1. July 20081 Health Care Guidelines Non-health Staff Training

2. July 2008 2 Overview Introduction Benefits of Health Care Guidelines What is a life-threatening emergency? What should be done in a life-threatening emergency? What is an urgent situation? What should be done in an urgent situation?

3. July 2008 3 Overview (continued) What should be done when health staff are not available? What are Symptomatic Management Guidelines (SMGs)? Who is authorized to use SMGs? Where can SMGs be found on center?

4. July 2008 4 Overview (continued) SMG example How should non-student health problems be addressed?

5. July 2008 5 Introduction Health care guidelines for non-health staff provide instructions on procedures to use when confronted with a variety of health situations including life-threatening emergencies, urgent health situations, and response to a health problem when health staff are not readily available

6. July 2008 6 Benefits of Health Care Guidelines Benefits of Health Care Guidelines include: Help ensure the safety and comfort of students Provide evidence-based scientific rationale to support decisions regarding treatment of students Decrease the possibility of medicolegal concerns for center staff Provide information and training on current health care practices for the staff

7. July 2008 7 Benefits of Health Care Guidelines (continued) Benefits of Health Care Guidelines include: (continued) Save time for the consulting medical personnel to address other problems requiring their special attention Allow the center physician to assume a supervisory/teaching role rather than only a service delivery role Facilitate the orientation of new health and non-health staff

8. July 2008 8 Benefits of Health Care Guidelines (continued) Benefits of Health Care Guidelines include: (continued) Provide non-health staff with direction for action, especially when a member of the health services staff is not available or not on center

9. July 2008 9 What is a life-threatening emergency? Causes death in minutes Includes the inability to breathe, inability of the heart to pump at a normal rate, and uncontrolled bleeding Examples: choking, severe allergic reaction, poisoning/drug overdose, gunshot/knife wound, drowning, head trauma, severe chest pain, acute asthma with difficulty breathing, shock, attempted suicide

10. July 2008 10 What should be done in a life-threatening emergency? First contact the local emergency response team by calling 911 Maintain airway and administer CPR if indicated Control bleeding Prevent and treat for shock Monitor vital signs

11. July 2008 11 What should be done in a life-threatening emergency? (continued) Inform the rescue team of known medical history, student medications and details of the event (when began, what changed, medications and treatment administered, vomiting) Once student is stabilized and/or transported off center, notify health staff, center director, and family contact

12. July 2008 12 What should be done in a life-threatening emergency? (continued) Document all that occurred in writing for inclusion in the student’s health record

13. July 2008 13 What is an urgent situation? Health problems that need evaluation by the center physician, center mental health consultant, or center dentist within a few hours May soon result in a life-threatening situation or produce permanent damage

14. July 2008 14 What is an urgent situation? (continued) Examples Fractures Serious lacerations Second degree burns (blistering) Diarrhea or vomiting lasting more than 24 hours Abdominal pain

15. July 2008 15 What is an urgent situation? (continued) Examples (continued) Complication of pregnancy Moderate/mild asthma Foreign body in the eye Severe depression or anxiety

16. July 2008 16 What should be done in an urgent situation? Notify the on-call health staff member immediately If health staff is unavailable, contact the local emergency response team

17. July 2008 17 What should be done in an urgent situation? (continued) If the student is taken off center, inform the rescue team of known medical history, student medications and details of the event (when began, what changed, medications and treatment administered, vomiting) Once student is stabilized and/or transported off center, notify health staff, center director, and family contact

18. July 2008 18 What should be done in an urgent situation? (continued) Document all that occurred in writing for inclusion in the student’s health record

19. July 2008 19 What should be done when health staff are not available? For an emergency situation First contact the local emergency response team (Call 911) For an urgent situation If health staff are not reachable after repeated attempts, contact the local emergency response team

20. July 2008 20 What should be done when health staff are not available? (continued) For an urgent situation (continued) If authorized to do so, follow symptomatic management guidelines for non-health staff Provide basic first aid measures if needed: o Keep the student warm and comfortable o Administer CPR if properly trained and certified o Stop bleeding by applying constant, direct pressure on the wound

21. July 2008 21 What are Symptomatic Management Guidelines (SMGs)? Assist non-health staff during hours when no health staff are present on center Provide guidance on how to handle common student symptoms Suggest parameters to follow (i.e., when to refer student urgently to the on-call health staff or to local emergency response team when on-call health staff are not available)

22. July 2008 22 Who is authorized to use SMGs? SMGs are approved by the center physician in consultation with the health and wellness manager (HWM) The center physician, center director, and HWM determine which patient care activities a center staff member may be called on to perform

23. July 2008 23 Who is authorized to use SMGs? (continued) Personal Authorization—the document outlining which patient care activities a center staff member may be called on to perform Personal Authorization is filed in the health and wellness center and in each staff member’s personnel folder Each department/dorm on center should have a copy of the SMGs and a copy of the personal authorizations for those staff members who usually work in that department/dorm. For instance, the RA's authorizations should be in the dorm they usually monitor, teachers personal authorizations should be with the SMGs in academics, the rec staff authorizations should be in recreation with the SMGs, etc.

24. July 2008 24 Where can SMGs be found on center? Residential advisor’s office Security office Health and Wellness Center Center Director’s office

25. July 2008 25 EXAMPLE: SYMPTOMATIC MANAGEMENT GUIDELINES FOR NON-HEALTH STAFF COLD AND SINUS CONGESTION Authorized non-health staff may manage a cold and sinus congestion as follows: 1. For fever, offer the student acetaminophen 1000 mg every 4 hours or ibuprofen 400 mg every 6 hours as needed. Encourage oral hydration. 2. Students with fever >101 o F should be referred to the health and wellness center for further evaluation. 3. For severe sinus congestion, offer saline nasal spray or nasal decongestant spray or pseudoephedrine (Sudafed) 30 mg – 60 mg every 8 hours until evaluated by health staff. Note that nasal decongestant spray should not be used for more than 3 days. WHEN TO CONTACT THE ON-CALL HEALTH AND WELLNESS STAFF · If the student has a persistent fever >101 o F that is unresponsive to medications listed in #1 · If the student is wheezing or has difficulty breathing · If the student has a severe sinus headache

26. July 2008 26 How should non-student health problems be addressed? For an emergency situation First contact the local emergency response team (Call 911) For all other situations Provide basic first aid and make patient comfortable Suggest person go to private physician or hospital emergency room Complete appropriate records and an incident report