School Health Office Guidelines

presented by

Wendy Fahey RNC, BSN

Belleville School District Nurse

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.

The Lasting Problem

Belleville School DistrictBelleville School DistrictSchool Emergency Response TeamSchool Emergency Response TeamEMERGENCY RESPONSE PROCEDURE-FOR STAFF

1. Assess the situation. Do not move student! Be sure it is safe to approach.2. Under life and death circumstances, 911 should be called immediately3. 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.

4. 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.

5. 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.

6. 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 ControlInfection Control

• 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

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.

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 sureCall 911

When to Call 911When to Call 911

Treatment of Students with Anaphylaxis?Treatment of Students with Anaphylaxis? Administration of EpinephrineAdministration of Epinephrine Call 911 Call 911 Monitor status of anaphylaxis Monitor status of anaphylaxis Monitor for relapse and administer 2Monitor for relapse and administer 2ndnd dose of epinephrine as dose of epinephrine as

needed may be given within 5 minutes of 1needed may be given within 5 minutes of 1stst dose given dose given Notify parents/physicianNotify parents/physician

PositioningPositioningDifficulty Breathing

Faint/Dizzy

Nausea

Exercise Induced AsthmaExercise Induced Asthma

Asthma:Asthma:Known Asthmatic having an attackKnown Asthmatic having an attack

1. Use their rescue inhaler

2. Encourage to cough to loosen the mucus in the airways

3. Encourage slow deep breathing

4. If symptoms do not improve quickly--seek medical attention

Call 911 if breathing does not improve after treatment.

BitesBites(Animal & Human(Animal & Human))

Parents of the biting student and thebitten 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 (from friction)

Do NOT break blister

Blisters heal best when kept clean and dry.

BurnsBurnsRemove the source

of burning

Dental InjuriesDental Injuries

Primary teeth:• Apply clean gauze to empty socket• Apply ice over injured area (on the face) if there is any swelling

Permanent teeth: • 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

ChokingChokingWe’ve all experienced choking, to varying degrees,

at some time in our livesCommon 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

ChokingChokingPartial obstruction… 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

ChokingChokingComplete obstruction…A complete obstruction occurs when something is lodged in the student’s throat completely blocking it and stopping any air movement. This is life threateningRequires urgent treatment

Signs and symptoms…•No air movement (no breathing)

•Unable to speak

•Unable to cough

•No breaths sounds

•Blue (cyanosis) around lips

ChokingChokingComplete obstruction…

Treatment…

Up to five vigorous back blows between shoulder blades with heel of hand

If unsuccessful…If unsuccessful… Up to five chest thrusts

If unsuccessful…If unsuccessful… Continue sequences of back blows and chest

thrusts until successful or ambulance arrives. CPR may be required.

EarEar

Eye InjuriesEye InjuriesUsually from direct blow or collisionMedical attention if direct blow causes:

• Black eye• Redness• Pain• Blurred vision

May be a sign of internal eye damage or swelling

Dangerous First AidDO NOT apply pressure to eye

DO NOT apply any medicine, drops or ointment to eye

Treatment for eye injuriesTreatment for eye injuries•Apply ice pack to eye for 10-15 min, (rest on forehead and cheek)

Treatment for foreign object in eyeTreatment 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/WoundExtremity Injuries: Soft Tissue/WoundPrompt and proper cleaning reduce risk of infection

Abrasions Gently clean with warm water & soap• Apply bandage

Contusions: Apply cold compress for 10-20 minLacerations: Apply pressure with gauze Gently clean with warm water & soap

• Apply bandage

Wounds that need medical attentionWounds 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

Extremity Injuries:Sprains & StrainsExtremity Injuries:Sprains & StrainsA sprainA 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 strainA 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 StrainsSprains and StrainsSymptoms…•Pain and tenderness around joints or muscles•Swelling•Discolouration to injured part•Decreased function of the injured part

Treatment-R.I.C.E

May result from collision, fall, direct blowFracture: 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

Extremity Injuries: BoneExtremity Injuries: Bone

Extremity Injuries TxExtremity Injuries TxFollow 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.

FaintingFaintingIf you observe any of the following signs of fainting, have the student lie down to prevent injury from falling:Extreme weakness or fatigueDizziness or light-headednessExtreme sleepinessPale, sweaty skinNausea

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 WELLFEVER & 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

HEAD HEAD INJURIESINJURIES

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.

Watch student for 20 min. Do NOT leave student alone

What is a concussion?What is a concussion?Mild traumatic brain injury

A disruption in normal brain function due to a blow or jolt to the headCenters for Disease Control

A trauma induced alteration in mental status that may or may not involve loss of consciousnessAmerican Academy of Neurology

Symptom relief for concussionSymptom relief for concussion• Rest• Fluids• Pain Reliever’s• Nausea and Vomiting

• Keep hydrated• Medication(avoiding sedating meds)

Post-Concussion syndromePost-Concussion syndromeRisk factors for complicated recoveryRisk 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 IllnessPrevention of Heat-related Illness

1. Adequate water supply and frequent water breaks.

2. Proper supervision of at risk athletes3. Awareness of environment

Heat ExhaustionHeat ExhaustionFrom exposure to high temperature and dehydrationFrom exposure to high temperature and dehydrationSymptoms: Weakness, malaise, headache, dizziness,

nausea, vomiting, muscle aches, sweating, flushed skin, high heart rate, fast breathing

Treatment: 1. Remove from heat2. hydrate (avoid caffeine)3. Rest4. Fanning

HeatstrokeHeatstrokeProgression from Heat ExhaustionProgression from Heat ExhaustionSymptoms:Symptoms:1. No sweating (usually),2. Confusionseizuresunconsciousness3. Body temperature > 104 degrees

Requires immediate medical attention: 911Treatment:extreme cooling measures

• ice packs• wet sheet

Heat CrampsHeat CrampsPainful, involuntary contractions of muscles in Painful, involuntary contractions of muscles in those who have been sweating and not those who have been sweating and not replacing electrolytesreplacing electrolytes

Usually occurs during rest period after activityUsually involve calves, thighs, shoulders

Treatment/Prevention:• fluids, electrolytes (sports drinks)

HYPOTHERMIA HYPOTHERMIA (EXPOSURE TO COLD)(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.

Hypothermia can occur after being

outside in the cold

Signs & Symptoms of Hypothermia (COLD)

ConfusionWeaknessBlurry visionSlurred speechNumbness

ShiveringSleepinessWhite or grayish skin colorImpaired judgmentSlow, irregular pulse

Spine Injuries: First AidSpine Injuries: First Aid Call 911 immediately Immobilization:

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

Nasal Injuries & Nosebleeds Nasal Injuries & Nosebleeds

Fractured Nose- seek medical attention• Ice for pain managementNosebleed: treatment Control bleedingControl bleeding• Tilt head forward• Apply steady pressure by pinching nostrils for 5 min.• Apply ice to bridge of nose

RashesRashesRashes may have many causes including heat, infection, illness, and reaction to medications, allergic reactions, insect bites, dry skin or skin irritations.

Some rashes may be contagiousWear disposable gloves to protect self when in contact with any rashRashes include such things as:HivesRed spots (large or small, flat or raised)Purple spotsSmall blisters

SPLINTERS & IMBEDDED PENCIL LEADSPLINTERS & 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

STINGSSTINGS 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 presentWash area with soap and waterApply cold compress

STOMACHACHES & PAINSTOMACHACHES & PAIN Stomachaches may have many causes including:IllnessOvereatingDiarrheaInjuryHunger Food poisoning

Menstrual difficulties Psychological issues Stress Constipation Gas pain

Allow student to rest 20 min. May provide comfort measures- Saltines- Peppermints- Water Encourage use of bathroom

VOMITINGVOMITING

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

Vomiting may have many causes including:IllnessBulimiaAnxietyPregnancy

Injury/head injuryHeat exhaustionOverexertionFood poisoning