1. Helping Belton ISD Students Stay Safe & Healthy
What Every BISD Staff Needs to Know About:
Responding to Emergencies (Mr. MERT)
Health Conditions: What Do I Do?
Field Trip Process: Health Needs
Communicable Disease Prevention Updates: Lice
Blood Borne Pathogens
SEVERE
LOW
BLOOD
GLUCOSE
My name is _____________ and I am the nurse at this campus. I would like to review a few critical guidelines and procedures that have to do with keeping our students healthy and safe.
We’ve ask that you attend this training rather than doing it online to not only have a nurse available for your questions, but to also facilitate documentation. Your initials on the sign-in sheet will ensure we credit you for this course on Eduphoria. We will provide this training on-line for those that were not able to attend. Keep in mind that this training provides knowledge, but does not test skills. If you need training for being a Diabetes Care Assistant or for administering medications while on a field trip, additional training is require. School nurses will provide this training as the needs arise with our students.
Belton ISD
Health Services

2. Is it an Emergency? Not responding?
What you see
What you do
They are not moving or responding when you tap their shoulders and yell:
“Hey, are you Ok?
Yell for help
Tell someone to call a MR. MERT (Medical Emergency Response Team) to your location. Remind them to bring the AED
If no one is with you and you are alone, go call 911 and get the AED
If it looks like they are not breathing : Place the AED and give CPR if you know how
Our goal when responding to medical emergencies is to get specially trained emergency help quick. If you come across a medical emergency, first of all, before you help, make sure the scene is safe- you can’t help if you get hurt. Belton ISD’s Medical Emergency Response Plan states that you are to call 911 if you witness a severe medical emergency, especially if the person is not responding and appears to not be breathing. You will call for help by saying: ‘MR. MERT TO _________________.

3. Automatic External Defibrillators (AEDs)
Open the case and pull the handle
Voice prompts will tell you:
Place the pads on the bear chest
Just like the picture on the pad
Do not touch the person if the AED tells you a shock is needed
Push the flashing orange button when it tells you to
Start CPR if the AED tells you to and leave the pads on
Here is how to use an AED

4. The above chart guides campuses in making assignments for their MR
The above chart guides campuses in making assignments for their MR. MERT team.

5.  Health Conditions: What Do I Do? Safe & Healthy
Many students have health conditions like asthma, seizures, diabetes, or severe allergies. One way you can know if your students have a health condition requiring an emergency plan is to check on Skyward. The information may be located on any student profile page by clicking on the red H to the right of the page.
Safe & Healthy

6. 
You may also see health alerts on the student’s emergency info page.If you are aware a student has a life-threatening condition and the information is not in Skyward, please communicate with their school nurse. This includes if you have students carrying inhalers or EPIPENs.
Safe & Healthy

7. Asthma Emergency Plan Safe & Healthy
All standard emergency plans not only have how to identify and respond in that type of emergency, but they should also include the student’s emergency contact information, names of trained caregivers , including the student’s nurse, and any additional instructions by the student’s physician, such as medications to give and when to call 911. We will get you a copy of any plans you might need for your students.
A healthy “air “ environment is also important for many of our students with asthma and severe allergies, like a latex allergy. Do not use strong perfumes, cleaners or room fresheners in common areas. This could trigger an asthma or allergic reaction. Latex balloons should not be brought into the campus. The most common plans will be for asthma, diabetes, seizures and severe allergies, including food allergies.
Safe & Healthy

8. Texas law requires annual training for all school districts on life-threatening food allergies for the purpose of providing all school staff basic knowledge and skills to identify children with a possible allergic reaction to food, to begin implementation of the student’s emergency plan and to also implement strategies to reduce the risks for food allergy reactions. One out of every 25 Americans has a food allergy and it is estimated that between people die annually from food allergy reactions or anaphylaxis. Though there are other allergens like bee stings, eight foods account for 90% of all allergic reactions- they are peanuts, tree nuts, milk, eggs, wheat, fish and shellfish, and soy.
Food Allergy

9. A severe allergic reaction, or anaphjylaxis, is rapid in onset and may cause death You may see swelling, hives, itchy red rash, trouble swallowing, shortness of breath, repeitive coughin, voice change, nausea & vomiting, diarrhea, abdominal cramping, and in severe cases, a drop of blood pressure and loss of consciousness.
Asthmatic children more likely to experience an anaphylactic reaction to foods and be higher at risk for death
Food Allergy

10. Severe Allergy Emergency Plan
Standard emergency plan protocol for students with severe allergies lists what typical minor and major symptoms would be. If the parents have not provided emergency medication for a severe allergic reaction, all we can do is call 911- and keep the student still and calm. Most physicians will prescribe oral medication like Benadryl for minor symptoms and an EPIPEN for a severe reaction, but take time to review the student’s emergency plan, because it may call for an EPIPEN even if the student accidently ingests the food allergen, even if there are no symptoms. Part of our training on medication administration will include instructions on how to administer an EPIPEN.
Safe & Healthy

11. Teacher/Coach Responsibilities
Review the Emergency Plan for Severe Allergy plan with the school nurse, if available, and with the student and his/her parent/guardian.
Keep the student’s plan accessible in the classroom and available for a substitute
Ensure that an adult accompanies a student suspected of having an allergic reaction or ask the nurse to come to the student
Notify the school nurse at least 48 hours before a field trip so that emergency plan and EPIPEN administration procedures can be reviewed with one to two staff going on the field trip.
Educate classmates to avoid endangering, isolating, stigmatizing or harassing students with food allergies
Ensure other staff, students and their parents comply with any risk-reduction strategies.
Food Allergy

12. Risk Reduction Strategies
No food sharing
No utensil sharing
Avoid serving food without appropriate ingredient labels
Hand washing before and after eating snacks/meals. Soap and water are best.
Avoid cross-contamination of food by wiping down eating surfaces before and after eating.
Designate allergen safe zones, such as designated tables/seating areas
Consider eliminating or limiting foods in the classroom, buses, after-school activities which may cause a life-threatening reaction to a student in a class
Avoid or use caution when using food for classroom activities, such as for crafts, science projects, holiday celebrations, etc.
Use non-food items as rewards instead of food
Avoid high-risk areas for field trips, i.e. corn fields,
exposure to latex balloons or seafood, etc.
Risk reduction strategies include:
No food sharing
No utensil sharing
Avoid serving food without appropriate ingredient labels
Hand washing before and after eating snacks/meals. Soap and water are best.
Avoid cross-contamination of food by wiping down eating surfaces before and after eating.
Designate allergen safe zones, such as designated tables/seating areas
Consider eliminating or limiting foods in the classroom, buses, after-school activities which may cause a life-threatening reaction to a student in a class
Avoid or use caution when using food for classroom activities, such as for crafts, science projects, holiday celebrations, etc.
Use non-food items as rewards instead of food
Avoid high-risk areas for field trips, i.e. corn fields, exposure to latex balloons or seafood, etc.
Food Allergy

13. Medications/Procedures/Supplies
Field Trips
Medications/Procedures/Supplies
Emergency Care Plans
Oral medications
Epipens
Inhalers
Diabetic supplies
Other equipment
Other emergency meds
Basic 1st Aid supplies
Asthma
Bleeding Disorder
Cardiac Condition
Diabetes
Seizures
Severe Allergies
Other special conditions or procedures
Make sure you are prepared before you go on field trips. As soon as field trips are approved, inform the school nurse of date, times, place, and students going.48 hours before, meet with school nurse and receive instructions on any student’s emergency plan and /or medications and practice the skills. Many meds do not need to be given on field trips, but some do. Board Policy FFAC outlines guidelines & procedures, but always remember to never provide medication to a student unless you have proper written authorization and the medication is in a properly labeled container. The day of the field trip go by and pick up a 1st Aid kit form the nurse and the medications. Each medication will be accompanied by written instructions and a space to document the time the med was given, if needed. Diabetics will be accompanied by an unlicensed diabetic care assistant (UDCA), but the school nurse needs to know in advance so instructions can be given to the assigned UDCA.
Medication Administration on Field Trips

14. Illness Prevention Possible Fever > 100°
Examples of When a Student Would be Excluded from School:
Possible Fever > 100°
“Wet” Rash that cannot be covered
Signs & Symptoms of a contagious disease, like pertussis, mmps, chickenpox, “pink-eye”
Illness Prevention Tips:
In order to slow down the spread of illnesses, the Texas Department of Health gives us guidelines to know when we need to send a student home. Please refer students to the school nurse when they are exhibiting signs & symptoms of a contagious disease and follow these illness prevention tips:
Wash Hands
Cover Cough
Stay Home if Sick- See Your Dr.
Get Flu Shot
Communicable Disease Prevention

15. Head Lice Updates Research & Recommendations from:
New Texas Law: No School Exclusion for Head LIce
Research & Recommendations from:
American Academy of Pediatrics
National Association of School Nurses
Texas Department of State Health Services
Head Lice Guidelines Reviewed By:
Background Information
There is no statue in Texas that addresses excluding children with head lice from school.
Lice are not a public health threat, they do not carry disease
Each school district can create head lice policies, but districts should ensure that its policy does not cause children to miss class unnecessarily or encourage the embarrassment and isolation of students who suffer from repeated head lice infestations
“No nit” policies place a disproportionate amount of emphasis on head lice management instead of focusing on real health concerns that should be a higher priority. This over-emphasis can lead to unproductive use of time by school staff and parents, missed classes, unnecessary absences, and parents missing work.
Belton ISD School Health Advisory Committee
Belton ISD Administration
Communicable Disease Prevention

16. Communicable Disease Prevention
Head Lice: Prevention
School Nurses provide Parental Education about identification, treatment and prevention in person & in writing, including on BISD website
Teachers avoid classroom activities that increase head to head contact (naptime)
All staff remind students about not sharing caps, hats, scarves, hairbrushes, combs
All staff avoid practice of having students pile coats, backpacks, etc. )Use separate hooks, cubbies)
Prevention: School nurses will provide information to families and staff about diagnosis, treatment, and prevention in person and in writing, as well as making it available on the BISD website. (No sharing of caps/hats/scarves/hairbrushes, etc., no close head to head contact, no piling of coats, backpacks, parents should check child’s hair regularly at home)
Communicable Disease Prevention

17. Head Lice: Identification & Referral
Refer those exhibiting signs (itching, visible nits or lice)
Check only those with possible close head to head contact- at discretion of nurse and principal
No head checks in the classroom
Screening Procedures: No mass classroom checks will be done. Research shows that unwarranted mass screenings disrupt student and teacher class time and take away from the nurses’ ability to address the needs of the more physically or mentally disabled student. Students who may have had close head contact with a student with head lice may be checked at the discretion of the school nurse. On rare occasions, Individual classroom checks may be done if the school nurse, in consultation with the school administrator, deems it necessary due to the number of confirmed cases. Since care should be taken to maintain privacy and confidentiality during these classroom screenings, a few students should be sent to the clinic at a time to be checked, rather than the nurse checking the classroom. . Ideally, a few students may be
Communicable Disease Prevention

18. Head Lice: Management of Confirmed Case
Nurse calls parent to inform of case and educate on treatment , encouraging parent to treat
Student may remain in class, but discouraged form close head to head contact
Head Lice Notice to Class sent only at discretion of nurse and principal with several cases
Management on the Day of Diagnosis: The student may remain in class but will be discouraged from close direct head contact with others. Confidentiality must be maintained. The nurse will call the parent of the student showing signs/symptoms of head lice and send home the Head Lice Notice to Parents form. This form contains treatment instructions as well as additional resource information. The nurse, in consultation with the principal, may send home the Head Lice Notice to Classroom Parents when there is an infestation (several cases) confined to a specific classroom. The American Academy of Pediatrics writes, “ Common sense should prevail when deciding how contagious an individual child may be (a child with hundreds versus a child with 2 live lice.)”
Communicable Disease Prevention

19. Communicable Disease Prevention
Head Lice: Exclusion?
Student with > 2 cases in same week can be excluded at discretion of nurse & principal until free of live lice
Nurse will re-examine student before allowing to return
Nurse should collaborate with CIS staff to offer extra extra help for students with excessive absences due to head lice
At the discretion of the school nurse and principal, students with live lice for more than 2 days may be excluded until free of live lice. If the parent is unable to pick the child up on the day of the exclusion, the child may remain in class, but will not be sent home on the school bus. Parents will be required to pick up their child from school at the end of the day.
Readmission criteria: The infected student may be re-examined by the school nurse and the parent questioned about treatment used before readmission.
The school nurse should offer extra help to families of children who are repeatedly or chronically infested, in the form of home visits in collaboration with CIS staff to ensure treatment is being conducted effectively. No child should be allowed to miss valuable school time because of head lice.
Communicable Disease Prevention

20. Communicable Disease Prevention
Head Lice: Educate!
Head Lice, American Academy of Pediatrics, published July, 2010
Pediculosis Management in the SCHool Setting, National Association of School Nursing, August 2010.
Managing Head Lice in School Settings, Texas Department of State Health Services, December, 2012.
Lice Management: Staff Information, Belton ISD Health Services, BISD website, 2013.
Take the time to read the links provided on the BISD website Health Services tab to help you better understand the new guidelines.
Communicable Disease Prevention

21. What Every BISD Staff Needs to Know About:
Helping Belton ISD
Students & Staff
Stay Safe & Healthy
What Every BISD Staff Needs to Know About:
Blood borne Pathogens
Board policy states we are to annually inform you of the district’s bloodborne pathogen exposure plan- so here goes….
Belton ISD
Health Services
BBP

22. Why do I need this training?
Your job duties may put you at risk of exposure to blood or other potentially infectious material (OPIM)
Breaking up fights
Assisting with nose bleeds, cuts
Assisting diabetic student
Working with combative students including those who bite and break the skin
Providing swallowing therapy
You need this training because Your job duties may put you at risk of exposure to blood or other potentially infectious material (OPIM) because your job duties may put you at risk of exposure to blood or other potentially infectious material. Some of you routinely
Break up fights
Assist with nose bleeds, cuts
Assist diabetic student
Work with combative students including those who bite and break the skin or you may
Provide swallowing therapy
BBP

23. What are bloodborne pathogens?
Viruses, bacteria, and other microorganisms that are carried in the bloodstream and can cause serious diseases
The most common BBP are:
Human Immunodeficiency Virus (HIV)
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)

24. These disease can lead to problems like cirrhosis, liver cancer, liver failure, aids and death.
Many Symptoms appear months after exposure and HEP B can survive outside of the body for up to a week

25. How do BBPs enter your body?
Direct contact with blood or other body fluids of an infected person through:
Open cuts, wounds, skin abrasions
Blood splashing into your eyes, nose, or mouth
BLOOD + ENTER BODY

26. Belton ISD Provides the Hepatitis B vaccine to :
Staff working in special-ed self-contained classrooms
Staff working in the school health clinics
Staff whose school duties placed them at risk to frequently come in contact with blood or other potentially infectious material
3shots: 1-2 months apart
Notify the BeltonISD School Health Coordinator immediately if you have not received the vaccine (See Hep B form)
Most insurances do not charge. Belton ISD will provide if your insurance does not cover the vaccine

27. Best Practice: Universal Precautions
“All Blood is the Same”
When you take Universal Precautions you act like all human blood may be infectious and treat everyone the same. You will take precautions with everyone’s blood.

28. Best Practice: Wear Gloves
Wear gloves when you might be coming in contact with someone’s blood or body fluids.
Wear goggles or gowns if needed.

29. Best Practice: Wash Hands
Wash hands with soap and water before eating, after any contact with blood, body fluids, or soiled objects, After using the toilet, after assisting with personal hygiene, after the removal of gloves

30. Best Practice: Proper Cleaning
Belton ISD trains staff to clean up blood & body fluids properly using the right cleaners and the right method.
Waste such as bloody tissues should be disposed of in a plastic-lined trash and after being double-bagged, can be thrown in the dumpster

31. Best Practice: Sharps Containers
Use sharps containers if you are diabetic and will be checking you blood sugar or give yourself injections at school and make sure students are using them as well. They are located in the health clinics, and we can make sure they are also available in staff lounges if needed.

32. Best Practice: Report Exposure
When blood or body fluids gets in through non-intact skin or mucous membranes, or if you are poked with a needle, do the following:
Wash the exposed area with soap and water, or irrigate the eyes with water
Report the incident to the Health Services Coordinator for investigation and proper referral
The district will provide for additional medical evaluation and treatment if needed
Health Services: Charlotte Smith, RN

33. BBP: INFORMATION ACCESS
Annual Training
Web Access: Staff Training Tab of School Health Service Page
Written Access:
BBP Exposure Control the school health office of each campus or department in the district
Contact me or the Health Services Coordinator if you have any questions about BBP.
Belton ISD
BBP
Exposure
Control
Plan
BBP

34. Questions or Comments? References & Resources
Emergency:
American Academy of Pediatrics (AAP). (2008) Disaster planning for schools. Pediatrics, 122 (4) pp. 895‐ 901. doi: /peds.2008‐2170
Cole, V., Henry, B., Tyson, D., Fitzgerald, R., Hopkins, R. (2007). In the face of danger: Comprehensive emergency preparedness and response for schools. Penn GSE Perspectives on Urban Education, Retrieved from 2_In%20the%20Face%20of%20Danger.html
Doyle, J., & Loyacono, T. (2007). Disaster preparedness guidelines for school nurses. Silver Spring, MD: National Association of School Nurses.
Fitzpatrick, B. (2006). Emergency management, crisis response and the school nurse’s role. In J. Selekman (Ed.) School nursing: A comprehensive text. (pp. 205‐ 233). Philadelphia: F.A. Davis Company.
Diabetes
Care, 34(Supp 1), S70‐S74.
American Association of Diabetes Educators (AADE). (2008). Position statement: Management of children with diabetes in the school setting. The Diabetes Educator, 34(3), 439‐443.
American Nurses Association /National Association of School Nurses (ANA/ NASN). (2011). Scope and standards of practice: School nursing, 2nd ed. Silver Spring, MD: Nursebooks.org.
Food Allergy
American Academy of Allergy, Asthma and Immunology Board of Directors (1998). Position Statement-Anaphylaxis in schools and other child-care settings. Journal of Allergy Clinical Immunology: 102(2),
Food Allergy Network (2001). Information about anaphylaxis: Commonly asked questions about anaphylaxis.
Mudd, K. E. & Noone, S. A., (1995). Management of severe food allergy in the school setting. Journal of School Nursing: 11(3), 30-32
National Association of School Nurses (2000). Position Statement-Epinephrine use in life-threatening emergencies. Scarborough, ME: Author.
You may review this training sections on the Health Services BISD district website – Please refer any questions to your school nurse.

35. Questions or Comments? References & Resources
Medication
Belton Independent School District Board Policy (2012). FFAC Legal and Local: Wellness and Health Services: Medical Treatment: Administering Medication. Retrieved June 22, 2012 from
Belton Independent School District Board Policy (2012). FFAF Legal: Wellness and Health Services: Individualized Health Plan. Retrieved June 22, 2012 from
Texas Department of State Health Services (2011). Texas School Health Guidelines: School health Manual: Chapter 5, 208. Retrieved June 22, 2012 from
American Academy of Pediatrics. (2009). Policy statement guidance for the administration of medication in school. Pediatrics 124, 1244‐1251.
American Nurses Association / National Council of State Boards of Nursing (ANA/NCSBN). (2006). Joint statement on delegation. Retrieved from
American Nurses Association (ANA). (2005). Principles of delegation. Silver Springs, MD: Author.
Canham, D.L., Bauer, L., Concepcion, M., Luong, J., Peters, J., & Wilde, C. (2007). An audit of medication administration: A glimpse into school health offices. Journal of School Nursing, 23, 21‐27. doi: /
Clay, D., Farris, K., McCarthy, A.M., Kelly, M.W., Howard, R. (2008). Family perceptions of medication administration at school: errors, risk factors and consequences. Journal of School Nursing, 24, 95‐102. doi: /
Gursky, B. S., & Ryser, B. J., (2007). A training program for unlicensed assistive personnel. Journal of School Nursing, 23, 92‐97. doi: /
BBP
Contact info:
Belton ISD Health Services