YORK REGION DISTRICT SCHOOL BOARD

Policy and Procedure #662.0, Student Health Supports

The Student Health Supports policy and related procedures address the provision of student health supports in schools, and includes the following procedures:

Administration of Medication to Students

Management of Communication Disorders

Management of Physical Challenges

Management of Catheterization

Management of Suctioning

Diabetes Management

Seizures Management

Anaphylactic Reactions

Concussion Management

Pediculosis (Head Lice)

Communicable Diseases

Asthma Management

Medically Fragile Children What has changed?

Major Changes to the Document The following policy and procedures have now been subsumed under the Student Health Supports policy; Anaphylactic Reactions, Communicable Diseases and Fifth Disease, Concussion Management. Asthma (Ryan’s Law) has been included. Changes have been made regarding language in the Administration of Medication Procedure.

Reason for Revisions Four-year cyclical review and creation of an Asthma procedure.

Who is affected by these changes and what is the impact on current practice?

Principals Teachers Parents/guardians Students All staff will be directed to one policy regarding all questions and concerns about providing health supports at school.

Implementation Timelines

Immediate

Lead Superintendents/ Subject Matter Expert

Associate Director of Education, Program S. Yake, Superintendent of Education, Student Services K. Diakiw, Superintendent of Education, Curriculum and Instructional Services H. Sears

WORKING DOCUMENT

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Who has responsibilities? Board of Trustees

Director of Education

Principals, Managers and Supervisors

Staff

Community Care Access

Parents

Students

How is this policy and procedure related to Board priorities? The Student Health Supports policy and procedure supports student achievement and well-being by ensuring a safe and support school and working environment for students and staff members. What are the timelines and next steps? That is accordance with Board Policy #285.0, Board Policies and Supporting Documents, Working Document Policy #662.0, Student Health Supports be circulated to the system for comment for six school months. If approved, this policy and procedure will be adopted as a working document for six school months. Comments received during this time will be scheduled for consideration at the appropriate committee meetings. How do I find out more or provide feedback? Questions about this policy and/or procedure should be raised with your principal, manager or supervisor. If additional clarification is required, principals, managers and supervisors may contact the lead superintendent and/or subject matter expert. In accordance with Board Policy #285.0, Board Policies, Procedures and Supporting Documents, the Board welcomes all comments and suggestions on Board policy. Input is an important component of the review process. If you feel a policy and/or procedure needs to be revised, it is most helpful if you:

● Outline clearly the specific section(s) of the policy and/or procedure in which you are not comfortable; ● The reason(s) for your concern(s); and ● Suggest specific alternate wording to reflect your position.

Specific recommendations or questions about the policy and procedure review process should be submitted via e-mail to policy.committee@yrdsb.ca, or to the attention of the Manager, Corporate Secretariat and Trustee Services at policy.committee@yrdsb.ca.

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Legislative Context Ryan's Law (Ensuring Asthma Friendly Schools) Education Act Good Samaritan Act

Related Policies and/or Procedures

Policy #242.0, Standards of Conduct Policy #261.0, Equity and Inclusivity Policy #668.0, Caring and Safe Schools Department Director’s Office Student Services Curriculum and Instructional Services

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Board Policy #662.0

Student Health Supports Policy Statement The York Region District School Board believes the provision of student health supports contributes to a healthy and inclusive learning environment that improves student achievement and well-being. Providing health supports to students fosters increased independence and advocacy for their own care. The safety and well-being of students is a shared responsibility of the Board, school, family, health care provider and community partners. Application Providing health supports to students is the ongoing responsibility of parents/guardians. By requesting the assistance of staff members, parents/guardians partner with the school to support student needs. The York Region District School Board engages the services of external partners, such as, but not limited to York Region Public Health, to support the provision of health supports to students, as required. In some cases, coordinated supports are required. Staff members and those entrusted with student supervision have a duty of care to assist students during medical emergencies, to the extent of their capacity within the means available to them. Staff members cannot perform controlled acts as defined by the Regulated Health Professions Act as part of their assigned responsibilities unless otherwise authorized under another piece of legislation. Responsibilities The Board of Trustees is responsible for: ● reviewing the Student Health Supports policy in accordance with the priorities in the Trustees’ Multi-

Year Plan and the approved policy review cycle; and ● understanding and communicating with members of the community about the Student Health Supports

policy, as required.

The Director of Education is responsible for:

● implementing and operationalizing the Student Health Supports policy and procedure.

Associate Directors, Coordinating Superintendents and Superintendents of Education are responsible for:

● supporting the application of the Student Health Supports policy and procedures at each school; and ● ensuring all staff members receive appropriate training.

FIRST REVIEW

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Principals are responsible for: ● encouraging parents/guardians and students to supply information about any serious or life-threatening

medical conditions or other health-related matters; ● ensuring that appropriate staff members are aware of and receive appropriate training to support

students diagnosed with a serious or life-threatening medical condition or other health-related matter requiring school support;

● engaging with the appropriate community services, staff and parents/guardians on a regular basis to provide necessary supports;

● encourage parents/guardians to provide suitable medical identification for their child, where applicable; ● taking appropriate action to support serious or life-threatening medical conditions or other health-

related matters, as outlined in the appropriate procedure; ● ensuring that appropriate information about the Student Health Supports policy and related procedures

is communicated to the school community; and ● using professional judgment to determine whether or not to contact the Children’s Aid Society, when

despite notification, parents/guardians do not provide appropriate or necessary care or documentation to support the health and safety of their child.

All staff members are responsible for:

● being aware of students with health support needs and their requirements; ● taking appropriate action to implement the Student Health Supports policy and related procedures,

where applicable; and ● participating in appropriate training, as required.

Parent(s)/Guardian(s) are responsible for: ● informing the school if their child has a serious or life-threatening medical condition or other health-

related matters that require school support; ● take all reasonable measures to minimize the requirement for health supports during school hours,

where applicable, such as, but not limited to the administration of medication; ● working with the school to support students with serious or life-threatening medical condition(s) or other

health-related matters, including but not limited to, ● providing all appropriate information and completed documentation, as required, ● updating the school about any changes in the status of their child’s health, ● covering any costs incurred by the school associated with medical treatment, including the cost of

transportation by ambulance should this be required, and ● providing materials required to meet the health needs of their child, including, but not limited to,

medications, medical identification, specialized equipment, safe transport and disposal of items requiring special precautions such as sharps; and

● understanding that principals may contact the Children’s Aid Society, when despite notification, parents/guardians do not provide appropriate or necessary care or documentation to support the health and safety of their child.

Students with health support needs are responsible for: ● being as independent as possible with their own health care, to the extent they are capable and where

appropriate.

Administrative Services is responsible for:

● ensuring permit holders, cafeteria service providers and Student Transportation Services adhere to the

Student Health Supports policy and procedures, where applicable.

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Definitions Health Supports Health supports are services provided to students to enable them to attend school including, but not limited to, medication services, essential routine health services and emergency services.

Emergency Health Care Plan An Emergency Health Care Plan identifies the emergency procedures necessary to support a specific child’s needs. The plan should;

● include appropriate signatures; ● be made available to appropriate staff members; ● include a recent photo of the child; ● include provisions for off-site activities, including, but not limited to, being aware of the nearest

health care facility and emergency communication methods; and ● consider accessibility.

Where the student has an Individual Education Plan (IEP), include the student’s personal Emergency Health Care Plan and other relevant health-related information with the plan. Emergency Services Emergency services refer to services provided to students who require immediate care in a potentially life-threatening situation or as outlined in the Emergency Health Care Plan. Essential Routine Health Services Essential routine health services refer to services provided on a regular basis as part of a daily routine such as, but not limited to, catheterization, physical management, administration of medication, or ongoing observation of a student with certain health conditions. These needs and services should be outlined in the Essential Routine Health Services Plan. Essential Routine Health Services Plan This plan identifies the unique health needs and support services required for a student on a daily basis. The plan is developed by school staff members with information provided by parents/guardians and a registered health care professional. It may include an Emergency Health Care Plan. Physical management Physical management includes daily activities during which some students require the assistance of another person. This may include, but it not limited to, supports for lifting, positioning, mobility, oral feeding, toileting, range of motion activities and programming to meet the student’s physical needs. Legislative Context Education Act Health Protection and Promotion Act Regulated Health Professions Act Ryan’s Law (Ensuring Asthma Friendly Schools) Sabrina’s Law

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Related Policies and Procedures Equity and Inclusivity Accessibility Department Student Services; Curriculum and Instructional Services History Approved 1996 Amended 2001, 2002, 2007, 2009 Revision Drafted May 31, 2017

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Board Procedure #662.1

Administration of Medication to Students

This procedure outlines the process for administering medication to students. Application The administration of medication is a joint responsibility between the school and parents/guardians. Students are encouraged to be as independent as possible with the administration of medication, recognizing that in some cases support is required. In requesting assistance of staff members, parents/guardians should understand that this request is made of medically untrained persons. Staff members cannot perform controlled acts as defined by the Regulated Health Professions Act as part of their assigned responsibilities unless otherwise authorized under another piece of legislation. Medication must be supplied in the original registered dispensary container. It must include:

● the student’s name; ● date of issue; ● name of the medication; ● the name of the registered dispensary; ● the prescribed dosage and frequency; and ● the name of the prescribing registered physician or nurse practitioner.

The sensitivity and privacy of students should always be considered.

Definition Administration of Medication Administration of medication is the administration of medication prescribed by a registered physician or nurse practitioner.

Registered Dispensary A registered dispensary prepares and provides medication prescribed by a registered physician or nurse practitioner, such as, but not limited to, a pharmacy.

Responsibilities The Director of Education shall: ● allocate staff and resources to support the Administration of Medication to Students procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Administration of Medication to Students procedure at each school.

ATTACHED FOR INFORMATION

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Principals shall: ● ensure Staff Administration of Medication or Self-Administration of Medication forms are completed by

parents/guardians, as applicable; ● determine a secure place for storing medication; ● designate staff member(s) and alternates, or other staff members who are willing to administer the

medication and ensure that any training required for safe administration is provided; ● ensure designated staff members have all necessary information to support the administration of

medication; ● ensure proper records are maintained and retained in a central file in the school, including but not

limited to the appropriate administration of medication form and the Medication Administration Chart; ● ensure that the administration of routine medication is included in the Essential Routine Health Services

Plan and/or Emergency Health Care Plan, where applicable; and ● initiate a referral to the Community Care Access Centre for the administration of medications other than

those that can be taken orally, by inhalant, topically or self-injection, and complete an Emergency Health Care Plan.

Designated staff members shall: ● administer medication in accordance with Staff Administration of Medication or Self-Administration of

Medication forms and the student’s Essential Routine Health Services Plan and/or Emergency Health Care Plan, as applicable.

Parents/guardians shall: ● take all reasonable measures to minimize the need to administer medication at school; ● complete the Staff Administration of Medication Form or Self-Administration of Medication Form in

accordance with registered physician or nurse practitioner recommendations, annually or as required; and

● submit all relevant medical documentation including, but not limited to, a medical note or report. Students shall: ● alert staff members if they believe they are experiencing any symptoms associated with their medical

condition and require medication. Department Student Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.2

Management of

Communication Disorders

This procedure outlines the process for supporting the needs of students with communication disorders as outlined in Policy and Program Memorandum (PPM) 81 Provision of Health Support Services in School Settings. Application Under PPM 81, the provision of supports for students with speech and language disorders is governed by A Model for the Provision of Speech and Language Services and Interministerial Guidelines for the Provision of Speech and Language Services. Definitions Language Disorders Language disorders are characterized by delayed or impaired development of comprehension and/or spoken/written language and/or other symbol system. They may involve the form of language the content of language and/or the function of language in any combination. Speech Disorders Speech disorders include articulation/speech sound production problems, fluency disorders, voice disorders and resonance problems.

Responsibilities The Director of Education shall: ● allocate staff and resources to support the Board’s responsibilities associated with the Management of

Communication Disorders procedure.

Associate Directors and Superintendents of Education shall:

● support the implementation of the Management of Communications Disorders procedure.

Principals shall: ● familiarize themselves with the Management of Communication Disorders procedure; ● initiate a referral to the Board’s Speech-Language Pathology (S-LP) Services to determine eligibility for

referral to Community Care Access Centre (CCAC) for speech therapy services; ● designate a staff member within the school to take responsibility for referrals; ● during the referral process as outlined in the Directions for School Staff Facilitating S-LP Referrals to

Central CCAC, ensure the authorization and completion of all appropriate forms; and

ATTACHED FOR INFORMATION

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● facilitate completion of all CCAC referral forms for eligible students in kindergarten that have been referred to the CCAC through the York Region Preschool Speech and Language Program.

Board Speech-Language Pathologists shall: ● assess students, and where appropriate, initiate the referral process for speech therapy services to the

Community Care Access Centre (CCAC) using the Central CCAC School Health Support Services: Referral Form; and

● support staff members and parents/guardians when the student’s needs are language based and are not eligible for services through the CCAC.

Teachers , including Special Education Resource Teachers shall:

● refer students with speech or language concerns using the appropriate referral process to Speech and

Language Pathologists; ● participate in meetings, as appropriate, to support student speech or language needs; ● participate in the referral process to the Community Care Access Centre (CCAC) as required; and; ● file a copy of the referral form in the Ontario Student Record.

Parents/guardians shall: ● complete all appropriate forms, as required. Department Curriculum and Instructional Services; Student Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision Drafted May 31, 2017

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Board Procedure #662.3

Management of

Physical Challenges

This procedure outlines the process for supporting the needs of students with physical challenges. Definitions Physical Management Routines Physical management routines include daily activities during which some students require the assistance of another person. This may include, but is not limited to, supports for lifting, positioning, mobility, oral feeding, toileting, range of motion activities and programming to meet the student’s physical needs. Physical management routines may be part of a student’s Individual Education Plan and are developed with consideration of the health and safety needs of students and staff members. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Management of Physical Challenges procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Management of Physical Challenges procedure at each school.

Principals shall: ● facilitate the initial screening of students with physical challenges by the Board’s physiotherapists or

occupational therapists, as required; ● designate an educational assistant and trained alternate to provide services as per the student’s

Essential Routine Health Services Plan; ● arrange for annual safe lifting training provided by a regulated professional; ● ensure the completion of annual inspections for all person lifting devices; ● designate a staff member to perform a daily visual inspection of all person lifting devices; ● consult with the Board’s physiotherapists and/or occupational therapists to determine the

appropriateness for referral to the Community Care Access Centre (CCAC) for physiotherapy and/or occupational therapy services at school;

● participate in the referral process to the CCAC; and ● ensure that school staff members are not involved with administering general physical management

routines to students in schools without first consulting with Board physiotherapists or occupational therapists services.

ATTACHED FOR INFORMATION

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Board Physiotherapists and/or Occupational Therapists shall: ● in collaboration with parents/guardians and principal, provide training to appropriate school staff

members to address physical management needs of students, as required; ● provide annual training to designated school staff on safe lifting procedures; ● in collaboration with parents/guardians, principal and teacher, initiate appropriate referrals for students

who are eligible for physiotherapy and/or occupational therapy from the Children’s Treatment Network or the Community Care Access Centre (CCAC); and

● assist principals with referrals to the CCAC, if nursing services are required. Teachers shall: ● initiate referrals for physiotherapy and/or occupational therapy concerns to the Board using the

Request/Consent for Professional Services process; ● incorporate, as appropriate, physical management routines in a student’s Individual Education Plan,

where the student is engaged in increasing independence; ● follow the Essential Routine Health Services Plan; and ● participate in the referral process to the Community Care Access Centre in accordance with the Central

CCAC Referral Guidelines for School Health Support Services.

Educational Assistants shall: ● as designated by the principal, provide services to support physical management routines, as required; ● engage in annual training on safe lifting procedures where required; ● as designated by the principal, perform a daily visual inspection of all person lifting devices; and ● with appropriate training, engage in shallow suctioning, administration of continuous pre-set passive

oxygen, care for ostomy bag and appliance, application of condom for urinary drainage, monitoring clean intermittent catheterization, as directed by an Essential Routine Health Services Plan.

Community Care Access Centre Central and Central West (CCAC) shall: ● provide training in shallow suctioning, administration of continuous pre-set passive oxygen, care for

ostomy bag and appliance, application of a condom for urinary drainage and monitoring clean intermittent catheterization, as directed by an Essential Routine Health Services Plan and upon the request of a principal;

● work with Board physiotherapists and occupational therapists in training identified staff members, as required; and provide physiotherapy and occupational therapy upon referral and in compliance with CCAC Referral Guidelines for School Health Support Services.

Department Curriculum and Instructional Services; Student Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.4

Management of Catheterization

This procedure outlines the process for meeting the needs of students who require catheterization. Definitions Clean Intermittent Catheterization During clean intermittent catheterization, the catheter is inserted into a student’s bladder only until the bladder has been drained and then the catheter is removed. This procedure can be carried out by the student or by a health assistant. Sterile Catheterization During sterile non-intermittent catheterization, the catheter must be inserted by a Community Care Access Centre nurse or the parent/guardian and remains in the patient. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Management of Catheterization procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Management of Catheterization procedure at each school. Principals shall:

● initiate a referral the Community Care Access Centre (CCAC) Care Coordinator; ● coordinate the completion of the Essential Routine Health Services Plan and when required complete

the Emergency Health Care Plan in accordance with physician orders; ● send the Emergency Health Care Plan and Essential Routine Health Services Plan to the Student

Services Coordinator; ● follow the steps outlined in the Catheterization Chart; ● work with the Student Services Coordinator to allocate appropriate staff members to support

catheterization; ● ensure parents/guardians provide catheterization materials and biohazard waste containers; ● ensure the management and safe removal of biohazard waste containers; ● request the CCAC Care Coordinator provide consultation and training for educational assistants and

designate, with parent/guardian permission; and ● ensure that the Emergency Health Care Plan and/or Essential Routine Health Services Plan is not

altered until new physician orders are received.

ATTACHED FOR INFORMATION

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Care Coordinators for the Community Care Access Centre Central and Central West (CCAC) shall:

● forward updated written orders from physicians to the school, with parental permission, while the student is on their caseload;

● provide consultation and arrange required training for the educational assistant and designate; ● authorize nursing visit with the principal, parent/guardian, educational assistant and designate staff

member and CCAC for initial training and as required; ● work with the parent/guardian and principal to determine the duration of support required; ● assess catheterization needs for students and provide catheterization services, as needed; and ● provide ongoing consultation as needed.

Health Assistants and Assistants for the Developmentally Handicapped shall: ● administer or monitor clean intermittent catheterization and/or supervise student self-catheterization,

as required; ● ensure the safe storage and removal of biohazardous materials; and ● engage in training to provide clean intermittent catheterization.

Student Services Coordinators shall: ● when requested by principals, initiate a referral to the Community Care Access Centre (CCAC) Care

Coordinator and support the development of the Essential Routine Health Services Plan and Emergency Health Care Plan.

Parents/guardians shall: ● demonstrate the catheterization procedure to the school staff with Community Care Access Centre

nursing supervision; ● provide equipment for catheterization; and ● be a back-up to staff members if available.

Department Curriculum and Instructional Services; Special Education Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.5

Management of Suctioning

This procedure outlines the process for meeting the needs of students who require suctioning. Definitions Deep Suctioning Also referred to as chest suction or draining, deep suctioning is a regulated health act to be performed by a trained Registered Nurse under physician orders. The suctioning tube passes beyond the larynx into the lungs. This procedure is not to be performed by Board staff. Shallow Suctioning Shallow suctioning is not a regulated health act. The tube vacuums saliva from oral and/or nasal passages, and does not go beyond the teeth. Shallow suctioning may be performed by trained staff in accordance with the Shallow Suctioning Chart. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Management of Suctioning procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Management of Suctioning procedure at each school. Principals shall: ● contact the Community Care Access Centre (CCAC) Care Coordinator to help develop the Essential

Routine Health Services Plan; ● ensure the Essential Routine Health Services Plan is completed and includes orders from the registered

physician; ● send the Emergency Health Care Plan and/or Essential Routine Health Services Plan to the Student

Services Coordinator; ● assign an educational assistant and designate to provide shallow suctioning for students as required; ● request the CCAC Care Coordinator provide consultation and training for educational assistants and

designate, with parent/guardian permission; ● ensure parents/guardians provide suctioning materials and biohazard waste containers; ● ensure the management and safe removal of the biohazard waste containers; ● contact the CCAC Care Coordinator to obtain new physician orders, as required; and ● ensure that the Emergency Health Care Plan or Emergency Routine Health Services Plan is not altered

until new orders are received.

ATTACHED FOR INFORMATION

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Care Coordinators for the Community Care Access Centre Central and Central West (CCAC) shall: ● forward updated written orders from physicians to the school, with parental permission, while the

student is on their caseload; ● provide consultation and arrange training for the educational assistant and designate; ● authorize initial training with the principal, parent/guardian, educational assistant and designate staff

member and CCAC, as required; ● work with the parent/guardian and principal to determine the duration of support required; ● assess suctioning needs for students and provide suctioning support as needed; and ● provide ongoing consultation as required.

Educational Assistants and designates shall: ● assess and provide shallow suctioning as outlined in the Essential Routine Health Services Plan; ● ensure the safe storage and removal of biohazardous materials; and ● engage in training to provide shallow suctioning. Student Services Coordinator shall: when requested by principals, initiate a referral to the Community Care Access Centre (CCAC) Care Coordinator to support the development of the Essential Routine Health Services Plan and Emergency Health Care Plan Parents/guardians shall: ● demonstrate the suctioning procedure to the school staff with CCAC nursing supervision; ● provide equipment for shallow suctioning; and ● be a back-up to staff members if available.

Department Curriculum and Instructional Services; Special Education Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.6

Diabetes Management

This procedure outlines the process for meeting the needs of students diagnosed with diabetes. Definitions Blood glucose control Blood glucose control is the proper balance of food and insulin in the body. The balance may be affected by missing a meal or snack, or eating less than planned and could be a serious problem as it can easily result in very low blood glucose or hypoglycemia and requires immediate treatment. Diabetes Core Team The Diabetes Core Team is a group of hospital health professionals, generally comprised of hospital and community health care practitioners with expertise in diabetes and may include diabetic educators, social workers and physicians who support the student, his/her family and the school. Diabetes - Type 1 Type 1 diabetes occurs when the pancreas is unable to produce insulin. Diabetes - Type 2 Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that it produces. Hyperglycemia

Hyperglycemia or high blood glucose is when the blood glucose (sugar) is higher than an individual’s target range.

Hypoglycemia Hypoglycemia is an abnormal, low level of glucose in the blood. It can happen within minutes of a person appearing healthy and normal and may quickly become an emergency situation. Insulin Insulin is a hormone produced by the pancreas. Children with diabetes use insulin syringes, pens or pumps to give insulin.

Target Range Target range is acceptable blood glucose levels based on the Canadian Diabetes Association’s Clinical Practice Guidelines and is personalized for the student by the parent/guardian and Diabetes Core Team.

ATTACHED FOR INFORMATION

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Responsibilities The Director of Education shall: ● allocate staff and resources to support the Diabetes Management procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Diabetes Management procedure at each school. Principals shall: ● ask parents/guardians to inform the school if their child has diabetes; ● ensure annual in-service training is provided for school staff members at the beginning of each school

year by a regulated professional in the management of diabetes to ensure awareness of; ● diabetes management, ● signs, symptoms and emergency treatment of hypoglycemia, and ● use and location of emergency kits, where applicable;

● ensure training and information is provided to staff members as per the Diabetic Management Chart; ● ensure a planning meeting for school entry occurs to support effective transition; ● at the time of registration and the beginning of each school year,

● ensure that all staff members are made aware of students with diabetes and the location of emergency kits;

● ensure that occasional staff members, volunteers and Student Transportation Services are informed of students with diabetes, as required;

● if parents/guardians inform the school that their child has diabetes;

● ensure Kids with Diabetes Information Card, Essential Routine Health Services Plan and Request and Consent for Care of a Student with Diabetes are completed and updated as required,

● ensure Kids with Diabetes Information Card is posted in the office, common staff area, health room and provided to the student’s teachers,

● refer parents/guardians and staff members to resources offered through Canadian Diabetes Association and/or Canadian Pediatric Society, as required,

● ensure teachers are aware of signs and symptoms of hypoglycemia and the emergency treatment plans for each student,

● ensure parents/guardians are informed that, even if they have provided consent to let their child self-monitor their diabetes, the severity of their child’s reaction may hinder any attempt to do so and as a result, the child may require the assistance of others,

● ask parents/guardians to provide the school with all supplies required for the ongoing management of their child’s diabetes at school,

● ensure all supplies are kept in a secure location and information is available to staff members; ensure students are provided with an appropriate location to administer insulin,

● provide reasonable accommodation for students with diabetes whose blood glucose is below or above target limits as identified in the Kids with Diabetes Information Card,

● initiate a referral to the Community Care Access Centre (CCAC), with parental permission, if a registered physician has directed frequent blood glucose monitoring and insulin administration,

● contact the CCAC Care Coordinator regarding new medical orders and ensure previous procedures are not altered by school staff members until the new medical orders are received,

● assign a staff member and designate, as outlined in the Kids with Diabetes Information Card, to verify the glucometer reading and monitor the student during insulin self-administration, where appropriate, ensure the management and safe removal of the biohazard waste container;

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● if a student is known to have diabetes and has a perceived hypoglycemic reaction, authorize staff to respond using the emergency kit and remain with the student until recovery is complete or seek medical attention immediately should the symptoms continue; and

● if a student has experienced a hypoglycemic reaction or is non-compliant/incoherent, ● contact the parent/guardian (or emergency contact if unable to reach the parent/guardian) as per

the Emergency Health Care Plan.

Staff members shall: ● annually participate in training as required; and ● follow the guidelines as outlined in the Kids with Diabetes Information Card, Essential Routine Health

Services Plan and Tips for Teachers and school Staff Supporting Students who have Type 1

Diabetes.

Teachers shall:

● if parents/guardians inform the school that their child has diabetes;

● if asked, meet with parents/guardians of students with diabetes to discuss the diabetes management plan as outlined in the Kids with Diabetes Information Card and Essential Routine Health Services Plan;

● ensure an emergency kit provided by parents/guardians and the Kids with Diabetes Information Card are available in the classroom and taken on excursions and/or activities;

● communicate to students and staff members, as appropriate, about signs, symptoms and emergency treatment of hypoglycemia;

● ensure that occasional staff in the classroom are aware of students with diabetes by including Kids with Diabetes Information Card and emergency procedures in daily plans; and ask parents/guardians to replace items in the emergency kit as required.

Educational Assistants shall: ● verify the child’s reading of the glucometer and monitor the child during insulin self-administration, as

required.

Community Care Access Centre Central and Central West (CCAC) shall:

● arrange and facilitate a case conference with the parent/guardian, principal, appropriate staff members

and/or Student Services Coordinator to determine the level of intervention required or, when the student has acquired independent competency skills as determined by the core team checklist;

● ensure staff members receive Tips for Teachers and school Staff Supporting Students who have Type 1 Diabetes from the Diabetes Core Team;

● arrange for annual school staff member training in the management of diabetes with the Diabetes Education Centre or the CCAC Service Provider Organization;

● provide assessment/support for newly diagnosed diabetes and for children transitioning to independent competency of mechanical skills;

● assess need for registered nurse or registered practical nurse to monitor a student at school; ● administer insulin via pump/injection until student can demonstrate independence; ● ensure safe removal and disposal of biohazardous materials; and ● obtain verbal consent to exchange information with the school and Diabetes Core Team.

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Parents/guardians shall: ● inform the school if their child has diabetes and provide updated information on changes in their

condition, as needed; ● complete the Kids with Diabetes Information Card and Request and Consent for Care of a Student with

Diabetes upon registration and at the beginning of each school year; ● provide the school with all supplies required for the management of their child’s diabetes at school; ● consider providing their child with medical identification (e.g. MedicAlert® bracelet or necklace); and

ensure that their child leaves for school each day with all appropriate supplies required for the management of their diabetes.

Students shall: ● carry all appropriate supplies required for the management of their diabetes, where age and/or

developmentally appropriate; ● take responsibility for understanding and maintaining appropriate nutrition; and ● take age and/or developmentally appropriate responsibility for diabetes management. Department Curriculum and Instructional Services; Special Education Services Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.7

Seizures Management

This procedure outlines the process for meeting the specific needs of students with seizures. Definitions Seizure Disorder Seizure disorder is a neurological disorder which causes sudden bursts of hyperactivity in the brain. This hyperactivity produces seizures which vary from one person to another in frequency and form. A seizure may appear as a brief stare, change of awareness or convulsion. It may last a few seconds or a few minutes. Repeated brain seizures usually characterize a seizure disorder sometimes known as epilepsy.* *Adapted from Epilepsy Ontario and CBC.ca health. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Seizures Management procedure.

Associate Directors, Coordinating Superintendents and Superintendents of Education shall: ● support the implementation of the Seizures Management procedure at each school. Principals shall: ● coordinate the completion of the Essential Routine Health Services Plan and Emergency Health Care

Plan, in accordance with physician orders and ensure that they clearly outline procedures to be followed in response to a perceived emergency seizure event;

● ensure that seizure information from Epilepsy Ontario is shared with parents/guardians and staff members;

● at the time of registration and the beginning of each school year;, ● ensure that all staff members are made aware of students with a seizure disorder, and ● ensure that occasional staff members and volunteers are informed of any students with a seizure

disorder, as required; ● ensure the administration medication for seizure management as outlined in the Administration of

Medication to Students procedure; ● ensure a copy of the Emergency Health Care Plan and information from Epilepsy Ontario is posted in

the office, common staff area and health room, and provided to the student’s teachers; ● ensure annual in-service training is provided for staff members and volunteers, as appropriate, at the

beginning of each school year by a regulated professional in the management of seizures; and ● inform parents/guardians (or emergency contact if unable to reach the parent/guardian) if a student has

experienced a seizure as per the Emergency Health Care Plan.

ATTACHED FOR INFORMATION

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Teachers shall: ● meet with the parents/guardians of students with seizure disorders to create the seizure management

plan as outlined in the Emergency Health Care Plan. ● Use the Seizure Chart to track student seizures where appropriate. Community Care Access Centre Central and Central West (CCAC) shall: ● provide professional development to staff members regarding the management of seizures, upon principal

request.

Parents/guardians shall: ● inform the school about their child's seizure disorder; ● provide school staff with signs of seizure activity specific to their child; ● collaborate with the school in the development and completion an Emergency Health Care Plan and/or

Essential Routine Health Services Plan; and ● complete all required documentation for the Administration of Medication to Students, if applicable.

Students shall: ● take age/developmental appropriate responsibility for indicating to adults when experiencing warning signs

of possible seizure activity; and ● take age/developmental appropriate responsibility for seizure management. Department Student Services

Procedure History Approved 1996 Amended 2001, 2002, 2009 Revision drafted May 31, 2017

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Board Procedure #662.9

Anaphylactic Reactions

This procedure outlines the process for managing anaphylactic reactions of students. Application The Board recognizes that there can be major challenges for students or staff members who are at risk of anaphylaxis. This procedure applies to anyone at risk who has been diagnosed by an allergist or a physician responsible for prescribing treatment and outlines strategies to reduce risk of a potential reaction. If a student is known to be at risk of anaphylaxis and is experiencing a perceived anaphylactic reaction, the following steps should be taken:

Follow the Anaphylactic Reactions Protocol;

Staff members are required to assist in the administration of epinephrine with the assurance that they will not be held responsible for any adverse reaction resulting from such administration;

Have the individual transferred to hospital to seek immediate medical attention preferably by ambulance;

Ensure the used epinephrine auto-injector and Anaphylactic Reactions Protocol form accompany the student to the hospital as long as no delay is caused in the transporting of the student.

Strategies to Reduce Risk of Exposure to Anaphylactic Causative Agents The four categories to consider when providing a safe environment for staff members, students and members of the community at risk of anaphylaxis are: 1. information and awareness for the entire school community or workplace; 2. avoidance of the allergen that causes anaphylactic reactions wherever possible and acknowledging

that it is impossible to ensure the elimination of all allergens in schools and workplaces; 3. emergency response procedures in case of accidental exposure; and 4. fostering a safe, caring and supportive environment for those at risk of anaphylaxis.

Strategies to reduce risk of exposure include, but are not limited to: ● making reasonable efforts to limit the student’s exposure to the life-threatening allergen in foods, craft

materials and insect stings; ● avoiding the cross-contamination of food allergens; ● establishing lunchroom/classroom eating area practices that limit allergen contact for the at-risk student

or staff member; ● encouraging parent(s)/guardian(s) to avoid the use of substitute peanut butter products; ● taking special precautions in planning field trips, extra-curricular events, special celebrations and

fundraising events; and ● inviting the student at risk to identify a “buddy” who is able to recognize symptoms of an anaphylactic

reaction and to alert an adult.

More information is available in the Best Practices for Avoiding Anaphylactic Reactions document.

ATTACHED FOR INFORMATION

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Definitions Age and/or Developmentally Appropriate Students in Junior Kindergarten to Grade 12 are required to carry their epinephrine auto-injector with them at all times. However, it is recognized that age and/or developmental concerns for individual students will need to be considered by the superintendent of schools and principal in consultation with the parent(s)/guardian(s). Allergens For the purpose of this policy, allergens are any substance or condition that can bring on an allergic reaction leading to a life-threatening allergic reaction known as anaphylaxis. Anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Anaphylactic Reaction Signs and symptoms of anaphylaxis can occur within minutes of exposure to an allergen. In rarer cases, the time frame can vary up to several hours after exposure. The ways symptoms appear can vary from person to person and from episode to episode in the same person. Symptoms of anaphylaxis generally include two or more of the following body systems: skin, respiratory, gastrointestinal and/or cardiovascular. However, low blood pressure alone, in the absence of other symptoms, can also represent anaphylaxis. ● Skin - hives, swelling (face, lips, tongue), itching, warmth, redness; ● Respiratory (breathing) - coughing, wheezing, shortness of breath, chest pain or tightness, throat

tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing;

● Gastrointestinal (stomach) - nausea, pain or cramps, vomiting, diarrhea; ● Cardiovascular (heart) - paler than normal skin colour/blue colour, weak pulse, passing out, dizziness

or lightheadedness, shock; ● Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine

cramps, metallic taste.

Epinephrine Auto-injector A medical device that is used to deliver a pre-measured dose (or doses) of epinephrine. Epinephrine Epinephrine is a synthetic version of the hormone adrenaline that is used in the treatment of anaphylaxis and life-threatening asthma attacks. A second dose of epinephrine may be administered as early as 5 minutes after the first dose if there is no improvement in symptoms.

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Responsibilities The Director of Education shall: ● allocate staff and resources to support the Anaphylactic Reactions procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Anaphylactic Reactions procedure at each school; and ● ensure all staff members are trained annually.

Principals shall: ● communicate the Anaphylactic Reactions procedure as outlined in the Anaphylactic Reactions

Communication Protocol for Principals; ● ask parent(s)/guardian(s) to inform the school about all known allergies and to identify if their child is at

risk of anaphylaxis; ● encourage the entire school community to assist in managing exposure to identified allergens, by:

● periodically communicating identified allergies and avoidance strategies, as outlined in Best

Practices for Avoiding Anaphylactic Reactions, and

● sending home letter to parents/guardians informing them of known severe allergens and avoidance strategies, if applicable;

● provide annual in-service training at the beginning of the school year for all school staff in; ● anaphylaxis prevention, ● recognition of allergic reactions and appropriate responses, ● proactive communication of a caring and safe environment, ● Board policy and procedure related to students at risk of anaphylaxis, and ● use and location of epinephrine auto-injectors;

● invite before and after school program staff and volunteers to the annual in-service training; ● at the time of registration and again at the beginning of each school year;

● ensure all staff members are made aware of students with anaphylaxis and the location of their epinephrine auto-injector;

● ensure occasional staff members and volunteers are informed of any students with anaphylaxis, and

● provide Student Transportation Services and cafeteria food service providers with a current copy of the Anaphylactic Reactions Protocol form;

● if no back-up epinephrine auto-injectors have been provided, purchase back-up stock epinephrine auto-injector(s) using school funds to store in a designated area;

● if an anaphylactic reaction occurs and no epinephrine auto-injector is available for the student, ensure that either another student’s back-up epinephrine auto-injector or a school-purchased auto-injector is used, and replace the auto-injector using school funds as soon as possible;

● if parents/guardians inform the school that their child is at risk for anaphylaxis: ● ensure that an Anaphylactic Reactions Protocol form is completed and updated annually; ● ensure that parent(s)/guardian(s) are aware that any staff member may administer epinephrine and

signed authorization for a staff member to administer an epinephrine auto-injector is not required, and

● ask parent(s)/guardian(s) to provide at least one in-date epinephrine auto-injector to the school;

in cases of financial difficulty, encourage parent(s)/guardian(s) to contact Food Allergy Canada for support to purchase the epinephrine auto-injector;

ensure that any epinephrine auto-injector carried by a student is prescribed by a registered physician, nurse practitioner or allergist;

additionally, encourage parents to provide a second epinephrine auto-injector to the school,

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when a second epinephrine auto-injector is provided, store it in an accessible location known to all staff along with documentation as outlined in the Anaphylactic Reactions Protocol form, and

where it is age and/or developmentally appropriate, ensure the student keeps one epinephrine auto-injector with them at all times,

● maintain open communication with parent(s)/guardian(s), staff members and students; ● encourage the student to wear medical identification, e.g. MedicAlert® bracelet or necklace; and ● maintain a file for each anaphylactic student outlining;

their allergies,

current treatment,

instructions from the student’s registered physician or nurse practitioner, if provided,

a current emergency contact list, and

strategies to support the student; ● ensure staff members bring epinephrine auto-injectors on field trips, as required; ● meet with the parent(s)/guardian(s) when necessary, to discuss;

the student’s level of responsibility,

the consequences of not having the epinephrine auto-injector close to the child,

an alternate plan that will allow efficient response, if it is determined that it is in the best interest of the child not to carry the epinephrine auto-injector,

if parent(s)/guardian(s) refuse to allow their child to carry the epinephrine auto-injector at school, include a notation in the student’s Emergency Response/Action Plan,

● if parent(s)/guardian(s) refuse to provide the school with an epinephrine auto-injector and refuse to allow the student to carry an epinephrine auto-injector,

send a letter to the student’s parents/guardians outlining the risk to their child;

suggest the parent(s)/guardian(s) contact Food Allergy Canada to discuss the refusal,

seek permission of parent(s)/guardian(s) to discuss the refusal with the registered physician or nurse practitioner,

invite a public health nurse to discuss the refusal with the child’s parent(s)/guardian(s),

consult with the Superintendent of Schools regarding next steps, and

use professional judgment to determine whether or not to contact the Children’s Aid Society, if necessary;

● if attempts to resolve non-compliance persist;

send a letter including a non-compliance waiver to the student’s parent(s)/guardian(s) outlining the risk to their child and have the waiver signed and returned to the school,

ensure the letter provided to parents includes a disclaimer for the Board;

identify individual students at risk of anaphylaxis to all school staff each September;

post this information in common staff areas; and

inform teachers and others who have contact with this student that they will not be carrying their epinephrine auto-injector; and

● if a student is experiencing an anaphylactic reaction, ensure appropriate action is taken as outlined.

All staff members shall:

● annually participate in training for anaphylactic reactions, and review the Anaphylactic Reactions procedure and Best Practices for Avoiding Anaphylactic Reactions;

● if a student is experiencing an anaphylactic reaction, take appropriate action as outlined; ● practice allergen avoidance measures within the school, at school or work-related events and out-of-

school or workplace activities following the Best Practices for Avoiding Anaphylactic Reactions; ● communicate health or safety concerns to an administrator or supervisor; and ● inform their supervisor of their own potentially life-threatening allergies.

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Teachers shall: ● if asked, meet with the parent(s)/guardian(s) of a student with anaphylaxis to discuss and record;

● the student’s needs, and ● the school procedure in case of emergency and the Anaphylactic Reactions Protocol;

● ensure that epinephrine auto-injectors and the student’s Anaphylactic Reactions Protocol form are taken on excursions and/or activities;

● communicate to students and staff members about how to help avoid allergens and reduce risks; and ● ensure that occasional staff in the classroom are aware of students at risk of anaphylaxis by including

the Anaphylactic Reactions Protocol form and emergency procedures in daily plans.

Outdoor Education Centre staff members and teachers planning remote field trips shall: ● when students have potentially life-threatening allergies, ensure awareness of the estimated time to

reach the nearest hospital or medical facility; and ● provide school staff members with the availability of two-way communication.

Student Transportation Services (STS) shall:

● ensure that the current Anaphylactic Reactions Protocol form is available on file in the STS office, in

the appropriate service provider’s dispatch office, and in the appropriate school vehicle(s); ● require the service provider to ensure all regular and substitute drivers who transport students with

anaphylaxis have received training, including, but not limited to, recognition of symptoms of anaphylactic reactions, proper administration of epinephrine auto-injector, and how to contact emergency services;

● ensure that service providers have developed an emergency plan to respond to anaphylactic reactions; ● work with the principal and the service provider to assign a specific seat to a student with anaphylaxis,

if required; and ● advise bus drivers to enforce the no food or beverage consumption rule on school buses.

Cafeteria Food Service Provider (Secondary Schools) shall: ● ensure that the current Anaphylaxis Reactions Protocol form is available on file in their office; ● ensure that all personnel are trained to reduce the risk of cross-contamination through purchasing,

handling, preparation and serving of food; ● ensure that the contents of all foods served in school cafeterias and brought in for special events are

clearly identified; and ● participate in the school’s anaphylaxis training on how to recognize the symptoms of an anaphylactic

reaction and how to respond. Parent(s)/guardian(s) shall: ● inform the school of any known allergies and if their child is at risk of anaphylaxis by completing the

Anaphylactic Reactions Protocol form upon registration and each September; ● call the school to schedule a meeting to discuss their child’s Anaphylactic Reactions Protocol form if

they choose; ● provide the school with at least one in-date epinephrine auto-injector, and preferably two, to be used in

the event of an anaphylactic reaction; ● ensure that their child, where age and/or developmentally appropriate, carries the epinephrine auto-

injector with him/her at all times; ● replace the epinephrine auto-injectors before the listed expiry date; ● sign the waiver if they choose not to provide the school or their child with an epinephrine auto-injector;

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● consider providing their child with medical identification, e.g. MedicAlert® bracelet or necklace; encourage the child to practice allergen avoidance measures; and

● practice allergen avoidance measures at all times.

Students shall: ● carry their epinephrine auto-injectors at all times, where age and/or developmentally appropriate; ● practice allergen avoidance measures; ● refrain from sharing food or items that could include an allergen; and ● alert staff if they believe they have been accidentally exposed to an allergen or have any concerns

related to potential allergens..

The responsibilities above will be assessed based on the student’s age and capability to understand their life-threatening condition. Students with special education needs would require additional assistance and advocacy by staff members and parents. Legislative Context Sabrina’s Law Education Act Good Samaritan Act Related Policies and Procedures Respectful Workplace and Learning Environments Equity and Inclusivity Caring and Safe Schools Department Education and Community Services History Approved January 2006 (formerly part of Procedure 662, Provision of Health Support Services in School Settings) Working Document May 2012, February 2013, December 2015 Revised May 2008, March 2013 Policy Memo Recommendation to Delete 2017 (Subsumed into Policy and Procedure #662.0, Health Supports) Revision drafted May 31, 2017

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Board Procedure #662.10

Concussion Management

This procedure outlines the steps to follow if a student has a suspected or diagnosed concussion and effective management procedures to guide a student’s return to learning and physical activity after a diagnosed concussion. Application Recognizing the serious effect concussions can have on student learning, achievement and well-being, the Board is committed to working with parents/guardians and community partners to provide all appropriate supports to prevent and minimize the risk of sustained concussions. This procedure applies to all students, including those suspected of having a concussion or to students who have been diagnosed with a concussion by a registered physician or nurse practitioner. It does not apply to staff members who may have a concussion. Policy #540.0, Health and Safety – Employees outlines the commitment of the Board to providing and maintaining a safe and healthy working environment that supports the safety and well-being of employees. If a concussion is suspected, the following steps must be taken: 1. Stop the activity and do not allow the student to participate in physical activity that day even if the

student states that they are feeling better. 2. Monitor the student. 3. Call 911 if student loses consciousness or if symptoms are serious or worsen. 4. If the student can be safely moved, remove them from the activity unless the student has lost

consciousness. 5. Contact parents/guardians or emergency contact (if the parent/guardian is not available) and inform

them that:

They need to pick up their child.

The child should be examined by a registered physician or nurse practitioner as soon as possible

The child should be monitored for 24-48 hours as signs and symptoms may take hours or days to emerge.

6. Stay with the student or ensure the student is supervised by an adult. Continue to monitor and document any changes until parent/guardian or emergency contact arrives.

7. Ensure principal is aware of the incident. 8. Provide parents/guardians with Student Tracking for Concussion Management Protocol and

Recognizing and Monitoring Symptoms during Recovery from a Concussion. 9. Inform parents/guardians that they must return Student Tracking for Concussion Management Protocol

with signature from a registered physician or nurse practitioner. 10. Do not administer medication unless required for other conditions.

If a student is diagnosed with a concussion, the following steps should be taken; 1. Follow the Student Tracking for Concussion Management Protocol. 2. Ensure all appropriate staff members are aware of and implement modifications as outlined in the

Student Tracking for Concussion Management Protocol. 3. Ensure the student does not participate in physical activity before the in-school team meeting takes

place. 4. Hold an in-school team meeting.

ATTACHED FOR INFORMATION

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5. Following the in-school team meeting, ensure all appropriate staff members are aware of and provide accommodations and appropriate strategies as outlined in the Summary of Accommodation for Students Returning to School after a Concussion.

6. Share information with before and after school providers, occasional staff members and volunteers, as required.

7. Continue to monitor student’s physical, cognitive, social and emotional well-being. 8. Communicate with parents/guardians as needed and share progress. 9. Maintain communication with the in-school team as needed. 10. Once a registered physician or nurse practitioner has provided clearance for return to learn:

Follow return to physical activity guidelines as outlined in the Student Tracking for Concussion Management Protocol.

If any signs or symptoms of a concussion reappear, follow the steps for a suspected concussion. 11. Following the stages of the Student Tracking for Concussion Management Protocol, obtain clearance

for return to physical activity from parent/guardian.

Definitions Concussion A concussion: ● is a brain injury that causes changes in how the brain functions and that can lead to symptoms that can

be physical (e.g., headache, dizziness), cognitive (e.g., difficulty in concentrating or remembering), emotional/behavioural (e.g., depression, irritability), and/or related to sleep (e.g., drowsiness, difficulty in falling asleep);

● may be caused either by a direct blow to the head, face, or neck or by a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull;

● can occur even if there has been no loss of consciousness; and ● cannot normally be seen by means of medical imaging tests, such as X-rays, standard computed

tomography (CT) scans, or magnetic resonance imaging (MRI) scans. (Adapted from Ontario Ministry of Education Policy/Program Memorandum 158) Student Tracking for Concussion Management Protocol The Student Tracking for Concussion Management Protocol outlines the steps to be taken in developing an individualized and gradual return to learning and physical activity plan for a student following a diagnosed concussion. In-School Team An In-School Team meets to discuss, problem solve and recommend strategies to support a student’s academic, behavioural, social and/or emotional areas of strength and need. The team may include but is not limited to school staff members, Student Services staff, students and/or parents/guardians, as appropriate. Ongoing interventions and progress are also monitored through the In-School Team process. Risk-Reducing Strategies Strategies to minimize the risk of concussion include: ● information/actions that prevent concussions from happening such as but not limited, to rules and

regulations; and ● minimizing slips and falls by checking that classroom floor and activity environments provide for safe

traction and are obstacle free. (Adapted from Ontario Physical Education Safety Guidelines - Concussion Package)

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Responsibilities The Director of Education shall: ● allocate staff and resources to support the Concussion Management procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Concussion Management procedure.

Principals shall: ● ensure that information about the Concussion Management procedure and support documents is

shared with all school staff, parents/guardians, students, and before and after school program providers at the beginning of the school year;

● within 24 hours of a significant injury on Board property or at a Board-related activity or event, submit an accident/injury report form to the Senior Manager of Administrative Services, as outlined in Procedure #NP138.0, Insurance: Personal Liability, Property Damage and Student/Visitor Injuries;

● if a student is suspected of having a concussion, ensure appropriate action is taken as outlined; and ● if a student is diagnosed with a concussion;

● ensure appropriate action is taken as outlined, ● maintain a file for the student outlining the student’s information, details of the diagnosed

concussion, and any other relevant information, including the Student Tracking for Concussion Management Protocol, and

● schedule and participate in in-school team meeting to identify accommodations required for the student, ensuring students and parents/guardians have the opportunity to participate.

In-School Teams shall: ● assess needs of student and determine the supports or accommodations required, taking into account

input from parents/guardians; registered physician or nurse practitioner recommendations; the student’s academic, social and mental well-being; student’s symptoms and the concussion protocol;

● complete the Summary of Accommodation for Students Returning to School after a Concussion and share with the principal, all appropriate staff members, parents/guardians and student, and provide a copy to be kept in the student’s file;

● communicate the outcome of the in-school team meeting with parents/guardians and the student; and ● hold follow-up meeting(s) if needed to consider all relevant and new information and determine

appropriate supports. School staff members shall:

● participate in training on concussion management; ● if a student is suspected of having a concussion, ensure appropriate action is taken as outlined; ● if a student is diagnosed with a concussion, ensure appropriate action is taken as outlined; ● if a registered physician or nurse practitioner indicates on the Student Tracking for Concussion

Management Protocol that the student does not have a concussion, allow the student to resume regular learning and physical activities; and

● understand; ● appropriate strategies to minimize the risk of concussion, as outlined in Ophea Safety Guidelines, ● common signs and symptoms of concussions, ● steps to follow if they suspect a student may have a concussion, ● effective management procedures to guide students’ return to learning and physical activity after a

diagnosed concussion, and ● only a registered physician or nurse practitioner can diagnose a concussion.

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Before and after school care providers are responsible for: ● being aware of the Concussion Management policy and procedure; and ● taking appropriate action in the event of a suspected or diagnosed concussion.

Parents/guardians shall: ● inform the school if their child has a concussion or is experiencing symptoms of a concussion; ● if their child has a suspected concussion;

● understand that the child will be removed from physical activity even if the student states that he/she is feeling better

● arrange to pick up child, ● understand that their child should be examined by a registered physician or nurse practitioner as

soon as possible, ● complete the Student Tracking for Concussion Management Protocol with a registered physician

or nurse practitioner, and ● understand that their child should be monitored for 24-48 hours, as signs and symptoms may take

hours or days to emerge; ● understand that if no concussion is diagnosed, the student may resume regular learning and physical

activities unless symptoms reappear; and ● understand that if a concussion is diagnosed by a registered physician or nurse practitioner, the student

will follow the Student Tracking for Concussion Management Protocol.

Department Curriculum and Instructional Services Procedure History Working Document Policy and Procedure February 2015 Policy subsumed by Policy #662.0, Health Supports Revision Drafted May 31, 2017

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Board Procedure #662.11

Pediculosis (Head Lice)

The procedure outlines how issues related to pediculosis (head lice) in schools will be addressed. Application of Procedure In responding to pediculosis in schools, the dignity and feelings of the students and their families will be given highest priority. The Ministry of Health, York Region Health Services and the Canadian Pediatric Society consider pediculosis (head lice) to be a nuisance and not a communicable disease. If a student is identified as having live pediculosis, the following steps should be taken: 1. Call the parent/guardian and request they pick up their child and begin treatment as soon as possible. 2. Send home A Message to Families about the Presence of Pediculosis (Head Lice) and the Canadian

Pediatric Society Head Lice Facts with the student. 3. Request parents/guardian complete the Pediculosis Treatment Form indicating treatment has been

administered. 4. Check the student’s head, or assign a designate to this role, to ensure all live pediculosis have been

removed from the hair before readmission to school. 5. Take all reasonable precautions as outlined in the Prevention of Pediculosis guideline.

When a student is identified as having nits and not live pediculosis, the following steps should be taken:

1. Send home A Message to Families about Possible Exposure to Pediculosis (Head Lice) and the

Canadian Pediatric Society Head Lice Facts with the student. 2. Request parents/guardian complete the Pediculosis Treatment Form indicating treatment has been

administered. 3. Allow the student to remain in the classroom.

Definitions Nits (eggs) Nits are half the size of the head of a pin and shaped like a tear drop. They are a creamy colour and found close to the scalp, on the shaft of the hair. They resemble dandruff but are attached to the hair by a cement-like material and are very difficult to remove. It is usually the eggs that are noticed first. Outbreak An outbreak of pediculosis is considered to be 10 per cent or more of the school population.

ATTACHED FOR INFORMATION

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Pediculosis (Head Lice) Head lice are tiny (3 mm long) wingless insects with flattened bodies. They cling to the hair by means of six legs. They live mostly behind the ears and at the nape of the neck. The female lays tiny, creamy colour eggs called nits. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Pediculosis (Head Lice) procedure.

Associate Directors and Superintendents of Education shall: ● support the implementation of the Pediculosis (Head Lice) procedure at each school. Principals shall: ● review the Pediculosis (Head Lice) procedure with staff members and distribute the Prevention of

Pediculosis at the beginning of each school year; ● share information with parents/guardians about pediculosis, at the start of the school year and

throughout the year as appropriate; ● direct parents/guardians to contact ACCESS YORK at 1-877-464-9675 for additional information on

pediculosis; ● take all reasonable precautions as outlined in the Prevention of Pediculosis guideline; ● if a student is identified as having nits or live pediculosis, ensure appropriate action is taken as outlined;

and ● where a parent/guardian has not taken effective treatment steps to remove the pediculosis;

refer the parent/guardian to Canadian Pediatric Society for further information, and

ensure school staff members take additional preventative measures to avoid transfer of pediculosis, as outlined in the Prevention of Pediculosis.

School staff members shall: ● report any suspected cases of pediculosis to the principal; ● if a student is identified as having nits or live pediculosis, take appropriate action as outlined; and ● take all reasonable precautions as outlined in the Prevention of Pediculosis guideline.

Parents/guardians shall: ● report any suspected cases of pediculosis to the school; ● when their child is suspected or identified to have pediculosis:

apply treatment, as outlined in the Canadian Pediatric Society Head Lice Facts, and

complete the Pediculosis Treatment Form indicating treatment has been administered.

Department Curriculum and Instructional Services

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Procedure History Revised December 1996 Amended 2004 Working Document January 2015 Revision drafted May 31, 2017

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Board Procedure #662.12

Communicable Diseases

Policy Statement This procedure outlines the process for addressing communicable diseases. Application The Board will prevent discrimination against persons afflicted with communicable diseases or infections, recognizing that students or staff members with communicable diseases or infections have a right to privacy and to reasonable accommodation, in keeping with current legislation. Medical records for students and staff members will be kept confidential, and no person will be privy to such information unless required by law. Definitions Communicable Disease A communicable disease is any condition which is transmitted directly or indirectly to a person from an infected person or animal. Reportable Diseases A reportable disease is an illness, which must be reported to the local Medical Officer of Health, in accordance with Ontario Regulation 559/91, Specification of Reportable Diseases and amendments under the Health Protection and Promotion Act. If an illness is reportable, contact ACCESS YORK at 1-877-464-9675.

Responsibilities The Director of Education shall: ● allocate staff and resources to support the Communicable Diseases procedure

Associate Directors and Superintendents of Education shall: ● support the implementation of the Communicable Diseases procedure at each school.

Principals, Managers and Supervisors shall: ● report reportable diseases to the local Medical Officer of Health or designate; ● determine through consultation with the local Medical Officer of Health or designate, or an appropriate

physician whether a student or staff member may safely attend their usual school or work location; ● ensure all staff are familiar with routine practices to protect their health and well-being;

ATTACHED FOR INFORMATION

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● ensure staff members who are required to clean up blood and body fluid spills receive information and instruction about infection control to protect their health and well-being; and

● work with their superintendent, Corporate Communications and the local Medical Officer of Health or designate, to inform staff members, students and the community about the presence of reportable diseases, where appropriate.

Corporate Communications shall: ● liaise with York Region Community and Health Services and the superintendent or designate, to inform

staff members, students and the community about the presence of reportable diseases, as appropriate.

All staff members shall: ● follow established cleaning protocols and infection control practices, where applicable; and ● seek appropriate medical care and follow health care professional’s advice.

Legislative Context Education Act Health Protection and Promotion Act

Department Human Resource Services Policy History Approved 1989 Amended 1995, 2001, 2008, 2013 Revision drafted May 31, 2017

Student Health Supports 39

Board Procedure #662.13

Asthma Management

This procedure outlines the process for supporting the needs students with asthma. Application People with asthma have sensitive airways that react to triggers. There are many different types of triggers for example poor air quality, mold, dust, pollen, viral infections, animals, smoke and cold air. If a student is known to have asthma and is experiencing asthma symptoms, any staff member may assist in the administration of the prescribed asthma medication as outlined in the Asthma Management Plan, with the assurance that they will not be held responsible for any adverse reaction resulting from such administration. Definitions Asthma Asthma is a very common chronic (long-term) lung disease that can make it hard to breathe and can be life threatening. (Adapted from the Ontario Lung Association). Symptoms of asthma can include coughing, wheezing, difficulty breathing, shortness of breath and chest tightness. Asthma medication – controller medication Controller medications are prescribed and usually taken regularly every day to control asthma. Usually, they are taken at morning and at night and not generally taken at school. Asthma medication – reliever medication Reliever medication is prescribed, fast-acting medication (usually blue in colour) that is issued when someone is having asthma symptoms. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Asthma Management procedure. Associate Directors and Superintendents of Education shall:

● support the implementation of the Asthma Management procedure at each school.

Principals shall: ● ask parent(s)/guardian(s) to identify if their child has asthma by completing the Asthma Management

Plan; ● ask parents to complete the Staff Administration of Medication Form or Self-Administration of

Medication Form in accordance with registered physician or nurse practitioner recommendations for controller medications if required;

ATTACHED FOR INFORMATION

Student Health Supports 40

● ensure administration of medication in accordance with the Administration of Medication to Studentsprocedure;

● ensure parent(s)/guardian(s) are aware that any staff member may administer the prescribed relieverasthma medication and signed authorization is not required;

● work with school staff members to identify asthma triggers in classrooms, common school areas andin planning field trips and implement strategies to reasonably reduce the risk of exposure;

● permit a student to carry controller asthma medication if they have parent/guardian permission or isover the age of 16;

● where students with asthma are not carrying asthma medication with them, ensure asthmamedication is readily accessible by the teacher and/or supervisor;

● if a second reliever inhaler is provided, keep in main office and ensure staff are aware of its location;● provide annual in-service training at the beginning of the school year for all school staff in;

● recognition and prevention of asthma triggers,● recognition of asthma symptoms and appropriate responses,● Board policy and procedure related to students with asthma, and● location of asthma medication;

● invite before and after school program staff and volunteers to the annual in-service training;● at the time of registration and again at the beginning of each school year;

● ensure that all staff members are made aware of students with asthma and the location of theirasthma medication,

● ensure that occasional staff members and volunteers are informed of any students with asthma,and

● provide Student Transportation Services and cafeteria food service providers with a current copy of the Asthma Management Plan;

● maintain a file for each student with asthma outlining:● current treatment,● current emergency contact list, and● strategies to support the student;

● ensure students and/or staff members bring asthma medication on field trips, as required;● if a student is known to have asthma and is experiencing asthma symptoms, follow the Asthma

Management Plan.

All staff members shall:

● annually participate in training for asthma management and review the Asthma Managementprocedure;

● take appropriate action in the event of an emergency, as outlined; and● support the identification of asthma triggers in classrooms, common school areas and in planning

field trips and implement strategies to reasonably reduce the risk of exposure, as required.

Teachers shall:

● ensure that asthma medication and the student’s Asthma Management Plan are taken on excursionsand activities outside the school, as required; and

● ensure that occasional staff are aware of students with asthma and their Asthma Management Planby including a communication on daily plans.

Student Transportation Services

● ensure that the current Asthma Management Plan is available on file in the STS office, in theappropriate service provider’s dispatch office, and in the appropriate school vehicle(s); and

● require the service provider to ensure all regular and substitute drivers who transport students withasthma have received training, and how to contact emergency services;

Student Health Supports 41

Parents/guardians shall: ● inform the school if their student has asthma by completing the Asthma Management Plan form upon

registration and at the start of each school year; ● complete the Staff Administration of Medication Form or Self-Administration of Medication Form in

accordance with registered physician or nurse practitioner recommendations for controller medications, if required;

● ensure that their child, where age and/or developmentally appropriate, carries their in-date asthma medication, as required; and

● where students with asthma are not carrying asthma medication with them, ensure asthma medication is readily accessible by the teacher and/or supervisor.

Students shall: ● carry asthma medication with them if they have parent/guardian permission or are over the age of 16;

and ● alert staff if they are experiencing asthma symptoms and require assistance. History Drafted May 31, 2017

Student Health Supports 42

Board Procedure #662.14

Medically Fragile Children This procedure outlines the process for students who are medically fragile. Application Students who are deemed medically fragile may require a variety of health supports. The processes for providing these supports are outlined in the following procedures: Administration of Medication to Students Management of Communication Disorders Management of Physical Challenges Management of Catheterization Management of Suctioning Diabetes Management Seizures Management Definitions Medically Fragile A child’s condition is deemed medically fragile when results from medical and/or physiological condition(s) require ongoing, frequent or time-consuming caregiver intervention and monitoring on a 24-hour basis for survival. There must be demonstrable risk of significant exacerbation of the child’s health status associated with not meeting those care requirements. A medically fragile child is determined through a nursing assessment of the child’s needs which indicates any of the following procedures/health risks:

● deep suctioning (suction beyond the mouth/oral cavity); ● tracheotomy tube care with or without oxygen; ● continuous (all day) g- or j-tube feeds; ● extreme risk of respiratory or cardiac arrest (life threatening not due to anaphylaxis but perhaps

seizures); ● ventilators; and/or ● administration of intravenous medication. Responsibilities The Director of Education shall: ● allocate staff and resources to support the Medically Fragile Child procedure. Associate Directors, Coordinating Superintendents and Superintendents of Education shall: ● support the implementation of the Medically Fragile Child procedure at each school.

ATTACHED FOR INFORMATION

Student Health Supports 43

Principals shall: ● ensure health supports for medically fragile students are provided in accordance with the appropriate

procedures, including but not limited to; ● coordinating the completion and collection of appropriate documentation, including, but not limited

to, Essential Routine Health Services Plan and the Emergency Health Care Plan, ● working with Community Care Access Centre (CCAC) Care Coordinator as outlined to support

student and staff member needs, where required, ● working with the Student Services Coordinator, as required, to allocate appropriate staff members

to support student needs, and ● ensuring appropriate staff members are made aware of student needs; and

● ensure the health and safety needs of the medically fragile child who travels unattended on a bus are being met by providing Student Transportation Services with the appropriate documentation along with the Request for Special Transportation form;

Teachers and support staff shall: ● provide health supports as required for medically fragile students in accordance with the appropriate

procedures and as outlined in documentation such as, but not limited to, Essential Routine Health Services Plan and the Emergency Health Care Plan;

● meet with parents/guardians of a medically fragile child, if requested, to discuss student needs in accordance with the appropriate procedures; and

● ensure that occasional staff in the classroom are aware of medically fragile students by including a communication on daily plans about emergency procedures.

Outdoor Education Centre staff members and teachers planning remote field trips shall: ● ensure awareness of the estimated time to reach the nearest hospital or medical facility; ● provide school staff members with the availability of two-way communication; and ● collaborate with Student Services, as required, to examine barriers to access and develop appropriate

accommodations. Parents/guardians shall: ● complete documentation as required; ● provide the school with all appropriate supplies to meet the student’s health support needs; and ● consider providing their child with medical identification (e.g. MedicAlert bracelet or necklace).

Students shall: ● alert staff if they believe they are experiencing any symptoms associated with their medical condition;

and ● take age and/or developmentally appropriate responsibility for their health care needs.

The Community Care Access Centre Central and Central West (CCAC) shall be expected to: ● provide consultation and arrange appropriate training, as required and in accordance with the

appropriate procedures; and ● provide contracted essential routine health services for medically fragile students in their care; ● work with parents/guardians, principal and Board staff members as required and in accordance with

the appropriate procedures;

Student Health Supports 44

Student Transportation Services (STS) shall: ● ensure that the health and safety needs of the medically fragile child who travels unattended on STS-

provided transportation are met; and ● ensure that the student’s Emergency Health Care Plan and/or a Kids with Diabetes Information Card,

along with the Board’s Student Transportation Services form Request for Special Transportation are received by the principal and are accessible in the event of an emergency.

History Drafted May 31, 2017