Life saving science: English four-year olds' understanding of injuries and the appropriate first aid treatment

This small study conducted by an experienced First aid instructor and science educator sought to establish 
a baseline pilot study of what actions were observed and identified as injuries and subsequent first 
aid. A class of 29 four-year-old children were shown 8 nine inch tall Teddy Bears, dressed as World 
War I pilots. Each Teddy Bear with a simulated injury was shown by the researcher to the child and 
asked, what could be done to help each injured Teddy. Their responses were recorded by writing and 
analysed by a read and re-read process with a goal to establish the categories of the child’s rationale for 
their responses for reason of injuries and actions. A simple appropriate approach was then discussed 
with each child. The data indicated that children’s main solution to treatment was to ‘put on a bandaid’. 
The results showed that children had little comprehension of further treatment.


Introduction
Science curriculum is an appropriate place to introduce pupils of all ages to the basic concepts of first aid.The sciences are the obvious subject in which to incorporate the learning of first aid while the pertinent science concept is taught, such as gravity in the treatment of a haemorrhage, or forces in the cause of fractures (Tunnicliffe 2007).First aid has been taught traditionally by the voluntary societies as a mixture of theoretical instruction with basic human anatomy and physiology to explain causes and treatment of injuries.The model of instruction has been of lecture and demonstration with trainees involved in roleplay and simulations as realistic as possible, "All work must actually be carried out as in real life, so far as is practicable…" (the Order of St John, 1992).Simulations such as those presented by the Casualties Union have provided realism.
Little is known when children begin to understand the importance of safety and keeping the body healthy, and what people can do to relieve symptoms of injuries as well as prevent them.We know that young children entering preschool at 4 years old have limited knowledge of the internal anatomy of organisms, knowing that there are a few organs, particularly the heart, brain, stomach and bones (Reiss and Tunnicliffe 1992).We also know that, as children mature, many of them acquire a greater knowledge of anatomy but understanding of systems and how they interrelate is lacking.However, there is little work on the knowledge of first aid amongst young people.As children develop, they likewise acquire more first aid knowledge as described by the progression of first aid manuals.However, if first aid is to be incorporated within the formal curriculum in relevant subject areas, particularly science, it is thus a necessity to elicit the knowledge and beliefs that young children hold.

Rationale
Children think and reason largely in the same way as adults but lack experience (Goswani and Bryant 2007) and respond at exhibits, to narrative, hands-on involvement and adults providing support (Russell 1999).Moreover, role-play is regarded as a leading learning activity between young children and adults (Rogers and Evans 2006) as well as being an important tool in science teaching (Parkinson 2002).Furthermore, 'pretending' is more effective when carried out with, and scaffolded by, an adult (Goswani and Bryant 2007).There is an overlap between experiences in the early years and the traditional teaching of first aid because of the ways in which children at this stage experience the world and learn best by role-play, simulation, and make believe as they act out ideas and fantasies, often based on something they have experienced in their life.Thus, I investigated young children's knowledge of some usual injuries illustrated by injury simulations on these familiar soft toys, and the actions they thought to be effective, through role-play and simulation, with an adult, and focused on 'injured' Teddy Bears.

Method
From my observations over many years, I consider there to be an overlap between experiences in their early years and the traditional teaching of first aid.This small study sought young children's knowledge of first aid by investigation and simulation of role-play by an adult, and focused on injured Teddy Bears.Eight identical toy bears, in flying jackets, flying helmets and goggles were purchased from an Air Ambulance Charity and used in the simulations.Each of these 'Teddies' was 'treated' to simulate commonly occurring injures, one per toy bear, such as a red streak of lipstick on a fore paw to represent a cut, and the injury was identifies in words by the researcher as the start of the observation.Each bear toy was placed at a separate appropriate location within the Foundation Area.For example the 'unconscious' Teddy was placed outside play area at the foot of slide ladder.
The work was undertaken in the Foundation (Early years, 4-5 yr.olds) of a Community School in South East England.Attainment on entry in this school, as evidenced by the foundation stage profile published on the internet, was below average, particularly in language skills, incomes and education (Acorn 2007).All children attending preschool during this year had parents or guardians who signed a permission slip informing them of the research taking part in the study as the subjects of this investigation.No child was withdrawn.All children in the year were 'seen' individually during regular school sessions.

Photo. Teddy First Aid
Initial interviews were in the adjacent family room where some 'injured' teddies were positioned.The child was invited to hold and carry round a 'real' Teddy as we looked at the injured and asked what we could do to help.To engage the children and to encourage them to talk, a 'Teddy' was introduced to the child and asked by the adult if they would like to hold it and whether they had a Teddy at home.Once the child talked they were asked what Teddy could do to keep healthy and then with the researcher, looked at the injured teddies and talked about what we could do to help.Thus, the scenarios involved role-play and simulation, as in traditional first aid instruction.Responses were written on separate prepared sheets at the time.There were eight scenarios.The injuries were based on those in a questionnaire designed to elicit an existing understanding of first aid by the British Red Cross as a preliminary exercise before pupils follow their Life live it programme for secondary pupils (BRCS 2006).The injuries simulated were: a burnt paw, a bleeding paw, a piece of glass embedded in paw, the bear had fallen to the floor with a seizure, the bear had been knocked by a car, a bear being unwell having drunk some poison near the sink, an unconscious bear, the condition caused from a fall from the slide, and a leg fractured in a fall.A verbal scenario, supported by the 'injured Teddy bear' in an appropriate position, was used to put the injury into context was given at each 'casualty', such as 'Teddy has fallen over on a piece of glass which has stuck into his fore paw which is bleeding'.The injuries were simulated using everyday materials.For example; a burn was simulated with fixing a piece of small bubble wrap smeared with Vaseline and lipstick onto the paw of a bear.Twenty nine children were interviewed over a term.However, one child was an elective mute.She joined in the activity but did not verbally respond hence only 28 responses were analysed.After each 'accident' the child was told the appropriate age related treatment that they could undertake.The children focused on the injury, recall-ing their own relevant experiences.Few thought and worked out a course of action.One child explained that their kitchen had been set on fire and another how they had been burnt and taken to hospital.The researcher checked the authenticity of the reported incidents.They were true.The children carried the teddy and fiddled with it whilst talking.The transcripts were read and re-read and categories of responses emerged.Four themes emerged from an identification of the categories of responses given by the children and transcribed to the injured incidents.The theme which emerged for treating the injury by the child at the injury, from the read re-read process, were not mutually exclusive.They were: Don't Know; Tell an adult, (usually Mother or doctor); Care for Teddy; Treat the injury/situation with an imaginary solution, or, most often, from their experience of their own injuries, usually applying a band-aid!

Results
After analysis of the contents of the transcripts the data for each injury were recorded in Table 1.Those regarding the burn showed most information.The bleeding paw was treated by putting on a band-aid over the cut.When asked the children, they did not know how to use the telephone to call for help but the response, 'call the doctor' or 'take to doctor' was almost a mantra.Not all children answered the question about a source of treatment for each injury.The detailed summary of responses from each child for the burn injury are shown in Table 2.
Table 2.These are example of responses of children's for the questions of treatments for a burn and their source of information  This simulated burn injury was the one to which more children provided personal information.Some children thought about the treatment.One sturdy little boy reasoned that best treatment for the fractured leg was, 'Cut it off'.He was of the opinion that the unconscious casualty should be 'left to die'.The reference to wear a wristband reflects this child's experience at home where a relative wore a medic alert bracelet.

Action
The content of responses to all the simulated fell into four main themes: what to do, such as tell an adult.e. Pragmatic.Few and far between.One boy in particular were very pragmatic and for example, the broken leg incident remarked 'Cut it off'.

Conclusions
The findings were discussed with the Head teacher and the teacher in charge of the foundation stage curriculum.These findings provide a base on which effective teaching could develop for life skills and language as well as science, first aid and health education.These children did not know how to use the telephone and the school is now going to ensure that this is taught.Children who experienced the injury knew more about treatment.Language was an impediment.Unless children had experience of an injury they did not understand some words like 'burn', 'unconscious'.These had to be explained first.However, the data demonstrated that young children are aware of injuries and the need for treatment for them and are capable of reasoning within their experience and common sense.If helping children to feel safe but able to help in cases of accident is part of their educational entitlement, action in emergencies can be incorporated in a developmental sequence across the to Dr I put my finger on kettle, It was hot, I thought it cold had to put plaster on finger

Table 1 .
Children's Sources of information about treating injuries