FIRST AID SUGGESTIONS FOR ELEMENTARY SCHOOL TEACHERS

FIRST AID SUGGESTIONS FOR ELEMENTARYSCHOOL TEACHERS

JACK C. SHRADER, M.D.Indianapolis City Hospital

Indianapolis^ Indiana

EDITOR’S NOTE. In this day and age of diversified activities in the elemen-tary schools, teachers often find themselves in a situation where first aidtreatment is necessary to protect the health of a child. In the followingarticle Dr. Shrader has given up-to-date first aid suggestions that willserve the classroom teacher in most school situations. It is the editor’ssuggestion that after you read this article you put it in the top drawer ofyour desk and keep it for ready reference.

This article is not intended to be a comprehensive treatise onfirst aid management. It includes a brief outline of the morecommon injuries which the elementary school teacher will becalled upon to handle, such as those arising in the classroom, onthe playground, or on the field trip. Remember that first aid,by definition, is the immediate, temporary treatment givenbefore a physician^ services are obtained. To most persons,first aid means to do something in a hurry, but in reality theelement of rush is rarely necessary. There are only two emer-gencies where seconds count, namely: profuse hemorrhage andasphyxia. It is not so important, in many cases, to know whatto do, as it is to know what not to do.

Medicine is far from an exact science like mathematics orphysics. Consequently, doctors may vary slightly in their opin-ions on certain phases of treatment. That is to say, there may beseveral means to one end. It must also be remembered thattreatment must always be individualized, both as to the patientand to the circumstances.

I. GENERAL PRINCIPLES

There are certain general principles which are applicable inthe management of all first aid problems that may arise indealing with children. First of all, always keep calm. Childrenare quick to sense a teacher’s distress, and this will most cer-tainly aggravate an unpleasant situation. For example, walk,do not run, and speak quietly. Secondly, it is wise to ease thepain promptly. Much can be accomplished toward this end bydistraction of attention. Have the child grip one hand with theother and squeeze it tightly, or close his eyes tightly, or hold hisnose and breathe through his mouth. Numerous other examples

530

�

FIRST AID SUGGESTIONS 531

could be mentioned�any little thing which will distract hisattention, and at the same time give him the feeling that he isdoing something to help. It is good psychology to allow thechild to perform as much of the first aid treatment for himselfas practicable. A third suggestion is to always encourage thechild by commending his endurance and manliness. Never shamea child in front of his classmates, no matter how trivial the in-jury.

II. FIRST AID TREATMENT OF CUTS AND SMALL OPEN WOUNDSShock and Fainting. Injuries likely to be encountered are

rarely so severe as to produce a condition of-shock. However,some children become faint and nauseated at the sight of blood.The head should be lowered, either by having the patient bendover in his chair so that his head is between his knees, or byhaving him lie flat on his back with his legs elevated, if possible.Never use a pillow. Inhalations of aromatic spirits of ammoniaare often beneficial. The oral administration of this drug isseldom justified as it is more apt to cause nausea and vomiting.Never give an unconscious person a drink of water. It is notnecessary to drench the individual. Warm, moist cloths on theforehead are better than cold applications. Vigorous massage ofthe limbs toward the heart is a useful circulation stimulant.

Control of Hemorrhage. Unless a large artery has been severed,the most valuable, single procedure in the control of bleedingfrom small wounds is direct pressure over the bleeding area bymeans of a sterile gauze compress, or simply a clean cloth.The mistake is often made of removing this every few minutesto peek at the wound. Maintain constant pressure for 15 to 20minutes to afford a chance for the clot to form. Elevation of theinjured extremity will lower the blood pressure so that bleedingwill be diminished. Scalp wounds bleed quite freely, and theyshould have constant pressure until a physician’s services canbe obtained.

Christopher states, În the average man the sight of bloodinvariably invokes the idea of a tourniquet. As a result, thetourniquet has been perhaps, much misused, and done moreharm than actual good." The common error is to apply thetourniquet tight enough to occlude the venous return, but nottight enough to stop the arterial flow of blood into the particularextremity. This, naturally, only causes more profuse hemor-rhage. Actually, there are surprisingly few instances, where a

532 SCHOOL SCIENCE AND MATHEMATICS

tourniquet will do more good than direct pressure over thebleeding area. The second error in application of a tourniquetis in making it too tight so that pressure on nerve trunkscauses a transitory paralysis. Use tourniquets only when theperson is obviously losing considerable blood from an extremity,i.e. traumatic amputation or its equivalent.

Cleansing of the Wound. The importance of cleansing a woundthoroughly with soap and water has in the past been greatlyunderestimated. No antiseptic or combination of antisepticscan begin to sterilize a wound safely, if thorough scrubbing witha brush, soap, and water, has been omitted. A badly contami-nated and lacerated wound should be cleansed by a doctor.

Antiseptics. After the wound and the skin adjacent have beencleansed with soap and water, and all foreign bodies removedfrom the wound, it is then ready for application of an antiseptic.An ideal antiseptic is one that will destroy the most germs whileproducing the least damage to the tissue cells. The cell is the all-important unit in combatting infection and bringing abouttissue repair. Strong antiseptics often hinder this process. Wemust not underestimate the natural defense reaction of thebody to infection. It is not necessary to kill the invading bac-teria outright, only to inhibit the growth of the bacteria. Inother words, weaken the bacteria without weakening thenatural defense processes of the body. The time-honored tinc-ture of iodine has been replaced by safer and more effectiveagents. The alcohol may evaporate as the solution ages, andsevere tissue damage may result from applying this concen-trated iodine solution. Also burns have been produced by re-peated application of fresh iodine solutions. Iodine may bemistaken for argyrol, and thus cause severe damage to the eye,or nasal mucosa. Another great disadvantage, especially for usewith children, is that it smarts severely. Merthiolate and Meta-phen are two highly efficient and safe antiseptics, but they alsohave the disadvantage, of causing intense stinging for a fewmoments. For the first aid treatment of small cuts or abrasionssuffered by children, 2 to 4 per cent aqueous mercurochromeis recommended. Children will volunteer for this treatmentsooner than for iodine application. It does not sear the tissuesas does tincture of iodine and penetrates wet wounds better. Itdoes not become more toxic on aging. According to DeLaureat,if 2 ounces of a 2 per cent solution were swallowed, no moreserious consequences than a sore mouth and diarrhea would


result. This consideration is of some consequences around smallchildren.

Dressing. Sterile gauze squares are the ideal dressing material.For small cuts, a good dressing can be purchased ready-made,consisting of a strip of adhesive to which a small piece of gauzeis attached. It is bad practice to apply adhesive directly overa wound, as this seals in anaerobic bacteria, such as the tetanusbacillus, prevents drainage, and is painful to remove. For thesame reason, liquid collodion should never be used directly on awound.

Lockjaw (Tetanus Prophylaxis). Any wound received on theplayground, street, or field-hike, is a potential source of lockjaw.The child’s doctor should be consulted as to the advisability oftetanus antitoxin. This is imperative in puncture wounds, be-cause they are difficult to clean even with specialized instru-ments.

III. BURNS

Fire. The first requisite in the first aid treatment of minorburns suffered by children is to alleviate pain. This is accom-plished to some extent by application of a paste of baking sodain water, any good burn ointment, plain or carbolated vaseline,any clean oily substance, or cold water. Severe burns character-ized by blistering or breaking of the skin should be treated by aphysician as infection is imminent. Never apply iodine to aburn. Do not use an ointment on extensive severe burns as afirst aid measure, as this interferes with the treatment used bysome physicians. For such extensive burns cover the individualwith sterile gauze (or a clean cloth) soaked in one of the followingsolutions.

1 teaspoon *table salt to a pint of warm water1 teaspoon Epsom salt to a pint of warm water1 teaspoon baking soda to a pint of warm waterThe measurements need not be exact. The dressings should be

kept moist and warm until medical aid is obtained.Hot Water. The first aid for scalds is the same as that de-

scribed above.Acid. Immediately flush the area with running water until a

weak alkali can be procured to neutralize the acid. Soda bi-carbonate is the best alkali to use. Do not use lye or strongammonia as this will cause further damage to surrounding tissueand will neutralize no better than soda.


Alkali (Lye). Immediately flush with water as above, but usevinegar as a neutralizing agent. Do not use a strong acid.

Carbolic Acid (Phenol). This is not a true acid and is neutral-ized by rubbing alcohol in large quantities, not by soda. Flushwith water before and after the alcohol. If phenol is freely takeninternally, do not give alcohol, as this hastens the absorption ofphenol into the circulation.

Electricity. Many children have at some time received anelectric shock from probing a light socket with a metal objector their fingers. Such burns may appear inconsequential on thesurface, but are sometimes deep and extensive, as one type ofcurrent destroys tissue as it passes through. The other type ofcurrent causes severe shock, but rarely severe burns. Electricshock should be an indication for immediate artificial respirationuntil a physician arrives. One must also remember the danger oftouching a person still in contact with an electric current.Always use a non-conductor, such as wood (dry) or heavy rubber,as an implement to remove the victim from the source of thecurrent.

Sunburn. This condition can be more serious than usuallyrealized. It is advisable to dismiss a child with a severe sunburnfrom school, as children usually consider it a good joke to slapthe victim on the back. Any good burn ointment should be usedas a first aid remedy. As a prophylaxis, olive oil, applied freelyto the skin, will prevent severe burns from developing.

IV. FOREIGN BODIES

Particles in the Eye. Children frequently get particles of dirtor debris into the eye while playing on the school grounds.In order to remove the particle, the upper lid of the eye shouldbe grasped by the lashes, and pulled out and down, so as tooverlap slightly the lower lid, and held this wây for severalseconds. This causes considerable lacrymation which tends towash the particle to the inside corner. Several drops of mineraloil or olive oil in the eye will help to dislodge the foreign bodyand lessen the irritation. There are many old remedies for amote in the eye, but they are all based upon the three reliableprinciples: keep the eye closed, do not wink or rub the eye, andprovide something to occupy the child^s attention while thetears have an opportunity to form and float the particle to an in-nocuous location.

Obviously, the only certain method for dealing with such a


situation is to visualize the particle and brush it out with thetip of a cotton applicator, preferably moistened with boric acid.If, however, the particle is firmly attached to the transparentportion of the eye, it would be wiser to seek a physician’sservices at once as unskilled attempts at removal can lead toserious infection or perforation.

In order to inspect the eye carefully, first pull the lower liddown and have the child look upward as you search the insideof the lower lid. If not seen there, evert the upper lid. This iseasily done by having the child look downwards, then pull theupper lid down and out by the lashes and place a match ortooth pick on the upper lid about one fourth inch from the mar-gin and press in gently with this stick with one hand, while yougently turn the lid over the stick with the other hand. Anyparticle here is thus made readily accessible.

Chemical Burns of the Eye. Any acid or alkali splashed into theeye should immediately be washed out wdth large quantities ofwater. A drinking fountain may serve as an ideal means offlushing the eye. Too much water cannot be used. Then place afew drops of clean oil in each eye and apply a moist compress.A doctor should be summoned as soon as possible.

Foreign Bodies in ihe Stomach. This condition is likely tocause considerable apprehension on the part of the teacher,wîch will be communicated to the child, and create unneces-sary excitement and fear. It is, however, not in the field offirst aid treatment. Do not attempt to induce vomiting, as inmost cases this will be more dangerous than natural passage. Itis well to consult a physician as soon as practicable.

V. FRACTURES AND SPRAINSImportant Suggestions. The first aid treatment for fractures

and sprains is a comprehensive subject and only the generalprinciples can be mentioned here. If in doubt about the injuryit is safest to assume a fracture is present until proven otherwiseso it is best not to move the child until a splint has been applied.This is to prevent further damage as the broken ends are verysharp. Should a bone be protruding through the skin, it shouldnot be touched. Beware of swelling, blueness, coldness, and in-creasing pain in the hand or foot of a splinted extremity. Thismeans the circulation is dangerously impaired, and the splintshould be loosened.

Splints can be made from any firm material, and should be


padded on the side next to the body. They should be long enoughto extend beyond the joints on each side of the fracture, butremember, splints are only to secure immobilization of the brok-en bone until the patient can be taken to a doctor.The Sprained Ankle. It is sometimes impossible, without an

X-ray to differentiate a sprain from a fracture. In fact, theyoften occur together. In school children, however, fractures ofthe ankle are very rare.No weight should be borne on the ankle. The leg should be

elevated on a pillow, as dependency increases the swelling andpain. Apply cold packs or ice packs until seen by a physician.

VI. BITES AND SCRATCHES

Bites. These are usually inflicted by dogs or cats. Naturally,hydrophobia is always to be feared in such cases. It is importantto identify the offending animal, so that it can be watched forthe development of rabies. First aid treatment of the bite is thesame as for any small open wound. However, it is imperativethat such cases be seen by a physician. Bites from other petsare dangerous in that they may cause severe infection and alsotransmit certain diseases. Rat bites are especially to be feared.The human bite frequently causes the most necrotizing woundsseen. Do not fail to clean these as thoroughly as possible.

Scratches. These are usually dangerous only in that they maycause infection and blood poisoning. If the animal is rabid, thescratches arc dangerous from that standpoint, as the claws arelikely to be contaminated with saliva which transmits the virusof hydrophobia.

Snake Bites. Here is the situation in which a tourniquet insome form is indispensable. Apply it only tight enough to oc-clude venous return and thus increase the bleeding. Never leaveon longer than one hour at a time. Rather deep incisions (înch) should be made with a sharp knife, or razor blade aroundthe bite. Suction should be applied for an hour or so, untilmedical aid is obtained. This will, of necessity, usually be by themouth. Do not give whiskey, as it may do more harm than good.Bring the patient to a doctor as soon as possible. If a field tripis contemplated into inaccessible regions, a snake-bite FirstAid Kit and directions should be taken along.

Bee Stings. The pain is best relieved by applying a paste ofsoda and water or a compress soaked in weak ammonia waterto the area. The "stinger^ should be pulled out promptly. Coldcompresses lessen the pain and swelling.


Spider Bites. In the United States the only authentic cases ofarachnidism have been due to the bite of the Black Widow(Latrodectus mactans). It is also called shoe-button, hour-glass,and T-dot Spider. The bite stings for a few moments and thensubsides. In 15 to 30 minutes pain reappears at the site of thebite and spreads all over the body. There is considerable painfulmuscle spasm, and often spasmodic twitching of muscles. Thebite itself may hardly be visible, and is not particularly tender.If the bite is noticed at the moment of its infliction, it would bewise to employ the same methods as used in poisonous snakebites. Apply a tourniquet at once, between the bite and theheart. Make several radially placed incisions at the site of thebite..These should be |- to ^ inch in depth, so as to bleed freely.Suck the wound thus made, trying not to swallow the blood.This will remove some of the poison and lessen the severity of theillness. If, however, symptoms of generalized pain have alreadybegun, hot baths or soaks will ease them some. Opiates will haveto be administered as soon as a doctor can be reached. Bitesfrom other spiders are best treated by applying a compresssoaked in warm Epsom salt solution, made by adding a table-spoon of salts to one pint of water.

CJiiggers. This is an infestation with a small mite, which bur-rows under the skin and causes intense itching. They are oftencontracted on field trips in summer. Treatment is purely symp-tomatic, until medical consultation is obtained. CalamineLotion Compound is the safest and most effective first aidremedy to alleviate the itching.

VII. MISCELLANEOUSNosebleed. This is probably one of the most common emer-

gencies and one which usually is of little consequence, although itcauses considerable apprehension. The first principle is to remainquiet. It is better to sit up, as a horizontal position increases theblood pressure slightly, at the site of the hemorrhage and hindersclotting. Have the child sit with his head thrown back, andbreathe through his mouth. Discourage any snuffling or blowingof his nose. If the bleeding point is anterior, coagulation isfacilitated by pinching the soft part of the nose tightly for 5 to10 minutes. The insertion of a small pack of gauze or cotton, ortissue may help. However, this should be done gently, and itshould be directed backwards, not upwards. The old remedy ofplacing ice on the back of the neck, perhaps, is of value only inthat the patient is compelled to remain quiet to keep it in place.


In practically all cases of spontaneous nose-bleed, the hemor-rhage will stop of its own accord in several minutes. If muchdifficulty is experienced, a physician should be consulted.

Convulsions. In cases of convulsions a physician should besummoned at once. In all probability, the seizure will haveceased in a few minutes, leaving the child in a dazed stupor.The teacher should never allow herself to become alarmed, butremain calm. Convulsions are almost never immediately danger-ous per se. It is, however, her responsibility to see that thechild is protected from pounding his head or chewing his tongueduring the seizure. Do not forcibly restrain his movements, butprotect him from striking himself on any firm object that wouldinflict bruises or cuts. A pencil wrapped with a handkerchiefis perhaps the most readily available object to insert betweenthe teeth to prevent chewing the tongue.Water Blisters. These are caused by some source of irritation.

First take measures to remove that source. It is not necessaryto open the blister as a first aid measure, unless inflamation isalso present. In such case, the blister should be opened by adoctor, and the infection treated, as serious blood poisoninghas resulted from seemingly insignificant blisters. If the blisterhas broken, treat it as a small open wound.

Blood Blisters. The same principles of treatment apply here.It is not necessary to open these to drain the blood as a firstaid measure.

Sunstroke. This is caused by direct exposure to the sun^s rays.It is’characterized by a flushed face and hot dry skin. There isheadache, dizziness, malaise, and sometimes vomiting. Un-consciousness will eventually occur. Treatment includes anymethod to cool the child. Remove him from the direct sun andbathe him with cool water. Keep cold, wet cloths on the foreheador an ice bag, or ice wrapped in cloth. Remember these are onlyfirst aid measures until a doctor can be contacted. Severecases have been wrapped in a sheet, kept wet with cold water.There is always danger of cooling too much. Stop treatmentevery 30 minutes and observe the patient. If the skin remainshot and flushed, continue cooling procedures. If muscle crampsoccur, these may be relieved by taking salt tablets.Head Injuries. Such a term is used by the medical profession

to indicate those injuries in which there is a possibility of injuryto the brain. Children, invariably, are receiving bumps on the


head from time to time, which cause swelling, pain, and tender-ness. These require no treatment, usually. However, when aperson is knocked unconscious, he has received some braininjury. Often by the time the doctor arrives, consciousness hasbeen regained, and there appears to be nothing to fear. Yet thepatient may lapse into coma again within an hour or two. Thismust be considered as indicating immediate hospitalization.Any person who has been "knocked out" from a blow on thehead must be under medical observation for at least 24 hours,preferably in a hospital.

The Black Eye. This is not a very severe injury, and calls forno alarm. The use of compresses, kept moist with cold wateronly, is the ideal treatment. The traditional beefsteak is notnecessary.

Froslbifs. Fingers, toes, and ears are most frequently affected.Occasionally the nose and cheeks may be frost bitten withoutproducing much pain. This is a condition in which ice crystalsare actually formed in the tissues. Contrary to most belief,such tissue should not be rubbed with snow. It is possible forears to become frozen so stiff that pieces will break off if rubbedbriskly. The best treatment is to heat the frozen area slowly, byholding the ears or nose or cheeks with the hands. Above all,do not apply hot water or radiant heat to frozen parts, as theywill crack open, cause serious trouble, and probable gangrene.

In conclusion it is well to bear in mind that the suggestionsgiven for first aid treatment are only temporary measures.For all injuries the child should always be kept in the mostcomfortable and calm situation while the services of a physicianare being secured. Some schools are fortunate in having a doctoror nurse on the premises while others must depend on outsideaid. The best rule for all situations is to keep these suggestionsin mind and use common sense.

An educational program for common defense must in practical ways bothincrease our skills and enlighten our understandings for the pursuit of com-mon democratic purposes. If we can see that during the last four years thedemocratic peoples have become the victims of their own ignorance�theirignorance of the ways of dictatorship and their ignorance of the ways andmeans of making democracy work, nationally and internationally�thenwe must see that education carries a major responsibility for the ultimatevictory of free government.�John W. Studebaker, U. S. Commissioner ofEducation, Atlantic City address^ February 24, 1941.

Documents

FIRST AID SUGGESTIONS FOR ELEMENTARY SCHOOL TEACHERS