Planning for emergencies in school: the school nurse role

CONFLICT OF INTEREST / COMMERCIAL SUPPORT DISCLOSURE This educational activity is being presented without the provision of commercial support and without bias or conflict of interest from the planners and presenters.

LECTURE OBJECTIVES Describe the key steps in planning for individual health emergencies Identify unique challenges in emergency care of students with special needs Discuss the importance of nursing protocols, written procedures and individual care plans Explain the function of triage in determining disposition Describe telephone triage techniques Describe communication during an emergency Discuss the role of documentation, data collection, and post-incident evaluation

YOUR ROLE IN EMERGENCY CARE As a school nurse you have an instrumental role in developing a comprehensive management plan for school emergencies

DEFINING YOUR ROLE Collaboration with staff, administrators, community, EMS, hospital EDs Planning for any emergency that is likely to arise Responding swiftly and appropriately when an incident occurs Documenting the event immediately afterward Maintaining the program through regularly scheduled review

PLANNING FOR EMERGENCIES Assess potential for emergency incidents Meet local EMS agencies and emergency care Develop written protocols and procedures for clinical care and transport Coordinate staff training in emergency procedures Ensure essential skills and certifications are maintained Maintain essential equipment and supplies .

ASSESSING THE POTENTIAL FOR INCIDENTS Who are your potential patients? Students, staff, administrators, volunteers, visitors What types of injuries or illness could occur? Where could injuries or illness take place? Indoors, outdoors, playgrounds, school buses, sporting events, field trips When could an injury or illness occur? Before, during, after school

ADDITIONAL CONSIDERATIONS Cultural diversity within the school community Cultural beliefs regarding causes of illness Traditional remedies and rituals Decision-making within the extended family Students with special needs Age and developmental level of the student population Availability of health care services outside of the school setting

WORKING WITH EMS & THE COMMUNITY FOSTER RELATIONSHIPS WITH: EMS Responders Law Enforcement Agencies Hospitals Public Health Services Social Services Mental Health Organizations Faith Based Organizations

EMS DATA SHEET Develop a data sheet summarizing EMS response information to gauge adequacy of the emergency plan EMS response coordinator information 911 or alternative emergency number in your area Projected time before rescuers arrive Certification, skill levels, and responsibilities of designated responders Nearest hospitals and pediatric trauma center with distance and transport times Protocols for transporting a student with special needs to a different hospital at the family request

DEVELOPING PLANS & PROTOCOLS Written guidelines are the backbone of your emergency plan All instructions should be clear and understandable Incorporate scope of practice, ECPs, providers’ orders, standing orders

NURSING PROTOCOLS Should align with professional nursing association guidelines Telephone Triage An emergency arises at another site You aren’t immediately available to respond to a call Transport Procedures Triage criteria and school policies EMS, school bus, or private vehicle and by whom Financial responsibility for transport Procedures for Others to Follow Emergency Care Plans

COORDINATING PERSONNEL Organize Your Resources Identify key personnel Roster with the following Contact information Work schedules Qualifications and certifications Specific responsibilities or capabilities First Aid/CPR/AED Assistance for students with disabilities

TRAINING PERSONNEL Coordinate Appropriate Training Principles of scene-safety assessment Following standard precautions Communicable disease precautions Hepatitis B vaccination Procedures for reporting potential exposure to infectious or dangerous substances Obtaining a medical evaluation following an exposure incident Basic first-aid, CPR, and AED

EQUIPMENT & SUPPLIES What equipment might be needed? Where may it be needed? See Health Room Equipment and First Aid Supplies in Appendix B

HEALTH ROOM EQUIPMENT AND FIRST AID SUPPLIES (page 535)

AUTOMATED EXTERNAL DEFRIBRILLATORS CONSIDERATIONS FOR ADOPTING AN AED POLICY Federal, state, and local laws and regulations Safety, effectiveness, and cost of the device Training requirements and guidelines for using the AED Placement, ease of access, and availability of AEDs throughout the school Identification and resolution of liability issues Current data regarding the effectiveness of AEDs in the school setting Does not replace need for CPR

EMERGENCY RESPONSE Emergent Urgent Non-urgent See Table 1-1 Assess the Situation How serious is the incident? Where is it taking place? Is more than one person involved? Form a Triage Decision Emergent Urgent Non-urgent See Table 1-1 Can inform if activation of Emergency / Crisis Response Plan is warranted

STANDARD TRIAGE PROTOCOLS (page 11)

TELEPHONE TRIAGE EFFECTIVE COMMUNICATION Do not rely on the caller’s assessment May have limited medical knowledge Gather all of the information you need to make an assessment Must make a rapid triage decision Develop and trust your intuition Speak with the student Do not discount subjective responses Document the call IF YOU HAVE ANY DOUBT ABOUT THE URGENCY OF THE STUDENT’S CONDITION, ALWAYS HAVE THE STUDENT TRANSPORTED TO THE NEAREST MEDICAL FACILITY

MAINTAINING COMMUNICATION COMMUNICATION-RELATED TASKS INCLUDE: Notifying the student’s parent/guardian Emotional reactions Employ nursing skill and diplomacy Obtain consent Notifying the student’s primary care provider Consent for release of information Communicating with school administrators and teachers EMS activation

DOCUMENTATION IF IT ISN’T DOCUMENTED, IT DIDN’T HAPPEN IN THE EYES OF THE LAW Develop a format to record information quickly and efficiently Good documentation Establishing and maintaining credibility Legal protection Document each and every call Hand-off Nursing Process Subjective and objective data that formed the basis for your nursing assessment and plan of action Interventions performed Student’s response to interventions Communication The name of the person who was called The date and time of the call A summary of the conversation Outcome

INCIDENT REPORTS Required when an injury occurs Reports should include On school grounds During school transport At an off-campus school function Reports should include Outcome of the incident Affected student’s status A copy of your nursing documentation Analyze reports regularly to identify preventive action. Conduct a thorough post-incident evaluation

MAINTAINING THE PROGRAM Complex system of interrelated roles and responsibilities Organic program that develops as data is collected and analyzed Meticulous attention to maintenance can ensure that the program continues to meet changing needs and legal obligations

DATA COLLECTION DATA CAN BE USED BY DECISION-MAKERS TO: Review and revise policy and protocols Evaluate staff assignments Allocate budgeted expenses Develop in-service programs for staff Consider alterations to the physical environment

CONSISTENT FORMAT In order to aggregate data across individual schools or districts, essential data must be: COLLECTED consistently (each time you perform an assessment in the health office or anywhere else in the school) RECORDED consistently (capturing the same data points each time, using consistent standards and terms)

DATA TO COLLECT Reason for visit (new illness or injury, follow-up) Demographic data (age, grade, sex) Nursing assessment (mild exacerbation of asthma, injury to hamstring) Nursing interventions (medication, emergency care, counseling) Triage category (emergent, urgent, non-urgent) Outcome/disposition (referral to primary care provider, ED treatment and release, hospital admission) School time missed due to incident (hours, days)

ILLNESS-SPECIFIC DATA Signs and symptoms that brought the student to the health office (difficulty breathing, rapidly spreading rash, abdominal discomfort) Date and time of onset Relevant health history (chronic illness or contributing disability)

INJURY-SPECIFIC DATA Date and time of injury Where the injury took place (playground, gym, classroom) Type of injury sustained (laceration or abrasion; sprain or dislocation; suspected fracture) Apparent cause of injury (a fall down the stairs; sports activity; assault) Contributing factors (a particular piece of equipment; playing surface; intentional harm) Protective equipment in use (goggles, helmet, padding) Supervision provided (name of responsible adult) and adequacy of supervision for activity

PROGRAM MAINTENANCE Keeping protocols and procedures current Staying on top of certifications Keeping your roster up to date Maintaining equipment and supplies

SUMMARY Your role is pivotal in providing optimal care for urgent and emergent illness Work collaboratively with all involved parties Develop a comprehensive program School policy and protocols, data collection, communication, documentation, and ongoing evaluation are all part of the emergency care program An organized system for data collection permits analysis Identify actions to reduce both incidence and risk Keep abreast of current statutes and standards of practice

RESOURCES SNEMS-C Manual Chapter 1, pp 1-20 Key points, p 581

QUESTIONS?