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TEACHING OF FIRST-AID

THE LANCETLONDON : SATURDAY, JANUARY 25, 1941

TEACHING OF FIMST-AtU

WE are beginning to see that our teaching hospitalsmust become educational centres for everything con-cerned with the art of healing. Evolution along thoselines has developed considerably in the last fiftyyears : the dental school was attached to the medicalschool, the nursing, massage and radiographic schoolsdeveloped in turn, but nowhere has there yet arisenthe complete school of healing, where all, except a fewseniors, are learning their jobs and passing on to takeup posts in other institutions. A new stage in theevolution of a fully comprehensive school has beenreached at Queen’s Hospital, Birmingham, where aschool for training industrial workers in first-aid is tobe established as part of the Accident Hospital andRehabilitation Centre, primarily to meet the needsof firms not large enough to have their own trainednurse or doctor. Here trainees will live in the

hospital for a fortnight and act as nursing orderlies.The need for such training centres, extended to meetthe needs of first-aiders both inside and outside thefactories, is evident, for though first-aid parties aredoing and have done valuable work in air-raids it canscarcely be said that all is well with first-aid. Everydoctor, of course, has his funny story of how the first-aider shouldered him out of the way ; but this wouldnot matter if confidence and competence always wenthand in hand.

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Training of first-aiders in England has been under-taken by the St. John Ambulance Association and theBritish Red Cross. The first is primarily a peace-time organisation, and the second, though designed forwar, has been chiefly active in training volunteernurses for hospitals. The textbooks of neither were

designed to meet the type of problem presented byair-raids, and the only widely circulated book writtento that specific end is the A.R.P. Handbook, No. 10.1The result is that training of first-aid parties to meetpresent emergencies starts with an initial handicapof a syllabus and an examination unsuited to the needsof the moment. Medical lecturers are not devoid ofblame. One at least read the book to the class with-out comment; another occupied half an hour of afour-hour course to wardens in explaining thepsychological theory of shock ; and another, advisingon treatment, startled his hearers by remarking

" Justinject a little strychnine-you can’t go wrong." Norare these isolated instances. We can all recalllecturers, able clinicians, whose teaching ability wasnon-existent. This is not beyond remedy, for teach.ing is a job with a technique that can be acquired ;lecturers must realise this, and remember that thepresentation of the facts is as important as the factsthemselves. Those who have been teaching or

examining first-aiders in recent months are well awareof the recurrent faults of candidates and of doctrine.The avidity with which tourniquets are applied, theunpadded splint hard on the malleolus, the single1. The Training and Work of First-Aid Parties. H.M. Stationery

Office, 6d.

(proprietary) disinfectant of which they have heard,the fumbling for pressure-points, the incompetentSchafer’s method-how familiar they are. Most

dangerous of all, perhaps, is ignorance about shock.A correspondent writes : " The first candidate whoknows when shock appears and that its effects can be

explained from the reduction of blood-volume wins abottle of beer or a box of chocolates-but we have nothad to present a prize in two years." First-aid needsa background of sound first principles or it cannot beapplied intelligently ; and sometimes even thelecturer lacks the background.How the proper training and teachers are to be

obtained is not easy to answer. An M.O.H. recentlyexpressed the opinion that it is desirable for allmembers of first-aid posts to be sent to casualtydepartments for training, and only those who candevote sufficient time to gaining this experienceshould be retained at the posts. On another page anaccount will be found of a scheme for a national school

giving a fortnight’s intensive course in similar fashionto the A.R.P. schools. The proposal is attractive inmany ways, but has the questionable purpose oftraining lay instructors. If the first-aid training nowgiven by doctors is unsatisfactory, training given bylay instructors would scarcely be likely to improve onit. The scheme, however, deserves full publicity sothat its strengths and weaknesses can be gauged. Inthe first place is a fortnight long enough to teachanyone anything in such a way that it will stick ?Those who have lectured to nurses know that it is notuntil the second year that facts learned in the first

year become everyday equipment in the student’smind. Only by working with new knowledge over aperiod of time can we convert it into a familiar tool.A fortnight’s course of the kind would be excellent fordoctors about to teach first-aid, if they could beinduced to take it. They would have both knowledgeand experience already, and would need to be toldonly what was relevant to their purpose and how topresent it. But for lay first-aiders some longerpreparation is surely necessary. Possibly the studentcould split his fortnight’s training, starting with aweek of intensive study and practical experience,under supervision, in clinics and outpatient depart-ments ; then returning to his own district for sixmonths to attend routine night or week-end classesdesigned to stamp in his hastily acquired knowledgeand technique ; and finally spending a second weekat the school for revision and further practicalexperience before sitting for his examination. Somesuch system would ensure a competent standard ; butfirst-aid is unsatisfactory at present because it is

badly taught, and our first step must be to ensurethat the teachers learn how and what to teach.

MANAGEMENT OF SECONDARY SHOCKCURRENT opinion on the treatment of wound shock

is expressed in the Medical Research Council memoran-dum 3 which says that " the most important singlerequirement for arresting the progressive deterioration... is restoration of blood-volume." This opinion isjustified by the experience of the Army Blood- .transfusion Service with air-raid casualties. But the

2. Publ. Hlth, October, 1940, p. 5.3. Treatment of Wound Shock : Instructions produced in

cooperation with the Army Medical Service, M.R.C. WarMemorandum No. 1. London, 1940.