First aid in primary schools : Maltese educators’ knowledge and attitudes towards its provision

Abstract

Overview of the topic: Primary school educators are often the first to respond when pupils experience accidents or sudden illness at school. While quick first aid can be vital, studies show that many teachers feel unprepared or reluctant to intervene, citing limited training, low confidence, legal concerns, and fear of doing harm (The Malta Independent, 2017). The Theory of Planned Behaviour (Ajzen, 1991) helps explain these patterns, as intention to give first aid depends on attitudes, perceived social expectations, and sense of control. The Health Belief Model (Rosenstock, 1974) further highlights how beliefs about risk, severity, and the balance of barriers versus benefits shape action. Guided by these frameworks, this study examines Maltese primary educators’ knowledge, confidence, and attitudes toward first aid, as well as barriers and supports influencing their readiness to act. The research questions that follow set out this focus in detail. The research questions: The four main research questions for this study are: 1. What are the knowledge levels of primary school educators towards providing first aid? 2. What are the attitudes of primary school educators towards providing first aid? 3. How prepared do primary school educators are to give first aid? 4. What are the key challenges and obstacles educators face when responding to medical emergencies? 5. How factors influence their confidence in responding to student injuries? 6. How factors influence their effectiveness in responding to student injuries? Methodology: This study used an purposely devised online questionnaire distributed first via primary school heads and then widened through social media and snowball sampling, yielding 107 responses; a Raosoft power check against the ~2,573 educator population indicated a 9.19% margin of error, so findings were interpreted with caution. This is especially so, since randomization could not be achieved. Data were analysed in SPSS v29 using descriptive statistics and frequencies; Likert-scale items captured attitudes, while demographics, prior first-aid exposure, and experience were also collected. Normality checks guided the choice of non-parametric tests: Chi-square for associations, Mann-Whitney U for two-group comparisons, and Kruskal-Wallis H for three or more groups, with p<.05 as the significance threshold. To improve representativeness in summary estimates, weights were applied to correct imbalances in gender and role. Findings: The study found that Maltese primary school educators view first aid as essential, strongly supporting mandatory, practical training. Confidence was highest in basic skills but lowest in pediatric CPR and head injury management. Males reported slightly higher confidence, while females and non-parents showed more concern about training gaps, legal issues, and mistakes. Key barriers identified by the participants included lack of confidence, legal fears, and time constraints, with top incentives being paid training time, legal protection, and supportive policies. Feedback from the opened ended questions emphasised the need for compulsory, hands-on, child-focused training during work hours, backed by resources and clear protocols. Implications and recommendations: Compulsory, hands-on, child-focused first aid training during working hours is recommended, with emphasis on pediatric CPR and head injury management. This should be supported by clear protocols, adequate resources, legal protection, and a positive school culture. Without such measures, hesitancy may waste valuable time, lack of knowledge may result in inadequate care, and educators may feel anxious or restrict activities out of fear of accidents, limiting pupils’ experiences. Conclusion: This study found that while primary school educators generally hold positive attitudes toward first aid and recognise its importance for student safety, many lack the knowledge, confidence, and preparedness to intervene effectively in emergencies. The most prominent barriers were low confidence, fear of legal repercussions, and time constraints, with lack of knowledge and fear of parental reactions also discouraging action. Educators reported being more motivated to become certified first aiders when supported through structural measures such as paid training time, legal reassurance, stress management support, and clear school policies, rather than through financial rewards alone. Confidence and effectiveness were strongly shaped by access to training, legal awareness, and workplace support, with both male and female educators emphasising the value of compulsory, child focused first aid preparation. Together, these findings highlight the need for systemic and policy-driven approaches to strengthen knowledge, reduce barriers, and foster a culture of safety within primary schools.