information on topics of each section and related first aid actions.
Furthermore, each section was ended by revealing some previous studies
which are related to the heading of section.

2.1. Section A (Historical Overview):
First aid skills and expertise as it known today, were recognized back
in history but more simply, particularly during warfare (Pearn, 1994).There
are many evidence and clues across the ancient civilizations about simple
skills used to help injured people instantaneously especially by militaries.
For example, a scene painted on a traditional Greek pottery believed to be
from 500 years BC, shows the greatest Grecian warrior Achilles from Greek
mythology applying bandage to his injured escort Patroclus during the siege
of Troy which is an early example for providing first aid without organized
medical support (Cotterell, 1996). As further evidence during the bronze age
in the middle east, the gospel of St Luke (x, 30) memorialized the good
Samaritan ethical values of assisting persons and efficiency of bandaging
injured people (Pearn, 1994).
Decreasing morbidity and death by applying early first aid, during
wars were a big concern for many ancient militaries. The Roman military
had the most successful experience for emergency medical services to
support their legions, especially under the role of Emperor Augustus (63 BC-
14 AD), who developed such services. The Romans medical services
comprised physicians, surgeons, hygiene officers and bandagers whom
called capsarii, where they had been wearing the same uniforms for the
soldiers, and they trained medically within Legion itself, and because they
were on the front lines their ability to provide accurate first aid had been
effective. Also they were supported by special units of horses, stretcher-
bearers, carriages and wagons to help in transporting wounded soldiers to
field hospital (Eastman, 1992; Gabriel and Metz, 1992).
A major public concern in the late 18th
century directed to the
drowning due to high mortality. So that, a society for protecting peoples’ life
from water accidents started in Amsterdam 1767, and later in 1773, the
physician William Hawes started to publicize the efficiency of artificial

breathing as a way for resuscitation of drowned people, which in turn, led to
founding society for drowned persons in 1774 named the Royal Humane
Society, which had a major contribution in promoting resuscitation (Collins,
2007; Price, 2014).
Hence, the historical roots of first aid as a profession in its own right
belongs to about 120 years ago or few more. In which, military surgeons and
Royal Humane Society instructions’ contributed in first aid evolution (Pearn,
1994).
Later in early 19th
century Baron Dominique Jean Larrey, the
Napoleon’s famous surgeon created ambulance corps and called flying
ambulance in French, in which aimed to provide first aid during battle
(Efstathis, 1999). After that, Jean Henri Dunant witnessed the consequence
of Solferino battle in 24 June 1859 and his future work led to establishment
of Red Cross, which it is still the largest worldwide provider for first aid
(Pearn, 1994).
Credit goes to the development of first aid to the British Surgeon-
Major Peter Shepherd and before him to the Prussian surgeon Friedrich Von
Esmarch. In 1870, Friedrich Von Esmarch was the first person who
introduced an official organized first aid to the Prussian army and used the
term “erste hilfe” which its translation to English means first aid. Also he
trained the soldiers to provide first aid including bandaging and splinting
skills, for wounded comrades during Franco-Prussian war and designed
Esmarch bandage to show the soldiers the accurate way of first aid (Efstathis,
1999).
Thereafter, Shepherd noticed the worth and importance of Esmarch’s
effort, and his new instructions in bandaging and basic first aid skills. So
that, Shepherd quickly developed and extended first aid skills for medical
division in British army. In 1878, Surgeon-Major Peter Shepherd with help
of Colonel Francis Duncan and doctor Coleman, held the first public first aid

course in Woolwich, London. Soon later, the St John Ambulance
Association organized similar classes in other British cities. Consequently,
more than one thousand persons had been trained on first aid within a year.
The members of St John Ambulance Association were the first people whom
used the English term first aid (Pearn, 1994; Efstathis, 1999).
It didn’t take so long after the first public first aid classes to test the
readiness of community in applying first aid, where after nine month of
Shepherd training class Woolwich disasters happened. These two tragedies
despite of high rate of deaths, approved the importance of providing first aid
by people at site of incidence as possible before transporting the victims or
before professional medical helps arrive (Efstathis, 1999).
During the 20th
century and later 21th century many scientific
researches had conducted regarding first aid knowledge and practices
(Langley and Silva, 1986; Gagliardi et al., 1994; Conrad and Beattie, 1996;
Altintaş et al., 2005; Başer et al., 2007; Yurumez et al., 2007; Al-Robaiaay,
2013; Al-samghan et al., 2015; Khatatbeh, 2016).
2.2. Section B (Literatures Regarding General Information
About First Aid):
The concept of first aid, since its modern evolution has formulated
many definitions. Despite of maintaining the essence of the first aid
definition but they began to differ in the built-in as needed, and there became
the existence of the first aid in many practical and scientific fields. The field
of first aid is affected by both training and regulatory constraints. Therefore,
the definition of this scope mutable and could be defined regarding to
surrounding circumstances, needs and regulations (Singletary et al., 2015).
First aid entered many disciplines and become more advanced and multi
diverged such as pediatric first aid, mental health first aid, wilderness first
aid, sport first aid, aquatic first aid and so many other disciplines. For
example of various definitions of first aid, 2004 manual of first aid definition

was “first aid is the temporary and immediate care given to the person who
is injured or suddenly become ill” (Gupta, 2004). Soon later, 2005 California
code of regulation defined first aid as “first aid is any one-time treatment and
any follow up visit for the purpose of observation of minor scratches, cuts,
burns, splinter etc., which do not ordinarily require medical care.” (Kirby
and Mather, 2005).
The 2010 Guidelines for first aid, stated by American heart association
and American red cross defined first aid as “the assessment and interventions
that can be performed by a bystander or by the victim (self-care) with
minimal or no medical tools.” (Markenson et al., 2010). Later American
Academy of Pediatrics set pediatric first aid definition according to their
discipline, it was defined as the initial medical care that you give to a child
who is injured or suddenly become sick (American Academy of Pediatrics,
2012). After that, American heart association and American red cross
updated their definition in 2015 and referred to first aid as assisting activities
and immediate care obtained for severing illness or sudden injury with
purpose of life’s preservation, suffering alleviation, additional illness or
injury deterrence and recovery promotion (Singletary et al., 2015).
First aid is complex and situation specific, so that more informed and
better trained, first aiders are more eligible to deal with unexpected illness
or sudden injury (Saubers and Iannelli, 2008). Thus first aid must be
medically sound and based on scientific knowledge, and in absence of such
knowledge, the expert must be consulted. First aid can be obtained by
everybody and comprises self-care, so that first aider can be any person exist
in the scene of emergency and provides such care like parents, teachers,
policeman, fireman, first responder, professional medic, etc. (Piazza, 2014;
Singletary et al., 2015).
There are three main objectives for first aid, firstly to preserve life, not
merely victim’s life, but first aider’s life as well. Because if first aider put

his/her life in danger might ends up struggling for his own life instead of the
victim’s. Secondly to avoid worsening of condition. The third aim of first
aid is to encourage recovery, which means first aider actions should assist
injured person toward improvement, certainly after preventing situation
from getting worse (Barraclough, 2015).
First aider qualifications include the ability to: first aid needs
estimation, assessment and prioritization; using suitable knowledge, skills
and behaviors to obtain appropriate care; and finally recognition for any
limitation and looking for further care when it’s needed (Singletary et al.,
2015).
The way that the first aider must act during an emergency is an
important issue, these actions according to their priorities are: foremost the
first aider must make sure that the scene of accident is safe and there are no
instant hazards such as fallen electricity lines or hazardous materials; second
action is to check for any life threatening conditions (e.g. severe bleeding,
breathing difficulties or loss of consciousness); then the first aider should
call for emergency medical services and perform Cardio Pulmonary
Resuscitation (CPR) if needed and ask for near help if not trained for CPR;
after that the first aider must stop any bleeding and check for any head, neck
or spinal injury and must not transfer the victim except if it is required (Jones,
2012). The next step in first aider action is to look for any indicators for
special health problems such as diabetes mellitus or asthma, through any
medications or drug prescriptions, also the first aider must stay calm and
quiet during emergency and act quickly to save victim’s life until medical
helps arrive. Avoiding direct contact with blood and other bodily fluids if
not wearing disposable gloves is an essential matter. Finally the first aider
should use proper hand washing technique before and after first aid
administration (Jones, 2012).

First aid priority always given to life threatening cases. The (A and B)
priority of treatment for any case is to make sure that the airways are open
and the victim is breathing normally, and this is called the primary survey,
the moment that first aider became sure that the victim is breathing normally
the (BBB) is the next priority and it’s given to deal with any bleeding and
after that to deal with bone injuries, so that this called secondary survey as
in (figure 2.1) (Barraclough, 2015).
Figure 2.1. Priority of Treatment. Adopted from First aid made easy manual, by (Barraclough,
2015)
Baser et al., 2007 conducted scientific research to evaluate and
determine Turkish primary school teachers’ knowledge and attitude
concerning first aid. The study sample included three hundred twelve
primary school teachers asked on first aid for hemorrhage, epistaxis,
wounds, object aspiration and insects’ stings. The study result indicated that
the progress of primary school teachers’ age was accompanied with more
unlikely first aid practices and attitudes. Finally, study pointed that the
knowledge and attitude of primary school teachers toward first aid was

insufficient and recommended for first aid and pediatric basic life support
training (Başer et al., 2007).
During the same year a study in Poland done by Wisniewski &
Majewski 2007 to assess knowledge and attitude about first aid among
selected high school teachers in the western Pomerania region. Sample of
one hundred school teachers encompassed in this survey from two high
schools of two polish cities. The study tool used in this work was a consistent
questionnaire used formerly to determine problems of providing first aid
among Polish society. The study result showed that despite the fact that the
majority of targeted teachers previously had first aid courses, the level of
their knowledge required to provide first aid was insufficient. For example,
the result indicated that 50% of teachers had theoretical knowledge about
rules of providing first aid but only one third of the respondents were able to
put these theoretical rules into practice in reality. Also the majority of
teachers demonstrated negative attitude toward providing first aid in
emergency cases. So that, the study concluded that the training for
administering first aid is mandatory for teachers as well as pupils and should
be done by medical professional staff, and the study did not omit to mention
the importance of changing negative attitude of teachers during first aid
session by focusing on ethical value of human assistance (Wiśniewski and
Majewski, 2007).
Few years later, Ali et al., in 2010 performed an educational training
program about first aid for recently graduated nursery school teachers and
aimed to develop, implement and evaluate such program about first aid for
emergencies happening in preschools. The interventional program included
60 female participants of recently graduates of specific education college,
university of Zagazig. The data collection of study divided into three parts,
in the first part a questionnaire used to assess teachers’ knowledge regarding
first aid, and during second part an educational program implemented on
twenty sessions (30 - 45) minute per session, and also participant teachers

were distributed to smaller groups during practical sessions and finally the
third part was an evaluation of program by analyzing the pre and post test
results of the respondents. Besides an observational check-list used to assess
participants first-aid practices regarding wounds, seizure, fractures,
epistaxis, burns and choking. The result confirmed that a significant
improvement of knowledge and practice from (0 – 10%) at pre-test to (80-
95%) in post-test result scores, which indicated that the program was
successful, hence, the study recommended to add first aid practical courses
for undergraduate curriculum and periodic training courses for graduated
nursery teachers (Ali et al., 2010).
During the next year Bildik et al., in 2011 adopted study purposed to
define the education faculty students’ level of first aid knowledge and
evaluate training administered to them. The study sample encompassed
eighty-eight students from university of Gazi, faculty of education in capital
Ankara. Almost 20 hours of training for first aid provided completed in 3
months, and pre-test/post-test questionnaire plus final exam performed for
participants. Results of the study noticed significant improvement in
knowledge and skills after training (Bildik et al., 2011).
Hirca 2012 reviewed Turkish literatures regarding first aid, the
research entitled “does teachers’ knowledge meets first aid needs of Turkish
schools?” and obviously aimed to assess if teachers of Turkish schools
having adequate first aid knowledge throughout reviewing preceding articles
done in this field in Turkey. The study outcome revealed that the knowledge
of Turkish school teachers on first aid was ranging from moderate to
unsatisfactory. Most of teachers formerly did not get correct information
regarding first aid and even if they had previous training on first aid, it was
limited on theoretical sides not practical sides in such sessions. Finally, the
study recommended for applying more researches and studies to investigate
knowledge of teachers in first aid skills (Hırça, 2012).

Later, in 2013 Al-Robaiaay conducted study on primary school
teachers’ knowledge about first aid in Baghdad, Al-Rusafa. The objective of
the study included estimation of knowledge of primary school teachers about
first aid for situations like fractures and external bleeding and determination
effect of years spent on teaching on knowledge levels of teachers and
whether there was needs for first aid training or not. A cross-sectional study
carried out in several areas in Baghdad, Al-Rusafa over five months and
included one hundred primary school teachers (26% of them were science
teachers and 22% of them were art and sport teachers). The result showed
that only 4% of participants had good knowledge, while 19% of them had
fair knowledge but the larger proportion of them (77%) had poor knowledge
about first aid. Besides to inadequate knowledge of teachers that concluded
by the study, also the study noticed that both years spent in teaching and
material taught by teachers had no significant effect on teachers’ knowledge.
Al-Robaiaay recommended for regular first aid training and also adding first
aid education to syllabus of institutes that prepares future teachers (Al-
Robaiaay, 2013).
Furthermore, in 2013 Kumar et al., carried out a study aimed at
assessing practices and perceptions of school teachers toward first aid, and
to find rapport between sociodemographic characteristic and first aid
practices, and also to discover any factors that may influence teachers’
perceptions and practices regarding first aid. A cross-sectional study design
applied for nine months by using self-administered questionnaire which was
tested formerly, and included forty school that selected randomly in city of
Mysore. From 262 school teachers involved in the study 57.3% were from
urban areas while 42.7% from rural ones, additionally, 49.6% of teachers’
age was above 40 years old. Despite of study results that exposed already
97.3% of selected teachers were heard the term first aid previously, just
78.8% of them comprehended that wounds needs first aid and only 30.2% of
them were mindful that fainting needs first aid. So that, the total deduction

referred that teachers’ perceptions and practices regarding first aid is poor
and disappointing (Kumar et al., 2013).
Devashish et al., in 2013 performed a research to evaluate teachers’
knowledge and practices about first aid, their readiness and if they need first
aid training in the city of Vadodara. The study done through cross-sectional
design and included 236 school, which two teachers selected from each
school (one teacher of physical education and the second teacher from other
subjects) and the total number of respondents were 472 teachers (394 males
and 78 females), and the study lasted from January 2010 to December 2010.
The result of the study showed that just 2.96% of teachers were previously
trained on first aid, 14.83% of teachers answered correctly 70% of the
questionnaire. Also the authors noticed a significant association between
first aid training and better knowledge and also noteworthy association
between knowledge score and age, gender, teaching experience and school
level (primary, secondary and higher secondary) had been recognized.
Generally, paucity in knowledge of teachers detected and based on results of
study, the researchers concluded and recommended that first aid training is
important and must be regular and updated as well as it must continue
throughout teachers’ professional career (Devashish et al., 2013).
Sonmez et al., in 2014 conducted a study that aimed to evaluate
preschool teachers’ knowledge regarding first aid practices in city of Isparta,
Turkey and to identify factors that may affect such levels of knowledge.
Total 110 of preschool teachers included in this cross-sectional study by
using a questionnaire consisted of 20 points scale. Study result pointed that
washing a wound after a dog bite by soap and water and immobilization of
fallen child from high altitude were the issues which had lowest knowledge
by participants, and their scores were 16.4% and 20.9%, respectively.
Additionally, the findings of the study revealed that the age, employment
years, previous first aid training and previous experience with situation that

needs first aid had no significant effect on teachers’ levels of knowledge.
Likewise, the study detected that participants had poor knowledge and since
first aid training did not show noteworthy differences on their knowledge,
the researchers inference was that the quality of training need to be received
is a fundamental matter (Sönmez et al., 2014).
Another study done by Ammirati et al., in 2014 aimed at assessing the
knowledge assimilated by children below 6 years of age who were trained
by their own teachers and after that comparing the results with another group
of untrained children. The study included training teachers on first aid by
professional medical emergency staff then 315 pupils selected randomly and
divided to 18 classes (nine of them for trained pupils and nine of classes for
untrained ones). The majority of trained pupils provided the expected
answers, besides the trained group revealed paramount ability to describe
emergency situations and had better alert for emergency conditions that
needs first aid. The study leveled that those small children were able to
assimilate first aid skills taught by teachers and also not forgot to mention
that public health goal of trained teachers as well as pupils regarding first aid
cannot be reached without providing qualitative education and training to
teachers to make them able to transfer such skills and knowledge to others
(Ammirati et al., 2014).
Shobha Masih et al., in 2014 conducted a quasi-experimental study
with one group in Dehradun district of Uttarakhand. The study aimed at
evaluating the efficiency of educational program on information of teachers
regarding first aid for minor injuries in school children. 50 primary school
teachers were selected by convenience sampling, and 94% of selected
teachers were female, the result showed that 72% of them experienced
previous injuries in school children and 86% of them had no previous
training about first aid, but instead of that 74% of them had appropriate
knowledge about first aid from other sources like: reading, friends, relatives

and health professionals personnel. The study concluded that the applied
program was effective and revealed the further need for such programs to
improve the total health standards for school children (Masih et al., 2014).
A year later, Al-Samghan et al., in 2015 applied a study to explore the
knowledge of primary school teachers regarding first aid. The study was
carried out using descriptive/cross-sectional design and included 187
teachers of governmental primary schools of Abha city in Saudi Arabia. A
self-administered questionnaire used among participants in boys’ schools
only. The result showed that teachers’ mean of age was 41.5+7.4 years and
ranged from 25 to 58 years. The result cleared that 28.3% of teachers
attended courses on first aid while 62.3% of those had first aid courses
reported that these courses included practical training. Moreover, only 31%
of them had acceptable knowledge regarding first aid for poisoning, while
52.4% of them had satisfactory scores regarding first aid for bleeding.
Overall conclusion of study revealed unsatisfactory knowledge among
respondents. So that, the researchers recommended to introduce first aid
education and training in curriculum of schools, institutions and colleges, as
well as recommended to apply such studies in girls’ primary schools and also
secondary schools and declared the obvious need for more researches in this
field for future (Al-samghan et al., 2015).
Abdella et al., in 2015 performed an interventional program regarding
first aid for kindergarten teachers which aimed at evaluating effectiveness of
applied program on teachers’ knowledge and practice regarding first aid.
Fifty teachers of governmental kindergarten included by using convenience
sampling method. In general, and brief term, the result of the study detected
significant improvement for both knowledge and practices of involved
teachers. The study concluded that the good improvement in teachers scores
synthesized by a well-designed program. Moreover, adding first aid learning
and training to core curriculum of faculties that prepare future teachers and
initiating periodic sessions for first aid to refresh and improve teachers’

information and skills, were recommended by researchers (Abdella et al.,
2015).
2.3. Section C (Literatures Regarding Wounds and Bleeding):
2.3.1. Wounds and Bleeding:
Human history is full of a lot of evidence on the wound care across
civilizations. From clay tablet, which is one of the ancient medical scripts
that dates back to 2200 BC which described the three assisting wounds
healing steps, and passing through the ancient Egyptian papyruses dating
back to 1400 BC, that documented open wounds’ treatment by putting honey
and grease into open wounds to improve healing, and even arriving to
Hippocrates 400 BC the Greek physician who used piece of tin pipe to inject
fluids and to suck pus out of wounds, and so many other examples reaching
to our recent days contributed in wound caring and healing, as well as
evolution of wound infection prevention (Broughton et al., 2006; Shah,
2011).
The breakdown in the skin and underlying tissues causing wounds, as
well, Physical injury or mechanical forces (for instance surgical incisions)
may result in wounds (Taylor et al., 2011).
According to Fundamentals of Nursing Standards and Practice 2011
wounds can be classified according to various terms, but usually described
based on the causes. So that, classification based on causes of wounds are:
1- Intentional wounds: occurs due to treatment and usually done under sterile
circumstances e.g. surgical incisions.
2- Unintentional wounds: mostly, follows trauma or accident. These wounds
are unanticipated and occurs in unsterile situation, which makes risk for
infection higher (DeLaune and Ladner, 2011; Sussman and Bates-Jensen,
2012; Berman et al., 2016).
Furthermore, another classification set depending on skin integrity,
and categorized wounds into:

1- Open wounds: occurs by break of the skin or surgical incision.
2- Closed wounds: may be caused by external blow or crushing and
includes internal hemorrhage (Nugent and Vitale, 2014; Burton and Ludwig,
2015)
Proper wound care is necessary to promote healing that results in an
intact skin layer. Intact skin is the first line of defense of the body against
invasion by infectious microorganisms. The skin defends the body in other
ways by serving as a sensory organ for pain, touch, and temperature (Bryant
and Nix, 2015).
First aid procedures for open wounds done through the following
steps:
First of all, in case of no severe bleeding the wound must cleaned by
rinsing it gently under running water with soap to minimize risk of infection
and clean the wound then using disinfectants or sanitizers (American
Academy of Pediatrics, 2012).
Then placing the injured child in proper position, after that, looking at
the wound for any foreign bodies. Subsequently, raising the wound site
above heart’s level, later, performing direct pressure with disinfected or
clean dressing that is enough for covering the wound (Barraclough, 2015).
Meticulously, bleeding caused by injury wounds may cause serious
threat to the life of casualty, particularly if the amount of blood loss was
more than one liter so that techniques used to stop bleeding are an important
matter and includes: direct pressure, indirect compression points, and
tourniquet (constricting stretchable band that tied strongly above the wound)
used to evade massive blood loss (Usman and Davidson, 2014).
For direct pressure keeping an eye on the following steps is necessary:
1- Carefully, taking out any foreign body sticking into the wound.
2- Using a sterile or clean bandage and wrapping it gently around the
wound and applying direct pressure till the bleeding stops.

3- If the bandage or dressing used very immersed or soaked with blood
without removing it, putting more dressing around bleeding site as an
alternative.
4- If the bleeding is in arms or legs, raising that part above heart’s
level, in order to decreasing blood oozing thru the wound.
Pressure points are used in case the direct pressure was ineffective,
and the bleeding persists. Thus, the pressure points for body parts in brief
terms are as next:
- The pressure point for arm bleeding is superior part of arm, below the
armpit (axilla).
- Forearm pressure point is the inner (interior) part of arm, just under the
elbow.
- The wrist is the site of pressure point application for hand bleeding.
- The pressure point for skull bleeding is the temple (tempora) an area
located behind the eyes.
- For neck bleeding the pressure applied to carotid vessels which are located
a little away from mid-line of neck (Rhoads and Meeker, 2008; Usman and
Davidson, 2014).
2.3.2. Epistaxis:
The history of providing first aid for epistaxis, backs in date to 5th
century BC, which Hippocrates mentioned how to stop nose bleeding, in a
time noticed development of scientific medicine in ancient Greek society
(Pikoulis et al., 2004; Aydin et al., 2009; Al-azzaawi et al., 2014).
Epistaxis refers to the nose bleeding or hemorrhage from the nose and
commonly originates in the anterior portion of the nasal cavity (Nettina,
2010). Nose-bleeding is common significant problem which may cause
extreme anxiety to the patients and their families; in addition, up to 60% of
general population affected by epistaxis for one time at least, which usually
can be stopped with simple home remedies or stop on its own without any
medical management, but occasionally nose bleeding may be huge and

deadly (Chaiyasate et al., 2005; Mann et al., 2005; Hussain et al., 2006;
Kucik and Clenney, 2011; Mcgarry, 2013). Likewise, up to 60% of children
suffers from epistaxis for one time at least by age of ten (Davies et al., 2014).
Recurrent nose-bleeding due to unknown causes occurs in about 9%
of children between age 1 and age 16, and generally is simple and self-
limiting but only severe cases referred for professional medical treatment,
even though there is no consensus on effective methods to treat epistaxis,
besides, epistaxis treatment has undergone important modifications in latest
years (Douglas and Wormald, 2007; Qureishi and Burton, 2012; Mcgarry,
2013).
Epistaxis or nose bleeding resulted from many causes such as trauma,
structural alteration or pathological origins (Ward, 2014). According to
Lippincott Manual of Nursing Practice, 2010 these causes can be categorized
to:
1- Local causes such as:
a. Dryness leading to crust formation and bleeding occurs with
removal of crusts by nose picking, rubbing, or blowing.
b. Trauma e.g. direct blows.
2- Systemic (pathological) causes which are less common, for
example hypertension, arteriosclerosis, renal disease and (bleeding disorders
which are most common among systemic causes) (Nettina, 2010).
First aid management for epistaxis depends on severity and cause
of bleeding but usually includes:
1- Placing the child in an upright position then leaning him/her
forward to reduce venous pressure, and asking the child to breathe gently
through the mouth to avoid swallowing of blood.
2- compressing the soft part of nostril using index finger and thumb
for 5 to 10 minutes to keep pressure on the nasal septum and some first aid
guidelines recommends that before applying the pressure to nostril, to ask

the child to blows his/her nose gently to reduce the amount of dried blood
before bleeding stops. These two steps presented visually in (figure 2.2).
3- As advanced procedure if the bleeding did not stop a cotton pledget
soaked with a vaso-constricting agent then inserted into each nostril, and
pressure is applied if bleeding is not controlled by compression alone, after
5 to 10 minutes, the cotton is removed, and the site of bleeding is recognized.
Figure 2.2. First Aid for Nosebleeds. Adopted from The Everything First Aid Book
by (Saubers, 2008).
4- In case of recurrent epistaxis further medical diagnostic measures
and cares needed by referring the child to medical facilities (Nettina, 2010;
American Academy of Pediatrics, 2012; Mulla et al., 2012).
A postal survey done in 2010 among teachers of local South Wales
schools to explore epistaxis rate of recurrence and management in school
setting. Total 112 questionnaires were returned from total 157 questionnaires
distributed to 116 primary school and 41 secondary school. Therefore, 32
secondary school teacher and 80 elementary school teacher responded to
study tool. The results showed that only 25% of secondary teachers and
37.5% of primary teachers were aware on rules of nose bleeding
management. The study concluded that notwithstanding of frequently

occurrence of epistaxis in schools, the teachers used incorrect methods to
stop epistaxis, in addition to the fact that most epistasis cases stops
spontaneously (Robertson, King and Tomkinson, 2010).
In 2015 another study conducted by Banafi et al., on prevention of
accidents and first aid knowledge for parents of preschools’ students, and
included six Hungarian kindergartens. Only 234 self-administered
questionnaires obtained from all 307 that were distributed. The study result
showed that 74.3% of the respondents faced at least one accident previously,
while 74.4% of them had previous training on first aid. As well as, about
(3/4) of them (73.5%) answered correctly on epistaxis question, while 18.8%
of them reported that the child must lean his/her head backward which makes
higher risk for blood aspiration. The highest level of knowledge toward
epistaxis and choking matched previous study in Taiwan. Finally, the total
knowledge of first aid detected unsatisfactory despite of high scores in
choking and epistaxis management. Thus, the researchers recommended to
apply a wider survey to detect the population knowledge on first aid and to
organize first aid sessions to increase the knowledge about first aid (Bánfai
et al., 2015).
2.4. Section D (Literatures Regarding Bone Injuries and
Fractures):
Human attempts for early care and treatment of fractures and other
bone injuries were noticed through the history. Edwin Smith Papyrus (1600
BC) described bandaging of humeral fracture preceded by reduction using
traction and also mentioned shoulder dislocation management by reduction.
Likewise, many other ancient Egyptian manuscripts referred to approaches
for orthopedic surgery established by them. Later, the scripts noted by Greek
physician Hippocrates described fracture reduction in detail and noted the
bandaging and splinting of fractures. The Roman Celsus (25 BC – 50 AD)
described many issues regarding skull fractures and depressed fractures,

some of these issues were founded accurately in comparing with our recent
medicine. And so that the mankind history until our days, witnessed many
remedies and interventions regarding fractures’ first aid and treatment.
(Brorson, 2009; Blomstedt, 2014; Ganz and Arndt, 2014).
Globally, the foremost reason of mortality, disability and morbidity
among children is injury. As well as, many studies estimated that these
common childhood injuries affect about 25% of children annually.
According to WHO fractures are the most common types of childhood
accidental injuries that affect kids below 15 years of age and necessitates
hospitalization in developing countries. In addition, fractures consist about
10 to 25% of all juvenile injuries. Besides, about 3-11% of school children
are injured in sport activities during school time (Rennie et al., 2007;
Shanmugam and Maffulli, 2008; Khadilkar et al., 2015).
A fracture is defined as “an incomplete or complete disruption in the
continuity of bone structure” and knew according to its type and extent, and
usually fracture occurs when the bone is exposed to a great stress more than
its ability to tolerate (Smeltzer et al., 2010); Or in another word, a fracture
defined as a loss or shatter of the bone (Judge, 2005; McRae and Esser,
2008; Walker, 2013).
Fractures are classified into several types according to many criteria
such as mechanism, displacement, pattern, pathology, fragments and
location; but generally classified into open and closed fractures (Whiteing,
2008).
Open fractures (complex or compound) are defined as fractures in
which skin or mucous membrane wound extended to the fractured bone or
the fractured bone breakout through the skin, while closed fractures (simple)
are defined as fractures in which no skin or tissue disruption occurs by
fractured bone (Whiteing, 2008; Dandy and Edwards, 2009; Smeltzer et al.,
2010; Wright, 2014)

Common types of open and close fractures (Transverse, Oblique,
Spiral, Comminuted, Avulsion, Impacted, Fissure and Greenstick) are
showed in figure (2.3).
Figure 2.3 Types of fractures. Adopted from Orthopedic and Trauma Nursing by (Clarke &
Santy-Tomlinson 2014).
First aid intervention for musculoskeletal injuries such as fractures,
sprains or even strains generally includes the principle of RICE, which
means the following:
- “R” refers to REST: and means the injury must be placed in rest
(comfort) situation and any effort should be banned, e.g. don’t allow
the child play or move by his/her own on injured area or even the
first aider must be cautious to keep his weight away from injury site
and not move the bone to prevent fragmentation of bone (Dvorchak,
2010; American Academy of Pediatrics, 2012; Barraclough, 2015).
- “I” refers to ICE: and means that an ice or cold pack should be placed
on site of injury to help in vasoconstriction of blood vessels and thus
will help in reducing swelling; this must be applied as soon as
possible for 10 minutes and should be repeated every 2 hours for 24
hours or 48 hours as maximum (Saubers and Iannelli, 2008;
Barraclough, 2015).
- “C” refers to COMPRESSION: and means necessity of using an
elastic or firm bandage to injured musculoskeletal area (Piazza,
2014; Barraclough, 2015).

- “E” refers to ELEVATION: and means the affected area must be
elevated to reduce swelling specially in joint injury (Barraclough,
2015).
The first aider must keep in his/her mind some important notes such as:
never attempt to straighten a knee joint by force and never try to align the
ends of an open fracture, and also don’t give the casualty any fluids or foods,
because a surgery may be needed. Furthermore, the affected area must not
be rubbed, and the joint below and above fracture must be immobilized
(Meredith, 2006; Dvorchak, 2010).
The immobilization done by using splints or slings or both as needed
and according to fracture’s type or site Figure (2.4), the splints used to
immobilize the joint below an above fracture and it should be firm, lengthy
and wide enough for fixing the joint below and above the fracture and
prevent any movement immediately, and it may be an umbrella, piece of
wood or even a rifle, while the sling made of triangular or roller bandage and
used to immobilize some parts of body such as jaw, collar bones or limbs
and the slings may be spontaneously selected from surroundings area of
injury, it may be a belt, shoe lace, piece of cloth or even neck ties (Karesh,
2012; Gloster and Johnson, 2016).
The fracture’s intervention is differing in detail according to location
and type of fracture, thus first aid for neck, head, legs, arms, fingers, pelvis,
ribs, spinal cord and other types of fractures are the same in general principle,
but may contrast in detail and type of interventions needed. Therefore,
dealing with different fractures in depth, needs first aider provided with
proper training and knowledge on first aid.

Figure 2.4 A. Fixing with splint only B. Fixing with both splint and sling. Adopted
from First Aid for Nurses by (Karesh, 2012).
Another common musculoskeletal injury among school aged children
are sprains, which are relates directly to early engagement in sport activities
since primary stages of their life, and increased principally during last years
as a way for improving body fitness , which makes risk for injury more
factual (Caine et al., 2008; Gottschalk and Andrish, 2011; Doherty et al.,
2014; Dorje et al., 2014). Globally, almost one ankle sprain occurs in
everyday per ten thousand persons (Waterman et al., 2010).
Sprains are defined as injuries to ligament, which are band of tissues
that hold bones in position and connect them to other bones or to the joints.
Common signs and symptoms of sprain are: pain and tenderness, fast
swelling of area, discoloration of skin and bruising in area. Concisely,
emergency first aid for sprains includes immobilization, elevation,
application of cool pack and referring to a health facility for further
professional medical care (Jones, 2012; Flegel, 2014; Stephens, 2016).
Sundblad et al., in 2005 conducted a study about injuries of school
children during physical activities. The outcome of study showed that most
common kind of injuries among study population were strains and sprains
(49% of all injuries), while the wounds made only 14%. However, the rate
incidence for fractures were 5%, for dislocations 4% and for concussions

5%. As well, 33% of injured children were attended by parents or other
grownup household member, while the class teachers and sport trainers
cared for 26% of all incidence. Besides, the physicians and school nurses
cared 17% and 24% of all injuries, respectively. This study revealed the
importance of providing first aid training and increasing related knowledge
for class teachers, educators and sport coaches, because the school teachers
are the first persons which confronting child emergencies at school
(Sundblad et al., 2005).
Albrecht & Strand in 2010 applied a survey study on sport coaches’
knowledge and qualification concerning first aid. From total 594 of school
coaches participated the study only 154 completed the survey questionnaire
that was consisted from four sections about first aid for injuries and sudden
illnesses, as well as questions about CPR/AED. So that, the results revealed
higher knowledge and confidence when confronting an emergency for
teachers with first aid certification in comparing to those without
certification. Thus, the researchers underlined the importance of giving
official and high quality training for school sport teachers (Albrecht and
Strand, 2010).
2.5. Section E (Literatures Regarding Other Medical
Emergencies and Illnesses):
2.5.1. Asthma:
The historical chronicles denoted that the ancient Chinese and
Egyptians were the first nations who treated asthma. But the origins of the
word asthma back in date into Greek term “aazein” which its literal
translation into English means “to pant or exhale with open mouth”.(Gordon,
2008; Singh and Singh, 2014; Bhattacharjee et al., 2015; Tanaka, 2015).
Asthma is considered as very common respiratory disorders, and
higher level for asthma incidence recorded throughout the last decades.
Likewise, asthma is a world challenging health problem, which according to

WHO it affects around 235 million persons around the globe and annually
kills more than 180.000 person, and as well as global childhood mortality
due to asthma range between 0.0 to 0.7 per 100.000 every year. Furthermore,
the children are the most age group influenced by asthma which is most
common chronic childhood illness especially between ages of 5 to 14 years
(Subbarao et al., 2009; WHO, 2013; Asher and Pearce, 2014).
Asthma is defined as chronic airway inflammation or increased airway
responsiveness that leads to dyspnea, wheezing and coughing or even
variable airway obstruction (Innes and Maxwell, 2016).
Sign and symptom of asthma attack generally are: productive cough,
dyspnea, using accessory respiration muscles, tachycardia, tachypnea and
noticeable expiratory wheezing (Japp and Robertson, 2013; Linton, 2016)
The factors that increase risk of asthma attack and considered as
triggers (acute asthma exacerbations) are:
1- air pollution. 2- allergens such as dust. 3- exercise (exercise induced
asthma). 4- hormones (in females during menstruation). 5- occupational.
6- psychological.(Greener, 2015).
Asthma first aid management includes following actions:
1- First of anything giving the medication of asthma that the child brought
with him.
2- Remain providing inhaler, one puff per minute.
3- Putting the child in a comfortable position which makes breathing easier
to him (sit him/her upright or lean forward).
4- Loosen the child’s clothes to ease the breathing.
5- helping the child to breath slowly (inhale/exhale).(McMurray, 2011).
A pilot study conducted in 2012 in a rural school in Illinois, USA by
Lucas et al. about primary school teachers’ knowledge concerning asthma
care in children. The questionnaire used contained common information on
asthma and its related management. The result revealed insufficient
knowledge among the respondents, besides, the result noticed that teachers

were not ready to deliver asthma care. Thus, the researchers recommended
to educate teachers on health issues and any cares needed, to insure
protection of kids during class period (Lucas et al., 2012).
A prospective, cross-sectional research conducted in Quetta, Pakistan
in 2015 by Aqeel et al., in order to assess teachers’ knowledge and awareness
toward asthma and factors that may increase the risk for asthma attacks. The
study concluded that a training programs needed to improve teachers’
knowledge about asthma symptoms and proper care needed in asthma
emergency situations. Thus, researches recommended to organize such
sessions and programs in Quetta, Pakistan to ensure pupils health safety
during school time (Aqeel et al., 2015).
2.5.2. Epilepsy:
The earliest description of epilepsy backs in date to Akkadian
civilization in ancient Mesopotamia around 2000 BC. In nutshell, the
contribution of ancient Iraqi civilization about epilepsy description,
diagnosis and treatment was very clear, in spite of it connectedness to many
myths. The real origin of word epilepsy that is used in our time relates to
Greek verb (epilambanein), which means “possess, distress or to take hold
of”. These studies continued since antiquity and until it developed in our
recent times due to huge progression and discoveries in medicine (Devinsky
and Lai, 2008; Magiorkinis et al., 2010; Wang et al., 2011; Magiorkinis et
al., 2014).
Epilepsy is one of the oldest and common non-communicable disease,
affecting nearly 50 million persons around the globe, and it’s expected to
increase every year. The global childhood incidence of active epilepsy
estimated around 10.5 million children, which represents 25% of total
epilepsy population around the globe. What makes epilepsy an important
issue, is that the most age group vulnerable to injury due to epilepsy are
children; and as it known negative effect of epilepsy on personal life it’s also
severely influences the social life of epileptic children and thus their quality

of life in home, schools, community, etc.(Calisir et al., 2006; Guerrini, 2006;
De-Boer et al., 2008; Ngugi et al., 2010; Camfield and Camfield, 2015;
Davidson et al., 2016).
Epilepsy classified into generalized and partial. Also, the partial
epilepsy classified into simple and complex, while generalized epilepsy
categorized into tonic-clonic, absence, myoclonic jerks, tonic and atonic
seizures (Glasper et al., 2015; Harrisson, 2016).
Clinical features of seizures influenced by: brain parts affected (one
part or more), pattern of spread of through the brain, age and epilepsy
etiology (Glasper et al., 2015).
Management of seizure differs according to types, but generally the
first aid actions for epilepsy are as next:
1- Protecting epileptic child from injury, by removing any close harmful
stuffs especially in generalized seizures.
2- Supporting the victim’s head, by placing billow, towel, blanket, soft pad
or folded clothes under the head.
3- Placing piece of wood or anything between the teeth to prevent him/her
from biting the tongue.
4- loosen the tied clothes to ease the breathing.
5- Turning the victim on his/her side if there was fluid getting out from the
mouth (milk, blood or saliva) in order to drain the fluid out.
6- Observing the child until the seizure ends then putting the child in
recovery position for a while until breath normally and be more conscious.
7- If the child became blue CPR must be provided.
8- The first aider must never attempt to hold or replace the epileptic victim
(American National Red Cross, 2007; O’Hara, 2007; AAP, 2012).
In 2013 a community based research conducted on knowledge,
attitude and perception of secondary school teachers in Osogbo, Nigeria. The
study results showed there was a shortage in their knowledge about first aid
actions. Generally, a positive attitude noticed among most of teachers. The

study recommended for educational courses on epilepsy and other illnesses
in classroom and also on emergency measures needed for such conditions
(Mustapha et al., 2013).
A planned teaching program aboutknowledge and attitude on epilepsy
and its related first aid actions among primary school teachers in Nagpur city
in India and done in 2016. The result showed that there was no significant
relation between first aid management and knowledge and attitude toward
epilepsy, while a significant association founded for age, gender and
teaching experience with both teachers first aid management of epilepsy and
teachers knowledge and attitude toward epilepsy. The conclusion of
researcher based on the results was that the program was successful (Wagh,
2016).
2.5.3. Diabetes Mellitus:
The physicians in ancient Egypt 3500-2000 BC identified the
symptoms of diabetes mellitus (D.M). However, the origins of (Diabetes
Mellitus) is ancient Greece, which the word diabetes means siphon (running
through) and the word mellitus means sugarcoated or sweet. Nutshell, the all
ancient Egypt, Chinese, Greece, Rome, and Indian considered diabetes as a
significant morbidity. As well, the famous Muslim physician Avicenna was
the first one who confirmed the sweet characteristic of diabetic urine (King
and Rubin, 2003; Eknoyan, 2006; Dupras et al., 2010; Zhang et al., 2010;
Laios et al., 2012).
Diabetes mellitus had become a worldwide chronic epidemic in spite
the fact that it is not a communicable disease, but due to high incidence and
prevalence rates. WHO estimation for D.M cases in 2000 was 154 million
persons and founded to be 246 million in 2006, furthermore, by 2025
prospected to be 380 million persons. In middle-east and north African
district, the disease estimated to be almost 9.2% of populations (34 million),
and 17 million of them non diagnosed persons, furthermore, in middle-east
only approximately 60.000 cases younger than fifteen years old founded to

have diabetes type1 every year. Moreover, in 2013 the mortality of D.M
estimated to be about 4% of all mortality reasons, and it consist the fifth
leading cause of death in Arab world countries and other Asian states like
Korea (Levitt, 2008; Kim, 2011; Majeed et al., 2014; Abuyassin and Laher,
2016; Zayed, 2016).
Diabetes mellitus is a disorder resulted from lack or absence of insulin
production by pancreas or existence of factors opposing the insulin works
(Watkins, 2003; Rosdahl and Kowalski, 2012).
Diabetes mellitus is classified into: insulin dependent (type 1 DM)
which usually affects the children, non-insulin dependent (type 2 DM)
usually affects the adults, gestational diabetes mellitus(which occurs during
pregnancy) and other types like diabetes insipidus, prediabetes (LeMone et
al., 2011; Rosdahl and Kowalski, 2012).
All types of diabetes of mellitus are causing hyperglycemia
(increasing blood glucose levels), thus, the major symptoms of
hyperglycemia are: polyuria, polydipsia (thirst and dry mouth), nocturia
(frequent nightly urination), fatigue, lethargy, muddling of vision,
polyphagia (especially for sweets) and sometimes headache, nausea and
irritability (Pearson and McCrimmon, 2014).
Besides the hyperglycemia that caused by diabetes and needs
management, occasionally hypoglycemia (decreasing blood sugar levels)
occurs which is resulted due to many causes such as excessive diabetes drug
dose, or excessive exercise or during night sleep and considered as life
threatening condition even more than hyperglycemia, and most usual
symptoms of hypoglycemia are: sweating, hunger, shuddering, tachycardia,
confusion, drowsiness, speech difficulty, nausea, headache, tiredness, or
even loss of consciousness. But these aforementioned symptoms vary
according to the age and severity of hypoglycemia (Pearson and
McCrimmon, 2014).

First aid for sever hyperglycemia was not discussed because it needs
to provide emergent medical supervision by physician only, so that, referring
the child to the hospital to receive proper medication (insulin or anti-diabetic
drugs) is the proper action (Jones, 2012).
Hypoglycemia first aid is done by giving any sugary fluid, grape, or
any sweet chocolate to the victim as soon as possible to reduce risk of shock.
If the child did not respond transferring the case into medical emergency
department is the solution because it might have hyperglycemia or already
entered into shock(Jones, 2012).
A study done in 2012 by Boden et al. on primary school staff concerns
regarding diabetic children cares at school. An interview conducted with 22
primary school staff, and the results revealed teacher’ great fears and
concerns on appropriate diabetes care, and also equals to viewpoints of local
health care providers whom detected the influence of school environment
and family dynamics on care of diabetic kids during school time. Thus, the
conclusion was that the best way to loosen the anxiety and fears toward care
of children with diabetes and also to improve their knowledge and
confidence is to provide training sessions on diabetes (Boden et al., 2012).
Additionally, another work done in 2012 in Turkey by Aycan et al.,
in order to assess teachers’ knowledge on diabetes mellitus and its
management in school. Using a self-administered questionnaire, total 1054
teachers included in the study that lasted for one year. The results showed
that 47.6% of teachers had fair knowledge while 32.4% of them had poorer
level of knowledge, beside that only 625 teachers of total 1054 were alert
that level of blood glucose may decline in diabetic child and needs urgent
care. Hence, teachers who had a child with diabetes, showed better
knowledge. The recommendation of study was to increase extent of such
training programs for teachers and community as whole (Aycan et al., 2012).

2.5.4. Poisoning:
Childhood food poisoning is an important and common global health
issue, which causes many morbidities and deaths every year. According to
WHO, in 2004 the global deaths due to accidental poisoning were around
346.000 persons and 91% of those deaths were in low or middle income
countries. Additionally, every year nearly 1.5 million cases of childhood
diarrhea caused by contaminated food. Moreover, WHO estimated that about
45.000 deaths occurring every year around the globe in kids and youth below
twenty years of age, which consist around 13% of total poisoning fatalities
(Buzby and Roberts, 2009; Kebriaee-zadeh et al., 2014; Shabestari et al.,
2014; Ansong et al., 2016; Azab et al., 2016).
Food poisoning can be chemical or biological. Thus many definitions
set for food poisoning, according to the causative origins. For instance,
bacterial food poisoning is a poisoning caused by consumption of preformed
toxins in food which results in a toxic morbidity rather than enteric infection,
e.g. food poisoning due to ingestion of Staphylococcus aureus (Kwara,
2016). Another definition defined food poisoning as group of morbidities
resulted from ingestion of foodstuffs contaminated with infectious
microorganism or their toxins or by foods contaminated with chemical (both
metallic or organic) substances (Al-Mazrou, 2004).
According to a study done in 2014, the most common signs and
symptoms of poisoning are neurological (altered consciousness, headache
and vertigo), gastrointestinal (nausea, vomiting, abdominal pain and
diarrhea) and respiratory such as dyspnea (Keka et al., 2014).
First aid for food poisoning preceded by following assessment:
1- Detecting the times that symptoms needed to appear after eating
(immediate or after a while).
2- Knowing the type of food eaten.
3- Asking if any other person became ill.
4- Noticing if patient having diarrhea or vomiting.

5- Observing the victim for any fever or neurological symptoms (Smeltzer
et al., 2010).
Food poisoning first aid procedures includes: lying the child dawn,
giving lots of fluids (especially water and milk), not inducing vomiting
without medical supervision, providing CPR if needed and the most
important matter seeking for medical attention (National Safety Council,
2004).
A study was conducted in 2010 on students of Taif university in Saudi
Arabia toward knowledge, attitude and practices concerning food poisoning.
The results showed deficit knowledge among more than half of students and
similarly more than half of them responded negatively toward attitude
questions, but the practices questions showed higher scores especially in
hygienic food measure, except of the popular habit of eating meat, rice by
hands and sharing the same cup of soup and milk by several peoples which
can be. Also, the female, were more aware about food poisoning, risk factors
and safety measures (Sharif and Al-Malki, 2010).
Another study was performed in 2014, which evaluated the
knowledge of university students in Istanbul, Turkey, about first aid for
poisoning cases. Total 936 student participated in study, by responding to a
questionnaire formed from twenty-one questions. The results clearly showed
deficit knowledge for most of students except those from medical
disciplines, whom answered the questions correctly due to previous
education and information on first aid. This led to a clear conclusion, that
previous education and knowledge affects knowledge level on first aid. Thus
the study recommended to organize first aid training and educating session
for all students about all first aid issues and not only for poisoning to improve
their knowledge, response and practices in such condition which requiring
first aid (Goktas et al., 2014).
Likewise, another research was conducted in Turkey in 2015, on
mothers’ knowledge about poisoning, in which overall 290 mothers were

evaluated by a questionnaire consisted from three parts. The results revealed
a clear significant relationship between the poisoning knowledge and
educational level, career and the neighborhood living within (area of living).
The study concluded that the mothers’ knowledge was unsatisfactory and
recommended for future educational meetings and using visual and social
media to increase mothers and families knowledge on poisoning and
protective methods (Sivri and Ozpulat, 2015).
2.6. Section F (literatures regarding burns):
The human discovery for fire was a real revolution and turning point
in human history. Despite of worthy benefits of fire, this discovery was
accompanied by negative effects. These negative effects summoned the
emergence of therapeutic methods and remedies to deal with it. The ancient
Egyptians, Greeks, and Romans doctors contributed in wound care. This
evolution in burn care continued until the early nineteenth century, where
Guillaume Dupuytren developed a burn classification which continued to
our recent days and helped in better dealing with burns, and its’ early
management and treatment (Branski et al., 2012; Pećanac et al., 2013; Baker
et al., 2015).
Worldwide, incidence of burns ranked as fourth among all other
injuries in 2004, and approximately 11 million people were affected by
burns. Luckily, the majority of burn injuries are not fatal, despite of global
mortality that estimated as 300,000 deaths every year due to burns. Likewise,
in middle east countries such as in Turkey the 53.6% of burns incidence
affected children; and so that, in Sulaimaniyah, Iraq the incidence admission
due to burns was 1044 per 100,000 persons, which showed higher incidence
for childhood burns comparing to local population. Another research in
Mosul, Iraq revealed that fatality rate among pediatric burns visited a
hospital in one year was 16.75%, and a similar study in Baghdad showed
that delay of initial car (first aid), ignorance of protection measures,

especially for children were some reason for high incidence and mortality
among targeted population (Hettiaratchy and Dziewulski, 2004; Carini et al.,
2005; Tarim et al., 2005; Mashreky et al., 2008; Peck, 2011; Lee et al., 2014;
Zubeer and Mohammad, 2014; Othman et al., 2015).
Burns are defined as tissue injuries due to friction, heat, radiation,
chemicals and electricity. Generally, sign and symptom of burns includes:
localized redness, swelling and pain; in sever burn there will be blisters, skin
may peel and appears white or charred, numbness feeling and may be
comprises headache, fever and shock in extreme burns (Krapp, 2002; Longe,
2006).
Burns are categorized into three degrees:
1- 1st
degree burns: causes swelling and redness outer layer of skin
(epidermis).
2- 2nd
degree burns: and comprises swelling, redness and blistering of
skin, and may extend to under layer (dermis).
3- 3rd
degree burns: and also called full thickness burn, which the
entire depth of skin is destroyed and causes scaring; also damage may extend
to fatty layer, muscles or even bones (Ewen and Hart, 2011; Narins, 2013;
Roth and Hughes, 2016).
According to National Safety Council 2004 first aid guide the burns
are in general heat burns, sun burns, inhalational burns, chemical burns and
electrical burns. And first aid for burns detailed as following:
1) 1st
degree burns’ first aid: includes stopping the burning by
removing source of heat, cooling the area by water (within room
temperature) but not icy or very cold to prevent tissue damage, removing any
clothes or other things around affected area before swelling and protecting
the burned area from any pressure or rubbing.
2) 2nd
degree burns’ first aid: included also stopping the burning, then
cooling the area affected (also within room temperature) by immersing small
area in a sink or covering area with wet clothes for at least 10 minutes (but

must be cautious to not covering most of body) then removing it,
furthermore, removing any jewelry or clothes from region and putting loose
dressing on area to protect it but without letting it stick on burned skin (if
large area affected e.g. face, genitals, legs and arms, don’t wait and transfer
the victim to hospital as quick as possible).
3) 3rd
degree burns’ first aid: and the most serious type of burns
included similarly as aforementioned stopping the burning and cooling the
burned area (around only areas of 1st
and 2nd
degree burns), removing the
clothing and jewelry, calling for medical help and establishing first aid
measures for shock prevention and care, by asking the casualty to lie dawn,
elevating legs and keeping his/her normal body temperature; furthermore,
covering area with clean or sterile dressing and do not put anything on
affected area e.g. oils, lotions and creams (National Safety Council, 2004;
Rosdahl and Kowalski, 2012; Goutos and Tyler, 2013).
In such cases basic life support (BSL) may needed; so that, the victims
breathing must be watched. Be cautious, in third degree burns do not cool
more than 20% of body surface with water for adults and 10% of body
surface for a child, due to high risk of hypothermia and shock. Similarly, as
1st
and 2nd
degree burns anything must not be placed on burn’s area and
furthermore the victim should forbid from drinking any fluids (National
Safety Council, 2004).
A study was conducted in New South Wales to survey the general
population knowledge on first aid for burns. The total number of people
responded to the survey was 7320 persons. The result showed that 82% of
them answered that they will cool the burn with water but only 9% of them
stated that they will continues the cooling for 20 minutes. The study
concluded that most people were unenlightened toward the time needed for
cooling burns, and for steps of first aid needed to deal with burn injury. Thus,
the study recommended for more effort in providing wider and clearer first
aid message to the community (Harvey et al., 2011).

Graham et al., conducted a study in 2012 in United Kingdom to
evaluate first aid knowledge of burns among parents in south Yorkshire.
Total 188 parent included in the study and responded by structured
questionnaire. Briefly, the results emphasized the needs to develop parents’
awareness on first aid for burns and also the most points of concern showed
by results were, on question about time of cooling a burn, applying correct
dressing and remembering correct first aid steps. (Graham et al., 2012).
Later, another study done in UK 2013 by Davies et al., to assess the
level of information on burns’ first aid among parents. The total number of
parents included in study and responded to the questionnaire was 106, and
the result showed that only 32% of them had acceptable knowledge burns
first aid, while 43% of them had humble or no information on study subject.
Additionally, 40% of respondent had previous training and most of them
(74%) had acceptable knowledge. Totally, the study revealed poor level of
knowledge among the respondents, thus the recommendation by researcher
was to organize training courses for all new parents especially low-income
families (Davies et al., 2013).
2.7. Section G (Literatures Regarding Bites, Foreign Bodies
and Stings):
Choking is defined as accidental inhalation or consumption of foods
or other substances resulting in obstruction of airways and thus suffocation
(Dolkas et al., 2007).
Signs and symptoms for chocking in a conscious child above one year
of age includes: incapability to talk or breath, high-pitched noises,
unproductive coughing and cyanosis (Einzing and Kelly, 2010).
First aid procedures for an aware choking child of more than one
year of age includes:
1- Standing behind the child and wrapping the arms around his/her waist.

2- Making a fist with one hand and grapping it with other hand, then placing
thumb’s sides of the fist in the middle of child’s abdomen, just below the
sternum.
3- After keeping the elbows out pressing the fist into the child’s abdomen,
quickly for five times, with keeping the child up and without touching the
rib bones (Heimlich Maneuver).
4- Continuing in abdominal thrusts until the child expelling the object.
5- It is important to not interfering if the child was able to cough effectively
or able to talk, and just delivering back blows to help in expelling of foreign
body (Einzing and Kelly, 2010).
Dogs are responsible for 80-90% of bites in children. Besides, it’s
considered as a global problem around the world, which sometimes leads to
death caused by huge trauma, and not to mention, the economic burden of
rabies virus immunization. Due to dog bites nearby fifteen million person
receiving rabies prophylaxis, around the globe. Similarly, human bites
consist 23% of bites cared by doctors. Human bites considered some times
more dangerous than other animal bites due to risk of transmitting infectious
diseases such as Hepatitis B and AIDS (Ambro et al., 2010; Jaindl et al.,
2012; Chaudhuri, 2015; Rothe et al., 2015; Ponsich et al., 2016).
The first aid procedure for animals (e.g. dogs) and human’s bites,
before transferring into hospital includes:
1- If there was no sever bleeding, the wound must be washed by water and
soap then cleaned and covered with sterile gauze.
2- If there was bleeding exist, first of everything must control the bleeding
then referring the child to hospital as soon as possible (Piazza, 2014).
In 2013 a study conducted in India by Kakrani et al., to evaluate the
rural community awareness concerning dog bits’ management. The study
conducted thru interviewing 300 persons were attending with the bits’
victims and lasted for one month. The result of the study showed that only
37.3% of participants were aware that they must observe the dog bit victim

for ten days after accident, furthermore, 52.1% of participants sensed that
washing of wound with water and soap is useful. Over all persons included
in study precisely 59% of reported that rabies vaccine was expensive for
them. Finally, the study concluded that there was a big gap between
knowledge required and risk presented in area and recommended for
applying more education programs in association with health volunteers
(Kakrani et al., 2013).
After food allergy insect stings considered to be the second reason for
anaphylaxis. According to some reports, up to 2.8% of total severe allergic
reactions in country residence triggered by insect stings. (Fernandez et al.,
2005; Jennings et al., 2010).
Insects or bee stings usually causes pain, redness and swelling around
the site of sting, and its considered harmful than being dangerous. But it
might cause serious allergic reaction, so the victim must be observed for any
allergy symptoms. However, the first aid actions for stings are: removing the
sting if it is visible by scraping or brushing it away by finger nail, then
applying a cold compress and raising the affected part above the level of
heart to minimizing any swelling, during that observing the victim’s vital
signs is important, so that, if any breathing difficulty, itching in skin or
wheezing appeared, should seeking for immediate medical intervention
(Piazza, 2014).
A study conducted in 2016 by Raju in Mysore, India and aimed to
evaluate the effectiveness of structured teaching program on primary school
teachers’ knowledge concerning first aid for insects’ sting and related
preventing measures. A random sample of 60 primary school teachers used,
and an experimental design of single group pre and post-test was applied.
The pre-test results revealed that 6.7% of participants had humble
knowledge, while total 80% of them had moderate knowledge, and only
13.3% of them had respectable knowledge. In post test results the total 65%
of teachers sustained good knowledge and 35% of them had moderate

knowledge, which shows a significant improvement in their knowledge
toward insect stings prevention and first aid. The study concluded that the
teaching program for teachers regarding first aid was essential for
improvement in their knowledge (Raju, 2016).
2.8. Section K (Literatures Regarding Attitude):
Teacher must take the responsibility and must have the will to deal
with school emergencies because he/she represents the first line in saving
school children’s life during school time. Thus, this matter relates to attitudes
which affects such wish or wills, this also includes teachers acceptance for
child with special needs or chronic illnesses in their classes (Joseph et al.,
2015; Vaz et al., 2015).
Attitudes are well-defined as total evaluations toward some objects
and issues or attitudes are emotion that habitually influenced by human
beliefs, that predispose our responses to objects, persons and occasions. The
relationship between attitudes and action is mutual in which both of them
affecting each other. In brief term attitudes represents subjective evaluation
of our beliefs, behaviors and concepts (Baumeister and Bushman, 2011;
Feldman, 2011; Myers, 2014). There are three component of attitudes,
believe (cognitive component), feeling (affective component) and behavior
(Hewstone et al., 2005).
Attitudes are usually abstracted into three classes of human response
and they are:
- Cognitive: represents our beliefs toward objects or other persons.
- Affective: represents our feeling toward individuals or objects.
- Behavioral: represents our actions toward objects and persons
(Walker et al., 2007).
Attitudes are formed due to numerous influences, and all of them
considered as forms of learning. So that, attitude formed by direct contact,

direct instructions, interaction with others and indirect conditioning
(observational learning) (Ciccarelli and White, 2015).
Chinese research conducted by Li et al., in 2012 for knowledge and
attitude of preschools’ staff regarding pediatric first aid in Shanghai, China;
and aimed to assess basic level of knowledge and total attitude about first
aid among respondents. A cross-sectional study was performed among staff
of selected preschools by using of stratified random sample. The tool of
study was a multiple choice questionnaire. The research result revealed that
none of 1067 study participants were answered all questions correctly and
just 39 individual (3.7%) carried out successful scores. Particularly,
insufficient knowledge about first aid for epileptic fits detected which only
(16.5%) of them answered such questions correctly. While the correct
answers for eye chemical injuries, inhaled poison, and choking respectively
were 23%, 27%, and 30.1%. Attitude concerning first aid administration was
positive in majority of participants, and most of them felt positively toward
first aid learning and accepted the importance of learning such skills.
Nutshell, these scores carried out using multiple linear regression and
revealed that higher scores were associated with higher education and
previous first aid training. Depending on result of study that showed low
level of knowledge regarding first aid the study concluded that there was an
urgent need to arrange practical educational sessions regarding first aid for
preschools’ staff and undergraduate ones (Li et al., 2012).

Chapter Three: Methodology 50
Chapter Three
Methodology
This chapter will demonstrate the methodology of existing study and
all various stages that passed through, from the beginning of its approval and
ending with the analysis of its’ collected data.
3.1. Study Design:
A descriptive, cross-sectional study design was carried out, so as to
attain the stated objectives. During the period from 1st
November 2015 to 4th
September 2016.
3.2. Administrative Arrangements:
The Central Statistical Organization (CSO), in the Ministry of
Planning, gave an official consent for the using of the questionnaire draft
concerning the research subject (Appendix B).
Another official agreement was taken from General Directorate for
Education in the province of al-Najaf in order to collect required data from
governmental primary schools in Al-Najaf city (Appendix B).
3.3. Ethical Consideration:
The participants were fully acquainted of the current study and its
aims and then a voluntary verbal consent was obtained in order to participate
in the study. Besides, the confidentiality of information obtained from
teachers has been taken into account. Also, an ethical approval was obtained
from ethical committee of research in Faculty of Nursing/University of Kufa
regarding confidentiality and anonymity of participants (Appendix C).
3.4. Setting of the Study:
The study was conducted at governmental primary schools in
(northern, southern and old-city neighborhoods) of Al-Najaf City, Iraq. A
total of the (30) governmental primary schools selected randomly from total
(235) governmental primary schools existed in Al-Najaf City.

3.5. The Sample of the Study:
3.5.1. The Sample Size:
An equation for sample size estimation in cross-sectional studies was
used, to determine the sample size and the numbers of questionnaires needed
to be distributed as following
𝒛 𝟐×𝒑𝒒
𝒅 𝟐
(Naing et al., 2006; Hajian-Tilaki,
2011; Charan and Biswas, 2013).
In which, the
𝒛 𝟐×𝒑𝒒
𝒅 𝟐
(Z) refers to confidence level that is 95%, so that, the Z →1.96.
(P) refers to estimated proportion of expected outcomes according to
previous studies if exist as used in current study or according to
probability rule 50% = 50%.
(q) means (1- p).
(d) refers to the level of significance or desired precision, which is
(0.05).
Additionally, according to previous study on teachers’ knowledge
about first aid done in Baghdad, Iraq by (Al-Robaiaay, 2013); the percentage
of good and moderate knowledge among primary school teachers concerning
first aid was nearby 23%, so that, the (p = 23), and when applying the
equation
𝒛 𝟐×𝒑𝒒
𝒅 𝟐
→
(𝟏.𝟗𝟔) 𝟐×𝟎.𝟐𝟑(𝟏−𝟎.𝟐𝟑)
(𝟎.𝟎𝟓) 𝟐
→ the results was (272) and we added
15% to original number (272) to become 313, and it was approximated to
320, in case of losing or wrong filling of some questionnaires by
respondents, which meant the total numbers of questionnaires that will be
distributed.
3.5.2. The Sampling of the Study:
Information that obtained from General Directorate for Education in
the province of al-Najaf revealed that (235) governmental primary schools
of both boys and girls were existed in the Al-Najaf city. In addition, every
school was represented by a number and then by using SPSS (SPSS → Data

→ Select cases) a simple random sample of 30 primary schools was
generated. Moreover, by using simple random sampling technique, 313
primary school teachers were selected randomly from aforementioned 30
primary schools.
3.6. Instrument of the Study:
By reviewing related literatures and studies the questionnaire was
prepared and modified depending on previous studies (Başer et al., 2007; Li
et al., 2012; Al-Robaiaay, 2013; Masih et al., 2014), and it was divided into
three main parts (part one contained sociodemographic information, part two
included questions on knowledge about first aid and it was also sub-divided
into six portions and part three which included questions to determine
primary school teachers’ attitudes regarding first aid). The total number of
questions for this tool was 50 questions (38 of questions for knowledge
concerning first aid and 12 of questions for attitudes toward first aid).
3.7. Current Study Validity:
Capability of collecting needed data by questionnaire called validity.
For determining the validity of created questionnaire (17) experts (which are
having beyond five years of experience in the medical and nursing
profession), were consulted in order to explore the current study’s
questionnaire for its competence, relevance, intelligibility and clearness to
achieve the selected objectives.
A pilot copy of current study questionnaire was constructed and
offered to the experts detailed in (Appendix A).
Furthermore, majority of experts approved that the questionnaire was
well designed and developed in order to assess the primary school teachers’
knowledge and attitudes toward first aid. Moreover, the suggestions of vast
majority of experts were taken into consideration. So far, the final copy of
research tool was reformed and prepared for carrying out the study.

3.8. Pilot Study:
A random sample of (30) primary school teachers from three
governmental primary schools (two boys’ schools and one girl school) in the
City of Al-Najaf were included in the pilot study, in which they were (21)
female teachers and (9) male teachers, besides, the pilot study sample was
excluded from the total study sample. So that, this pilot study was conducted
from January 24th
to January 31th
; 2016.
The pilot study aimed to:
1) To recognize the selected teachers’ understandability of questions
in the study tool and if they find some questions fuzzy or incomprehensible.
2) Improving the reliability of the current study questionnaire.
3) To estimate the typical time that needed during data collection
process.
3.9. Reliability:
By using Cronbach’s Alpha coefficient test the reliability of the study
instrument was specified, in addition, this test was performed separately for
both knowledge and attitude questions (Table 3.1). The result of test showed
acceptable reliability depending on the value of the Cronbach’s Alpha which
was (0.780) for knowledge scale and (0.820) for attitude scale. Moreover,
the data were collected from (30) primary school teachers by means of
created questionnaire.
Table 3.1. Reliability of the current study instrument:
Scale
Number of
questions
Cronbach’s
Alpha value
Accepted
value
Assessment
Knowledge 38 0.780 0.70 pass
Attitude 12 0.820 0.70 pass
3.10. Data Collection:
By using a developed and revised questionnaire, and by means of self-
administered technique the data was collected. Besides, the researcher met

the principals of schools and asked for names, genders and numbers of
teachers existed at the time of study in order to choose randomly among
them. After that, the researcher obtained verbal agreement of the selected
teachers to participate in the study. Then, every teacher selected was told
about the subject of the study and the right way to fill the questionnaire
fields. Finally, the selected teachers filled the questionnaires without
supervision of researcher. Totally, the number of questionnaires collected
and were usable for statistical analysis were 302, while 8 questionnaires were
invalid due to mistakes in filling and 7 ones were not returned at all, and the
socio-demographic data were missing in 3 questionnaires. The data
collection period continued from 10th
February 2016 to 13th
April 2016.
3.11. The Statistical Analysis:
All questionnaires of the respondents were checked for any errors,
inconsistency or missed data, then transferred into a computerized data form,
coded with specific code for each variable and response. Data of the 302
participant’s teachers were entered and analyzed by means of the statistical
package for social sciences (SPSS), V.23, 2015. Percentages, means,
frequencies and standard deviation were the obtained descriptive statistics.
All numerical variables and the scoring variables were tested for normal
distribution using the normal P-P plot and also checked for Skewness or
Kurtosis. However, all the scale variables were normally distributed with
small Skewness and Kurtosis in some variables. For the assessment of the
relationship between overall knowledge or attitude of participants with other
variables, Chi Squared test was used, and the P.value was calculated. The
level of significance was set at ≤ 0.05 as significant. In conclusion, the results
and findings of existing study were presented in tables as well as figures with
a clarifying section for each table or figure using the Microsoft Office Word
program software for windows, version 2013.

Scoring of Knowledge and Attitude of Questionnaire Items:
1. Knowledge Scores:
Each item of the knowledge questions had three responses, yes, no, don’t
know, therefore, according to the ideal answers for each questions, the
responses of participants categorized either, correct, incorrect or uncertain
for the response of don’t know. The scores were three points for accurate
answer, two points for uncertain and one point for incorrect answer, this
scoring is widely used in analysis of knowledge questionnaires that use 3
points Likert’s scales. Then the mean score for each question was calculated
which is equal to the mean score of all participants for the question. The
evaluation of the knowledge then categorized into three categories; good,
fair or poor according to the value of the mean score.
Poor Knowledge: mean score = 1 – 1.67
Fair Knowledge: mean score = 1.68 – 2.33 and
Good Knowledge: mean score > 2.33
2. Attitude Scores:
The attitude questionnaire used the 5 points Likert’s scale model,
however, the scoring system is not much different than the 3 points scales
but the higher scores given to the more positive attitude and the lower score
given to the least negative attitude, with a score ranged 1 – 5. then the
responses of participants assessed according to these scores and given a
suitable score, however, uncertain or undecided response was considered the
midpoint of this scoring system and given a score of 3 which is equal to the
mean of scores (1, 2, 3, 4, 5), (15/3). As in this scale two responses below 3
(negative attitude) and two responses above (positive attitude), therefore, the
cutoff point of 3 was used to differentiate between the positive and negative
attitude of participants, and the according to mean score for each item or
domain or the overall attitude score, participants categorized:
Positive Attitude: mean score ≥ 3
Negative Attitude: mean score < 3

All variables scores were tested for normal distribution and
statistically analyzed using the standard statistical tests for parametric
variables and managed as scale variables. while the categories of the scores
were managed as nominal or ordinal variables, accordingly.

Chapter Four
Results and
Findings

Chapter Four: Results 58
Chapter Four
Results of the Study
Table 4.1. Socio-demographic characteristics of the studied group
(N = 302)
Characteristic Frequency Percentage
Age (year) 21 - 30 30 9.9
31 - 40 98 32.5
41 - 50 103 34.1
> 50 71 23.5
Gender Female 231 76.5
Male 71 23.5
Residence Urban 294 97.4
Rural 8 2.6
Marital Status Married 263 87.1
Single 20 6.6
Widow 15 5.0
Divorced 4 1.3
Number of children None 61 20.2
1 - 2 43 14.2
3 - 4 124 41.1
5 or more 74 24.5
Monthly Income (IQD) < 700,000 87 28.8
700,000- 1000,000 154 51.0
≥1000,000 61 20.2

This table revealed that, a total of 302 primary school teachers were
enrolled in this study, with a mean age of 43.5 ± 9.1 (range: 22 - 62) years,
furthermore, majority of participants aged more than 30 years. Females were
the dominant represented 76.5% of the studied group compared to 71 male
teachers (23.5%). Vast majority of the participants (97.4%), were urban
residents and (87.1%) of participants were married, only (20.2%) of the
participant had no children and the remaining (79.8%) had at least one child.
Nearly half of the participants had a monthly income of 700,000-1000,000
IQD, while 87 (24.5%) had an income of < 700,000 IQD and (20.2%) had a
monthly income of > 1000, 000 IQD.
Table 4.2. Educational level and years of experience of the studied group
Variable Frequency Percentage
Educational Level Institute 211 69.9%
College 82 27.2%
Others 9 3.0%
Years of experience
(year)
1 - 10 64 21.2%
11 - 20 106 35.1%
21 - 30 92 30.5%
> 30 40 13.2%
This table showed that the educational level and years of experience
of the studied group. It had been found that more than two thirds of
participants, (69.9%), had an institute level of education and 27.2% had a
college level while only 3% had other level of education including higher
education. Additionally, majority of the participant teachers (78.8%), had an
experience of more than 10 years, while only 64 teachers (21.2%), had
experience of 1-10 years.

Table 4.3. Distribution of Previous and source of Information about first
aid
Variable Frequency Percentage
Previous Information about first aid
Yes 184 60.9
No 118 39.1
Source of information*
Reading 69 22.8
Mass media 106 35.1
Training course 47 15.6
Previous experience 33 10.9
Internet 33 10.9
* Response more than one.
This table showed the distribution of participant teachers according to
their previous information about first aid and the source of these information,
as it shown in this table, 184 teachers (60.9%), claimed that they had a
previous information about first aid, and they get their information from
reading (22.8%), mass media (35.1%), training course (15.6%), previous
experience (10.9%), and from internet (10.9%) of participants, it is worth
mentioning, that some teachers obtained their information about first aid
from more than one source of information.

Table 4.4. Responses of participants regarding the general information
about first aid
General information
about first aid
Correct Uncertain Incorrect mean
score
evaluation
No. % No. % No. %
The main purpose of first
aid is to preserve life.
294 97.4 3 1.0 5 1.7 2.96 Good
Qualification of a good
first aider is to be good
listener.
37 12.3 16 5.3 249 82.5 1.30 Poor
Preventing accidents is the
responsibility of first
aider.
174 57.6 62 20.5 66 21.9 2.36 Good
First aid is applied
immediately to treat the
injured child until medical
help arrives
283 93.7 13 4.3 6 2.0 2.92 Good
When you are providing
first aid, the first priority
is given to life threatening
case
253 83.8 36 11.9 13 4.3 2.79 Good
Overall for this domain 2.46 Good
This table summarized the number and percentage of responses to
questions on general information about first aid of the participant teachers
with the mean scores and evaluation for each question and the domain, it had
been found that 97.4% of the participants were correctly identified the main
purpose of first aid and they had good information on this question,
conversely, poor knowledge was reported regarding the qualification of a
good first aider where only 12.3% had the correct response for this question,
the responses to other questions were good , and the correct responses were
57.6% for the question about responsibility of first aider, 93.7% for when the
first aid applied and 83.8% were correctly respond about the first priority
given by the first aid provider, however, the overall evaluation for this
domain was good with a mean knowledge score of (2.46). Moreover,
according to the mean scores of the participants for this domain, it had been

found that 212 (70.2%) of participants had good knowledge about the general
information on first aids and the remaining 29.8% had fair knowledge, while
none of the participants had poor knowledge for this domain, (Figure 4.1).
Figure 4.1. Distribution of participant teachers according to their
knowledge on general information on first aid (N = 302)
212
90
0
0
50
100
150
200
250
300
Good Fair Poor
Numberofparticipants
Knowledge
Good
Fair
Poor

Table 4.5. Responses of participants regarding the first aid of Wounds
and Bleeding
Wounds and Bleeding
Correct Uncertain Incorrect
mean
score
evaluation
No. % No. % No. %
Bleeding from avulsion of
teeth is the most common
type of bleeding that occurs
among school children
104 34.4 90 29.8 108 35.8 1.99 Fair
In case of nose bleeding
child, the best way to help
stop bleeding is to sit down,
lean backward and pinch
nostrils
64 21.2 41 13.6 197 65.2 1.56 Poor
The first action to control
bleeding is apply direct
pressure to the wound
58 19.2 31 10.3 213 70.5 1.49 Poor
The main types of wounds
are lacerations, punctures and
abrasions
30 9.9 122 40.4 150 49.7 1.60 Poor
The main aim of wound care
is to prevent infections.
142 47.0 22 7.3 138 45.7 2.01 Fair
The first way to clean a
wound is by water
146 48.3 69 22.8 87 28.8 2.20 Fair
Overall of this domain 1.81 Fair
This table showed the responses of participants about the first aid of
wounds and bleeding. Consequently, questionnaire had found that the
knowledge of participants regarding the questions in this domain ranged
between poor and fair giving an overall mean score for this domain of 1.81
and an evaluation of fair knowledge.

knowledge on first aids for wounds and bleeding (N = 302)
This figure showed the distribution of participant teachers according
to their knowledge scores for this domain, where only 10 participants (3.3%)
had good knowledge, 161 (53.3%) had fair and 131 (43.4%) participant
teachers had poor knowledge about the first aid for wounds and bleeding.
10
161
131
0
50
100
150
200
250
300
Good Fair Poor
Knowledge
Good
Fair
Poor

Table 4.6. Responses of participants regarding the first aid of Bone and
joint injuries.
Bone and joint injuries
mean
score
evaluation
No. % No. % No. %
There are two types of fractures
open and closed.
68 22.5 131 43.4 103 34.1 1.88 Fair
The fracture victim should be
given fluids.
24 7.9 77 25.5 201 66.6 1.41 Poor
In case of bone fractures you
must just splint the fractured
bone then seeks medical help.
167 55.3 35 11.6 100 33.1 2.22 Fair
During the fracture
immobilization only the direct
fracture area should be
immobilized.
50 16.6 55 18.2 197 65.2 1.51 Poor
In case of open fractures you
should align the ends of broken
bone then splint it.
16 5.3 112 37.1 174 57.6 1.48 Poor
Joints injuries include Sprains
and dislocations.
227 75.2 61 20.2 14 4.6 2.71 Good
The first aid measures for joint
injuries are immobilize area,
apply ice/cold pack, use soft
splint, and seek medical
attention.
25 8.3 49 16.2 228 75.5 1.33 Poor
Overall for this domain 1.79 Fair
This table showed the results regarding the responses of participant
teachers on the first aid of bone and joint injuries questions, the responses of
participants were either good or fair for all questions in this domain except
for the question about joints injuries include sprains and dislocations where
75.2% of participant correctly respond to, giving a good knowledge for this
question. However, the overall, knowledge of the participants for this
domain was fair with a mean overall knowledge score of (1.79).

knowledge on first aids for bone and joints injuries (N = 302)
This figure showed the distribution of participants according to their
knowledge about the first aid for bone and joint injuries, where only 8
participants (2.6%) had good knowledge on this domain, 205 (67.9%) fair
and 89 (29.5%) had poor knowledge on first aid for bone and joints injuries.
8
205
89
0
50
100
150
200
250
300
Good Fair Poor
Knowledge
Good
Fair
Poor

Table 4.7. Responses of participants regarding the first aid of medical
situations.
Medical situations
mean
score
evaluation
No. % No. % No. %
Knowledge to help a child to
breathe more easily during
asthma attack,
32 10.6 133 44.0 137 45.4 1.65 Poor
Know the action if a diabetic
child suddenly falls during
class.
162 53.6 83 27.5 57 18.9 2.35 Good
First aid for a seizure attack 44 14.6 43 14.2 215 71.2 1.43 Poor
Shock is a life-threatening
condition
72 23.8 73 24.2 157 52.0 1.72 Fair
The main purpose of raising the
legs of a fainted person
120 39.7 41 13.6 141 46.7 1.93 Fair
First aid for Food choking 156 51.7 49 16.2 97 32.1 2.20 Fair
The main signs of food
poisoning
267 88.4 32 10.6 3 1.0 2.87 Good
Must try to induce vomiting to a
food poisoned child.
24 7.9 49 16.2 229 75.8 1.32 Poor
The best options to rescue a
food poisoned child.
82 27.2 128 42.4 92 30.5 1.97 Fair
As it shown in (Table 4.7), poor knowledge was reported among
participants regarding the first aid for asthma attack, first aid for a seizure
attack, first aid for a food poisoned child. Fair knowledge was reported
regarding the knowledge about shock, main purpose of raising the legs of a
fainted person, first aid for food choking, the best options to rescue a food
poisoned child. A good knowledge was reported for only two of the
questions on first aid of medical situations these are the action if a diabetic
child suddenly falls during class and the main signs of food poisoning,

nonetheless, the overall knowledge for this domain was fair and the mean
knowledge score was (1.97).
knowledge on first aids of medical situations (N = 302)
This figure revealed that, only 10 (3.3%) of participants had good
knowledge on this domain, 269 (89.1%) had fair and 23 (7.6%) had poor
knowledge on the first aids for medical situations.
10
269
23
0
50
100
150
200
250
300
Good Fair Poor
Knowledge
Good
Fair
Poor

Table 4.8. Responses of participants regarding the first aid of Burns.
Knowledge item of
Burns
Correct Uncertain incorrect
mean
score
evaluation
No. % No. % No. %
Classification of burns 113 37.4 47 15.6 142 47.0 1.90 Fair
A child with reddening
of skin after a burn has
an intermediate burn.
57 18.9 128 42.4 117 38.7 1.80 Fair
Electrical burns can
cause serious injuries to
vital organs.
167 55.3 52 17.2 83 27.5 2.28 Fair
Before doing any first
aid action you must
remove clothes around
the burned area.
109 36.1 28 9.3 165 54.6 1.81 Fair
In case of simple or
medium burn you can’t
cool the burned area
with water before taking
the victim to hospital.
51 16.9 97 32.1 154 51.0 1.66 Poor
Usually in severe burns,
the patient does not feel
pain in the place of
burn.
37 12.3 56 18.5 209 69.2 1.43 Poor
Knowledge about rescue
procedures for electrical
shock victims
150 49.7 31 10.3 121 40.1 2.10 Fair
This table showed the knowledge responses of participant teachers on
questions of the first aid of burns, in all questions except two, the participant
had fair knowledge, while they had poor knowledge regarding the cooling of
burned areas in case of simple or medium burns and also poor knowledge
regarding patient’s feeling of pain in case of severe burns. The overall
knowledge for this domain was fair, (mean score: 1.85), and only 23
participants (7.6%) had good knowledge on this domain, 196 (64.9%) had
fair and 83 (27.5%) had poor, (Figure 4.5).

knowledge on first aids of burns (N = 302)
23
196
83
0
50
100
150
200
250
300
Good Fair Poor
Knowledge
Good
Fair
Poor

Table 4.9. Responses of participants regarding the first aid of bites, stings
& foreign body.
Bites, stings & foreign
body
mean
score
Evaluation
No. % No. % No. %
Knowledge about dog's
bite without severe
bleeding
30 9.9 25 8.3 247 81.8 1.28 Poor
The first aid action for
foreign bodies in the nose.
128 42.4 72 23.8 102 33.8 2.09 Fair
Rubbing the eye is the best
action to remove foreign
bodies from eye.
179 59.3 35 11.6 88 29.1 2.30 Fair
Serious allergic reaction of
an insect bite can cause
breathing emergency.
43 14.2 100 33.1 159 52.6 1.62 Poor
As it shown in this table, the knowledge of participants regarding
dog’s bite without bleeding and Serious allergic reaction of an insect bite
was poor, while for the first aid action for foreign bodies in the nose and the
best action to remove foreign bodies from eye was fair, however, the overall
knowledge for the first aid of bites, stings & foreign body was fair with a
mean score of (1.82).
Moreover, 31 participants had good knowledge on this domain
represented only 10.3% of the studied group, 172 (57%) had fair knowledge
and 99 (32.8%) had poor knowledge regarding the first aid of bites, stings &
foreign body, (Figure 4.6).

knowledge on first aids for bites, stings & foreign body. (N = 302)
Table 4.10. Evaluation of teachers’ overall knowledge about first aid in
school.
Overall knowledge Frequency Percent
Fair 287 95.0
Poor 15 5.0
Total 302 100.0
This table showed the evaluation of the participants’ knowledge for
different domains and the total scores for all questions on knowledge about
first aids; the overall knowledge of the participants was fair in 287 participant
teachers (95%) and poor in only 15 (5%), while none of the participants had
good overall knowledge about first aids in school, and the evaluation for
overall knowledge was fair with a mean score of (1.95).
31
172
99
0
50
100
150
200
250
300
Good Fair Poor
Knowledge
Good
Fair
Poor

Table 4.11. Relationship between overall knowledge of participants and
their socio-demographic characteristics
Socio-demographic
characteristic
Overall knowledge
P.value
Fair
(n=287)
Poor
(n=15)
Frequency percent Frequency percent
Age (year)
21 - 30 26 86.7 4 13.3
0.10
31 - 40 96 98 2 2
41 - 50 98 95.1 5 4.9
> 50 67 94.4 4 5.6
Gender
Male 65 91.5 6 8.5
0.98
Female 222 96.1 9 3.9
Residence
Urban 280 95.2 14 4.8
0.32
Rural 7 87.5 1 12.5
Marital Status
Married 249 94.7 14 5.3
0.71
Single 20 100 0 0
Widow 14 93.3 1 6.7
Divorced 4 100 0 0
Number of children
None 57 93.4 4 6.6
0.22
1 – 2 42 97.7 1 2.3
3 - 4 115 92.7 9 7.3
5 or more 73 98.6 1 1.4
Educational Level
Institute 202 95.7 9 4.3
0.29College 77 93.9 5 6.1
Others 8 88.9 1 11.1
Years of experience
1 - 10 59 92.2 5 7.8
0.22
11 - 20 104 98.1 2 1.9
21 - 30 86 93.5 6 6.5
> 30 38 95 2 5
Monthly Income
(IQD)
< 700,000 79 90.8 8 9.2
0.025
700,000 -
1000,000
151 98.1 3 1.9
≥1000,000 57 93.4 4 6.6
This table showed that the analysis using the cross tabulation for
overall knowledge of participants against their socio-demographic
characteristics to assess the relationship between these two variables

revealed no statistically significant association with all variables, (P> 0.05),
except with the monthly income, (P=0.025), where, a direct relationship had
been found, teachers with lower income had the lower knowledge score and
more likely to have poor knowledge about first aid.
Table 4.12. Responses of participant teachers to questions on attitude
toward first aid.
Attitude toward first aid
Strongly
agree
Agree Undecided Disagree
strongly
disagree
No. % No. % No. % No. % No. %
It is crucial to learn first aid in
daily life. 141 46.7 156 51.7 2 0.7 0 0.0 3 1.0
Learning of first aid is so
complicated and difficult. 3 1.0 31 10.3 57 18.9 155 51.3 56 18.5
Believe the first aid action
should be done only by
experienced health care
professionals.
9 3.0 40 13.2 21 7.0 154 51.0 78 25.8
Think that teacher training for
first aid is helpful. 143 47.4 148 49.0 3 1.0 4 1.3 4 1.3
Tend to watch TV programs
about dealing with emergencies
and first aid.
77 25.5 168 55.6 29 9.6 21 7.0 7 2.3
Feel uncomfortable to see
injuries or bloods 72 23.8 126 41.7 23 7.6 58 19.2 23 7.6
Think, It is very important to
keep first aid box in school 172 57.0 100 33.1 11 3.6 7 2.3 12 4.0
As a teacher, refuse to accept a
child with epilepsy in the class. 51 16.9 75 24.8 48 15.9 79 26.2 49 16.2
Believe that first aid should be
taught to teachers as well as their
pupils
105 34.8 174 57.6 11 3.6 10 3.3 2 0.7
In emergency situation in the
class that needs first aid, it
preferred to ask other teachers
for help instead
24 7.9 91 30.1 45 14.9 108 35.8 34 11.3
Believe an asthmatic or diabetic
child should be isolated with
special needs kids.
28 9.3 75 24.8 27 8.9 121 40.1 51 16.9
If the teacher have first aid
knowledge and skills, will
perform first aid to a child in
need.
123 40.7 156 51.7 12 4.0 5 1.7 5 1.7
This table shows teachers’ responses regarding different questions on
attitudes toward first aid for each question.

Table 4.13. Frequency distribution of domains and overall attitude
toward first aid of participant teachers (N=302)
Attitude toward
Positive Negative
Mean score Evaluation
No. % No. %
Learning first aid 297 98.3% 5 1.7% 4.15 Positive
Giving first aid 284 94.0% 18 6.0% 3.6 Positive
Medical condition 194 64.2% 108 35.8% 3.15 Positive
Overall 282 93.4 20 6.6% 3.7 Positive
Figure 4.7. Distribution of participant teachers according to their attitude
toward first aids in schools, (N =302)
The responses of participant teachers to different domains of attitude
toward first aid are shown in (Table 4.13). Furthermore the distribution of
participants’ attitude toward different domains of attitude questionnaire,
revealed that majority of the participants, (98.3%), had positive attitude
toward learning first aid, in this domain, the mean score for this domain was
(4.15) giving an evaluation of positive attitude. Regarding the giving first aid
domain, 94% of participant teachers had positive attitude and showed clearly
the desire to give first aids when needed, the mean score for this domain was
(3.6) and evaluated as overall positive. For the third domain concerning the
282; 93.4%
20; 6.6%
Positive
Negative

attitude toward medical conditions, the score was lower than the fore
mentioned two domains; 194 (64.2%) of participants had positive attitude
toward this domain and, unfortunately, 108 (35.8%) had negative attitude for
this domain, nonetheless, the mean score of this domain was (3.15) which
still within the overall positive attitude. Additionally, the overall mean score
for all domains of attitude, was (3.7) giving an evaluation of overall positive
attitude toward first aid among studied group, on the other hand, 282
participants (93.4%) had an overall positive and only 20 (6.6%) had an
overall negative attitude toward first aid, these findings are demonstrated in
(Table 4.13 and Figure 4.7)

Table 4.14. Relationship between attitude of participants toward first aid
in schools and their socio-demographic characteristics
Socio-demographic characteristic
Attitude
P.value
Positive
(n= 282)
Negative
(n=20)
Freq. percent Freq. percent
Age (year)
21 - 30 28 93.3 2 6.7
0.34
31 - 40 93 94.9 5 5.1
41 - 50 98 95.1 5 4.9
> 50 63 88.7 8 11.3
Gender
Male 66 93.0 5 7.0
0.87
Female 216 93.5 15 6.5
Residence
Urban 276 93.9 18 6.1
0.034
Rural 6 75.0 2 25.0
Marital Status
Single 15 75.0 5 25.0
0. 40
Widow 13 86.7 2 13.3
Divorced 4 100.0 0 0.0
Married 250 95.1 13 4.9
Number of children
None 53 86.9 8 13.1
0.133
1 - 2 40 93.0 3 7.0
3 - 4 118 95.2 6 4.8
5 or more 71 95.9 3 4.1
Educational Level
Institute 197 93.4 14 6.6
0.70College 76 92.7 6 7.3
Others 9 100.0 0 0.0
Years of experience
1 - 10 61 95.3 3 4.7
0.003
11 - 20 100 94.3 6 5.7
21 - 30 89 96.7 3 3.3
> 30 32 80.0 8 20.0
Monthly Income (x 1000
IQD)
< 700,000 82 94.3 5 5.7
0.23
700,000 -
1000,000 146 94.8 8 5.2
≥1000,000 54 88.5 7 11.5
This table demonstrates the relationship between attitude of
participants toward first aid in schools and their socio-demographic
characteristics, it had been found that positive attitude was significantly
associated with urban residency, and the 21- 30 years of experience,
(P< 0.05), other variables were insignificantly associated with the attitude,
(P> 0.05).

Chapter Five
Discussion of the
Results

Chapter Five: Discussion 79
Chapter Five
Discussion
Globally, the foremost reason for childhood mortalities during school
age is sudden injuries and sicknesses. So that, knowledge about first aid must
cover all measures to save a child’s life in case of such unexpected illnesses
and injuries. Furthermore, the early time following the injury is decisive and
countless, victims die before they reach to a health facility due to
inappropriate care or lack of knowledge of respondents to emergencies, as
well, the unpleasant consequences of an injury can be prevented by providing
proper first aid by teachers and even students (Hatzakis et al., 2005; Başer et
al., 2007; Yurumez et al., 2007; Abd el-Ghany et al., 2014; Dasgupta et al.,
2014; Sonavane et al., 2014; Younis and El-Abassy, 2015).
Therefore, the current study tried to assess the knowledge and attitude
of primary school teachers of governmental primary schools at Al-Najaf city;
and also to identify any possible association between participants’
knowledge and attitude and their socio-demographic characteristic.
For well-organized discussion of the results and findings, this chapter
will be divided according to objectives and domains of the current study.
5.1. Socio-demographic Characteristic and Educational Level of
Participants:
The present study included a group of (302) Iraqi primary school
teachers with a mean age of 43.5 (range:22-62) years, besides, the
mainstream of participants’ age was above 40 years. This finding is similar
to a study done by Sunil Kumar et al in 2013, which reported that majority
of participants were above 40 years of age (Kumar et al., 2013), Conversely,
Rohitash Kumar in 2015 reported that the age of majority of a group of
Indian teachers was below 40 years of age, this discrepancy could be
explained by using a convenient sample in that study, which cannot be
considered representative to the general teachers population (Kumar, 2015).

Furthermore, female was the dominant gender, and represented almost
three quarters of the studied group. These findings may come back to that
females are having better desire and more willing than males to work in the
primary education sector, in addition, the working time in schools are utmost
appropriate for females in Iraq. Moreover, an Indian research conducted in
2014 by Masih et al reported that the female gender was the predominant
gender, (94%) of teachers (Masih et al., 2014). Similarly, Turkish
researchers, Sonmez et al, in 2014 reported that (98.1%) of teachers were
female (Sönmez et al., 2014).
From other point of view, vast majority of school teachers in the
present study were resident in urban areas , which is consistent with the
demographic distribution of Al-Najaf province that confirm this fact, where
more than 70% of Al-Najaf population dwelling in urban areas (NCPP,
2012), in addition, the present study conducted in the center of Al-Najaf city.
Regarding marital status and number of children the teachers did have,
the current study found that higher proportion of participants were married
(more than four-fifth of participants) , in addition, about 79.8% of teachers
had children which reflects the nature of Iraqi society and its traditions,
especially as confirmed by statistics of the Central Organization for Statistics
of the Ministry of Planning, where statistics showed an early age for
marriage in general for girls throughout Iraq and particularly of Najaf, which
ranked the first among other provinces regarding the early age of marriage ,
which considered higher in Iraq comparing to other Arab societies (CSO,
2007a, 2007b; NCPP, 2012).
With respect to monthly income of participants in this study, the
outcome showed that more than half of teacher included in this study had a
monthly income of (700,000) to one million IQD, which is considered lower
than average family expenditure set by the Ministry of Planning in 2012
which was (1664,000) IQD, which may refer to unsatisfactory monthly
income in relation to rises of cost of living (CSO, 2012).

Also, the result of present study about educational level and years of
experience of participants revealed that majority of teachers were graduated
from teachers’ institute, while only 27.2% were graduated from college and
only 3% of the participants had another educational certification (higher
education e.g. high diploma, master degree or doctorate degree), this finding
was not unexpected, , because in Iraq, most of teachers during the past time
were entering teachers’ institute or teachers’ preparation school after prep to
shorten the period needed for employment. Additionally, colleges were not
available in all Iraqi provinces as in the present time. However, this was
consistent in part, with the Indian study of Rohitash Kumar, that found only
7% of teacher had higher education while the majority of them had a college
level of education which was higher than our finding (Kumar, 2015).
Majority of participants had an experience in education more than ten
years (>78.8%), and this attributed to reduction in the employment rate by
Ministry of Education in the last years which lead to reduction of numbers
of recently employed teachers. Likewise, the Indian research done by
Devashish et al in 2013 reported that nearly 75.63% of participants had more
than ten years of experience in teaching (Devashish et al., 2013). Moreover,
this finding disagreed with Shobha Masih et al in 2014, in which informed
that 84% of teachers had less than ten years of teaching experience, because
the participants were selected younger by using non-probability sampling
technique (Masih et al., 2014).
5.2. Previous Information on First Aid among Participants:
Concerning previous information on first aid among participants, the
present study found that almost (61%) of participants mentioned that they
had previous information about first aid and when they were asked about the
source of these information, it appeared that reading and mass media were
more frequent sources of information about first aid, followed by reading
and training course, while previous experience and interned had the lowest
score.

Moreover, achieving of mass media on highest rate among sources of
previous information about first aid, may imply the importance of this
source, also what supports this finding is that the teachers when they were
asked about their willingness to watch special programs, about first aid and
health topics on TV, (80.1%) of them have expressed their consent to this
trend, which shows a very positive tendency to obtain information on the
first aid from this source, where it can be used to educate teachers and overall
population about first aid.
Likewise, Al-Samghan et al from Saudi Arabia reported in 2015 that
76.3% of teachers gained their information from mass media (Al-samghan
et al., 2015). Additionally, an Egyptian study in 2014 was done by Abd-el-
Ghany et al showed that most of participants attained their information about
first aid from TV, in which underscoring the importance of mass media not
only for teachers but for all sectors of society, especially Arabian ones (Abd
el-Ghany et al., 2014).
Furthermore, reading ranked as second source of information
according to current results (22.8%), while it was (60.2%) in a Turkish study
done in 2007, which can be interpreted due to diverse habits and hobbies
between communities (Başer et al., 2007).
However, many researchers highlighted in their studies the importance
of first aid training sessions for teachers’ knowledge, perception, practice
and attitudes regarding first aid (Ali et al., 2010). During the current study
only 47 (15.6%) of participant teachers alleged that they obtained their
information from training courses. This low number is at first step related to
absence of any training programs for teachers regarding first aid at Iraqi
schools (Al-Robaiaay, 2013). Despite this low proportion of trained teachers,
they are likely to receive such training in first aid when they were students
or through some non-governmental and non-official community activities.
Similarly, the current study agreed with other works done in Saudi
Arabia and China, that their results revealed similar numbers which less than

30% of teachers were trained on first aid or at least received some lectures
for it (Li et al., 2012; Al-samghan et al., 2015).
Also, our findings regarding preceding first aid training were in
contrast with result of previous studies done in Turkey, Poland, France, and
Australia, that are interested in first aid programs in schools, and showed
higher proportions of teachers whom received previous training during
different stages of their career, and about 60 – 70 % of teachers in these
studies received previous training on first aids, due to wide applying such
programs for training on first aid in these countries, even if it were not
mandatory, regardless of quality of such programs (Wiśniewski and
Majewski, 2007; Yurumez et al., 2007; Ammirati et al., 2014; Reveruzzi et
al., 2016).
In the existing result it was very distinct that previous experience of
teacher (when they were practicing a previous condition or situation that
needed first aid) and the internet had the less frequent sources of information
score than other sources.
Regarding internet, the present study showed that only (10.9%), of
participants were obtained information from this source, in which it is quite
similar to the findings of Abd-el-Ghany et al in 2014 in which revealed that
the internet had the lowest score (14.1%) among other sources of information
(Abd el-Ghany et al., 2014). This can be clarified as the nature of social
media (e.g. Facebook, YouTube and twitter…etc.) that usually used by
society for social, political, Entertaining, communicative and profit purposes
rather than educational aims.
As well, concerning previous experience of participants in the current
research toward situations and conditions that needed first aid, only (33)
teachers experienced such conditions, this disagreed with a study done in
Mangalore, India in 2015 in which stated that (88) teachers faced such
situation, while (74 out of 88) teachers handled with it (Joseph et al., 2015).

The reason might be due to few serious accidents happening in Iraqi schools
or due to the absence of records that confirm such situations.
The discrepancy in the findings regarding the sources of information
about first aids among different studies might be attributed to the
demographic, cultural, governmental and regulatory differences among these
populations in different countries.
5.3. General Information of Primary School Teachers about First Aid:
Concerning assessment of overall teachers’ knowledge on general
information about first aid, current finding revealed that (70.2%) of the
respondents had an overall good knowledge on general information about
first aid, which giving the impression that the teachers having a good general
perception and information on first aids’ purposes and priorities, where
majority of the participant had the correct responses about these conceptions,
however, unfortunately when the teachers, asked a more deeply and specific
question on first aider qualification only 12.3% of them answered this
question correctly, this finding supported by a study done in 2013 by Kumar
and others and found that 97.3% of teachers heard about first aid in general
while when the questions get more complexity the participants were found
to have unsatisfactory knowledge on first aid (Kumar et al., 2013). As well,
the Polish study by Wiśniewski and Majewski distinguished that more than
half of participant teachers had general proper knowledge about first aid
without the ability to apply it if needed (Wiśniewski and Majewski, 2007).
In addition, according to research outcome in 2014 by Joseph et al 67.1% &
65.8% of respondents had moderate knowledge regarding definition of first
aid and its purposes, respectively (Joseph et al., 2014).
Nevertheless, this is dissimilar with another finding of Devi in 2006,
which found that only 13.3% of them had overall good knowledge regarding
general information about first aid in pretest results while it was raised up to
80% in post-test outcome due to success of an educational program (Devi,

2006). And this reflected the importance of educational program on first aid
for teachers.
5.4. Teachers’ Knowledge about First Aid for Wounds and Bleeding:
Moreover, regarding the overall respondents’ knowledge about first
aid for wounds and bleeding, it was fair for this domain, however, (3.3%)
had good knowledge, (53.3%) of the participants had fair knowledge and
(43.4%) had poor knowledge concerning this domain. In details, the
questions such as epistaxis management, stopping the bleeding and washing
wounds by running water to decrease the risk of infection were answered
correctly as (21.2%), (19.2%) & (48.3%), respectively. In total, paucity was
noticed in teachers’ knowledge regarding questions of this domain in which
three of questions had fair assessment while the remaining three questions
had poor assessment especially in questions concerning epistaxis and means
to stop bleeding.
Likewise, present result was in same line with two other studies one
done in Iraq by Al-Robaiaay in 2013 and the other one conducted in India in
2014, in both of them majority of participants answered questions regarding
epistaxis and means to stop bleeding incorrectly (Al-Robaiaay, 2013;
Dasgupta et al., 2014).
On the contrary, Li et al., in 2012 found that the percentage of correct
responses by selected teachers regarding aforementioned questions was
higher in some aspects while similar in another one as following (for
epistaxis management 52.1%, for bleeding cessation 61.7% and 41.7% for
flushing wound by running water) (Li et al., 2012).
5.5. Teachers’ Knowledge about First Aid for Bone and Joint Injuries:
Furthermore, the teachers’ responses to questions regarding bone and
joint injuries, showed that most answers ranged from poor to fair assessment,
except one question. As well, the overall evaluation of this domain was fair.

Moreover, our findings agreed with study done in 2015 by Abdella et
al., in Saudi Arabia, in which the pre-test results showed only 12% of
teachers sustained satisfactory knowledge regarding first aid for fractures
(Abdella et al., 2015). Additionally, Kumar et al., in 2013 found similar
results to current study, which more than 55.7% of teachers said to avoid
movement the fracture site and 19.6% of them answered correctly question
regarding supporting fracture site (Kumar et al., 2013); whereas in current
study the correct responses percentage were 55.3% & 16.6%, respectively.
Moreover, in existing study results, lower correct responses to questions
regarding types of fractures, immobilization of fracture and first aid for open
fractures & joint injuries had been found, in which might be attributed to
dearth of both previous training and former information about first aid.
5.6. Teachers’ Knowledge about First Aid for Medical Conditions:
In addition, first aid knowledge of teachers concerning medical
conditions revealed insufficient (poor) knowledge regarding seizure attack,
asthma attack & poisoning while the other responses varied between fair and
good assessment. Total 89.1% of teachers sustained an overall knowledge
evaluated as fair domain.
Regarding knowledge on seizure attack the results of current study
evaluated as poor which agreed with findings of Li et al., in 2012 which only
14.1% of teachers had correct knowledge about first aid to epilepsy (Li et
al., 2012); also, Dasgupta et al., found that only 18.1% of participants in pre-
test results answered correctly this question (Dasgupta et al., 2014). whereas,
lower proportion of correct knowledge about seizure attack was reported by
Joseph et al., in 2015 where only 4.8% of teachers had correct answer
(Joseph et al., 2015). Additionally, only 13.8% of participants in research
done in 2014 by Joseph et al., acceptably responded to knowledge about
seizure’s first aid (Joseph et al., 2014).
As well, teachers’ perception and knowledge about questions
regarding asthma evaluated as poor in the current research. Moreover, Faisal

Alnasir conducted a study in Bahrain in 2004 and agreed with current study
that school teachers had poor knowledge regarding asthma management, as
well, Govender and Gray results in study done in south Africa in 2012
determined that teachers’ knowledge on asthma and its care was deficient
and needed training programs to improve it (Alnasir, 2004; Govender and
Gray, 2012).
Furthermore, the current study result concerning diabetes emergency
was good in which (53.6%) of teachers responded correctly, this finding was
close to that of Al-Samghan et al study in which 46.5% of teachers had
correct knowledge on hypoglycemia management at school, while it found
to be more higher in study applied in 2015 by Mobarak et al which reached
around 76% for untrained participants (Al-samghan et al., 2015; Mobarak et
al., 2015).
Also, for fainting in 2014 a study by Sonmez et al., found that 60% of
teachers recognized the correct response to fainting due to previously
received training of most of participants, which is in contrast to the current
study that only around 40% responded to this query suitably (Joseph et al.,
2015).
Furthermore, existing result showed fair knowledge among teachers
about first aid for choking. Additionally, studies results done by Abdella et
al, Joseph et al, Snomez et al and Mobark et al, fluctuated from poor to fair
toward choking management, which is slightly similar to current study
findings about choking emergency treatment, which was fair (Sönmez et al.,
2014; Abdella et al., 2015; Joseph et al., 2015; Mobarak et al., 2015).
Whereas, evaluation for poisoning first aid & poisoning priority were
poor and fair, respectively, in the current study, in which agreed with Baser
et al., 2007 and Al-Samghan et al., 2015 outcomes that low number of
teachers provided correct response regarding first aid for poisoning (Başer et
al., 2007; Al-samghan et al., 2015).

Generally, insufficient knowledge among primary school teachers was
observed in the current study, which indicates a lack in the participants’
information regarding such conditions.
5.7. Teachers’ Knowledge about First Aid for Burns:
Regarding, knowledge of teachers and responses on questions
regarding burns and their first aids the existing study found that 64.9% of
participants sustained an overall fair knowledge for questions on burns,
while only less than 10% of them had good knowledge. Most of questions
for this domain had fair evaluation, except questions regarding cooling burns
and pain symptom in severe burns which were evaluated as poor.
In general, this result was close to that reported in Joseph et al study
in 2014, which found that about 69% of participants had moderate
knowledge regarding first burns (Joseph et al., 2014).
However, inconsistent to the current finding, Nitin Joseph et al study
in 2015 found that (80.8%) of teachers sustained good knowledge regarding
burn first aid, which might be related to the fact that nearly half of
participants were trained on first aid previously (Joseph et al., 2015).
5.8. Teachers’ Knowledge about First Aid for Foreign Bodies (Eyes &
Ears), Dog’s Bite and Stings:
With regard to primary school teachers’ first aid information for
foreign bodies (eyes & ears), dog’s bite and stings, the recent study noted an
overall fair knowledge, which more than half of them sustained fair
knowledge, less than one third of participants had poor knowledge and only
(31) teacher (10.3%) had good information regarding this domain. In details,
dog’s bite and insect stings obtained poor assessment in which only 9.9%
and 14.2% of teachers answered them correctly, respectively, besides,
foreign bodies in eyes and ears had fair assessment.
For dogs’ bite immediate care, Snomez et al outcome agreed with the
current study, which found that only 16.4% of teachers had correct

knowledge about this question, besides, in 2006 the pretest result of Devi
found that only 6.77% of teachers had adequate knowledge for both animal
bites and insects’ stung; as well, Baser et al outcomes in 2007 noticed that
more than 50% of teachers ignorant to accurate care for insect stings (Devi,
2006; Başer et al., 2007; Sönmez et al., 2014).
In addition, a study in 2015 in Saudi Arabia noted that only 39% and
24.6% of primary school teachers responded correctly to eye and nose first
aids, respectively, which is somewhat lower than current study, moreover,
Nitin Joseph in 2015 found that (54.8%) of school teachers had good
information on first-aid for foreign bodies in eye which is higher than present
study, this disparity in results of these two studies related to difference in
number of participants whom had previous information and prior training
sessions on first aid (Al-samghan et al., 2015; Joseph et al., 2015).
5.9. Teachers’ Overall Knowledge about First Aid:
Totally, the result of current study revealed that total knowledge about
first aid of majority of teachers was fair knowledge and only (5%) had poor
knowledge about first aids, giving an overall evaluation of fair (moderate)
knowledge. This may be due to the ease of most of the questions, and the use
of self-administered questionnaire in which obtaining answers from other
sources couldn’t be excluded. The findings and evaluation of the teachers’
knowledge in the present study, lead to consider teachers’ responses as
unsatisfactory, especially if take into account that majority of questions was
not practical but theoretical. While, a study done in Baghdad found that
(77%) of participants had poor knowledge, which is lower than the current
study in Al-Najaf, whereas, the majority of teachers had overall fair
assessment (Al-Robaiaay, 2013); which may be due to variances in
profoundness of asked questions.
However, the overall assessment of this study agreed with Sunil
Kumar study in 2013 which revealed that most of teachers’ responses ranged
from poor to fair for knowledge regarding first aid (Kumar et al., 2013).

Subsequently, greatest proportion of research’s regarding school teachers’
information about first aid, found unsatisfactory knowledge (either poor or
fair), and needed to be improved by regular training programs (Sosada et al.,
2002; Yurumez et al., 2007; Hırça, 2012; Li et al., 2012, 2014; Devashish et
al., 2013; Sönmez et al., 2014; Al-samghan et al., 2015; Joseph et al., 2015).
5.10. Primary School Teachers’ Attitude Toward First Aid:
Concerning participants’ attitude toward first aid, the present study
found that overall attitude of vast majority of teachers was positive, in which
93.4% of teachers had positive attitude, while only 6.6% of participants’ had
negative attitude, toward first aid, which can be explained by the noble
humanistic values in our Arab societies, and especially Iraqi society that is
well recognized for desire to help others.
Likewise, the existing study results are analogous to studies done by
Chinese researchers Feng Li et al in 2012 and Indian researchers Nitin
Joseph et al in 2015, in which stated that majority of teachers had positive
attitude toward first aid regardless of level of knowledge about first aid found
among participants (Li et al., 2012; Joseph et al., 2015). However, a polish
study conducted in 2007 by Wisniewski and Majewski disagreed with
current study and stated that most of teachers had undesirable attitude toward
first aid and pointed the importance of accentuating the moral and noble
value of assisting others during any training sessions to modify the passive
attitude of participants (Wiśniewski and Majewski, 2007).
With respect to questions about importance of first aid learning, the
result of current study exposed positive attitude among overwhelming
majority of teachers toward learning first aid. A similar finding was informed
by Joseph et al in 2015, in which majority of teachers’ attitude was positive
toward learning first aid (Joseph et al., 2015). Also, the Chinese study by Li
et al stated that the teachers had positive attitude when they responded to
questions concerning attitude toward learning first aid (Li et al., 2012).

Regarding questions about attitudes in the direction of providing first
aid, positive attitude was reported by current study, but slightly, it was lower
than rates in the direction of learning first aid, in which also agreed with
findings by Engeland et al in 2002 and Li et al in 2012 (Engeland et al.,
2002; Li et al., 2012).
As well, attitude toward accepting children with some medical
conditions in classroom, that may worsen and may need to apply first aid in
future such as diabetic child and children with epilepsy the responses of
teachers were unsatisfactory and it was toward the negative attitude, that
might be contributed to insufficient knowledge regarding such conditions,
which reveal the need of training programs not only for first aid but, also for
other health issues in order to improve teachers’ confidence in providing first
aid, in which agreed with conclusion of Iranian study done in 2015 by Karimi
and Heideri that there is a need to improve first aid management of teachers
regarding seizure attack regardless teachers’ positive attitude (Karimi and
Heidari, 2015). The Saudi Arabian study in 2014 by Abulhamail et al
supported this trend, in which reported that positive responses toward
questions such as objecting on having epileptic child in classroom and
seclusion of them in special classrooms were 25% and 27%, respectively,
but also the researchers noticed that the well informed teachers had more
positive responses than uninformed ones (Abulhamail et al., 2014).
Generally, regardless of the unsatisfactory teachers' knowledge about
first aid, the general trends of studies reported positive attitude towards first
aid among teachers despite the disparities in rates, and even in some
implemented educational program on first aid such as Kumar et al in 2016,
in which pre-test results reported modest majority for positive attitude
toward first aid, while it raised up to 93.3% in post-test results which reveals
the importance of training not only for raising the level of knowledge, but
also to improve the attitudes of teachers toward first aid (Kumar et al., 2016).

5.11. The Relationship between Participants’ Overall Knowledge and
Attitude Toward First Aid and Their Socio-demographic
Characteristic:
The current study findings presented, that there was no significant
relationship between teachers’ socio-demographic characteristics (age,
gender, residence, marital status, number of children, educational level and
years of experience) and overall knowledge about first aid, except the
monthly income, in which the better knowledge was noticed among teachers
with average and high monthly income, and this is considered as natural
result, because, whenever person was more financially comfortable he/she
will have sufficient time to read and practice his/her hobbies and acquire
information in all fields of life (health and cultural). Consequently, the Iraqi
researcher Al-Robaiaay in 2013 found that years of experience were not
associated with teachers knowledge (Al-Robaiaay, 2013); likewise, this
finding was supported by Joseph et al results in 2015, in which stated that
the level of knowledge was not associated with age, gender and years of
experience (Joseph et al., 2015).
In contrary, the study done by Sunil Kumar and others reported that a
significant association found between teachers’ knowledge and their (urban
residency, experience above 10 years and educational levels) (Kumar et al.,
2013).
Moreover, concerning teachers’ overall attitude with
sociodemographic, no significant relationship was found except with urban
residency and years of experience.
Furthermore, the study done by Baser et al in 2007 revealed that the
sociodemographic characteristic of participants had no significant relation to
their knowledge and attitude regarding first aid (Başer et al., 2007).

Chapter Six
Conclusions
and
Recommendations

Chapter Six: Conclusions and Recommendations 94
Chapter Six
Conclusions and Recommendations
This chapter will address the most important conclusions that have
been reached during the current study, in addition to the recommendations
of the study, which will be divided into recommendations to the Iraqi
Ministry of Education and the Iraqi Ministry of Health.
6.1. Conclusions:
So that, the final conclusions can be drawn are:
1. The majority of teachers were female and above 40 years of age.
2. The overall knowledge of participant teachers was fair in all first aid
domains except the general information it was good.
3. Vast majority of the participants’ teachers had positive attitude toward
first aid in primary schools.
4. The lowest teachers' attitude response was toward medical conditions
that may need first aid which calls attention to this issue.
5. The socio-demographic characteristics of teachers showed
insignificant relation to their knowledge, but monthly income; where a
significant direct association between teachers’ monthly income and their
Knowledge about first aids had been reported.
6. No significant association was found between participants’ attitude
toward first aid and their socio-demographic characteristics, except with
urban residency and (21-30) years of experience.
6.2. Recommendations:
The following recommendations have been reached based on the
outcome of the current study and the conclusions that emerged from:
6.2.1. Recommendations for Iraqi Ministry of Education:
1) Working on the establishment of compulsory courses for teachers on
first aid in collaboration with the Ministry of Health, and paying attention
for the quality of such courses.

Chapter Six: Conclusions and Recommendations 95
2) Encouraging teachers to learn first aid through incentives, if not
financially at least let it be morally.
3) Adding first aid education to the curriculum of colleges and institutes
of teachers' preparation.
4) Acting to educate pupils in a simple way about first aid, in the future.
5) Reconsidering certified safety measures and standards in schools to
match the global standards.
6) Retaining a first aid box at each school.
6.2.2. Recommendations for Iraqi Ministry of Health:
1) The provision of medical staff from the physicians and nurses, who
are specialists to train teachers on first aid, in collaboration with the Ministry
of Education.
2) Providing professionally trained nurses on first aid to work in schools,
because school nurses are not present in Iraqi schools, like many other
countries where school nurses playing important role in maintaining pupils’
health.
3) Working on finding steady records, that document the occurrence of
emergencies and accidents in schools, to create a database, which helps to
handling more properly of such cases, as well as, to build a first aid guide
applicable to the circumstances of Iraq in collaboration with Ministry of
Health.
4) Using mass media and TV for educating the community as whole, and
not teachers only about first aid; with focusing on the humanitarian aspects
of helping others and providing first aid.
5) Working with the Ministry of Education, to raise awareness and
educate teachers about the chronic diseases (D.M, epilepsy, asthma…, etc.)
that may require providing first aid; at least by using educational posters and
leaflets.

References 97
:‫العربية‬ ‫المصادر‬
‫الجزء‬ ،‫المائدة‬ ‫سورة‬ ،‫الكريم‬ ‫القران‬‫السادس‬،‫من‬ ‫جزء‬‫اآلية‬32.
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Appendix – A: Panel of experts.
Appendix – B: Administrative Arrangements.
Appendix – C: Ethical Considerations.
Appendix – D: Linguists Certification.
Appendix – E: Questionnaire in Arabic.

Appendix A Panel of Experts
‫االستبيان‬ ‫استمارة‬ ‫تحكيم‬ ‫خبراء‬
‫ت‬‫الخبير‬ ‫اسم‬‫اللقب‬‫العمل‬ ‫مكان‬
‫االختصاص‬
‫الدقيق‬
1‫ف‬ ‫محمد‬ .‫د‬‫ـ‬‫خليف‬ ‫اضل‬‫ـ‬‫ة‬‫أستاذ‬
/ ‫بغداد‬ ‫جامعة‬
‫التمريض‬ ‫كلية‬
‫صحة‬ ‫تمريض‬
‫المجتمع‬
2.‫د‬‫محمود‬ ‫هللا‬ ‫عبد‬ ‫الكريم‬ ‫عبد‬‫أستاذ‬
/ ‫الكوفة‬ ‫جامعة‬
‫كلية‬‫الطب‬
‫المجتمع‬ ‫طب‬
3.‫د‬‫النقيب‬ ‫محمد‬ ‫الخالق‬ ‫عبد‬‫أستاذ‬
‫التقنيات‬ ‫كلية‬
‫الطبية‬ ‫و‬ ‫الصحية‬
‫بغداد‬
‫حياتي‬ ‫إحصاء‬
4.‫د‬‫ناصر‬ ‫محمد‬ ‫كافي‬‫أستاذ‬‫مساعد‬
5.‫د‬‫فرج‬ ‫كريم‬ ‫رعد‬‫مدرس‬
‫كلية‬‫التمريض‬
6‫حمزة‬ ‫الحسن‬ ‫عبد‬ ‫راجحة‬ .‫د‬‫أستاذ‬
‫كلية‬‫التمريض‬
‫البالغين‬ ‫تمريض‬
7‫جهاد‬ ‫كاظم‬ ‫سلمى‬ .‫د‬‫مساعد‬ ‫أستاذ‬
/ ‫بابل‬ ‫جامعة‬
8‫عبدعلي‬ ‫كريم‬ ‫ضياء‬ .‫د‬‫مدرس‬
9‫علي‬ ‫أدهم‬ ‫سحر‬ .‫د‬‫مساعد‬ ‫أستاذ‬
10‫العباس‬ ‫عبد‬ ‫فاضل‬ .‫د‬‫مساعد‬ ‫أستاذ‬
‫الفرات‬ ‫جامعة‬
‫التقنية‬ ‫األوسط‬
‫حياتي‬ ‫إحصاء‬
11‫فالح‬ ‫عبدهللا‬ ‫منصور‬‫مدرس‬
12‫الياسري‬ ‫عجيل‬ ‫أمين‬ .‫د‬‫مساعد‬ ‫أستاذ‬
13‫محمد‬ ‫جاسم‬ ‫سالم‬ .‫د‬‫مساعد‬ ‫أستاذ‬
‫كلية‬‫الطب‬
‫المجتمع‬ ‫طب‬
14‫الجبوري‬ ‫غانم‬ ‫مرتضى‬ .‫د‬‫مدرس‬
15‫عبدالواحد‬ ‫سعدي‬ ‫هالة‬ .‫د‬‫مساعد‬ ‫أستاذ‬
16‫قاسم‬ ‫جبار‬ ‫وسام‬ .‫د‬‫مساعد‬ ‫أستاذ‬
‫بغداد‬ ‫جامعة‬/
17‫الكالبي‬ ‫شاكر‬ ‫أحمد‬ .‫د‬‫مساعد‬ ‫أستاذ‬
‫كلية‬‫اللغات‬
‫اإلنكليزية‬ ‫اللغة‬

Appendix B Administrative Agreements

Appendix C Ethical Consideration

Appendix D Linguistic Certification

Appendix E Questionnaire
‫استب‬‫ـــــــــــــــــ‬‫ي‬‫ـــــــــــــــــــــــــــــــــــــــــــــ‬:‫حول‬ ‫ان‬
‫معارف‬‫معلمي‬ ‫اتجاهات‬‫و‬‫االبتدائية‬ ‫المدارس‬‫نحو‬‫األولية‬ ‫اإلسعافات‬‫النجف‬ ‫مدينة‬ ‫في‬
‫األشرف‬.
‫ء‬‫الجز‬‫األول‬::‫افية‬‫ر‬‫الديموغ‬ ‫المعلومات‬
.‫أ‬:‫الشخصية‬ ‫البيانات‬
1.:‫العمر‬‫سنة‬
2.:‫الجنس‬‫ذكر‬‫أنثى‬
3.‫حضر‬ :‫السكن‬‫يف‬‫ر‬
.‫ب‬‫االجتماعية‬ ‫البيانات‬-:‫االقتصادية‬
1.:‫الزوجية‬ ‫الحالة‬‫اعزب‬‫أرمل‬‫مطلق‬
‫ج‬‫متزو‬
2.:‫األطفال‬ ‫عدد‬
3.:‫ي‬‫الشهر‬ ‫الدخل‬
‫من‬ ‫أكثر‬
‫دينار‬ ‫ن‬‫مليو‬
‫من‬700‫ن‬‫مليو‬ ‫الى‬ ‫ألف‬
‫دينار‬
‫من‬ ‫أقل‬700
‫دينار‬ ‫ألف‬
.‫س‬:‫التعليمي‬ ‫ى‬‫المستو‬
‫معهد‬ /‫دار‬ ‫يج‬‫ر‬‫خ‬
‫المعلمين‬
‫يج‬‫ر‬‫خ‬‫كلية‬‫ى‬‫اخر‬
.‫د‬:‫الوظيفة‬ ‫ات‬‫و‬‫سن‬ ‫عدد‬
4.‫هل‬‫تلقيت‬‫في‬‫وقت‬‫مضى‬‫أي‬‫معلومات‬‫عن‬‫اإلسعافات‬:‫األولية‬‫كال‬‫نعم‬
(‫هو‬ ‫فالخيار‬ ‫نعم‬ ‫اب‬‫و‬‫الج‬ ‫كان‬ ‫اذا‬)
‫المطالعة‬‫التلفاز‬‫يبية‬‫ر‬‫تد‬ ‫ة‬‫ر‬‫دو‬‫سابقة‬ ‫بة‬‫ر‬‫تج‬‫نت‬‫ر‬‫االنت‬

‫الجزء‬‫الثاني‬:‫أسئلة‬‫لتقييم‬‫المع‬‫ا‬‫رف‬‫حول‬‫اإلسعافات‬‫األولية‬.
:‫األولية‬ ‫اإلسعافات‬ ‫عن‬ ‫عامة‬ ‫معلومات‬‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
1‫الغرض‬‫الرئيس‬‫من‬‫اإلسعافات‬‫األولية‬‫هو‬‫الحفاظ‬‫على‬‫الحياة‬.
2‫من‬‫ن‬‫يكو‬ ‫ان‬ ‫الجيد‬ ‫المسعف‬ ‫مؤهالت‬‫مستمع‬‫ا‬‫جيد‬‫و‬ ‫ا‬‫هادئ‬.‫ا‬
3‫منع‬‫ادث‬‫و‬‫الح‬‫هي‬‫من‬‫مسؤولية‬‫المسعف‬.
4
‫يتم‬‫تطبيق‬‫ـــــــعافات‬‫ـ‬‫اإلس‬‫األولية‬‫ا‬‫ر‬‫فو‬‫لعالج‬‫الطفل‬‫ـــــــاب‬‫ـ‬‫المص‬‫لحين‬‫ـــــــول‬‫ـ‬‫وص‬
‫المساعدة‬‫الطبية‬.
5
‫للحالة‬ ‫تعطى‬ ‫األولولة‬ ‫فةن‬ ‫األولية‬ ‫ــــــــعافات‬‫ـ‬‫اإلس‬ ‫بتقديم‬ ‫تقوم‬ ‫عندما‬‫المهددة‬
.‫بالموت‬
‫األول‬ ‫المجال‬(1:).‫النزلف‬‫و‬ ‫الجروح‬‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
6
‫الناجم‬ ‫النزف‬‫فال‬ ‫أ‬ ‫في‬ ‫ــــــــيوعا‬‫ـ‬‫ش‬ ‫النزف‬ ‫اع‬‫و‬‫أن‬ ‫ار‬ ‫ا‬ ‫هو‬ ‫ــــــــن‬‫ـ‬‫الس‬ ‫انقالع‬ ‫عن‬
.‫المدارس‬
7
‫النزلف‬ ‫ف‬ ‫و‬ ‫على‬ ‫ــــــاعدي‬‫ـ‬‫تس‬ ‫رلقة‬ ‫ــــــل‬‫ـ‬‫أفض‬ ‫فةن‬ ‫للطفل‬ ‫األنف‬ ‫نزف‬ ‫حالة‬ ‫في‬
‫ن‬‫ستكو‬‫الجلوس‬‫و‬‫إلى‬ ‫الميل‬‫الخلف‬‫وقرص‬‫الخياشيم‬.
8‫أول‬‫اء‬‫ر‬‫إج‬‫ة‬‫للسيطر‬‫على‬‫النزلف‬‫خالل‬ ‫من‬ ‫هو‬‫الضغط‬‫المباشر‬‫على‬‫الجرح‬.
9‫هي‬ ‫الجروح‬ ‫اع‬‫و‬‫أن‬ ‫اهم‬‫جروح‬.‫السحجات‬ ‫و‬ ‫الاقوب‬ ‫و‬ ‫التمزقات‬
10.‫االلتهابات‬ ‫لمنع‬ ‫هو‬ ‫بالجرح‬ ‫للعناية‬ ‫الرئيس‬ ‫الغرض‬
11‫األولى‬ ‫الخطوة‬‫الجرح‬ ‫لتنظيف‬.‫بالماء‬ ‫غسله‬ ‫ن‬‫ستكو‬
‫المجال‬‫الااني‬(2):‫إصابات‬‫العظام‬‫المفاصل‬‫و‬.‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
12‫و‬ ‫الكسور‬ ‫من‬ ‫نوعان‬ ‫هنالك‬.‫المغلقة‬ ‫و‬ ‫المفتوحة‬ ‫هي‬
13.‫ائل‬‫و‬‫الس‬ ‫بالكسر‬ ‫المصاب‬ ‫يعطى‬ ‫أن‬ ‫يجب‬
14
‫عن‬ ‫البح‬ ‫م‬ ‫ــــــــور‬‫ـ‬‫المكس‬ ‫العظم‬ ‫تابيت‬ ‫عليك‬ ‫يجب‬ ‫العظام‬ ‫ــــــــور‬‫ـ‬‫كس‬ ‫حالة‬ ‫في‬
‫الطبية‬ ‫العناية‬.
15.‫فقط‬ ‫الكسر‬ ‫منطقة‬ ‫تابيت‬ ‫يجب‬ ‫المكسور‬ ‫العظم‬ ‫تابيت‬ ‫خالل‬
16
‫عليك‬ ‫يجب‬ ‫المفتوحة‬ ‫ــــــــور‬‫ـ‬‫الكس‬ ‫حالة‬ ‫في‬‫تعديل‬‫نهايتي‬‫م‬ ‫ــــــــور‬‫ـ‬‫المكس‬ ‫العظم‬
.‫للمستشفى‬ ‫ارساله‬ ‫م‬ ‫الكسر‬ ‫تابيت‬
17‫اءات‬‫و‬‫االلت‬ ‫تتضمن‬ ‫المفاصل‬ ‫إصابات‬‫الخلع‬‫و‬.
18
‫التدابير‬‫المعتمدة‬‫في‬‫ــــــــعافات‬‫ـ‬‫اإلس‬‫األولية‬‫ــــــــابات‬‫ـ‬‫إلص‬‫ــــــــل‬‫ـ‬‫المفاص‬‫هي‬‫تابيت‬
،‫المنطقة‬‫استخدام‬ ‫و‬،‫ة‬‫بار‬ ‫كمادة‬ ‫او‬ ‫لج‬ ‫كمادة‬‫استخدام‬‫و‬‫ة‬‫جبير‬،‫لينة‬‫التماس‬‫و‬
‫العناية‬.‫الطبية‬

‫المجال‬‫الاال‬(3):‫حاالت‬‫بية‬‫ى‬‫أخر‬..‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
19
‫م‬ ‫و‬ ‫يمف‬ ‫تجعله‬ ‫ان‬ ‫عليك‬ ‫يجب‬ ‫الررو‬ ‫نورة‬ ‫ناء‬ ‫أ‬ ‫التنفس‬ ‫على‬ ‫فل‬ ‫ــــاعدة‬‫ـ‬‫لمس‬
.‫الطبية‬ ‫العناية‬ ‫عن‬ ‫له‬ ‫تبح‬ ‫م‬ ‫يتنفسه‬ ‫نفس‬ ‫كل‬ ‫مع‬ ‫ي‬‫ظهر‬ ‫على‬ ‫نطبطب‬
20
‫إذا‬‫ـــــقط‬‫ـ‬‫س‬‫ـــــاب‬‫ـ‬‫مص‬ ‫فل‬‫ي‬‫ـــــكر‬‫ـ‬‫بالس‬‫فجأة‬‫في‬‫ناء‬ ‫أ‬‫الدر‬‫س‬،‫فالعمل‬‫األول‬‫هو‬
‫اعطائه‬‫ائل‬‫و‬‫الس‬‫السكرلة‬‫أو‬‫أي‬‫شيء‬‫حلو‬‫م‬‫التماس‬‫العناية‬‫الطبية‬.
21
‫حمله‬ ‫عليك‬ ‫يتوجب‬ ،‫ـــية‬‫ـ‬‫اس‬‫ر‬‫الد‬ ‫ـــتك‬‫ـ‬‫حص‬ ‫ناء‬ ‫ا‬ ‫ع‬‫ـــر‬‫ـ‬‫ص‬ ‫نورة‬ ‫الى‬ ‫فل‬ ‫تعرض‬ ‫اذا‬
.‫صحية‬ ‫عاية‬‫ر‬ ‫مركز‬ ‫أقرب‬ ‫إلى‬
22
‫الصـدمة‬‫ة‬‫عبار‬‫عن‬‫حالة‬‫تهدد‬‫الحياة‬‫ناجمة‬‫من‬‫انخفاض‬‫الترولة‬‫الدمولة‬‫إلى‬
،‫األنسجة‬‫و‬‫المؤشر‬‫األول‬‫للصدمة‬‫هو‬‫فقدان‬‫الوعي‬.
23
‫إن‬‫الغرض‬‫الرئيس‬‫من‬‫رفع‬‫الساقين‬‫لشخص‬‫أغمي‬‫عليه‬‫هو‬‫زلادة‬‫تدفق‬‫الدم‬
‫إلى‬‫الدماغ‬.
24
‫ـــعافات‬‫ـ‬‫اإلس‬‫األولية‬‫لالختناق‬‫بالطعام‬‫ـــمل‬‫ـ‬‫تش‬‫ـــجيع‬‫ـ‬‫التش‬‫ـــعال‬‫ـ‬‫الس‬ ‫على‬‫ومن‬‫م‬
‫الظهر‬ ‫على‬ ‫الضرب‬( ‫الدفع‬‫و‬‫الضغط)البطني‬‫إذا‬‫لزم‬‫األمر‬.
25
‫أبرز‬‫عالمات‬‫ــــــــمم‬‫ـ‬‫التس‬‫الغذائي‬‫هي‬‫الغايان‬‫التقيؤ‬‫و‬‫وآالم‬‫البطن‬‫الصـــــــــداع‬‫و‬
‫الحمى‬‫و‬‫اإلسهال‬‫و‬.
26.‫التقيؤ‬ ‫على‬ ‫غذائيا‬ ‫المتسمم‬ ‫الطفل‬ ‫ح‬ ‫يجب‬
27
‫اعطاءي‬ ‫و‬ ‫مستلقيا‬ ‫جعله‬ ‫هي‬ ‫غذائي‬ ‫تسمم‬ ‫بحالة‬ ‫فل‬ ‫إلسعاف‬ ‫ات‬‫ر‬‫خيا‬ ‫أفضل‬
.‫للمستشفى‬ ‫ارساله‬ ‫م‬ ‫ائل‬‫و‬‫الس‬ ‫من‬ ‫المزلد‬
‫ابع‬‫ر‬‫ال‬ ‫المجال‬(4:).‫ق‬‫الحرو‬‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
28‫تصنف‬.‫درجات‬ ‫الث‬ ‫إلى‬ ‫ق‬‫الحرو‬
29‫لديه‬ ‫فةن‬ ‫ق‬‫الحر‬ ‫بعد‬ ‫محمر‬ ‫جلدي‬ ‫فل‬‫ق‬‫حر‬.‫متوسط‬
30.‫الجسم‬ ‫في‬ ‫حيولة‬ ‫أعضاء‬ ‫في‬ ‫ة‬‫خطير‬ ‫إصابات‬ ‫تسبب‬ ‫قد‬ ‫الكهررائية‬ ‫ق‬‫الحرو‬
31‫إسعافات‬ ‫أية‬ ‫تقديم‬ ‫قبل‬،‫أولية‬‫ق‬‫الحر‬ ‫منطقة‬ ‫حول‬ ‫المالبس‬ ‫الة‬‫ز‬‫إ‬ ‫عليك‬.
32
‫المتوســــطة‬ ‫أو‬ ‫البســــيطة‬ ‫ق‬‫الحرو‬ ‫حالة‬ ‫في‬‫ال‬‫يمكنك‬‫تبرلد‬‫المنطقة‬‫المحروقة‬
‫بالماء‬‫قبل‬‫أخذ‬‫المصاب‬‫إلى‬‫المستشفى‬.
33.‫ق‬‫الحر‬ ‫مكان‬ ‫في‬ ‫بألم‬ ‫المصاب‬ ‫يشعر‬ ‫ال‬ ‫الشديدة‬ ‫ق‬‫الحرو‬ ‫في‬ ‫عادة‬
34
‫الطاقة‬ ‫ــدر‬‫ـ‬‫مص‬ ‫عن‬ ‫له‬‫ز‬‫ع‬ ‫ــمل‬‫ـ‬‫تش‬ ‫كهررائية‬ ‫ــدمة‬‫ـ‬‫بص‬ ‫ــاب‬‫ـ‬‫المص‬ ‫ــعاف‬‫ـ‬‫اس‬ ‫اءات‬‫ر‬‫إج‬
‫ـات‬‫ـ‬‫نبض‬ ‫اقبة‬‫ر‬‫وم‬‫قلبه‬‫ـتخدام‬‫ـ‬‫اس‬ ‫وعدم‬ ‫ـه‬‫ـ‬‫وتنفس‬‫ق‬‫الحر‬ ‫مكان‬ ‫لتبرلد‬ ‫الماء‬‫ونقله‬
‫ع‬‫بأسر‬.‫للمشفى‬ ‫وقت‬
‫الخامس‬ ‫المجال‬(5‫ال‬ :)‫عضات‬‫و‬‫اللسعات‬‫اال‬‫و‬‫جس‬‫ا‬‫م‬‫الغرلب‬‫ة‬.‫نعم‬
‫غير‬
‫متأكد‬
‫ال‬
35
‫نزلف‬ ‫ن‬‫دو‬ ‫من‬ ‫ـب‬‫ـ‬‫الكل‬ ‫ــــــــــة‬‫ـ‬‫عض‬ ‫ـة‬‫ـ‬‫ـال‬‫ـ‬‫ح‬ ‫في‬‫ـب‬‫ـ‬‫يج‬ ،‫ـاد‬‫ـ‬‫ح‬‫الجرح‬ ‫تنظيف‬ ‫ـك‬‫ـ‬‫علي‬
‫لمدة‬ ‫الماء‬‫و‬ ‫ن‬‫بالصابو‬5‫الطبية‬ ‫للعناية‬ ‫تسعى‬ ‫م‬ ‫دقائق‬.

36
‫لألج‬ ‫األولي‬ ‫اإلسعافي‬ ‫اء‬‫ر‬‫اإلج‬ ‫هو‬ ‫ى‬‫األخر‬ ‫األنف‬ ‫فتحة‬ ‫إغالق‬ ‫مع‬ ‫التمخيط‬‫سام‬
‫األنف‬ ‫في‬ ‫الغرلبة‬.
37‫األجسام‬ ‫الة‬‫ز‬‫إل‬ ‫اء‬‫ر‬‫إج‬ ‫أفضل‬ ‫هو‬ ‫العين‬ ‫فرك‬‫العين‬ ‫من‬ ‫الغرلبة‬.
38
‫ـــية‬‫ـ‬‫تنفس‬ ‫حاالت‬ ‫ـــبب‬‫ـ‬‫تس‬ ‫أن‬ ‫يمكن‬ ‫ة‬‫ـــر‬‫ـ‬‫الحش‬ ‫للدغة‬ ‫الخطير‬ ‫ـــي‬‫ـ‬‫ـــس‬‫ـ‬‫التحس‬ ‫التفاعل‬
.‫ارئة‬
‫الجزء‬‫الثالث‬:‫تقييم‬‫اتجاهات‬‫المعلم‬‫ين‬‫حول‬‫اإلسعافات‬‫األولية‬.
‫ت‬‫السؤال‬
‫غير‬
‫موافق‬
‫بشدة‬
‫غير‬
‫موافق‬
‫غير‬
‫متأكد‬
‫موافق‬
‫موافق‬
‫بشدة‬
1
‫أعتقد‬‫أنه‬‫من‬‫المهم‬‫تعلم‬‫اإلسعافات‬‫األولية‬‫في‬
‫الحياة‬‫اليومية‬.
2
‫أعتقد‬‫أن‬‫عملية‬‫تعلم‬‫ععععععافات‬‫ع‬‫اإلس‬‫األولية‬‫هي‬
‫معقدة‬‫جدا‬‫وصعبة‬.
3
‫بأن‬ ‫اعتقد‬ ‫انا‬‫القيام‬‫ب‬‫ج‬ ‫األولية‬ ‫ععععععافات‬‫ع‬‫اإلس‬
‫ة‬ ‫الرعا‬ ‫مجال‬ ‫في‬ ‫العاملين‬ ‫بواسطة‬ ‫فقط‬ ‫تم‬ ‫أن‬
.‫الخبرة‬ ‫ذوي‬ ‫الصحية‬
4
‫أعتقد‬‫أن‬‫تدر‬‫المعلمين‬‫م‬ ‫لتقد‬‫ععععععافات‬‫ع‬‫اإلس‬
‫األولية‬‫أمر‬‫مفيد‬.
5
‫أنا‬‫أميل‬‫ععععععاهدة‬‫ع‬‫لمش‬‫البرامج‬‫ونية‬ ‫التلفز‬‫حول‬
‫عل‬‫ع‬‫عام‬‫ع‬‫التع‬‫مع‬‫عاالت‬‫ع‬‫ح‬‫الطوارئ‬‫عات‬‫ع‬‫عاف‬‫ع‬‫عععععع‬‫ع‬‫واإلس‬
‫األولية‬.
6
‫أشعر‬‫بعدم‬‫االرتياح‬‫ة‬ ‫لرؤ‬‫اإلصابات‬‫أو‬‫الدماء‬
‫أمام‬‫عيني‬.
7
‫أعتقد‬‫أنه‬‫من‬‫المهم‬‫جدا‬‫على‬ ‫اإلبقاء‬‫عععندو‬‫ع‬‫ص‬
‫اإلسعافات‬‫األولية‬‫في‬‫المدرسة‬.
8
،‫كمعلم‬‫عا‬‫ع‬‫أن‬‫أرفض‬‫قبول‬‫عال‬‫ع‬‫األطف‬‫عععععععابين‬‫ع‬‫المص‬
‫بالصرع‬‫في‬‫صفي‬.
9
‫أعتقد‬‫أن‬‫ععععععافات‬‫ع‬‫اإلس‬‫األولية‬‫ج‬‫ان‬‫درس‬
‫للمعلمين‬‫وكذلك‬‫تالميذهم‬.
10
‫إذا‬‫في‬ ‫طارئة‬ ‫حالة‬ ‫لدي‬ ‫كان‬،‫صععفي‬‫أنا‬‫أفضععل‬
‫أن‬‫أطلعع‬‫المعلمين‬‫ن‬ ‫اآلخر‬‫عععععول‬‫ع‬‫للحص‬‫على‬
،‫المساعدة‬‫بدال‬‫مني‬.
11
‫عد‬‫ع‬‫أعتق‬‫أنعه‬‫نبغي‬‫أن‬‫عزل‬‫العذي‬ ‫عل‬‫ع‬‫الطف‬‫عاني‬‫ع‬‫ع‬
‫من‬‫الربو‬‫أو‬‫ري‬ ‫عععععع‬‫ع‬‫الس‬‫مع‬‫االطفعععال‬‫ذوي‬
‫االحتياجات‬‫الخاصة‬.
12
‫حول‬ ‫مهعععارات‬‫ل‬‫وا‬ ‫عرفعععة‬‫م‬‫ل‬‫ا‬ ‫لعععدي‬ ‫كعععان‬ ‫إذا‬
‫الذي‬ ‫للطفل‬ ‫ها‬ ‫أؤف‬ ‫عععوف‬‫ع‬‫س‬ ‫األولية‬ ‫ععععافات‬‫ع‬‫اإلس‬
‫حتاجها‬.

‫الخالصة‬
:‫مقدمة‬‫اإلصابات‬ ‫تعد‬‫الطارئة‬‫بالذكر‬ ‫الجديرة‬ ‫األسباب‬ ‫أهم‬ ‫إحدى‬ ‫من‬ ،‫المفاجئة‬ ‫واالمراض‬
‫هذا‬ ‫من‬ .‫المدرسة‬ ‫سن‬ ‫في‬ ‫هم‬ ‫الذين‬ ‫أولئك‬ ‫وخاصة‬ ‫األطفال‬ ‫في‬ ‫والوفيات‬ ‫او‬ ‫العوق‬ ‫الى‬ ‫تؤدي‬ ‫والتي‬
‫استعداد‬ ‫على‬ ‫ليكونوا‬ ،‫ضرورية‬ ‫األولية‬ ‫باإلسعافات‬ ‫االبتدائية‬ ‫المدارس‬ ‫معلمي‬ ‫معرفة‬ ‫فإن‬ ،‫المنطلق‬
‫األولي‬ ‫اإلسعافات‬ ‫لتقديم‬‫اثناء‬ ‫األطفال‬ ‫يحتاجها‬ ‫عندما‬ ‫ة‬‫وقت‬‫الم‬‫درس‬.‫ة‬
‫المنهجية‬:‫أجريت‬‫اال‬ ‫المدارس‬ ‫معلمي‬ ‫على‬ ‫مقطعية‬ ‫وصفية‬ ‫دراسة‬‫في‬ ‫الحكومية‬ ‫بتدائية‬
‫النجف‬ ‫مدينة‬،‫للفترة‬‫الممتدة‬‫من‬‫األول‬‫من‬‫الثاني‬ ‫تشرين‬2015‫الى‬‫الرابع‬‫من‬‫ايلول‬2016،‫بهدف‬
‫عالقة‬ ‫أي‬ ‫على‬ ‫العثور‬ ‫أجل‬ ‫من‬ ،‫وكذلك‬ ،‫األولية‬ ‫اإلسعافات‬ ‫نحو‬ ‫اتجاهاتهم‬ ‫المشاركين‬ ‫معارف‬ ‫تقييم‬
‫يتعلق‬ ‫فيما‬ ‫اتجاهاتهم‬ ‫معارفهم‬ ‫مع‬ ‫للمعلمين‬ ‫والديموغرافية‬ ‫االجتماعية‬ ‫الخصائص‬ ‫بين‬ ‫داللة‬ ‫ذات‬
‫األولية‬ ‫باإلسعافات‬.
‫حكومية‬ ‫ابتدائية‬ ‫مدرسة‬ ‫ثالثين‬ ‫اختيار‬ ‫تم‬‫عشوائيا‬‫اختيار‬ ‫تم‬ ‫ثم‬ ‫من‬ ،320‫المدارس‬ ‫معلمي‬ ‫من‬
‫الدراسات‬ ‫في‬ ‫العينة‬ ‫حجم‬ ‫لتحديد‬ ‫المستخدمة‬ ‫المعادلة‬ ‫خالل‬ ‫من‬ ،‫أيضا‬ ‫عشوائي‬ ‫بشكل‬ ‫االبتدائية‬
‫للتحليل‬ ‫الصالحة‬ ‫لالستبانات‬ ‫الكلي‬ ‫العدد‬ ‫كان‬ ،‫وأخيرا‬ .‫المقطعية‬302.
‫استخدام‬ ‫تم‬‫استمارة‬‫استبيان‬‫ت‬‫األو‬ ‫الجزء‬ ‫وتضمن‬ ،‫أجزاء‬ ‫ثالثة‬ ‫من‬ ‫تكون‬‫ل‬‫منها‬‫االستعالم‬
،‫للمشاركين‬ ‫والديموغرافية‬ ‫االجتماعية‬ ‫الخصائص‬ ‫عن‬‫فيما‬‫المتعلقة‬ ‫األسئلة‬ ‫الثاني‬ ‫الجزء‬ ‫تضمن‬
‫أسئلة‬ ‫األخير‬ ‫الجزء‬ ‫شمل‬ ‫بينما‬ ،‫مجاالت‬ ‫ستة‬ ‫إلى‬ ‫مقسمة‬ ‫كانت‬ ‫التي‬ ‫األولية‬ ‫اإلسعافات‬ ‫حول‬ ‫بالمعارف‬
‫مقسما‬ ‫كان‬ ‫وكذلك‬ ،‫األولية‬ ‫اإلسعافات‬ ‫نحو‬ ‫المعلمين‬ ‫اتجاه‬ ‫بخصوص‬‫أقسام‬ ‫ثالثة‬ ‫إلى‬.
:‫النتائج‬‫وأظهرت‬‫النتائج‬‫مجموع‬ ‫من‬ ‫أن‬302،‫الدراسة‬ ‫شملتهم‬ ‫معلما‬287(95٪‫كان‬ )
‫وفقط‬ ‫متوسطة‬ ‫عامة‬ ‫معرفة‬ ‫لهم‬15(5٪‫معد‬ ‫شبه‬ ‫معلوماتهم‬ ‫كانت‬ ‫المشاركين‬ ‫المعلمين‬ ‫من‬ )‫و‬،‫مة‬
‫الجيدة‬ ‫للمعرفة‬ ‫منهم‬ ‫أي‬ ‫امتالك‬ ‫عدم‬ ‫الى‬ ‫باإلضافة‬.
‫أن‬ ‫النتائج‬ ‫اظهرت‬ ‫فقد‬ ،‫االولية‬ ‫االسعافات‬ ‫نحو‬ ‫المعلمين‬ ‫اتجاهات‬ ‫يخص‬ ‫فيما‬282
(93.4%‫امتلكوا‬ ‫الذين‬ ‫عدد‬ ‫فيما‬ ‫االولية‬ ‫االسعافات‬ ‫نحو‬ ‫ا‬ّ‫م‬‫عا‬ ‫ايجابيا‬ ‫توجها‬ ‫لديهم‬ ‫كان‬ ‫المعلمين‬ ‫من‬ )
( ‫وبنسبة‬ ‫العشرون‬ ‫يتجاوز‬ ‫لم‬ ‫االولية‬ ‫االسعافات‬ ‫نحو‬ ‫سلبيا‬ ‫اتجاها‬6.6%.‫المعلمين‬ ‫من‬ )
‫ي‬ ‫فيما‬‫تعلق‬‫ب‬‫والديموغرافية‬ ‫االجتماعية‬ ‫الخصائص‬ ‫بين‬ ‫االحصائية‬ ‫الداللة‬ ‫ذات‬ ‫العالقة‬
‫بالنسبة‬ ‫حين‬ ‫في‬ ،‫شهري‬ ‫الدخل‬ ‫مع‬ ‫اال‬ ‫مهم‬ ‫ارتباط‬ ‫أي‬ ‫ايجاد‬ ‫يتم‬ ‫لم‬ ‫معرفتهم‬ ‫مستويات‬ ‫مع‬ ‫للمشاركين‬
‫أثبتت‬ ‫الخبرة‬ ‫وسنوات‬ ‫الحضرية‬ ‫المناطق‬ ‫في‬ ‫اإلقامة‬ ‫فقط‬ ،‫األولية‬ ‫اإلسعافات‬ ‫نحو‬ ‫المعلمين‬ ‫التجاهات‬
‫ع‬‫بهم‬ ‫الخاصة‬ ‫واالجتماعية‬ ‫الديموغرافية‬ ‫البيانات‬ ‫مع‬ ‫داللة‬ ‫ذات‬ ‫القة‬.

:‫والتوصيات‬ ‫االستنتاجات‬،‫للدراسة‬ ‫واإلجمالي‬ ‫النهائي‬ ‫االستنتاج‬ ‫اظهر‬‫بأن‬‫معرفة‬
‫المعلمين‬‫االسعافات‬ ‫حول‬،‫مرضية‬ ‫غير‬ ‫كانت‬ ‫األولية‬‫في‬،‫حين‬‫أبدى‬‫المشاركون‬‫بشكل‬‫عام‬‫اتجاهات‬
‫إيجابية‬‫نحو‬‫اإلسعافات‬‫األولية‬،‫وبالتالي‬‫أوصى‬‫الباحث‬‫ب‬‫إقامة‬‫دورات‬‫تدريبية‬‫إلزامية‬‫للمعلمين‬‫في‬
‫بداية‬‫كل‬‫عام‬‫دراسي‬.

‫العالي‬ ‫التعليم‬ ‫وزارة‬‫العلمي‬ ‫والبحث‬
‫الكوفة‬ ‫جامعة‬
‫نحو‬ ‫االبتدائية‬ ‫المدارس‬ ‫معلمي‬ ‫واتجاهات‬ ‫معارف‬
‫االولية‬ ‫اإلسعافات‬‫في‬‫مدينة‬‫االشرف‬ ‫النجف‬
‫رسالة‬‫مقدمه‬‫إلى‬‫التمريض‬ ‫كلية‬ ‫مجلس‬-‫جامعه‬‫الكوفة‬
‫من‬ ‫كجزء‬‫متطلبات‬‫درجة‬ ‫نيل‬‫الماجستي‬/‫التمريض‬ ‫في‬ ‫علوم‬ ‫ر‬
‫تمريض‬ ‫فرع‬‫المجتمع‬ ‫صحة‬
‫قبل‬ ‫من‬
‫التميمي‬ ‫علي‬ ‫منصور‬ ‫حسين‬
‫ب‬‫أشراف‬
.‫أ‬‫م‬.‫د‬‫الحسناوي‬ ‫خضير‬ ‫وناس‬ ‫فاطمة‬
‫القعدة‬ ‫ذو‬1437‫هجرية‬‫أيلول‬2016‫ميالدية‬

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