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SCHOOL HEALTH MANUAL

 

 

 

CONTENTS--EMERGENCIES IN THE SCHOOL SETTING

Click below on the topic you wish to review:

 

Emergencies

First Aid Policy

Recommended Procedures For Emergency Care

Crises Intervention Action Plan

 

 

 

 

EMERGENCIES

 

 Revised 6/2002

Injuries and illness are common occurrences in the school aged population.  Increasing enrollments of students with disabilities  increases the possibility of true medical emergencies in schools.  The school has responsibility for the safety and well-being of students and personnel during the hours of school attendance, on school property, or during school sponsored activities.  Therefore, local school district policies should address:

 

1.      Preventive measures to limit the occurrence of injury.

2.      Policies to define what action will be taken in the event a serious injury, other emergency, or crisis.

3.      Facilities and supplies to accommodate students with special needs, illness or injury.

 

PREVENTION:

 

·        School safety,  injury prevention and first aid should be incorporated in a coordinated school health program and emphasized via health promotion activities.

 

·        The school nurse should monitor the school environment for safety hazards and audit injury reports to identify problem areas.  Areas identified as high risk should be assessed for causative factors and a report submitted to the principal and other appropriate personnel as needed, for corrective action.

 

·        Schools should have adequate health service facilities, supplies and qualified personnel to handle accidents, sudden illness, or crisis.

 

·        An Emergency Information Card system should be maintained in the health rooms or office for each student.  This information must be kept confidential.

 

·        All school designated personnel, including school bus drivers and cafeteria workers, should be trained to give immediate and temporary first aid care for acute illness or injury.

 

·        All emergency incidents should be carefully documented.  A parent/guardian of the student sustaining an injury or other health emergency should be notified immediately.  All symptoms may not manifest at once and parents must be made aware of later evolving signs and symptoms, and encouraged to seek further medical aid if necessary.  A copy of an incident report and action taken should be filed in the student's  health record and a copy sent to the principal.

 

·        All animal bites should be reported to the principal and town health officer after emergency care is given.

 

 

FIRST AID POLICY

 

 

First aid is immediate and temporary treatment and care in the event of an injury before medical care can be obtained. A school policy on first aid should be established.   All school personnel should be aware of the policy.  Factors to consider in establishing the policy include:  

 

 

The written policy should establish certain procedures for handling emergencies and clearly state the responsibilities of various school personnel.  The following minimum content is suggested for a school-wide first aid policy:

·        Designation of:

       --At least one first-aid qualified staff person in each building, two   

        in larger buildings, to administer first aid. 

       --Procedures for notifying parents.

       --Procedures regarding the transportation of students to care.

·        Orientation/in-service training in the first aid/emergency policy and procedures and use of School Emergency Manual for each new staff person; a review of requirements annually for all schools.

·        A complete first-aid kit (and current American Red Cross First Aid Textbook) in each school (or more, depending on number of classrooms, floors and children), a simple first aid kit in each classroom, and periodic restocking of the first aid kits by a designated person.

·        Handling of body fluids, see Universal Precautions, Communicable Diseases.

·        Ingestion of poisonous substances should be managed in accordance with recommendations of Maine Poison Control Center, telephone # 1-800-222-1222.

 

 

Emergency Information Cards:

 

Each school should maintain emergency information on each child and school personnel:

 

1.      Name of parent and/or other responsible person, address, telephone numbers day and evening;

 

2.      The name and phone number of the family physician;

 

3.      Pertinent medical or physical conditions and instructions for handling the situation (e.g.,  seizures, severe allergies, diabetes);

 

4.      Name or other person in case parent/guardian can't be reached.

 

 

Liability:

 

Schools and school employees have a  legal responsibility for the children enrolled; as “loco parentis” (in the place of the parents).  Schools and their officers and employees must, therefore, exercise the caution which parental figures would exercise toward children, to avoid unreasonable risks of foreseeable harm to them.  Where a child is injured, the person in charge must take all reasonable steps to minimize the injury and secure medical help.  This  means rendering first aid, or taking those immediate steps necessary to obtain first aid.

 

Maine law provides immunity to school "employees" (other than licensed personnel) "who render first aid, emergency treatment or rescue assistance to a student during a school program. . . ." (Title 20-A, Chapter 201, §4009) (see statute).  However, the law excludes actions that are "willfully, wantonly or recklessly or by gross negligence".   A school nurse or physician is held to the standard of care of their profession.


Accident/INCIDENT Reports:

 

The report should include all relevant information about the incident and witnesses to it.  The form should be filed as described in school policies.  A copy of the report or a notation about the incident should be included in the child's health record.

 

When an employee has been injured, a workers' compensation claim must be filed in a timely manner by the employee.  Employees should be provided with workers' compensation forms, or, directed to the appropriate person handling such reports.  If claims are not filed in a timely manner, the employee could be denied benefits to which he/she is entitled.

 

In all incidences especially in the case of an injury causing a serious health problem  a follow-up study is needed.  A review of the cause and steps to correct a physical/structural/equipment problem may occur.

 

CLASSIFICATION:

 

Health Problems, by time allowed before intervention is needed to save lives/prevent disability:

 

EMERGENT: Immediate Action

URGENT:  1 Hour

NON-URGENT: Few Hrs.

Bleeding:

Acute asthma episode

Abdominal pain

Lacerated limb

Allergic reaction - no breathing

Minor burns

Severed limb

difficulty

Impetigo

Student with a clotting  disorder

Bite - animal

Pediculosis

Respiratory problem:

Bite  - human

Tinea

Respiratory arrest

Blood -  exposure to another

Conjunctivitis

Obstructed airway

person's when there is an

Dysmenorrhea

Severe allergic reaction/anaphy-

open wound

Epitaxis

laxis

Bleeding - internal

Fainting

Severe acute asthma episode or

Burns - partial or full thickness

Fever under 103degrees F

status asthmaticus

Chest - penetrating & crushing

Hay fever

Spine injury

injuries

Headache

Head injury - moderate to severe

Eye - foreign body or corneal

Insect bites

Poisoning - consumption of over-

abrasion

Minor lacerations

dose of medication/drug or other

Dislocations

Abrasions

injurious agents

Fractures (except spine and/or

Nauses

Skin or eye contact with corrosive

skull, which are emergent)

Vomiting

chemical

Head injury - mild

Absence

Diabetic student - hypoglycemia

Fever of 103+degrees F

Myoclonic & partial seizures

Tonic-clonic seizure > 3 min.

Hyperthermia - environment

Sore throats

    

etiology

Upper respiratory infections

 

Hypothermia - environmental

Sprains

 

  etiology

Strains

 

Tooth - avulsiHon

Toothache

 

Tonic-clonic seizure <3min.

 

 

School Emergency Manual is available on the web athttp://www.maine.gov/dps/ems/docs/index.html

 

RECOMMENDED PROCEDURES FOR EMERGENCY CARE

 

"First Aid is the immediate, temporary treatment given in case of accident or sudden illness before the services of a physician can be secured."

 

This guide is to aid school personnel in taking quick and effective action in case of sudden illness or injury at school.  Recognizing that it is important to prevent injury or illness when possible, the school should, nevertheless, be prepared to give first aid emergency care when necessary. Procedures outlined in this guide are not a substitute for professional care.


ADRENALIN ADMINISTRATION

For emergency use only for allergic reaction.

Signs and Symptoms:

-respiratory difficulty

-tingling sensation around mouth or face, nasal congestion, itching, wheezing

-faintness

-a sense of tightness in the chest

-low BP with weak, rapid pulse.

Action:

1.       Send for ambulance.      

2     Give 0.5cc (1/2cc) of adrenalin chloride 1:1000 intra muscular (0.3c for children under 60lbs.)

3.       Observe pulse, respiration, color.

 

Epi-pens are available. Epi-pens  and adrenalin chloride require

physician order.

 

 

BACK OR NECK INJURY

Keep the person in the position found, and place where injury occurred.  Do NOT bend back.  Keep flat.  Do NOT allow movement of head.  Keep person warm.  If necessary, treat for shock.

 

BITES & STINGS

Insect:  Use cold to relieve pain.

Human & Animal: Cleanse wound with soap and water.  See that animal is confined, if possible, and reported to appropriate authority.  Advise medical care.

 

BLEEDING

Wearing gloves, exert pressure with fingers or hands directly over the bleeding site using clean dry dressing.  Elevate about level of heart if no fracture.

BLISTERS

Wash area with soap and water.  Apply dry sterile dressing.

 

BUMPS & BRUISES

1.       Apply cold compresses directly following injury.

2.       Watch for swelling and notify parent.

 

BURNS

Flame & Scald Burns

Immerse part in cold water, or apply ice only.  Advise medical care.

Chemical burns

Flush area thoroughly with cold water immediately.

 

CONVULSIONS

Lower person to floor with head to one side.  Do NOT restrain.  Do NOT force anything in the mouth.  Loosen clothing.  Do NOT move person until he/she is quiet and relaxed.

 

DIABETES

Insulin Reaction

Signs

1.       sudden onset

2.       pale, moist skin

3.       excited behavior

4.       normal to rapid, shallow breathing

5.       moist tongue

6.       hungry

 

Treatment

Give quick acting sugar immediately, i.e. sugar cubes, fruit juice, candy.

If untreated, will lead to unconsciousness.

Causes

Unusual physical exertion without adequate food.

Emotional upset/tension/stress.

 

Diabetic Coma

Signs

 

1.       gradual onset

2.       flushed, dry skin

3.       drowsy

4.       deep, labored breathing

5.       vomiting

6.       dry tongue

7.       thirsty

 

Treatment

Insulin needed.  Call parent, physician or ambulance.

 

 

ELECTRIC SHOCK

Break the contact between person and electric conductor at once.  Do NOT touch person or clothing until contact is broken.

Start mouth to mouth resuscitation if person is not breathing.

Send for ambulance.

 

EARS

Gently place a loose cotton plug at the opening of external canal.  Severe earache or foreign body in ear requires person to be examined by physician.  Do NOT put anything in the ear, i.e., oil.

 

 

EYES

Foreign Body

Flush eye with water.  Superficial bodies can sometimes be removed by everting the eyelid and gently touching the foreign body with a moist applicator.  If the foreign body is embedded, notify parent and advise medical care.

Eye Wounds

Wounds of the eye ball should be seen by a physician.  Cover both eyes to decrease

eye movement.  Never exert pressure.

Wounds of the eyelid - apply a dry sterile dressing and hold firmly in place.

Chemical Burns

Flush immediately for 20 minutes with clear water by tilting head toward the injures side, holding the eyelid open with the finger and thumb, slowly pouring fluid into the corner of the eye (never directly on the eye ball).  Apply dry sterile dressing, and have person taken to  medical care.

Hot Metal Burns

Do not irrigate.  Apply dressing and ice pack, then take to medical care.

 

FAINTING - SHOCK

 Keep the person lying down with head lowered and feet elevated.  Bathe face with cold water.  Do NOT let the person drink.  Cover with a blanket for warmth.  Notify parent and/or physician.

 

 

FRACTURES

Keep person quiet and warm.  Avoid moving injured part.  Apply splint or support.  *Wearing gloves, cover the area with a sterile dressing if the skin is broken.

Notify parent and arrange transportation.

 

FROSTBITE

Signs & Symptoms

- Skin is white and/or glossy.

Action

1.       a) Immersing affected area in warm water (100-105F.);

        b) Applying firm steady pressure of warm hands (no rubbing);

        c) Holding fingers motionless in the armpits.

2.       Obtain medical care as soon as possible.

 

 

HEAD INJURY

Keep person lying down with head elevated.  Apply cold compress or ice to

site of injury.

Observe and warn parents to watch for increasing headache, vomiting, or lethargy for at least 48 hours

 

MOUTH & THROAT

Toothache

Advise parent to take person to dentist.

Mouth Injury

*Wearing gloves, control bleeding and clean wound with tap water.

Foreign Bodies

Sweep finger in throat to remove the foreign body.  If person is choking and is unable to breath, stand behind person, put arms around and apply sudden upward thrusts to upper abdomen and lower rib cage (Heimlich Maneuver).  Repeat.

 

 

NOSEBLEED

*While cleaning, wear gloves.  Have person sit upright, breathing through the mouth.  Person should gently blow his/her nose to clear out clots, then pinch both nostrils together for five (5) minutes

 

PAIN

Abdominal

Have person lie down.  Advise parent to have person examined by a physician.

Leg & Joint Pains

Advise parent to have person seen by a physician, if pain is persistent.

 

POISON OAK, IVY, & SUMAC

If exposure occurs at school, wash the exposed areas with hot water and liquid dishwashing detergent or alcohol.  Rinse in clear water.  If inflammation develops, advise.

 

Poison Control Telephone Number:

1-800-222-1222

 

SPLINTERS

Remove splinter with sterile needle or tweezers, if it is superficially lodged, and can be easily removed.

 Clean area well with soap and water before and after removing.  If splinter is pressure treated wood, follow up for blood poisoning.

 

STRAINS & SPRAINS

Apply ice or cold compresses as soon as possible after injury.  Elevate the injured part.  Advise medical care.

 

TOOTH INJURY

If tooth is lost due to trauma replace tooth in socket.  Keep moist.  Immediate dental care is necessary.

 

WOUNDS & ABRASIONS

Abrasion

*Wearing gloves, control bleeding.  Cleanse the wound with soap and water.  Apply sterile dressing.

Lacerations & Puncture Wounds

*Wearing gloves, control bleeding.  Clean around the wound with soap and water.  Apply sterile dressing.

 

 

*When rubber or polyethylene gloves are unavailable, use any cloth or other barrier to avoid or minimize direct contact with blood.  Always wash hands immediately after treatment.

 

 

CRISIS INTERVENTION ACTION PLAN

 

Title 20-A §1001 (16) requires school boards to adapt a "crisis response plan" to deal with crisis or potential crisis involving violent acts.

 

In cases of a crisis, informed personnel should notify school officials as soon as possible.  As much information as is known should be given to the administrator.  The superintendent will decide how and how much information should be shared with the public.  It is strongly urged that schools develop a plan to deal with crises, whether they occur within the school setting or outside the school but influencing students and personnel within the school setting.  Following is a suggested plan that was developed by SAD #71.

 

Following are suggested role of respective Staff:

1.      School nurse:  Provide emergency first aid treatment to sustain life and provide assistance to rescue personnel when they arrive on the scene.

 

2.      Guidance counselors and social workers:  Meet with individuals and/or small groups to help students cope with the stressful event and/or grieving process.  These individuals can guide students thorough the initial shock and conduct informal assessments.  If necessary they contact parents and school administration when they feel private counseling or long-term treatment is necessary.

 

3.      School administrators:  Central office administrators direct and authorize news releases and/or reports to necessary agencies.  The superintendent and assistant superintendent report to the school board in a timely fashion.  With assistance from appropriate building level administrators, they oversee all legal matters surrounding the crisis.

 

4.      Building level administrators organize a current directory of trained people both in the building and in the district who are available to assist in different emergencies.  Each year they forward an updated list to the central office.  When a crisis or emergency arises, they take whatever immediate action is necessary to insure the safety and welfare of those in the building.  They direct first response relief efforts by trained building personnel and local officials.  They cooperate and provide necessary assistance to trained emergency personnel once they arrive on the scene.  As soon as practical, they report appropriate details to the central office and building staff.

 

5.      Teachers:  Inform students of the basic facts surrounding the incident and share concerns with the class.  Teachers also refer needy students to the appropriate support system.

 

Situation #1:  A crisis which could have a serious effect on students occurs outside of school.

 

1.      Any staff member who learns of a potential problem reports to either the superintendent, elementary supervisor, coordinator of special programs, or building principal.  When administrative personnel are unavailable, report to the appropriate secretary.

 

2.      The building principal or elementary supervisor initiates the call list to notify all teachers of an important meeting 10-15 minutes before school the next day.

 

3.      The principal asks members of the building's crisis intervention team to meet approximately 20-30 minutes before the full-staff meeting.  At the same time he/she outlines the building's response, and considers recommendations from the team.

 

Tasks are assigned to team members (i.e., finding class coverage, finding space for small groups, identifying individuals to meet with troubled students, preparing fact sheets, etc.)

 

4.      The principal meets with the full faculty and reads a p repaired statement reporting basic, factual information regarding the crisis.  He then briefly describes the crisis team's planned response and asks that staff be prepared to direct students accordingly.

5.      The classroom teacher reads an announcement which reports the basic facts of the crisis.  At the end of these remarks, teachers respond to questions they can answer and allow those affected to express feelings if they choose to do so.  When necessary, classroom teachers send especially troubled students to guidance or other especially designated areas.  Through the remainder of the day, opportunities can be given at the beginning of each period for teachers to express their feelings and to allow others to share theirs as well.

 

6.      Counselors and social workers (depending on the severity of the crisis) meet individually and in small groups with those affected.  They attempt to identify those in need of professional counseling and report to parents and appropriate administrators.

 

7.      Principals take calls from parents and report only public information regarding the event and the steps the school is taking to help students (as outlined in the crisis plan).

 

8.      Teachers continue to watch their classes in the time following the crisis for behaviors which might be related to the incident.  They report observations to the principal, guidance personnel, and social workers.

 

9.      Generally, news reporters will not be permitted to photograph or interview students during any crisis or grieving process.  Staff members are asked to defer any requests for information to the administration.

 

Situation #2:  A crisis which could have a serious effect on students occurs while students are in school.

1.      Any staff member aware of a serious problem takes whatever immediate steps are necessary to protect life and reports to the principal as soon as possible.

 

2.      The principal initiates first response measures (those that have not already been taken) and works with appropriate trained staff in the building until outside help arrives.

 

3.      The principal and/or his designee(s) cooperate with emergency personnel called to the scene.

 

4.      The principal and/or his designee(s) attempt to contact the parent(s) of the student(s) injured.

 

5.      The principal reports to the building staff and central office administration in a timely fashion.

 

6.      Members of the staff with direct knowledge of the event report details to the principal as soon as the immediate crisis has passed.

 

7.      The principal consults with members of the building's crisis intervention team, if necessary, to outline how information regarding the crisis should be further reported to students, staff, and public.  In addition, he works with the crisis team to devise any follow-up strategies.

 

8.      The principal meets with the staff to report the incident.  At this time the action plan developed by the crisis team is presented.

 

As necessary, the intervention strategies and guidelines described in steps 6-9 of situation #1 are employed.

Reference:

Guidelines for Emergency Medical Care in School (RE9954), American Academy of Pediatrics (www.aap.org/policy/re9954.html)

Emergency Guidelines for Maine Schools (www.state.me.us/dps/ems/docs/index.html)

School Guidelines for Dealing with Student with Food Allergies, NSBA, FAAN, NASN, NAGSP (www.foodallergy.org/guidelines.html)