Emergency
Medical
Guidelines
1
Medical Table of Contents
Basic Supplies Needed in a First Aid Kit ..................................3
Medical/Health Emergencies .................................................4
Emergency Procedures...........................................................5
Triage .....................................................................................6
START .....................................................................................7
Allergic Reactions ...................................................................8
Bleeding .................................................................................9
Pressure Points .....................................................................10
Asthma .................................................................................11
Choking.................................................................................12
Heimlich Maneuver ..............................................................13
CPR .......................................................................................14
Child CPR ..............................................................................15
Seizures ................................................................................16
Stabbing/Gunshot Wounds ..................................................17
Diabetes ...............................................................................18
Heat Stroke...........................................................................19
Poisoning ..............................................................................20
Behavior Concerns ...............................................................21
OSHA – Exposure to Blood and/or Body Fluids ....................22
AED (Defibrillator) ................................................................23
2
Basic Supplies Needed in a First-Aid Kit
2”x2” and 4”x4” Sterile Gauze Dressings – Individually Wrapped
Sterile Gauze by the roll
Sterile self-adhesive pads
Adhesive Tape
Band-aids (various sizes)
Barrier Device (CPR mask)
First Aid Spray
Cotton balls
Q-Tips
Cold Packs
First Aid Cream
Antibiotic Ointment
Tweezers
2 – Triangular Bandages/slings
Vaseline Petroleum Jelly
Alcohol
Sharp Scissors
Thermometer and Shields
Tongue Depressors
Gloves
Whenever an emergency arises, please call 9-1-1. Once emergency
services have been summoned and you find that you don’t need
their services, the dispatch center can notify the unit to disregard.
It is always better to call and have them on their way and not need
them, than to desperately need their services and not have them
accessible!!!!
3
MEDICAL/HEALTH EMERGENCIES
Have 9-1-1 called immediately for:
Anaphylactic Reaction (severe allergic
reaction)
Head Injury with loss of consciousness
Amputation
Neck or back injury
Bleeding (severe)
Heat Stroke
Breathing difficulty (persistent)
Paralysis of any type
Broken Bones
Poisoning
Burns (chemical, electrical – 3rd degree)
Seizure (if not history or trauma-related)
Chest Pain (severe)
Shock
Choking
Traumatic injury
Drowning
Unconsciousness
Electrical Shock
Wound (deep or extensive)
Frostbite
Other – when in doubt
Never leave an ill or injured individual unattended. Have someone else call 9-1-1 and then attempt to
reach parents or guardians. Do not wait for the parent’s permission before you call 9-1-1, if it is truly a
medical emergency, call immediately. The parent cannot instruct you to refrain from calling 9-1-1.
Religious, ethnic or cultural reasons are not sufficient to remove the responsibility from the division for not
providing prompt, appropriate medical aid.
When in doubt, call 9-1-1. Err on the side of caution. The school division does not incur liability
by calling 9-1-1. However, the school division can incur significant liability by failing to call 9-1-1.
Concern over who pays ambulance and emergency room bills is not important in a crisis.
Do NOT move an injured individual or allow the person to walk (bring help and supplies to the
individual). Other school staff or responsible adults should be enlisted to help clear the area of
students who may congregate following an injury or other emergency situation.
Henry County Schools policy states that at least 3 staff members from
Elementary and 5 from Middle and High Schools be certified in CPR/1 st Aid and
Diabetes Education annually.
4
Emergency Procedures
For Injury or Illness
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, building damage, fire or smoke, traffic or violence.
2. Notify building response team.
3. A responsible adult should stay at the scene and give help until the
person(s) designated to handle emergencies arrives. This person(s) will
take charge of the emergency and render first aid as needed.
4. Do NOT give medications unless there has been prior approval by the
student’s guardian and doctor according to School BD policy.
5. Do NOT move a severely injured or ill student unless absolutely necessary
for immediate safety. If moving is necessary, follow guidelines in NECK
AND BACK section.
6. The responsible school authority or a designated employee should notify
the parent/legal guardian of the emergency as soon as possible.
7. A responsible individual should remain with the injured student on the
scene and at the hospital until a family member arrives.
Post Crisis Intervention Following Serious Injury or Death







Discuss with Building Response Team
Determine level of intervention for staff and students.
Counseling rooms (preferably Media Center) for students and/or staff.
Escort affected students, siblings and close friends and other affected
individuals to meet with Crisis Team staff members.
Assess stress level of staff. Recommend counseling as needed.
Follow-up with students and staff who receive counseling.
Designate staff person(s) to attend funeral.
5
Triage
Triage means “to sort” and “to do the most good for the most people.”
Triage Categories
GREEN – “Walking Wounded”
Minor injuries that can wait for longer
periods of time. Injuries include: minor
lacerations, contusions (bruising), sprains
and superficial burns.
YELLOW – Seriously Injured
Injuries may include: Penetrating
abdominal wounds, severe eye injury,
fractures, burns (other than face, neck or
perineum), and open thoracic (chest)
wounds.
RED – Critically Wounded or LifeThreatening
Examples may include: Airway obstruction
or heart failure, external hemorrhage,
shock, sucking chest wound and burns of
the face and neck.
BLACK – Deceased
Injuries may include: Severe head injury,
burns over 85% of the body, multi-system
trauma and signs of impending death.
6
START
Start is the mnemonic when performing a triage assessment in
reference to a mass casualty incident.
*Simple *Triage *And *Rapid *Transport
START Triage
Respirations
Under 30/minute
Over 30/minute
NO
Perfusion
Immediate
Cap refill >2 sec,
Position Airway
NO
Dead or
Expectant
Control
Bleeding
YES
Cap refill < 2 sec,
Mental Status
Immediate
Immediate
Failure to follow simple
commands
Can follow simple commands
Delayed
Immediate
7
Allergic Reaction
Children may experience a delayed allergic reaction up to
2 hours following food ingestion, bee sting, etc.
Does the student have any symptoms of a severe allergic
reaction which may include flushed face, dizziness,
seizures, confusion, weakness, paleness, hives over body,
blueness around mouth or eyes, difficulty breathing,
drooling or difficulty swallowing, or loss of consciousness?
Symptoms of a mild allergic reaction:

Red, watery eyes

Itchy, sneezing, runny nose

Hives or rash on one area

Check student’s
airway

Look, listen and feel
for breathing.

Check breathing
status
NO
Adult(s) supervising student during
normal activities should be aware
of the student’s exposure & should
watch for any delayed symptoms of
a severe allergic reaction for up to
2 hours.
YES
Is student having
difficulty breathing or
clearing throat?
YES
If student is so
uncomfortable that
he/she is unable to
participate in school
activities, contact
responsible school
authority and parent
or legal guardian.
NO
Administer standing
order for Benadryl
(according to
physician’s orders)
If student
begins to
have
difficulty
breathing
….
Refer to student’s plan.
Administer standing order
for Epinephrine (according
to child’s age and weight).
CALL 9-1-1, Contact responsible school authority and
parent or guardian.
8
Bleeding
The human body circulates 5-7 gallons of blood every minute. Oxygenated blood
keeps the organs supplied with oxygen which is imperative to sustaining life.
Is bleeding bright red and spurting? Is injured part amputated or severed?
NO
YES
Bleeding is dark red and flowing
steady or oozing.
CALL 9-1-1 Expose wound. Apply
direct pressure over wound with a
pad or cloth. Have victim lie on his
back if able. Raise injured area
above level of the heart. Apply a
firm dressing. Check circulation and
reassess every 10 minutes. Keep
applying more bandages and hold
pressure.
Expose wound. Cover wound
with clean bandage. Do not
remove old dressing. Continue to
re-enforce and add more gauze if
bleeding through existing
dressing. Seek medical attention
if necessary.
Is patient
pale and
less
coherent?
YES
NO
Continue as above.
Raise legs at least 6-12.” Continue to
monitor while waiting for EMS
personnel. If unable to stop bleeding,
consider using a constrictive wrap or
apply pressure on a pressure point
(brachial, femoral or radial arteries).
Cover student with a blanket.
9
Pressure Points
Pressure points are places where an artery can be pressed against an
underlying bone to prevent the blood from flowing past. Use a
pressure point to reduce severe bleeding only as a last resort and then
with extreme care.
Is patient bleeding from legs
and feet?
Lay the victim down and bend the
injured leg at the knee. Press
down firmly in the center of the
groin, one thumb on top of the
other, against the rim of the pelvis.
Do not press forcefully for longer
than 6 minutes.
Is the patient bleeding from
arms and hands?
Hold the victim’s arm at right
angles to the body. The brachial
artery runs along the inner side of
the upper arm. To control
bleeding from the lower arm, put
one hand under the upper arm
and press your fingers against the
bone.
Have someone to immediately call 9-1-1.
10
ASTHMA
Students with a history of breathing difficulties including asthma should be known to
appropriate staff. A care plan should be developed. Henry Co. policy allows a student to
possess and use an asthma inhaler at school if orders are on file in the office.
A student with asthma/wheezing may have breathing
difficulties which may include:

Did breathing
difficulty develop
rapidly?

Are the lips,
tongue or nail
beds turning
blue?


Uncomfortable coughing
Wheezing – a high-pitched sound during
exhale.
 Rapid breathing
 Flaring (widening) of the nostrils.
 Feeling of tightness of the chest.
 Not able to speak in a full sentence.
Increased use of accessory muscles to breathe.
NO
Refer to Student’s Emergency Plan
YES
YES
Does student have doctor and parent
approved medication?
(administer
medication)
NO
Remain Calm. Encourage student to sit quietly,
breathe slowly and deeply in through the nose and out
through the mouth.
CALL 9-1-1.
Has an inhaler already been
used?
Are symptoms getting worse?
YES
CALL 9-1-1.
NO
Administer
medication as
ordered
Contact responsible school
authority and parent.
11
CHOKING
.
Choking is defined as the inability
to breathe. Causes may be
from food, inhaling toxic fumes, drowning or strangulation.
Physical Findings:

Victim conscious and making attempts to breathe

Complete or near-complete inability to speak

Grasping of neck, usually with both hands, palms toward neck.

Rapid onset of cyanosis (blueness of lips and fingertips),
cessation of breathing efforts, and loss of consciousness.
Is victim unable to cough,
speak or breathe?
YES
CALL 9-1-1
NO
Continue to monitor. If
breathing becomes more
difficult or ceases.
Do Heimlich
Maneuver (see
following page)
Make sure someone calls
parent/guardian.
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HEIMLICH MANEUVER
Action
1.
Stand behind the person and wrap your
arms around his/her waist.
Rationale
1.
Rescuer’s arms should be just above
the belt line. The victim’s head, arms,
and upper torso are allowed to lean
forward.
2. Make a fist with one hand and grasp the
fist with your other hand. Place the
thumb side of your fist against the
victim’s abdomen slightly above the
navel and below the rib cage.
2. This action cannot be done on obese or
pregnant victims. For these victims, the
rescuer must do chest thrusts.
3. Press your fist into the victim’s
abdomen with a quick upward thrust.
3. This action produces a sudden sharp
rise in intra-thoracic pressure which will
eject the bolus or object that is
occluded.
If patient goes
unresponsive, begin
CPR. (See CPR).
13
CPR (CardioPulmonary Resuscitation)
CPR is a combination of breaths and chest compressions given to a
victim who is in cardiac arrest. (Cardiac arrest is when the heart is
not beating).
When administering CPR, it is important for it to be performed according to the
American Heart Association standards. The 3 major steps are:
C-A-B
C ompression
Adult CPR
A irway
B reathing
Compression
If the victim is still not breathing normally, coughing or
moving, begin chest compressions. Push down on the
chest 11/2 to 2 inches 30 times right between the nipples.
Pump at the rate of 100/minute, faster than once per
second.
Airway
Tilt the head back and listen for breathing. If not
breathing normally, pinch nose and cover the mouth with
yours and blow until you see the chest rise. Give 2
breaths. Each breath should take 1 second.
Breathing
CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL
HELP ARRIVES
NOTE: This ratio is the same for one-person & two-person
CPR. In two-person CPR the person pumping the chest
stops while the other gives mouth-to-mouth breathing.
14
CHILD CPR
CPR for children is similar to CPR for adults. The compression to
ventilation ratio is 30:2. There are, however, 3 differences.
1) If you are alone with the child, give two
minutes of CPR before calling 911.
2) Use the heel of one hand for chest
compressions . (Prevents compressing too deep).
3) Press the sternum approximately one-third
to one-half the depth of the chest height.
Continue CPR until Emergency Responders
arrive and take over care of the patient.
15
SEIZURES
Students with a history of seizures should be known to appropriate school
personnel. An emergency care plan should be on file containing a
description of the onset, type, duration and after effects of the seizures.
Seizures may be any of the following:




Episodes of staring with loss of eye contact
Staring involving twitching of the arm and leg muscles
Generalized jerking movements of the arms and legs
Unusual behavior for that person (running, belligerence, making strange sounds, etc.)
Refer to student’s emergency care
plan.





Observe details of the seizure for
parent/legal guardian, emergency
personnel or physician. Note:
If student seems off balance, place him/her on the
floor (on a mat) for observation and safety.
DO NOT restrain movements.
Move surrounding objects to avoid injury.
DO NOT place anything between teeth or give
anything by mouth.
Keep airway clear by placing student on his/her
side. A pillow should not be used.





Seizures are often followed by
sleep. The student may also
be confused. This may last
from 15 minutes to an hour or
more. After the sleeping
period, the student should be
encouraged to participate in all
normal class activities.

NO


Duration
Kind of movement or behavior.
Body parts involved.
Loss of consciousness, etc.
Is student having a seizure longer
than 5 minutes?
Is student having a seizure
following one another at short
intervals?
Is student without a known history
of seizures having a seizure?
Is student having any breathing
difficulties after the seizure?
YES
Contact responsible school
authority and parent or legal
guardian.
CALL 9-1-1.
16
STABBING AND GUNSHOT INJURIES

Call 9-1-1 for EMS and
police.

Intervene only if the situation
is safe for you to approach.
Refer to your school’s policy for
addressing violent incidents.
Wear disposable gloves when
exposed to blood or other body fluids.

Check student’s
airway.

Look, listen and
feel for breathing.

If student stops
breathing, start
CPR. See
section on CPR.
Is the student:
 Losing consciousness?
 Having difficulty breathing?
 Bleeding uncontrollably?
YES
NO
1.
2.
3.
4.
5.
+
Lay student down in a position of comfort if he/she
is not already doing so.
Elevate feet/legs 8-10 inches unless painful.
Press injured area firmly with a clean bandage to
stop bleeding.
Elevate injured part gently, if possible to decrease
bleeding.
Keep body temperature normal. Cover with a
blanket if available.

Provide emotional support. Keep calm and
try to calm patient.

Contact parent/guardian and school
authorities.
17
DIABETES
A student with diabetes should be known to all appropriate staff. An Individualized Health Care
should be available. Staff in a position to administer approved medications should be trained
annually.
A student with diabetes may have the following
symptoms:






Irritability and feeling upset
Personality changes
Sweating and feeling “shaky.”
Loss of consciousness
Confusion or strange behavior.
Rapid, deep breathing.
Refer to student’s Individualized
Health Care Plan.
Is the student:
-
Unconscious or losing consciousness?
Having a seizure?
Unable to speak?
Having rapid, deep breathing?
NO
Is a blood
sugar monitor
available?
YES
Give student “quick acting sugar” such as fruit juice, regular soda,
sugar, hard candy, cake icing gel or instant glucose.
Allow
student to
check blood
sugar.
Continue to watch the student in a quiet
place. The student should begin to
improve in approx. 10 minutes.
Is blood sugar less than 70 or
“LOW” or is blood sugar “HIGH”
according to IHP.
Allow student to recheck sugar.
LOW
YES
HIGH
Contact parent/guardian
and appropriate school
authority.
Continue to watch
student. Is the
student improving?
NO
CALL 9-1-1. Administer
Glucagon if ordered and
available. Turn patient on
side in case of vomiting.
18
HEAT STROKE/HEAT EXHAUSTION
Heat Emergencies are caused by spending too much time in the heat.
Heat emergencies can be life-threatening situations.
Strenuous activity in the heat may cause
heat-related illness. Symptoms include:





Is student unconscious or losing
consciousness?
Red, hot, dry skin
Weakness and fatigue.
Cool, clammy hands
Vomiting
Loss of consciousness.

Remove student from the heat
to a cooler place.

Have student lie down.
NO
YES
1. Quickly remove student from heat
to a cooler place.
2. Put student on his/her side to
protect the airway.
3. Look, listen and feel for breathing.
4. If student stops breathing, start
CPR. See “CPR.”
Cool rapidly by completely wetting clothing with
room temperature water. Do NOT use ice
water.

Does student have
hot, dry, red skin?

Is student vomiting?

Is student confused?
YES
CALL 9-1-1.
NO
Give clear fluids such as
water, 7-Up or Gatorade
frequently in small amounts if
student is fully awake and
alert.
Contact parent/guardian
and school authority.
Contact responsible
parent/guardian and school
authority.
19
POISONING AND OVERDOSE
Poisons can be swallowed, inhaled, absorbed through the skin or eyes or injected. Call
Poison Control when you suspect poisoning from:





Medicines
Insect bites and stings
Snake bites
Plants
Chemicals/cleaners
Possible warning signs of poisoning include:









Pills, berries or unknown substance in
student’s mouth
Burns around mouth or on skin
Strange odor on breath
Sweating
Nausea or vomiting
Dizziness or fainting
Seizures or convulsions.
Do NOT induce vomiting or give
anything UNLESS instructed to
by Poison Control. With some
poisons, vomiting can cause
greater damage.
Do NOT follow the antidote label
on the container, it may be
incorrect.




Drugs/alcohol
Food poisoning
Inhalants
OR if you are not sure.



Wear disposable
gloves.
Check student’s
mouth
Remove any
remaining
substances from
mouth.
If possible, find out:
 Age and weight of student
 What the student swallowed
 What type of “poison” it was
 How much and when it was taken.
CALL POISON CONTROL
1-800-222-1222
Follow their advice!
CALL 9-1-1.



If student becomes unconscious,
place on his/her side. Check
airway.
Look, listen and feel for breathing
If student stops breathing, begin
CPR. See “CPR” section.
Contact parent/guardian and
school authority.
Send sample of the vomited material and
ingested material with its container (if
available) to the hospital with the student.
20
BEHAVIORAL EMERGENCIES
Students with a history of behavioral problems, emotional problems or
other special needs should be known to school staff.
Behavioral or psychological
emergencies may present in
different forms such as
depression, anxiety, phobias,
suicidal thoughts, and violent
behavior. Intervene only if
the scene is safe.
Does the student have visible injuries?
YES
NO
Treat injuries.
Call 9-1-1 if
warranted.
-
-
YES
Call the
Police.
Does student’s behavior present an
immediate risk of physical harm to
anyone?
Does the student have a weapon?
NO
The cause of the behavior may be due to numerous
reasons including:
- Fever
- Diabetes
- Poisoning/overdose
- Alcohol or drug use
- Head injury.
The student needs to be evaluated by a health care
provider to determine the cause of his actions.
Suicidal and violent behavior
should be taken seriously.
If the student has threatened to harm himself
or others, follow your protocol for suicide.
Contact school
authority and
parent/guardian.
21
EXPOSURE TO BLOOD AND/OR BODY FLUIDS
Wash affected area with copious amounts of soap and water.
If eyes, nose or mouth are affected, rinse with copious amounts
of water.
If skin is broken, contact responsible school authority and
parent/legal guardian.
URGE immediate medical care.
Parents/legal guardian of the student(s) should be notified that their
child may have been exposed to blood and/or body fluids from
another student. Individual confidentiality must be maintained when
sharing this information.
Check student(s) immunization record(s) to determine last
tetanus injection and dates of 3 Hepatitis B injections.
22
AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)
For Children Over 1 Year of Age and Adults
CPR and AED’s are to be used when a person is unresponsive or when
breathing or heart beat stops.
All schools in Henry County have an AED.
1. Tap or gently shake the shoulder. Shout, “Are you Okay?” If victim is
unresponsive, shout for help and send someone to CALL 9-1-1 and get the
school’s AED.
2. Follow primary steps for CPR.
3. If available, set up the AED according to instructions.
a. Connect Electrodes.
b. Apply Pads
c. Press “Analyze” button. Follow prompts.
Depending on how the AED analyzes the heart rhythm, you may be
advised to deliver several shocks, no shocks, or shocks followed by
CPR.
23