First Aid Training

Health and safety training is an important component of childcare. By enforcing proper and proactive first aid training, childcare programs can help ensure that children remain safe and healthy while in their care.

First-aid Basics

Caring for Our Children: National Health and Safety Standards: Guidelines for Out-of- Home Child Care Programs has become the authoritative resource on health and safety in childcare. According to this guide, at least one person who has completed training in pediatric first aid must be in attendance wherever children are present. It is recommended that this training include resuscitation skills such as management of blocked airways and rescue breathing but not necessarily Cardiopulmonary Resuscitation (CPR). The need for cardiac resuscitation is rare in childcare settings, occurring only when children have specific problems such as cardiac arrhythmia or drowning.

Staff who care for children with special health care needs that require cardiac resuscitation should learn CPR (see section below on children with special health care needs). At least one caregiver should be certified in CPR when children are regularly swimming or wading. Training also should include the recognition and treatment of anaphylaxis (a life-threatening allergic reaction).

The Caring for Our Children guidelines state that at least one person trained in first aid should be present at all times--this does not mean just one person must be trained; it means that a trained person must always be available on site and wherever you have children (during transportation, field trips, etc.) If one caregiver with first aid training is on vacation when an emergency occurs, someone else in the program should be on hand to assist. Childcare programs often have staff turnover so be prepared by having as many caregivers trained in first aid as possible. When training opportunities arise, consider sending several staff members. Many childcare programs choose to train all caregivers in first aid. If this is not the case, it is important for all staff to know which caregivers are trained. If an emergency occurs on the playground and the supervising caregiver does not know who to ask for first aid assistance, valuable time can be lost. Use regular communication methods such as staff meetings, newsletters, or bulletin boards to remind staff of who has received training.

First-aid training for childcare providers should include guidance on treating abrasions and lacerations, burns, puncture wounds from splinters, and eye injuries. Childcare providers also should be prepared to treat the following injuries and health care needs:

• Bleeding, including nosebleeds
• Poisoning
• Convulsions or non convulsive seizures
• Sprains or fractures
• Head injuries
• Dental and mouth injuries
• Heat or cold-related injuries
• Electric shock
• Insect, animal, and human bites
• Allergic reactions

Periodic retraining is recommended to ensure that caregivers stay current and do not forget skills and procedures. To find out about training opportunities in your area, contact your local health department. In addition, the American Red Cross, hospitals, fire departments, and community colleges often provide health and safety training. Trainers often will come to your childcare program for on site training. Many states have childcare health consultants who can work with your program on a variety of health and safety issues. Contact your local health department or childcare referral agency to see if a childcare health consultant is available in your area.

Emergency Care

In the event of an emergency, it is important that childcare providers be prepared. This can be accomplished by ensuring that the following recommendations from the American Academy of Pediatrics (AAP) are in place before an emergency occurs:

• Establish procedures for contacting help in emergency situations (who to call first and when to call 911).
• Have the names and phone numbers of emergency contacts for children in your care available at all times and have a plan for contacting these individuals when an emergency arises.
• If the childcare program is large, ensure that at least two caregivers are trained to handle emergencies according to established policies until help arrives. In family care, the family provider should be trained.
• Be sure that a complete emergency medical kit with items such as disposable non porous gloves, scissors, tweezers, a non glass thermometer, bandage tape, sterile gauze pads, bandages, splints, and eye dressing is available at all times. In addition, a list of emergency phone numbers should be available to caregivers who are trained in first aid.

Special Health Care Needs

Some children will require specialized medical care in emergencies. To ensure that children with special health care needs are properly cared for, develop emergency care plans that address specific needs of the individual. This is particularly important for children who have health conditions that make it likely they will need emergency care--such as those who have severe food or insect allergies, asthma, diabetes, or hemophilia. This plan should ensure that necessary supplies are included in the emergency kit and that transportation to the nearest medical facility and parental permission to transport are secured in advance.

When caring for a child with special needs, it is important that the child's physician be involved. Not only can physicians offer input about whether rescue breathing and blocked airway management skills are sufficient or if skills in cardiac resuscitation are necessary to meet particular health needs, they provide a medical perspective that can help prevent medical emergencies or injuries from happening in the first place. Promoting a three-way partnership among physicians, parents, and caregivers is beneficial to all children, whether or not they have special health care needs.

Preventing Injury in Childcare

Of course, the best way to approach first aid is to take a preventive stance. By having written policies for health and safety in place, creating a safe environment, educating children on safety, and ensuring appropriate supervision, it is possible to prevent most serious injuries from happening or to limit the effect that injuries have on children's health and well-being. To ensure continued health and safety, regularly review your program's policies and procedures and consider ways in which they can be improved to protect all the children in your care.

Diona Reeves
Health Communications Specialist, CYKE, Inc.

TRAINING RESOURCES

To find out about first aid training in your area, contact your local health department, the American Red Cross, hospitals, fire departments, or community colleges.

INTERNET RESOURCES

Caring for Our Children: National Health and Safety Standards: Guidelines for Out-of-Home Child Care Programs, online at nrc.uchsc.edu. Search for information about first aid in childcare.

The Centers for Disease Control and Prevention (CDC) offer guidelines on how to handle specific injuries and illnesses, as well as sample childcare emergency forms and injury reports, www.cdc.gov.

Sample injury reporting form: www.childhealthonline.org/topicforms.htm

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