Chapter 15

First aid at school

parents and guardians, as well as other members of the community at large.

2. Vital signs
Vital signs are basic indications (signs) of the human body’s life-sustaining (vital) functions, indicating

Learning objectives

the maintenance of basic physiological functions that are necessary for a human body to survive.

You will be able to gain proper understanding and explain:

Specifically, vital signs refer to the level of consciousness, respiratory rate, pulse rate, blood pressure,- What vital signs mean, and assess them correctly.

and body temperature. Assessment of these signs, i.e., performing a vital sign check, provides a- How to care for minor injuries and illnesses that may happen around you.

measure of a person’s physical condition.

- Rest, Ice, Compression, and Elevation (RICE) method for injuries.
- The importance of cardiopulmonary resuscitation (CPR) and Automated external defibrillators(AEDs), and practice using them.

Vital signs are affected by factors such as age and gender. They also constantly fluctuate to somedegree with daily activities such as exercise and food intake. Nevertheless, a sudden change in a vital
sign may indicate the presence of a threat to life, and knowing the correct ways of measuring vital signs
and their reference ranges is critical when you provide first aid. It is also useful to be familiar with yourIn this chapter, you will learn about injuries and illnesses that may happen around you, and how tonormal respiratory rate, pulse rate, blood pressure, and body temperature, for it helps detect any

observe and provide care. Here we will focus on minor injuries and illnesses for which children canabnormalities in your body based on your vital signs.

provide care by themselves. Specifically, we will look at injuries such as those of limbs, and illnesses
such as abdominal pain, diarrhea, headache, and fever. In addition, you will also learn about vital signs
as an important measure of the level of urgency of a particular sickness.

1) Consciousness

Since teachers are not medical experts, this chapter covers first aid for laypeople. Understanding
what is included in first aid can vary among different countries and regions. For the purpose of thisBeing medically conscious means that one is able to respond properly to stimuli from within one’s body

chapter, the International First Aid and Resuscitation Guidelines 20161 are used as a primaryor from the outside world. One’s state of consciousness is assessed based on both one’s state of alertness

reference.

and cognitive function.
To assess someone’s consciousness, you talk to the person, saying, “Mr./Ms. ●●, are you OK?”,

1. Necessities for learning first aid

gently shake their shoulder, or apply a mild pain stimulus (Figure 15.1). Because the brain is responsible
for consciousness, a decreased level of consciousness is a sign that there is a problem with the brain,
making it a medical emergency.

First aid is the immediate assistance provided to a sick or injured person until professional help arrives.
You never know when or where an injury or illness can happen. Some injuries and illnesses are time

Some injuries and illnesses are medical emergencies and require immediate care, while others are
not so time sensitive. In Cambodia, there are situations where it takes time for one to reach a hospital.

ou

respond quickly, it may save a life.

Areysomeone present (i.e., a bystander) happens to have knowledge and skills of first aid and is able toOK?

sensitive. In a time-sensitive situation, it may be too late if you wait until the ambulance arrives. If

Even if a person is not in a life-threatening situation, providing proper care can help prevent an injury orillness from becoming worse and alleviate pain. It is therefore important to learn first aid knowledge
and skills, even for the general public.

Figure 15.1 Assessing consciousness

Teachers, besides being members of the general public, are in a position to keep children safe at
school. School is a place where children of different ages learn in groups, a circumstance which can give

There are many scales used to evaluate impairment of consciousness. Here we pick one that is

rise to an unexpected injury. For these reasons, teachers need to learn first aid. In addition, school is one

commonly used globally, called the Glasgow Coma Scale (GCS).2 On the GCS, lower total scoresof the places best suited to learn about first aid, not only for teachers but for pupils/students and theirindicate lower levels of consciousness. A GCS total score of 15 or higher indicates the person is fully

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conscious, while scores of 13–14 indicate mild impairment of consciousness, and 12 or lower, semicoma

60 breaths per minute or more in adults and adolescents, children, infants, and neonates, respectively) oror coma (Table 15.1).

very low (10, 15, 25, and 40 breaths per minute or fewer in adults and adolescents, children, infants, andneonates, respectively) respiratory rates.1
Table 15.1 Glasgow Coma Scale (GCS)2

Eye opening response (E)Best verbal response (V)Best motor response (M)Opens spontaneously

4

Opens to voice sound3

Opens to pain / pressure

2

None

1

Oriented

5

Confused

4

Inappropriate words

3

Incomprehensible sounds

2

None

1

amplitude, tension, and quality in addition to the number of beats. When one is in shock, it may be

Obeys commands

6

difficult to take the pulse at the radial artery. In such a case, you take the pulse at the carotid artery

Localizes pain

5

(Figure 15.2). If the pulse is not palpable, immediate cardiopulmonary resuscitation (CPR) is required.

Normal flexion / withdraws to pain

4

Reference ranges for pulse rate vary among different organizations and authorities, but they are typicallyAbnormal flexion

3

70–90 pulses per minute for children of school age, and a rate of lower than 50 pulses per minute or

Extension

2

None

1

3) Pulse
A Pulse is a palpable wave of blood that is sent into the aorta by the pumping action of the heart as theleft ventricle contracts, and which travels through the arterial system of the body (see Chapter 2). A slow
pulse rate or an irregular pattern indicate abnormalities in the heart or the circulatory system. The pulse
may be palpated through the walls of a peripheral artery. The pulse is typically taken at the radial artery(Figure 15.2). To take the pulse, you place the tips of your index, second, and third fingers on the arteryof a subject and count the beats for a period of 1 minute. While doing so, you also assess the rhythm,

120 pulses per minute and higher should be considered a medical emergency.3

Column: What is orientation?

Orientation is one’s capability to grasp and understand the situation in which they are placed, suchas the time now, and why they are there. In order for one to have good mental orientation, there
should be no significant damage done to their function in terms of consciousness, perception,
attention, memory, and thoughts, at the very least. If people have impaired consciousness or memory
problems due to organic brain disorders, they have become “disorientated.” They lose their senseof place and identity, or time and date.

radial artery

carotid artery

Figure 15.2 Points to take pulse

2) Respiration

4) Blood pressure

Respiration involves bringing oxygen, which is required to produce energy to sustain life and perform
activities, into the body through inhalation, and flushing carbon dioxide, which is generated as a

Blood pressure is the pressure of circulating blood against the walls of arteries. The pressure of blood

metabolic end product, out of the body through exhalation (see Chapter 2). Low respiratory rates andagainst the arterial walls as the heart contracts is called the systolic pressure, while that of blood as theshallow respiration indicate inadequate oxygen intake. You assess respiration based on the measurement

heart relaxes is called the diastolic pressure (see Chapter 2). The higher the cardiac output is, and theand rhythm of respiration, by looking at the movements of the chest and abdomen per minute. Poor

higher the peripheral resistance is, the higher the blood pressure becomes. Decreased blood pressure

respiration results in the face or lips turning dark purple. If one shows such symptoms (i.e., cyanosis),indicates abnormalities in the blood circulation. Meanwhile, hypertension serves as an indicator ofassess their respiration very carefully. Special attention is required in a case of very high (20, 30, 40, andprogression of arterial stiffness. As blood pressure varies depending on age, gender, ethnicity, and288

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measurement conditions, the parameters of hypertension are determined by individual organizations
and authorities.

Column: Non-contact body thermometer

WHO defines hypertension as follows:

With the onset of the COVID-19 pandemic, “non-contact” body thermometers are becoming“Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure

increasingly more common. Such thermometers measure the amount of infrared radiation emitted

readings on both days are ≥140 mmHg and/or the diastolic blood pressure readings on both days are ≥90

by a human body and convert it into a temperature. They offer great convenience, for you can use

mmHg.”

4

one to take the body temperature hygienically and quickly. However, due to the space between thesensor and the object of measurement, temperature readings may be affected by the air condition,

Blood pressure is measured using a sphygmomanometer. There are several types ofand may not be accurate under measurement conditions. It is recommended that you follow

sphygmomanometers; they may be aneroid or digital sphygmomanometers, and sites of placement may

manufacturer’s instructions, and if the reading is not in agreement with the observed conditions

include an upper arm, wrist, or finger.

(e.g., you feel hot but the temperature reading is low), you should take another measurement using
an axillary thermometer.

3. First aid proceduresFirst aid procedures are as follows: observation, assessment, and care.

1) Observation
Figure 15.3 Examples of digital sphygmomanometers

First aid begins with observation. You make an assessment by listening (interview), looking (visual
examination), and touching (palpation). Listening means that you ask about the circumstance in which
an affected person’s injury or illness occurred (when, where, why, what, how). Looking means observing5) Body temperature

the person’s general condition and the state of injury or illness very closely. Touching means placing
your hand over the affected area and assessing any skin swelling, heat sensation, or tension. Vital signs

Body temperature refers to internal body temperature,

are also a critical part of observation.

and values vary depending on the site used formeasurement. While body temperature may bemeasured in the rectum, in the mouth, or at the
tympanic membrane, it is commonly measured in theAngle of thermometer
under the arm: 30-45°

2) Assessment

axilla. Axillary temperature is skin temperature, andBased on the information obtained through listening, looking, and touching, as well as the vital signis therefore lower than internal temperature by about

values, you make an assessment. Teachers are laypeople and not healthcare professionals, and are

1°C. When taking measurements, wipe any sweat off

not able to make a diagnosis. Nevertheless, you can infer the injury or illness, and take action accordingly.

first, then place the thermometer under the arm, angling

First, you determine the level of urgency. If the case is urgent, the affected person should seek medical

it so that its tip is in the deepest crease of the armpit, as

attention immediately. If it is not very time sensitive, then you provide care according to the symptoms.

shown in the picture (Figure 15.4). Body temperatureUrgent conditions of sickness include a lack of consciousness, stab or gunshot wounds to the head,varies among individuals, and it is important to assesschest, neck, or abdomen, fractures of the pelvis or the femur, amputations of limbs, and burns covering

the temperature by taking one’s normal temperaturea large area.3

into account. A temperature of 38°C (100.4°F) or
higher is considered a fever.1
Figure 15.4 Taking body temperature

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3) Action
Based on the assessment that has been made, take action. How to provide care according to the symptoms
will be discussed in the following section.

immediately.
Column: Management of nosebleeds

Most nosebleeds are caused by picking of the nose or scratching it with fingernails. Bleeding often
Column: What is shock?

occurs in the 1-cm area at the front of the nose (i.e., Kiesselbach’s area). To care for a nosebleed,have the injured person tilt their head down slightly, pinch the nose around Kiesselbach’s area

Shock is an acute syndrome in which an attack to a living body or the response of body to the attack

between the thumb and index finger, and press firmly towards the back of the nose (Figure 15.5).

has caused a failure to maintain blood flow to vital organs, resulting in a disturbance in cellular

Bleeding should normally stop after around five minutes. Tipping the head up may cause blood tometabolism or damage to organs, potentially threatening to the life of the person. If shock progresses,

run down the throat; tilting the head down is preferable. A nosebleed as a result of trauma may

it can cause mulfunctions and result in death; if any symptom of shock is observed, urgent action isindicate a potential fracture of the nasal bone; cool the nose with a wet towel and seek medical

needed in response. Symptoms of shock include pallor, writhing movements, cold sweat, impalpableattention.

pulse, and decreased blood pressure.

4. Appropriate first aid care for different situations
1) First aid for injuries(1) Head trauma

Kiesselbach’s
area

Head traumas vary widely depending on the site and extent of injury, ranging from severe to mild.
Examples of severe cases of head trauma include a fracture of the skull, and a concussion caused by a

Figure 15.5 Points to apply pressure

jolt to the head. Some symptoms, such as acute epidural hematoma, may appear several days later.
Common steps that should be taken are as follows. First, find out how the injury occurred. Since theinjured person may not know everything that has occurred, seek information from other people whohave been on the scene. Knowing how it occurred will help you determine the severity of the injury.

(3) Chest or abdominal trauma

Next, check the vital signs, especially the level of consciousness. If there is any vital sign abnormality,

In the case of chest or abdominal trauma, it is possible that internal organs may be damaged. Assess thetransfer the person to a healthcare facility as quickly as possible. If there is any wound, stop the bleeding

injured person’s general condition, focusing on the vital signs. It is also helpful to ask about the cause ofand protect the affected area, as appropriate for the type of trauma. If there is swelling, cool the affected

the contusion in making necessary decisions. If the injured person has any vital sign abnormality,

area. In cases of head contusion, symptoms may worsen gradually; the injured person should be placedcomplains of intense pain, or has symptoms of shock, seek medical attention immediately.

at rest for 24 hours with their conditions monitored. Symptoms to look out for during this 24-hour period
include vomiting, seizures, headache, numbness of the limbs, and vision problems. If any of theseabnormalities is observed, seek medical attention immediately.

(2) Facial trauma(4) Limb traumaa) Wounds
Wounds include abrasions, cuts, puncture wounds, and bites. An abrasion is a wound where an areaof the epidermis is damaged due to external friction. A cut is a line of damage to the skin caused as a

Features projecting from the face, such as the forehead, nose, mouth, and cheeks are more prone to facial

result of a sharp object moving on the body surface. A puncture wound is a puncture caused by the stabtrauma. One type of facial trauma that requires particular attention is ocular contusion. Cases of ocularof a sharp object into the skin. A bite is a wound caused by the teeth of an animal or a human (Figure

contusion can become severe, as it can involve damage to the retina or a fracture of the bone under the15.6).

eye, which is thin and prone to fracture. Assess the injured eye by comparing it to the other, uninjured

The basics of care are: rinse the wound, stop the bleeding, and protect the wound (Figure 15.7).

eye, focusing on any bleeding, eye movement, and change in vision. If the injured person has anything

First, rinse the wound with clean water. As any foreign matter remaining in the wound can make itwrong with eye movement, double or blurry vision, or constriction of visual fields, seek medical attention

susceptible to suppuration, rinse the wound carefully with clean water to wash off any foreign matter or

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bacteria around the wound. This may also help stop bleeding more quickly, as the cold water cause theStop the bleeding, if any. Cover the wound with a clean cloth (preferably gauze), and apply pressure

capillaries to constrict. It is preferable to use tap water to rinse the wound; if you have no access to clean

directly over the dressing. Blood has a coagulation mechanism (i.e., platelets form a plug the rupture

water, however, bottled water or tea with no sugar added may be used in its stead. In the absence of cleanof the blood vessel, followed by the action of coagulation factors, which forms a fibrin clot). Most

water, using an antiseptic may be beneficial. Do not use pooled water to rinse a wound as it may

injuries are bleeding from capillaries or small veins (i.e., blood oozing out), and this can be stopped bypotentially be contaminated with pathogens.

simply applying pressure. In the case of bleeding from an artery, however, blood spurts out and thus
cannot be stopped by direct compression alone; seek medical attention as soon as possible.

Type

Characteristics / keys to treatment

Once the wound has been rinsed clean and the bleeding stopped, apply a clean cloth (preferably
gauze) over the wound and secure it with a strip of surgical tape to keep the wound clean and prevent itfrom drying out. Change the gauze as appropriate if it is contaminated by blood or effusion.

Epidermis
DermisEpidermis
Subcutaneous
DermisEpidermis
tissueAbrasion

Epidermis
DermisSubcutaneous
tissueDermisSubcutaneous
tissueSubcutaneous
tissueAn abrasion is a wound where an area of theepidermis is damaged due to external friction. The
surface of the wound is scraped off, leaving it
irregular; this often causes foreign matter to remainin the wound, making it susceptible to infection. It
is important to rinse any foreign matter off
thoroughly.

A cut is a line of damage to the skin caused as theresult of a sharp object moving on the body surface.
A cut left open is susceptible to infection. It isadvisable to cover the wound by holding the skin on
either side of the cut so that the cut is closed, andsecuring it with a strip of surgical tape.

Cut

1 Rinse
Rinse wound withclean water

2 Stop bleeding

Cover with clean clothand apply pressure

3 Protect
Apply clean clothor bandage

Figure 15.7 Keys to caring for wounds

Column: Special considerations when treating bleeding

A puncture is caused by the stab of a sharp object
into the skin. A wound may be small in area, but if
it is deep, it may have caused internal damage. A
wound caused by a rusty or contaminated object
can result in tetanus infection, which is caused byanaerobic bacteria; check the vaccination status andseek medical attention.

Some infectious diseases, such as hepatitis B and AIDS, are transmitted through blood. When caring
for a person who is bleeding, wear vinyl gloves or use plastic bags, taking care not to come in directcontact with the injured person’s blood. In the event of having contact with blood, wash it off withwater immediately.
There is no problem for a victim to touch one’s own blood; it may be advisable to occasionallyhave an injured child try to stop the bleeding, so long as the injury is minor.

Puncture wound
Column: Management of outdoor injuries caused by animals or insects

Caused by an animal or a human. A bite with sharp
teeth in particular can cause deep tissue destruction.
In addition, animals may harbor various bacteria
and viruses in their mouth, which may result in not
only wound infection but animal-borne infection as
well. Provide first aid, and make sure the injured
person seeks medical attention without fail.

Bite● Snake bites
Squeeze out effusion (blood) from the snake bite wound, rinse it thoroughly, and cover it with a clean
cloth. Keep the wound location at a level below the heart, and keep the person still. If one is bitten
by a venomous snake, one will experience intense pain and a burning sensation immediately
following the bite, and the site of the bite will start swelling. When you are unsure if the bite has been
made by a venomous snake, yet the injured person suffers from intense pain and significant swelling,
seek medical attention without delay in case it was indeed a venomous snake bite. If you know what

Figure 15.6 Major types of wounds, their characteristics and treatment294

kind of snake it was that made the bite, inform the staff at the hospital.
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295

1

2

3

● Animal bites

Joint head

Animals harbor various bacteria in their mouths, and their bites may potentially cause the wound to
become suppurative or lead to tetanus. A bite by a stray dog or cat can result in rabies. In Cambodia,
there are approximately 800 deaths a year from rabies, and 40% of the victims are those under the

Joint socket

age of 14.5 In the case of an animal bite, it is important that the wound be rinsed with clean waterand protected with clean cloth (gauze), and that the injured person seek medical attention without
delay.
● Bee stings
Pinch the sting site firmly and rinse the wound, squeezing out effusion (blood). Remove the bee
stinger, if it is left behind. When doing so, exercise caution and avoid grabbing the stinger, as it may
cause the venom to be released into the body of the person stung. It is advisable to cool the sting

Ligament

SprainPeriarticular tissues
damaged.

site with a wet towel.

Fracture

1 A break in the continuity of the bone

alone.

2 Broken ends of the bone out of place,with the surrounding tissue damaged.
3 One side of the bone disarticulated
and curved.

With a person who has in the past received a bee sting and experienced symptoms such as rashand nausea, another sting may trigger anaphylactic shock. Anaphylactic shock is a medical
emergency, and a stung person should be monitored for about 30 minutes following the sting (seeDislocation

A joint head and a joint
socket are stuck inabnormal locations due
to external force.

Figure 15.8 Differences between sprains, fractures, and dislocations

Chapter 5).

Outdoor injuries caused by animals and insects are preventable. Familiarize yourself regularlyc) The RICE method for treating injuries

with information concerning areas infested with snakes, bees, etc., and avoid places where one may
potentially encounter them. Give children guidance on clothing and precautions to take when going

The basics of care for these conditions are: Rest, Ice, Compression, and Elevation (RICE) (Figure

outdoors. It is also important to take public health measures such as wild dog control and canine

15.9).

rabies vaccination.5

Rest refers to resting the affected area. It helps to reduce the movement of the injured site and relievepain, as well as reducing bleeding (internal bleeding) and swelling. Make sure the injured person movesb) Contusions, sprains, fractures, and dislocations (Figure 15.8)

or rests in a position that prevents any weight from being put on the injured site.
Ice refers to cooling the affected area. It promotes the constriction of the blood vessels in tissues ofA contusion is a condition in which a strong impact due to a fall, collision, etc., inflicts damage to thethe affected area, minimizing the progression of bleeding (internal bleeding) and reducing swelling. It

tissues beneath the skin even without a wound on the surface of the skin, causing internal bleeding. As

also helps reduce pain from the injury. It is advisable to use iced water at 0°C or so to cool deeper parts

it can occur in any area of the human body, it is necessary to have an accurate understanding of the level

efficiently. Place ice cubes and water in a plastic bag, and apply it to the affected area. Ice the area forof risk and its characteristics.

around 15–20 minutes; stop when the injured person experiences a loss of sensation on the skin, andA sprain is a condition in which force is applied to a joint, causing damage to periarticular tissues
such as tendons, ligaments, or cartilages. A sprain often occurs in the ankle. In particular, a form ofsprain where the foot turns inward, causing the damage to the outside of the ankle, called an inversion
sprain, is quite common.

resume the icing when they regain the sensation. Repeat this process for the first 72 hours after injury,
which is considered the acute stage.
Compression involves application of an appropriate level of pressure over the affected area, which
prevents cellular fluid in tissues from flowing into other areas, thus reducing bleeding (internal bleeding)

A fracture is a broken bone caused by the application of force greater than the bone strength. In

and swelling. Pay attention to the degree of pressure applied, as overly tight compression can compromise

cases of growing children, an incomplete fracture in which the bone is bent or cracked is quite common,

blood circulation. Check the color of the tips of the digits and measure their temperature as appropriate

in addition to a complete fracture in which the bone is broken completely.

to ensure that blood circulation is not compromised.

A dislocation is a condition in which the articular surface of the head of a bone and that of the socketof another have shifted from their normal locations due to external force and become stuck in abnormal

Elevation refers to keeping the injured area above the level of the heart. This facilitates the return ofblood flow to the heart, helping to reduce bleeding (internal bleeding) and swelling.

locations. A dislocation commonly occurs in the shoulder, elbow, finger, and jaw joints.
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occurred, as well as assessing children’s growth on an ongoing basis (through health check-ups)
and sharing health-related information.

(5) Burns
Rest

Ice

A burn is damage to skin tissues caused by heat. Pain may persist and worsen with time. Burns areclassified as first-, second-, and third-degree burns (I, II, III), depending on the depth of tissue damage(Figure 15.10). That said, the severity of a burn is determined not only based on how deep the skindamage is alone but in combination with how large the area affected is. The larger the affected area is,and the deeper the damage penetrates, the severer a burn is.

Compression

Epidermis

Elevation

First degree (erythema)
Superficial second degree

Figure 15.9 RICE method for treating injuries

DermisColumn: Preparedness for injuries at school

Deep second degree

Children can get injured at school. To avoid panicking in such eventualities, it is important that
schools have a response system in place in advance. Specifically, arrangements for emergencies

Sub-cutaneous tissue

should be made, including who will provide care, who will contact parents, and what to do when an

Third degree (necrotic)

injured child needs to be transported to hospital. Individual communities may or may not have ahealthcare institution, and may have different approaches to care (e.g., schools with only maleteachers may not provide care to girls, parents or guardians of children cannot afford medical fees);
it is recommended that schools work together with parents/guardians and local specialist

First degree(I)

Damage to the epidermis. The site appears red on the surface; symptoms include stinging
pains and burning sensation. Sunburn is an example of first-degree burns.

Column: First aid in school

Damage extends into the dermis. Includes two subcategories: superficial dermal burns anddeep dermal burns. The site appears red on the surface, with the presence of blisters. With
Second degree
a superficial second-degree burn, the affected person will experience the same subjective(II)symptoms as those with first-degree burns, while a deep second-degree burn is less painful
due to the damage caused to the sensory nerves.

You are advised to have a first-aid kit of basic items including thermometers, nail clippers, adhesive

Third degree(III)organizations to build such a system.

bandages, face masks, gauze, surgical dressing, and antiseptics, so that you can respond to injuries

Damage to all skin layers, involving the subcutaneous tissues. The site appears white, andpainless.
Figure 15.10 Classification of burns

or other health problems. That being said, first aid provided at school is a procedure to temporarily
keep an injury or illness from worsening and relieve pain, and is not medical treatment. As a matterof principle, a teacher, who is not a healthcare provider, should not use pharmaceuticalproducts.

298

To care for a burn, cool the affected area with water as soon as possible. For a site that cannot becooled with water, apply a cool, wet towel. Do not use ice directly on the site, as it can cause damage to

One of the pillars of the National School Health Policy 2019 is the establishment of “healththe skin. Cool the site until the pain eases. After cooling, protect the wounds with gauze or other dressing.

rooms” to provide first aid. This suggests that schools in Cambodia are slowly starting to implement

Do not break any blisters, as they serve to protect the wounds. A burst blister can lead to bacterial

school nurse’s offices (see Chapter 1). It is advisable that a health room or its equivalent be equipped

infection. Seek medical attention for a second-degree or severer burn that covers a wide area, or a third-with what they need to provide first aid, including first-aid kits, treatment tables, chairs, and cots. In

degree burn. If a person sustains a burn with clothes on, taking the clothes off may cause damage to skinaddition to providing first aid, a health room serves as a school health center as they keep a record

tissues; do not remove the clothes but cool the affected area over the clothes, and seek medical attentionof health room visits and identify when, where, and what types of injuries and health problems havepromptly.
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Column: Care for injuries provides an opportunity for health education

According to the International first aid and resuscitation guidelines 2016,1 we need to teach children
how to provide first aid not only in school health classes but also in other classes, and using a variety
of other opportunities as well. Teachers may find themselves in a position to provide care for a child
who was injured at school. Rather than stopping at simply providing care, you can instead take it asan opportunity for children to think about prevention of and response to injuries. For children, doing
so when they have just gotten injured will drive the point home to them, giving them a chance tolearn something they will be able to use in years to come.

2) First aid for illnesses

Figure 15.11 Disposing of bodily waste / vomit(1) Abdominal pain / diarrhea
Abdominal pain or diarrhea is often caused by a digestive problem. However, some may complain of
abdominal pain caused by a urinary or gynecological problem. For these reasons, it is necessary to
perform thorough assessment and vital sign checks to determine the level of severity.
First, observe the characteristics of the abdominal pain a person experiences, and ask whether or not
he/she has symptoms such as vomiting and diarrhea. Ask the person about his/her experience with(2) Headache
Headache may occur due to a variety of factors. Check the vital signs of the sick person, and ask about
the characteristics of the headache in detail (i.e., when did it start? What kind of headache? How long
has it been going on?).

meals, urination, and for females, menstruation. If the person suffers from frequent vomiting or diarrhea

First of all, check for any trauma. If the person has trauma, and experiences vomiting and impairedin addition to abdominal pain, suspect infectious gastroenteritis (see Chapter 7). If it is not an urgent

consciousness, it is a medical emergency. Headache accompanied by high fever and seizures also

case, keep the sick person at rest and monitor their conditions. If he/she is experiencing diarrhea, haverequires particular attention. Check for a runny nose and assess the condition of the throat, too, for ear,him/her replace lost water and salts (electrolytes) in small, frequent amounts to avoid dehydration.

nose, and throat problems can also be a cause of headache.
If the sick person has normal vital signs and only mild symptoms, keep him/her at rest and monitor

Column: Disposal of bodily waste / vomit

School is a place where people live their lives in groups, and it is necessary to properly dispose ofhuman bodily waste or vomit as a source of infection. Failure to dispose properly of bodily waste or

their conditions. Since headache may be caused by irregular lifestyle habits, including lack of sleep andeyestrain, it is also important to review his/her daily life.

(3) Fevervomit may potentially lead to widespread infection (such as norovirus infection). It is therefore

Fever is an inflammatory response to various virus or bacterial infections. Check the vital signs andnecessary for teachers to be able to dispose of them properly. The disposal procedures are as

observe the general condition of the sick person. In general, a fever of 38°C or higher is considered tofollows (Figure 15.11).

be high. One has the chills as their body temperature goes up. During fever, have the sick person liei) Put on protective equipment (wear a mask and vinyl gloves at minimum; single-use masks
and gloves are preferable). In the case of a closed space, ventilate the space.

quietly and replace water and salts (electrolytes) to prevent dehydration. If he/she has the chills, keep
him/her warm with blankets and towels. If sweating, have him/her change clothes. If a person has a feverii) Wipe up bodily waste / vomit with paper towels, working inward to prevent spreading.

accompanied by severe headache/abdominal pain or vomiting, seek medical attention promptly as he/iii) Put the collected bodily waste / vomit, as well as the paper towels used, immediately in ashe may be at a risk of falling into a critical condition.

plastic bag, seal tightly, and dispose of it.
iv) Disinfect the areas that have been soiled with bodily waste or vomit, using a disinfectant.
Vomit tends to spread over a wide area; disinfect a 2-meter circle from its center, working
inward. Dispose of the paper towels, mask, and gloves used in a plastic bag.
v) After completing the process, wash your hands with soap and gargle.

Column: Responsible self-medication, self-care and self-healing mechanisms

WHO, in its guidelines on the use of pharmaceutical products (the Guidelines for the Regulatory
Assessment of Medicinal Products for Use in Self-Medication), recommends the practice of selfcare and responsible self-medication, in which individuals take responsibility for their own health300

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and care for “minor ailments” of body and mind that do not require medical attention, by means of
6,7

making adjustments in their everyday lives and using non-prescription medicinal products.

CPR is a technique to restore spontaneous blood flow and the respiration of a sick person who

The

is in cardiopulmonary arrest. Chest compression promotes the flow of blood to the brain and thehuman body has innate defense and other systems, which give our body the ability to heal illness

heart by applying pressure to the area around the heart (Figure 15.12). If the person who finds a sick(self-healing mechanisms) (see Chapter 7). For instance, having a fever or inflammation means that

person performs CPR at once, the person’s chance of survival will increase.8,9

our body’s defensive response is at work, trying to rid the body of viruses and other invaders. And
in addition to using healthcare services, we can also use our wisdom to adopt everyday lifestyle● Increased access to AEDs

behaviors that are effective in helping our body restore its health, such as eating well-balanced

AED stands for automated external defibrillator. An AED is a medical device that can analyze themeals and getting adequate sleep, all based on particular symptoms we may be experiencing.

electrocardiogram and deliver defibrillation (i.e., sending an electrical shock to the heart to reset a

In some cases, however, self-care or self-medication may have a negative impact. In order tonormal rhythm), and a layperson can operate one (Figure 15.13). When you turn on the AED, it will

promote self-care and self-medication successfully, it is necessary to promote social empowerment

give voice prompts. When you attach a pair of pads to the chest area, automated analysis of theas well, with an aim to advance people’s health education, general knowledge, and socioeconomic

electrocardiogram will be performed. If defibrillation is required, instructions to do so will be given instatus.

6,7voice prompts. Press the defibrillation button to start defibrillation. Once a person falls into
cardiopulmonary arrest, their survival rate decreases by 7–10% for every minute without
defibrillation.8,9 It is therefore critical to use an AED at the first possible moment to save their life.

Column: Cardiopulmonary resuscitation and AED

In Cambodia, AED awareness is not very high yet, and there are not many AED locations,● Why is cardiopulmonary resuscitation (CPR) necessary?

although it is gradually becoming more common. In Phnom Penh, a Japanese soccer player has

If you find yourself in the presence of a sick person who requires immediate emergency medical

donated an AED to the KMH Stadium, while another has been placed at Aeon Mall, as well. It iscare, such as one who is unconscious, in cardiac arrest, or in respiratory arrest, you may be able toanticipated that there will be more AEDs accessible, primarily at locations where large crowds ofsave the sick person’s life if you can perform cardiopulmonary resuscitation (CPR). Even if you are apeople gather and accidents are prone to happen. At the same time, it is necessary to create moremember of the general public who is not a healthcare provider, if you have received training and areopportunities for as many people as possible to learn how to use an AED first-hand.

able to give CPR, the chance of the person’s life being saved will increase if you perform chest
compression while waiting for an ambulance to arrive after contacting medical services.

i) Place the heel of one hand on thecenter of the person’s chest, andplace the heel of the other handover the first.

Figure 15.13 Example of AED useii) Push straight down on the chest,
keeping your elbows straight andpositioning your shoulders overthe point of compression.

● Special considerations when performing CPR(1) If the sick person is an infant, you many need to adjust the point and depth of compression,
taking into account the smaller body.
(2) Recommended CPR steps are subject to update. You will need to check the most current

100 compressions per minutePush down by 5 cm

information.

Figure 15.12 Keys to chest compression

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Chapter 16
Exercises for further thought and research[15-1] Find out about injuries common among children in Cambodia, and discuss what to do to preventthem.

Disability and special education needs[15-2] Assuming an injury that is likely to happen to children, such as an abrasion or cut, discuss possible
ways to teach children how to treat it.
[15-3] Concerning first aid procedures that are actually performed in daily life, discuss what kinds ofLearning objectives

scientific evidence form a basis for the procedures, and whether there is anything that can be done

You will be able to gain a proper understanding and explain:

to improve on them.

- The deﬁnition of disease, impairment, disability, and handicap using speciﬁc examples.

[15-4] Look back on experiences of your own or someone close to you of injuries or illnesses in the past,and reflect on what care was given, what action was taken in response, and what you/they were
and were not able to do. Discuss what issues Cambodia has.

- The medical model of disability, the social model of disability, and the integrated model ofdisability (International Classiﬁcation of Functioning, Disability and Health: ICF).
- Challenges in education of children with disabilities in Cambodia.
This chapter ﬁrst provides basic knowledge necessary to understand disease, impairment, disability, andhandicap. Secondly, we explain the medical model of disability, the social model of disability, and theInternational Classiﬁcation of Functioning, Disability and Health (ICF) as an integrated model ofdisability. Finally, we describe the present situation of special education needs for children withdisabilities in Cambodia.
Note that in this chapter health is mainly treated as a factor of disability; that is, in terms of healthconditions such as disease or injury. This differs from the broad meaning ascribed to health in theprevious chapter (e.g. Chapter 1).

1. Aspects of disease, impairment, disability, andhandicap
1) Disease
References

Disease results from abnormalities in all or part of the physiological state of living creatures. Someone

1

The International Federation of Red Cross and Red Crescent Societies. International first aid and resuscitation guidelines 2016.

suffering from a disease is incapable of fulﬁlling normal functions, and generally experiences various

https://www.ifrc.org/Global/Publications/Health/First-Aid-2016-Guidelines_EN.pdf
2

Jain S, Iverson LM. Glasgow Coma Scale. https://www.ncbi.nlm.nih.gov/books/NBK513298/

types of pain. However, some diseases such as diabetes produce no sense of pain before growing severe.

3

Foundation for Ambulance Service Development: Report of the committee for the criteria for determining levels of severity andurgency during an emergency medical evacuation. 2004. https://www.mhlw.go.jp/shingi/2009/08/dl/s0825-6c.pdf

4WHO. Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension

5

Pasteur Institute in Cambodia. Rabies Prevention Centers – Pasteur Institute in Cambodia (pasteur-kh.org). https://www.pasteur-kh.
org/rabies-prevention-centers/

6WHO. The benefits and risks of self-medication. WHO Drug Information. 14:1-2. 2000. https://apps.who.int/iris/bitstream/
handle/10665/57617/WDI_2000_14_n1_p1-2_eng.pdf?sequence=1&isAllowed=y7

A disease can be deﬁned as a condition in which cells suffer damage for some reason and fail to function
normally.
Diseases recognized as resulting from morphological abnormalities in cells are referred to as“organic diseases.” They contrast with “functional diseases,” in which current medical knowledge
cannot identify any cellular abnormalities. Cancer, diabetes, cerebrovascular disease, and heart disease
are considered organic diseases, while mental illnesses are placed in the functional disease category.

Bennadi D. Self-medication: A current challenge. Journal of Basic and Clinical Pharmacy. 5.19-23. 2014. https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC4012703/

8

American Heart Association: Hands-only CPR. https://international.heart.org/en/hands-only-cpr

9Larsen MP, Eisenberg MS, Cummins RO, et al. Predicting survival from out-of hospital cardiac arrest: a graphic model. Annals ofEmergency Medicine. 22:1652–1658. 1993. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600120/pdf/649.pdf

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