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BASIC EMERGENCY LIFESAVING SKILLS (BELS): A Framework for Teaching Emergency Lifesaving Skills to Children and Adolescents

Children’s Safety Network
National Injury and Violence Prevention Resource Center
Education Development Center, Inc.
55 Chapel Street, Newton, MA 02458-1060
(617) 969-7100 Ext. 2207
www.edc.org/HHD/csn
Cite as: Maternal & Child Health Bureau (1999) Basic Emergency Lifesaving Skills (BELS): A Framework for Teaching Emergency Lifesaving Skills to Children and Adolescents. Newton, MA: Children’s Safety Network, Education Development Center, Inc.

Contributors

This publication was prepared for the Health Resources and Services Administration’s Maternal and Child Health Bureau. It was developed by the Children’s Safety Network (CSN) National Injury and Violence Prevention Resource Center at Education Development Center, Inc., under Grant # MCJ-253A21-05-3 with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Mention of programs or publications in this document does not imply endorsement by CSN or HRSA.

This project was carried out under the direction of Stephanie Bryn, M.P.H., Project Officer, HRSA, MCHB. Lisa Marie Bernardo, R.N. Ph.D., University of Pittsburgh School of Nursing, produced the final draft of this document. Ken Allen, B.S., Senior Program Planning Associate, Emergency Medical Services for Children National Resource Center and Cindy R. Doyle, B.S.N. M.A., Special Assistant to the Director. Division of Child, Adolescent and Family Health, MCHB, played critical roles in bringing BELS to its final form. Julie Weiss, Ph.D., Unlimited Horizons Education Consulting, produced the first draft of BELS. BELS was designed and formatted at EDC by Kay Baker and Dorothy Geiser. Production was overseen by Jennifer Roscoe of Editorial and Design Services, EDC. Marc Posner served as Project Director.

The following advisors and consultants reviewed drafts of this document, attended review meetings, and offered valuable advice and input.

Ken Allen
Emergency Medical Services for Children
National Resource Center
Washington, D.C.

Jean Athey (retired)
Health Resources and Services Administration
Maternal and Child Health Bureau
Rockville, Md.

Bob Bailey
North Carolina Emergency Medical Services for Children
Raleigh, N.C.

Renee Barrett
EMSC National Resource Center
American School Health Association
Silver Spring, Md.

Fred Brown
National Association of Elementary School Principals
Alexandria, Va.

Daryl Burnett
Human Resources and Services Administration
Bureau of Primary Health Care
Rockville, Md.

Lisa Cohen Barrios
Division of Adolescent and School Health
Centers for Disease Control and Prevention
Atlanta, Ga.

Beth Cooper
American Heart Association
Dallas, Tex.

Garry Criddle
National Highway Traffic Safety Administration
Washington, D.C.

Edward De Vos
Education Development Center, Inc.
Children’s Safety Network
Newton, Mass.

Lisabeth DiLalla
Southern Illinois University School of Medicine
Carbondale, Ill.

Tim Dunn
Education Development Center, Inc.
Newton, Mass.

George L. Foltin
Center for Pediatric Emergency Medicine Bellevue Hospital Center
New York University
School of Medicine
New York, N.Y.

Susan Gallagher
Children’s Safety Network
Newton, Mass.

Anara Guard
Children’s Safety Network
Newton, Mass.

Dianne Hagan
Massachusetts Department of Public Health
State Adolescent Health Coordinator Network
Executive Committee
Boston, Mass.

Chris Hanna
Children’s Safety Network
Marshfield, Wis.

Stephen Hargarten
Medical College of Wisconsin
Milwaukee, Wis.

Pat Hauptman
National Assembly on School-based Health Care
Baltimore, Md.

Gabriella Hayes
National PTA
Chicago, Ill.

Charlotte Hendricks
American School Health Association
Pelham, Ala.

Janet Houston
Dartmouth Medical School
Hanover, N.H.

Lou Jordan
Emergency Training Associates
Union Bridge, Md.

Debra A. Kilpatrick
National Highway Traffic Safety Administration
Washington, D.C.

Mary Sue Lancaster
United States Department of Education
Washington, D.C.

Eva Marx
Education Development Center, Inc.
Newton, Mass.

Chris Miara
Children’s Safety Network
Newton, Mass.

Angela Mickalide
National SAFE KIDS Campaign
Washington, D.C.

Stephanie Malloy
Children’s Safety Network
Newton, Mass.

Mary Marks
Fairfax County Public Schools
Falls Church, Va.

Susan McHenry
National Highway Traffic Safety Administration
Washington, D.C.

David Miller
Colorado Department of Health and Environment
Denver, Colo.

Connie Monahan
New Mexico Department of Public Health
Santa Fe, N.Mex.

Jonathan Moore
International Association of Fire Fighters
Washington, D.C.

Lori Moore
International Association of Fire Fighters
Washington, D.C.

Lawrence Newell
National Safety Council
Itasca, Ill.

Paul Pepe
Pennsylvania State EMS Director
Pittsburgh, Pa.

Mary Ann Polacek
American Red Cross
Falls Church, Va.

Ellen Schmidt
Children’s Safety Network
American School Health Association
Washington, D.C.

Carl P. Valenziano
Morristown Memorial Hospital
Morristown, N.J.

Malcolm Watson
Department of Psychology
Brandeis University
Waltham, Mass.

Jane Martin
Health Resources and Services Administration
Rockville, Md.

Angela Martinelli
Health Resources and Services Administration
Bureau of Health Professions
Rockville, Md.

Kathryn Rasala
Education Development Center
Newton, Mass.

Rich Schieber
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Ga.

Martin Singer
New Hampshire Department of Health and Human Services
Concord, N.H.

Doris Sligh
United States Department of Education
Washington, D.C.

Becky J. Smith
American Association for Health Education
Reston, Va.

Richard Smith III
Indian Health Service
Rockville, Md.

Susan Winingar
United States Department of Education
Washington, D.C.

Susan Wooley
American School Health Association
Kent, Ohio

Mary Vernon
Division of Adolescent and School Health
Centers for Disease Control and Prevention
Atlanta, Ga.

Lenore Zedosky
West Virginia Department of Education
Charleston, W.Va.

Table of Contents

Preface
Section I: Teaching Basic Emergency Lifesaving Skills
Section II: Integrating Child Development Principles and Basic Emergency Lifesaving Skills Training
Section III: Prioritizing the Basic Emergency Lifesaving Skills
Section IV: Teaching Basic Emergency Lifesaving Skills to Children and Adolescents: Cognitive, Psychomotor and Social/Moral Approaches
Section V: Developing Basic Emergency Lifesaving Skills Training Opportunities
Section VI: Advocating for BELS
Section VII: Appendices

Preface

Health education is an important component of American students’ primary and secondary schooling. Students are taught the importance of nutrition, exercise, dental, and personal hygiene; the avoidance of substance use and abuse; and the prevention of injury and illness. One aspect of injury prevention is how to perform basic emergency lifesaving skills—basic first aid and cardiopulmonary resuscitation (CPR). It is well known that when CPR and basic first aid are performed in the out-of-hospital setting, victims’ survival rates increase significantly.1,2,3 Parents, students, and other members of the public, then, are the individuals likely to administer CPR and first aid prior to the arrival of emergency medical services (EMS) personnel. The introduction, acquisition, and reinforcement of basic emergency lifesaving skills during the school years may heighten students’ confidence to respond in an emergency and may provide the impetus for updating these skills after high school graduation. Schools play an important role in providing students with basic emergency lifesaving skills as part of the school health education program.4,5 The feasibility of this undertaking is well documented. 5-12

Basic emergency lifesaving skills are those essential interventions known to stabilize an injured or ill person’s health condition until the arrival of an adult, EMS professional, or other responsible person. This document, Basic Emergency Lifesaving Skills (BELS): A Framework for Teaching Emergency Lifesaving Skills to Children and Adolescents, provides a developmental approach for teaching these skills to the student population.

The BELS Framework consists of seven sections:

• Section I: Background information on teaching basic emergency lifesaving skills to students

• Section II: Overview of cognitive, physical, and social/moral development principles pertinent to schoolchildren’s ability to learn and perform emergency skills

• Section III: Sequence of basic emergency lifesaving skills performance

• Section IV: Developmental principles and teaching strategies for the cognitive, psychomotor and social/moral learning of basic emergency lifesaving skills from kindergarten through 12th grade

• Section V: Application of the BELS Framework for critiquing and selecting basic emergency lifesaving skills curricula

• Section VI: Advocacy issues for incorporating basic emergency lifesaving skills into school curricula

• Section VII: Resource list, selected bibliography, and evaluation form

Basic emergency lifesaving skills are introduced, acquired, and reinforced according to students’ ages and developmental levels. This training should be offered at regular intervals for students to practice these skills and keep them current.4,7-11,13 This is why standardized, consistent training throughout the school years is vital for skill introduction, acquisition, and reinforcement.

The BELS Framework is for teachers, health care providers, parents, and community members as they advocate for basic emergency lifesaving skills training for children and adolescents. Parents and teachers who mandate, advocate, or recommend that schoolchildren be taught effective emergency skills can use BELS as a framework for suggesting how and when this content is offered. Educators who design materials for teaching emergency skills to students can apply the BELS Framework to their course content. Emergency-care professionals and teachers can evaluate commercially available materials or self-designed lesson plans using the BELS Framework as a guide.

The BELS Framework fits comfortably within school health programs under comprehensive school health education, thus creating an opportunity for its inclusion in school curricula and health care provision in the school setting. Training in basic emergency lifesaving skills instills in students a sense of social responsibility, allows them to gain confidence in responding to sudden and perhaps frightening events, and teaches them to recognize the need for and how to call for emergency assistance.4

References

1Cummins, R., Ornato, J., Thies, W., Pepe, P. et al. (1991). State-of-the-art review—Improving survival from sudden cardiac arrest: The “chain of survival” concept. A statement for health professionals from the advanced cardiac life support subcommittee and the emergency cardiac care committee, American Heart Association. Circulation, 83, 1832–1847.

2Becker, L., Berg, R., Pepe, P., Idris, A., Aufderheide, T., Barnes, T., Stratton, S., & Chandra, N. (1997). A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation: A statement for healthcare professionals from the ventilation working group of the basic life support and pediatric life support subcommittees, American Heart Association. Annals of Emergency Medicine, 30 (5), 654–666.

3Vincent, R., Martin, B., Williams, G., Quinn, E., Robertson, G., & Chamberlain, D. (1984). A community training scheme in cardiopulmonary resuscitation. Medical Practice, 288, 617–620.

4American Academy of Pediatrics. Committee on School Health. (1993). Basic life support training in school. Pediatrics, 91 (1), 158–159.

5Van Kerschaver, E., Delooz, H., & Moens, G. (1989). The effectiveness of repeated cardiopulmonary resuscitation training in a school population. Resuscitation, 17, 211–222.

6Lind, B. (1973). Teaching resuscitation in primary schools. Anesthetist, 22, 464–465.

7Vanderschmidt, H., Burnap, T., & Thwaites, J. (1975). Evaluation of a cardiopulmonary resuscitation course for secondary schools. Medical Care, 13 (9), 763–774.

8Vanderschmidt, H., Burnap, T., & Thwaites, J. (1976). Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study. Medical Care, 14 (2), 181–184.

9Plotnikoff, R. & Moore, P. (1989). Retention of cardiopulmonary resuscitation knowledge and skills by 11- and 12-year-old children. The Medical Journal of Australia, 150, 296–302.

10Lester, C., Weston, C., Donnelly, P., Assar, D., & Morgan, M. (1994). The need for wider dissemination of CPR skills: Are schools the answer? Resuscitation, 28, 233–237.

11Moore, P., Plotnikoff, R., & Preston, G. (1992). A study of school students’ long term retention of expired air resuscitation knowledge and skills. Resuscitation, 24, 17–25.

12Mowbray, A., McCulloch, W., Conn, A., & Spence, A. (1987). Teaching of cardiopulmonary resuscitation by medical students. Medical Education, 21, 285–287.

13Assar, D., Chamberlain, D., Colquhoun, M., Donnelly, P., Handley, A., Leaves, S., Kern, K., & Mayor, S. (1998). A rationale for staged teaching of basic life support. Resuscitation, 39, 137–143.

Section I: Teaching Basic Emergency Lifesaving Skills

Introduction

About 91,155,000 visits are made to Emergency Departments (ED’s) annually in the United States; children and adolescents comprise 31,447,000 (34%) of these visits.1 The overall estimated adjusted injury rate for individuals ages 1–17 years who required medical attention is 27 per 100 children.2 Tables 1-1 and 1-2 illustrate these data. These statistics show that it is quite likely for children and adolescents to experience an injury or illness that requires medical attention. It is also likely that other children or adolescents will be involved with the victim, such as walking to or from school or while babysitting, and may be the first person available to render assistance. For example, 44% of the injuries sustained by children and adolescents seeking ED treatment occurred in the home setting.1

Immediately following a sudden illness or injury, basic emergency lifesaving skills are administered to the victim by a trained person until EMS arrival. This “chain of survival” includes early access to care, early CPR, early defibrillation, and early advanced care.3 When trained in basic emergency lifesaving skills, children and adolescents can recognize the need for care, administer CPR, and operate an automatic external defibrillator prior to EMS arrival. One recent study underscores the importance of using basic emergency lifesaving skills. Among 300 children 17 years of age and younger who sustained cardiopulmonary arrest, 181 (60%) were in their homes with family members present; only 31 of these children received CPR from a family member before EMS arrival.4 Conceivably, school-age siblings trained in basic emergency lifesaving skills for children would contribute to early care prior to EMS arrival. Additional training in basic pediatric life-support skills is strongly recommended.5 This section highlights current trends in basic emergency lifesaving skills training and offers suggestions for their incorporation into the school’s health education curriculum.

Current Basic Emergency Lifesaving Skills Training

Although teaching basic emergency lifesaving skills to students is widely accepted and advocated,6–14 no national guidelines exist to mandate this training within United States school curricula. The School Health Policies and Programs Study (SHPPS), conducted in 1994 by the Centers for Disease Control and Prevention, was a national survey of health education practices at state, district, school, and classroom levels.15 This study found that only 37.5% of the states and 61.9% of the districts required CPR training; 48% of schools included CPR training in their curricula.15 For first aid training, 55.8% of the states and 73.9% of the districts required this topic, with 58.8% of the schools offering this training.15

*Data abstracted from: Weiss, H., Mathers, L., Forjuoh, S., & Kinnane, J. (1997). Child and adolescent emergency department visit databook (pp. 62-63). Pittsburgh, Pa.: Center for Violence and Injury Control, Allegheny University of the Health Sciences.

*Data abstracted from: Scheidt, P., Harel, Y., Trumble, A., Jones, D., Overpeck, M., & Bijur, P. (1995). The epidemiology of nonfatal injuries among US children and youth. American Journal of Public Health, 85 (7) (p. 937).

Unlike the United States school systems, Scandinavian and European school systems recognize the clear importance of this training. In Norway, first aid content within the school curriculum has been compulsory since 1922; in 1961, mouth-to-mouth resuscitation, a precursor to CPR, was added.8 In 1992, the European Resuscitation Council recommended that schools include CPR training in their curricula.13

To encourage the inclusion of basic emergency lifesaving skills training in the school curricula, the Emergency Medical Services for Children Program jointly administered by the Human Resources and Services Administration, Maternal and Child Health Bureau, and the National Highway Traffic Safety Administration, added an objective to its five-year plan for improving emergency care. This objective is to “increase the number of school districts that require proficiency in first aid and CPR as a condition for high school graduation.”16 Similarly, Healthy People 2000 developed an objective, “to provide academic instruction on injury prevention and control, preferably as part of quality school health education, in at least 50% of public schools systems (K–12).”17 This objective presumably covers basic emergency lifesaving skills training as a measure for secondary injury prevention. The Human Resources and Services Administration, Maternal Child Health Bureau funded the development of the BELS Framework to help address these objectives.

The Importance of Basic Emergency Lifesaving Skills Training for Students

Mastering basic emergency lifesaving skills is critical for the student population. Schoolchildren, while playing or attending school, may encounter situations in which a friend suddenly becomes ill or injured. Adolescents are likely to care for infants and young children as parents, baby-sitters or child care workers; these young children are vulnerable to choking and other situations where emergency skills must be employed quickly and accurately. Equipping students with the proper emergency skills training allows them to feel confident in obtaining and delivering assistance.

Children can be taught elements of basic emergency lifesaving skills beginning in kindergarten. At high school graduation, all students should have received comprehensive training in first aid and CPR. The primary and secondary school audience is ideal for receiving basic emergency lifesaving skills training. They are very receptive to new information, and they learn knowledge and skills very quickly.12 They also are interested in learning how to act in an emergency situation. A survey of 154 junior and senior high school students found that “what to do in an emergency” was one of their top five health-related questions.18 Heath and Nielsen reported similar enthusiasm for CPR training among 450 children ages 10–11 years and 14–15 years.19

Among 41 students ages 11–12 years attending a school-based CPR program,13 32% had received previous CPR training through their local EMS, scouting organizations, sports clubs, the American Red Cross, or their parents.14 After completing a bystander care program in Indiana, high school students had a significant increase in knowledge of what to do at the scene of a motor vehicle crash as well as an increased willingness to stop at a crash scene to render assistance.20 Similar results were obtained in students 10–17 years of age following completion of a bystander care program in Wisconsin.20 Children with moderate intellectual disabilities are able to learn first aid skills, as well.21

Students are an ideal audience for learning basic emergency lifesaving skills, and the school setting is optimal for delivering this activity. Among 476 randomly selected adults, almost half (n=226) completed at least one CPR course. Most received CPR training because of a school or work requirement,22 leading to the conclusion that exposure to CPR in the school setting may be the only CPR course a person receives.

Introducing Basic Emergency Lifesaving Skills to the Student Population

Basic emergency lifesaving skills are taught in a variety of settings—schools, social organizations, and community organizations and agencies.

School Setting

There are two methods for teaching basic emergency lifesaving skills in the school setting: 1) integration throughout the entire curriculum and 2) introduction of these skills through outside sources, such as community organizations.

Schools offering basic emergency lifesaving skills training through their curriculum assumedly attain the same three advantages as those who offer CPR training, as described by Lester et al.12 First, because the content is compulsory, a wide audience is reached, including minority populations. Second, revisions to basic emergency lifesaving skills content are built directly into the curriculum. Teachers are assured that the previous content was taught, and the students can expand their repertoire of skill application. Finally, the emergency training curriculum is standardized and is taught by professional educators. This approach enhances standardization and diminishes confusion when students are first introduced to, then later taught, these basic emergency lifesaving skills.

While integration of basic emergency life saving skills education into a school district’s health curriculum is ideal, many schools do not offer this content within their academic offerings. Teachers then must provide the content in their own classes, where they may teach the content themselves or enlist the expertise of others. The SHPPS study reported that among the lead health education teachers, only 43.8% and 30.5% received CPR and first aid training, respectively.15 Typical resources that teachers might enlist include emergency and health care professionals from local EMS agencies or hospitals and adults or professionals from national organizations. Appendix B lists these organizations and their courses.

The length of time devoted to teaching CPR and first aid varies. SHPPS reported that among teachers who taught CPR and first aid as a major topic, 58.4% and 40%, respectively, taught these subjects for one to three class periods, while only 7.7% and 10.1% taught them for 13 or more periods.15 For changes to occur in general health knowledge, practices, and attitudes, an estimated 50, 30, and 40 classroom hours, respectively, are needed.23 In comparing these calculations to the number of class periods in which CPR and first aid are taught, more classroom time should be devoted to teaching basic emergency lifesaving skills to students.

Social Organizations

Social organizations also advocate first aid training for schoolchildren. For example, the Boy Scouts of America has a first aid component in their program.24 The Girl Scouts of America advocates taking a first aid and CPR course.25 Both organizations encourage the attainment of basic emergency lifesaving skills through merit badge programs.

Community Agencies

Hospitals are another source for educating children and adolescents in basic emergency lifesaving kills, usually at no or low cost. For example, safe babysitting or parenting courses may be offered to adolescents. Community CPR courses may offer training to children, adolescents, and their parents. Nurses, physicians, and others usually teach these courses.

Public safety agencies, such as EMS, police, and fire departments, may offer training in basic emergency lifesaving skills. People trained will be certified as CPR or first aid instructors. They, too, may offer training within their communities.

Conclusion

There is a need for school systems to recognize the importance of basic emergency lifesaving skills training and to incorporate this content into the current health education curricula. While social organizations and community agencies offer such training, it may not be provided consistently over time and in a developmentally appropriate manner. Training in basic emergency lifesaving skills competes with other educational priorities. Parents, teachers, and health care professionals must advocate to bring this important education issue to the forefront for serious consideration by school boards and administrators. Teachers can capitalize on children’s willingness to learn basic emergency lifesaving skills and reinforce skills performance on an annual or more frequent basis.

References

1Weiss, H., Mathers, L., Forjuoh, S., & Kinnane, J. (1997). Child and adolescent emergency department visit databook. Pittsburgh, Pa.: Center for Violence and Injury Control, Allegheny University of the Health Sciences.

2Scheidt, P., Harel, Y., Trumble, A., Jones, D., Overpeck, M., & Bijur, P. (1995). The epidemiology of nonfatal injuries among US children and youth. American Journal of Public Health, 85 (7), 932–938.

3Chandra, N. & Hazinski, M. (Eds.). (1994). Textbook of basic life support for healthcare providers (pp.1–4). Dallas: Author.

4Sirbaugh, P., Pepe, P., Shook, J., Kimball, K., Goldman, M., Ward, M., & Mann, D. (1999). A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Annals of Emergency Medicine, 33 (2), 174–184.

5Emergency Cardiac Care Committee and Subcommittees, American Heart Association. (1992). Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Journal of the American Medical Association, 268 (16), 2178.

6Committee on School Health. (1993). Basic life support training in school. Pediatrics, 91 (1), 158–159.

7Van Kerschaver, E., Delooz, H., & Moens, G. (1989). The effectiveness of repeated cardiopulmonary resuscitation training in a school population. Resuscitation, 17, 211–222.

8Lind, B. (1973). Teaching resuscitation in primary schools. Anesthetist, 22, 464–465.

9Vanderschmidt, H., Burnap, T., & Thwaites, J. (1975). Evaluation of a cardiopulmonary resuscitation course for secondary schools. Medical Care, 13 (9), 763–774.

10Vanderschmidt, H., Burnap, T., & Thwaites, J. (1976). Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study. Medical Care, 14 (2), 181–184.

11Plotnikoff, R. & Moore, P. (1989). Retention of cardiopulmonary resuscitation knowledge and skills by 11- and 12-year-old children. The Medical Journal of Australia, 150, 296–302.

12Lester, C., Weston, C., Donnelly, P., Assar, D., & Morgan, M. (1994). The need for wider dissemination of CPR skills: Are schools the answer? Resuscitation, 28, 233–237.

13Basic Life Support Working Party. (1992). Guidelines for basic life support. Resuscitation, 24, 103–110.

14Lester, C., Donnelly, P., Weston, C., & Morgan, M. (1996). Teaching schoolchildren cardiopulmonary resuscitation. Resuscitation, 31, 33–38.

15Collins, J., Small, M., Kann, L., Pateman, B., Gold, R., & Kolbe, L. (1995). School health education. Journal of School Health, 65 (8), 302–311.

16Emergency Medical Services for Children Program. (1995). Five year plan. Washington, DC: Maternal and Child Health Bureau, United States Department of Health and Human Services.

17U.S. Public Health Service. (1991). Healthy People 2000: National Health Promotion and Disease Prevention Objectives—Full Report with Commentary. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service publication (PHS) 91-50212.

18Sutherland, M. (1979). Relevant curriculum planning in health education: A methodology. The Journal of School Health, September, 387–389.

19Heath, J. & Nielsen, D. (1996). Experiments in CPR and clinical reality. Resuscitation, 32, 159–160.

20U.S. Department of Transportation. National Highway Traffic Safety Administration. (1996). Bystander Care Demonstration Projects. Washington, D.C.: Author. DOT HS 808 357.

21Marchand-Martella, N., Martella, R., Agran, M., Salzberg, C., Young, K., & Morgan, D. (1992). Generalized effects of a peer-delivered first aid program for students with moderate intellectual disabilities. Journal of Applied Behavior Analysis, 25 (4), 841–851.

22Scheatzle, M., Dearwater, S., Pepe, P., Forjuoh, S., & Aronson, A. (1999). Motivation and perceived barriers to participating in CPR training identified by a cross-sectional phone survey. Academic Emergency Medicine, 6 (5), 429.

23Connell, D., Turner, R., & Mason, E. (1985). Summary of findings of school health education evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health, 55 (8), 316–321.

24Birkby, R. (1990). Boy scout handbook (10th Ed.). Irving, Tex.: Boy Scouts of America.

25Lombardi, J. (1995). Cadette girl scout handbook. New York: Girl Scouts of the United States of America.

Section II: Integrating Child Development Principles and Basic Emergency Lifesaving Skills Training

Introduction

The field of child development explains the physical, cognitive, social, and moral growth of children as they interact with the world. Cognitive development is how children understand and learn. Social development is how children respond to and communicate with others. Moral development is how children develop and apply principles of justice and fairness. Educators need to consider child development principles and their implications for how children learn, perform, and value basic emergency lifesaving skills, as children’s ability to perform emergency skills depends on their understanding of the skill and their ability to physically perform the skill in an emotionally stressful situation. This section highlights the cognitive, social, and moral development in children (7–12 years) and adolescents (13–18 years) and applies this knowledge to emergency skill acquisition.

Schoolchildren (Ages 7–12 Years)

Schoolchildren ages 7–12 years are in a stage of rapid growth. Their bones are elongating, their weight is increasing, and their body proportions are becoming adult-like. Their fine and gross motor abilities are advancing, their muscular strength is increasing, and they enjoy being active. Puberty may begin in females at approximately 10 years of age or younger. Organized and cooperative games and activities are important avenues for learning.

Cognitively, these students are in the concrete operational period. During this period, children work through problems mentally if the problems relate to real objects.1 These children can consider two or more aspects of a situation simultaneously and when making comparisons, can take into account more than one variable.2 The concepts of mass and numbers (conservation and reversibility) are present.1 For example, children with concrete operational thinking understand that a volume of fluid maintains its same volume when poured from a tall, thin glass into a short, round glass. The concept of time is further developed as well. Schoolchildren are curious about their bodies and want to learn about how their body functions. They also want to learn about how things work and why certain activities are done in a certain manner. Children this age can begin to cope with responding to an emergency and using available supplies for rendering care.3

Socially, children ages 7–12 years place increasing emphasis on the opinions of their peers as compared to their families’ and teachers’ opinions. It is important for them to gain social acceptance and be involved in social situations. Other social skills include having a sense of humor, a willingness to share with others, being positive and creative, and being a leader.2

Morally, children 7–12 years of age understand that rules evolve from mutual consent and respect; these rules can be changed under certain conditions. Within this age group, there is a wide diversity of moral development. Some children behave to earn a tangible reward and/or avoid punishment. Others conform to peers’ or adults’ standards to gain approval, while others follow the social order of rules. A conscience develops, with younger schoolchildren identifying a particular body area (heart, brain) for its location and older schoolchildren personifying the conscience as an abstract entity within the child that arouses such feelings as guilt.2

Adolescents (Ages 13–18 Years)

Adolescents also are growing rapidly, with hormone production increasing and bodily appearances becoming adult-like. They experience “growth spurts” and sexual development that herald the onset of puberty. Such development leaves them feeling out of control, and they experience anxiety about their appearance, vocal tone, or other features. They, too, enjoy being active, and usually are involved in many school activities, employment, and other venues. Older adolescents may serve as volunteers on their local fire or EMS squads.

Cognitively, adolescents are in the stage of formal operations. They can reason about ideas, impossibilities, probabilities, and broad abstract concepts.1 Socially, adolescents may have ambivalent relationships with their parents, in which they strive to be independent yet want the family to support them.4 Their peer group is very important, and everyone strives to look and act alike, which provides them with a sense of safety and belonging.

Morally, adolescents strive to meet the expectations or follow the rules of their family, peer group, or nation. In mid- to later adolescence, many develop their own moral principles that are valid and apart from the principles set forth by the family or peers.4 This is based on the adolescents’ own beliefs of what is right and wrong.

Providing Basic Emergency Lifesaving Skills Training

Selected principles of child development applied to education content and teaching strategies for basic emergency lifesaving skills training are highlighted in Table 2-1. Specific strategies are discussed in Section IV.

Children’s and adolescents’ emerging sense of moral judgment and conscience deserves special attention when teaching basic emergency lifesaving skills. The need to always stay safe cannot be over-emphasized with this population. Even when applying basic emergency lifesaving skills to a pretend “victim,” students aged 13–18 years may experience guilt if they believe they should have acted differently. Feelings of guilt may arise if they choose to place their own safety ahead of the victim’s needs or if others second-guess their actions. Religion, gender, culture, and ethnicity influence children’s perceptions about emergencies or helping others; these factors must be assessed and addressed prior to the provision of basic emergency lifesaving skills training. Section V outlines criteria for addressing multicultural awareness.

Conclusion

Child and adolescent development principles are useful to provide a theoretical foundation for their behaviors. The integration of these principles into basic emergency lifesaving skills training is critical, as important concepts may escape students’ attention if the instructor does not present the material in a developmentally appropriate manner. Teaching strategies should be adapted to the audience’s gender, cultural, ethnic, and religious needs as well. Appreciating the energy and enthusiasm of the student audience results in an enjoyable education experience.

References

1Dixon, S. (1992). Setting the stage: Theories and concepts of child development. In S. Dixon and M. Stein (Eds.). Encounters with children: Pediatric behavior and development (2nd Ed.) (pp. 13–26). St. Louis, Mo.: Mosby Year Book.

2Putnam, N. (1992). Seven to ten years: Growth and competency. In S. Dixon and M. Stein (Eds). Encounters with children: Pediatric behavior and development (2nd Ed.) (pp. 317–338). St. Louis, Mo.: Mosby Year Book.

3Steward, M. & Steward, D. (1981). Children’s conceptions of medical procedures. In R. Bibace and M. Walsh (Eds.). Children’s conceptions of health, illness, and bodily functions (pp. 67–83). San Francisco: Jossey-Bass, Inc.

4Felice, M. (1992). Fourteen to sixteen years: Mid-adolescence—The dating game. In S. Dixon and M. Stein (Eds.). Encounters with children: Pediatric behavior and development (2nd Ed.) (pp. 359–369). St. Louis, Mo.: Mosby Year Book.

5Frieberg, K. 1992). Human development: A life span approach (4th Ed.). Boston: Jones and Bartlett Publishers.

6Bowden, V. (1998). Growth and development. In V. Bowden, S. Dickey, & C. Greenberg (Eds.). Children and their families: The continuum of care (pp.170-240). Philadelphia: W. B. Saunders Co.

Section III: Prioritizing the Basic Emergency Lifesaving Skills

Introduction

The BELS Framework considers basic emergency lifesaving skills to be those essential interventions that are known to stabilize an injured or ill person’s health condition until an adult, emergency care professional, or other responsible person arrives. The prioritized delivery of basic emergency lifesaving skills is outlined in Table 3-1. Other skills, such as bandaging or splinting, often are included in first aid curricula. The BELS Framework emphasizes only lifesaving skills, listed in Table 3-1.

Basic emergency lifesaving skills are learned by repeating the skills sequence in the same order from beginning to end.1 Because it is unlikely that schoolchildren will master this skill sequence on the first attempt, practice and reinforcement throughout their school years is very important. This is another reason why standardized, consistent training throughout the school years is so vital to the training’s success. Students have varying abilities to learn and perform; therefore, individual differences in teaching and learning should be considered.1 This section describes the basic emergency lifesaving skills to be taught to students.

Introducing Basic Emergency Lifesaving Skills to Students

The basic emergency lifesaving skills outlined in Table 3-1 should be introduced to students throughout their schooling based on their age, cognitive, physical, social, and moral development. With basic emergency lifesaving skills training, the skill itself never changes, but the activities used to perform the skills change in concert with the children’s ages and developmental abilities. For example, staying safe for a 7 year old is to leave the scene and to get an adult; for a 17 year old, staying safe includes using personal protective equipment. The matrix in Table 3-2 depicts the age at which basic emergency lifesaving skills are introduced and taught, based on empirical findings and experts’ recommendations.

There are two considerations in basic emergency lifesaving skills training and application: 1) attainment of developmental milestones and 2) introduction/re-introduction, acquisition, and reinforcement of basic emergency lifesaving skills.

Attainment of Developmental Milestones

While the child development principles outlined in Section II are presented as discrete stages, children achieve developmental milestones at their own pace. For example, a child may be physically stronger and faster than his or her classmates, but may lag in emotional maturity or social skills. Educators who teach basic emergency lifesaving skills to students usually know their audience and adapt their teaching strategies accordingly. Cultural, social, and ethnic diversity, as well as gender roles, also must be considered during teaching and testing,2,3 as well as during the selection or creation of an appropriate basic emergency lifesaving skills training curriculum.2,3

Introduction, Acquisition, and Retention of Basic Emergency Lifesaving Skills

Basic emergency lifesaving skills are introduced to students in accordance with their age and developmental capabilities. By ages 7–9 years, students begin to learn complex motor tasks and participate in group activities, such as sports.4 They are taught new skills and acquire and improve upon these skills through practice and play. With basic emergency lifesaving skills, consideration should be given to skill introduction without acquisition so the students can process the information prior to actually acquiring the skill.

For example, rescue breathing may be introduced in the year prior to its actual performance and acquisition to familiarize the students with this skill. This sequence is reflected in the matrix, which shows that conceivably a skill would be introduced in one grade and acquired in the next year. Once introduced and acquired, these basic skills are re-introduced, acquired, and reinforced in subsequent years. For example, rescue breathing would be reintroduced to familiarize the students with the skill before moving on to chest compressions involved in CPR. This reintroduction reinforces students’ learning and enhances their confidence in performing the skills.

Schoolchildren and adolescents rarely will need to use the basic emergency lifesaving skills for which they have been trained. Thus, without skill reinforcement in a timely manner, skill deterioration will occur. Plotnikoff and Moore reported that among fortyfive 11- and 12-year-old students, CPR knowledge and skills performance declined markedly within five months of their training.5 More encouraging were the outcomes reported by Moore et al., who found that adolescents who had been trained in CPR five years earlier had better psychomotor performance than those adolescents who had not received earlier training.6> There was, however, no difference between these two groups in their written testing. These findings underscore the importance of basic emergency lifesaving skills training and scheduled reinforcement throughout students’ schooling. In basic emergency skill training, repetition reinforces confidence and aids with skill retention by building upon known skills, introducing new skills, and reinforcing all skills upon high school graduation.1,7

Conclusion

Schoolchildren and adolescents have the ability to make a difference in the care of an injured or ill person. Their actions, whether to run for help or deliver rescue breathing, can positively affect the outcome of an emergency situation. First and foremost, the responsibility of children and adolescents during an emergency situation is to stay safe. Emphasizing their own safety balances their concern for others with their own needs, especially in situations where the outcome might be grim.

References

1American Red Cross. (1996). American Red Cross. First aid—Responding to emergencies. Instructor’s manual (2nd Ed.). St. Louis, Mo.: Mosby Lifeline.

2Lewis, B., Kaplon, S., & Weinberg, K. (1994). Do children retain what they are taught? The Journal of Burn Care and Rehabilitation, 15, 298–302.

3Taylor, C. (1988). Trauma prevention in rural Alaska: The development of safety and first aid curriculum for young children. Journal of Emergency Nursing, 14 (5), 36A–39A.

4Busch, B. (1992). Developmental assessment of children of school age and adolescents. In M. Levine, W. Carey, & A. Crocker (Eds.). Developmental-behavioral pediatrics (pp. 624–625). Philadelphia: W. B. Saunders Co.

5Plotnikoff, R. & Moore, P. (1989). Retention of cardiopulmonary resuscitation knowledge and skills by 11- and 12-year-old children. The Medical Journal of Australia, 150, 296–302.

6Moore, P., Plotnikoff, R., & Preston, G. (1992). A study of school students’ long term retention of expired air resuscitation knowledge and skills. Resuscitation, 24, 17–25.

7Perez, C., Braslow, A., & Bock, H. (1996). National Standard Curriculum for Bystander Care (p.14). Washington, D.C.: U.S. Department of Transportation. National Highway Traffic Safety Administration.

Section IV: Teaching Basic Emergency Lifesaving Skills to Children and Adolescents: Cognitive, Psychomotor and Social/Moral Approaches

Introduction

Section IV synthesizes the content described in Sections II and III and provides ageappropriate guides for teaching basic emergency lifesaving skills to students from kindergarten through 12th grade. These tables describe the emergency skills that are developmentally appropriate for each age group. Following the emergency skills and specific actions, educational considerations based on the children’s cognitive, psychomotor, and social and moral developmental levels are outlined. Examples of how these developmental factors are applied to the teaching of emergency skills are incorporated. For children younger than 6 years of age (pre-kindergarten), staying safe is the only skill recommended.

A few recommendations for teaching basic emergency lifesaving skills include:

1. Have high expectations of the students.1 Students enjoy challenges, and they enjoy learning. Such attention promotes both academic and behavior progress. Students experience satisfaction and pleasure not only in performing activities but in performing them correctly in all of their details; this opens up an entire new area of learning for students.2

2. Display children’s work on classroom walls.1 This action sends the message that the students’ work is important, and emergency care is important as well. Consider having students create a poster or bulletin board with the basic emergency lifesaving skills that they learned.

3. Begin the program on time and end on time.1 Students then know what is expected of them, which translates into appropriate student behavior in preparation for learning.

4. Engage students in the learning process,1 making them active learners. Behavior and achievement are enhanced when students are encouraged to hold positions of responsibility.1 In basic emergency lifesaving skills training, this translates to being a group or peer leader.

5. Demonstrate an excitement and interest in the basic emergency lifesaving skills.2 Such enthusiasm attracts the students’ attention and participation.

6. Incorporate new media as they become available. For example, interactive videos, virtual reality, and other yet-to-be developed educational strategies should be evaluated for their usefulness in teaching basic emergency lifesaving skills to students of all ages.

References

1Dworkin, P. (1992). Schools as milieu. In M. Levine, W. Carey, & A. Crocker (Eds.). Developmental–behavioral pediatrics (2nd Ed.) (pp. 183–184). Philadelphia: W. B. Saunders Co.

2Montessori, M. (1967). The discovery of the child (pp. 90, 169). Notre Dame, Ind.: Fides Publishers, Inc.

References

1Busch, B. (1992). Developmental assessment of children of school age and adolescents. In M. Levine, W. Carey, & A. Crocker, (Eds.). Developmental-behavioral pediatrics (2nd Ed.) (p. 625). Philadelphia: W. B. Saunders Co.

2Montessori, M. (1967). The discovery of the child (p. 306). Notre Dame, Ind.: Fides Publishers, Inc.

References

1Montessori, M. (1967). The discovery of the child (pp. 100, 306). Notre Dame, Ind.: Fides Publishers, Inc.

References

1Levine, M. (1992). Middle childhood. In M. Levine, W. Carey, & A. Crocker (Eds.). Developmental-behavioral pediatrics (2nd Ed.) (pp. 48–64). Philadelphia: W. B. Saunders Co.

2Montessori, M. (1967). The discovery of the child. (pp.100,120). Notre Dame, Ind.: Fides Publishers, Inc.

References

1American Trauma Society. (1996). Bystander care of the injured course. Upper Marlboro, Md.: Author.

2Atkins, D., Hartley, L., & York, D. (1998). Accurate recognition and effective treatment of ventricular fibrillation by automated external defibrillators in adolescents. Pediatrics, 101 (3), 393–397.

3Moore, J. (1987). Effects of assertion training and first aid instruction on children’s autonomy and self-care agency. Research in Nursing and Health, 10, 101–109.

4Parker, M. (1979). Health education for the preadolescent: Basic first aid. The Journal of School Health, May, 266.

5Busch, B. (1992). Developmental assessment of children of school age and adolescents. In M. Levine, W. Carey, & A. Crocker, (Eds.). Developmental behavioral pediatrics (2nd Ed.) (p. 625). Philadelphia: W. B. Saunders Co.

References

1American Trauma Society. (1996). Bystander care of the injured course. Upper Marlboro, Md.: Author.

2Atkins, D., Hartley, L., & York, D. (1998). Accurate recognition and effective treatment of ventricular fibrillation by automated external defibrillators in adolescents. Pediatrics, 101 (3), 393–397.

3Mills, A. & Tweed, W. (1981). Heart-Alert: Evaluation of a community training program for cardiopulmonary resuscitation. Canadian Medical Association Journal, 124, 1135–1136.

4Marchand-Martella, N., Martella, R., Agran, M., Salzberg, C., Young, K., & Morgan, D. (1992). Generalized effects of a peer-delivered first aid program for students with moderate intellectual disabilities. Journal of Applied Behavior Analysis, 25 (4), 841–851.

Section V: Developing Basic Emergency Lifesaving Skills Training Opportunities

Introduction

This section outlines the process for applying the BELS Framework to the evaluation and selection of basic emergency lifesaving skills training programs and curricula. This process is useful for teachers, health care professionals, and other adults interested in providing basic emergency lifesaving skills training to students.

1. Convene A Team of Interested Individuals

The introduction of basic emergency lifesaving skills into an existing school curriculum or social organization requires planning and foresight. A team approach is helpful, as collaboration is encouraged, early “buy in” is achieved, and everyone feels confident with the planned approach. Team members include teachers; parents; adolescents with EMT or CPR/first aid training; public safety professionals, health care professionals from local hospitals, clinics and private practices; business people; and local chapter affiliates of national organizations and agencies. Appendix B lists information for these organizations and agencies.

The basic emergency lifesaving skills in the BELS Framework should be introduced and reinforced annually through age-appropriate teaching strategies. Adequate time for their introduction, acquisition, and reinforcement should be allotted. The amount of time is based on the audience’s age and developmental level; reason for teaching these skills (e.g., babysitting course); expected outcome (e.g., merit badge or community service requirement); and course time requirements (e.g., CPR training may require eight hours).

Once the team has agreed on the amount of time devoted to the skills training, the team agrees on the course content.

2. Review Existing Educational Programs And Curricula

Numerous educational programs and curricula for teaching basic emergency lifesaving skills to children and adolescents are available. These materials may be obtained for free, may have a fee for their use, or may be downloaded from the Internet. Examples of these texts and programs are listed in Appendix B. Advantages to using existing programs are that they have validity and have instructors trained in the course materials. Certified instructors are required to teach CPR and first aid courses in accordance with the policies set forth by their associations. Disadvantages are that the programs may not be available on a local level or they may require more time or money than is available.

When reviewing educational materials, the BELS skills content should be clearly identifiable and should be written in the sequence described in Section III. The program’s education strategies should be developmentally appropriate for the audience, as described in Section IV. The selected educational program should have sequential components that build upon previous knowledge over time; selecting a stand-alone program will not meet students’ needs over time. The program should meet the audience’s ethnic, religious, gender, cultural, and geographic needs. If the existing program does not meet these needs, knowledgeable individuals should make the appropriate modifications.

Table 5-1 applies Banks’ characteristics of multicultural schools to delivery of basic emergency life-support skills training. The goal is for the audience to safely and cor-rectly deliver basic emergency lifesaving skills within these considerations. For example, children living in rural areas may not have 911 capabilities, or there may be an hour’s wait for EMS. An educational program must address these issues during skills training.

The team of interested community leaders considers what the program will cost to implement, including student and instructor workbooks, equipment rental, instructor time and travel, and other costs. The team explores potential funding sources, such as charging a course fee, utilizing existing funds, and obtaining donations or grants from local philanthropic organizations. Monetary donations or in-kind contributions (time, advertising) may be secured through local businesses; pediatricians, family practice physicians, or other health care professionals; EMS agencies; and hospitals.

The setting for the educational program is another factor to consider. There should be enough space for small groups, equipment, and helpers. Adequate lighting is necessary. Personal protective equipment, cleaning supplies, and other materials for hygiene are needed as well.

Once a program is selected, the program is scheduled and implemented.

References

1Considerations adapted from: Banks, J. An introduction to multicultural education (2nd Ed). (pp. 18–20, 111), Boston: Allyn and Bacon.

3. Teaching And Evaluating the Program

Schedule the lifesaving program in advance and allot adequate time for registration. At least one team member should be available during the educational program to assure that the team’s expectations are met and that the content is in accordance with the BELS Framework. Parents may be invited and encouraged to participate in the program. The team member should observe the audience’s interest in the content; their ability to stay on task; the rapport between the instructor and the audience; the instructor’s ability to communicate with the audience; and the use of developmentally appropriate and culturally appropriate teaching strategies.

At the completion of the program, the instructor should meet with the team member and review the audience’s response and the applicability of the program content. Finally, the audience should be asked individually and as a group for their impressions of the program.

The team should reconvene and evaluate the program’s content and the audience’s response. At this time, the team should decide whether to continue with the program for the following year or select a different program.

Conclusion

Basic emergency lifesaving skills curricula are available from a variety of professional sources. Each curriculum has its own objectives, content, and teaching strategies. Teachers, parents, and others interested in providing educational opportunities for emergency skills training need to objectively evaluate existing curricula for their congruence with the BELS Framework, time required for implementation, cost, space required, and audience needs. Conducting evaluations while the program is being taught, and assessing the program’s effects on students at its completion, can influence future opportunities for basic emergency lifesaving skills training in school and community settings. Table 5-2 summarizes these steps in a checklist format for efficiency.

References

1Banks, J. (1999). An introduction to multicultural education. (2nd Ed.). Boston: Allyn and Bacon.

Section VI: Advocating for BELS

Introduction

The BELS Framework demonstrates that a need exists for basic emergency lifesaving skills training for students in a school setting. Sequential training undertaken by qualified professionals using developmentally-appropriate teaching strategies and activities promotes skill acquisition and retention. A team effort is needed to adequately facilitate and evaluate this undertaking. This section outlines future directions for basic emergency lifesaving skills training for students.

Advocacy Activities

Teachers, parents, and others interested in advocating for basic emergency lifesaving skills training for children and adolescents have a variety of options. These options include: 1) policy development, 2) research, and 3) education. While these efforts may take years to come to fruition, persistence will be rewarded.

Policy Development

• Convene a team of interested community members, as suggested in Section V. Using the BELS Framework, as well as data from the community, develop a position statement on the importance of basic emergency lifesaving skills training for students. The local health department, hospitals, or public safety agencies may be able to provide data on the number of people requiring CPR or other first aid measures. Such information emphasizes the need for training in the student population.

• Schedule appointments with local school board officials, state representatives, or government agencies to review the position statement. Other interested parties include organizations and agencies listed in Appendix B, health care professionals (including pediatricians1), and others. Involve the media throughout this process.

• Collaborate with teachers, school administrators, school board officials, and others to incorporate this training into the school curriculum. Volunteer to review curricula and lend assistance. Ask if the local school district has a school health advisory council to address policies and programs related to health education. Such councils frequently are comprised of teachers, parents, administrators, health care professionals, counselors, school board members, students, and members of churches or religious organizations.2 Volunteer to establish, serve on, or advise the council.

• Continue to advocate until basic emergency lifesaving skills training is put into school curricula.

Research

• Collaborate with teachers and health care professionals on research related to basic emergency lifesaving skills training. Compare student performance before and after training, as well as periodically. Do skills deteriorate, improve, or remain the same? Does students’ knowledge decrease, increase, or remain unchanged over time? Which teaching methods are best for presenting these skills?

• Conduct periodic literature reviews on the subject of teaching resuscitation or CPR to children. Also, access websites for information on this topic. Creative teaching strategies may be available that are not known in the local school.

Education

• Schedule appointments with the local affiliates of the organizations listed in Appendix B to learn about CPR and first aid training.

• Peruse local bookstores for books on CPR and first aid for young audiences.

• Become a CPR and/or first aid instructor.

• Educate others on the importance of basic emergency lifesaving skills training for students.

• Survey parents to determine their opinions about basic emergency lifesaving skills training. Among 302 parents surveyed about their children’s school health education, 88.4% perceived first aid to be a very important component, ranking it third behind education on alcohol/drugs and nutrition.3 Documenting parents’ opinions provides evidence for inclusion of basic emergency lifesaving skills training in their children’s schooling.

• Encourage parents and children to attend CPR and first aid classes together. Davis reported on efforts to provide CPR training to an entire community during a mass training session.4 The poor turnout of citizens was disappointing; future mass training sessions should take a family approach where children and parents can learn CPR together.

• Evaluate curricula for evidence of cultural, ethnic, and gender sensitivity.

Helping Students Who Have Helped Others

The purpose of teaching basic emergency lifesaving skills is to provide students with cognitive, psychomotor, and social and moral preparation for actually using these skills to assist others. Teachers, parents, and health care professionals need to be aware of the emotional impact that occurs when students assist others in emergency situations.

Children and adolescents who provide basic emergency lifesaving skills should be praised for their actions and supported in their decision making during the emergency care situation. Following their involvement in an emergency situation, whether as a victim or emergency skill provider, students must receive a counseling (debriefing) session with a qualified individual, such as a school counselor. The counselor reviews with the student the events that took place and helps the student sort through any feelings, emotions, or thoughts about the emergency situation. Students need to know that it is normal to be upset after they have assisted in an emergency situation.

A counseling or debriefing session with the parents also is helpful so they know what to expect in their child’s behavior. Following their involvement in an emergency situation, children and adolescents may exhibit signs of emotional distress, such as an inability to sleep or concentrate, preoccupation with the event and their actions, decreased appetite, a lack of interest in academic and social activities, and an exaggerated concern for the safety of their families. Should these behaviors persist, additional counseling from a qualified professional should be obtained.

Conclusion

Basic emergency lifesaving skills are known to improve the victims’ outcomes prior to the arrival of EMS or other professionals. Basic emergency lifesaving skills training, taught consistently throughout the school years with developmentally appropriate strategies, will enhance students’ confidence and ability in recognizing and responding to emergency situations. Teachers, parents, and community members can collaborate with available resources to offer such training in the school setting. School systems need to have the support of teachers, parents, and administrators—as well as the monetary and human resources—to effectively offer this skill training. Such exposure to emergency skills training during childhood and adolescence may prompt adults to participate and may encourage students to continue their training through adulthood.

References

1American Academy of Pediatrics. Committee on School Health. (1993). Basic life support training in school. Pediatrics, 91 (1), 158–159.

2Collins, J., Small, M., Kann, L., Pateman, B., Gold, R., & Kolbe, L. (1995). School health education. Journal of School Health, 65 (8), 302–311.

3Colwell, B., Forman, M., Ballard, D., & Smith, D. (1995). Opinions of rural Texas parents concerning elementary school health education. Journal of School Health, 65 (1), 9–13.

4Davis, R. Hope for hearts: Mass CPR training. USA Today, September 23, 1999.

Section VII: Appendices

Appendix A
Selected Bibliography

Atwell, N. (1987). In The Middle: Writing, Reading, and Learning with Adolescents. Portsmouth, N.H.: Boynton/Cook.

Ault, R. (1983). Children’s Cognitive Development. (2nd Ed.). New York: Oxford University Press.

Berger. K.S. (1991). The Developing Person Through Childhood And Adolescence. (3rd Ed.). New York: Worth Publishers.

Berk, L. & Winsler, A. (1995). Scaffolding Children’s Learning: Vygotsky and Early Childhood Education. NAEYC Research Into Practice Series. Washington, D.C.: National Association for the Education of Young Children.

Bredekamp, S. (Ed.). (1987). Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth through Age 8. (expanded ed.). Washington, D.C.: National Association for the Education of Young Children.

Bredekamp, S. & Copple, C. (Eds.). (1997). Developmentally Appropriate Practice in Early Childhood Program. (rev. ed.). Washington, D.C.: National Association For The Education Of Young Children.

Bronfenbrenner, U. (1993). The Ecology of Cognitive Development: Research Models and Fugitive Findings. In Development in Context, edited by R.H. Wozniak and K.W. Fischer. Hillsdale, N.J.: Erlbaum.

Case, R. (1985). Intellectual Development: Birth to Adulthood. Orlando: Academic Press.

Elkind, D. (1984). All Grown Up and No Place to Go: Teenagers in Crisis. Reading, Mass.: Addison-Wesley.

Feldman, S. & Elliott, G. (Eds.). (1990). At the Threshold: The Developing Adolescent. Cambridge, Mass.: Harvard University Press.

Gardner, H. (1993). Multiple Intelligences: The Theory in Practice. New York: Basic Books.

Kellough, R., Kellough, N., & Hough, D. (1993). Middle School Teaching: Methods and Resources. New York: Macmillan.

Klahr, D. (1989). Information-processing approaches. In R. Vasta (Ed.), Annals of Child Development (vol. 6). Greenwich, Conn.: JAI Press.

Kuhn, D., (Ed.). (1990). Developmental Perspectives on Teaching and Learning Thinking Skills. Contributions to Human Development. Basel: Karger.

Moll, L., (Ed.). (1990). Vygotsky and Education: Instructional Implications and Applications of Sociohistorical Psychology. Cambridge: Cambridge University Press.

National Association for the Education of Young Children and NAECSSDE (March 1991). Guidelines for appropriate curriculum content and assessment in programs serving children ages 3 through 8. Young Children, 46 (3), 21–38.

National Association for the Education of Young Children (January 1988). NAEYC position statement on developmentally appropriate practice in the primary grades, serving 5- through 8-year olds. Young Children, 43, 64–84.

National Highway Traffic Safety Administration. (1983). Guidelines for a K–12 Traffic Safety Education Curriculum. (vol. II). Washington, D.C.: National Highway Traffic Safety Administration.

National Middle School Association (1995). This We Believe: Developmentally Responsive Middle Level Schools: A Position Paper. Columbus, Ohio: National Middle School Association.

Olson, D. & Torrance, N. (1996). The Handbook of Education and Human Development: New Models of Learning, Teaching and Schooling. Cambridge: Blackwell Publishers.

Stevenson, C. (1992). Teaching Ten to Fourteen Year Olds. New York: Longman.

Thompson, N.J., & McClintock, H.O. (1998). Demonstrating your program’s worth: A primer one valuation for programs to prevent unintentional injury. Atlanta: National Center for Injury Control and Prevention, Centers for Disease Control and Prevention.

Vander Zanden, J. (1993). Human Development. (5th ed.). New York: McGraw-Hill.

Wersch, J. (1985). Culture, Communication and Cognition: Vygotskian Perspectives. Cambridge: Cambridge University Press.

Wood, C. Developmental Teaching: A Closer Look at the Middle School Child, Ages 9–12. Greenfield, Mass.: Northeast Foundation for Children.

Appendix B:
Agencies, Organizations, and Publishers

Numerous agencies, organizations, and publishers have educational products, such as curricula and manuals, for teaching basic emergency lifesaving skills to children, adolescents, and adults. The contact information for many of these agencies, organizations, and publishers is listed below. The list is not exhaustive or comprehensive. When selecting educational products, contact the agency, organization, or publisher; obtain information about the educational products; and apply the BELS guidelines offered in Section V.

BELS Evaluation Form

We would like to know what you think about the BELS Framework and appreciate you completing this evaluation form.

1. I have used the BELS Framework to (check all that apply):
   ____Inform myself to teach emergency skills to children and adolescents
   ____Prepare for a training or workshop
   ____Develop teaching materials
   ____Teach emergency skills to children and adolescents
   ____Advocate the teaching of emergency skills to children and adolescents
   ____Other (Please elaborate on other side.)

2. The BELS Framework is
   ____Very useful
   ____Useful
   ____Somewhat useful
   ____Not useful

3. The skill sequence outlined in the BELS Framework
   ____Accurately lists those emergency skills that should be taught to children and adolescents
   ____Includes too many emergency skills
   ____Omits important emergency skills that children should learn (Please elaborate on other side.)

4. The match of emergency skills to grade and age levels in the BELS Framework is
   ____Very accurate
   ____Accurate
   ____Less than accurate
   ____Seriously lacking in accuracy
   ____Not sure/don’t know

5. The material on child development in the BELS Framework is
   ____Very useful
   ____Useful
   ____Somewhat useful
   ____Not useful
   ____Not sure/don’t know

6. The material on teaching strategies in the BELS Framework is
   ____Very useful
   ____Useful
   ____Somewhat useful
   ____Not useful
   ____Not sure/don’t know

If you have any additional thoughts or comments on the BELS Framework, we would like to hear them. Thank you.

Please remove this form from this publication and return to:

Stephanie Bryn, MPH
Maternal and Child Health Bureau
5600 Fishers Lane, Room 18A-39
Rockville, MD 20857
Fax: (301) 443-1296