ALWAYS
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Listen carefully
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Make eye contact
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Use a calm, confident voice
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Do not speak too quickly
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Keep instructions simple
Diabetes
Test levels, pupils must wash their hands before testing.
Low below 4 mmols

Give fast acting sugar i.e. 6 x Haribos, fruit juice, lemonade
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Re-test after 15 minutes
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If still dropping give more sugar and phone parent
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Back to lesson when levels reach 4 or above
High 10-20 mmols
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Drink plenty of water, urinate and exercise
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Re-test after 15 minutes, if dropping then back to class
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If rising or over 20 mmols phone parent as will probably need insulin and eat. The parent will advise how many units the patient needs.
Insulin
The pupils will come to the medical room at lunchtime to take their insulin. The insulin pens are in the medical cupboard. The pupils will administer it in private without supervision in the back medical room. They will return the pen to the medical administrator when finished.
Asthma
Symptoms
Coughing, wheezing, tight chest, difficulty talking, difficulty breathing out.

Sit the child down quietly
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Assist to use own inhaler if they have one – use a spare spacer if possible
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Call an ambulance if :-
No improvement in 5-10 minutes
Child is too breathless to speak
Child is exhausted
The child looks blue
Epilepsy
Symptoms Very individual, form of seizure in many cases after PE, look for trigger factors i.e. strobe lighting
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If appropriate follow the care plan
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Protect pupil from harming themselves during the seizure
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Never restrain a full seizure
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Allow the seizure to run its course
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Recovery position after
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Allow to rest
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Maintain privacy and dignity
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Call an ambulance if 1 st ever seizure or more than one in a row

Anaphylaxis
Symptoms Swelling of tongue inability to swallow, rapid swelling of throat tissues, hives, loss of consciousness
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Oral antihistamines if held in medical room
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Phone parent to collect or,
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Adrenalin injections if carried on child or spare held in medical room, upper outer thigh through clothes.
Hold for 10 seconds.
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Call for an ambulance
Electric Shock

If casualty still in contact with electric source do not touch them
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Turn off source of electricity if possible
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Alternatively move source away from both you and the casualty. Stand on dry insulating material such as a plastic mat or wooden box and using a non-metallic pole or broom push the casualty’s limb away from the electrical source
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Once safe perform primary survey, airway, breathing, circulation and treat any condition found
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Call for an ambulance
Unconscious
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Call for an ambulance
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Put in recovery position
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Call for defibrillator (AED) in case needed
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Get someone to check medical notes
Unconscious and not breathing
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Call for an ambulance
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Start CPR
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Use AED as instructed by Ambulance Service
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Get someone to check medical notes
Choking
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Encourage coughing
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Remove any obvious obstruction from the mouth
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If casualty cannot speak or stops coughing or breathing carry out back blows
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Support upper body with one hand and lean them well forward
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Give up to five sharp blows between the shoulder blades with the heel of your hand
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Stop if the obstruction clears
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Check the mouth
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Repeat up to 3 times if not cleared
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Call for an ambulance
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Continue back blows until help arrives
Hyperventilation / Panic attack
Symptoms Unnaturally fast breathing, fast pulse rate, apprehension, dizziness or faintness, trembling, sweating and dry mouth, tingling and or cramps in the hands and or feet and around the mouth.
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Remove them from the stressful situation
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DO NOT advise them to breathe from a paper bag as may cause more harm
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Be firm but kind and reassuring
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Sit them in the back medical room where it is quiet
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Ask friends to leave
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Observe until casualty is able to regain control of breathing

Bleeding from Lacerations, Grazes, Punctures, Incisions
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Put on protective gloves
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If possible elevate and support the wound to reduce blood loss
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Control the bleeding using direct pressure over the wound with clean dry non fluffy cloth
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If there is an object in the wound apply pressure either side
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Once controlled, clean wound with alcohol free cleansing wipes
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Dress with plaster or bandage, if blood seeps through apply a second one on top
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Check circulation beyond the bandage every ten minutes
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Send to lesson or phone home depending on severity of the wound
Infected Wounds
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Put on protective gloves
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Cover the wound with a sterile dressing
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Raise and support the injured part with a bandage to help reduce swelling
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Lay the casualty down if it is a head wound, head and shoulders slightly raised
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Advise to seek medical advice
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If infection is advanced and casualty is sweating, shivering and lethargy, phone home to take to A&E
Bruising
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Raise and support the injured part in a comfortable position
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Apple firm pressure to the bruise using a cold compress
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Keep the compress in place for at least ten minutes
Blisters
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Ask patient to clean the area with wipe
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Cover the blister
Fainting
Symptoms Brief loss of consciousness causing casualty to fall to ground, slow pulse, pale, cold skin and sweating
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Lay casualty down on back
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Raise legs to improve blood flow to the brain
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Watch face for signs of recovery
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If possible plenty of fresh air / open a window
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Bystanders to stand clear
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When recovered help to sit up gradually
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If starts to faint again, advise to lay down again and raise legs until fully recovered
Amputation
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Control the bleeding by applying direct pressure and raising the injured part above the casualty’s heart
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Place a sterile dressing or a non-fluffy, clean cloth on the wound and secure it with a bandage
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Treat for shock
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Call for an ambulance
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Wrap the severed part in kitchen film or a plastic bag. Wrap the package in soft fabric and place in a container full of ice. Give it to the emergency service personnel
Crush Injury
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If you know the casualty has been crushed for less than 15 minutes and you can release them, do this as quickly as possible
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Control the bleeding
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Support any suspected fracture
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Treat for shock

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If the casualty has been crushed for more than 15 minutes, or you cannot move the cause of the injury, leave in the position found and comfort and reassure
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Call for an ambulance
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Monitor vital signs, level of response, breathing, pulse
Eye Wound
All eye injuries are potentially serious even superficial grazes to the surface
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Lie casualty on his back
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Hold his head to keep it as still as possible
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Tell casualty to keep both eyes still
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Give sterile dressing to hold over the affected eye
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Arrange to take to A&E
Bleeding from the ear
Symptoms include sharp pain, earache, deafness and possible dizziness. Clear fluid or watery blood indicates a more serious, underlying head injury
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Put on protective gloves
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Help patient into a half-sitting position with his head tilted to the injured side to allow blood to drain away
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Hold a sterile dressing lightly in place on the ear
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Do not plug the ear
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Arrange to take to A&E
Bleeding from the mouth
Cuts to the tongue, lips or lining of the mouth are usually caused by patient’s own teeth or braces.
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Put on protective gloves
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Ask the patient to sit down with this head forwards and tilted slightly to the injured side, to allow the blood to drain from the mouth
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Place a sterile gauze pad over the wound
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Ask the patient to squeeze the pad between his thumb and finger and press on the wound for ten minutes
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If bleeding persists, replace the pad
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Let the blood dribble out of the mouth
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Swallowing the blood may induce vomiting
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Do not wash the mouth out as may disturb clot
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Avoid drinking hot drinks for 12 hours
Nosebleed
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Put on protective gloves
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Sit patient down and tilt his head forward to allow the blood to drain from the nostrils.
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Ask him to breathe through his mouth
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Instruct him to pinch the soft part of his nose for up to ten minutes.
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Reassure
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Advise not to speak, swallow, cough, spot or sniff as this may disturb blood clots that have formed in the nose
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Keep giving supply of tissues
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Soiled tissues must be put in the yellow clinical waste bin
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After ten minutes, tell the patient to release pressure. If the bleeding has not stopped tell him to reapply the pressure for two further periods of ten minutes
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Once the bleeding has stopped clean up and give spare tissues just in case starts again
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Advise not to blow nose
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If the nosebleed is severe, or lasts longer than 30 minutes arrange to take to A&E

Knocked-out adult tooth

Put on protective gloves
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Gently push the tooth into the socket
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Press a gauze pad between the bottom and top teeth to help keep the tooth in place
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Alternatively, place the tooth in a small container of milk to prevent from drying out
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Arrange to take to dentist or A&E
Closed Fracture – skin is not broken – your aim is to prevent movement at the injury site
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Keep patient still
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Support the joints above and below the injured area until it is immobilized with a sling or bandage
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Place padding around the injury for extra support
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Do not raise an injured leg but can elevate uninjured limb if patient is in shock
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Do not allow the patient to eat or drink in case an anaesthetic may be needed
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Arrange to take to A&E
Open Fracture – skin is broken and bone visible – your aim is to prevent infection and control bleeding
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Put on protective gloves
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Cover the wound with a sterile dressing or large, clean non-fluffy pad
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Build up pads around the bone until you can bandage over it without it pressing on the injury
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Secure the dressing with a bandage. Bandage firmly, but not so tight that it impairs the circulation beyond the bandage
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Immobilise the injured part as for a closed fracture
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Do not raise an injured leg but can elevate uninjured limb if patient is in shock
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Do not allow the patient to eat or drink in case an anaesthetic may be needed
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Call for an ambulance
Dislocated Joint
Symptoms Sickening, severe pain, inability to move the joint, swelling and bruising around the affected joint, shortening, bending or deformity of the area – your aim is to prevent movement at the injury site
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Do not try to replace a dislocated bone into its socket as this may cause further injury
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Hand or arm injury remove bracelets, rings and watches in case of swelling
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Keep the patient still
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Immobilise the injured arm / leg / shoulder using bandages where possible
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Arrange to take to A&E or phone for an ambulance
Strains and sprains – R- I- C- E

Rest the injured part
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Apply Ice pack
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Provide comfortable support, bandage over the ice pack.
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Elevate
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If in doubt treat as a closed fracture
Cramp

Stretch the affected muscles
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Once the spasm has passed massage the affected part of the leg / foot
Stroke – F-A-S-T

Facial weakness, uneven smile or droopy mouth
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Arm weakness, unable to raise both arms
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Speech problems
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Time – call an ambulance

There may also be:
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Sudden weakness or numbness of the face, arm or leg on one or both sides of the body
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Sudden loss or blurring of vision in one or both eyes
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Sudden difficulty with speech or understanding the spoken word
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Sudden confusion
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Sudden severe headache with no apparent cause
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Dizziness, unsteadiness or sudden fall
BURNS
Full thickness burns: pain sensation may be lost, skin looks waxy, pale or charred
Partial-thickness burns: the skin becomes red and raw and blistering
Superficial burns: redness, swelling and tenderness
Dry Burn – most common from cookery lesson. Flame, contact with hot object, friction i.e. rope burn
Scald – Steam, hot liquids or hot fat
Electrical Burn – low voltage, high voltage, lightning strike
Cold Injury – Frostbite, freezing metals, freezing vapours
Chemical Burn – including inhaled fumes and corrosive gases. Domestic chemicals and agents, industrial chemicals
Radiation Burn – Sunburn, over exposure to ultraviolet rays
Burns that need hospital treatment: o Full thickness burns o All serious burns involving the face, hands, feet or genital area o All burns that extend right around an arm or a leg o All partial-thickness burns larger than 1% of body surface i.e. the size of the patient’s palm and fingers o All superficial burns larger than 5% of body surface i.e. five palm areas o Burns comprising of a mixed pattern of varying depths
WHAT TO ASSESS

Consider the circumstances in which the burn has occurred.

Is the airway affected

Extent, location and depth of burn
How to treat minor burns and scalds

Flood the injured part with cold water or cold compress for at least ten minutes or until the pain is relieved.

Gently remove any jewellery, watches, belts or constricting clothing from the injured area before it begins to swell

Cover the burn with kitchen film, lengthways, not around the limb
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If patient is remaining in school, cover with a plaster to prevent infection, advise to remove it when they get home
How to treat severe burns and scalds
Your aims o To stop the burning and relieve the pain o To maintain an open airway o To treat associated injuries o To minimise the risk of infection o To minimise the risk of shock o To arrange urgent removal to hospital o To gather information for the emergency services