2EMERGENCY GUIDELINES FOR SCHOOLS 3RD EDITION, 2007Ohio Department of HealthSchool and Adolescent HealthSchool Nursing ProgramProject StaffAngela Norton, MA; Program AdministratorDorothy Bystrom, RN, M.Ed.; School Nursing Program SupervisorDiana McMahon, RN, MSN; School Nurse Consultant – Emergency PreparednessAnn Connelly, RN, MSN; School Nurse ConsultantAcknowledgementsSpecial thanks go to the following individuals for their outstanding contributions to thedevelopment and preparation of the Emergency Guidelines for Schools (EGS):William Cotton, MD; Columbus Children’s HospitalPresident; Ohio Chapter of the American Academy of PediatricsWendy J. Pomerantz, MD, MS; Cincinnati Children’s HospitalOhio EMSC Grant Principal InvestigatorAmerican Academy of Pediatrics Representative to the State Board of EMSChristy Beeghly, MPH; ConsultantWe 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 forChildren (EMSC) ProgramMembers of the American Academy of Pediatrics, Ohio Chapter, Committee on PediatricEmergency Medicine and the Ohio EMSC CommitteeSchool nurses and other school personnel who took time to provide feedback on their use of theEGS so they could be improved for future usersThe EMSC National Resource Center and other state EMSC programs that adopted the EGS andprovided feedbackOriginal Project Staff - Ohio Department of Public Safety, Division of EMSChristy Beeghly, MPH; Ohio EMSC Coordinator,Alan Boster; Ohio EMSC Coordinator,Original funding for this project included the Emergency Medical Services for Children Program, Health Resources and ServicesAdministration, Maternal and Child Health Bureau, and the National Highway Traffic Safety Administration. Funding for thecurrent edition was provided by the U.S. Department of Health & Human Services, Maternal and Child Health Bureau Grant #B04MC and by the Centers for Disease Control (CDC) Bioterrorism Grant # U901CCU
3HOW TO USE THE EMERGENCY GUIDELINES In an emergency, refer first to the guideline for treating the most severesymptom (e.g., unconsciousness, bleeding, etc.). Learn when EMS (Emergency Medical Services) should be contacted. Copythe When to Call EMS page and post in key locations. The back outside cover of the booklet contains important information about keyemergency numbers in your area. It is important to complete this informationas soon as you receive the booklet as you will need to have this informationready in an emergency situation. The guidelines are arranged with tabs in alphabetical order for quick access. A colored flow chart format isused to guide you easilythrough all steps andsymptoms from beginning toKEY TO SHAPES & COLORSending. See the Key toShapes and Colors. Take some time to familiarizeyourself with the EmergencyProcedures for Injury orIllness. These proceduresgive a general overview of therecommended steps in anemergency situation and thesafeguards that should betaken. In addition, information hasbeen provided aboutInfection Control, PlanningSTARTFIRST AIDSTART &QUESTIONORSTOPNOTEStart here.Provides first-aid instructions.Asks a question. You will havea decision to make based on the student'scondition.Stop here. This is the final instruction.A note to provide background information.This type of box should be read beforeemergencies occur.for Students with SpecialNeeds, Injury Reporting,School Safety Planning andEmergency Preparedness.Emergency Guidelines for Schools, 3rd edition
4MEDICAL SERVICES (EMS) 9-1-1 WHEN TO CALL EMERGENCYMEDICAL SERVICES (EMS) 9-1-1Call EMS if:The child is unconscious, semi-conscious or unusually confused.The child’s airway is blocked.The child is not breathing.The child is having difficulty breathing, shortness ofbreath or is choking.The child has no pulse.The child has bleeding that won’t stop.The child is coughing up or vomiting blood.The child has been poisoned.The child has a seizure for the first time or a seizure that lasts more than fiveminutes.The child has injuries to the neck or back.The child has sudden, severe pain anywhere in the body.The child’s condition is limb-threatening (for example, severe eye injuries,amputations or other injuries that may leave the child permanently disabledunless he/she receives immediate care).The child’s condition could worsen or become life-threatening on the way tothe hospital.Moving the child could cause further injury.The child needs the skills or equipment of paramedics or emergency medicaltechnicians.Distance or traffic conditions would cause a delay in getting the child to thehospital.If any of the above conditions exist, or if you are not sure, it is best to callEMSEmergency Guidelines for Schools, 3rd edition
5EMERGENCY PROCEDURES FOR INJURY OR ILLNESS 188.8.131.52.184.108.40.206.9.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.A responsible adult should stay at the scene and give help until the person designated tohandle emergencies arrives.Send word to the person designated to handle emergencies. This person will take charge ofthe emergency and render any further first aid needed.Do NOT give medications unless there has been prior approval by the student’s parent orlegal guardian and doctor according to local school board policy.Do NOT move a severely injured or ill student unless absolutely necessary for immediatesafety. If moving is necessary, follow guidelines in NECK AND BACK PAIN section.The responsible school authority or a designated employee should notify the parent/legalguardian of the emergency as soon as possible to determine the appropriate course ofaction.If the parent/legal guardian cannot be reached, notify an emergency contact or theparent/legal guardian substitute and call either the physician or the designated hospital onthe Emergency Medical Authorization form, so they will know to expect the ill or injuredstudent. Arrange for transportation of the student by Emergency Medical Services (EMS), ifnecessary.A responsible individual should stay with the injured student.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 bephotocopied and used as needed. A copy of the form with instructions follows.POST-CRISIS INTERVENTION FOLLOWING SERIOUS INJURY OR DEATHDiscuss with counseling staff or critical incident stress management team.Determine level of intervention for staff and students.Designate private rooms for private counseling/defusing.Escort affected students, siblings and close friends and other highly stressedindividuals to counselors/critical incident stress management team.Assess stress level of staff. Recommend counseling to all staff.Follow-up with students and staff who receive counseling.Designate staff person(s) to attend funeral.Allow for changes in normal routines or schedules to address injury or death.Emergency Guidelines for Schools, 3rd edition
6PLANNING FOR STUDENTS WITH SPECIAL NEEDS HEALTH CONDITIONS: Some students in your school may have special emergency care needs due to health conditions, physicalabilities or communication challenges. Include caring for these students’ special needs in emergency anddisaster planning.HEALTH CONDITIONS:Some students may have special conditions that put them at risk for life-threatening emergencies: Seizures Diabetes Asthma or other breathing difficulties Life-threatening or severe allergic reactions Technology-dependent or medically fragile conditionsYour school nurse or other school health professional, along with the student’s parent or legal guardianand physician should develop individual emergency care plans for these students when they are enrolled.These emergency care plans should be made available to appropriate staff at all times.In the event of an emergency situation, refer to the student’s emergency care plan.The American College of Emergency Physicians and the American Academy of Pediatrics have created anEmergency Information Form for Children (EIF) with Special Needs, that is included on the next pages. It canalso be downloaded from This form provides standardized information that can be used toprepare the caregivers and health caresystem for emergencies of children with special health care needs. TheEIF will ensure a child’s complicated medical history is concisely summarized and available when needed most -when the child has an emergency health problem when neither parent nor physician is immediately available.PHYSICAL ABILITIES:Other students in your school may have special emergency needs due to their physical abilities. Forexample, students who are: In wheelchairs Temporarily on crutches/walking casts Unable or have difficulty walking up or down stairsThese students will need special arrangements in the event of a school-wide emergency (e.g., fire,tornado, evacuation, etc.). A plan should be developed and a responsible person should be designated toassist these students to safety. All staff should be aware of this plan.COMMUNICATION CHALLENGES:Other students in your school may have sensory impairments or have difficulty understanding specialinstructions during an emergency. For example, students who have: Vision impairments Hearing impairments Processing disorders Limited English proficiency Behavior or developmental disorders Emotional or mental health issuesThese students may need special communication considerations in the event of a school-wideemergency. All staff should be aware of plans to communicate information to these students.
7EmergencyInformationFormforChildrenWithSpecialNeeds Last name:RevisedInitialsDate formcompletedBy WhomBaseline physical findings:Baseline vital signs:Birthdate:Nickname:Name:HomeAddress:Home/WorkPhone:Parent/Guardian:EmergencyContactNames&Relationship:Signature/Consent*:PrimaryLanguage:PhoneNumber(s):Physicians:Primarycarephysician:EmergencyPhone:Fax:CurrentSpecialtyphysician:Specialty:AnticipatedPrimaryED:Pharmacy:AnticipatedTertiaryCareCenter:Diagnoses/Past Procedures/Physical Exam:220.127.116.11.Synopsis:Baseline neurological status:*Consent for release of this form to health care providers
8hand sanitizer may be used according to manufacturer’s instructions. INFECTION CONTROLTo reduce the spread of infectious diseases (diseases that can be spread fromone person to another), it is important to follow universal precautions. Universalprecautions are a set of guidelines that assume all blood and certain other bodyfluids are potentially infectious. It is important to follow universal precautionswhen providing care to any student, whether or not the student is known to beinfectious. The following list describes universal precautions:x Wash hands thoroughly with running water and soap for at least 15 seconds:18.104.22.168.5.Before and after physical contact with any student (even if gloves have been worn).Before and after eating or handling food.After cleaning.After using the restroom.After providing any first aid.Be sure to scrub between fingers, under fingernails and around the tops andpalms of hands. If soap and water are not available, an alcohol-based waterlesshand sanitizer may be used according to manufacturer’s instructions.x Wear disposable gloves when in contact with blood and other body fluids.x Wear protective eyewear when body fluids may come in contact with eyes (e.g.,squirting blood).x Wipe up any blood or body fluid spills as soon as possible (wear disposablegloves). Double bag the trash in plastic bags and dispose of immediately. Cleanthe area with an appropriate cleaning solution.x Send soiled clothing (i.e., clothing with blood, stool or vomit) home with thestudent in a double-bagged plastic bag.x Do not touch your mouth or eyes while giving any first aid.GUIDELINES FOR STUDENTS:x Remind students to wash hands thoroughly after coming in contact withtheir own blood or body fluids.x Remind students to avoid contact with another person’s blood or bodyfluids.Emergency Guidelines for Schools, 3rd edition
9AUTOMATIC EXTERNAL DEFIBRILLATORS (AEDS) FOR CHILDREN OVER 1 YEAR OF AGE & ADULTSCPR and AEDs are to be used when a person is unresponsive or when breathing or heart beatstops.If your school has an AED, this guideline will refresh information provided in training courses as toincorporating AED use into CPR cycles.1. Tap or gently shake the shoulder. Shout, “Are you OK?” If person is unresponsive, shout for helpand send someone to CALL EMS and get your school’s AED if available.2. Follow primary steps for CPR (see “CPR” for appropriate age group – infant, 1-8 years, over 8years and adults).3. If available, set up the AED according to the manufacturer’s instructions. Turn on the AED andfollow the verbal instructions provided. Incorporate AED into CPR cycles according to instructionsand training method..IF CARDIAC ARREST OR COLLAPSE WASWITNESSED:IF CARDIAC ARREST OR COLLAPSE WAS NOTWITNESSED:4. Use the AED first.4. Start CPR first. See age appropriate5. Prepare AED to check heart rhythmand deliver 1 shock as necessary.6. Begin 30 CPR chest compressionsfollowed by 2 normal rescuebreaths. See age-appropriate CPRguideline.7. Complete 5 cycles of CPR (30chest compressions to 2 breaths ata rate of 100 compressions perminute).8. Prompt another AED rhythm check.9. Rhythm checks should be performed after every 2minutes (about 5 cycles) of CPR.10. REPEAT CYCLES OF 2 MINUTES OF CPR TO 1AED RHYTHM CHECK UNTIL VICTIMRESPONDS OR HELP ARRIVES.CPR guideline. Continue for 5 cycles orabout 2 minutes of 30 chestcompressions to 2 breaths at a rate of100 compressions per minute.5. Prepare the AED to check the heartrhythm and deliver a shock as needed.6. REPEAT CYCLES OF 2 MINUTES OFCPR TO 1 AED RHYTHM CHECKUNTIL VICTIM RESPONDS OR HELPARRIVES.
10ALLERGIC REACTION Children may experience a delayed allergic reaction upto 2 hours following foodingestion, bee sting, etc.Does the student have any symptoms of asevere allergic reaction which may include:.Students with life-threatening allergiesshould be known toappropriate school staff.An emergency careplan should bedeveloped. Staff in aposition to administerapproved medicationsshould receiveinstruction.yFlushed face?Dizziness?Seizures?Confusion?Weakness?Paleness?yNOHives all over body?Blueness around mouth, eyes?Difficulty breathing?Drooling or difficulty swallowing?Loss of consciousness?Symptoms of a mild allergicYESreaction include:y Red, watery eyes.y Itchy, sneezing, runny nose.y Hives or rash on one area.yCheck student's airway.Look, listen and feel for breathing.If student stops breathing, startCPR. See "CPR."Adult(s) supervising studentduring normal activities shouldbe aware of the student'sexposure and should watch forDoes student have an emergencycare plan available?any delayed symptoms of asevere allergic reaction (seeabove) for up to 2 hours.If student is souncomfortable thathe/she is unable toparticipate in schoolNOFollow school policiesfor students withsevere allergic reactions.Continue CPR if needed.YESRefer to student's plan.Administer doctor-andparent/guardian-approvedmedication as indicated.activities, contactresponsible schoolauthority & parentor legal guardian.CALL EMSContact responsibleschool authority &parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
11ASTHMA - WHEEZING - DIFFICULTY BREATHING Students with ahistory of breathingdifficulties includingasthma/wheezingshould be known toappropriate school staff.A care plan which includesan emergency action planshould be developed. ORCallows students topossess and use an asthmainhaler in the school. StaffA student with asthma/wheezing may have breathingdifficulties which may include:y Uncontrollable coughing.y Wheezing - a high-pitched sound during breathing out.y Rapid breathing.y Flaring (widening) of nostrils.y Feeling of tightness in the chest.y Not able to speak in full sentences.y Increased use of stomach and chest muscles duringbreathing.must try to remain calmdespite the student's anxiety.Staff in a position toyDid breathing difficulty develop rapidly?Are the lips, tongue or nail beds turning blue?YESadminister approvedmedicationsshould receiveinstruction.NORefer to student'semergency care plan.CALLEMSDoes student have doctor-and parent/guardian-approved medication?Has an inhaler already beenused? If yes, when and how often?YESYESNONORemain calm. Encourage the student to sitquietly, breathe slowly and deeply in through thenose and out through the mouth.Administermedication asdirected.Are symptoms not improvingor getting worse?NOYESContactresponsibleschool authority& parent/legalguardian.CALL EMSEmergency Guidelines for Schools, 3rd edition
12BEHAVIORAL EMERGENCIES .Behavioral or psychological emergencies may take many forms(e.g., depression, anxiety/panic, phobias, destructive orStudents with a historyof behavioral problems,emotional problems orother special needsshould be known toappropriate schoolstaff. An emergencycare plan should bedeveloped.assaultive behavior, talk of suicide, etc.).Intervene only if the situation is safe for you.Refer to your school's policy for addressingbehavioral emergencies.Does studenthave visibleinjuries?NOYESSee appropriate guideline toprovide first aid.CALL EMS if any injuries.require immediate care.yDoes student's behavior present an immediaterisk of physical harm to persons or property?Is student armed with a weapon?CALL THEPOLICE.YESNOThe cause of unusual behavior may be psychological, emotionalor physical (e.g., fever, diabetic emergency, poisoning/overdose,alcohol/drug abuse, head injury, etc.). The student should be seenby a health care provider to determine the cause.Suicidal and violent behavior should be taken seriously.If the student has threatened to harm him/herself or others,.contact the responsible school authority immediately .Contactresponsibleschool authority &parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
13BITES or other body fluids. soap and water. See "Bleeding." (HUMAN & ANIMAL)Wear disposable gloveswhen exposed to bloodor other body fluids.Wash the bite area withsoap and water.Press firmly witha clean dressing.See "Bleeding."Is studentbleeding?Hold under runningwater for 2-3 minutes.YESNOCheck student's immunizationrecord for tetanus. See"Tetanus Immunization."Bites from the followinganimals can carry rabiesand may need medicalattention:y Dog y Bat.y Opossum. y Skunk.y Raccoon y Fox.y Coyote y Cat.If skin is broken, contactresponsible school authority& parent/legal guardian..URGE IMMEDIATEMEDICAL CARE.Is bite froman animalor human?ANIMALHUMANIf bite is from a snake, hold thebitten area still and below thelevel of the heart.CALL POISON CONTROLFollow their directions.Parents/legalguardians of the studentwho was bittenand the studentwho was biting should benotified that their student mayhave been exposed to bloodfrom another student. Individualconfidentiality must beyIs bite large or gaping?Is bleeding uncontrollable?maintained whensharing information.YESCALL EMS9-1-1.NOReport bite toproper authorities,Contact responsibleschool authority &parent/legal guardian.usually the local healthdepartment, so theanimal can be caughtand watchedfor rabies.Emergency Guidelines for Schools, 3rd edition
14Wear disposable gloves when Check student's immunization record BLEEDINGWear disposable gloves whenexposed to blood or other body fluids.Check student'simmunization recordfor tetanus. See"Tetanus Immunization."Is injured partamputated (severed)?NOYESCALL EMSy Press firmly with a clean bandageto stop bleeding.y Elevate bleeding body part gently .If fracture is suspected, gentlysupport part and elevate.y Bandage wound firmlywithout interfering with circulationto the body part..y Do NOT use a tourniquet.y Place detached part in a plastic bag.y Tie bag.y Put bag in a container of ice water.y Do NOT put amputated part directlyon ice..y Send bag to the hospital with student.Is there continueduncontrollable bleeding?YESCALL EMSNOy Have student lie down.y Elevate student's feet 8-10 inches unlessthis causes the student pain or discomfortor a neck/back injury is suspected.y Keep student's body temperature normal.y Cover student with a blanket or sheet.If wound is gaping,student may needstitches. Contactresponsible schoolauthority & parentor legal guardian.URGE MEDICAL.CARE.Contactresponsibleschool authority& parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
15most recent draft EGS 122006.igx BLISTERS (FROM FRICTION) Wear disposable gloves whenexposed to blood and other bodyfluids.Washthe area gentlywithwater. Use soap ifnecessaryto remove dirt.YESApplycleandressingand bandage to preventfurther rubbing.Is blister broken?NODo NOT break blister.Blisters heal best when.kept cleanand dry.If infectionissuspected, contactresponsible schoolauthority&parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
16school with unexplained, unusual or frequent bruising, consider the BRUISESIf student comes toschool with unexplained,unusual or frequentbruising, consider thepossibility of child abuse.See "Child Abuse."yIs bruise deep in the muscle?Is there rapid swelling?Is student in great pain?YESNOContact responsibleRest injured part.school authority & parentor legal guardian.Apply cold compress or icebag, covered with a cloth orpaper towel, for 20 minutes.If skin is broken,treat as a cut. See"Cuts, Scratches& Scrapes."Emergency Guidelines for Schools, 3rd edition
17situation is safe for you If student comes to school with pattern BURNSAlways make sure thesituation is safe for youbefore helping the student.If student comes toschool with patternburns (e.g., iron orcigarette shape) orglove-like burns,consider the possibilityof child abuse. See"Child Abuse."ELECTRICALWhat type of burn is it?CHEMICALHEATyWear gloves and ifpossible, goggles.yRemove student's clothingand jewelry if exposed tochemical.Rinse chemicals off skin,eyes IMMEDIATELY withlarge amounts of water.See "Eyes" if necessary.Rinse for minutes.Flush the burn withlarge amounts of coolrunning water or cover itwith a clean, cool, wet cloth.Do NOT use ice.Is student unconsciousor unresponsive?YESNOSee "Electric Shock."yIs burn large or deep?Is burn on face or eye?Is student having difficultybreathing?Is student unconscious?Are there other injuries?CALL POISON CONTROL.while flushing burn andfollow instructions.YESNOCover/wrap burnedCheck student's immunizationpart loosely with aclean dressing.record for tetanus.See "Tetanus Immunization."CALL EMSContactresponsibleschool authority &parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
18NOTES ON PERFORMING CPR The American Heart Association (AHA) issued new CPR guidelines for laypersons in 2005.* Otherorganizations such as the American Red Cross also offer CPR training classes. If the guidance in this bookdiffers from the instructions you were taught, follow the methods you learned in your training class. In orderto perform CPR safely and effectively, skills should be practiced in the presence of a trained instructor. It is arecommendation of these guidelines that anyone in a position to care for students should be properly trainedin CPR.Current first aid, choking and CPR manuals and wall chart(s) should also be available. The AmericanAcademy of Pediatrics offers the Pediatric First Aid for Caregivers and Teachers (PedFACTS) ResourceManual and 3-in-1 First Aid, Choking, CPR Chart for sale atCHEST COMPRESSIONSThe AHA is placing more emphasis on the use of effective chest compressions in CPR. CPR chestcompressions produce blood flow from the heart to the vital organs. To give effective compressions,rescuers should:Follow revised guidelines for hand use and placement based on age.Use a compression to breathing ratio of 30 compressions to 2 breaths.“Push hard and push fast.” Compress chest at a rate of about 100 compressions per minute for allvictims.Compress about 1/3 to 1/2 the depth of the chest for infants and children, and 1½ to 2 inches foradults.Allow the chest to return to its normal position between each compression.Use approximately equal compression and relaxation times.Try to limit interruptions in chest compressions.BARRIER DEVICESBarrier devices, to prevent the spread of infections from one person toanother, can be used when performing rescue breathing. Several differenttypes (e.g., face shields, pocket masks) exist. It is important to learn andpractice using these devices in the presence of a trained CPR instructorbefore attempting to use them in an emergency situation. Rescue breathingtechnique may be affected by these devices.CHOKING RESCUE - CHANGE IN OHIO REVISED CODE (ORC)ORC Employee trained in Heimlich maneuver to be present while students served food.Any school district or nonpublic school that operates a food service program pursuant to sectionor [ ] of the ORC shall require at least one employee who has receivedinstruction in methods to prevent choking and has demonstrated an ability to perform the Heimlichmaneuver to be present while students are being served food.Any nonpublic school or employee of a nonpublic school is not liable in damages in a civil action forinjury, death, or loss to person or property allegedly caused by an act or omission of the nonpublicschool or an employee of the nonpublic school in connection with performance of the duties requiredunder division (A) of this section unless such act or omission was with malicious purpose, in badfaith, or in a wanton or reckless manner.*Currents in Emergency Cardiovascular Care, American Heart Association, WinterEmergency Guidelines for Schools, 3rd edition
19CARDIOPULMONARY RESUSCITATION (CPR) FOR INFANTS UNDER 1 YEAR CPR is to be used when an infant is unresponsive or when breathing or heart beat stops.1. Gently shake infant. If no response, shout for help and send someone to call EMS.2. Turn the infant onto his/her back as a unit by supporting the head and neck.3. Lift chin up and out with one hand while pushing down on the forehead with the other to openAIRWAY.4. Check for BREATHING. With your ear close to infant’s mouth, LOOK at the chest formovement, LISTEN for sounds of breathing and FEEL for breath on your cheek.5. If infant is not breathing, take a normal breath. Seal your lips tightly around his/her mouth and nose. Whilekeeping the airway open, give 1 normal breath over 1 second and watch for chest to rise.theIF CHEST RISES WITH RESCUE BREATH (AIRGOES IN):6. Find finger position near centerof breastbone just below thenipple line. (Make sure fingersare NOT over the very bottom ofIF CHEST DOES NOT RISE WITH RESCUEBREATH (AIR DOES NOT GO IN):6. Re-tilt head back. Try to give 2 breaths again.IF CHEST RISES WITH RESCUE BREATH,FOLLOW LEFT COLUMN.the breastbone.)IF CHEST STILL DOES NOT RISE:7. Compress chest hard and fast 30times with 2 or 3 fingers about 1/3 to1/2 the depth of the infant’s chest.Use equal compression andrelaxation times. Limitinterruptions in chestcompressions.8. Give 2 normal breaths, eachlasting 1 second. Each breathshould make chest rise.9. REPEAT CYCLES OF 3OCOMPRESSIONS TO 2 BREATHS AT ARATE OF 100 COMPRESSIONS PERMINUTE UNTIL INFANT STARTSBREATHING EFFECTIVELY ON OWN ORHELP ARRIVES.7. Find finger position near center of breastbonejust below the nipple line. (Make sure fingersare not over the very bottom of thebreastbone.)8. Using 2 or 3 fingers, give up to 5 chest thrustsnear center of breastbone. (Make surefingers are NOT over the very bottom of the9. Look in mouth. If foreign object isseen, remove it. Do not perform ablind finger sweep or lift the jaw ortongue.REPEAT STEPS 6-9 UNTILBREATHS GO IN, INFANTSTARTS TO BREATHE ON OWNOR HELP ARRIVES.Call EMS after 2 minutes (5 cycles of 30compressions to 2 rescue breaths) if notalready called.Pictures reproduced with permission.Textbook of Pediatric Basic Life Support, 1994Copyright American Heart Association.Emergency Guidelines for Schools, 3rd edition
20CARDIOPULMONARY RESUSCITATION (CPR) FOR CHILDREN 1 to 8 YEARS OF AGE CPR is to be used when a student is unresponsive or when breathing or heart beat stops.1. Tap or gently shake the shoulder. Shout, “Are you OK?” If child is unresponsive, shout forhelp and send someone to call EMS and get your school’s AED if available.2. Turn the child onto his/her back as a unit by supporting head and neck. If head or neck injuryis suspected, DO NOT BEND OR TURN NECK.3. Lift chin up and out with one hand while pushing down on the forehead with the other to openthe AIRWAY.4. Check for normal BREATHING. With your ear close to child’s mouth, take 5-10 seconds toLOOK at the chest for movement, LISTEN for sounds of breathing and FEEL for breath on your cheek.5. If you witnessed the child’s collapse, first set up the AED and connect the pads according to the manufacturer’sinstructions. Incorporate use into CPR cycles according to instructions and training method. For anunwitnessed collapse, perform CPR for 2 minutes and then use AED.6. If child is not breathing, take a normal breath. Seal your lips tightly around his/her mouth; pinch nose shut.While keeping airway open, give 1 breath over 1 second and watch for chest to rise.IF CHEST RISES WITH RESCUE BREATH(AIR GOES IN):7. Find hand position near centerof breastbone at the nippleline. (Do NOT place your handover the very bottom of theIF CHEST DOES NOT RISE WITH RESCUE BREATH(AIR DOES NOT GO IN):7. Re-tilt head back. Try to give 2 breaths again.IF CHEST RISES WITH RESCUE BREATH, FOLLOWLEFT COLUMN.breastbone.)IF CHEST STILL DOES NOT RISE:8. Compress chest hard and fast30 times with the heel of 1 or 2hands.* Compress about 1/3 to 1/2 depth of child’schest. Allow the chest to return to normal position8. Find hand position near center of breastbone at thenipple line. (Do NOT place your hand over the verybottom of the breastbone.)between each compression.9. Compress chest fast and hard 5 times with the heelLift fingers to avoid pressureon ribs. Use equalcompression and relaxationtimes. Limit interruptions inchest compressions.9. Give 2 normal breaths, eachlasting 1 second. Each breath should make theof 1 or 2 hands.* Compress about 1/3 to 1/2 depthof child’s chest. Lift fingers toavoid pressure on ribs.Look in mouth. If foreign objectis seen, remove it. Do NOTperform a blind finger sweep orlift the jaw or tongue.chest rise.REPEAT STEPS 6-9 UNTILREPEAT CYCLES OF 30 COMPRESSIONS TO 2BREATHS AT A RATE OF 100 COMPRESSIONSPER MINUTE UNTIL CHILD STARTS BREATHINGON OWN OR HELP ARRIVES.BREATHS GO IN, CHILD STARTS TO BREATHEEFFECTIVELY ON OWN OR HELP ARRIVES.11. Call EMS after 2 minutes (5 cycles of 30compressions to 2 rescue breaths) if notalready called.Pictures reproduced with permission.Textbook of Pediatric Basic Life Support, 1994Copyright American Heart Association*Hand positions for child CPR: hand: Use heel of 1 hand only. hands: Use heel of 1 hand withsecond on top of first.Emergency Guidelines for Schools, 3rd edition
21CARDIOPULMONARY RESUSCITATION (CPR) FOR CHILDREN OVER 8 YEARS OF AGE & ADULTSCPR is to be used when a person is unresponsive or when breathing or heart beat stops.1. Tap or gently shake the shoulder. Shout “Are you OK?” If person is unresponsive, shout for help and sendsomeone to call EMS AND get your school’s AED if available.2. Turn the person onto his/her back as a unit by supporting head and neck. If head or neckinjury is suspected, DO NOT BEND OR TURN NECK.3. Lift chin up and out with one hand while pushing down on the forehead with the other toopen the AIRWAY.4. Check for normal BREATHING. With your ear close to person’s mouth, LOOK at the chestfor movement, LISTEN for sounds of breathing and FEEL for breath on your cheek.Gasping in adults should be treated as no breathing.5. If you witnessed the collapse, first set up the AED and connect the pads according to the manufacturer’sinstructions. Incorporate use into CPR cycles according to instructions and training method. For anunwitnessed collapse, perform CPR for 2 minutes and then use AED.6. If victim is not breathing, take a normal breath, seal your lips tightly around his/her mouth; pinch nose shut.While keeping airway open, give 1 breath over 1 second and watch for chest to rise.IF CHEST RISES WITH RESCUE BREATH(AIR GOES IN):7. Give a second rescue breath lasting 1 seconduntil chest rises.8. Place heel of one hand ontop of the center ofbreastbone. Place heel ofother hand on top of the first.Interlock fingers. (Do NOTplace your hands over thevery bottom of the breastbone.)9. Position self vertically above victim’s chest andwith straight arms, compress chest hard and fastabout 1½ to 2 inches 30 times in a row withboth hands. Allow the chest to return to normalposition between each compression. Lift fingerswhen compressing to avoid pressure on ribs. LimitIF CHEST DOES NOT RISE WITH RESCUEBREATH (AIR DOES NOT GO IN):7. Re-tilt head back. Try to give 2breaths again.IF CHEST RISES WITH RESCUEBREATH, FOLLOW LEFT COLUMN.IF CHEST STILL DOES NOT RISE:8. Place heel of one hand on top of the center ofbreastbone. Place heel of other hand on top of thefirst. Interlock fingers. (Do NOT place your handsover the very bottom of the breastbone.)9. Position self vertically above person’s chest andwith straight arms, compress chest 30 times withboth hands about 1½ to 2 inches. Lift fingers toavoid pressure on ribs.interruptions in chest compressions.Look in the mouth. If foreign object is seen, remove10.11.12.Give 2 normal breaths, each lasting 1 second.Each breath should make the chest rise.REPEAT CYCLES OF 30 COMPRESSIONS TO2 BREATHS AT A RATE OF 100COMPRESSONS PER MINUTE UNTIL VICTIMRESPONDS OR HELP ARRIVES.Call EMS after 2 minutes (5 cycles of 30compressions to 2 rescue breaths) if not alreadycalled.it. Do not perform a blind finger sweep or lift thejaw or tongue.REPEAT STEPS 6-9 UNTIL BREATHS GO IN,PERSON STARTS TO BREATHE EFFECTIVELYON OWN OR HELP ARRIVES.Pictures reproduced with permission.Textbook of Pediatric Basic Life Support, 1994Copyright American Heart Association.Emergency Guidelines for Schools, 3rd edition
22CHOKING (Conscious Victims) Call EMS after starting rescue efforts.INFANTS UNDER 1 YEARBegin the following if the infant is choking and isunable to breathe. However, if the infant is coughingor crying, do NOT do any of the following, but callEMS, try to calm the child and watch for worsening ofsymptoms. If cough becomes ineffective (loss ofsound), begin step 1 below.CHILDREN OVER 1 YEAR OF AGE & ADULTSBegin the following if the victim is choking and unableto breathe. Ask the victim: “Are you choking?” If thevictim nods yes or can’t respond, help is needed.However, if the victim is coughing, crying or speaking,do NOT do any of the following, but call EMS, try tocalm him/her and watch for worsening of symptoms. Ifcough becomes ineffective (loss of sound) and victimcannot speak, begin step 1 below.1. Position the infant,with head slightlylower than chest,face down on yourarm and supportthe head (supportjaw; do NOTcompress throat).2. Give up to 5 back slaps with the heel of handbetween infant’s shoulder blades.3. If object is not coughedup, position infant face upon your forearm with headslightly lower than rest ofbody.1. Stand or kneel behind child with arms encirclingchild.4. With 2 or 3 fingers, giveup to 5 chest thrusts nearcenter of breastbone, justbelow the nipple line.2. Place thumbside of fist against middle ofabdomen just above the navel. (Do NOT placeyour hand over the very bottom of the breastbone.Grasp fist with other hand.)5. Open mouth and look. Ifforeign object is seen,sweep it out with finger.6. Tilt head back and lift chinup and out to open theairway. Try to give 23. Give up to 5 quick inward and upward abdominalthrusts.4. REPEAT STEPS 1-2 UNTIL OBJECT ISCOUGHED UP, CHILD STARTS TO BREATHEOR CHILD BECOMES UNCONSCIOUS.breaths.IF CHILD BECOMES UNCONSCIOUS, PLACE ON7. REPEAT STEPS 1-6UNTIL OBJECT IS COUGHED UP OR INFANTBACK AND GO TO STEP 7 OF CHILD OR ADULTCPR.STARTS TO BREATHE OR BECOMESUNCONSCIOUS.FOR OBESE OR PREGNANT PERSONS:8. Call EMS after 2 minutes (5 cycles of 30compressions to 2 rescue breaths) if not alreadycalled.Stand behind person and place your arms under thearmpits to encircle the chest. Press with quickbackward thrusts.IF INFANT BECOMES UNCONSCIOUS, GO TOSTEP 6 OF INFANT CPR.Pictures reproduced with permission.Textbook of Pediatric Basic Life Support, 1994Copyright American Heart Association.
23CHILD ABUSE & NEGLECT If student has visible injuries, refer to the appropriate guidelineto provide first aid.CALL EMS if any injuriesrequire immediate medical care.All school staff are required to report suspected childabuse and neglect to the County Children Servicesagency. Refer to your own school's policy foradditional guidance on reporting.County Children Services Agency.Phone #______________________Abuse may be physical, sexual or emotional in nature.Some signs of abuse follow. This isNOT a completelist:Child abuse is a complicated issue withmany potential signs. According toOhio Revised Code (ORC) Section, anyone who cares forchildren should be trained in therecognition of child abuse and neglect.All school personnel who suspect that achild is being abused or neglected aremandated (required) to make a report totheir Children Services or local lawenforcement agency. The ORCprovides immunity from liability for thosewho make reports of possible abuse orneglect, and requires Children Servicesagencies to keep reporters' identitiesconfidential. Failure to report suspectedabuse or neglect may result ina penalty of a fourth-degreemisdemeanor.yDepression, hostility, low self-esteem, poor self-image.Evidence of repeated injuries or unusual injuries.Lack of explanation or unlikely explanation for an injury.Pattern bruises or marks (e.g., burns in the shape of acigarette or iron, bruises or welts in the shape of a hand).Unusual knowledge of sex, inappropriate touching orengaging in sexual play with other children.Severe injury or illness without medical care.Poor hygiene, underfed appearance.If a student reveals abuse to you:yRemain calm.Take the student seriously.Reassure the student that he/she did the right thing bytelling.Let the student know that you are required to report theabuse to Children Services.Do not make promises that you can not keep.Respect the sensitive nature of the student's situation.If you know, tell the student what steps to expect next.Follow required school reporting procedures.Contact responsibleschool authority.Contact ChildrenServices. Follow upwith school report.Emergency Guidelines for Schools, 3rd edition
24COMMUNICABLE DISEASES For more information on protecting yourself fromcommunicable diseases, see "Infection Control."Chickenpox, pink eye, strep throat and influenza(flu) are just a few of the common communicablediseases that affect children. There are manymore. In general, there will be little you can do fora student in school who has a communicabledisease. Following are some general guidelines.Refer to your local school's exclusionpolicy for ill students.Signs of PROBABLE Illness:..A communicabledisease is a diseasethat can be spread fromone person to another.Germs (bacteria,virus, fungus, parasite)cause communicablediseases.ySore throat.Redness, swelling, drainage of eye.Unusual spots/rash with fever or itching.Crusty, bright yellow, gummy skin sores.Diarrhea (more than 2 loose stools a day).Vomiting.Yellow skin or yellow "white of eye".Oral temperature greater than F.Extreme tiredness or lethargy.Unusual behavior.Signs of POSSIBLE Illness:y Earache.y Fussiness.y Runny nose.y Mild cough.Contactresponsible schoolauthority & parent orlegal guardian.URGE MEDICALCARE.Monitor studentfor worsening ofsymptoms.Contact parent/legalguardian anddiscuss..Emergency Guidelines for Schools, 3rd edition
25CUTS (SMALL), SCRATCHES & SCRAPES (INCLUDING ROPE & FLOOR BURNS) Wear disposable gloveswhen exposed to bloodor other body fluids.Is the wound:yLarge?Deep?Bleeding freely?NOYESyWash the wound gently with water. Use soapif necessary to remove dirt.yPat dry with clean gauze or paper towel.Apply clean gauze dressing (non-adhering orSee"Bleeding."non-sticking type for scrapes) and bandage.Check student's immunizationrecord for tetanus.See "Tetanus Immunization."Contactresponsibleschool authority &parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
26DIABETES A student with diabetes may have the following symptoms: Irritability and feeling upset.Change in personality.Sweating and feeling "shaky."Loss of consciousness.Confusion or strange behavior.Rapid, deep breathing.ySeizure.Listlessness.Cramping.Dizziness.Paleness.Rapid Pulse.A student with diabetesshould be known toappropriate schoolstaff. An emergency careplan should be developed.Staff in a position toadminister any approvedmedications shouldreceive training.Refer to student's emergency care plan.Is the student:yUnconscious or losing consciousness?Having a seizure?Unable to speak?Having rapid, deep breathing?NOYESDoes student havea blood sugarmonitor available?YESAllow student tocheck blood sugar.NOGive the student " sugar" such as:y Fruit juice or soda pop (not diet) 6-8 ounces.y Hard candy (6-7 lifesavers) or 1/2 candy bar.y Sugar (2 packets or 2 teaspoons).y Cake decorating gel (1/2 tube) or icing.y Instant glucose.yquiet place. The student should beginContinue to watch the student in ato improve within 10 minutes.Allow student to re-check blood sugar.Is blood sugarless than60 or "LOW"according toyLOWemergency care plan?orIs blood sugar"HIGH"Continue to watchaccording to emergencycare plan?YESthe student. Isstudent improving?NOHIGHContactresponsibleschool authority& parent/legalguardian.CALL EMS9-1-1..If student is unconscious,see "Unconsciousness."Emergency Guidelines for Schools, 3rd edition
27Wear disposable gloves when exposed to blood or other body fluids. DIARRHEAWear disposable gloves whenexposed to blood or other body fluids.A student may come to the officebecause of repeated diarrhea orafter an "accident" in the bathroom.Does student have any of the following signs ofprobable illness:yMore than 2 loose stools a day?Oral temperature over F? See"Fever."Blood present in the stool?Severe stomach pain?Student is dizzy and pale?NOYESyContact responsibleschool authority &parent/legal guardian.URGE MEDICAL CARE.Allow the student to rest ifexperiencing any stomach pain.Give the student water to drink..If the student'sclothing is soiled, weardisposable glovesand double-bag theclothing to be senthome. Wash handsthoroughly.Emergency Guidelines for Schools, 3rd edition
28Contact responsible school authority& parent/legal guardian. most recent draft EGS igxEARSDRAINAGE FROM EARDo NOT trytocleanout ear.Contactresponsible schoolauthority& parentor legal guardian..URGE MEDICALCARE.EARACHEContact responsible schoolauthority& parent/legal guardian.URGE MEDICAL CARE..If there is nopain, the studentmayreturntoclass. Notifytheparent or legalguardian.OBJECT IN EAR CANALAsk student if he/sheknows what is inthe ear.YESDo yoususpect a liveinsect is inthe ear?YES ORGentlytilt head towardthe affected side.NODid object come outonits own?NONOT SUREContactresponsible schoolDo NOT attemptto remove.authority& parent orlegal guardian.Do NOT attemptto remove..URGE MEDICALCARE.Emergency Guidelines for Schools, 3rd edition
29ELECTRIC SHOCK available to call EMS, perform CPR first yTURN OFF POWER SOURCE, IF POSSIBLE.DO NOT TOUCH STUDENT UNTIL POWERSOURCE IS SHUT OFF.yOnce power is off and situation is safe,approach the student and ask, "Are you OK?"If no one else isavailable to call EMS,perform CPR firstfor 2 minutes and thencall EMS yourself.Is studentYESunconscious orNOunresponsive?Treat any burns.See "Burns."CALL EMSyKeep airway clear.Look, listen and feel for breath.If student is not breathing,start CPR. See "CPR."Contactresponsibleschool authority& parent orlegal guardian.URGE MEDICAL.CARE.Contactresponsibleschool authority &parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
30cup or similar object to keep student from rubbing, most recent draft EGS igxEYESWithanyeye problem,ask the student ifhe/she wears contactlenses. Have studentremove contactsbefore giving anyfirst aid to eye.EYE INJURY:Keep student lyingflat and quiet.yIs injurysevere?Is there a change invision?Has object penetrated eye?YESNOIf anobject haspenetrated the eye,Contactresponsible schoolauthority& parent orlegal guardian..URGE IMMEDIATEMEDICAL CARE.do NOT removeobject.Cover eye witha papercup or similar object tokeep student from rubbing,but do NOT touch eye orput any pressure on eye.CALL EMSContact responsible.school authority&parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
31Follow their directions. EYESPARTICLE IN EYEKeep student fromrubbing eye.If particle doesnot flush out of eye oryif eye pain continues,contact responsibleschool authority &parent/legal guardian..If necessary, lay student downand tip head toward affected side.Gently pour tap water over theopen eye to flush out the particle.URGE MEDICALCARE.CHEMICALS IN EYEyWear gloves and if possible, goggles.Immediately rinse the eyewith large amountsof clean water for 20 to 30 minutes. Use aneyewash if available.Tip the head so the affected eye is below theunaffected eye and waterwashes eye fromnose out to side of the face.Contactresponsibleschool authority& parent/legalguardian.CALL POISON CONTROL.Follow their directions.If eye has beenburned by chemical,CALL EMSEmergency Guidelines for Schools, 3rd edition
32FAINTING If you observe any of the following signs of fainting, have the student lie down toprevent injury from falling:Fainting may have many causesincluding:y Injuries Not eating.y Illness Stress.y Fatigue.y Poisoning.y Diabetic reaction.y Severe allergic reaction.y Standing still for too long..If you know the cause of thefainting, see the appropriateguideline.y Extreme weakness or fatigue.y Dizziness or light-headedness.y Extreme sleepiness.y Pale, sweaty skin.y Nausea.Most students who faint will recoverquickly when lying down. If student doesnot regain consciousness immediately,see "Unconsciousness."yyBlood loss/shock. yHeat exhaustion. yyIs fainting due to injury?Was student injured whenhe/she fainted?NOYES ORNOT SUREyKeep student in flat position.Elevate feet.Loosen clothing around neck and waist.Keep airway clear and monitor breathing.Keep student warm, but not hot.Control bleeding if needed (weardisposable gloves).Give nothing by mouth.Are symptoms (dizziness, light-headedness,weakness, fatigue, etc.) still present?NOTreat as possible neck injury.See "Neck & Back Pain."Do NOT move student..Keep studentlying down. Contactresponsible schoolauthority & parent orlegal guardian.URGE MEDICALCARE.YESContactresponsibleschool authority& parent/legalguardian.Emergency Guidelines for Schools, 3rd editionIf student feels better, and there is nodanger of neck injury, he/she may bemoved to a quiet, private area.
33FEVER & NOT FEELING WELL most recent draft EGS igxFEVER & NOT FEELING WELLTake student's temperature.Note oral temperatureover F as fever.Have the student liedownina room thataffords privacy.Give no medication,unless previouslyauthorized.Contactresponsibleschool authorityand parent orlegal guardian.Emergency Guidelines for Schools, 3rd edition
34FRACTURES, DISLOCATIONS, most recent draft EGS igxFRACTURES, DISLOCATIONS,SPRAINS OR STRAINSSymptoms mayinclude:yPain in one area.Swelling.Feeling "heat" in injured area.Discoloration.Limited movement.Bent or deformed bone.Numbness or loss of sensation.Treat all injuredparts as if theycould be fractured.yIs bone deformed or bent inanunusual way?Is skinbrokenover possible fracture?Is bone sticking throughskin?YESyNOCALL EMS9-1-1.yRest injured part bynot allowingstudent to put weight onit or use it.Gentlysupport and elevate injuredpart if possible.Applyice, covered witha clothorpaper towel, to minimize swelling.After period of rest, re-check the injury.y Is paingone?y Canstudent move or put weight oninjured part without discomfort?yIs numbness/tingling gone?Has sensationreturned to injured area?yLeave student ina positionof comfort.Gentlycover brokenskinwitha cleanbandage.Do NOT move injured part.Contactresponsibleschool authority& parent/legalguardian.YESNOContactresponsible schoolauthority& parentor legal guardian.If discomfortis gone afterperiod of rest,allow student toreturnto class.Emergency Guidelines for Schools, 3rd edition.URGE MEDICALCARE.
35most recent draft EGS 122006.igx FROSTBITE Exposure to cold evenfor short periods of time maycause "HYPOTHERMIA" inchildren(see "Hypothermia").The nose, ears, chin, cheeks, fingers and toes are theparts most oftenaffected byfrostbite.Frostbittenskinmay:y Look discolored (flushed, grayish-yellow, pale).y Feel cold to the touch.y Feel numb to the student.Deeplyfrostbittenskinmay:Frostbite canresultinthe same type oftissue damage as aburn. It is a seriousconditionandrequires medicalattention.yLook white or waxy.Feel firm or hard (frozen).yTake the student to a warm place.Remove cold or wet clothing and give student warm, dryclothes.Protect cold part from further injury.Do NOT rub or massage the cold part or apply heat such asa water bottle or hot running water.Cover part looselywithnonstick, sterile dressings or dryblanket.Does extremity/part:yLook discolored - grayish, white or waxy?Feel firm/hard (frozen)?Have a loss of sensation?YESCALL EMSKeep student warmNOKeep studentand part warm.and part covered.Contactresponsibleauthority& parentor legal guardian.Encouragemedical care.Contactresponsibleauthority&parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
36¾ Oral temperature over 100.0 F HEADACHEGive nomedicationunless previouslyauthorized.See"HeadInjuries."Has a headinjury occurred?YESNOyIs headache severe?Are other symptoms present such as:¾ Vomiting?¾ Oral temperature over FYES(See "Fever")?¾ Blurred vision?¾ Dizziness?Contactparent/legalguardian..URGE MEDICALCARE.NOHave student lie downfor a short time in a roomthat affords privacy.Apply a cold cloth or compressto the student's head.If headachepersists, contactparent/legalguardian.Emergency Guidelines for Schools, 3rd edition
37HEAD INJURIES . at school are minor. Head wounds may bleed easily and If studentonly bumped head anddoes not have any other complaintsor symptoms,see "Bruises.".Many head injuries that happenat school are minor. Headwounds may bleed easily andform large bumps. Bumps tothe head may not beserious. Head injuries fromfalls, sports and violence maybe serious. If head isbleeding, see "Bleeding."yWith a head injury o ( ther thanhead bump), always suspectneck injury as well.Do NOT move or twist theback or neck.See "Neck & Back Pain" foryHave student rest, lying flat.Keep student quiet and warm.ymore information.Is studentvomiting?YESTurn the head and bodytogether to the side, keepingNOWatch student closely.Do NOT leave student alone.the head and neck in astraight line with the trunk.Are any of the following symptoms present:.yUnconsciousness?Seizure?Neck pain?Student is unable to respond to simple commands?Blood or watery fluid in the ears?Student is unable to move or feel arms or legs?Blood is flowing freely from the head?Student is sleepy or confused?YESCALL EMSyCheck student's airway.Look, listen and feel for breathing.If student stops breathing, startCPR. See "CPR."NOEven if studentwas only brieflyconfused and seemsfully recovered, contactresponsible school authority& parent or legal guardian.URGE MEDICAL CARE..Watch for delayedsymptoms.Give nothingby mouth. Contactresponsible schoolauthority &parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
38HEAT STROKE - HEAT EXHAUSTION Heat emergenciesare caused byStrenuous activity in the heat may causeheat-related illness. Symptoms may include:spending too muchtime in the heat. Heatemergencies canbe life-threateningsituations..yRed, hot, dry skin.Weakness and fatigue.Cool, clammy hands.Vomiting.Loss of consciousness.yProfuse sweating.Headache.Nausea.Confusion.Muscle cramping.yRemove student fromtheheat to a cooler place.Have student lie down.Is student unconsciousor losing consciousness?NOYESyQuickly remove student from heatto a cooler place.y Does student have hot,yPut student on his/her side todry, red skin?y Is student vomiting?y Is student confused?protect the airway.Look, listen and feel for breath.If student stops breathing, startYESyCPR. See "CPR."NOCool rapidly by completelyGive clear fluids such as water,7Up or Gatorade frequently insmall amounts if student is fullyawake and alert.Contactresponsibleauthority &parent/legalguardian.Emergency Guidelines for Schools, 3rd editionwetting clothing with roomtemperature water.Do NOT use ice water..CALL EMSContact responsibleauthority & parentor legal guardian.
39HYPOTHERMIA most recent draft EGS 122006.igx (EXPOSURE TO COLD)Hypothermia canoccur after a student has beenoutside inthe cold or incold water. Symptomsmayinclude:Hypothermia happens afterexposure to cold whenthe bodyis no longer capable ofwarming itself. Young childrenare particularlysusceptible toyConfusion.Weakness.Blurry vision.Slurred speech.yShivering.Sleepiness.White or grayish skin color.Impaired judgment.hypothermia. It canbe a life-threatening conditionif leftuntreated for too long.y Take the student to a warm place.y Remove cold or wet clothing andwrap student ina warm, dryblanket.Does student have:y Loss of consciousness?y Slowed breathing?y Confused or slurred speech?y White, grayishor blue skin?YESContinue to warm student withblankets. If student is fullyawake and alert, offer warm(NOT hot) fluids, but no food.NOy CALL EMSy Give nothing bymouth.y Continue to warmstudent withblankets.y If student is sleepyor losingconsciousness, place student onhis/herside to protect airway.y Look, listenand feel for breathing.y If student stops breathing, start CPR.Contactresponsibleauthority& parentor legal guardian.Encouragemedical care.See "CPR".Emergency Guidelines for Schools, 3rd edition
40MENSTRUAL DIFFICULTIES Is it possible thatstudent is pregnant?YES ORNOT SURESee"Pregnancy."NOFor mildcramps,recommendregularAre cramps mildor severe?MILDactivities.SEVEREA short period of quietrest may provide relief.Give no medications unlesspreviously authorized byparent/legal guardian.Urge medical care ifdisabling cramps orheavy bleeding occurs.Contactresponsibleschool authority& parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
41MOUTH & JAW INJURIES Wear disposable gloves when Check student's immunization recordfor tetanus. See"TetanusWear disposable gloves whenexposed to blood or other body fluids.Immunization."See"HeadInjuries."Do you suspect a head injuryother than mouth or jaw?YESNOSee"Teeth."YESHave teeth been injured?NOyDo NOT try tomove jaw.Gently supportHas jaw been injured?YESyjaw with hand.NOIf tongue, lips or cheeks arebleeding, apply direct pressurewith sterile gauze or clean cloth.Contact responsibleschool authority &parent/legal guardian.URGE IMMEDIATEMEDICAL CARE.yIs cut large or deep?Is there bleeding thatcannot be stopped?NOYESSee"Bleeding."Contactresponsibleschool authority &parent/legal guardian.Place a cold compress over thearea to minimize swelling.Encouragemedical care.Emergency Guidelines for Schools, 3rd edition
42NECK & BACK PAIN most recent draft EGS 122006.igx Suspect a neck/back injuryif painresults from:y Falls over 10 feet or falling onhead.y Being thrownfrom a moving object.y Sports.y Violence.y Being struck bya car or fast moving object.A stiff or sore neck fromsleeping ina "funny" positionisdifferent thanneck painfrom aHas aninjuryoccurred?YESDid student walk inor wasstudent found lying down?LYING DOWNNOWALK INsuddeninjury. Non-injured stiffnecks maybe uncomfortablebut theyare not emergencies.If student is souncomfortable that heor she is unable toparticipate innormalactivities, contactresponsible schoolauthority& parent/legalyDo NOT move student unless thereis IMMEDIATE danger of furtherphysical harm.If student must be moved, supporthead and neck and move student inthe directionof the head withoutbending the spine forward. .Do NOT drag the student sideways.guardian.Have student lie downonhis/herback. Support head byholding it ina "face forward" position.Try NOT to move neck or head..yKeep student quiet and warm.Hold the head still bygentlyplacing one ofyour hands oneachside of the head.CALL EMSContact responsibleschool authority&parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
43NOSE yoususpect a head injuryother thana nose- bleed or brokennose. most recent draft EGS igxNOSESee "Head Injuries" ifyoususpect a headinjuryother thana nose-bleed or brokennose.NOSEBLEEDWear disposable gloveswhenexposed to bloodor other bodyfluids.Place student sitting comfortablywithhead slightlyforward or lying onside withhead raised onpillow.Encourage mouthbreathing and discouragenose blowing, repeated wiping or rubbing.If blood is flowing freelyfrom the nose,provide constant uninterrupted pressure bypressing the nostrils firmlytogether for about15 minutes. Applyice to nose.If blood isstill flowing freelyafter applyingpressure and ice,contact responsibleschool authority&parent/legalguardian.BROKEN NOSEy.Care for nose as in"Nosebleed" above.Contact responsible school authority&parent/legal guardian.URGE MEDICAL CARE.Emergency Guidelines for Schools, 3rd edition
44most recent draft EGS 122006.igx NOSE OBJECT IN NOSEIs object:y Large?y Puncturing nose?y Deeplyimbedded?NOHave student hold theclear nostril closed whilegently blowing nose.YES ORNOT SUREDo NOT attempt to remove.See "Puncture Wounds" ifobject has punctured nose.Contactresponsible schoolauthority& parent orlegal guardian..URGE MEDICALCARE.Did object comeout onown?YESIf there is noNOpain, student mayreturnto class.If object cannot be removed easily,do NOT attempt to remove.Notifyparent orlegal guardian.Emergency Guidelines for Schools, 3rd edition
45POISONING & OVERDOSE y Pills, berries or unknown Poisons can be swallowed, inhaled,absorbed through the skin or eyes,or injected. Call Poison Controlwhen you suspect poisoning from:y Medicines.y Insect bites and stings.y Snake bites.y Plants.y Chemicals/cleaners.y Drugs/alcohol.y Food poisoning.y Inhalants.Or if you are not sure.Possible warning signs ofpoisoning include:y Pills, berries or unknownsubstance in student's mouth.y Burns around mouth or on skin.y Strange odor on breath.y Sweating.y Upset stomach or vomiting.y Dizziness or fainting.y Seizures or convulsions.Wear disposable gloves.Check student's mouth.Remove any remaining substance(s)from mouth.yyDo NOT induce vomiting or giveanything UNLESS instructed to byPoison Control. With some poisons,vomiting can cause greater damage.Do NOT follow the antidote label on thecontainer; it may be incorrect.If student becomes unconscious,place on his/her side. Check airway.Look, listen and feel for breathing.If student stops breathing, startIf possible, find out:y Age and weight of student.y What the student swallowed.y What type of "poison" it was.y How much and when it was taken.CALL POISON CONTROL.Follow their directions.yyCPR. See "CPR."Send sampleof the vomitedmaterial and ingestedmaterial with itscontainer (if available)to the hospital withCALL EMS.Contactresponsible school authority &parent or legal guardian.the student.Emergency Guidelines for Schools, 3rd edition
46Pregnant students should be known to appropriate school staff. PREGNANCYPregnant students should be knownto appropriate school staff.Any student who is old enough tobe pregnant, might be pregnant.Pregnancy may be complicatedby any of the following:SEVERE STOMACH PAINCALLEMSContact responsibleSEIZUREThis may be a seriouscomplication of pregnancy.VAGINAL BLEEDINGschool authority &parent or legalguardian.Contactresponsible schoolauthority & parentor legal guardian..URGE IMMEDIATEMEDICALCARE.AMNIOTIC FLUID LEAKAGEThis isNOT normal and mayindicate the beginning of labor.MORNING SICKNESSTreat as vomiting. See "Vomiting."Emergency Guidelines for Schools, 3rd editionContactresponsibleschool authority& parent/legalguardian.
47PUNCTURE WOUNDS See "Eyes . Do NOT or other body fluids. wounded? - Eye Injuries."Do NOT.Wear disposable gloveswhen exposed to bloodor other body fluids.Has eye beenwounded?YEStouch eye.NOIs object stillstuck in wound?YESNOyDo NOT try toprobe or squeeze.Wash the wound gently withsoap and water.yyDo NOT remove object.Wrap bulky dressing aroundobject to support it.Try to calm student.Check to make sure theobject left nothing in thewound (e.g., pencil lead).Cover with a clean bandage.See "Bleeding" if wound isdeep or bleeding freely.yIs object large?Is wound deep?Is wound bleeding freelyor squirting blood?Check student's immunizationrecord for tetanus. See"Tetanus Immunization."NOYESContactSee "Bleeding" ifwound is deepresponsibleschool authority &CALL EMSor bleeding freely.parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
48RASHES most recent draft EGS 122006.igx Some rashes maybe contagious. Wear disposablegloves to protect self whenincontact withanyrash.Rashes mayhave manycauses including heat,infection, illness, reactionto medications, allergicreactions, insect bites, dryskinor skinirritations.Rashes include suchthings as:yHives.Red spots (large or small, flat or raised).Purple spots.Small blisters.Other symptoms mayindicate whetherthe student needs medical care.CALL EMSContact responsible.school authority&parent/legal guardian.Does student have:y Loss of consciousness?y Difficultybreathing or swallowing?y Purple spots?YES.NOIf anyof the following symptoms are present,contact responsible school authority& parent orlegal guardianand URGE MEDICAL CARE:ySee "AllergicReaction" and"CommunicableDisease" for moreinformation.Oral temperature over F (See "Fever").Headache.Diarrhea.Sore throat.Vomiting.Rash is bright red and sore to the touch.Rash (hives) all over body.Student is so uncomfortable (e.g., itchy, sore,feels ill) that he/she is not able to participate inschool activities.Emergency Guidelines for Schools, 3rd edition
49A student with a history of appropriate school staff. An SEIZURESSeizures may be any of the following:yEpisodes of staring with loss of eye contact.Staring involving twitching of the arm and leg muscles.Generalized jerking movements of the arms and legs.Unusual behavior for that person (e.g., running,belligerence, making strange sounds, etc.).A student with a history ofseizures should be known toappropriate school staff. Anemergency care plan shouldbe developed, containing adescription of the onset, type,duration and after effectsof the seizures.Refer to student's emergency care plan.yIf student seems off balance, place him/heron the floor (on a mat) for observation andObserve details of the seizure forsafety.Do NOT restrain movements.Move surrounding objects to avoid injury.Do NOT place anything between the teethor give anything by mouth.Keep airway clear by placing student onhis/her side. A pillow shouldNOT be used.parent/legal guardian, emergencypersonnel or physician. Note:y Duration.y Kind of movement or behavior.y Body parts involved.y Loss of consciousness, etc.Is student having a seizure lastingyylonger than5 minutes?Is student having seizures followingone another at short intervals?Is studentwithout a known historyofseizures having a seizure?Is student having any breathingdifficulties after the seizure?YESNOySeizures are often followed by sleep.The student may also be confused.This may last from 15 minutes to an houror more. After the sleeping period, thestudent should be encouraged toparticipate in all normal class activities.Contactresponsibleschool authority& parent or legalguardian.CALL EMSEmergency Guidelines for Schools, 3rd edition
50SHOCK Signs of Shock: If injury is suspected, see Neck & Back . Pain" and treat as a possible neck injury.Do NOT move student.unless he/she is endangered."yPale, cool, moist, skin.Mottled, ashen, blue skin.Altered consciousness or confused.Nausea, dizziness or thirst.Severe coughing, high pitchedwhistling sound.Blueness in the face.Fever greater than F incombination with lethargy, loss ofconsciousness, extreme sleepiness,abnormal activity.yAny serious injury or illness may lead toshock, which is a lack of blood and oxygengetting to the body tissues.Shock is a life-threatening condition.Stay calm and get immediate assistance.Check for medical bracelet or student'semergency care plan if available.yUnresponsive.Difficulty breathing or swallowing.Rapid breathing.Rapid, weak pulse.Restlessness/irritability.ySee the appropriate guideline to treat the mostsevere (life or limb threatening) symptoms first.Is student:y Not breathing? See"CPR" and/or "Choking."y Unconscious? See"Unconsciousness."y Bleeding profusely? See"Bleeding."YESNOCALL EMSy9-1-1.Contactresponsible schoolKeep student in flat position of comfort.Elevate feet 8-10 inches, unless this causes painor a neck/back or hip injury is suspected.Loosen clothing around neck and waist.Keep body normal temperature. Cover studentwith a blanket or sheet.Give nothing to eat or drink.If student vomits, roll onto left side keeping backand neck in straight alignment if injury issuspected.authority & parent orlegal guardian.URGE MEDICALCARE if EMSnot called.Emergency Guidelines for Schools, 3rd edition
51SPLINTERS OR IMBEDDED PENCIL LEAD Wear disposable gloveswhen exposed to bloodor other body fluids.Check student's immunizationrecord for tetanus.See "Tetanus Immunization."Gently wash area withclean water and soap.Is splinter or lead:yProtruding above theNOsurface of the skin?Small?Shallow?YESyyLeave in place.Do NOT probe under skin.yRemove with tweezers unlessthis causes student pain.Do NOT probe under skin.Contactresponsible schoolauthority & parent orlegal guardian.Encouragemedical care.Were you successful inremoving the entiresplinter/pencil lead?YESNOWash again.Apply cleandressing.Emergency Guidelines for Schools, 3rd edition
52STABBING & GUNSHOT INJURIES yCALL EMS for injuredstudent.Call the police.Intervene only if the situationRefer to your school's policy foraddressing violent incidents.yis safe for you to approach.Wear disposable gloves when exposedto blood or other body fluids.yCheck student's airway.Look, listen and feel forbreathing.If student stops breathing,start CPR. See "CPR."Is the student:y Losing consciousness?y Having difficulty breathing?y Bleeding uncontrollably?YESNOyLay student down in a position of comfort ifhe/she is not already doing so.Elevate feet 8-10 inches, unless this causespain or a neck/back injury is suspected.Press injured area firmly with a cleanbandage to stop bleeding.Elevate injured part gently, if possible.Keep body temperature normal. Coverstudent with a blanket or sheet.Check student's immunizationrecord for tetanus.See "Tetanus Immunization."Contactresponsibleschool authority &parent or legalguardian.Emergency Guidelines for Schools, 3rd edition
53STINGS of allergy to stings school staff. An emergency care plan Students with a historyof allergy to stingsshould be known to allschool staff. Anemergency care planshould be developed.Does student have:yDifficulty breathing?A rapidly expanding area ofswelling, especially of the lips,NOYESmouth or tongue?yA history of allergy to stings?Refer to student'semergency care plan.A student may have a delayedallergic reaction up to2 hours after thesting. Adult(s) supervising studentduring normal activities should beaware of the sting and shouldwatch for any delayed reaction.If available, administerdoctor- and parent- orguardian-approvedmedications.CALL EMSyCheck student's airway.Look, listen and feel forbreathing.If student stops breathing,yRemove stinger if present.Wash area with soap and water.Apply cold compress.start CPR. See "CPR."Contact responsibleschool authority & parentor legal guardian.Emergency Guidelines for Schools, 3rd editionSee"AllergicReaction."
54in a room that affords privacy. If stomachache STOMACHACHES/PAINStomachaches/pain may have manycauses including:y Illness.y Hunger.y Overeating.y Diarrhea.y Food poisoning.y Injury.yMenstrual difficulties.Psychological issues.Stress.Constipation.Gas pain.Pregnancy.Has a serious injury occurredresulting from:ySports?Violence?Being struck by a fastmoving object?Falling from a height?Being thrown from aSuspect neck injury.See "Neck and Back Pain."YESmoving object?Contactresponsibleschool authority &parent/legal guardian.URGE PROMPT.NOTake the student's temperature.Note temperature over Fas fever. See"Fever."MEDICAL CARE.Does student have:yFever?Severe stomach pains?Vomiting?YESNOAllow student to rest minutesin a room that affords privacy.If stomachacheAllowpersists or becomesstudent toreturn toDoes studentfeel better?worse, contactresponsible schoolYESNOclass.authority & parentor legal guardian.Emergency Guidelines for Schools, 3rd edition
55most recent draft EGS 122006.igx TEETH BLEEDING GUMSContactresponsibleschool authority&parent/legal guardian..URGE DENTALCARE.Bleeding gums:y Are generallyrelated tochronic infection.y Present some threat tostudent's general health.No first aid measure inthe school will be of anysignificant value.TOOTHACHE OR GUM INFECTIONThese conditions canbedirect threats to student'sgeneral health, not justlocal toothproblems.No first aid measure inthe schoolSee "Mouth & Jaw"for tongue, cheek,lip, jaw or othermouthinjurynotinvolving theteeth.will be of anysignificant value.Relief of paininthe school oftenpostponesdental care. Do NOT place pain relievers(e.g., aspirin, Tylenol) on the gum tissue ofthe aching tooth. They can burn tissue.Contactresponsibleschool authority&parent/legal guardian.URGE DENTAL.CARE.Emergency Guidelines for Schools, 3rd edition
56Do NOT scrub the knocked-out tooth. TEETHDISPLACED TOOTHContactresponsibleDo NOT tryto move tooth intocorrect position.school authority &parent/legal guardian.OBTAIN.EMERGENCYDENTAL CARE.KNOCKED-OUT OR BROKEN PERMANENT TOOTHyFind tooth.Do NOT handletooth by the root.If tooth is dirty, clean gently by rinsing with water.Do NOT scrub the knocked-out tooth.The following steps are listed in order of preference.Do not replant.primary (baby) teethWithin minutes:.back in socket.(No. 1 in list.)Contact responsibleschool authority & parentor legal guardian.OBTAIN EMERGENCY.DENTAL CARE. THESTUDENT SHOULDBE SEEN BY A1. Place gently back in socket and have studenthold in place with tissue or gauze,or2. Place in HBSS (Save-A-Tooth Kit) if availableSee ''Recommended First Aid Supplies" oninside back cover,or3. Place in glass of milk,or4. Place in normal saline,or5. Have student spit in cup and place tooth in it,or6. Place in glass of water..TOOTH MUST NOT DRY OUT.Apply a cold compress toface to minimize swelling.DENTIST AS SOONAS POSSIBLE.Emergency Guidelines for Schools, 3rd edition
57most recent draft EGS 122006.igx TETANUS IMMUNIZATIONProtection against tetanus should be considered withany wound, even a minor one. After any wound, checkthe student's immunization record for tetanus andnotify parent or legal guardian.A minor wound would need a tetanus booster only if ithas beenat least 10 years since the last tetanus shot or ifthe student is 5 years old or younger.Other wounds suchas those contaminated bydirt, fecesand saliva (or other bodyfluids); puncture wounds;amputations; and wounds resulting from crushing, burns,and frostbite need a tetanus booster if it has beenmorethan5 years since last tetanus shot.Emergency Guidelines for Schools, 3rd edition
58or brush. Ticks may carry be completely removed. . bare hands. Students should be inspectedfor ticks after time in woodsor brush. Ticks may carryserious infections and mustbe completely removed..Do NOT handle ticks withbare hands.Refer to your school's policyregarding the removal of ticks.Wear disposable gloves when exposedto blood and other body fluids.Wash the tick area gently with soap andwater before attempting removal.yUsing tweezers, grasp the tick as close to the skin surface aspossible and pull upward with steady, even pressure.Do NOT twist or jerk the tick as the mouth parts may break off.It is important to remove theENTIRE tick.Take care not to squeeze, crush or puncture the body of the tick asits fluids may carry infection.After removal, wash the tick area thoroughly with soap and water.Wash your hands.Apply a bandage.Ticks can be safely thrown away byplacing them in container of alcohol orflushing them down the toilet.Contactresponsibleschool authority &parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
59UNCONSCIOUSNESS most recent draft EGS 122006.igx If student stops breathing,Unconsciousness mayhave manycauses including:and no one else is availableto call EMS, administerCPR for 2 minutes andthencall EMSyourself.yInjuries.Blood loss/shock.Poisoning.Severe allergic reaction.Diabetic reaction..yHeat exhaustion.Illness.Fatigue.Stress.Not eating.If youknow the cause of the unconsciousness,see the appropriate guideline.See"Fainting".YESDid student regainconsciousness immediately?NOIs unconsciousness due to injury?y See "Neck & Back Pain" andtreat as a possible neck injury.y Do NOT move student.yOpenairwaywithhead tilt/chinlift.Look, listenand feel for breathing.Is studentbreathing?Begin CPR.See "CPR".YESNOCALL EMSyKeep student inflat positionof comfort.Elevate feet 8-10 inches unless this causespainor a neck/back or hip injuryis suspected.Loosenclothing around neck and waist.Keep bodynormal temperature. Cover studentwitha blanket or sheet.Give nothing to eat or drink.If student vomits, roll onto left side keepingback and neck instraight alignment if injuryissuspected.Examine student from head-to-toe and givefirst aid for conditions as needed.CALL EMS9-1-1.Contactresponsibleschool authority&parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
60VOMITING most recent draft EGS 122006.igx Vomiting mayhave many causes including:y Illness y Injury/head injury.y Bulimia y Heat exhaustion.y Anxiety y Overexertion.y Pregnancy. y Food poisoning..Wear disposable gloves whenexposedto blood and other bodyfluids.Take student's temperature.Note oral temperature over100.0 F as fever. See "Fever".If a number of students orstaff become ill withthesame symptoms, suspectfood poisoning.CALL POISON CONTROL.and ask for instructions.See "Poisoning" andnotifylocalhealthdepartment.yHave student lie downonhis/her side ina room that affordsprivacyand allow him/her to rest.Applya cool, damp clothto student's face or forehead.Have a bucket available.Give no food or medications, althoughyoumayofferstudent ice chips or small sips of clear fluids containingsugar (suchas 7Up or Gatorade), if the student is thirsty.Does the student have:yRepeated vomiting?Fever?Severe stomachpains?Is the student dizzyand pale?Contactresponsibleschool authority&parent/legal guardian..URGE MEDICALCAREYESNOContactresponsibleschool authority&parent/legalguardian.Emergency Guidelines for Schools, 3rd edition
62EVACUATION – RELOCATION CENTERS Prepare an evacuation To-Go Bag for building and/or classrooms toprovide emergency information and supplies.EVACUATION:Call Notify administrator.Administrator issues evacuation procedures.Administrator determines if students and staff should be evacuated outside of buildingor to relocation centers. _______________________________ coordinatestransportation if students are evacuated to relocation center.Administrator notifies relocation center.Direct students and staff to follow fire drill procedures and routes. Follow alternateroute if normal route is too dangerous.Turn off lights, electrical equipment, gas, water faucets, air conditioning and heatingsystem. Close doors.STAFF:Direct students to follow normal fire drill procedures unless administrator or emergencyresponders alter route.Take evacuation To-Go Bag with you.Close doors and turn off lights.When outside building, account for all students. Inform administrator immediately if anystudents are missing.If students are evacuated to relocation centers, stay with students. Take roll againwhen you arrive at the relocation center.RELOCATION CENTERS:List primary and secondary student relocation centers for facility, if appropriate.The primary site is located close to the facility.The secondary site is located further away from the facility in case of community-wideemergency. Include maps to centers for all staff.Primary Relocation Center __________________________________________________Address __________________________________________________________________Phone ____________________________________________________________________Other information ___________________________________________________________Secondary Relocation Center ________________________________________________
63HAZARDOUS MATERIALS INCIDENT OCCURS IN SCHOOL: Notify building administrator.Call or local emergency number. If material is known, report information.Fire officer in charge may recommend additional shelter or evacuation actions.Follow procedures for sheltering or evacuation.If advised, evacuate to an upwind location, taking evacuation To-Go Bag with you.Seal off area of leak/spill. Close doors.Secure/contain area until fire personnel arrive.Consider shutting off heating, cooling and ventilation systems in contaminated area toreduce the spread of contamination.Notify parent/guardian if students are evacuated, according to facility policy.Resume normal operations after fire officials have cleared situation.INCIDENT OCCURS NEAR SCHOOL:Fire or police will notify school administration.Consider shutting off heating, cooling and ventilation systems in contaminated area toreduce the spread of contamination.Fire officer in charge of scene will recommend shelter or evacuation actions.Follow procedures for sheltering or evacuation.Evacuate students to a safe area or shelter students in the building until transportationarrives.Notify parent/guardian if students are evacuated, according to facility policy and/orguidance.Resume normal operations after consulting with fire officials.Consider extra staffing for students with special medical and/or physical needs.
64PANDEMIC FLU PLANNING FOR SCHOOLS FLU TERMS DEFINEDSeasonal (or common) flu is a respiratoryillness that can be transmitted person toperson. Most people have some immunity anda vaccine is available.Avian (or bird) flu is caused by influenzaviruses that occur naturally among wild birds.The H5N1 variant is deadly to domestic fowland can be transmitted from birds to humans.There is no human immunity and no vaccine isavailable.Pandemic flu is virulent human flu that causesa global outbreak, or pandemic, of seriousillness. Because there is little natural immunity,the disease can spread easily from person toperson. Currently, there is no pandemic flu.INFLUENZA SYMPTOMSAccording to the Centers for DiseaseControl and Prevention (CDC) influenzasymptoms usually start suddenly and mayinclude the following:xFeverxHeadachexExtreme tirednessxDry coughxSore throatxBody acheInfluenza is a respiratory disease.Source: Centers for Disease Control andPrevention (CDC)INFECTION CONTROL GUIDELINES FOR SCHOOLS1) Recognize the symptoms of flu:x Feverx Coughx Headachex Body ache2) Stay home if you are ill.3) Cover your cough:xUse a tissue when you cough or sneeze and put used tissue in the nearest wastebasket.xIf tissues are not available, cough into your elbow or upper sleeve area, not your hand.xWash your hands after you cough or sneeze.4) Wash your hands:xUsing soap and water after coughing, sneezing or blowing your nose.xUsing alcohol-based hand sanitizers if soap and water are not available.5) Have regular inspections of the school hand washing facilities to assure soap and paper towelsare available.6) Follow a regular cleaning schedule of frequently touched surfaces including handrails, doorhandles and restrooms.7) Have appropriate supplies for students and staff including tissues, waste receptacles fordisposing used tissues and hand washing supplies (soap and water or alcohol-based handsanitizers).
65SCHOOLS ACTION STEPS FOR PANDEMIC FLU The following are steps schools can take before, during and after a pandemic flu outbreak.Remember that a pandemic may have several cycles, waves or outbreaks so these steps mayneed to be repeated.PREPAREDNESS/PLANNING PHASE - BEFORE AN OUTBREAK OCCURS1. Develop a pandemic flu plan for your school using the CDC School Pandemic Flu PlanningChecklist available at2. Build a strong relationship with your local health department and include them in the planningprocess.3. Train school staff to recognize symptoms of influenza.4. Decide to what extent you will encourage or require students and staff to stay home when theyare ill.5. Have a method of disease recognition (disease surveillance) in place. Report increasedabsenteeism or new disease trends to the local health department.6. Make sure the school is stocked with supplies for frequent hand hygiene including soap, water,alcohol-based hand sanitizers and paper towels.7. Encourage good hand hygiene and respiratory etiquette in all staff and students.8. Identify students who are immune compromised or chronically ill who may be most vulnerableto serious illness. Encourage their families to talk with their health care provider regardingspecial precautions during influenza outbreaks.9. Develop alternative learning strategies to continue education in the event of an influenzapandemic.RESPONSE - DURING AN OUTBREAK1. Heighten disease surveillance and reporting to the local health department.2. Communicate regularly with parents informing them of the community and school status andexpectations during periods of increased disease.3. Work with local education representatives and the local health officials to determine if theschool should cancel non-academic events or close the school.4. Continue to educate students, staff and families on the importance of hand hygiene andrespiratory etiquette.RECOVERY - FOLLOWING AN OUTBREAK1. Continue to communicate with the local health department regarding the status of disease inthe community and the school.2. Communicate with parents regarding the status of the education process.3. Continue to monitor disease surveillance and report disease trends to the health department.4. Provide resources/referrals to staff and students who need assistance in dealing with theemotional aspects of the pandemic experience. Trauma-related stress may occur after anycatastrophic event and may last a few days, a few months or longer, depending on the severityof the event.Emergency Guidelines for Schools, 3rd edition
66EMERGENCY PHONE NUMBERS Complete this page as soon as possible and update as needed.EMERGENCY MEDICAL SERVICES (EMS) INFORMATIONKnow how to contact your EMS. Most areas use 9-1-1; others use a 7-digit phone number. EMERGENCY PHONE NUMBER: or _________________________________ Name of EMS agency __________________________________________________ Their average emergency response time to your school ________________________ Directions to your school _____________________________________________________________________________________________________________________ Location of the school’s AED(s) ___________________________________________BE PREPARED TO GIVE THE FOLLOWING INFORMATION & DO NOT HANG UPBEFORE THE EMERGENCY DISPATCHER HANGS UP: Name and school name ____________________________________________ School telephone number ___________________________________________ Address and easy directions _________________________________________ Nature of emergency_______________________________________________ Exact location of injured person (e.g., behind building in parking lot)__________ Help already given_________________________________________________ Ways to make it easier to find you (e.g., standing in front of building, red flag, etc.).OTHER IMPORTANT PHONE NUMBERS School Nurse Responsible School Authority Poison Control Center Fire Department Police Hospital or Nearest Emergency Facility County Children Services Agency Rape Crisis Center Suicide Hotline Local Health Department Taxi Other medical services information(e.g., dentists or physicians):Emergency Guidelines for Schools, 3rd edition____________________________9-1-1 or _____________________HOPE1-800-SUICIDE