First Aid In High School - Special Academic Support

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Should first aid courses be compulsory in South African high schools Life Orientation curriculum, from grade 10 onwards, in order to decrease risks whilst an individual is having an epileptic attack?

Introduction

The South African Department of Health defines epilepsy as, a chronic disorder of the brain. It is characterised by recurrent seizures, which are brief episodes of involuntary movement that may involve part of the body (partial) or the entire body (generalised), and are sometimes accompanied by loss of consciousness and control of bowel or bladder function. (2) First aid is currently not freely available to high school students within South Africa through their Life Orientation curriculum, this is unfortunate because, 1 in every 100 people in South Africa suffer from epilepsy (1), this not only affects the lives of people suffering with the condition but also individuals living around them, if every epileptic person has 4 immediate family members this results in an additional 2 million South Africans affected by this condition (1).

Life Orientation Curriculum

The South African Life Orientation (LO) curriculum dedicates 2 hours per week towards LO which translates into 66 hours per annum in Grades 10 & 11 and 56 hours in total for Grade 12 (3). As seen in Image A of the appendix there are 6 topics covered in LO and majority of the hours are dedicated to development of the self in society, careers and career choices as well as physical education.(3) The South African Department of Basic Education lists that LO teaches life skills, as seen in Image B of the appendix, and states that it is a desirable competencies applicable for meaningful adaptation such as communication, conflict resolution, problem solving, self-management and etc.(3) According to that statement first aid could be seen as a life skills as it posses desirable competencies applicable for meaningful adaptation, such as problem solving. Meriam Webster defines first aid as emergency care or treatment given to an injured or ill person before professional medical assistance obtained (4) this simplifies into practical problem solving.

The LO curriculum could allocate 18 hours towards Level 1 first aid training as one of the skills taught is casualty management which includes seizures (5), the skills taught in Level 1 can be seen in the appendix under first aid levels, Level 1 (6 & 7). By including first aid into the LO curriculum the Department of Education would be equipping learners with valuable life skills as well as better their problem solving skills.

The challenge of including first aid into the curriculum is that the South African Department of Basic Education receives limiting funds from the government, in 2018 the Department of Basic Education was given R 246,8 billion (9), the departments funding in 2018/19 decreased by 2,9% from the previous year and investments in education have decreased by 10% (8). Majority of the budget goes towards salaries and this has resulted in the per learner allocation to reduce from R 16 435 per learner in 2017 to approximately R 15 963 in 2019 (8). Mismanagement of Basic Education funds given to the provinces (8) also makes it extremely challenging for first aid to be integrated into the LO curriculum as Level 1 training prices ranges from R 400 R 600 per learner.

Epilepsy

Epilepsy is the 4th most common neurological disease worldwide (11) and according to the World Health Organization (WHO) low- and middle- income countries possess 80% of the worlds epileptic (12). South Africa is currently an upper middle- income country (13) with approximately over half a million South Africans suffering with epilepsy (1). Depending on the strength of medication required anti- epileptic medication prices can range from R 27, 76 to R 522, 32 (14). This makes medication extremely expensive and affordable at the same time and, with 55,5% of the South African population living below the poverty rate of R 992 monthly per person (15) this would make anti- epileptic medication quite expensive for families living below the poverty rate. Also, as stated earlier, if all epileptic persons have 4 immediate family members then an extra 2 million people are affected (1).

Approximately 65 million people, internationally, suffer from epilepsy (refer to appendix for types pf seizures). One in 26 people will develop epilepsy at some point of their life (16), 1 in 20 people will have one epileptic attack at some point of their lifetime (17), but this does not mean that they have epilepsy. Mainly persons below the age of 20 and above the age of 65 have seizures this is due to: difficulties in birth, childhood infections or accidents in youth are common reasons in persons below age 20, incidents such as strokes or heart attacks or a common reason in persons age 65 and above (17). Myoclonic, Atomic and Tonic- clonic seizures (refer to types of seizures in appendix) could result in falls which cold lead to severe damage to the head but, with basic knowledge such as first aid the damage could be less severe. A quarter of new epileptic cases worldwide are in minors and this is due to an increase in population as well as complications during childbirth such as fetal injury (18). Approximately 600 people die annually from seizures (19) and it is unknown if the deaths could be prevented according to SUDEP (sudden, unexpected, witnessed or unwitnessed, non- traumatic, and non- drowning death in patients with epilepsy, but epilepsy does kill 1 in 4500 children and 1 in 1000 adults (20). Laceration is the largest injury caused by epilepsy and is the result of a shearing force and causes deeper skin tearing through the epidermis and dermis and sometimes a subcutaneous tissues (21).

Conclusion

By the inclusion of first aid to the LO curriculum for Grade 10s in South African high schools there could be a positive change in the risks faced during epileptic attacks and, although this has not been tested with epilepsy countries overseas such as: the United States of America and Canada have seen a decrease in injury throughout schools (22) due to the introduction of first aid.

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