Training Today: First Aid - First response

In 2012, nine-month old Millie Thompson (right) choked to death while being fed shepherd's pie at nursery. At the inquest, her mother Joanne said: 'All we want to know is how this happened and to make sure that this never happens to anyone else ever again.'

The verdict was misadventure, with none of the staff at Ramillies Hall School and Nursery, Manchester, singled out for blame. But since then, Ms Thompson and husband Dan have set up Millie's Trust, a charity providing first aid education and training, and launched a petition calling for all nursery practitioners to be first-aid trained. The petition was signed by more than 100,000 people.

As a result, new legislation is planned, stating that all newly qualified practitioners at Level 2 and Level 3 must have either an emergency paediatric first aid or full first aid certificate. It is estimated that this will result in 15,000 first aid trained practitioners feeding into the sector every year.

As well as the new training requirements, there are Government plans for a kitemark, 'Millie's Mark', to be awarded to nurseries with 100 per cent of staff trained in first aid, expected to be available from next year.

The new rules are not set to come into effect until September 2016, but they will mean big changes. While early years providers are currently required to have one first aider on the premises at all times, there is an aspiration for all staff to be qualified as well as new starters. Childcare minister Sam Gyimah has said he expects all nursery staff to be trained in first aid within 'two to three years'. So what will the law mean for nurseries in practice, and what should be done to prepare?

NEW RULES

National Day Nurseries Association (NDNA) director of quality and workforce development Stella Ziolkowski says the move is a 'great stride in protecting children and keeping them safe'. And there are obvious benefits. 'The more people you have trained up, the bigger the pool of staff you have who are equipped to be able to react quickly in an emergency.'

However, it is not yet clear who will foot the bill. The Government plans to run a public consultation on the proposals later this year. 'We have been calling for paediatric first aid to be part of accredited programmes and to fall into the funding for accredited programmes because it will be another financial burden,' says Ms Ziolkowski, who sees funding as a Government issue. 'Nurseries may have to push fees up or take more paid-for places, which will impact on the business model. We need to make sure that funding is attached to these qualifications.'

Covering costs

Keith Appleyard is treasurer at Fiveways Playcentre, which has one setting, 36 staff and a total of 240 children on roll. He says his nursery is considering putting fees up by an extra 24p per hour from September, a 4.8 per cent increase, in part because of pressure from the new training costs. 'Out of 36 staff, 32 have up-to-date certificates, and four of those expire next year,' he says. 'It now costs £100 a head to take the course through the local council, which means allowing £300 for an estimated three new starters each year.' However, certificates are only valid for three years, and he estimates having to spend £1,200 each year to keep up the current levels of staff training.

'For the past few years our total training budget has been £2,500, set at approximately 1 per cent of payroll. This leaves only £1,000 for all other training needs, so if this became a statutory requirement rather than a voluntary one, and we were to double our training budget, then this would add another 1 per cent to our existing prices.'

Financial support and training currently provided by local authorities for early years first aid varies from area to area. Richmond-upon-Thames provides two funded places on paediatric first aid training per early years setting, and one per registered childminder. The offer, and the number of courses, will conti- nue for the coming year, remaining unchanged despite the law that came into effect in September 2014 stating that childcare providers no longer have to use local authority-approved first aid courses.

Ms Ziolkowski says that while there has been a fall in the number of courses provided by local authorities overall, they will need to play their part once the plans go ahead.

'Local authorities looking to offer this support has to be a massive consideration in terms of getting everybody qualified. The Government has to financially support them to do so.'

Getting ready

Nurseries may be free to choose their own providers, but courses must cover the content as for St John Ambulance (right) or British Red Cross (see box) and be renewed every three years. The Early Years Foundation Stage (EYFS) framework states that early years providers should choose trainers that have a nationally approved and accredited first aid qualification or are a member of a trade body with an approval and monitoring scheme.

Ms Ziolkowski advises that settings should begin looking at their options now. 'Nurseries can start thinking about getting extra people trained and talking to their local authority about sufficiency of training, asking them what their plans are to be able to support them,' she says.

Fiveways is not the only setting that is exceeding the current requirements. The Spanish Nursery and Children's Centre, in Camden, north London, is another example. It is a small nursery with 35 children and six staff, all of whom have been trained in paediatric first aid since the nursery opened in January 2013.

Co-director Carmen Rampersad recommends organising training on a rota system to help spread the cost and make sure there is always someone in the setting with fresh knowledge, 'otherwise you'll end up at the end of the three-year period (when the certificate expires) with people not remembering their first aid as well as they could because it's not something they use on a day-to-day basis'. This rota system is also an approach used by some larger nurseries, such as Advantage Children's Day Nursery in Tolworth (see box).

Meanwhile, Small Wonders nursery in Merseyside has not only ensured that all its 50 staff are trained in first aid but has invested in a defibrillator for each of its three settings. The North West Ambulance service helped it source the devices, which can restart the heart during cardiac arrest, for about £1,000 each.

Manager Sarah Stout admits that it is a big investment which may present challenges for other nurseries, but says that Small Wonders is 'very lucky' with its budget since it was able to afford the new equipment without having to cut back in other areas. For nurseries that need financial assistance, she points towards a scheme run by the British Heart Foundation (BHF; see 'More information' column).

When it comes to guidance, the NDNA has been working with the Government on a list of best practice case studies (again, see 'More information' column).

Ms Ziolkowski says that having a good first aid programme in place is not only about the training but about giving the subject ongoing attention - 'checking confidence levels, to make sure staff are able to react in emergency situations'.

Keeping knowledge fresh is one of the key aims at The Spanish Nursery. 'We have staff meetings every four weeks. We get people who have been on training to share their knowledge and what they've learned, and to suggest any changes to practice they think we need,' says Ms Rampersad.

The nursery also uses a DVD from the BHF, 'Skills for Life', and staff have a British Red Cross phone app, Baby and Child First Aid, which has reminders on good practice. The DVD, which looks at dangers like choking, burning and fractures, is intended for adults and doesn't provide specific techniques needed for administering first aid to babies, but Ms Rampsersad says the techniques are similar to those used for young children.

COURSES

While the content is the same for all providers, trainers have some freedom on how the course is delivered. Tigerlily Training, for example, uses St John Ambulance content then co-ordinates with organisations such as the Anaphylaxis Campaign and Meningitis Now to write its lesson plans.

The Health and Safety Executive offers guidance to help organisations choose a training provider (see 'More information' column).Ofqual's Register of Regulated Qualifications provides a list of regulated first aid course suppliers.

Training providers

Some examples of paediatric first aid courses include:

• Millie's Trust: Level 3 Paediatric First Aid. Twelve-hour qualification that aims to give childcarers confidence in the setting. www.milliestrust.com
• Tigerlily Training: Paediatric First Aid. Delivered in one day with an at-home e-learning module, as a traditional two-day course or as a Level 3 qualification. Has a partnership with the NDNA giving discount to members. www.tigerlilytraining.co.ukSafe and Sound: Blended Paediatric First Aider. One-day course with material provided for at-home study beforehand. www.safeandsound.uk.net
• BNG Training: Paediatric First Aid. A two-day course leading to a Level 2 award in paediatric first aid (QCF). www.bngearlyyearstraining.co.uk
• British Red Cross: Paediatric First Aid. Can be used as evidence for an NVQ in childcare and education. www.redcrossfirstaidtraining.co.uk
• St Andrew's First Aid: Paediatric First Aid. Two-day course for nurseries and childminders. www.firstaid.org.uk.
• Pulse First Aid. Level 3 in Paediatric First Aid. Can work towards NVQ. www.pulsefirstaid.co.uk.
• PACEY: Paediatric Training for Childcare Professionals. Face-to-face course; practical and theory assessed. www.pacey.org.uk.

WHAT THE COURSE INVOLVES

Content is the same for St John Ambulance and British Red Cross, with one exception. British Red Cross includes adult first aid as a final session, so that the learner can act as an appointed first aider in his/her workplace. The core course content includes:

 - unconscious and breathing baby and child
- unconscious and not breathing baby and child
- choking baby and child
- shock
- first aid kits and hygiene techniques
- bleeding and wounds
- burns and scalds
- objects in eyes, ears and nose
- recording, reporting and administering medication
- extremes of hot and cold
- sickness and fever
- meningitis
- broken bones
- head, neck and back injuries
- swallowing something harmful.

CASE STUDY: ADVANTAGE CHILDREN'S DAY NURSERY

Advantage Children's Day Nursery has a comprehensive ongoing plan and budget for first aid - providing training for all its staff as well as meetings and competency checks. It offers 169 places for children from birth to school age and operates from purpose-built premises in Tolworth, London. It was judged outstanding at its past three Ofsted inspections.

'We allocate a budget for 15 members of staff every six months,' explains manager Hazel Moody. 'It's usually about £900 for 15 members of staff. We've got 70 members of staff here, so it's obviously not possible to train everybody at the same time - we have a rolling programme.

'We have 52 staff qualified in paediatric first aid, and we're holding a training session in August so we should soon have the whole team qualified.

'Every member of staff has a CPD file, and we have a training grid to make sure that we're up to date. We talk about first aid at staff meetings, and go over any incidents that have happened - how it was dealt with, and whether we could have done better. Then we'll talk about any current issues, so if there's been anything in the news about a child being hurt we ask how we'd have dealt with that.

'You don't actually know how people will cope in an emergency until they have to deal with something, but you have to make sure you've got more experienced people around the younger ones. We make sure we have that mix.'

MORE INFORMATION

• BHF DVD, www.bhf.org.uk/publications/emergency-life-support/ skills-for-life-dvd
• British Red Cross app, www.redcross.org.uk/en/What-we-do/ First-aid/Baby-and-Child-First-Aid-app
• EYFS framework, http://bit.ly/1Tau33B
• HSE guidance, www.hse.gov.uk/firstaid/approved-training.htm
• Millie's Trust, www.milliestrust.com
• NDNA case studies, www.ndna.org.uk/NDNA/need_to_know/ you_need_to_know_paediatric_case_studies.aspx
• The Register of Regulated Qualifications, http://register.ofqual.gov.uk/qualification.

Download pdf