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One of your pupils is having an asthma attack. What do you do? Caroline Green examines first aid in the classroom

There are few things more frightening for a teacher than to witness a child under his or her care suffering a medical emergency. If you have first aid training you'll probably know what to do, but the chances are that you will have only a vague knowledge of first aid and would be worried about taking inappropriate action and making a bad situation worse.

As well as accidents, the most common emergencies in schools are attacks of asthma, epilepsy and diabetes and a potentially fatal form of allergic reaction called anaphylaxis. It is likely that in any given class at least one child will suffer from one of these conditions. So how clear are a teacher's duties when it comes to giving medical help?

Not as clear as you might expect, according to Les Roberts, assistant secretary for training at the National Association of Schoolmasters Union of Women Teachers. "Teachers often don't know where they stand in relation to this," he says. "Even very experienced teachers may not know what they're supposed to do in a medical situation."

As the law stands, schools are not required to have a qualified first aider. The law treats schools as workplaces, and requires all employers to provide "adequate and appropriate care" for their employees. There is no specific law for schools, and it's up to each employer - in this case the local authority or school - to assess the level of care that is needed. Guidelines from the Health and Safety Executive put schools into the "low risk" category, which means that schools with 50 staff or more must have one qualified first aider. Schools with fewer than 50 members of staff need only an "appointed person", who does not have to be trained in first aid and whose role does not extend much beyond dialling 999 when the need arises and making sure the first aid box is fully stocked.

The Government will be issuing new guidelines early this year. Details are being kept under wraps, but the National Union of Teachers is hopeful of change. Doug McAvoy, NUT general secretary, says: "Our line is that it's not sufficient for employers only to consider employees; they should be taking the number of pupils into account. Every school should have at least one qualified first aider and, where there are split site schools, there should be one in each site." The NUT would also like to see people with specialist first aid knowledge working in schools with large PE, science and CDT units.

Although teachers are not contractually obliged to know what to do in an emergency, it is possible they will find themselves having to deal with one. For this reason, it is a good idea for all teachers to have basic first aid awareness; at the very least, you should know which children in your class suffer from medical conditions.

Many children may require medication during school hours. According to guidelines from the Department for Education and Employment: "Teachers' conditions of employment do not include giving medication or supervising a pupil taking it, although staff may volunteer to do this." If you do offer, make sure the school provides you with the right training.

If you want to learn basic first aid, the St John Ambulance Brigade runs a variety of courses, including one designed for teachers which can fit in with Inset days. It won't make you a qualified first aider, but it is a good primer, according to the St John senior training officer, Terry Perkins. He says: "In an ideal world, everyone in the school will know how to deal with emergencies. We'd like to see first aid knowledge spread throughout society, including all teachers. When you think about it, it almost comes down to the ethics and morals of looking after a child to know what to do."

Liz Brodie, spokeswoman for the National Asthma Campaign, agrees. "The main message we want to get across is that teachers don't need to know every single thing about asthma," she says. "They're not expected to be health professionals. But they should know the very basics, such as what to do if a child has an attack."


* Asthma

Symptoms include wheezing, blue skin, distress and anxiety. Try to reassure the child and make sure they sit down and there is plenty of fresh air. Encourage them to use any medication they might carry, usually an inhaler. If it gets worse or doesn't improve, call 999.

* Epilepsy

Epileptic seizures fall into three main categories. An absence seizure often means a child will look blank for a few seconds, possibly with some twitching and blinking. Just repeat what you said and make a note that it's happened. A tonic clonic seizure is more likely to involve convulsions, stiffening and possibly incontinence. Cushion the child's head, using your arms if nothing else is around. Never put anything between their teeth, restrain them or move them. With a partial seizure, the child may look conscious but not respond. They may wander about and pluck at their clothes. Talk reassuringly and move dangerous objects out of the way. If in doubt, call 999.

* Diabetes

Symptoms of hypoglycaemia (known as a 'hypo') are: hunger, sweating, drowsiness, pallor, glazed eyes, shaking, mood changes or lack of concentration. The child will need some fast-acting sugar in the body; send another child to get it. If the child is unconscious, call 999 immediately.

* Anaphylactic shock

Anaphylazsis is an acute, severe allergic reaction triggered by certain foods (such as nuts, shellfish and cow's milk), drugs (such as penicillin), or stings from insects like bees, wasps and hornets. Symptoms include: itching and a metallic taste in the mouth, swelling in the throat and tongue, hives on the body and difficulty in swallowing. Call 999. The child may carry a type of pen or syringe with which they can inject adrenaline. If so, help them to use it.

* Further reading: First Aid Manual, Dorling Kindersley Pounds 9.99. Emergency Aid in School, St John Ambulance Brigade Pounds 4.95

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