Crossing Boundaries: The History of First Aid in Britain and France, 1909-1989

Over the past twenty years historians have developed a sophisticated understanding of the growth of primary and secondary healthcare provision in Britain. However, this focus on professional, institutional care has overlooked the history of the personal, voluntary and communitarian forms of healthcare generally known as first aid. Yet understanding the trajectory of non-institutional treatment across the twentieth century, and in particular the effect of freely available universal healthcare provision on the willingness of the public to self-treat minor injuries, can help to illuminate the boundaries of state provision, individual responsibility and voluntary action in the era of welfare states. Moreover, tracing the fate of first aid provides an opportunity to inform responses to the current crisis in the British National Health Service, especially recent heavy demands on GP surgeries and accident and emergency departments.

First aid is a broad term encompassing activities from applying a sticking plaster, to preparing for and managing the effects of war. We will focus on the initial treatment of minor injuries and techniques for basic life support undertaken by people other than recognized medical professionals. A major focus for our research will be the first aid activity and the diffusion of first aid knowledge conducted by the British Red Cross. Furthermore, the typicality of the British experience will be considered through an examination of the development of non-professional treatment in France. France has been chosen as its healthcare system and voluntary associations developed in different ways to those in England. In comparison to England there has been a more prominent, and controversial, role for religious organisations, a greater level of state intervention in the oversight of first aid providers and a set of priorities strongly influenced by the experience of war and invasion. Moreover, the centrality of contributory insurance and the freedom of doctors from state employment may have shaped the continuing role of first aid within the French system.

Currently, there is a lack of literature on first aid written by historians, and there is also a dearth of evaluation of past first aid practices by medical researchers, which has recently been addressed by a study initiated by the British Red Cross. A medical humanities approach to this topic offers a more rounded view of first aid, examining memories and reflections of first aid practice along with traditional archival research. Our methods include examining records in archives of the British and French Red Cross, St John Ambulance, the National Archives in Britain and the National Library in France, British and French local archives, and the Mass Observation Archive in Sussex which documents public opinions. Further research will explore educational books and films, and oral testimony in order to investigate the policy and techniques of first aid. In addition to social, cultural, economic and political history, our approach is informed by sociological concepts in relation to the boundaries of knowledge between differently trained people. How are safe practices chosen for the public, while preserving the status of trained professionals? Which objects and practices are the medical profession willing to share and which are the public willing to use? Our evaluation of these topics will be enhanced through group interviews, to which working and retired medical practitioners and British Red Cross first aid volunteers and co-ordinators will contribute in order to discuss the history of first aid practices and opportunities for enhancing policy and practice today. Publications, a website, and interactive events will disseminate the outcomes of our research.

Four key groups which our study should impact upon are policy makers, first aid charities, healthcare professionals, and the public, all of whom can consider the value of lessons from first aid practice in the past. As historian Virginia Berridge (2003) has advocated with various examples, history of medicine has the direct ability to inform policy. Our proposed outcomes include articles aimed at policy makers and practitioners, for which we will seek advice from first aid co-ordinators and practitioners through our advisory board and witness seminars.

By identifying the strategies, knowledge and products used in the past for managing minor health care issues we hope to inform debates about how best to address the current access crisis. We have agreements with beneficiaries: the British Red Cross (BRC), and with practitioners through a large regional group practice of ten GP surgeries based in York and Hull (Haxby Group). These advisors will attend our witness seminars and advisory board meetings in order to discuss the policy relevance of our project and to inform applications for impact-focused follow-on projects. The BRC campaigns for policy change regarding first aid, such as the statutory inclusion of first aid in the National Curriculum and the driving test, and argues that first aid does not 'have a home' in either the Department of Health or Education. We will discuss how historical experiences can inform this debate.

Our historical research is timely as over the past decade there has been a considerable increase in demand for access to GPs and Accident and Emergency Departments. A&E attendance increased by 50% between 2002/3 and 2012/13 while GP appointments increased by 40 million in 2013 alone, with almost as many people failing to get an appointment, illustrating the huge demand on primary care. Reasons for this increase are complex, including the increasing elderly population. However, since 2011, the National Self Care Forum - which includes representatives from the NHS Alliance and Royal College of Nursing - has estimated over 50 million unnecessary visits to GPs are reported each year.

We will also discuss how our research findings are relevant to debates regarding the safety of first aid practice. Relevant recent legislation includes the 2015 Social Action, Responsibility and Heroism (SARAH) Act, which is designed to protect individuals or groups who act 'heroically to help in dangerous circumstances' from litigation if something goes wrong. The value of the SARAH law has been debated with claims that it is not necessary as it responds to popular mythology, and may now permit negligence. Our project will contribute to this debate by investigating whether this mythology is rooted in debates about appropriate and risky first aid practices during the twentieth century.

Direct engagement with the public will take place through interactive events introducing the first aid techniques used in the First World War, and in general. Events will take place in a former Red Cross Hospital in Hull, and the Thackray Medical Museum in Leeds. We will use these activities to support the work of first aid charities by inspiring people to sign up for training with the BRC or St John Ambulance. In order to inform these events for families, we will discuss our project with the Parenting Forum discussion group which is organised by History and Policy. These interactive events will be enhanced by educational materials for use in museums with families and primary school pupils. Our project will also be disseminated to a wider audience through a website on the history of first aid. By having a rounded approach to disseminating the variety of sources we are researching, from oral histories and Mass Observation to material culture and films, we have the potential to engage the adult British population by capturing their imagination through relaying the experiences of past generations' first aid practice.