EMERGENCY GUIDELINES FOR SCH OOLS 3RD EDITION LIST OF CONTENTS (cid:104) AEDs (cid:104) Ear Problems (cid:104) Stabs/Gunshots (cid:104) Allergic Reaction (cid:104) Electric Shock (cid:104) Stings Guidelines (cid:104) Asthma & (cid:104) Eye Problems (cid:104) Stomachaches & Difficulty Breathing (cid:104) Fainting Pain for helping an (cid:104) Behavioral (cid:104) Fever (cid:104) Teeth Problems Emergencies (cid:104) Fractures & Sprains (cid:104) Ticks ill or injured (cid:104) Bites (cid:104) Frostbite (cid:104) Tetanus (cid:104) Bleeding (cid:104) Headache (cid:104) Unconsciousness student when (cid:104) Blisters (cid:104) Head Injuries (cid:104) Vomiting (cid:104) Bruises (cid:104) Heat Emergencies the school (cid:104) Burns (cid:104) Hypothermia Also Includes: (cid:104) CPR (Infant, Child (cid:104) Menstrual Difficulties (cid:104) Emergency Plans nurse is not & Adult) (cid:104) Mouth & Jaw Injuries & Procedures (cid:104) Choking (cid:104) Nose Problems (cid:104) Calling EMS available. (cid:104) Child Abuse (cid:104) Poisoning & Overdose (cid:104) Safety Planning (cid:104) Communicable (cid:104) Pregnancy (cid:104) Infection Control Diseases (cid:104) Puncture Wounds (cid:104) Special Needs (cid:104) Cuts, Scratches (cid:104) Rashes (cid:104) Recommended & Scrapes (cid:104) Seizures First Aid Supplies (cid:104) Diabetes (cid:104) Shock (cid:104) Emergency Phone (cid:104) Diarrhea (cid:104) Splinters Numbers ODH 3610.13 (Rev.2/07) EMERGENCY GUIDELINES FOR SCHOOLS 3RD EDITION, 2007 Ohio Department of Health School and Adolescent Health School Nursing Program Project Staff Angela Norton, MA; Program Administrator Dorothy Bystrom, RN, M.Ed.; School Nursing Program Supervisor Diana McMahon, RN, MSN; School Nurse Consultant – Emergency Preparedness Ann Connelly, RN, MSN; School Nurse Consultant Acknowledgements Special thanks go to the following individuals for their outstanding contributions to the development and preparation of the Emergency Guidelines for Schools (EGS): William Cotton, MD; Columbus Children’s Hospital President; Ohio Chapter of the American Academy of Pediatrics Wendy J. Pomerantz, MD, MS; Cincinnati Children’s Hospital Ohio EMSC Grant Principal Investigator American Academy of Pediatrics Representative to the State Board of EMS Christy Beeghly, MPH; Consultant We would also like to acknowledge the following for their contributions to the EGS development: Staff at the Ohio Department of Public Safety, Division of Emergency Medical Services, EMS for Children (EMSC) Program Members of the American Academy of Pediatrics, Ohio Chapter, Committee on Pediatric Emergency Medicine and the Ohio EMSC Committee School nurses and other school personnel who took time to provide feedback on their use of the EGS so they could be improved for future users The EMSC National Resource Center and other state EMSC programs that adopted the EGS and provided feedback Original Project Staff - Ohio Department of Public Safety, Division of EMS Christy Beeghly, MPH; Ohio EMSC Coordinator, 1997-2003 Alan Boster; Ohio EMSC Coordinator, 1997-2003 Original funding for this project included the Emergency Medical Services for Children Program, Health Resources and Services Administration, Maternal and Child Health Bureau, and the National Highway Traffic Safety Administration. Funding for the current edition was provided by the U.S. Department of Health & Human Services, Maternal and Child Health Bureau Grant # B04MC07800-01-00 and by the Centers for Disease Control (CDC) Bioterrorism Grant # U901CCU516983. ABOUT THE G UIDELINES The Ohio Department of Health, School and Adolescent Health, in collaboration with the Ohio Department of Public Safety’s (ODPS), Emergency Medical Services for Children (EMSC) program, and the Emergency Care Committee of the Ohio Chapter, American Academy of Pediatrics (AAP) have produced this third edition of the Emergency Guidelines for Schools (EGS). The initial EGS were field tested in seven school districts throughout Ohio in 1997 and revised based on school feedback. In March 2000, the EGS won the National EMSC Program’s Innovation in Product Development Award. This award is given to recognize a unique product designed to advance emergency medical services for children. To date, more than 35,000 copies of the EGS have been distributed in Ohio and thousands more throughout the United States, as they have been adapted for use in other states. The EGS were evaluated in spring 2000, and a second edition incorporated recommendations of school nurses and secretaries who used the book in their schools and completed the evaluation. This third edition is the result of careful review of content and changes in best practice recommendations for providing emergency care to students in Ohio schools. Please take some time to familiarize yourself with the format and review the “How to Use the Guidelines” section prior to an emergency situation. The emergency guidelines are meant to serve as basic what-to-do-in-an-emergency information for school staff without nursing or medical training when the school nurse is not available. It is strongly recommended that staff who are in a position to provide first aid to students complete an approved first aid and CPR course. In order to perform CPR safely and effectively, skills should be practiced in the presence of a trained instructor. The EGS have been created as recommended procedures. It is not the intent of the EGS to supersede or make invalid any laws or rules established by a school system, a school board or the State of Ohio. Please consult your school nurse if you have questions about any of the recommendations. The document is three-hole punched so you may place it in a binder and add specific instructions for your school as needed. In a true emergency situation, use your best judgment. Ohio law contains protections that may provide immunity for school staff from personal civil liability in certain circumstances. Chapters 2744 and §2305.23 (§2305.23, §2305.231, §2305.235) of the Ohio Revised Code (ORC) describe some of these protections in detail. For example, ORC Chapter 2744 provides that employees of a political subdivision (defined in ORC §2744.01) cannot be held personally liable if the employee was acting both in good faith and not manifestly outside the scope of employment or official responsibilities. Other related ORC references are cited throughout the EGS where appropriate. Additional copies of the EGS can be downloaded and printed from: • The Ohio Department of Public Safety, Division of EMS at http://www.ems.ohio.gov - select EMS for Children (EMSC), or • The Ohio Department of Health at http://www.odh.ohio.gov - select Programs, then School Nursing, or • The Ohio Chapter of the American Academy of Pediatrics at http://www.ohioaap.org. Emergency Guidelines for Schools, 3rd edition Emergency Guidelines for Schools, 3rd edition HOW TO USE THE EMERGENCY GUIDELINES (cid:131) In an emergency, refer first to the guideline for treating the most severe symptom (e.g., unconsciousness, bleeding, etc.). (cid:131) Learn when EMS (Emergency Medical Services) should be contacted. Copy the When to Call EMS page and post in key locations. (cid:131) The back outside cover of the booklet contains important information about key emergency numbers in your area. It is important to complete this information as soon as you receive the booklet as you will need to have this information ready in an emergency situation. (cid:131) The guidelines are arranged with tabs in alphabetical order for quick access. (cid:131) A colored flow chart format is used to guide you easily KEY TO SHAPES & COLORS through all steps and symptoms from beginning to ending. See the Key to START Start here. Shapes and Colors. (cid:131) Take some time to familiarize FIRST AID Provides first-aid instructions. yourself with the Emergency Procedures for Injury or Illness. These procedures START & QUESTION give a general overview of the Asks a question. You will have OR a decision to make based on the student's recommended steps in an condition. QUESTION emergency situation and the safeguards that should be taken. STOP Stop here. This is the final instruction. (cid:131) In addition, information has been provided about NOTE A note to provide background information. Infection Control, Planning This type of box should be read before emergencies occur. for Students with Special Needs, Injury Reporting, School Safety Planning and Emergency Preparedness. Emergency Guidelines for Schools, 3rd edition Emergency Guidelines for Schools, 3rd edition WHEN TO CALL EMERGENCY MEDICAL SERVICES (EMS) 9-1-1 Call EMS if: (cid:137) The child is unconscious, semi-conscious or unusually confused. (cid:137) The child’s airway is blocked. (cid:137) The child is not breathing. (cid:137) The child is having difficulty breathing, shortness of breath or is choking. (cid:137) The child has no pulse. (cid:137) The child has bleeding that won’t stop. (cid:137) The child is coughing up or vomiting blood. (cid:137) The child has been poisoned. (cid:137) The child has a seizure for the first time or a seizure that lasts more than five minutes. (cid:137) The child has injuries to the neck or back. (cid:137) The child has sudden, severe pain anywhere in the body. (cid:137) The child’s condition is limb-threatening (for example, severe eye injuries, amputations or other injuries that may leave the child permanently disabled unless he/she receives immediate care). (cid:137) The child’s condition could worsen or become life-threatening on the way to the hospital. (cid:137) Moving the child could cause further injury. (cid:137) The child needs the skills or equipment of paramedics or emergency medical technicians. (cid:137) Distance or traffic conditions would cause a delay in getting the child to the hospital. If any of the above conditions exist, or if you are not sure, it is best to call EMS 9-1-1. Emergency Guidelines for Schools, 3rd edition Emergency Guidelines for Schools, 3rd edition EMERGENCY PROCEDURES FOR INJURY OR ILLNESS 1. Remain calm and assess the situation. Be sure the situation is safe for you to approach. The following dangers will require caution: live electrical wires, gas leaks, building damage, fire or smoke, traffic or violence. 2. A responsible adult should stay at the scene and give help until the person designated to handle emergencies arrives. 3. Send word to the person designated to handle emergencies. This person will take charge of the emergency and render any further first aid needed. 4. Do NOT give medications unless there has been prior approval by the student’s parent or legal guardian and doctor according to local school board policy. 5. Do NOT move a severely injured or ill student unless absolutely necessary for immediate safety. If moving is necessary, follow guidelines in NECK AND BACK PAIN section. 6. The responsible school authority or a designated employee should notify the parent/legal guardian of the emergency as soon as possible to determine the appropriate course of action. 7. If the parent/legal guardian cannot be reached, notify an emergency contact or the parent/legal guardian substitute and call either the physician or the designated hospital on the Emergency Medical Authorization form, so they will know to expect the ill or injured student. Arrange for transportation of the student by Emergency Medical Services (EMS), if necessary. 8. A responsible individual should stay with the injured student. 9. Fill out a report for all injuries requiring above procedures as required by local school policy. The Ohio Department of Health has created a Student Injury Report Form that may be photocopied and used as needed. A copy of the form with instructions follows. POST-CRISIS INTERVENTION FOLLOWING SERIOUS INJURY OR DEATH (cid:131) Discuss with counseling staff or critical incident stress management team. (cid:131) Determine level of intervention for staff and students. (cid:131) Designate private rooms for private counseling/defusing. (cid:131) Escort affected students, siblings and close friends and other highly stressed individuals to counselors/critical incident stress management team. (cid:131) Assess stress level of staff. Recommend counseling to all staff. (cid:131) Follow-up with students and staff who receive counseling. (cid:131) Designate staff person(s) to attend funeral. (cid:131) Allow for changes in normal routines or schedules to address injury or death. Emergency Guidelines for Schools, 3rd edition Emergency Guidelines for Schools, 3rd edition