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Each year, one in four children under 14 can expect to make a visit to casualty. But a scheme to raise young people's awareness of safety issues and teach life-saving skills aims to cut that figure and reduce the pressure on overburdened hospitals, reports Sarah Jewell.

Help, help, I need help, somebody help me," nurse Louise Nixon shouts in a voice so loud and so urgent that everyone in the room jumps. The children from Dunmore junior school sit up, their eyes wide. Ms Nixon is bending over a plastic manikin on the floor, trying to breathe life into it. It feels like a life-or-death situation, and it is. With the help of a plastic head and a plastic bag, she is showing a class of 10-year-olds how to resuscitate an unconscious adult. The children watch spellbound, then it is their turn.

Ms Nixon is a staff nurse and trainer for the injury minimisation programme for schools (IMPS) at the John Radcliffe hospital in Oxford. Every week during term time, she teaches life-saving techniques to Year 6 children from local primary schools. They watch an interactive video on how to cope with the five most common accidents: choking, cuts, falls, electrocution, and scalding. Then they visit the accident and emergency department and see equipment such as the heart monitor and oxygen mask. In the plaster room, each has a finger put in a cast.

Ms Nixon knows from her work as a nurse in Aamp;E how important it is for children to learn about accident prevention and how to cope in an emergency, and she has seen the benefits of the course. "We've had lots of letters thanking us, saying they've put into practice what we've told them - for instance, children who said they had twisted their ankles or cut themselves skateboarding or skating and knew what to do." And in some cases they've saved lives: "We had a 10-year-old boy who, two days after seeing the video, saved his choking brother's life by banging him on the back. They were in the bath together and his two-year-old brother had swallowed a piece of soap."

Reducing the number of accidents to children (and ultimately adults) is the long-term aim of IMPS. The trip to the casualty department is just part of a programme of accident prevention education that centres on the national curriculum. The scheme is the brainchild of Keith Willett, a consultant orthopaedic trauma surgeon at the John Radcliffe. He, with a senior Aamp;E nurse and a paediatric health visitor, realised the need to educate children, rather than adults, in injury prevention because "the problem in teaching accident prevention to adults is the British mentality of 'it will never happen to me' ", he says.

After spending time in Canada, where he found a "very different attitude to the community and education", he realised the best approach was to give children the knowledge and experience to assess risk and "build it into the education system". In 1994, following the white paper The Health of the Nation, he set up IMPS with the aim of developing a generation of children who as adult citizens would "have a different attitude to injury prevention and the immediate care of their neighbour".

Teachers are given a resource pack with pre-prepared lessons linked to the national curriculum key stage 2 targets, including literacy, numeracy and PSHE frameworks. This was done because, as Mr Willett explains, "we knew we couldn't get schools to do extra work; teachers don't have time to add lessons on safety awareness and this way schools can use the packs and teach risk assessment without taking time out of the curriculum". For example, a sample science lesson in the pack on mass, velocity and friction uses experiments to calculate car-stopping distances. This links to lessons on crossing roads and allows children to form their own conclusions about the risks.

Marion Haines enjoys teaching with the IMPS resources at Dunmore."The children find the lessons fun because they know you are teaching them life skills, and the trip to the hospital is the icing on the cake. We then come back to school and do follow-up work."

Emily Foggin, 11, says: "It was really interesting. I liked doing the resuscitation and I enjoyed having the plaster put on my finger. I will try to explain it to my friends. It is definitely worthwhile." All the children gave positive feedback. "It's good because young children need to know about IMPS and how to handle dangerous accidents," Keerah Boyce, 11, says. Her classmate Jake Downe, 10, agrees. "It was good because now if we see someone who's unconscious we can go to them and know what to do."

Mr Willett sees the results of ignorance about accident prevention every day in his work as a trauma surgeon. "People think an accident is unavoidable, and in some cases that's true, but if someone has a car accident because they are driving too fast there is a preventable element - taking a risk is determined by how that individual sees the danger to him or herself. Whether you take the risk or not is based on personal experience."

It is this concept of risk awareness that IMPS is trying to teach, concentrating on 10 to 11-year-olds because this is the year before children are most at risk from accidents, according to Department of Trade and Industry research. Once they start secondary school and become more independent, their risk of being involved in an accident increases sharply, especially for boys. "The accident rate is higher as they are more adventurous and take more risks. Boys are also more involved in sports, particularly contact sports, so there is a higher risk of having an accident," says Mr Willett.

In 1999, the Government recognised this in its white paper Saving Lives: our healthier nation, which highlighted its aims for accident reduction and acknowledged that to reduce the number of deaths and injuries caused by accidents, it had to target key groups, particularly young people aged up to 15. In 1999, 423 children died as a result of accidents - 270 boys and 153 girls. About 2.28 million children aged 14 and under (one in four, and more than 6,200 a day) were treated at Aamp;E departments. The cost to the NHS is estimated at pound;100 million a year. Set against this, IMPS seems cost-effective.

As a charity, it has to do a lot of fundraising but, as marketing manager Julia Grinsted says: "It is hard, yet worth it. To run IMPS for 2,500 children in one county costs pound;25,000 a year - pound;10 per child - which is far less than the cost of one child with head injuries spending a couple of weeks in intensive care."

So far, 16,000 children in Oxfordshire have been taught the programme and the word is spreading, with 14 IMPS centres in Britain and one in Hong Kong. And adults have benefited too. As Mr Willett puts it: "Over the past seven years we have covertly put teachers trained in basic life-saving and life and first aid into every school in Oxfordshire, because we've taught the adults as well." For Jane Breslin, a parent who joined the trip to the John Radcliffe, there is no question about the value of IMPS. "The programme is wonderful," she says. "It has taught the children lessons for life and I think it will benefit them greatly. It has also done wonders for me. I have never been first-aid trained, but it has given me an insight into emergency situations."

There is no evidence yet of the long-term effect of IMPS, but Mr Willett says: "We know that six months after the children have been on the course, they maintain the knowledge they have learned about accident prevention, risk awareness and first-aid skills. I hope people will be better able to deal with minor injuries and avoid having to go to casualty."

For more information about IMPS, contact: 01865 228937, www.impsweb.co.uk There are IMPS centres in Scarborough, Chester, Hull, Harrogate, Sunderland, Bradford, Weston-super-Mare, Manchester, Stoke Mandeville, Banbury, Oxford, Nottingham and Sandwell. Another is under development in Eastbourne

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