MSAD #4

MSAD #4 District Emergency Plan

A medical emergency occurs whenever a student, staff member, or visitor sustains a serious injury and/or faces a life-threatening situation. Should this situation occur during regular school hours, the following steps need to be taken:

• Notify the office of the medical situation and request Emergency Announcement.
• Announce CODE BLUE and location for all situations in which the person is unconscious, not breathing, respiratory distress (turning blue or ashen), choking.
• Announce CODE RED and location whenever a person is down…unable to move, bleeding, head injuries, fractures, etc.
• The adult at the scene will control traffic. Staff members certified in CPR and First Aid will go to the scene to assist the victim until emergency personnel arrive
• The office will call the school nurse at 343-0526
• The office will call 911 as directed and be prepared to give the caller’s name, the name and address of the school, nature of the injury or medical condition, location of the person needing assistance, school phone number, and any special information the paramedics need to know
• The office will notify the parent/guardian
• The office will notify the principal and superintendent
• A medical emergency form or accident form will be completed

Should an emergency situation occur during after school activities, the supervising adult will assume responsibility for calling 911, notifying parents/guardian, and informing school administration.

Site______________________________Date________________Time_________

Name of Person with medical emergency_________________________________

Nature of Emergency________________________________________________

_________________________________________________________________

_________________________________________________________________

First Aid Administered at the scene _____________________________________

__________________________________________________________________

__________________________________________________________________

Administered by ____________________________________________________

911 called by __________________________________________Time________

Parent/Guardian called by ________________________________Time _______

Taken by Ambulance to __________________________________Time_______
Name of hospital

Person completing this form _______________________________
Signature

**If injury has occurred, fill out student/staff/visitor accident report**

Reference Sections

A. Allergic Reaction
B. Asthma Attack
C. Blood Loss
D. Burns
E. Cardiac Arrest
F. Choking
G. Cold Related
H. Dental Injury
I. Diabetes
J. Eye Injury
K. Head Injury
L. Heart Attack
M. Heat Exhaustion
N. Inhalants
O. Poisonings
P. Seizures
Q. Shock
R. Spinal Injury

Asthma is the most common chronic illness among children. An asthma attack occurs when the air passages of the lungs swell up, tighten and clog with mucus. The child struggles to breathe.

Common Triggers of Asthma: Respiratory infections and colds, allergic reactions, vigorous exercise, exposure to cold, air pollution/fumes/strong odors, cigarette smoke, stress/excitement.

Common symptoms of asthma: Feeling tightness or pain in the chest, wheezing, frequent coughing throughout the day, difficulty breathing or shortness of breath, little energy for active play.

If these symptoms occur, do the following:

1. Call the school nurse at 343-0526
2. Help the child to sit upright in a comfortable position; leaning forward
with elbows on knees may be helpful.
3. Have the child take their albuteral inhaler – 2 puffs
4. Talk calmly to the child
5. If the child does not feel relief within 10 minutes, call the parent
6. If the child’s lips or fingernails are grey or blue, call 911

Occasionally a child may be breathing very rapidly with shallow, quick breaths. If this happens and the child is not known to have asthma (ask them), this is hyperventilation. The child should be instructed to slow their breathing down. Demonstrate this and have them breath with you. You may also have them breathe into a paper bag.

Severe blood loss can occur for a variety of reasons and may be obvious as in cuts or puncture wounds, or hidden as in internal injury received from a fall or a severe blow to the abdomen. No matter what the cause, there are basic steps to take.

1. Call for help, either the office, who will activate the emergency procedures, or 911 directly.
2. Call the school nurse at 343-0526.
3. Attempt to stop obvious bleeding by applying a bandage (this can be bunched up article of clothing or a gauze bandage, if handy)
4. Be sure the injured person is lying down
5. Keep the person covered and warm
6. Try to stay calm and talk to the person. Ask them what happened. Tell them that help is on the way.

An accidental exposure means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. In the event of an accidental exposure to an employee, the procedure is as follows:

1. Immediate first aid- Employee will wash the exposed site thoroughly with soap or disinfectant and water. Flush eyes and/or mucous membranes with water immediately.

2. Immediately report injury to supervisor and school nurse. If immediate supervisor is not available, report to another school administrator.

3. The school nurse or supervisor will arrange for a medical post-exposure evaluation and follow-up.

4. Required forms to be completed within 24 hours are:

a. Employee Injury Report, using back of form as needed to describe in full how the exposure to blood or body fluid occurred.
b. Supervisor’s Injury Report

5. The school nurse will meet with the employee.

a. The employee will be given bloodborne pathogen information.
b. Blood collection and testing will be discussed.
c. The employee will be referred to the School Doctor’s office for a medical post- exposure evaluation. The form, Medical Care Provider Report will accompany.
d. The employee will be informed of laws concerning disclosure of identity of source individual.

6. If the source individual is known, the school nurse will assist in making arrangements to have the source individual tested for HIV, HBV, and HCV infectivity.

7. The school nurse will meet with the employee after all data has been collected to complete a Follow-up Outcome Report and discussed any additional concerns.

8. Flow of completed forms:

a. Original copies to Superintendent’s office.
b. Retain copy of each form for employee’s personnel file.

Date_________________

Employee’s Name _______________________________________ DOB_________________

The above named individual was seen by me today following an accidental exposure to blood.

Blood was collected for HBV, HCV, and HIV serological testing: YES______ NO_____

Serological testing was done at this time: ____________

Blood was collected, but the employee declined baseline testing at this time: YES___ NO____

Blood will be held for 90 days YES_____ NO_____

My recommendation is as follows:

Hepatitis vaccine required: YES______ NO_____

Initial dose administered: YES______ NO_____ Date (if yes) __________________

Signature__________________________________________________Date________________

Please print name and address of Health Care Provider completing this report: ___________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

There are a variety of types of burns and degrees of seriousness. If anyone sustains a serious electrical, chemical or thermal burn, 911 needs to be called immediately. You also need to do the following:

• Remove any clothing from around the burned area if possible. If clothing sticks, do not attempt to remove it
• Keep the person lying down with the feet elevated (shock position)
• Because swelling will occur, try to remove all rings, bracelets, watches
• Cover the burned area with a sterile bandage
• Try to keep the person warm, but not overheated
• Try to stay calm and keep talking to the person

Serious burn situation

• 3rd degree (tough, brownish surface to body)
• Deep 2nd degree (charred or white)
• Burns to critical areas – face, hands, feet, ears, genitalia
• Other injuries at same time like fractures
• Altered level of consciousness
• Breathing distress

Electrical burns

• Safely remove student from source
• CPR as needed

Chemical Burns

• Flush with cool running water >20 minutes
• Send chemical agent and MSDS to emergency room w/student
• DO NOT APPLY ICE!!!

Thermal burns

• Apply cool running water or immerse area in cool water
• DO NOT APPLY ICE!!
• Cover with a dry, sterile, loose bandage

Sudden death occurs when the heart stops beating and breathing ceases abruptly and can occur following a heart attack, electrical shock, drug ingestion/overdose, drowning, major blood loss and shock

If this occurs, do ABC’s Refer to the following procedures:

1. Adult CPR
2. Child CPR
3. Infant CPR

Keep in mind that a person can choke on a foreign body at any time, but especially while eating. Be diligent while supervising students eating in the cafeteria. Remember, if a person seems to be in distress but is coughing, that is the normal way for the airway to try to rid itself of a foreign body. Assist and reassure the person. Be prepared to do the Heimlich maneuver if necessary.

Refer to the following procedures:

1. Adult choking FBAO
2. Child choking FBAO
3. Infant choking FBAO

This condition can occur due to prolonged exposure to outdoor cold, wind chill factors, cold water exposure.
Frostbite is one form (see definition next page)

General Guidelines:
Hypothermia: rewarm slowly
Frostbite: rewarm quickly
Avoid rubbing affected area
When rewarming, use warm water, NEVER HOT

DO:

Remove person to warm environment
Remove wet clothing
Keep person warm and covered
If alert, give sips of warm liquids
Call nurse at 343-0526
Call parents

If person becomes bluish around mouth or fingernails or has a change in level of consciousness:

Call 911
Be prepared to do CPR
Cold Related Emergencies
Frostbite

Frost nip:

Blanched white skin
Swelling of area

Superficial Frostbite:

Firm, waxy skin
Blisters develop in 24-48 hours

Deep Frostbite:

Mottled or gray-blue skin, firm to touch
Area may feel itchy or have no feeling
Death of tissue occurs over time

If a person has received a blow to the face or a fall that results in a major tooth fracture, displacement of multiple teeth, possible fracture of the jaw or other facial bones, or avulsion of a tooth (entire tooth is knocked out), the person needs to be seen immediately by a dentist or emergency room.

Do the following:

1. Call the nurse 343-0526
2. Call parents
3. Stay calm, talk to the person
4. Give them gauze to help stop the bleeding
5. If a tooth is knocked out, place it in milk and send with them
6. Keep the person in a upright position if possible

Diabetic Emergencies
Nearly 11 million Americans have diabetes and you may come in contact with a person with diabetes who needs your help. Be prepared! The two most common diabetic emergencies are described below.

Low Blood sugar (Insulin Reaction or Hypoglycemia)
Onset: Sudden
Signs:

Staggering, poor coordination
Anger, bad temper
Pale color
Confusion
Sudden Hunger
Sweating
Eventual Stupor or unconsciousness

Causes:

Failure to eat before strenuous exercise
Delayed or missed meals

Treatment: Provide Sugar.

If the person can swallow without choking, offer any
food or drink containing sugar, such as soft drinks, fruit juice, and candy.
Do not use diet drinks when blood sugar is low. If the person does not
feel better in 10-15 minute;
a. Call the nurse at 343-0526
b. Call parents

High Blood Sugar (Hyperglycemia)
Onset: Gradual
Signs:

Drowsiness
Extreme Thirst
Very frequent urination
Flushed skin
Vomiting
Fruity or wine-like odor on breath
Heavy Breathing
Eventual Stupor or unconsciousness

Causes:

Undiagnosed Diabetes
Insulin not taken
Stress, Illness, or injury
Too much food or drink or both

Treatment: take this person to the hospital

*****If you are uncertain whether the person is suffering form high blood sugar or low blood sugar, give some sugar-containing food or drink. If there is no response in 10-15 minutes, this person needs medical attention. Remember: Do not give food or drink if the person is unable to swallow.

a. Call nurse at 343-0526
b. Call parents

The most serious injuries to the eye are burns, blunt trauma, and a penetrating injury.
For:

1. Burns:

a. Chemical – Flush>20 minutes with water or saline
b. Thermal – Apply cool moist gauze
c. Radiation – Cover with a patch

2. Blunt Trauma

a. Apply Cool compress
b. Instruct person not to move rapidly, bend over, or cough

3. Penetrating injury

a. Do not try to remove anything

Call nurse at 343-0526
Call parents

**For burns and penetrating injuries call 911**

Whenever a person receives a blow to the head, especially if unconsciousness occurs, you should observe for:

1. Prolonged unconsciousness (more than one minute)
2. Dazed or drowsy condition
3. Difficulty remembering or recognizing the situation (where they are, time of day, your name, etc.)
4. Difficulty in eye control (blurred or double vision)
5. Severe headache
6. Nausea and vomiting (may occur later)
7. Neck pain

DO:

Call nurse at 343-0526
Call Parents
Keep person calm
Apply cool pack to head
Control bleeding if present

If injury to the neck is suspected:

DO NOT move the person
Stabilize the spine
Call 911
Call Nurse at 343-0526
Keep person on his/her back
Place both hands beside person’s head
Keep the head in a neutral position, neither tipped back nor forward
Continue to support the head until help arrives

Warning Signs:

A. Chest Discomfort

a. Mid Chest
b. Jaw Pain
c. Pain in arms and back
d. Heartburn like sensations

B. Shortness of Breath
C. Feeling of Weakness
D. Sweating

Cold, clammy feeling skin

E. Vomiting

Call 911
Call nurse at 343-0526

Risk Factors:

• High heat
• High humidity
• Tight clothing, overdressed
• Very young individuals
• Very old individuals
• Obese individuals
• Participation in sporting activities

Symptoms:

• Skin – cool, moist, pale or red
• Headache
• Nausea/vomiting
• Muscle cramps
• Fatigue
• Dilated pupils

Things to do:

• Put person into cool environment
• Loosen clothing
• Apply cool packs to neck, under arms, wrists
• Fan the person
• If no vomiting, have them drink water or electrolyte drink
• Call nurse at 343-0526
• Call Parents

Symptoms:

• Diminished consciousness or unconscious
• Hot/dry/red skin
• Fast shallow breathing
• Fast weak pulse
• Temperature > 104

This is Life Threatening:

• Immediately remove to cool environment
• Call 911
• Call nurse at 343-0526
• Cool down with cool compress
• Fan the person
• Be prepared to do CPR
• Call parent

Poisons enter the body by mouth (pill, liquids, contaminated food), by inhalation (carbon monoxide, chemical inhalants), by absorption (chemical on the skin), and by injection (bee stings, drugs).

You should:

1. Try to determine what the poison is – get container if possible
2. Call poison control 1-800-222-1222
3. Call nurse at 343-0526
4. Call parents

Be prepared for severe reactions that may result in heart and lung failure.

Be prepared to do CPR Call 911

Be prepared for a possible seizure Call 911

First Aid for Seizures

1. Keep calm! The student is usually not suffering or in danger.
2. IF THIS IS THE FIRST KNOWN SEIZURE FOR THE STUDENT, DELEGATE SOMEONE TO CALL THE PARMEDICS AND CONTACT THE PARENTS IMMEDIATLEY.
3. IN A STUDENT WITH A KNOWN SEIZURE DISORDER, CALL THE PARAMEDICS FOR ANY ONE OF THE FOLLOWING:

a. The seizure lasts for five minutes, or
b. Another seizure begins soon after the first, or
c. The student stops breathing, or
d. Student cannot be awakened after the seizure, or
e. There are specific physician orders stating to call the paramedics for parameters that are different than the above

4. If the student is not already on the floor, ease the student to the floor and place them on their side if possible. If the student is in a wheelchair, they should remain in the wheelchair unless they are sustaining injury.
5. To prevent injury:

a. Do not try to restrain the student’s movements
b. Clear the area of hard or sharp objects
c. Loosen any tight clothing or restrictive appliances

6. To ensure an open airway:

a. Position student’s head to the side
b. Wipe away oral secretions
c. Avoid putting fingers in the student’s mouth
d. Do not force anything into the mouth or offer anything to drink

Gloves and standard precautions are to be used for contact with oral secretions and body fluids.

7. Stay with and observe student until fully conscious. There is nothing you can do to stop a seizure; once it has begun it must run its course.
8. Describe the seizure by completing the Seizure Report Flow Chart.
9. Parents are to be notified of seizure. Report the seizure to an administrator.

Call 911 If…

• First known seizure
• Seizure lasts for 5 minutes
• Another Seizure begins soon after the first
• Student stops breathing
• Student cannot be awakened after the seizure
• There are specific physician orders stating to call paramedics for parameters different than the above

Shock is a serious medical situation that can occur after a traumatic experience, severe blood loss, burns, heart attack, serious infection, or fractures

Signs of shock:

Face pale
Skin cold and moist (clammy)
Weakness
Faintness
Nausea with or without vomiting
Restlessness

Do:

Keep person lying down
Keep warm
Call nurse at 343-0526
Call 911
Call parents
DO NOT GIVE LIQUIDS

If at any time a spinal injury is suspected, do the following:

• Do not move the person
• Support the neck (cervical spine) (SEE PICTURE)
• Keep person warm
• Stay calm
• Call nurse 343-0526
• Call 911
• Call parents

Keep person on his/her back
Place both hands beside person’s head
Keep the head in a neutral position, neither tipped back nor forward
Continue to support the head until help arrives

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