Emergency First Aid Guidelines for California Schools

Emergency First Aid Guidelines for

California Schools

Emergency Medical Services Authority

California Health and Human Services Agency

EMSA #196

Original 1994

Revised 2004

Revised 2013

Guidelines

Information

Pre-Incident

Instructions

Signs &

Symptoms

E-F

Signs &

Symptoms

H-L

Signs &

Symptoms

M-N

Signs &

Symptoms

P-R

Signs &

Symptoms

S-T

Signs &

Symptoms

V-Z

Signs &

Symptoms

A-B

Signs &

Symptoms

C-D

Emergency First Aid Guidelines for California Schools

Special Recognition

Ohio Department of Public Safety, Division of EMS, EMS for Children Program;

North Dakota EMS for Children Program

Emergency First Aid Guidelines for Schools - Pilot Project Staff (First Version)

Les Gardina, MSN, RN, EMSC Coordinator, County of San Diego EMS

Cynthia Frankel, RN, EMSC Coordinator, Alameda County EMS

Kris Helander-Daughtery, RN, BSN, Prehospital Care Coordinator, Alameda County EMS

Acknowledgements

We would like to thank the following for their review and contributions to the development of these

guidelines:

County of San Diego School Nurse Resource Group

California EMSC Technical Advisory Committee

California EMSC Coordinators Group

 SanDiegoUniedSchoolDistrict

Jim Harley, MD, San Diego Chapter of American Academy of Pediatrics, COPEM

 ChrisRiccitelli,RN,SchoolNurseProgramSpecialist,SanDiegoOfceofEducation

 BarbaraMuller,CoordinatorforBayRegionIV,AlamedaCountyOfceofEducation

 TerriChristofk,ShannonBrandt,JanBagdasar,MegPesavento,SanMarcosUnied

Frank De Luca, Chula Vista Elementary School

Anita Gillchrist, RN, School Nurse, San Ysidro Elementary

Stacy Hanover, RN, ED Supervisor, Children’s Hospital, Oakland, CA

Ruth Hawkins, RN, School Nurse, Encinitas Union Elementary

Patricia Murrin, RN, MPH, EMS Coordinator, County of San Diego EMS

Dale Parent, Chula Vista Elementary School

James E. Pointer, MD, Medical Director, Alameda County EMS

Mary Rutherford, MD, Director ED, Children’s Hospital, Oakland, CA

Augusta Saulys, MD, Emergency Department, Children’s Hospital, Oakland, CA

 PatStalcup,RN,SchoolNurse,RamonaUnied

Gary Vilke, MD, Medical Director, County of San Diego EMS

EMERGENCY FIRST AID GUIDELINES FOR

CALIFORNIA SCHOOLS - 2013 EDITION

The San Diego project developed these guidelines with “Funding provided by the State of California Emergency Medical

Services (EMS) Authority under Special Project Grant #EMS-1055 and EMS-2062.”

Funding for the Ohio project was supported by project MCH #394003-0 from the Emergency Medical Services for Children

Program (Section 1910, PHS Act), Health Resources and Services Administration, Maternal and Child Health Bureau and

theNationalHighwayTrafcSafetyAdministration.

Emergency First Aid Guidelines for California Schools

iii

EMS for Children Technical Advisory Subcommittee

Erin Dorsey, RN School Nurse

Huntington Beach High School

Cynthia Frankel, RN, MSN Prehospital Care Coordinator

Alameda County EMS Agency

Marianne Gauche-Hill, MD, FACEP, FAAP Professor of Medicine

David Geffen School of Medicine at UCLA

Director of EMS

Harbor-UCLA Medical Center

Nancy McGrath, RN, MN, CPNP Pediatric Liaison Nurse

Harbor UCLA Medical Center

California Emergency Medical Services Authority

Howard Backer, MD, MPH, FACEP Director

Farid Nasr, MD Specialty Care Systems Specialist

Sandy Salaber Associate Health Program Adviser

Tonya Thomas EMS for Children Program Coordinator

California Department of Education

Gordon Jackson Assistant Superintendent

Tom Herman Education Administrator

San Joaquin County Ofce of Education

Cheri Coburn, Ed.D, MS, RN Director of Comprehensive Health Programs

Sacramento State University

Jan Sampson, RN, DNP, CNE Associate Professor

School of Nursing

Acknowledgements

The EMS Authority would like to acknowledge and express appreciation for the support of the

EMS for Children Technical Advisory Committee. List of committee members:

http://www.emsa.ca.gov/tech_committee

Emergency First Aid Guidelines for California Schools

TABLE OF CONTENTS

ABOUT THE GUIDELINES...................................................................................................................... 4

RECOMMENDED FIRST AID EQUIPMENT AND SUPPLIES FOR SCHOOLS...................................... 6

HOW TO USE THE EMERGENCY GUIDELINES................................................................................... 7

KEY TO SHAPES & COLORS................................................................................................................. 8

EMERGENCY PROCEDURES................................................................................................................ 9

9-1-1 GUIDELINES FOR SCHOOLS....................................................................................................... 10

WHEN TO CALL EMERGENCY MEDICAL SERVICES (9-1-1)............................................................... 11

EMERGENCY PHONE NUMBERS.......................................................................................................... 12

DEVELOPING AN EMERGENCY PLAN.................................................................................................. 13

PLANNING FOR PERSONS WITH SPECIAL NEEDS............................................................................ 14

MEDICATION ADMINISTRATION IN SCHOOL SETTINGS .................................................................. 15

INFECTION CONTROL........................................................................................................................... 18

ALLERGIC REACTION............................................................................................................................ 19

ASTHMA/WHEEZING/DIFFICULTY BREATHING................................................................................... 20

BEHAVIORAL EMERGENCIES............................................................................................................... 21

BITES (HUMAN & ANIMAL)..................................................................................................................... 22

BITES & STINGS (INSECT)..................................................................................................................... 23

BITES & STINGS (MARINE).................................................................................................................... 24

BITES & STINGS (SNAKE)...................................................................................................................... 25

BLEEDING............................................................................................................................................... 26

BRUISES.................................................................................................................................................. 28

BURNS..................................................................................................................................................... 29

CPR.......................................................................................................................................................... 31

AUTOMATED EXTERNAL DEFIBRILLATORS (AED)............................................................................. 32

LAY PERSON CPR.................................................................................................................................. 33

FOR CHILDREN ONE YEAR OLD TO ADULT......................................................................................... 34

CHOKING................................................................................................................................................. 35

CHEST PAIN (POSSIBLE HEART ATTACK)........................................................................................... 36

CHILD ABUSE & NEGLECT..................................................................................................................... 37

COMMUNICABLE DISEASES................................................................................................................. 38

DIABETES................................................................................................................................................ 39

DIARRHEA............................................................................................................................................... 40

DROWNING/NEAR DROWNING............................................................................................................. 41

Emergency First Aid Guidelines for California Schools

EARS........................................................................................................................................................ 42

ELECTRICAL INJURY.............................................................................................................................. 43

EYES (INJURY)........................................................................................................................................ 44

FAINTING................................................................................................................................................. 46

FEVER & NOT FEELING WELL.............................................................................................................. 47

FINGERNAIL/TOENAIL INJURY.............................................................................................................. 48

FRACTURES, DISLOCATIONS, SPRAINS OR STRAINS...................................................................... 49

FROSTBITE............................................................................................................................................. 50

HEAD INJURIES...................................................................................................................................... 51

HEADACHE............................................................................................................................................. 52

HEAT EXHAUSTION/HEAT STROKE...................................................................................................... 53

HYPOTHERMIA (EXPOSURE TO COLD)............................................................................................... 54

LOSS OF CONSCIOUSNESS................................................................................................................. 55

MENSTRUAL PROBLEMS...................................................................................................................... 56

MOUTH & JAW INJURIES....................................................................................................................... 57

NECK & BACK PAIN................................................................................................................................ 58

NOSE....................................................................................................................................................... 59

POISONING & OVERDOSE.................................................................................................................... 61

PREGNANCY........................................................................................................................................... 62

RASHES................................................................................................................................................... 63

SEIZURES............................................................................................................................................... 64

SERIOUSLY ILL/SHOCK......................................................................................................................... 65

SPLINTERS or IMBEDDED PENCIL LEAD............................................................................................. 66

STOMACH ACHES/PAIN......................................................................................................................... 67

TEETH & GUMS...................................................................................................................................... 68

TETANUS IMMUNIZATION...................................................................................................................... 70

TICKS....................................................................................................................................................... 71

VOMITING................................................................................................................................................ 72

WOUNDS (CUTS, SCRATCHES & SCRAPES INCLUDING ROPE & FLOOR BURNS)........................ 73

WOUNDS (PUNCTURE).......................................................................................................................... 74

WOUNDS (STABS & GUNSHOT)............................................................................................................ 75

TABLE OF CONTENTS

Emergency First Aid Guidelines for California Schools

The Emergency First Aid Guidelines for California Schools’ document was initially developed by San

Diego and Alameda Counties, funded in part by a grant from the California Emergency Medical Services

(EMS) Authority. The Guidelines were originally based on the second edition of the Ohio Emergency

Guidelines for Schools, 2000. The Emergency First Aid Guidelines for California Schools manual is

meant to provide recommended procedures for school staff in responding to medical emergencies when

the school nurse is not available and until emergency medical services responders arrive on scene.

These guidelines provide recommended actions and do not supersede or invalidate any laws or rules

established by a school system, a school board, or the State.

Due to declining school district budgets, school nurses are not always present on school grounds when

medical emergencies occur. It is not uncommon to have a school nurse present for only two hours a

weekpercampus.Currently,onlyftypercent(50%)ofschooldistrictsinCaliforniahaveaschoolnurse

on staff. The Emergency First Aid Guidelines for California Schools was developed over a two-year

period and piloted in thirteen schools in San Diego County and three schools in Alameda County. They

were enthusiastically received in the pilot areas by school nurses and educators as a layperson’s

emergency medical reference tool.

Once the pilot projects were completed, the draft Guidelines were reviewed and revised by the local

Emergency Medical Services for Children (EMSC) Coordinators Group and the EMSC Technical Advisory

Committee (TAC). Extensive comments and revisions were made by these committees. The EMSC

Coordinators Group is composed of local EMSC program managers and the TAC membership is

composed of emergency physicians, nurses, prehospital and administrative experts in EMSC. The

EMSCTACrstapprovedthedraftGuidelinesduringitsJanuary29,2004meetingandforwardedthe

document to the EMS Authority for review and approval.

DuringtherstrevisionoftheGuidelinesdocumentin2004,theEMSAuthoritycollaboratedwiththe

California Department of Education and the California School Nurses Association. The revised

Emergency First Aid Guidelines for California Schools’ document was sent out for a 30-day public

comment period from April 16, 2004 to May 17, 2004. Comments and suggested revisions received

have been incorporated into the Guidelines and/or responded to as appropriate. The Emergency First

Aid Guidelines for Schools document was approved on June 23, 2004 by the Commission on EMS.

One hard copy and a CD of the Guidelines were distributed to approximately 10,000 California schools.

The current version, the second revision, is based on 2010 American Heart Association Guidelines for

CPR and ECC, which was approved by the EMSC TAC and EMSC Coordinators Group on January

26-27, 2012.

ABOUT THE GUIDELINES

Emergency First Aid Guidelines for California Schools

ABOUT THE GUIDELINES

(CONT.)

Please take some time to familiarize yourself with the format and review the “How to Use the Guidelines”

section on page 6 prior to an emergency situation. The guidelines are recommended procedures for

when advanced medically trained personnel are not available on the school site. It is strongly

recommended that staff who are in a position to provide rst aid to students complete an

approved rst-aid and cardiopulmonary resuscitation (CPR) course. Please consult your school

nurse if you have any questions concerning the recommendations contained in the guidelines.

These guidelines should not delay calling 9-1-1 in the event of an emergency.

Periodically, the EMS Authority may send out updates on procedures dealing with the medical

emergencies that are in the guidelines. When received, please remove the old information and replace

with the updated information.

We welcome comments, suggestions, or experiences using these guidelines.

Emailaddress:[email protected]

Emergency First Aid Guidelines for California Schools

RECOMMENDED FIRST AID EQUIPMENT AND

SUPPLIES FOR SCHOOLS

1. Current National American Red Cross First Aid Manual or equivalent.

2. American Academy of Pediatrics First Aid Chart.

3. Portable stretcher

4. Cot: mattress with waterproof cover

5. 10 Triage Tags

6. Blankets, sheets/pillows/pillow cases (disposable covers are suitable)

7. Wash cloths, hand towels, small portable basin

8. Covered waste receptacle with disposable liners

9. Manual resuscitation bag (Ambu bag) [optional]

10. Bandage scissors, tweezers

11. Disposable thermometer or electronic thermometer with disposable covers

12. Sink with running water

13. Expendable supplies (refer to http://www.redcross.org/disaster/masters/supply.html for

recommended inventory):

 • Pocketmask/faceshieldforCPR

 • Disposablegloves(includinglatexfreeglovesforpersonswithalatexallergy)

 • Soap(plain)

 • Cottontippedapplicators,individuallypackaged

 • AssortedBand-Aids(1”x3”)

 • Gauzesquares(2”x2”’;4”x4”),individuallypackaged

 • Adhesivetape(1”width)

 • Gauzebandage(2”and4”widths)rolls

 • Acebandage(2”and4”widths)

 • Splints(longandshort)

 • Coldpacks

 • Triangularbandagesforsling&Safetypins

 • Tongueblades

 • Disposablefacialtissues

 • Papertowels

 • Sanitarynapkins

 • Oneashlightwithsparebulbandbatteries

 • Hank’sBalancedSaltSolution(HBSS)–AvailableintheSave-A-Toothemergency

  toothpreservingsystemor1/3cupofpowderedmilkfordentalrst-aid(formixingwith

water to make a liquid solution)

 • Bleachforcleaningcontaminatedsurface

Emergency First Aid Guidelines for California Schools

HOW TO USE THE EMERGENCY GUIDELINES

The last page of this document provides space for important emergency phone numbers in your area. It

is important to complete this information, when you receive the document, to have this information ready

in an emergency situation.

Acoloredowchartformatisusedtoguideyoueasilythroughallsymptomsandmanagementsteps

from beginning to end. See the Key to Shapes and Colors (pg. 7).

Emergency Procedures for an Injury or Illness section (pg. 8) gives a general overview of the

recommended steps in an emergency situation and the safeguards that should be taken.

Additional information includes when to call EMS (pg. 10), developing a school wide emergency plan

(pg. 11), infection control procedures (pg. 12), and planning for persons with special healthcare needs

(pg. 12).

If medical assistance is needed, have someone contact the 9-1-1 system as soon as possible.

Emergency First Aid Guidelines for California Schools

KEY TO SHAPES & COLORS

START

HERE

This note provides

background information.

This type of box should be read

before emergencies occur.

Initial Information, questions, actions

? Questions Being Asked ?

You need to choose based on

person’s condition or response.

Follow the pathway for your answer.

Provides First-Aid

Instructions

STOP HERE

This is the nal

instruction

Additional Information

NO YES

Emergency First Aid Guidelines for California Schools

EMERGENCY PROCEDURES

1. Remain calm and assess the situation. Be sure the situation is safe for you to approach.

The following dangers will require caution: live electrical wires, gas leaks, chemical exposure,

 buildingdamage,unstablestructures,reorsmoke,trafc,agitatedorviolentstudents.

2. A responsible adult should stay at the scene and give help until the person designated to

handle emergencies arrives. For serious injury or illness, call 9-1-1 without delay.

3. Notify the responsible school nurse or administrator designated to handle emergencies. Upon

arrival this person should take charge of the emergency.

4. Do NOT give medications unless there has been prior written approval by the person’s

parent or legal guardian and doctor. Administer medications according to local school board

policy and state or federal laws and regulations.

5. Do NOT move a severely injured or ill person unless absolutely necessary for immediate

safety. If moving is necessary, protect the neck by keeping it straight to prevent further injury,

see the “Neck and Back Pain” guideline (pg. 56).

6. Call Emergency Medical Services (EMS 9-1-1), if appropriate, or arrange for transportation of

the ill or injured person, if necessary. Provide EMS personnel with copies of physician/parents’

signed record of medical instructions for emergencies (i.e., pupil emergency card).

7. The responsible school nurse, administrator, or a designated employee should notify the

parent/legal guardian of the emergency as soon as possible to determine the appropriate

course of action.

8. If the parent/legal guardian cannot be reached, notify a parent/legal guardian substitute and

call either the physician or the hospital designated on the Emergency Information Card, so they

will know to expect the injured or ill person.

9. Each person should have an emergency information record (i.e., student emergency card)

 onlethatprovidesessentialcontactinformation,medicalconditions,medicationsandan 

emergency care plan if appropriate. Provide a copy of student’s emergency information to EMS

upon arrival, if authorized by parent/legal guardian.

10. Fill out a report for all injuries and illnesses requiring above procedures if indicated by

school policy.

Emergency First Aid Guidelines for California Schools

9-1-1 GUIDELINES FOR SCHOOLS

CALL 9-1-1 FOR:

Difculty Breathing Caused by

• Absent or labored breathing (pg. 32)

• Choking (pg. 33)

• Wheezing due to allergic reaction

• Near drowning (pg. 39)

• After bee sting (pg. 17)

Loss of Consciousness (pg. 53)

For any reason, including

• After any injury

• With history of diabetes

• After seizure

• Unexplained reason

Uncontrolled Bleeding (pg. 24)

Head Injury with (pg. 49)

• Severe headache

• Vomiting

• Change in Behavior

Possible Poisoning (pg. 59)

IF IN DOUBT - CALL 9-1-1

Call 911 Immediately

• Verify address

• Answer Questions

• Follow Instructions

• Do Not Hang Up

• Stay Calm

• Provide First Aid

until ambulance

arrives

These guidelines are not intended to limit good judgment in emergency situations!

9-1-1 brings medical professionals to the scene of the emergency.

Delays in accessing the 9-1-1 system can cause harm to the injured. Consult your

local policies on the management of health emergencies.

Emergency First Aid Guidelines for California Schools

WHEN TO CALL EMERGENCY MEDICAL SERVICES

(9-1-1)

Call EMS if:

 The person is not breathing.

 Thepersonishavingdifcultybreathing,shortnessofbreathorischoking.

 The person has no pulse.

 The person is unconscious, semi-conscious or unusually confused.

 The person has bleeding that won’t stop.

 The person is coughing up or vomiting blood.

 The person has chest pain or pressure persisting more than 3-5 minutes, or has chest pain that

goes away and comes back.

 The person has been poisoned or taken an overdose.

 Thepersonhasaseizureforthersttime,aseizurethatlastsmorethan

5 minutes, multiple seizures, or has a seizure and is pregnant or diabetic.

 The person has received anti-seizure medication as allowed under the provisions of Education

Code Section 49414.7.

 The person has injuries to the head, neck or back.

 The person has sudden, severe pain anywhere in the body.

 The person has an open wound over a suspected fracture or where bone or muscle is exposed.

 The person’s condition is limb-threatening or other injuries that may leave the person

permanently disabled unless he/she receives immediate care; for example: lack of feeling or

normal color on injured limb (arm or leg); amputation; severe eye injury or chemical exposure to

the eye.

 Moving the person could cause further injury.

 The person needs the skills or equipment of paramedics or emergency medical technicians.

 Distanceortrafcconditionswouldcauseadelayingettingthepersontothehospital.

If any of the above conditions exist, or if you are not sure, it is best to call

EMS (9-1-1).

Sources: American Red Cross & American College of Emergency Physicians

Emergency First Aid Guidelines for California Schools

EMERGENCY PHONE NUMBERS

Complete this page as soon as possible, review annually and update as needed. Copy and

post near all phones.

EMERGENCY MEDICAL SERVICES (EMS) INFORMATION

EMERGENCY PHONE NUMBER 9-1-1

Location(s) of Automated External Debrillator(s) (AED)

________________________________________________________________________

Location of First Aid Supplies

________________________________________________________________________

BE PREPARED TO GIVE THE FOLLOWING INFORMATION &

DO NOT HANG UP BEFORE THE OTHER PERSON HANGS UP!

•Address

  •Exactlocationofinjuredperson(e.g.,parkinglotC,bigoaktree)

  •Provideeasydirectionstomakeiteasiertondyou

• School Telephone Number: __________________________

o Cell phone number, if applicable

  •Yourname

  •Schoolname

  •NatureofEmergency

Other Important Phone Numbers

School Nurse

Responsible School Administrator

Poison Control Center (National) 1-800-222-1222

Suicide Hotline 1-800-273-8255

Fire Department 9-1-1

Police 9-1-1

Hospital or Nearest Emergency Facility

Child Protective Services

Rape Crisis Center

Local Health Department

Other Medical Services Information

(i.e., physicians, urgent care centers, dentists, etc.)

Emergency First Aid Guidelines for California Schools

DEVELOPING AN EMERGENCY PLAN

A school-wide emergency plan should be developed in cooperation with school health staff, school

administrators, local EMS, local hospital, local health department and parent/guardian organizations. All

employees should be trained on the emergency plan and a written copy should be available at all times.

The plan should be reviewed and updated annually, and should consider the following:

• Staffrolesareclearlydenedinwriting.Forexample,staffresponsibilityforrenderingcare,

accessing EMS, notifying responsible school administrator and parents, and supervising uninjured

children are outlined and practiced. A responsible administrator for emergency situations has been

designated within each school. In-service training is provided to maintain knowledge and skills for

employees designated to respond to emergencies.

• At leastoneindividual,otherthanthenurse,istrainedinCPRandrstaidineachschool.Teachers

and employees working in high-risk areas or activities (e.g., labs, gyms, shops, P.E., etc.) are trained in

CPR,useofAED,andrstaid.

• Withappropriatestafftraining,theseFirstAidGuidelinescouldbeutilizedbystaffforimmediatecare

of students. The Guidelines are to be distributed or available to appropriate employees.

• Filesareinorderforeachstudentandarekeptinacentrallocation.Thelesshouldcontaincurrent

emergency contact and authorization information, immunization and medical records, phone number of

student’s doctor, medication administration forms and emergency care plans for students with special

needs.

• Firstaidkitsarestockedwithup-to-datesuppliesandareavailableincentrallocations,high-risk

areas, and for extracurricular activities. See “Recommended First Aid Supplies” (pg. 74)

• Allemployeeshaverapidaccesstoemergencynumbers.Emergencynumbersareavailableand

posted by phones. See “Emergency Phone Numbers” (pg. 75)

• SchoolpersonnelhavecommunicatedwithlocalEMSregardingtheemergencyplan,services

available, persons with special needs and other pertinent information about the school.

• AwrittenpolicydescribesproceduresforaccessingEMSwithoutdelayfromalllocations(e.g.,

playgrounds,athleticelds,eldtrips,extracurricularactivities,etc.).

• Awrittenpolicythatprovidesinstructionsfortransportationofaninjuredorillstudent.

• Considerationsandproceduresforapersonwithspecialneeds.See“Planning for Persons with

Special Needs” (pg. 12)

• Adoctororschoolnurseandadentistaredesignatedtoactasconsultantstotheschoolforhealth

and safety related questions. (Education Code 44871-44878)

• Allinjuriesaredocumentedinastandardformatandmaintainedinanorganizedmanner.Injury

reports are reviewed on a regular basis to revise the emergency plan and remedy hazards.

Emergency First Aid Guidelines for California Schools

PLANNING FOR PERSONS WITH SPECIAL NEEDS

Some persons in your school may have special emergency care needs due to their

medical conditions or functional needs.

Medical Conditions:

Some persons may have special or chronic conditions that put them at risk for serious or life-

threatening emergencies. For example, persons who have:

• Seizures

• Life-threateningorsevereallergicreactions

• Diabetes

• Technology-dependentormedicallyfragileconditions

Yourschoolnurseorotherdulyqualiedsupervisorofhealth,alongwiththeperson’sparentorlegal

guardian and personal physician, should develop individual emergency care plans for these persons

when they are enrolled. These emergency care plans should be made available to appropriate staff

at all times. In the event of an emergency situation, refer to the person’s emergency care plan. The

American College of Emergency Physicians (ACEP) and the American Academy of Pediatrics (AAP)

have created an Emergency Information Form for Children with Special Needs. It can be

downloaded from www.aap.org or www.acep.org.

Physical Abilities:

Other persons in your school may have special emergency needs due to physical disabilities. For

example, persons who are:

• Deaf

• Blind

• Inwheelchairsorusingotherassistivedevices

• Unableorhavedifcultywalkingupordownstairs

• Temporarilyoncrutches

Thesepersonswillneedspecialarrangementsintheeventofaschool-wideemergency(e.g.,re,

tornado, earthquake, building collapse, evacuation, etc.).

A plan should be developed and a responsible person should be designated to assist

these persons and staff to safety. All appropriate staff should be aware of this plan.

Emergency First Aid Guidelines for California Schools

MEDICATION ADMINISTRATION

IN SCHOOL SETTINGS

Asignicantandgrowingnumberofschoolchildrenhavehealthproblemsthatrequiretheadminis-

tration of medication during the school day. There are several reasons why students might require

medicationsinschools,including:(1)chronicconditionsrequiringmedicationinordertobenet

from classroom instruction; (2) acute, but temporary, medical needs that require medicine during

the school day, such as an antibiotic for an infection; or (3) conditions that might require emergency

medication, such as an Epinephrine (Epi-pen)® for a bee sting or food allergy.

Childrenwhorequiremedicationsinordertofullybenetfrompubliceducationareprotectedby

federal and state disability laws. It has become a complex issue due to a variety of factors, such

as federal and state disability law, new pharmaceutical and medical technologies, evolving mental

and medical health practices, fewer full-time school nurses, and increasing numbers of children with

complex as well as simple health needs in schools.

The National Association of School Nurses states that the school nurse has the educational back-

ground,knowledge,andlicensurethatprovidetheuniquequalicationstodirecttheadministrationof

medications in the school setting. The position statement recommends that “school districts develop

policies and procedures to address medication administration in accordance with federal and state

laws and guidelines.”

Ifachildneedsspeciedmedicationduringthecourseoftheschoolday

toattendschoolandbenetfromtheeducationalprogram;itisintheschool’sinteresttomakethis

accommodation.

California law states,

withafewclearlyspeciedlegalexceptions,thatonlyalicensednurseor

physician may administer medication. In the school setting, these exceptions are situations where:

(1) The student self-administers the medication; (2) parent or parent designee, such as a relative or

close friend, administers the medication4; or (3) there is a public disaster or epidemic.

The Legislature has enacted four statutes that authorize unlicensed school personnel to be trained

andsupervisedinordertoadministerfourspecicmedicationsinmedicalemergencies:

1. Under the supervision of a school nurse or physician designee, an unlicensed school

employee may administer epinephrine via auto-injector;

2. Under the supervision of a school nurse, physician, registered nurse, or public health

nurse, an unlicensed school employee may administer glucagon;

3. Under the supervision of a school nurse, physician, registered nurse, or public health

nurse, an unlicensed school employee may administer Diastat, and

4. Under the supervision of a school nurse, physician, registered nurse, or public health

nurse, an unlicensed school employee may administer insulin.

Emergency First Aid Guidelines for California Schools

MEDICATION ADMINISTRATION

IN SCHOOL SETTINGS

(CONT.)

In accordance with Education Code (EC) sections 49414, 49414.5 an unlicensed school employee

could “administer” epinephrine via auto-injector directly into a student suffering anaphylaxis,

glucagon via needle and syringe directly into a student suffering from severe hypoglycemia,

insulin, via needle and syringe directly into a student suffering from severe hyperglycemia or Diastat,

a medication that is administered rectally to a student with epilepsy suffering from seizures.

No other California statute allows an unlicensed school employee to administer any other medication

in California public schools, even if the unlicensed school employee is trained and supervised by a

school nurse or other similarly licensed nurse.

EC Section 49423 permits the school nurse or other designated school personnel to “assist”

students who must “take” medication during the school day that has been prescribed for that student

by his or her physician. The terms “assist” and “administer” are not synonymous. An example of an

unlicensed school employee “assisting” a student pursuant to EC Section 49423 would be when the

school employee removes the cap from the medication bottle, pours out the prescribed dose into a

cup or a spoon, and hands the cup or spoon to the student, who then “takes” or self-administers the

required medication. With the above-stated statutory exceptions, there is no clear statutory authority

in California permitting that same unlicensed school employee to “administer” any other medication.

PROGRAM ADVISORY ON MEDICATION ADMINISTRATION

CCR Title 5 601-611: California Department of Education “Program Advisory on Medication

Administration” (2005, reviewed 2012).

Aschoolmayadministermedicationtoachildonlyifaparentorguardianhasspecicallyrequested

such action and there is a reason to administer the medication when the child is at school.

Awrittenorderfromanindividualwhoislicensedtoprescribemedicationsmustbeonleinorderto

administer medications. Medication may be administered at school by the school nurse, other duly

qualiedsupervisorsofhealth,

site administrator or designee as allowed by law. Neither the school

nurse nor her designee is permitted to administer medication unless:

1. The medication is in the original properly labeled container. If it is a prescription medicine,

the student’s name, name of the drug, dosage, time for administering, and name of health

care provider and current date is printed on the container.

2. Writtenordersfromthestudent’shealthcareproviderareonleintheschoolstating:

 • Student’sname

 • DateofBirth

 • Nameofmedication

 • Dosage(EC Section 49423)

 • Purposeofthemedication

 • Methodofadministration(EC Section 49423)

 • Timeofdaymedicationistobegiven (EC Section 49423)

 • Anticipatednumberofdaysitneedstobegiveninschoolandpossiblesideeffects

Emergency First Aid Guidelines for California Schools

MEDICATION ADMINISTRATION

IN SCHOOL SETTINGS

(CONT.)

3. Name, address, telephone number, and signature of the California authorized health care

provider.

4. The parent/guardian provides written permission to the school to administer a prescription

or over-the-counter medication.

5. School personnel keep an individual record of any medications administered by school

personnel.

6. Medication is stored in a clean, locked cabinet or container.

7. Written statements authorizing medications to be administered at school be renewed yearly

or whenever changes in medication or authorized health care provider occur.

8. Changes in medication authorization that generate a new written statement include the

following circumstances:

a. Changes in medication dose, time, and method of administration

b. Change in medication

c. Change in California authorized health care provider

d. Discontinuance of medication administration

Additionally, school districts may want to consider requiring parents to sign a release from responsibility

pertaining to side effects or other medical consequences that may be related to the medication(s).

National Association of School Nurses. (2003). Position statement: Medication administration in the school setting.

http://www.nasn.org/positions/medication.htmv.

Schwab, N.C. and Gelfman, M.H.B., (2001). Legal Issues in School Health, Sun River Press, North Branch, MN: Sunrise River Press, 205.

California Business and Professions Code (Nursing Practice Act (NPA)) Sections 2725 and 2727 and the California Education Code.

NPASection2727(a)statesthatparentsandotherrelativesorclosefriendsmayadministermedication,whichisdenedas“gratuitousnursing.”

NPA Section 2727(d) states that a district not having a school nurse does not qualify as a “public disaster.”

EC Section 49414

EC Section 49414.5

ECSection49414.7isanoptionallawthatwassignedbyGovernorBrownOctober7,2011andwentintoeffectJanuary1,2012–SB61(Huff).

EC Section 49423 provides that unlicensed school personnel may assist with medication administration; BPC 2725(b)(2) and the CCR, Title 5, section 604

authorizespeciedpersonstoadministerinsulininCalifornia’spublicschoolspursuanttoaSection504PlanoranIEP.

California Code of Regulations Title V, Article 4.1: Administering Medication to Students or Otherwise Assisting Students in the Administration of Medication

During the Regular School Day. http://www.cde.ca.gov/ls/he/hn/documents/medadvisory.pdf

Medicationmaybeadministeredatschoolbytheschoolnurse,otherdulyqualiedsupervisorsofhealth,siteadministratorordesigneeasallowedbylaw,

the parent or guardian or their designee as allowed by law or LEA policy, a contracted licensed health care professional whose licensure permits

administrationofthemedication,orbythestudentunderspeciedconditions.Unlicensedschoolpersonneldesignatedbythesiteadministratoradminister

medication if: a. The unlicensed staff member is willing to perform medication administration; b. The unlicensed staff member is trained and determined to

be capable and competent to be able to safely and accurately administer the medication by a licensed health care professional, who is legally authorized to

provide such training and determine competence; c. The unlicensed staff member performing medication administration is supervised by the licensed health

care professional

who provided the training, and the supervision, review, and monitoring of the medication administration is documented.

Emergency First Aid Guidelines for California Schools

INFECTION CONTROL

To reduce the spread of infectious diseases (diseases that can be spread from one person to

another), it is important to follow Universal Precautions when providing care to any ill or injured

student, whether or not the person is known to be infectious. Universal precautions are a set of

guidelinesthatassumethatallbloodandcertainotherbodyuidsarepotentiallyinfectious.

The following list describes universal precautions:

 Wash hands thoroughly with soap and water for at least 20 seconds. When hands are

  visiblydirtyorvisiblysoiledwithbloodorotherbodyuids(besuretoscrubbetween

  ngers,underngernails,andaroundthetopsandpalmsofhands).Ifhandsarenot

visibly soiled you may use an alcohol-based hand rub.

Wash hands:

1. Before and after physical contact with any person

(even if gloves have been worn).

2. Before and after eating or handling food

3. After contact with a cleaning agent

4. After using the restroom

   5.Afterprovidinganyrst-aid

 Weardisposablegloveswhenincontactwithbloodandotherbodyuids.

 Wearprotectiveeyewearwhenbodyuidsmaycomeincontactwitheyes

(e.g., squirting blood).

 Wipe-upanybloodorbodyuidspillsassoonaspossible(wear disposable gloves).

Double-bag the trash in plastic bags, or place in a Ziploc bag and dispose immediately.

Clean the area with an approved disinfectant or a bleach solution (one part liquid bleach

to 10 parts water).

 Send all soiled clothing (i.e., clothing with blood, feces or vomit) home with the person in a

double-bagged plastic bag.

 Donoteat,touchyourmouth,ortouchyoureyeswhilegivinganyrstaid.

Guidelines:

• Remindstudentstowashhandsthoroughlyaftercomingincontactwithanybloodorbody

 uids.

• Remindstudentstoavoidcontactwithanotherperson’sbloodorbodyuid.

Emergency First Aid Guidelines for California Schools

Persons with a history of

life-threatening allergies should be

known to appropriate school staff.

An emergency care plan is needed

upon enrollment. Staff in a position

to administer approved medications

should receive instruction.

ALLERGIC REACTION

A person may experience a delayed allergic

reaction up to 2 hours following food or medication

ingestion, bites, bee sting or exposure to

chemicals, plants, etc

•Askifpersonishavingdifcultybreathingorswallowing

•Askpersoniftheyhaveahistoryofallergicreaction

•Checkforamedicalbraceletormedallion

•Doesthepersonhaveahistoryorcurrent

symptoms of a severe allergic reaction to

the recent exposure? (see below)

• Brushoffdrysubstances(weargloves)

• Flushcontactareaorsubstancefrom

skin and eyes with water

• Notifyadultsupervisingpersonof

exposure (bee sting or ingestion) and

possibility of delayed allergic reaction

• Observemildreactions

• Reviewperson’semergencyplan

• RefertoEmergencyAction/CarePlan,if

available

• AdministerEpinephrine(EpiPen)asper

school protocol

• Administerotherdoctorand

parent/guardian-approved medication as

prescribed - CALL EMS 9-1-1

YES

• Keepquiet&inpositionofcomfort

• Bepreparedtouse“CPR”

Is person so uncomfortable that he is

unable to participate in school

activities?

Return to class

Contact responsible school

nurse or administrator & parent

or legal guardian.

Symptoms of a Severe Allergic Reaction after Exposure

Difcultybreathing,wheezing    Pale,gray,blueorushedskin/lips

Difcultyswallowing,drooling    Poorcirculation(See“SeriouslyIll/Shock”)

Continuous coughing or sneezing Nausea and/or vomiting

Tightening of throat or chest Weakness, dizziness

Swelling of face, neck or tongue Seizures

Confusion or loss of consciousness Suddenly appears seriously sick/Generalized rash or hives

Symptoms Of A Mild Allergic Reaction

Red, watery eyes Itchy, sneezing, runny nose

Rash or hives in local area or widely scattered Localized swelling, redness

Emergency First Aid Guidelines for California Schools

ASTHMA/WHEEZING/DIFFICULTY BREATHING

Personswithahistoryofbreathingdifculties,

including asthma or wheezing, should be known

to appropriate school staff. Develop a school

asthma action plan during enrollment. Keep

asthma inhaler and spacer available. Student

may carry their own medication. Staff authorized

to administer medications should

receive instruction.

•Sitpersonuprightinpositionofcomfort

•STAYCALM.Bereassuring

•Askifpersonhasallergiesormedication

•Didbreathingdifcultydeveloprapidly?

•Isthestudenthavingdifcultyspeakingduetoshortnessofbreath?

•Arelips,tongueornailbedsturningblue?

•Changeinlevelofconsciousness-confusion?

CALL EMS 9-1-1

YES

•Ifavailable,checkschoolasthmaactionplan

•Ifpersonhasdoctorandparent/guardianapprovedinhalermedication,assistor

administer medication as directed

•Observefor4-5minandrepeatasdirected,ifnotimproved

•Encouragepersontositquietly,breatheslowlyanddeeplyinthroughthenoseand

out through the mouth

•Aresymptomsnotimprovingorgettingworse?

•Havingdifcultyspeakinginfullsentences?

•Loudwheezeorpersistentcough?

•Decreasedlevelofconsciousness?

YES

CALL EMS 9-1-1

Contact

responsible

school nurse or

administrator &

parent or legal

guardian.

•Maygiveroom

temperature water to drink

•Personmayreturntoclass

when recovered

Signs of Breathing Difculty

•Rapid/Shallowbreathing   •Tightnessinchest   •Excessivecoughing

•Notabletospeakinfullsentences •Wideningofnostrils  •Appearsveryanxious

•Wheezing(highpitchedsound)  •IncreaseduseWofstomach

and chest muscles

Asthma/wheezing attacks may be triggered by

many substances/activities. Hypersensitive

airways become smaller, causing wheeze, cough,

anddifcultybreathing.Attacksmaybemild,

moderate or severe. Refer to emergency

care plan.

Emergency First Aid Guidelines for California Schools

BEHAVIORAL EMERGENCIES

Persons with a history of behavioral

problems, emotional problems or

other special needs should be known

to appropriate staff. An emergency

care plan should be developed at time

of enrollment.

•Doesperson’sbehaviorpresentanimmediate,

risk of physical harm to self, other

persons or property?

•Ispersonarmedwithaweapon?

Are there visible injuries? Signs of

poisoning or patient has admitted to

taking medications or drugs.

Refer to your school’s policy for addressing behavioral

emergencies. Behavioral or psychological emergencies

may take many forms (e.g., depression, anxiety/panic,

phobias, destructive or assaultive behavior, etc.).

Intervene only if the situation is safe for you.

Call for assistance

Seeappropriateguidelinetoproviderst

aid, if any injury requires immediate care.

CALL EMS 9-1-1

YES

CALL POLICE 9-1-1

Ask for a police response.

YES

Communications should be non-threatening. Acknowledge that the person is upset, offer to

help, make eye contact, and avoid physical contact. Stay out of reach, and ensure an

accessible escape route. DO NOT challenge or argue. Attempt to involve people who the

person trusts, and talk about what is wrong. If available, have another adult stand nearby, in

a nonthreatening manner, in case student’s behavior escalates. Check Emergency

Action/Care Plan for more information.

If needed:

Suicide Hotline

(1-800-273-8255)

www.suicidepreventionlifeline.org

Contact responsible school

nurse or administrator and

parent or legal guardian.

The cause of unusual behavior may be psychological/emotional or physical (e.g., fever, diabetic emergency,

poisoning/overdose, alcohol/drug abuse, head injury, etc.).

The person should be seen by a health care provider to determine the cause.

Suicidal and violent behavior should be taken seriously. If the person has threatened to harm himself/herself

or others, contact the responsible school authority immediately.

Emergency First Aid Guidelines for California Schools

BITES (HUMAN & ANIMAL)

Wear disposable gloves

when exposed to blood

orotherbodyuids.

Is the person bleeding?

•Pressrmlywithaclean

dressing/cloth on bleeding site,

see “Bleeding” (pg. 24)

Is bite large or gaping?

Is blood spurting?

•Holdbiteareaunderrunningwater

for 2-3 minutes

•Washwithsoapandwater

•Ifwoundbled,applyclean

bandage

Is bleeding

uncontrolled?

Maintain direct pressure

CALL EMS 9-1-1

See “Bleeding” (pg. 24)

YES

If bite is from a snake, scorpion or other

reptile, hold the bitten area still and

below the level of the heart.

Call POISON CONTROL CENTER

1-800-222-1222

See “Snake Bite”, if appropriate (pg. 23)

Is bite from a human?

Check immunization record for DT,

DPT, Tdap, or DTaP (tetanus). See

“Tetanus” (pg. 68) for more information.

If bite is from an animal:

•Don’ttrytocatchortouch

the animal

•Getdescriptionandlocation

of animal

•ReporttoAnimalControlor

proper authority, usually the local

Health Department, so that

animal can be caught & watched

for rabies

Contact responsible school nurse

or administrator and parents/legal

guardian. If a human bite, inform both

the person bitten and the person biting

that they may have been exposed to

blood from another person. If skin is

broken seek medical care.

ENCOURAGE IMMEDIATE MEDICAL

CARE

File Incident Report

YES

Emergency First Aid Guidelines for California Schools

BITES & STINGS (INSECT)

Also see

Bites & Stings for:

Human (pg. 20)

Marine (pg. 22) &

Allergic Reaction (pg. 17)

Did a scorpion sting person?

Persons with a history of behavioral

problems, emotional problems or

other special needs should be known

to appropriate staff. An emergency

care plan should be developed at time

of enrollment.

Get description of insect or spider.

Call POISON CONTROL

CENTER

1-800-222-1222

Follow directions

Does person have symptoms of:

•Difcultybreathing?

•Swellingofface,tongueorneck?

•Coughingorwheezingthatdoesnotstop?

•Historyofsevereallergicreactions?

If known history of anaphylaxis to

insect bite or envenomation and

symptoms are present, even if mild,

administer doctor and parent/guardian

approved medication.

Use EpiPen if prescribed.

YES

•Movetoasaferareatoavoidmorestings

•Removestingerasquicklyaspossibleby

scrapingwithedgeofngernailorcreditcard

•Removeanytightttingjewelryfromaffectedarea

•Washareawithsoapandwater

•Applyiceorcoldpackwrappedincloth/towel

for 10-15 minutes

•Observeforatleast20minutesor

•CallEMS9-1-1ifperson’ssymptomsworsen

CALL 9-1-1

• Keeppersonquiet

• See“AllergicReaction”(pg.17)

• PositionofComfort

• Bepreparedtoperform“CPR”

•Anysignsofallergicreaction?

•Isbitethoughttobepoisonous?

•Ifanoldbite,isitreddened,weeping,

ulcerated or sore?

Return to class, ensure adult supervisor aware

of bite and possible delayed allergic reaction.

Contact responsible

school nurse or

administrator &

parent/legal guardian.

YES

• Allergicreactionsmaybedelayeduptotwo(2)hours

• See“AllergicReaction”forsignandsymptoms(pg.17)

Emergency First Aid Guidelines for California Schools

BITES & STINGS (MARINE)

Marine envenomation from bite, spine or

contact can cause anaphylaxis.

See “Allergic Reaction (pg. 17)

Marine eld trips should carry rst aid kits

with specic items for marine stings.

When unsure of marine animal or plant

contacted, obtain description and

Call POISON CONTROL CENTER

1-800-222-1222

Follow directions

Known history of

allergic reactions

should be recorded

at school and avail-

able to all school

staff. An emergency

care plan is needed.

Sponge:

May leave tiny

spicules in skin

Spine Puncture: .

Stingray,Stonesh,

Sea Urchin or Star

sh-Causes

severe intense pain

Jellysh

May cause severe

pain and shock

depending on

species

Coral

•Rinsewithsea

water (not fresh)

•Applyvinegar,

rubbing alcohol,

baking soda, if

available

•Removeadherent

nematocysts by

applying shave

cream, baking

soda or talc and

scrape with razor

or sharp edge

Fish Bite

There will be pain at the

site; possible breathing

difculties

•Usehotuid

•TreataswoundSee

“Wounds (Puncture)”

(pg. 72)

•Applypressureif

bleeding, clean wound,

apply clean dry

dressing

•Immersehandor

foot in hot (not

scalding) water

for 30-90 minute

to relieve pain

•Rinsewithsea

water or vinegar

to detoxify

•Remove

spicules with

tape, rubber

cement or facial

mask

Adult supervising person should be aware of sting and should observe

for allergic reaction.

Does person have:

 •Difcultybreathing?Hoarsenessordifcultyswallowing?

 •Swellingoftheface,throatormouth?

 •Ahistoryofallergytomarinestings?

Contact responsible

school nurse or

administrator &

parent or legal

guardian.

Injury from a marine spine

requires evaluation for

potential foreign body and

pain control

CALL EMS 9-1-1

See “Allergic Reactions”

(pg. 17)

YES

Emergency First Aid Guidelines for California Schools

BITES & STINGS (SNAKE)

Treat all snakebites as poisonous unless

snake is positively identied as harmless.

• DO NOT cut wound

• DO NOT apply tourniquet

• DO NOT apply ice

•Immobilizethebittenextremityatorbelowtheleveloftheheart

•Ifatschool,makepersonsitorliedown,keepatcompleterest,

avoid activity (walking)

•Keepvictimwarmandcalm

•Removeanyrestrictiveclothing,rings,andwatches

CALL EMS 9-1-1

•Washwithsoapandwater

•Coverwithcleancompress

•Monitorpulse,colorandrespirations;preparetoperform

CPR if needed

If greater than 30 minutes from emergency department:

•Applyatightbandagearoundtheentireextremitywherethe

biteoccurred.Donotcutoffbloodow

•Parentsmaytransportformedicalevaluationifconditionis

not life threatening

•Ifcapableandoff-road,walkslowlytoroadortrailheadand

then take to emergency department

•Issnakeknownaspoisonous?

•Ispersonnotbreathing?See“CPR(pg.29)

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE

MEDICAL CARE

ALL SNAKE BITES

•Needmedicalevaluation.

•Donottrytocaptureorkillsnake.

•Takepicture,ifpossible,ofsnake.

•Ifsnakeisdeadsendwithvictim

to hospital.

NO or UNKNOWN

YES

Severe:

•Fangmarksormark •Swellingoftongueorthroat

•Swelling,discolorationorpainatsite •Rapidswellingandnumbness

•Rapidpulse,weakness,sweating,fever •Severepain

•Shortnessofbreath •Shock

•Burning,numbnessortinlingsensation •Pinpointpupils

•Blurredvsion,dizziness,fainting •Twitching,seizures

•Nausea&vomiting •Paralysisandunconsciousness

•Lossofmusclecoordination

Signs & Symptoms of Poisonous Bite:

Emergency First Aid Guidelines for California Schools

BLEEDING

Wear disposable gloves when exposed to blood or other

bodyuids.Do not remove impaled object.

•Pressrmlywithacleanglovedhand,clothordressingforseveralminutestostopbleeding

•Objectinwound,see“Wound-Puncture”(pg.72)

•Elevatebleedingextremity.Iffractureissuspected,see“Fractures…”(pg.47)

•Ifamputatedpart,placepartinsealedplasticbagandplacebaginicewater

•DO NOT PUT AMPUTATED PART DIRECTLY ON ICE

CALL EMS 9-1-1

•Havepersonliedown

•Elevatefeet8-10inches,unlessthiscauses

pain/discomfort, OR a neck/back/hip injury is

suspected

•Keeppersonwarmbutnothot

•Reinforceexistingdressingandapply

pressure to wound as needed

•Bandagewoundrmly,butnottightenoughtocompromisecirculation

•Checkskincirculationfrequentlybycheckingforwarmth,pinkness,andgoodsensation

•Ifbandageissaturatedwithblood,DoNotremoveit

•Reinforcewithanotherdressingoverexistingdressing/bandage,and

•Holdrmpressurefor10minutes

•Washsurroundingareawithsoapandwater

•Rinse,patdry,andapplybandage

•Ifdeeporgaping,woundsmayneedstitches–

RECOMMEND MEDICAL CARE

Is there continued uncontrollable

bleeding?

Contact responsible

school nurse or

administrator & parent or

legal guardian.

•Isinjuredpartamputated(severed)?

•Isbloodbrightredorspurting?

•Ismuscle,fatorboneshowing?

CALL EMS 9-1-1

Maintain Direct Pressure on wound.

YES

Emergency First Aid Guidelines for California Schools

BLEEDING

Wear disposable gloves when exposed to blood and other

bodyuids.

•Washareawithsoapandwater

•DO NOT BREAK BLISTER

•Ifrupturedblister,cleanandcoverwith“2ndskinbandage,”plainathletic

tape, or “mole skin” type bandage

•Ifintactblister,applydressingandavoidfurtherfriction(differentshoes,

if possible)

•Ifred,sensitivebutnoblisters,applytapedirectlyoverarea

•Applybandage,tapeordressingtopreventfurtherrubbing

If infection is suspected,

contact responsible school

nurse or administrator &

parent or legal guardian.

Blisters heal best when kept clean and dry with

avoidance of further friction at blister site.

Emergency First Aid Guidelines for California Schools

BRUISES

A bruise is bleeding under the skin. Bleeding is usually

self-limited by pressure of surrounding tissues.

Initially red, later turning dark colors like purple.

An old bruise later may turn yellow then green.

Painful, large bruises or marked swelling areas may indicate

more severe damage of muscle, bone, or internal tissues

that need medical care.

If skin is broken:

Treat as a cut.

See “Wounds” (pg. 71)

If fracture suspected,

See“Fractures…”(pg.47)

•Restinjuredpart

•Applycoldcompressoricebagcoveredwith

a cloth or towel, to injured part (not more

than 20 min)

Is there rapid swelling?

Is person in great pain?

If it is too uncomfortable

to return to normal

activities, contact responsible

school nurse or administrator &

parent or legal guardian.

If a child comes to school

with unexplained, unusual or

frequent bruising, consider

the possibility of child abuse.

See

“Child Abuse” (pg. 35)

YES

CALL EMS 9-1-1

Consider other potential injuries and

see appropriate guide.

Contact responsible school

authority & parent or legal

guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE OR

Emergency First Aid Guidelines for California Schools

BURNS

Always make sure that the situation is safe for you

before helping the person.

Burns may be associated with other injuries,

see appropriate topic.

•Removefromsourceofburn

•Maintainairwayandbreathing,see“CPR”ifneeded(pg.32)

•Turnoffelectricalpower

•Checkforbreathingandotherinjuries

•Coverwithadry,preferablysterile,cleandressing

•Maintainnormalbodytemperature

•Electricshockthatleavesavisibleburnrequires

medical attention

•See“ElectricShock”

Areanyofthesendingspresent:

•Confusedorunconsciousness?

•Difcultybreathing?

•Sootaroundmouthornose?

•Burnonfaceoreye?

•Burnisdeeporincludesalargearea,ormultiplepartsofthebody?

•Burnedskiniswhite,brown,blackorcharred?

•Burnisfromanexplosion?

See “Burns

Thermal and Chemical”

(pg. 28)

YES

CALL EMS 9-1-1

What type of burn is it?

ELECTRICAL

CHEMICAL OR HEAT

(THERMAL)

Emergency First Aid Guidelines for California Schools

•Flushallburnswithcool

running water

•Coverlargeburnswitha

clean dry cloth

•Coversmallerburnsloosely

with a clean, cool, damp

cloth to cool the burn

and relieve pain

•Keepvictimwarm

DO NOT BREAK BLISTERS

•Coverwithdrydressing

•Forburnsonmultiplepartsof

body cover with dry clean

sheet.

Keep air off burn

•DONOTUSEointmenton

burns unless directed by

a physician

What type of burn is it?

Contact responsible

school nurse or administrator

& parent or legal guardian, if more

thanasmallsupercialburn.

ENCOURAGE URGENT

MEDICAL CARE

If person comes to

school with patterned burns

(e.g., iron or cigarette shape)

or glove-like burns, consider

the possibility of abuse.

See “Child Abuse” (pg. 35)

•Wearglovesand,ifpossible,goggles

•Avoidchemicalcontact

•Brushoffdrychemicalsfromskin

•Removeallclothingandjewelrypossibly

exposed to chemical

•Rinsechemicalsoffskin,eyesandawayfrom

body IMMEDIATELY with large amounts of

water. Rinse for 10 minutes.

•Ifeyesareinvolved,see“Eyes”(pg.42)

•Trytoidentifysubstance

BURNS

(CONT.)

Heat (Thermal) Chemical

•Keepwound/burnclean

•Treatotherinjuries

•Personswithsmalland

supercialburns(e.g.,

sunburn without blisters)

may return to class unless so

uncomfortable they are

unable to participate

CALL POISON

CONTROL CENTER

1-800-222-1222

whileushingburn&askfor

instructions.

Follow directions received.

Check person’s immunization record for DT, DPT

(tetanus). See “Tetanus” for more information.

Emergency First Aid Guidelines for California Schools

CPR

NOTES ON PERFORMING CPR

The American Red Cross (ARC) guidelines follow the American Heart

Association’s (AHA) new CPR guidelines for laypersons, “Guidelines 2010 for

Emergency Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.”

BARRIER DEVICES

Barrier devices, to prevent the spread of infections from one person to another, can be

used when performing rescue breathing. Several different types exist (e.g., face shields,

pocket masks). It is important to practice using these devices in the presence of a trained

CPR instructor before attempting to use them in an emergency situation.

AUTOMATED EXTERNAL DEFIBRILLATORS (AEDs)

AEDs are devices that help to restore a normal heart rhythm when the heart is

not beating properly. It does this by delivering an electric shock to the heart.

A physician’s prescription is required to purchase an AED. A physician is also required

to provide medical direction to the school or school district that acquires an AED. If your

school has an AED, obtain training in its use, and training in CPR, before an emergency

occurs. The majority of AED use in the schools will be on adults at the facility, since the

medical conditions likely to require use of an AED on a child are extremely rare.

AED training is offered through the American Heart Association, the American Red Cross,

the American Health and Safety Institute, the National Safety Council and other CPR and

AED training programs. AED manufacturers also offer training. The AED regulations are

available at the EMS Authority’s website http://www.emsa.ca.gov. See CA Code of

Regulations, Title 22, Division 9, Chapter 1.8, Training Standards and Utilization for

UseoftheAutomatedExternalDebrillatorbyNon-LicensedandCertiedPersonnel

for further information.

Emergency First Aid Guidelines for California Schools

AUTOMATED EXTERNAL DEFIBRILLATORS (AED)

CHECK WHICH APPLIES:

 NO AED AVAILABLE AT THIS

SCHOOL.

 My School’s AED is located at:

___________________________

Persons must be trained to use an AED. After receiving training on how to use the

AED, remember to:

•Checkforunresponsiveness

•Call9-1-1andretrievetheAED

•Checkforunresponsivenessorgaspingbreathing

•Ifunresponsiveorbreathingonlygaspingbeginchestcompressions

•TurnonAEDandfollowdirections

•AttachAEDelectrodepads,analyzerhythm

•WhentheAEDrecommendsthepatientneedstobeshocked,makesurenooneis

touching the person and press the “Shock” button

•FollowinstructionsfromAEDunit

•IfinstructedtodosobyAED,resumeCPRfor2minutesandfollowinstructionsfrom

AED device

•Ifnosignsofcirculation,resumeCPR

Emergency First Aid Guidelines for California Schools

CHECK FOR

UNRESPONSIVENESS

(Call out, rub arms/chest).

If responsive, no CPR needed.

If unresponsive, call 9-1-1.

If anyone else available, have them call

for help and an AED.

Additional written directions

and pictures on next page

(pg. 32).

Place on left side and

protect airway

CALL 9-1-1

See “Loss of

Consciousness” and

providerstaidas

needed (pg. 53).

LAY PERSON CPR

Infant CPR

• BEGIN CHEST COMPRESSIONS AT A RATE

OF 100/MIN; deliver 30 compressions

•Infants:use2ngersinmiddleofbreastbone

and compress ½” -1” inch

•Smallchildren:useheelofhand,compress

1½”-2”

•Adults:usebothhands–oneontopofotherin

middleofbreastboneandcompressatleast2”–

allow for full recoil of chest

If trained - Give 2 rescue breaths

•Tiltheadbackandopenjaw

•Covermouthwithyourmouth

•Givebreathsuntilchestrises

•Continuewith30compressionsand2

breaths

If untrained–continue“Handsonly”

•Continuebreathingandchest

compressions as needed

•REASSESSEVERY2MINUTESfor

responsiveness; if unresponsive,

continue CPR

•Ifpatientstartsbreathing,placeonleft

side and protect airway

Head Tilt

Adult CPR

Child CPR

If Breathing

Emergency First Aid Guidelines for California Schools

LAY PERSON CPR

(CON’T)

FOR CHILDREN ONE YEAR OLD TO ADULT

CPR is to be used when a child or adult is unresponsive or when breathing or heart beat stops.

1. Tap or gently shake the shoulder. Shout “Are you OK?” If that person is unresponsive,

shout for help and send someone to call EMS 9-1-1.

2. Turn the person onto his/her back as a unit by supporting the head and neck. If head

or neck injury is suspected, DO NOT BEND OR TURN NECK.

3. Lift chin up and out with one hand while pushing down on the forehead with the other

to open the AIRWAY. If head or neck injury suspected, hold head still and move jaw

forward to open airway.

4. Check for normal breathing by observation of chest, if there is no breathing or the patient is making gasping breaths

then begin chest compressions at a rate of 100 per minute. Compress 30 times before beginning rescue breaths.

5. If child is not breathing, seal your lips tightly around his/her mouth; pinch nose shut.

While keeping the airway open, give 2 slow breaths (1 to 1½ seconds per breath) until chest rises.

IF AIR GOES IN:

(Chest rises with rescue breath)

6. Place heel of one hand on the lower half of

breastbone. Do NOT place your hand over the very

bottom of the breastbone.

7. Compress chest 30 times with heel of one hand

 (atleast2inches).Liftngerstoavoidpressureonribs.

8. Give 2 slow breaths until chest rises.

9. REPEAT CYCLES OF 30 COMPRESSIONS TO

2 BREATHS AT A RATE OF 100 COMPRESSIONS

PER MINUTE UNTIL PERSON SHOWS SIGNS OF

BREATHING EFFECTIVELY ON OWN, SHOWS

OTHER SIGNS OF CIRCULATION, OR HELP

ARRIVES.

IF AIR WON’T GO IN:

(Chest does NOT rise with rescue breath)

6. Re-tilt head back (Steps 3-5). Try to give 2

breaths again.

IF AIR GOES IN, FOLLOW LEFT COLUMN.

IF AIR STILL WON’T GO IN:

7. Find hand position near center of breastbone.

Do NOT place your hand over the very bottom

of the breastbone.

8. Compress chest 30 times with the heel of 1

 hand(atleast2inches).Liftngerstoavoid

pressure on ribs.

9. Lift jaw and tongue and look in mouth. If foreign

 objectisseen,sweepitoutwithnger.Ifobject

is not seen, Do Not Sweep With Finger Blindly.

10. REPEAT STEPS 6-9 UNTIL BREATHS GO

IN, CHILD STARTS TO BREATH EFFECTIVELY

ON OWN, SHOWS OTHER SIGNS OF

CIRCULATION OR HELP ARRIVES.

1. Reproduced with permission, Pediatric Basic Life Support ©

1997, Copyright American Heart Association

2. Text based on Community First Aid & Safety, 2002 American

Red Cross

3. 2010 American Heart Association Guidelines for CPR

Emergency First Aid Guidelines for California Schools

CHOKING

FOR CONSCIOUS VICTIMS

Call 9-1-1 or activate EMS after starting rescue efforts.

INFANTS UNDER ONE YEAR OF AGE

Begin the following if the infant is choking and is unable to

breathe. However, if the infant is coughing or crying, DO

NOT do any of the following, but call EMS 9-1-1, try to calm

the child and watch for worsening of symptoms. If cough

becomes ineffective (loss of sound), begin step 1 below.

1. Position the infant, with head

slightly lower than chest, face

down on your arm and support the

head (support jaw; do NOT

compress throat).

2. Give up to 5 back blows with the

heel of the hand between infant’s shoulder blades.

3. If object is not coughed up,

position infant face up on your

forearm with head slightly lower

than rest of body.

4. With2or3ngers,giveupto5

chest thrusts near center of breastbone, about one

 ngerwidthbelowthenippleline.

5. Open mouth and look. If foreign

object is seen sweep it out with

 nger.

6. Tilt head back and lift chin up

and out to open the airway. Try

to give 2 breaths.

7. Repeat steps 1-6 until object is coughed up, infant

starts to breathe or infant becomes unconscious.

IF INFANT BECOMES UNCONSCIOUS, LAY ON BACK

AND GO TO PAGE 32, RIGHT COLUMN, STEP 6 OF

CPR INSTRUCTIONS USING 2 FINGERS IN MIDDLE OF

BREAST BONE FOR COMPRESSIONS.

CHILDREN OVER ONE YEAR OF AGE & ADULTS

Begin the following if the child/adult is choking and is unable

to breathe. However, if the child/adult is coughing or crying,

DO NOT do any of the following, but call EMS 9-1-1, try to

calm the child/adult and watch for worsening of symptoms. If

cough becomes ineffective (loss of sound), begin step 1.

1. Stand or kneel behind person and place your arms

under the armpits to encircle the chest.

2. Placethumbsideofstagainst

middle of abdomen just above

the navel. DO NOT place your

hand over the very bottom of

 thebreastbone.Graspst

with other hand. Press with

quick backward and upward

thrusts.

3. Give up to 5 quick inward and upward thrusts.

4. Repeat steps 1-2 until object is coughed up, or

person starts to breathe or becomes unconscious.

IF PERSON BECOMES UNCONSCIOUS, LAY ON BACK

AND GO TO PAGE 32, RIGHT COLUMN, STEP 6 OF CPR

INSTRUCTIONS.

FOR OBESE OR PREGNANT PERSON

Stand behind person and place your arms under the armpits

toencirclethechest.Placethumbsideofstagainstlower

half of breastbone and thrust backwards.

1. Reproduced with permission, Pediatric Basic Life Support,

2. Text based on Community First Aid & Safety, 2002 ,

American Red Cross

Emergency First Aid Guidelines for California Schools

CHEST PAIN (POSSIBLE HEART ATTACK)

Chest pain can be caused by:

•Injury

•Esophagealspasm

•Lunginammation

•Pneumonia

•Gastricdisturbance

•Anxiety/Stress

•Heartconditions

CALL EMS 9-1-1

Even if person objects.

Do not transport by private car.

•Askpersonifthishas

occurred before and what

made it better

•Placeinpositionof

comfort, usually reclining,

and keep quiet

•Loosentightclothing

•Anylossofconsciousnessorconfusion?

•Doespersonlookseriouslyill?

•Hasheartattacksymptom(s)?(seebelow)

•Hassignicantchestpainstoppedandreturned?

Cardiovascular disease and heart attacks are

rare among children under 18 years of age.

However, some children have a history of

heart problems. Check emergency medical

information.

The risk of heart attack increases steadily over

40 years of age.

•Ifunconscious,see“Lossof

Consciousness” (pg. 53)

•Ifbreathingstops;see“CPR”(pg.32)

•Placeinpositionofcomfort

•Keepcalm,don’tpanic,reassureperson

• DO NOT GIVE MEDICATIONS UNLESS

AUTHORIZED

Contact responsible school

nurse or administrator & parent/

legal guardian.

Signs & Symptoms Of A Heart Attack

•Chestpaindescribedasconstantheavypressure,viselike,orpaininthemiddleorupperchest.The

discomfort may travel across the chest to arm, neck or jaw and also include:

o Left arm/shoulder pain

o Jaw/neck pain

o Sudden unexplained weakness or dizziness with or without nausea

o Sweaty, clammy, pale, ashen or bluish skin

o Shortness of breath or breathing is abnormal

YES

Emergency First Aid Guidelines for California Schools

CHILD ABUSE & NEGLECT

If child has visible injuries,

refer to the appropriate

guidelinetoproviderstaid.

Call EMS 9-1-1 if any injuries require

immediate medical care.

Teachers and other professional school staff are required to report

suspected abuse and neglect to the Child Protective Services

Agency. Refer to your own school’s policy for

additional guidance on reporting.

Child Protective Services # _____________

Child abuse is a complicated is-

sue with many potential signs.

Anyone in a position to care

for children should be trained

in recognition of child abuse/

neglect. Mandated reporters

should receive

required annual training.

Abuse may be physical, sexual or emotional in nature.

This is NOT a complete list:

•Depression,hostility,lowself-esteem,poorself-image

•Evidenceofrepeatedinjuriesorunusualinjuries

•Lackofexplanationorunlikelyexplanationforaninjury

•Patternbruisesormarks(e.g.,burnsintheshapeofacigaretteoriron,bruisesor

welts in the shape of a hand)

•”Glove-like”or“sock-like”burnsonhandsorfeet

•Unusualknowledgeofsex,inappropriatetouchingorengaginginsexualplaywith

other children

•Poorhygiene,underfedappearance

•Severeinjuryorillnesswithoutmedicalcare

If a child reveals abuse to you:

•Staycalm

•Takethechildseriously

•Tellthechildthathe/shedidtherightthingbytellingyou

•Donotmakepromisesthatyoucannotkeep

•Respectthesensitivenatureofthechild’ssituation.Remembereachcaseisindividualanduse

your best judgment to act in the best interest of the child

•Followappropriatereportingprocedures

•SeeDepartmentofSocialServices,Publication132“TheCaliforniaChildAbuse&Neglect

Reporting Law - Issues and Answers for Mandated Reporters,” at

http://www.dss.cahwnet.gov/pdf/PUB132.pdf

Emergency First Aid Guidelines for California Schools

COMMUNICABLE DISEASES

For more information on protecting yourself from upper

respiratory infections listed under the “Emergency

Procedures” tab, see “Infection Control” (pg. 16).

CALL EMS 9-1-1.

Does the person have

SIGNS OF LIFE-THREATENING ILLNESS:

•Difcultybreathingorswallowing,rapidbreathing?

•Severecoughing,noisybreathing?

•Feverover100.0degreesFincombinationwithlethargy,

extreme sleepiness, abnormal behavior

A communicable disease

is a disease that can be

spread from one person

to another. Germs cause

communicable diseases

(bacteria, virus, fungus,

parasites).

YES

Does the person have?

SIGNS OF PROBABLE ILLNESS or INFECTION:

•Redness,swelling,drainageofeye?

•Unusualspots/rashwithfeveroritching?

•Crusty,brightyellow,swollen,tender,redoropen

draining skin sores?

•Diarrhea(morethantwoloosestoolsaday)?

•Vomiting?

•Yellowskinoryellow“whiteofeye”?

•Fevergreaterthan100.0degreesF?

•Extremetirednessorlethargy?

•Unusualbehavior?

Additional signs & symptoms:

Fussiness Runny nose Mild cough

Headache Itchy scalp Stomach ache

Sore throat Ear ache

Monitor child for worsening

of symptoms and contact

parent/legal guardian.

Remove student from

the classroom, contact

responsible school nurse or

administrator and parent or

legal guardian.

ENCOURAGE MEDICAL

CARE

In general, there will be little that you can do for a person in school who has an infection; however, limit the exposure and

spread of disease to others by encouraging student(s) to cover mouth and nose when coughing or sneezing; use a tissue

and encourage hand washing or use of alcohol based hand gel. Refer to your school’s exclusion policy for illness.

Common diseases include: Chicken pox, head lice, pink eye, strep throat and inuenza (u).

YES

Emergency First Aid Guidelines for California Schools

DIABETES

A person having a diabetic reaction could have the

following signs & symptoms:

 •Irritabilityandupset   •Rapidpulse

 •Sweatingandfeeling“shaky”  •Cramping

 •Changeinbehavior   •Dizziness

 •Unconsciousness   •Listlessness

 •Rapid,deepbreathing  •Pallor

 •Seizure    •Confusion

 •Fruityorsweetbreath

Give the person any one of the

following:

•Fruitjuiceorsodapop(notdiet)6-

8 ounces

•Sugar(2packetsor2teaspoons)

dissolved in water or juice

•Cakedecoratinggel(1/2tube)or

icing

•Instantglucosegel

Continue to watch the person in a quiet

place

Is the person:

 •Unconscious?

 •Confusedoractingunusual?

 •Havingaseizure?

 •Unabletospeak?

 •Havingrapid,deepbreathing?

A person with diabetes

should be known to

appropriate school staff.

A history should be obtained

and an emergency care plan

should be developed at time

of enrollment.

Does he/she have a blood

sugar monitor available?

Contact responsible

school nurse or

administrator & parent

or legal guardian.

Is person improving?

Does person have an

emergency action/care plan?

•Allowpersontocheckbloodsugar*

•FollowEmergencyAction/CarePlan

CALL EMS 9-1-1.

If unconscious, see “Loss of

Consciousness” (pg. 53)

YES

Emergency First Aid Guidelines for California Schools

DIARRHEA

Wear disposable gloves when exposed to

bloodorotherbodyuids.Apersonmaycome

totheofcebecauseofrepeateddiarrhea,or

after an “accident” in the bathroom.

•Checktemperature

•Allowthepersontorestifexperiencinganystomachpain

•Givethepersonsmallamountsofuid(water,sportdrink,etc.)todrinkto

prevent dehydration; avoid sodas

•Juiceorsportsdrinkmixed50/50withwater

Wash hands

thoroughly

Contact responsible school nurse or administrator & parent or legal guardian and urge

medical care if:

•Hasthreeormoreepisodesofdiarrhea

•Thepersonhasafever,over100.0degreesF,see“Fever”(pg.45)

•Bloodispresentinthestool

•Thepersonisdizzyandpale

•Thepersonhasseverestomachpain

If the person’s clothing is soiled:

•Maintainprivacy,offerchangeofclothingorablankettowrapupin

•Weardisposablegloves

•Double-bagtheclothingtobesenthome

Emergency First Aid Guidelines for California Schools

DROWNING/NEAR DROWNING

•CPRtrainedstaffshouldsendsomeoneforhelp.

•Getpersonoutofthewater.

•Placeonbackwithheadandneckstraight.

•OpenandmaintainAIRWAY(ifheadorneckinjury

suspected or unknown, assume injury and lift jaw without

moving head).

•Assessbreathing.

•Clearairwayofvomit/objectsifneeded.

•Supporthead&neckandturnbodyandheadasone

(logroll) to the left side.

•Minimizehead&neckmovement.

Is victim:

•Notbreathing?

•Unconscious,confused,lethargic?

Drowning can occur

in 2 inches of liquid.

Immediate medical

care is needed.

Is patient regurgitating water?

Give rescue breaths, if not

breathing, see “CPR”

(pg. 32)

CALL EMS 9-1-1

DO NOT MOVE VICTIM

Contact responsible school

authority and parent/legal

guardian.

•Supporthead&neck&turnbody&head

as one (logroll) to the left side

•Minimizehead&neckmovement

•Monitorbreathing,level

of consciousness and

circulation

•Ifchangesoccur,see

appropriate guideline

Was victim injured?

See appropriate

guidelines

If victim recovers with initial rescue efforts,

complications may still occur after near

drowning.

Contact responsible school

nurse or administrator & parent

or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL CARE

YES

Emergency First Aid Guidelines for California Schools

EARS

DO NOT:

•Trytocleanoutear

•Plugearcanal

•Stopowofdrainage

Is there a live insect in

the ear?

Take & record

temperature

DRAINAGE FROM EAR or EARACHE

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL

CARE

Ask person if he/she

knows what is in the ear

Gently tilt head

Put drop of oil in ear. Did

object come out?

DO NOT ATTEMPT TO

REMOVE INSECT OR

OBJECT

Do Not use a light to

attract an insect out, it

may excite the insect.

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL

CARE

OBJECT IN EAR CANAL

YES

NO or NOT SURE

Emergency First Aid Guidelines for California Schools

ELECTRICAL INJURY

•Injuryfromanyelectricsourceotherthanhousehold,

Call 9-1-1

•Ifexposedpowersource, TURN OFF POWER

SOURCE, if possible

•DO NOT TOUCH PERSON UNTIL POWER

SOURCE IS SHUT OFF

•Oncepowerisoffandsituationissafe,approachthe

person and ask, “Are you okay?”

•Anyelectricalshockwithinjuryneedsmedical

evaluation

Did person lose consciousness or

become unresponsive?

If patient is

unresponsive and no

one else is available

to call EMS, call EMS

yourself then

begin CPR.

Send someone to

CALL EMS 9-1-1

If unresponsive or has only

gasping breathing,

begin CPR;

see “CPR” (pg. 32)

If a person has signs of an electrical burn, it

may be subtle:

• Checkforotherinjuries

• Applyclean,drydressing

• DONOTuseointments

• Protectfromhotandcold

• Allelectricalburnsneedmedicalattention.

Electrical current can travel through the

underlying tissues and cause unseen injury

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL

CARE

Contact responsible

school nurse or

administrator & parent

or legal guardian.

YES

Emergency First Aid Guidelines for California Schools

EYES (INJURY)

Keep person comfortable

with head and chest in

sitting position or elevated

and quiet.

• Isinjurysevere?

• Isthereachangeinvision?

• Hasobjectpenetratedeyeoreyesocket?

With any eye problem, ask if the person

wears contact lenses. Have person remove

contacts before giving any rst-aid to eye.

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL

CARE

CALL EMS 9-1-1

If an object has penetrated the eye

or eye socket,

DO NOT REMOVE OBJECT.

A large object should be support-

ed with dressings to minimize

movement.

Keep person from rubbing eye, or moving object.

DO NOT TOUCH THE EYE

PUT ANY PRESSURE ON THE EYE OR THE OBJECT

Contact responsible

school nurse or

administrator & parent

or legal guardian.

EYES CONTINUED ON

NEXT PAGE (pg. 43)

YES

Emergency First Aid Guidelines for California Schools

EYES

(CONT.)

Keep person from

rubbing eye.

Ask what is in

eye?

• Havepersonblinkrepeatedlytoushoutparticle

• Ifnecessary,laypersondown,&tipheadtoward

affected side

• Gentlypourcooltapwateroveropeneyetoush

out particle

• Immediatelyusheyewithlargeamountsoftepidorcool,cleanwater

• Tiptheheadsothattheaffectedeyeisbelowtheunaffectedeyewashing

the eye from nose to side of face for 5-10 minutes

• Whileushingeyetrytodeterminesubstancethatenteredeyeand

Call POISON CONTROL CENTER

1-800-222-1222

Follow Instructions

Ifparticledoesnotush

out of eye, or if eye pain

continues, contact responsible

school nurse or administrator and

parent or legal guardian.

ENCOURAGE MEDICAL CARE

Close Eyelid & Cover

PARTICLE IN EYE:

Wear gloves and if

possible, goggles.

Ask what is in eye?

CHEMICALS IN EYE:

If eye has been injured by a chemical or con-

tinued pain or visual change

CALL EMS 9-1-1

Contact responsible

school nurse or

administrator & parent or

legal guardian.

Emergency First Aid Guidelines for California Schools

FAINTING

If you observe, or the person complains of any

of the following signs or symptoms of fainting,

have the person lie down to prevent injury from

falling:

• Extremeweaknessorfatigue

• Dizzinessorlight-headedness

• Extremesleepiness

• Pale,sweatyskin

• Nausea

Is fainting due to a forceful injury?

Fainting may have many causes including:

injuries, blood loss, poisoning, severe

allergy, diabetic reaction, heat exhaustion,

hypoglycemia, illness, fatigue, stress, not

eating, standing still for too long, etc.

Most persons who faint will recover quickly

when lying down. If person does not regain

consciousness within 1 minute, see “Loss of

Consciousness”

(pg. 53) and CALL 9-1-1.

Keep person lying down.

Contact responsible school

nurse or administrator &

parent or legal guardian.

ENCOURAGE

IMMEDIATE MEDICAL CARE

CALL EMS 9-1-1

See “Loss of

Consciousness” (pg. 53).

• Keeppersoninatpositionlyingonback

• Elevatefeetabovelevelofheart

• Loosenclothingaroundneckandwaist

Did person injure self when he/she

fainted/fell?

Are symptoms (dizziness,

light-headedness, weakness,

fatigue, etc.) still present?

• Keepairwayclearandmonitorbreathing

• Keeppersonwarm,butnothot

• Controlbleedingifneeded,see“Bleeding”(pg.24)

• Givenothingtoeatordrink

• Checkforamedicalalerttagorbracelet

If person feels

better, and there

is no danger of

neck injury, he/

she may be

moved to a quiet,

private area.

See appropriate guideline. If head

or neck injury suspected. Treat as

possible neck injury.

See “Neck & Back Pain” (pg. 56)

DO NOT MOVE PERSON

Contact responsible

school nurse or administrator

& parent/legal guardian.

YES

YES or NOT SURE

Emergency First Aid Guidelines for California Schools

FEVER & NOT FEELING WELL

Take person’s temperature, if possible.

Note temperature over 100.0 degrees F as fever.

Is Temp over 100.0

degrees F?

• Havethepersonliedowninaroomthataffordsprivacy.

• Givenomedicationsunlesspreviouslyauthorized;suchasace

aminophen or ibuprofen

Does child have fever and

• Isunresponsive?

• Islimp,weak,listlessornotmoving?

• Rashwithpurplespots?

• Limitedmovementofneck(stiff)?

• Firsttimeseizure?See“Seizures”(pg.62)

• Severeheadache?

• Abdominalpain?

• Difcultybreathing?

• Ifalert,giveuids(i.e.,juices,water,

soup or gelatin) as tolerated

• Avoidoverheatingwithexcessive

clothing/blankets

Contact responsible

school nurse or

administrator & parent

or legal guardian.

CALL EMS 9-1-1

YES

Emergency First Aid Guidelines for California Schools

FINGERNAIL/TOENAIL INJURY

Assess history of injury and examine injury.

Acrushinjurytongertipmayresultinfractureorbleedingunder

intactngernail,creatingpressurethatmaybeverypainful.

After 20 minutes of ICE, has pain subsided?

Canstudentgrasporpinchwithoutsignicantpain?

• Wearglovesifbleeding

• Usegentledirectpressureuntilbleedingstops.

• Washwithsoapandwater,applyBand-Aidortapeoverlaytoprotectnailbed

• ApplyICEPACKfor10-20minutesforpainandpreventswelling

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE MEDICAL

CARE

If you suspect a fracture,

see“Fractures…”(pg.47).

Return to class

Contact responsible

school nurse or

administrator & parent

or legal guardian.

NO YES

Emergency First Aid Guidelines for California Schools

FRACTURES, DISLOCATIONS, SPRAINS OR STRAINS

Treat all injured parts as if they

Could be fractured (See Signs &

Symptoms at bottom of page)

• Isboneorjointdeformedorbentinanunusualway?

• Isskinbrokenoverpossiblefracture?

• Isbonestickingthroughskin?

• Isskinoftheinjuredextremitypale/coolwhen

compared with opposite extremity?

•Avoidmovementofinjuredpart

•Donotallowpersontoputweightonitoruseit

•Splintwithtowel,cardboard,orsling

•Gentlysupportandelevateinjuredpartandadjacent

joint, with pillow or folded towel, if possible

•Applyice/cold(nomorethan20min/hr.),coveredwith

cloth or paper towel

Contact responsible

school nurse or

administrator& parent

or legal guardian.

ENCOURAGE

MEDICAL CARE

If bleeding, wear gloves and apply

direct pressure to bleeding site.

• ControlBleeding,see“Bleeding”

(pg. 24)

• Leaveinpositionofcomfort

• Coverbrokenskinwithclean

bandage

• DoNOTmoveorattemptto

straighten injured part

• Splint

• Givenothingtoeatordrink

• See“SeriouslyIll/Shock”ifneeded

(pg. 63)

After a period of rest, recheck the injury.

 • Isthepaingone?

 • Canpersonmoveorputweightoninjuredpart

without discomfort?

 • Isnumbness/tinglinggone?

 • Hasnormalsensationreturnedtoinjuredarea?

 • Iscoloration,circulationnormal?

Contact responsible

school nurse or

administrator & parent

or legal guardian.

If discomfort is

gone, allow person

to return to class.

Signs & Symptoms of Fracture, Dislocation, Sprains or Strains

• Painand/orswellinginonearea •Coldandnumb

• Largebruise/discoloration  •Lossofsensationormovement

• Sounds/feelslikebonesmoving •Disgurementatjoint

rubbing

• Bentordeformedbone/extremity

CALL EMS 9-1-1

YES

Emergency First Aid Guidelines for California Schools

FROSTBITE

Exposure to cold even for short periods of time may

cause “Hypothermia” (a low temperature) in children,

see “Hypothermia” (pg. 52). The nose, ears, chin,

cheeks,ngersandtoesarepartsmostoftenaffected

by frostbite.

Frostbitten skin may:

 • Lookdiscolored,grayish-yellow,pale,orwhite)

 • Feelcoldtotouch

 • FeelnumbtotTheperson

Deeply frostbitten skin may:

 • Lookwhiteorwaxy

 • Feelrm-hard(frozen)

Does extremity or body part:

•Lookdiscolored–grayish,whiteorwaxy?

•Feelrmhard(frozen)?

•Havealossofsensation?

Frostbite can result in

the same type of tissue

damage as a burn. It is a

serious condition and

requires medical

attention.

CALL EMS 9-1-1

Keep person and affected

area warm

• Taketowarmplaceandremovecoldorwetclothingandreplacewithwarm,dryclothes

• Protectcoldpartfromfurtherinjury(maynothaveanysensation)

• DoNOTrubormassagethecoldpartORapplyheatsuchasawaterbottleorhotrunningwater

• Putaffectedbodypartinbathtemperaturewatertowarm&potentiallythaw

• Coverpartlooselywithnonstick,cleandressingordryblanket

Contact responsible

school nurse or

administrator& parent

or legal guardian.

ENCOURAGE

MEDICAL CARE

Keep person and part warm

YES

Emergency First Aid Guidelines for California Schools

HEAD INJURIES

If person only bumped head and

does not have any other

complaints or symptoms,

See “Bruises” (pg. 26).

Ask questions about how injury

occurred.

Is person vomiting?

Many head injuries that happen at school are

minor. Head wounds may bleed easily and form

large bumps. Bumps to the head may not be

serious. Head injuries from falls, sports, &

violence may be serious. If head is bleeding,

see “Bleeding” (pg. 24).

With a head injury (other than minor head

bump), always suspect neck injury as well.

Do NOT move or twist the spine or neck,

see “Neck & Back Pain” (pg. 56).

Ifpersonwasbrieyconfusedand

seems fully recovered contact responsible

school nurse or administrator & parent or legal

guardian.

WATCH FOR DELAYED SYMPTOMS &

ENCOURAGE MEDICAL CARE.

Send home instructions for observing delayed

symptoms.

•Havepersonrest,lyingat

•Keeppersonquiet&warm

Turn the head and body together to the left

side, keeping the head and neck in a straight

line with the trunk.

Watch person closely.

DO NOT LEAVE PERSON ALONE

Are any of the following present:

• Unconsciousness,seizureorneckpain?

• Bloodisowingfreelyfromtheheadwound,

see “Bleeding” (pg. 24)?

  oMaintainrm,directpressure

• Inabilitytorespondtosimplecommands?

• Bloodorwateryuidfromearsornose?

• Inabilitytomoveorfeelarmsorlegs?

• Personissleepy,confusedorasksrepetitivequestions?

CALL EMS 9-1-1

Look, listen & feel for

breathing. If person stops

breathing,

see “CPR” (pg. 32)

GIVE NOTHING TO EAT

OR DRINK

Contact responsible

school nurse or

administrator& parent

or legal guardian.

Emergency First Aid Guidelines for California Schools

HEADACHE

Have person lie down for a

short time in a room that affords

privacy. Headache can be due

to the lack of adequate food or

water. Ask person when and

what they ate last.

Is temperature over

100.0 degrees F?

Has a head injury occurred?

If headache persists,

contact responsible

school nurse or

administrator &

parent or legal

guardian.

Give medication only if

previously authorized.

• Isheadachesevere?

• Areothersignsorsymptomspresent?(nausea,vomiting,

fever, vision disturbance or dizziness)

• Historyofchronicheadache,stiffneck,orsensitivityto

light (light hurts eyes)?

See

“Head Injuries”

(pg. 49)

See “Fever”

(pg. 45)

• Applycoldclothorcompresstohead

• Offerfoodorjuiceifpersonhasn’teatenadequately

• Allowtorestinquiet,lowlightroom

If not alert & in abnormal

mental state call 9-1-1.

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE

MEDICAL CARE

YES

Emergency First Aid Guidelines for California Schools

HEAT EXHAUSTION/HEAT STROKE

Heat exhaustion is common and is due to lack of body

uids.HeatStrokeislife-threateningandoccurswhenthe

body is overwhelmed by heat and cannot regulate body

temperature. Strenuous activity in the heat may cause

heat-related illness. See signs & symptoms of heat

emergencies below.

Is person unconscious or altered mental status?

Spending too much time in the

heat, especially with exertion,

may cause heat emergencies.

Heat emergencies can be

life-threatening situations.

• Movepersontoacoolerplace

• Havepersonliedown

• Elevatefeet

• Loosenorremoveouterclothing

• Spraywithwaterandfanperson

Contact responsible

school nurse or

administrator & parent

or legal guardian.

• Giveclearuidsfrequently(water,sportdrink,etc.),insmall

amounts, if fully awake and alert

• Ifconditionimproves,mayreturntoclass.NOP.E./Sports

• If no improvement, child NEEDS IMMEDIATE

MEDICAL CARE

Are any of the following happening:

• Hot,dry,redskin?

• Alteredmentalstatus?

• Vomiting?Fever?

• Confusion,dizziness?

• Rapidshallowbreathing?

• Quicklyremovepersonfromheatto

a cooler place

• Putonsidetoprotectairway

• Look,listenandfeelforbreathing.If

not breathing, see “CPR” (pg. 32)

CALL EMS 9-1-1

Remove outer clothing, as

appropriate. Cool rapidly by

completely wetting clothing/skin

with room temperature water.

DO NOT USE ICE WATER.

Signs & Symptoms of Heat Related Injury

Heat Exhaustion Heat Stroke

•Cool,moist,paleskin  •Hotskin(usuallydry)

•Weakness&fatigue  •Hightemperature

•Sweating,headache  •Rapid,weakpulse

•Vomiting,nausea   •Rapid,shallowbreathing

•Confusion,dizziness  •Seizure

•Musclecramping   •Lossofconsciousness

YES

Emergency First Aid Guidelines for California Schools

HYPOTHERMIA (EXPOSURE TO COLD)

Hypothermia can occur af-

ter being outside in the cold

or in cold water.

Does person have:

• Decreasingconsciousness?

• Slowedbreathing?

• Confusedorslurredspeech?

• White,grayishorblueskin?

• Nofeelinginpartofbody?

Hypothermia can happen from exposure to cold,

wet, & windy conditions [does not require freezing

temperatures] when the body is no longer capable of

warming itself. Young children are particularly

susceptible to hypothermia. It can be a

life-threatening condition if left untreated

for too long.

• Continuetowarmwithblankets

• Provideawarmenvironment

• Iffullyawakeandalert,offerwarm

 (NOTHOT)uids

• Iffrostbite,donotrub,see“Frostbite”

(pg. 48) and do not break blisters.

•Takepersontoawarmplace

•Removecoldorwetclothingandwrapin

a warm, dry blanket

CALL EMS 9-1-1

• Givenothingtoeatordrink

• Continuetowarmwithblankets

• Ifsleepyorlosingconsciousness,placeonleft

side and protect airway, see “Loss of

Consciousness” (pg. 53)

• Look,listenandfeelforbreathing.Ifbreathing

stops, see “CPR” (pg. 32)

Signs & Symptoms of Hypothermia (COLD)

  •Confusion •Shivering

  •Clumsy  •Lethargic

  •Blurryvision •Abnormalbehavior

  •Slurredspeech •Impairedjudgment

  •Uncoordinated •Slow,irregularpulse

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

MEDICAL CARE

YES

Emergency First Aid Guidelines for California Schools

LOSS OF CONSCIOUSNESS

Loss of consciousness may have many causes including:

injuries, blood loss, poisoning, severe allergic reaction, diabetic

reaction, heat exhaustion, illness, fatigue, stress, not eating,

etc. If you know the cause of the unconsciousness, see the

appropriate guideline.

Did person regain consciousness?

If victim stops breath-

ing, or has gasping

respirations begin

“CPR”.

• Positionpersonontheirback

• Loosenclothingaroundneck

and waist

• Elevatefeetandkeepwarm

• Controlbleedingifpresent

• Givenothingbymouth

• Keeppersonlyingdown10-15

minutes

Treat as having possible neck

injury. See “Neck & Back Pain”

DO NOT MOVE person,

unless a threat exists.

• Immobilizeneck

• OpenAIRWAYusingjaw

thrust maneuver

• Ifvomiting,turntoleftside

and support head in neutral

position with a towel roll

Is unconsciousness due to injury?

Is person

breathing?

• Ifnotbreathingorgaspingforbreath

• Begin“CPR”

CALL EMS 9-1-1

See

“Fainting” (pg. 44) or

“Seizures” (pg. 62

YES

YES or NOT SURE

Emergency First Aid Guidelines for California Schools

MENSTRUAL PROBLEMS

Menstrual problems may present

with:

• Abdominalpain,cramping

• Abnormalmenses

• Abnormalbleeding

Is it possible the person is pregnant?

[Note: negative history is not reliable]

Provide for

privacy

•Give no medications unless previously

authorized by parent/legal guardian

•If bleeding, offer a feminine pad

Does person have continuing severe abdominal pain?

See

“Pregnancy”

(pg. 59)

For mild cramps

recommend walking

or regular activities.

•Mildorseveresymptoms/cramping

•Abnormalbleeding

These may provide relief:

• Shortperiodofquietrest

• Warm(nothot)heatingpadoverlowerabdomen

(if allowed by the school district)

• Encouragemedicalcareifdisablingcrampsoccur

• ENCOURAGE IMMEDIATE MEDICAL CARE,

if heavy vaginal bleeding occurs (greater than

5 pads/tampons per day or continued bleeding for

7 or more days)

Contact responsible school

nurse or administrator &

parent or legal guardian.

CALL EMS 9-1-1

YES

SEVERE

YES or NOT SURE

MILD

Emergency First Aid Guidelines for California Schools

MOUTH & JAW INJURIES

Wear disposable gloves when

exposed to blood or other body

uids.Usedirectpressureto

control bleeding.

Does person have:

• Difcultybreathing?

• Chokingsensation?

• Lossofconsciousness?

• Persistentbleeding?

See “Head Injuries” (pg. 49) or

“NeckInjury…”(pg.56)ifyou

suspect an injury other than

mouth or jaw.

Contact responsible

school nurse or administrator and

parent or legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

Has jaw been injured?

Is cut large, deep?

CALL EMS 9-1-1

If tongue, lips, or cheek are

bleeding, apply direct pressure

with sterile gauze or clean cloth

• Lookfordifcultybreathing

Have teeth been injured?

•Placecoldcompressoverthe

area to minimize swelling

See

“Teeth &

Gums”

(pg. 66)

If unconscious:

• Protectneckby keeping straight

• Protectairwayby log rolling on to left side to

allow drainage of blood

• Gently support jaw with hand

• See “Teeth & Gums” (pg. 68) for any

tooth injury

• Control bleeding with direct pressure

Signs of jaw fracture include:

• Markedtendernessfromouteredgeofjaw

• Teethdonotttogethernormally

• Cannotopenjawwidely

• Painfultoclenchteeth

Emergency First Aid Guidelines for California Schools

NECK & BACK PAIN

Suspect a neck/back injury if pain results from:

• Fallsover8feetorfallingonhead

• Beingthrownfromamovingvehicle

• Sports

• Violence

• Beingstruckbyacarorotherfastmovingobject

Has an injury occurred?

A stiff or sore neck from sleeping in

a “funny” position is different than

neck pain from a sudden injury.

Non-injured stiff necks may be

uncomfortable, but they are usually

not emergencies.

Symptoms of Nerve Injury (see

below) need medical evaluation,

even if they resolve.

CALL EMS 9-1-1

Did person walk-in or was

person found lying down?

Allow person to assume position of comfort.

• Keepheadstraight

ADVISE PERSON NOT TO MOVE

HEAD OR NECK.

DO NOT MOVE PERSON unless there is

IMMEDIATE DANGER of further physical harm.

If person MUST be moved, support head and

neck–keephead,neckandbackfrombending.

• Keeppersonquietandwarm

• HoldheadstilluntilEMStakesovercarebygently

placing a hand on each side of head, OR

• Placerolleduptowels/clothingonbothsidesof

head so it will not move

If person is so uncomfortable

that he/she is unable to

participate in normal activities

contact responsible school nurse

or administrator & parent

or legal guardian.

May need medical

evaluation.

Contact responsible

school nurse or

administrator and

parent or legal

guardian.

Symptoms of Possible Spinal Nerve Injury

 • Lossofsensation  •Numbnessor

 • Lossofmovement  tinglingofarms

 • Electricshock-likepains orlegs

YES

WALK-IN

LYING DOWN

Emergency First Aid Guidelines for California Schools

NOSE

Can you see an object in

nose or did person put

something in their nose?

Is object:

• Large?

• Puncturingnose?

• Deeplyimbedded?

• Brisknosebleed?

Did object come out on its own?

DO NOT ATTEMPT TO REMOVE OBJECT.

See “ Wounds-Puncture” (pg. 72) if object

has punctured the nose.

Have person hold the clear

nostril closed while gently

blowing nose.

If there is no pain,

person may return to

normal activity. Notify

parent or legal

guardian.

OBJECT in NOSE

If object cannot be

removed easily,

DO NOT ATTEMPT

TO REMOVE.

Contact responsible

school nurse or

administrator & parent

or legal guardian.

Care as in “Nosebleed” on next page. Contact responsi-

ble school authority and parent/legal guardian.

ENCOURAGE MEDICAL CARE

NOSE CONTINUED ON

NEXT PAGE (pg. 58)

YES

YES or NOT SURE

BROKEN NOSE (swollen and/or deformed with nose bleed)

Emergency First Aid Guidelines for California Schools

NOSE

(CONT.)

Nosebleed may be caused by

injury, allergy, blowing or

picking nose, or dryness.

Wear disposable gloves when

exposed to blood or other body

uids

DO NOT TILT HEAD BACK

If head is tilted back, person

may spit up blood from throat.

Has bleeding stopped?

Encourage mouth breathing and discourage

nose blowing, repeated wiping or rubbing.

NOSEBLEED

• Leanheadforwardwhilesitting;ifneed

to lie down, lie down on side.

• Pinchnostrilstogetherjustbelownasal

bones, maintaining constant pressure

for 10-15 minutes.

• Ifcontinuedbleedingafterpressureor

if injury to nose, apply cold pack to

nose for 10-15 minutes and continue to

pinch for bleeding

Contact responsible

school nurse or

administrator & parent

or legal guardian.

ENCOURAGE

MEDICAL CARE

Person may return to normal

activity. Avoid strenuous

activity for the day to prevent

recurrence of bleeding. Notify

parent or legal guardian.

Emergency First Aid Guidelines for California Schools

POISONING & OVERDOSE

Ask person if they ingested any medications or other

substances. Possible warning signs of poisoning include:

• Pills,berriesorunknownsubstanceinmouth

• Burnsaroundmouthoronskin

• Strangeodoronbreath

• Sweating,chestorabdominalpain

• Upsetstomach,vomiting,diarrhea

• Dizzinessorfainting

• Seizureorconvulsions

Remove source of poisoning or get person away

from toxic fumes.

Is person unconscious?

Ispersonhavingdifcultybreathing?

See “Loss of Consciousness” (pg. 53)

Poisons can be swallowed, inhaled,

absorbed through the skin, eyes or

mucosa, or

injected.

When you suspect poisoning:

CALL EMS 9-1-1 & Poison

Control Center: 1-800-222-1222

Continue to monitor

• Airway

• Breathing

• Signsofcirculation(pulse,skin

 color,capillaryrell)

• Levelofconsciousness

• Speech,orientation

Wear gloves and remove any remaining substance in mouth.

Ifpossible,ndout:

• Ageandweightofperson

• Whatwasswallowedorwhattypeof“poison”itwas

• Howmuch&whenwasittaken

CALL EMS 9-1-1

DO NOT INDUCE VOMITING or

give anything UNLESS Poison

Control instructs you to. With some

poisons, vomiting can cause greater

damage.

DO NOT follow the antidote label on

the container; it may be incorrect.

CALL POISON CONTROL CENTER

& follow instructions.

Phone # 1-800-222-1222

CALL EMS 9-1-1

Send sample of vomited

material, or ingested material with

its container (if available), to the

hospital with the person.

• Ifpersonhasanychangesinlevelof

consciousness, place on his/her side and

look, listen and feel for breathing. If

breathing stops, see “CPR” (pg. 32)

• Contactresponsibleschoolnurseor

administrator & parent or legal guardian

YES

Emergency First Aid Guidelines for California Schools

PREGNANCY

For morning sickness,

see “Vomiting” (pg. 69).

Pregnancy may be

complicated by any of

the following:

Appropriate school staff should be made aware of any

pregnant students. Ask if person might be pregnant

and when her last menstrual period (LMP) occurred.

Keep in mind that any student who is old enough to be

pregnant might be pregnant. NOTE: History may not be

reliable.

CALL EMS 9-1-1

Vaginal Bleeding, if severe

Contact responsible

school nurse or administrator &

parent or legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

Short, mild cramps in a

near term person may be

normal. Contact responsible

school nurse or administrator &

parent or legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

Contact responsible

school nurse or administrator &

parent or legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

CALL EMS 9-1-1

Severe Stomach Pain or Cramps

• Personmaybeinlabororhavingamiscarriage

if cramps are strong and repeat or “water

has broken”

• Iflaborsuspectedorifsevereabdominal

pain persists

CALL EMS 9-1-1

Seizure

This may be a serious complication of late

pregnancy, see “Seizure” (pg. 62).

Amniotic Fluid Leakage

This is NOT normal and may indicate the beginning of labor or may lead to

infection. Contact responsible school nurse or administrator, and parent or

legal guardian.

Emergency First Aid Guidelines for California Schools

RASHES

•Somerashesmaybecontagiousbydirectcontactor

respiratory droplets

•Weardisposableglovestoprotectselfwhenincontact

with any rash.

Rashes may look like:

•Hives

•Redspots(largeorsmall,atorraised)

•Purplespots

•Blisters

Rashes may have many

causes, including heat,

infection, illness, allergic

reactions, insect bites, dry

skin or skin irritations.

CALL EMS 9-1-1

Contact responsible school

nurse or administrator & parent

or legal guardian.

See “Allergic Reaction”

(pg. 17) and

“Communicable Diseases”

(pg. 36) for more

information.

Other symptoms may indicate that the person needs

medical care. Does the person have:

• Abnormalbehavior?

• Difcultybreathingorswallowing?

• Purplespotswithfever?

• Light-headedness,extremeweakness?

If any of the following symptoms are found in

association with a rash, contact

responsible school nurse or administrator

& parent or legal guardian and

ENCOURAGE MEDICAL CARE

• Fever(See“Fever”)(pg.45)

• Headache

• Diarrhea

• Sorethroat

• Vomiting

• Rashisbrightredandsoretotouch.

• Rash(hives)isalloverbody

• Ifpersonissouncomfortable(e.g.,itchy,

sore, feels ill) that he/she is not able to

participate in school activities

YES

Emergency First Aid Guidelines for California Schools

SEIZURES

Refer to person’s Emergency Action/Care

Plan, if available, follow instructions from

person’s guardian or physician.

• Isseizurelastinglongerthan5minutes?

• Ispersonhavingmultipleseizures

following one another at short intervals?

• Ispersonhavinganybreathing

 difcultiesaftertheseizure?

A person with a history of seizures

should be known to appropriate staff.

An emergency care plan should be

developed containing a description of the

onset, type, duration and after effects of

that person’s seizures. If there is a history

of diabetes, check blood sugar, see

“Diabetes” (pg. 37).

• Duringorimmediatelyafteraseizure,placeon

 theoor(preferablyamat)forobservationand

safety

• DO NOT RESTRAIN MOVEMENTS

• Movesurroundingobjectstoavoidinjury

• Protectheadandneckusingajacketorpadding

like a folded towel/cloth

• DO NOT PLACE ANYTHING BETWEEN THE

TEETH or give anything by mouth

• Afterseizure,keepairwayclearby

placing person on his/her left side and

support the head in a neutral position

with a towel roll

• Seizuresareoftenfollowedby

sleepiness and confusion. This may last

from 15 minutes to an hour or more

Note:

Observe details of the seizure for parent or

legal guardian, emergency personnel, or

physician.

• Duration,movementofeyes,mouth,

arms & legs

• Lossofurine/bowelcontrol

• Lossofconsciousnessorchangein

behavior

After the sleeping period, the person

should return to normal and be

encouraged to participate in all

normal class activities.

Contact responsible

school nurse or

administrator & parent

or legal guardian.

CALL EMS 9-1-1

Signs & Symptoms of Seizure

• Episodesofstaringandnonresponsive

• Staringwithtwitchingofthearmand/orlegmuscles

• Generalizedjerkingmovementofarmsand/orlegswithunconsciousness

• Suddenunusualbehaviorforthatperson(e.g.,strangesounds,belligerence,running)

• Iftrainedpersonnelandmedicationavailable,administerDiastat.

YES

Emergency First Aid Guidelines for California Schools

SERIOUSLY ILL/SHOCK

Any serious injury or illness may lead to shock which

is a lack of blood and oxygen getting to tissue.

• STAY CALM and get medical assistance

• Shockisalife-threateningcondition

• Checkformedicalbraceletormedallion

Is person:

• Unconscious?See“LossofConsciousness”(pg.53)

• Notbreathing?See“CPR”(pg.29)

• Lookseriouslysick?(seesigns&symptomslisted

below)

• Bleedingprofusely?See“Bleeding”(pg.24)

For Injury

Do Not move

person until extent of injury

is known, unless

endangered.

• Liepersondown–keepbodyat

• ControlBleeding:applydirectpressureandsee“Bleeding”(pg.24)

• Ifpersonvomits,rollontoleftsidekeepingback&neckstraightifinjurysuspected

• Minimizepainbypositionofcomfort

• Elevatefeet8-10inches,unlessthiscausespain/discomfort,ORaneck/back/hipinjuryis

suspected

• Keepbodynormaltemperature,ifcoldprovideblankets.Avoidchilling

• NOTHINGtoEATORDRINK

Signs of SHOCK

• Pale,cool,moistskin   •Unresponsive   •Generalizedweakness

• Mottled,ashen,blueskin  •Abnormalbehavior  •Rapidordifcultybreathing

• Alteredconsciousness  •Restlessness/irritability

• Nausea,dizziness,thirsty

Contact responsible

school nurse or

administrator & parent or legal

guardian.

CALL EMS 9-1-1

Emergency First Aid Guidelines for California Schools

SPLINTERS or IMBEDDED PENCIL LEAD

Wear disposable gloves

when exposed to blood

orotherbodyuids.

Is splinter or pencil lead:

• Protrudingabovethesurfaceofskin?

• Smallandshallow?

Reassure victim pencil

“lead” is actually graphite

and does not cause lead

poisoning.

•Leaveinplace

•DO NOT PROBE UNDER SKIN

Gently wash area

with clean water

and soap.

• Removewithtweezersunlessthiscausespain

• DO NOT PROBE UNDER SKIN

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

Were you successful in removing

the entire splinter/pencil lead?

• Washtheareaagain

• Applycleandressing

Check immunization record for DT, DPT (tetanus).

See “Tetanus Immunization” (pg. 68).

YES

Emergency First Aid Guidelines for California Schools

STOMACH ACHES/PAIN

Stomach aches may have many causes including:

 • Illness  •Menstrualdifculties

 • Hunger  •Psychologicalissue

 • Overeating  •Constipation

 • Diarrhea  •Gaspain

 • Foodpoisoning •Pregnancy

 • Trauma

Has an injury occurred?

Have person lie down in a room that affords privacy.

Ask female when last menstrual period was? Is she pregnant? If yes, see “Pregnancy” (pg.59)

• Ifvaginalbleeding,see“MenstrualProblems”(pg.54)

• Taketemperature

• Notetemperatureover100.0degreesFas

fever, see “Fever” (pg. 45)

Does person have:

• Fever?

• Severestomachpains?

• Vomiting?

Allow person to rest for 20-30 minutes.

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

Is person better?

Contact responsible

school nurse or

administrator & parent or

legal guardian.

Allow person to return

to class/work

YES

Emergency First Aid Guidelines for California Schools

TEETH & GUMS

Generally, related to

chronic infection.

Presents limited threat

to general health.

For tongue, cheek, lip,

jaw or other mouth injury

not involving the teeth,

refer to “Mouth & Jaw”

(pg. 55).

Norstaidmeasure

in the school will be

ofanysignicant

value.

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

BLEEDING GUMS

Norstaidmeasure

in the school will be

ofanysignicant

value.

Generally, related to

chronic infection.

Presents limited threat

to general health.

TOOTHACHE or GUM ABCESS

Relief of pain in the school often postpones dental care.

Administer pain reliever, ibuprofen or acetaminophen as

school protocol allows.

DO NOT place pain relievers (e.g., Aspirin, Tylenol) on the

gum tissue of the aching tooth since they can cause burns to

the tissue!

A few comfort measures:

• Ifcavitiespresent,awarmsalt-waterrinse

may remove food

NOTE:

A loose temporary tooth may ache

Contact responsible

school nurse or

administrator & parent or

legal guardian.

ENCOURAGE IMMEDIATE

MEDICAL CARE

TEETH CONTINUED ON

NEXT PAGE (pg. 67)

Emergency First Aid Guidelines for California Schools

TEETH

(CONT.)

For primary (temporary) teeth:

• FindTooth

• Donothandlerootoftooth

• Use Disposable Gloves

• Havestudentbiteonfoldedgauzeto

stop bleeding

• Placetoothincontainerorenvelopetotake

home

• Returntonormalactivities

Contact responsible school

nurse or administrator & parent

or legal guardian.

OBTAIN EMERGENCY DENTAL

CARE. A DENTIST SHOULD SEE

THE PERSON WITHIN

60 MINUTES.

KNOCKED-OUT TOOTH or BROKEN PERMANENT TOOTH

If a permanent tooth is knocked-out (within 15-20 minutes):

 • Applycoldcompresstofacetominimizeswelling

 • Iftoothisdirty,holdtoothbycrownrinsewithwater

 • DONOTscrub,ruborscrapetoremovedirtfromtooth

 • PlaceinHBSS(Save-A-ToothKit)ifavailable,OR

 • Ifstudentisoldenough,gentlyinsertandholdthetoothinitssocket,if

not possible, place in glass of milk, OR

 • Havepersonspitincupandplacetoothinit

 • Remembertotakethetoothwithyou

TOOTH MUST NOT DRY OUT

DISPLACED TOOTH (Still in Socket)

DO NOT try to move

tooth into correct

position.

Emergency First Aid Guidelines for California Schools

TETANUS IMMUNIZATION

Protection against tetanus should be considered with any wound,

even a minor one. After any wound, check the person’s

immunization status for tetanus (DTaP, Tdap, DPT, DT Td) and

notify parent or legal guardian.

Note: Tetanus toxoid is nearly always combined with diphtheria

and pertussis (DPT or TdaP).

A wound would need a tetanus booster if it has been at least 5

- 10 years since the last tetanus shot or if the person is 5 years

old or younger.

Other wounds, such as those contaminated by dirt, feces, saliva

orotherbodyuids;puncturewounds;amputations;andwounds

resulting from crushing, burns, and frostbite need a tetanus

booster if it has been more than 5 years since the last tetanus

shot.

Emergency First Aid Guidelines for California Schools

TICKS

Refer to your school’s policy

regarding the removal of ticks.

Proceedifnotinconictwith

policy. Wear disposable gloves

when exposed to blood and

otherbodyuids.

Inspect for ticks after time in woods or brush.

Ticks may carry serious infections and must be

completely removed.

DO NOT handle ticks with bare hands.

• Usingtweezersgraspthetickasclosetotheskinsurfaceaspossibleandpull

upward with steady, even pressure

• DO NOT twist or jerk the tick as this may cause the mouthparts to break off.

It is important to remove the ENTIRE tick

• Takecarenottosqueeze,crush,orpuncturethebodyofthetickasitsuids

may carry infection

• DO NOT ATTEMPT TO BURN A TICK OFF OR PRICK IT WITH A PIN

• Afterremoval,washthetickareathoroughlywithsoapandwater

• Washyourhands

• ApplyaBand-Aidtypedressing.Ifpermittedbyschoolpolicy,usean

antiseptic or antibiotic ointment

Contact responsible

school nurse or

administrator & parent or

legal guardian.

Placingticksinacontainerofalcoholorushingthemdown

the toilet will safely dispose of them.

If any head or mouth parts remain in skin,

ENCOURAGE MEDICAL CARE.

Emergency First Aid Guidelines for California Schools

VOMITING

Vomiting may have many causes including:

•IllnessorInjury    •FoodPoisoning

•Pregnancy    •HeatExhaustion

•Overexertion    •DrugsorAlcohol

•ToxicExposureorIngestion  •NearFainting

•IntestinalIllness

If you know the cause of the vomiting see the appropriate

guideline.

Wear disposable gloves when exposed to blood and other

body uids.

Ispersonvomitingclotsormorethanecksor

streaks of blood? Does person have decreased level

of consciousness?

If a number of adults and/or

children become ill with the same

symptoms, suspect food

poisoning.

CALL POISON CONTROL

CENTER

1-800-222-1222

Follow instructions.

(See “Poisoning”)

Notify public health (usually

the local County Health Depart-

ment).

Phone #_________________

• Haveabucketavailable

• Applyacool,dampclothtofaceorforehead

• Havepersonreclineorliedowninapositionof

comfort in a room that affords privacy

• Givenofoodormedications

• Offericechipsorsmallsipsofclearuids(e.g.,

water, diluted 7-up, diluted Gatorade) and assess

 abilitytotolerateuids

Does patient have altered level of

consciousness, pain, and associated fever,

diarrhea, dizziness or lethargy?

See appropriate guidelines.

CALL EMS 9-1-1

Contact responsible

school nurse or administrator

& parent or legal

guardian.

ENCOURAGE MEDICAL CARE

YES

Emergency First Aid Guidelines for California Schools

Wear disposable gloves when exposed to blood

or other body uids.

Use direct pressure on the wound to

control bleeding.

Is the Wound:

• Large?

• Deep?

• Bleedingfreely?

Refer to primary care

provider as needed to

update immunizations

against tetanus.

Use wet gauze or

towel to wash the

wound gently with

clean water and

soap in order to

remove dirt.

• Rinseunderrunningwater

• Patdrywithcleangauzeorpapertowel

• Applycleangauzedressing

(non-adhering/non-sticking type)

and bandage

Apply direct

pressure on bleeding

site and see

“Bleeding” (pg. 24).

WOUNDS

(CUTS, SCRATCHES & SCRAPES

INCLUDING ROPE & FLOOR BURNS)

Notify parent if wound is

deep, dirty, gaping or has

embedded material. Contact

responsible school nurse or

administrator & parent or legal

guardian.

Some Signs of Internal Bleeding

Include persistent abdominal pain, rapid-weak pulse,

cool-moist skin, paleness, confusion or fainting, weakness,

vomiting or blood in sputum. Internal bleeding needs

emergency medical attention.

YES

Emergency First Aid Guidelines for California Schools

WOUNDS (PUNCTURE)

Wear disposable

gloves when exposed

to blood or other body

uids.Applydirect

pressure to control

bleeding.

DO NOT TRY TO PROBE

OR SQUEEZE

DO NOT

TOUCH EYE

See

“Eye Injury”

(pg. 42).

Has the eye been

injured?

• Isobjectlarge?

• Iswounddeep?

• Iswoundbleedingfreelyorsquirtingblood?

• Isairescapingfromwoundinthechest?

Is object still visible in

wound?

If wound is deep or bleeding

freely, treat as bleeding,

see “Bleeding” (pg. 24).

• Washthewoundgentlywithsoap

and water

• Coverwithacleanbandage

DO NOT REMOVE OBJECT

•Trytocalmperson

Check person’s immunization record

for DT, DPT (tetanus).

See “Tetanus” (pg. 68) for more

information.

Contact responsible school nurse or

administrator & parent or legal guardian. If

morethanasupercialwound

ENCOURAGE MEDICAL CARE

CALL EMS 9-1-1

See “Bleeding” (pg. 24)

YES

Emergency First Aid Guidelines for California Schools

WOUNDS (STABS & GUNSHOT)

CALL the police via 9-1-1

• TelldispatcherifEmergencyMedical

Services are also needed

• Interveneonlyifthesituationissafeforyou

to approach

• Getsomeonetoassistyou

Is the person:

• Pale,sweatyskin?

• Losingconsciousness?

• Havingdifcultybreathing?

• Bleedinguncontrollably?

Refer to your

school’s policy for

handling violent

incidents.

Wear disposable gloves when exposed to

blood or other body uids.

Contact responsible school

nurse or administrator &

parent or legal guardian.

Open the airway and look,

listen and feel for breathing,

see “CPR” (pg. 32).

•If impaled object, do not remove

•Pressrmlywithacleanbandagetostopbleeding,see

“Bleeding” (pg. 24)

•Havepersonliedown

•Elevatefeet8-10inches

•Elevateinjuredpartgently,ifpossible

•Coverwithablanketorsheet