1. Planning for emergencies in school: the school nurse role

2. 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.

3. 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

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

5. 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

6. 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 .

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. HEALTH ROOM EQUIPMENT AND FIRST AID SUPPLIES (page 535)

17. 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

18. 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

19. STANDARD TRIAGE PROTOCOLS (page 11)

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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)

27. 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)

28. 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)

29. 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

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

31. 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

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

33. QUESTIONS?