Transcript School Health Emergency Guidelines

School Health Office
Guidelines
presented by
Wendy Fahey RNC, BSN
Belleville School District Nurse
The Lasting Problem
Every year, more than 31 million children visit
the emergency department due to an illness or
injury.
Many incidents occur at school or on the
playground when an adult or school nurse is not
available.
Belleville School District
School Emergency Response Team
EMERGENCY RESPONSE PROCEDURE-FOR STAFF
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Assess the situation. Do not move student! Be sure it is safe to approach.
Under life and death circumstances, 911 should be called immediately
The staff or student at the scene will contact the office (2 way radio, phone the
office, send runner to the office). Never leave the injured staff or student
unintended.
If only one office staff is available call district nurse immediately. If two office
staff are available, one office staff first responder brings the emergency
response bag and 2 ways radio to scene. Second office staff will call District
nurse and building principal.
Upon arrival of the office staff, he/she will take over and follow standard First
Aid procedure and will call for more help, if needed. An administrator will also
immediately head to the scene.
Shelter in Place will be initiated. Office staff will call emergency contacts of
injured student or staff as soon as possible to determine appropriate course of
action.
Infection Control
To reduce the spread of it is important to follow Universal
Precautions. Universal precautions are a set of guidelines that
assume all blood and certain other body fluids are potentially
infectious.
Wash hands thoroughly with running water and soap for at least 15
seconds
• Before and after providing first aid
• Before dispending medications
• Before and after physical contact with any student
• If soap and water are not available, hand sanitizer may be used
• Wipe up any blood or body fluid spills as soon as possible
• Wear disposable gloves when in contact with blood and other body fluids
• Wear protective eyewear when body fluids may come in contact with
eyes
• Do not touch your mouth or eyes while giving any first aid
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When to Call 911
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Student’s life is at risk or risk of permanent injury
Student is having difficulty breathing or unable to speak
Student is unconscious, semi-conscious or unusually confused
Student is coughing up or vomiting blood
Student has seizure without a known history of seizures
Student ’s skin or lips look blue, purple or gray
Student has significant injuries to neck or back
Student ’s condition is limb-threatening
Student has sudden, severe pain anywhere in the body
Student has bleeding that will not stop
Student sustained an electrical burn
Student showing symptoms of heat stroke
Student choking with complete obstruction
Student was administered epinephrine and/or glucagon
If any of the above conditions exist or if you are not sure
Call 911
Treatment of Students with Anaphylaxis?
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Administration of Epinephrine
Call 911
Monitor status of anaphylaxis
Monitor for relapse and administer 2nd dose of epinephrine as
needed may be given within 5 minutes of 1st dose given
Notify parents/physician
Positioning
Difficulty Breathing
Faint/Dizzy
Nausea
Exercise Induced Asthma
Asthma:
Known Asthmatic having an attack
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Use their rescue inhaler
Encourage to cough to loosen the mucus in the
airways
Encourage slow deep breathing
If symptoms do not improve quickly--seek medical
attention
Call 911 if breathing does not improve after treatment.
Bites
(Animal & Human)
Parents of the biting student and the
bitten student need to be notified that
their child might have been exposed to
blood from another student.
Individual confidentiality must be
maintained when sharing information.
BLISTERS (from friction)
Blisters heal best when
kept clean and dry.
Do NOT break blister
Remove the source
of burning
Burns
Dental Injuries
Primary teeth:
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Apply clean gauze to empty socket
Apply ice over injured area (on the face) if there is any swelling
Permanent teeth:
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Handle by top of tooth
If tooth dirty gently rinse with water
Reinsert tooth back into socket if able
Transport tooth in milk
Apply ice over injured area (on the face) if there is any swelling
Dental attention ASAP
2 hours in the limit for reimplantation
Choking
We’ve all experienced choking, to varying degrees,
at some time in our lives
Common causes of choking are…
 Obstruction of the airway by food
 Children swallowing an object
 Talking or laughing while eating
 Running whilst eating or drinking
 Not chewing food correctly
 Eating too quickly
Choking
Partial obstruction…
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A partial obstruction occurs when something is stuck in
the student’s throat but is still able to breathe, with some
difficulty
Food or beverage ‘goes down the wrong way’ causing us
to panic while we try to cough it up
Generally this is over in a few seconds, or, until we cough
it up
Signs and symptoms…
• Can talk but with difficulty
• May have rattly voice
• More than likely coughing
• Some difficulty breathing
Choking
Complete obstruction…
A complete obstruction occurs when something is lodged in
the student’s throat completely blocking it and stopping any
air movement.
Signs and symptoms…
This is life threatening
•No air movement (no breathing)
Requires urgent treatment
•Unable to speak
•Unable to cough
•No breaths sounds
•Blue (cyanosis) around lips
Choking
Complete obstruction…
Treatment…
Up to five vigorous back blows between
shoulder blades with heel of hand
If unsuccessful…
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Up to five chest thrusts
If unsuccessful…
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Continue sequences of back blows and chest
thrusts until successful or ambulance arrives.
CPR may be required.
Ear
Eye Injuries
Usually from direct blow or collision
Medical attention if direct blow causes:
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Black eye
Redness
Pain
Blurred vision
May be a sign of internal eye damage or swelling
Dangerous First Aid
DO NOT apply pressure to eye
DO NOT apply any medicine, drops or ointment to eye
Treatment for eye injuries
• Apply ice pack to eye for 10-15
min,
(rest on forehead and cheek)
Treatment for foreign object in eye
• If able to visualize object may remove with clean
wet gauze
• Irrigate eye with water, if symptoms persist, may
have a corneal abrasion
Extremity Injuries: Soft Tissue/Wound
Prompt and proper cleaning reduce risk of infection
Abrasions Gently clean with warm water & soap
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Apply bandage
Contusions: Apply cold compress for 10-20 min
Lacerations: Apply pressure with gauze
Gently clean with warm water & soap
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Apply bandage
Wounds that need medical attention
A wound that will not stay closed
 A wound the needs 5 min of direct pressure to stop
the bleeding
 A wound longer than ½ inch
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Extremity Injuries:Sprains & Strains
A sprain is a stretching or tearing of
ligaments. Ligaments are tough bands of
fibrous tissue that connect one bone to
another. Common locations for sprains are
your ankles and knees.
A strain is a stretching or tearing of muscle
or tendon. People commonly call strains
"pulled" muscles.
Hamstring Muscle
tear
Hamstring and back injuries are among the
most common strains.
Sprains and Strains
Symptoms…
•Pain and tenderness around joints or muscles
•Swelling
•Discolouration to injured part
•Decreased function of the injured part
Treatment-R.I.C.E
Extremity Injuries: Bone
May result from collision, fall, direct blow
Fracture: a break in a bone;
may be partial or complete
Dislocation: displacement of a bone
(or bones) in a joint
6 cardinal signs:
Pain
Redness
Swelling
Warmth
Deformity
• Loss of function
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Extremity Injuries Tx
Follow the acronym R.I.C.E.
R…Rest the injured area. Have the athlete lie still and make them
as comfortable as possible.
I…Ice apply a cold compress, covered with cloth or paper towel.
Ice in a plastic bag rapped in a cloth.
C… Compression with the use of a roller bandage and in
conjunction with the ice will help reduce bleeding and swelling.
E… Elevation of the injured area above the level of the heart if the
injury permits will also help reduce blood flow to the area and
reduce pain.
Fainting
If you observe any of the following signs
of fainting, have the student lie down to
prevent injury from falling:
Extreme weakness or fatigue
Dizziness or light-headedness
Extreme sleepiness
Pale, sweaty skin
Nausea
Fainting may have may causes
including: standing still for too
long, illness, blood loss/shock,
heat exhaustion, diabetic
reaction, severe allergic
reaction, injuries. Most
students will recover quickly
when lying down.
FEVER & NOT FEELING WELL
• Have the student lie down
• Student may lay down for 20 min without fever
• Give no medication unless parents authorize and
board medication policy followed
Many head injuries that
happen at school are minor.
Head wounds may bleed
easily and form large bumps.
Bumps to the head may not
be serious. Head injuries
from falls, sports and
violence may be serious.
HEAD
INJURIES
Watch student for 20 min.
Do NOT leave student alone
What is a concussion?
Mild traumatic brain injury
A disruption in normal brain function due to a
blow or jolt to the head
Centers for Disease Control
A trauma induced alteration in mental status
that may or may not involve loss of
consciousness
American Academy of Neurology
Symptom relief for concussion
Rest
• Fluids
• Pain Reliever’s
• Nausea and Vomiting
• Keep hydrated
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Medication(avoiding sedating meds)
Post-Concussion syndrome
Risk factors for complicated recovery
Re-injury before complete recovery
Over-exertion, especially early after injury
Significant stress
•Unable to participate
in sports or exercise
•Medical uncertainty
•Academic difficulties
Prior illness or injury
•TBI
• Seizure
• Migraine
Psychiatric History
•Depression/Anxiety
•PTSD
Prevention of Heat-related Illness
1. Adequate water supply and frequent water
breaks.
2. Proper supervision of at risk athletes
3. Awareness of environment
Heat Exhaustion
From exposure to high temperature and dehydration
Symptoms: Weakness, malaise, headache, dizziness,
nausea, vomiting, muscle aches, sweating, flushed
skin, high heart rate, fast breathing
Treatment:
1. Remove from heat
2. hydrate (avoid caffeine)
3. Rest
4. Fanning
Heatstroke
Progression from Heat Exhaustion
Symptoms:
1. No sweating (usually),
2. Confusionseizuresunconsciousness
3. Body temperature > 104 degrees
Requires immediate medical attention: 911
Treatment:
extreme cooling measures
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ice packs
wet sheet
Heat Cramps
Painful, involuntary contractions of muscles in
those who have been sweating and not
replacing electrolytes
Usually occurs during rest period after activity
Usually involve calves, thighs, shoulders
Treatment/Prevention:
• fluids, electrolytes (sports drinks)
HYPOTHERMIA (EXPOSURE TO COLD)
Hypothermia happens after exposure
to cold when the body is no longer
capable of warming itself. Young
children are particularly susceptible to
hypothermia. It can be a life
threatening condition if left untreated
for too long.
Signs & Symptoms of Hypothermia (COLD)
Confusion
Weakness
Blurry vision
Slurred speech
Numbness
Shivering
Sleepiness
White or grayish skin color
Impaired judgment
Slow, irregular pulse
Hypothermia can
occur after being
outside in the cold
Spine Injuries: First Aid
Call 911 immediately
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 If student is on the ground, keep them perfectly still
 If student is standing, gently help them to the ground, lying
on back
Place objects around student to ensure
immobilization
 Place blanket/jacket over patient for warmth
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Nasal Injuries & Nosebleeds
Fractured Nose- seek medical attention
• Ice for pain management
Nosebleed: treatment Control bleeding
• Tilt head forward
• Apply steady pressure by pinching nostrils for 5 min.
• Apply ice to bridge of nose
Rashes may have many
causes including heat,
infection, illness, and
reaction to medications,
allergic reactions, insect
bites, dry skin or skin
irritations.
Rashes
Some rashes may be contagious
Wear disposable gloves to protect self
when in contact with any rash
Rashes include such things as:
Hives
Red spots (large or small, flat or raised)
Purple spots
Small blisters
SPLINTERS & IMBEDDED PENCIL LEAD
 Leave in place
 Do NOT probe under skin
 Remove with Splinter Out or
tweezers unless this causes
student pain.
 Do NOT probe under skin
 Wash again
 Apply clean dressing
STINGS
All school staff should know
students with an allergy to stings.
An emergency care plan will be
developed.
Allergic reactions may be life
threatening and may be delayed
up to two (2) hours after the
sting
Remove stinger if present
Wash area with soap and water
Apply cold compress
STOMACHACHES & PAIN
Stomachaches may have many causes
including:
 Menstrual difficulties
Illness
 Psychological issues
Overeating
 Stress
Diarrhea
 Constipation
Injury
 Gas pain
Hunger
Food poisoning
 Allow student to rest 20 min.
 May provide comfort measures
- Saltines
- Peppermints
- Water
 Encourage use of bathroom
VOMITING
Vomiting may have many causes
including:
Injury/head injury
Illness
Heat exhaustion
Bulimia
Overexertion
Anxiety
Food poisoning
Pregnancy
 Have student lie down on their side in
health room
 Apply a cool, damp cloth to student’s
face or forehead
 Have a bucket available
 Give no food or medications
 Give small sips of clear fluids, if thirsty