CLINIC MANAGEMENT TABLE OF CONTENTS State Requirements Introduction School Physical Requirements Immunization Requirements Birth Certificate Requirements Requirements for Educational Facilities Health Room Equipment and Supplies Emergency Health Standards Guidelines Emergency Preparedness Injury/Illness Assessment Guidelines Introduction Guidelines Clinic Records Clinic Maintenance & Warehouse Supplies Poisoning – Overdoses Table: possible overdose substance, effects and procedure Mandatory Child Abuse Reporting Physical & Behavioral Indicators of Child Abuse & Neglect Clinic Volunteers and Procedures Responsibilities Clinic Procedures Measurement of Body Temperature Measurement of Pulse Measurement of Respirations Measurement of Blood Pressure Application of Ice 11/11 STATE REQUIREMENTS INTRODUCTION The intent of the immunization and physical examination is to assure a healthy, protected school population and to identify and correct any problems or potential problems that might interfere with learning. Entrance requirements are based upon Florida Statute, regulations of The Department of Health and policies of the Pinellas County Schools Board. At the time of school registration, a State of Florida Department of Health, Cumulative School Health Record (DH Form 3041) should be opened and all health information placed inside. DH Form 3041 can be obtained through Health Services 588-6320. SCHOOL PHYSICAL REQUIREMENTS INITIAL ENTRANT 1. 3. 4. 5. 6. 7. A school physical (original or photocopy), signed or stamped by a licensed examiner and dated within one year prior to enrollment, is required for each student initially entering a Florida school FS 1003.22.. An appointment for a school physical is unacceptable for registration purposes. (Special consideration is given to students that are homeless. (S.390016) School physicals may be documented on the State of Florida, Department of Health, Student Health Examination (DH Form 3040) or any other form that is inclusive of the same data (i.e., height, weight, review of systems, any lab results, etc.). Middle School and High School Health Examination Forms (athletic physicals), Florida Special Olympics Medical Release and Head Start physicals are examples of acceptable entrance physicals, if signed by a licensed examiner and dated within one year prior to enrollment. Any health professional who is licensed in Florida, another state or a foreign country (refers primarily to foreign exchange students) where the student resided at the time of the physical and is authorized to perform a general health examination under such licensure (medical doctor, osteopath, chiropractor, nurse practitioner) is acceptable to certify that the physical examination has been completed. Infants, toddlers, and children registered in all pre-kindergarten programs are required to have a school physical dated within one year prior to enrollment and a new school physical each year thereafter until they become eligible for kindergarten registration. The school physical on file expires one year from the date that it was performed. When these children become eligible for kindergarten registration, the school physical on file must be dated within one year prior to the date of kindergarten registration. * A tickler system is recommended to assure follow-up after the expiration of pre-kindergarten yearly physicals. Any currently or previously enrolled student, regardless of the length of his/her enrollment in a Pinellas County School, who does not have a valid physical examination on file will be given 30 days to produce proper documentation. If unable to produce, the student will then be temporarily excluded from school until documentation is provided by the parent/guardian. A copy of the physical examination used for the student’s original registration in a Florida school is acceptable. Any student will be exempt from the requirement of a physical examination upon written request of the parent/guardian stating his objections to such an examination on religious grounds. A homeless student as defined in S. 1003.01 shall be given a temporary medical exemption for 30 school days. If a parent/guardian is unable to produce evidence of birth for registration purposes as stated in F.S. an affidavit of age signed by a public health officer or physician based on physical examination is acceptable. 11/11 STATE REQUIREMENTS (continued) SCHOOL PHYSICAL REQUIREMENTS (continued) TRANSFER STUDENT (from another Florida school only) 1. A student transferring from another Florida public school or re-entering a Pinellas County Public School must produce evidence (school physical used for original enrollment) of compliance with Florida school entry health examination statute at the time of initial enrollment. 2. A student transferring from any Florida private school must present a valid school physical prior to enrolling in a Pinellas County Public School. The physical used for original registration in any Florida school (public or private) is acceptable. 3. The cumulative health folder should be transferred to the requesting school upon student transfer. The folder should contain all health records including the Cumulative School Health record (DH 3041) and any health screenings which are not included on the DH Form 3041, such as vision, hearing and scoliosis screening (Student Health Screening Record, (PCS Form 2-407-A and B), the student’s school physical, nursing care plans and the Florida Certificate of Immunization (DH Form 680, Parts A,B,C.) Note that in some instances students will have a separate professional treatment health record which contains sensitive and confidential health services information which, in accordance with F.S. and permission of the parent/guardian or student and may not be automatically forwarded in the cumulative health folder. 11/11 STATE REQUIREMENTS (continued) IMMUNIZATION REQUIREMENTS INITIAL ENTRANT 1. A Florida Certificate of Immunization (DH Form 680- Attachment XIII) or a Religious Exemption Form/Immunization (DH Form 681- Attachment XI) are the only acceptable immunization certifications for first-time entrants to a Pinellas County School, grades pre-K through 12. An original or photocopy is acceptable, providing the information is complete and legible, and it is certified. Certified copies printed from Florida shots are acceptable. 2. If a parent/guardian does not have documentation of a student’s immunizations (lost, in transit, etc.), refer the parent to the Pinellas County Health Department for boosters and a Temporary Medical Exemption (DH Form 680-Part B). Note: A Temporary Medical Exemption without dates of immunizations is unacceptable. 3. The school may elect to call the student’s former school, physician, etc (at parent’s expense) and verify vaccines administered and the dates. The vaccines and their dates should be placed on school letterhead, signed by a school employee and given to the parent to take to the Pinellas County Health Department for transfer onto the Florida Certificate of Immunization. (DH-680) 4. Many students, especially those enrolled in pre-kindergarten programs, will have Temporary Medical Exemptions (they are in the process of completing necessary immunizations but cannot receive additional doses of vaccine because the appropriate time interval between shots has not passed). Two weeks to one month before the Temporary Exemption expires, the school should return the form to the parent, because it contains previous immunization information that may be needed by the physician to continue or complete the child’s immunizations. A photocopy of the form should be retained by the school until the original is returned. If the updated form is not returned by the expiration date, the child is out of compliance and should be excluded from school until the parent/guardian produces the proper documentation. A tickler system is recommended to assure follow-up of expirations of Temporary Medical Exemptions. 5. A permanent Medical Exemption (DH 680-PartC) will be used when the student is not fully immunized (per Part A) but cannot receive vaccine(s) due to medical contraindications. The vaccine(s) contraindicated should be listed and medical reasons for each exception should be stated. The physician should also include the dates of doses and types of vaccines that the child was able to receive. DH 680-Part C must be signed or stamped by a physician. Any currently or previously-enrolled student, regardless of his/her length of enrollment in a Pinellas County Public School, who does not have a valid Florida Certificate of Immunization on file will be given 30 days to produce proper documentation. The student will then be temporarily excluded from school until valid documentation is provided by the parent/guardian. 6. A homeless student as defined in S.1003.01/39.0016 shall be given a temporary medical exemption for 30 school days. 7. Requirements for currently enrolled students in Pinellas County can be viewed at: http://www.doh.state.fl.us/DISEASE_CTRL/immune/schoolguide.pdf 11/11 STATE REQUIREMENTS (continued) IMMUNIZATION REQUIREMENTS (continued) TRANSFER STUDENT (from another Florida School public or private) 1. 2. A student transferring from another Florida public school or re-entering a Pinellas County Public School must produce evidence of compliance with Florida immunization status at the time of his/her initial enrollment. Proof must be presented within 30 days of registration. Schools may elect to call the former Florida public school (at parent’s expense) to verify that a valid Florida Certificate of Immunization is on file. If records have not been received within 30 days of registration, the student will be temporarily excluded from school until the parent/guardian produces valid documentation. It is recommended that school personnel give duplicate copies of each student’s immunization record to the parent/guardian when the student transfers to another school, whether within Florida or another state. Department of Health strongly supports this recommendation as a convenience to families and school personnel. If the family has a copy of the student’s immunization record, they can ensure that their child will not be delayed in enrolling in a new school due to a lack of certification. A student transferring from any Florida private school must present a Florida Certificate of Immunization (DH Form 680) or a Religious Exemption from Immunization (DH 681) prior to enrolling in a Pinellas County Public School. BIRTH CERTIFICATE REQUIREMENTS If a parent/guardian is unable to produce evidence of birth for registration purposes, as stated in Florida Statute 232.03, an affidavit of age, sworn by the parent and accompanied by a certificate of age signed by a public health officer or physician based on a physical examination is acceptable. STATE REQUIREMENTS FOR EDUCATIONAL FACILITIES Health Room Equipment and Supplies: Each district school board must make adequate physical facilities available for health services per s. 381.0056 (7), F.S. Existing school buildings are expected to comply with the minimum requirements as identified in the Department of Education's guidelines, State Requirements for Educational Facilities. These guidelines have specifications for school clinics. The school health room should: Be located away from noisy, congested areas and preferably near the administrative office Be of sufficient size and layout to permit use for first aid, physical examinations, health conferences, and for student isolation or observation Have direct line-of-sight from the health room staff desk to the cot area Be equipped with minimum facilities such as sink for hand washing, locking medicine cabinet, supply storage, and examining equipment Preferably have a toilet facility included in the health room or at the very least be located adjacent to a toilet facility Be of sufficient size and equipped with privacy screening to permit examination of students who are unclothed Be appropriately staffed during school hours to serve the needs of students Be equipped with a telephone extension, computer hook up, and internet access Be considered an essential facility. The health room is the focal point for operation of an effective school health program and provides direct services to students. The lack of an adequate health room will seriously hamper the delivery of school health services. 11/11 STATE REQUIREMENTS continued) STATE REQUIREMENTS FOR EDUCATIONAL FACILITIES(continued) Health Room Equipment and Supplies (continued) Chapter 64F-6.004, F.A.C. requires that the school principal or designated person shall be responsible to assure first aid supplies, emergency equipment and facilities are maintained. Minimal health room equipment is as follows: Bed or cot: the number of cots is based upon student population – 3/500 students, 4/500-1000 students, plus 1 additional cot for each 1000 students A separate cot area for boys and girls is essential at the secondary level (curtains can be used to separate these areas) Desk, chair, and file cabinet Computer with internet access for record keeping and accessing health information First aid equipment (such as AED, CPR face shield, etc.) Covered trash container, biohazard trash container, sharps disposal container Accurate scale for measuring student weight, accurate measuring device for determining student height Wheel chair or stretcher for transporting ill or injured students Vision screening device Audiometer for conducting hearing screening (in cooperation with speech/language pathologist) Examining equipment such as exam table, gooseneck lamp, and stool are recommended for school sites providing ARNP or physician services Recommended health room supplies 11/11 Disposable sheets/towels/paper rolls to cover head area of cot Blanket (disposable or laundered after each student use) Emesis basin, washbasin Antibacterial liquid hand soap, approved spray disinfectant, room deodorizer First aid kit for use on other parts of campus First aid supplies including band-aids, gauze squares, elastic roller gauze, cotton balls, cotton tipped applicators, tape Gloves, non-latex (students may have latex allergy) Paper cups, medicine cups, towels and tissues Ice bag with disposable/washable cover Basic protection attire for emergency use, such as gown, mask, goggles Thermometers or other temperature assessing devices Sphygmomanometer and stethoscope Access to the student emergency file card Appropriate reference materials such as a current drug handbook and Control of Communicable Diseases book The use of other clinic supplies is dependent upon local school district policies and should be determined with the assistance of the School Health Advisory Committee EMERGENCY HEALTH GUIDELINES Emergency Guidelines 1. STANDARD UNIVERSAL PRECAUTIONS MUST BE USED IN THE ADMINISTRATION OF ALL FIRST AID. For detailed instructions, refer to the Chapter on Communicable Disease and Infection Control and Pinellas County Schools Blood borne Pathogens Exposure Control Program. Provided through the Risk Management Department. 2. “Emergency Guidelines for Schools”, a comprehensive and easy to use guide to handling a large variety of medical emergencies involving children, should be used by school personnel and other health professionals working in the schools as the primary guide in administering immediate care to those students who become ill or injured at school. 3. Chapter 64F-6.004, F.A.C. also requires that persons staffing the school health room and two additional school staff members be currently certified in first aid and cardiopulmonary resuscitation by a nationally recognized certifying agency (i.e. American Red Cross or American Heart Association). A list of persons currently certified to provide first aid and cardiopulmonary resuscitation is to be posted in the health room, school office, cafeteria, gymnasium, home economics classrooms, industrial arts classrooms, and any other areas that pose an increased risk potential for injuries. 4. CPR courses must be updated every two (2) years, depending upon the course provided. First aid courses must be updated every three (3) years. 5. All school personnel should be familiar with basic first aid and the principles of standard precautions. First aid supplies should be kept in easily accessible locations known to all. 6. Current emergency data for all students provided by the parent/guardian on the Student Clinic Card should be kept in an easily accessible file at each school. 7. Emergency medical services telephone number, 911, should be prominently placed on all phones. 11/11 EMERGENCY HEALTH GUIDELINES(continued) EMERGENCY PREPAREDNESS 1. Identify all persons trained in CPR and First Aid. Post the names and room numbers of trained personnel throughout the school (e.g. administration, labs, P.E., cafeteria, shop, all classrooms, health rooms, Emergency Guidelines for Schools etc.) 2. Make locations of first aid emergency equipment known to all staff members. 3. It is helpful to designate a “caller”. The “caller” places the call to 911 and attempts to contact the parent/guardian, the parent’s designee, and/or student’s physician. 4. 5. When calling for EMS: Dial 911 carefully. State: “We have an emergency involving (number of) students” State: type of injury. Give: name of school, address, phone number, location (e.g., gym, football field, etc.) When calling a parent: State who is calling Be reassuring. If student must be transported to an emergency facility prior to the arrival of the parent/guardian, confirm where student will be taken. Ask parent/guardian to go there. Remain calm. Give parent/guardian adequate, accurate information, but don’t cause another emergency. 6. Send personnel to the school entrance to direct EMS to the location of the emergency. 7. Keep Student Clinic Cards updated and in good order. It is recommended that new cards be completed yearly on each student. 8. If parent/guardian cannot be reached prior to transporting the student to the hospital, take a copy of the Student Clinic Card and emergency contact information. 9. Maintain adequate supplies for CPR and first aid. 11/11 INJURY / ILLNESS ASSESSMENT GUIDELINES INTRODUCTION The intent of this chapter is to provide a convenient guide for non-emergency and emergency situations. It is not intended as a guide for the diagnosis or treatment of health problems of the school-age child. Emergency health needs arise from injury, sudden illness, or the progression of a minor discomfort or symptom. It is important for school personnel to respond quickly, to provide first aid and to minimize further injury and /or insult to the student while he/she is within the school environment. While teachers and administrators are routinely responsible for dealing with these situations, they should consult with the school nurse whenever the need arises. First aid and emergency care should save lives, prevent further injury, alleviate pain, and ensure safe transfer of the student to parents and/or ill student when parents or persons designated by parents cannot be reached. The information presented in this chapter is intended for use as a guide in meeting health needs and is not a substitute for prudent thinking and common sense response to health situations. INJURY / ILLNESS ASSESSMENT GUIDELINES An area should be maintained for the assessment and isolation of illness or injured students. The area should be situated so that students may be supervised by an adult at all times. Adequate privacy for conferences with students and parents/guardians should be provided. 1. The classroom teacher has primary responsibility for early detection of sudden illness and referral of the sick student to health room personnel or the principal. Refer problems to the school nurse using the appropriate student referral form. See Student Referral, (PCS Form 2-2335) 2. Staff should follow guidelines outlined in “Emergency Guidelines for Schools”, which is available on line. The emergency guidelines are meant to serve as basic “what to do in an emergency” information for school staff without medical/nursing training when the school nurse is not available. It is strongly recommended that staff who are in a position to provide first aid to students complete an approved first aid and CPR course. Staff should take time to familiarize themselves with the format and review the “How to Use the Guidelines” section prior to an emergency situation. 3. Standard blood and body fluid precautions must be used in the administration of all first aid. (For detailed information, refer to the Chapter on Communicable Diseases and Infection Control and Pinellas County Schools Blood Borne Pathogens Exposure Control Plan provided through Risk Management Department.) 4. When students come to the health room seeking relief for minor discomforts: Tactfully question the student regarding the nature of the complaint. Listen carefully to the student’s complaint, and accurately record the information given on the Clinic Card. Proper evaluation of illness may be difficult at times. Many students who have no organic disease will be sent to the health room “feeling bad.” Example: Many stomachaches are caused by failure to eat breakfast or failure to allow adequate time in the bathroom for bowel movements. Observe for visible signs of illness. (See Chapter on Communicable Diseases and Infection Control.) 11/11 INJURY / ILLNESS ASSESSMENT GUIDELINES (continued) 5. 6. 7. 8. 9. 10. 11. 12. 13. Check vital signs, and if deviations from normal are detected, the parent/guardian should be notified. If vital signs are normal, the student should be allowed to rest for a short period. If the student still does not feel well enough to return to class, the parent/guardian should be notified. A little personal attention for minor complaints is frequently sufficient to help the student return to his/her classroom. The student with a minor complaint should be encouraged to remain in school unless it would compromise the health of other students. The student who frequently visits the health room should be referred to the school nurse. Information of a private or personal nature may be divulged in the course of caring for a student. It is imperative that such information be kept in confidence. An exception is reporting that information to appropriate staff only if this is relative to the student’s wellbeing. Students who present with a complaint of menstrual cramps should be given information on “Menstrual Pain” to take home for review with their parent/guardian. Menstrual pain results in a significant number of school absences and missed classes, and students should be encouraged to seek treatment. Students who are very ill or who have suffered a serious injury should be accompanied by an adult to the health room or office. In some cases of injury, the student should not be moved until emergency assistance arrives. Parent/guardian should be contacted immediately when it is determined the student is too ill to remain in school. It should be made clear to parent/guardian that the school health room is not to be used as a long-term holding area for ill or injured students. Parent/guardian should be given facts, not a diagnosis: - “Your child has an elevated temperature of 101 and a rash,” not, “Your child has the measles.” - “Your child states that he is nauseated and he appears pale and listless,” not, “Your child has the flu.” For any wound, the student’s immunization record should be reviewed for the date of the last tetanus toxoid (DTaP, Td, and/or Tdap) administration. Notify the family of this date and advise them to consult their family physician or the Department of Health to determine the necessity for administration of tetanus booster. Send home a “Wound Care” information sheet, if appropriate. A student with a suspected communicable disease should be isolated from other students until the parent/guardian arrives. Make every effort to protect the privacy of the student in cases where illness or infestations may be embarrassing. No student is permitted to leave the school before the parent/guardian is consulted except when a major emergency necessitates immediate transfer to the hospital or physician’s office. All incidents involving a head injury should be carefully documented. The parent/guardian should be notified immediately by telephone and in writing via a Notice of First Aid for Bump or Blow to the Head of the incident, since head injury symptoms may not be obvious at once and parents/guardian must be made aware of the possibility of signs and symptoms developing later. When a major emergency necessitates immediate transfer to the hospital or physician’s office. 11/11 INJURY / ILLNESS ASSESSMENT GUIDELINES (continued) Immediate Evaluation and Referral to Treatment Facility Needed (Call 911): Acute airway obstruction, choking Cardiac or respiratory arrest Near-drowning Massive external hemorrhage and internal hemorrhage Internal poisoning Anaphylaxis Neck or back injury Chemical burns of the eye Heat stroke Penetrating/crushing chest wounds Vomiting large quantities of blood Crushing chest pain Dislocations and (possible) fractures Extended period of unconsciousness Major burns Respiratory distress Unresolving tachycardia-rapid heart rate Drug overdose Head injury with lose of consciousness Penetrating eye injuries Seizures, cause unknown Medical Consultation Desirable within an Hour: Laceration (with severe bleeding controlled) Bites and stings (animal, insect and snake) without anaphylaxis Burns and blisters Accidental loss of a tooth Acute emotional state Possible reaction to drugs High fever (above 103) Asthma/wheezing Non-penetrating eye injury Attention by a Trained Staff Person with School Nurse/Parent Consultation Needed: Convulsions in known epileptic Insulin reaction in diabetic Abdominal pain Fever (100-103) Sprains Minor Injuries/Illnesses can be Handled by a Trained Staff Person Following Standardized Procedures: 11/11 Abrasions Minor burns Nose bleeds Mild headaches Menstrual cramps CLINIC RECORDS When students are sent to the office or health room unaccompanied, it is helpful to have the sending teacher complete a brief Clinic Referral Form. This form can be used by personnel in the health room or office to communicate the disposition of the student to the person initiating the referral. 1. Each school should maintain a file with Student Clinic Cards (PCS Form 11-1454) for every student to be used as quick reference in case of an emergency. a. The clinic card should be filled out at the beginning of each school year, kept up to date, and made accessible to personnel responsible for the health room area. b. Clinic cards should be reviewed annually by the school nurse. c. Special health needs should be flagged on the card to identify the student with special health problems. d. Medications or specific procedures to be taken in case of an emergency should be recorded in detail. e. The reverse side of the Student Clinic Card has been designated to maintain a record of the individual student’s visits to the health room. See list of approved abbreviations on next page to use when documenting care of student. The full signature (first and last name) of staff person should be printed and signed in signature verification area. f. Those students who exhibit frequent or patterned health room visits should be referred to the school nurse for further evaluation via nursing assessment. g. Dated clinic cards should be stored at the school for a three-year period or sent to central Records (Records Retirement) for disposition, providing the student had a new and current clinic card on file. 3. Administration of medication is sometimes necessary during the school day to comply with the physician’s prescription. Authorization is granted for school district personnel to administer medication in 1006.062, Florida Statute. 4. Trained school personnel shall administer medication (s) only to those students who have an Administration of Prescription Medication form and/or an Administration of Over-the-Counter Medication form (WH 98333 and 98334) on file at the school. a. The Administration of Medication form shall provide for either the physician’s and parent’s/guardian’s signature for administration of over-the-counter medications or only the parent’s/guardian’s signature for administration of prescription medications. b. Student Medication cards should be transferred to the nurse’s confidential file if they become inactive, until the end of the school year. At that time, the Nurse confidential file shall be sent (along with other medical documents) to Central Records where they are stored for the required 7 years. 5. Students who require treatments or procedures during school hours (e.g. nebulizer, blood glucose monitoring, catheterization, tube feedings, etc.) require an Authorization for In-School Treatment/Procedure (PCS Form 2-2334), Authorization for Diabetes Management in School (PCS form 2-2966) or g-tube feeding orders on file at the school. The form must be signed by the parent/guardian, principal, physician, and school nurse and filed in the treatment log. 6. Students with chronic health conditions such as asthma, insulin dependent diabetes mellitus, seizure disorders, severe food allergies etc. may require a Health Care Plan. Individualized health care plans provide specific preventive measures and interventions for that student’s condition. Pinellas County School Health Services and/or the Department of Health will initiate these care plans. Personnel are available through both offices to answer any questions pertaining to them. 7. All incidents involving a head injury should be carefully documented. The parent/guardian should be notified immediately by telephone and in writing via a Notice of First Aid for Bump or Blow to the Head of the incident, since head injury symptoms may not be obvious at once and parents/guardian must be made aware of the possibility of signs and symptoms developing later. 8. Refer to the Risk Management Department Procedure Guide for information regarding student accidents. 11/11 Approved School Health Abbreviations List 2011 B/A BP BS CP C/O Band-Aid applied Blood pressure Blood sugar Care plan Complains of Emergency Medical Service Emergency room Follow up Headache Home visit Left message Nausea/Vomiting Pulse Pick/up Rest room Return to class Stomachache Shortness of breath EMS ER F/U H/A HV LM N/V P P/U RR RTC S/A SOB S/W SW T TC Soap and water Social Worker Temperature Telephone call @ At ↑ ↓ R L Ø Č Up/increased/elevated Down/decrease Right Left No/None With 11/11 CLINIC MAINTENANCE AND WAREHOUSE SUPPLIES 1. The school should maintain a neat-well organized health room. 2. Work areas should be provided for health room personnel. Adequate privacy should be provided for students. 3. Emergency medical services telephone number 911 should be prominently placed on all 4. 5. 6. 7. phones. A list of persons currently trained in CPR and First Aid and their location in the school. The “Emergency Guidelines for Schools” should be highly visible in the health room. Locations of emergency equipment and supplies should be prominently posted in the health room. Storage areas for supplies and medications should be kept under constant supervision and locked when not in use. Warehouse items should include: Antiseptic Liquid Soap Bandage 2” roll Band-Aid 1”x 3” Band-Aid 2” x 3” Biohazard labels Cold compress- reusable Cot paper white, 18”x 125” Cotton balls, non-sterile Cotton tip applicators Digital thermometers- LCD Display and probe covers Electronic thermometers and probe covers Eye patches Gauze sponges sterile 3”x 3” Gloves, protective (latex and non-latex Kleenex tissue Mask/Eye shield Medicine cups Pedicu-sticks (for head lice inspection) Personal protective equipment kit Tape, adhesive ½” Tape, adhesive 1” Tongue blades Tweezers NOTE: Refer to Warehousing Services Catalog “First Aid” 8. Some medical supplies have an expiration date, after which the product’s effectiveness may be compromised. It may be helpful to establish a regular schedule for checking first aid supplies noting expiration date; breaks or tears in sterile packaging, and amount of remaining supplies. All supplies past expiration date should be disposed. 9. It should be remembered that most minor injuries can be satisfactorily handled by washing with regular soap and water and covering with a dry band aid. Use of all other topical antiseptics should be discontinued. 11/11 Poisoning / Overdoses POISONING – MEDICAL EMERGENCY- CALL 911 1. Call 911—Ask for Poison Control (or call Poison Control directly at 1-800-2221222) and follow instructions. 2. Save the label or container of the suspected substance for identification. If the student vomits, save a sample of the vomited material for analysis. Wearing disposable gloves, check student’s mouth and remove any remaining “poison.” If possible, ascertain age and weight of student, what student swallowed, amount and when it was taken. 3. Watch breathing. If breathing stops, start RESCUE BREATHING. 4. Notify parent/guardian 5. Record action taken on a health room activity log, Student Clinic Card and Injury Report. 6. Place referral in nurse’s mailbox for follow-up, when appropriate. OVERDOSE: DRUG OR ALCOHOL INTOXICATION 1. Call 911 as appropriate and notify parent/guardian. 2. Secure as much information as possible about drug, amount ingested, etc. Wearing disposable gloves check student’s mouth and remove any remaining “poison.” If possible, ascertain age and weight of student, what student swallowed, amount and when it was taken. 3. Do not leave student alone. Be supportive, gentle, and tolerant. 4. Observe for SHOCK. 5. Watch breathing. If breathing stops, start RESCUE BREATHING. 6. Record action taken on a health room activity log, Student Clinic Card and Injury Report. 7. Place referral in nurse’s mailbox for follow-up, when appropriate. 11/11 Substances Possible Effects Procedures to Follow for all Possible Overdoses Stimulants; nicotine, Caffeine, amphetamines, Cocaine, crack Respiratory difficulty, fatigue, For all possible overdoses: increased, pulse rate and blood pressure, increased, alertness, 1. Call 911 excitation, loss of appetite, Insomnia. OD: irritability, agitation, 2. Notify parent or guardian. increased body temperature, hallucinations, convulsions, 3. Secure as much possible death. information as possible about drug, amount Depressants/Narcotics: alcohol, Loss of coordination, ingested etc. sedatives, tranquilizers, opium, sluggishness, slurred speech, morphine, heroin, codeine, disorientation, depression, 4. DO NOT LEAVE barbiturates, meperidine euphoria, drowsiness, respiratory STUDENT ALONE depression, constricted pupils, sleep, nausea. OD; total loss of 5. Be supportive, gentle and coordination, nausea, tolerant. Watch breathing, unconsciousness, cold clammy if breathing stops, start skin, dilated pupils, convulsions, RESCUE BREATHING coma, possible death Cannabis: THC, marijuana, Hashish Relaxed inhibitions, euphoria, increased appetite, distorted perceptions, disoriented behavior. OD: fatigue, paranoia, possible psychosis 6. If the student does vomit send a sample of the vomit and ingested material with its container (if available) to the hospital with the student Hallucinogens: PCP (angel dust), Illusions, hallucinations, distorted LSD, mescaline, Peyote, perception of time and distance. psilocybin (mushrooms) OD: Longer and more intense “trips” or episodes, psychosis, convulsions, possible death from behavior. 7. Do NOT follow an antidote label on a container: it may be incorrect Inhalants: aerosols, solvents, nitrous oxide, Amyl nitrite, butyl nitrite Exhilaration, confusion, poor coordination. OD: Heart failure, unconsciousness, asphyxiation, brain damage, possible death. Designer drugs; XTC (ecstasy), nexus Uncontrolled tremors, drooling impaired speech, paralysis, brain damage, blurred vision, paranoia, illusions, hallucinations, impaired perception. OD: Possible death. 11/11 MANDATORY CHILD ABUSE REPORTING FL Statute 39.201 requires teachers and other school personnel to report any “suspected child abuse” to the abuse registry by calling 1-800-962-2872 (1-800-96-ABUSE) or sending a fax transmittal form to 1-800-914-0004. Use “Abuse/ Neglect Report Form” (PCS form 21490) 1. 2. 3. 4. Notify your building principal or designated administrator of the report. You may wish to involve other Student Services personnel. They can interview the student and assist you with the report process. However, because you are the person who observed the marks and/or heard the child’s story, you must be present when the report is made. If you suspect abuse, it is your legal obligation to report the suspected abuse. Be sure you have correct names of the child and D.O.B.; responsible adults; perpetrator, if known; address and telephone numbers; and the nature of abuse written down before you call. Always ask for the name and operator I.D. # of the person who takes your report. If you have any questions regarding indicators of abuse and neglect, refer to the last page of the Child Abuse reporting Procedure brochure available from the school social worker and discuss the case with your school social worker. Telephone numbers you may need: Abuse Registry Fax Reporting Social Work Administration Local Law Enforcement Help-a-Child Pinellas County Sheriff’s Office C.P.I Division/Admin office C.P.I. Captain 5. 6. 7. 8. 9. 11/11 1-800-962-2873 (1-800-96-ABUSE) 1-800-914-0004 727-588-6431 544-3900 582-6200 582-3823 582-3825 After the Abuse Registry has received the report, complete the “Abuse and Neglect Form,” - PCS 1490, at your school within 48 hours. If the Abuse Registry does not accept the report because it is a criminal matter, ask them to transfer you to the police department and make the report directly to law enforcement. If the Registry operator tells you that the situation you describe is not a reportable offense or that they cannot accept the report, discuss this with your school social worker, guidance counselor or principal or call the Social Work Administrator at 588-6431. If abuse recurs, report again, even if the first report was not accepted by the Abuse Registry. If you are aware that the DCF already has an open case, call the local case worker or his/her supervisor. Additional information that you share about an open abuse case will be helpful, and your name will not be shared by DCF with the family. Physical and Behavioral Indicators of Child Abuse and Neglect Physical Indicators Behavioral Indicators Physical Abuse Unexplained Bruises and Welts: on face, lips, mouth on torso, back, buttocks, thigh on various states of healing clustered, forming regular patterns reflecting shape of article used to inflict (electric cord, belt buckle) on several different surface areas regularly appear after absence: weekend/vacation Wary of adult contact Apprehensive When Other Children Cry Behavioral extremes: Aggressiveness & withdrawal Frightened of Parents/guardian Afraid to Go Home Reports Injury by Parents/Guardian Unexplained Burns: cigar or cigarette burns especially on soles, palms, back or buttocks immersion burns (sock like, glove like, doughnut-shaped on buttocks or genitalia) patterned like electric burner, iron, etc. rope burns or arms, legs, neck or torso Unexplained Fractures to skull, nose, facial structure in various stages of healing multiple spiral fractures to external genitalia Unexplained Lacerations or Abrasions: to mouth, lips, gums, eyes, external genitalia Physical Neglect 11/11 Consistent hunger, poor hygiene, inappropriate dress Consistent lack of supervision, especially in dangerous activities or long periods Unattended physical problems or medical needs Abandonment Begging, stealing food Extended stays at school (early arrival/ late departure) Constant Fatigue, listlessness or falling asleep in class Alcohol or drug abuse Delinquency (i.e.: thefts) States: “there is no caretaker” Physical Indicators Sexual Abuse Difficulty walking or sitting Torn, stained or bloody underclothing Pain or itching in genital area Bruise or bleeding in external genitalia, vaginal or anal areas Venereal disease - especially in pre-teens Pregnancy Behavioral Indicators Emotional Maltreatment Speech Disorders Lags in Physical Development Failure to thrive Unwilling to change for Gym or participate in Physical Education class Withdrawal, fantasy or infantile behavior Bizarre, sophisticated or unusual sexual behavior or knowledge Poor peer relationships Delinquent or Runaway Reports Sexual Assault by Caretaker Habit Disorders (Sucking, Biting, Rocking, etc.) Conduct Disorders (antisocial, destructive, etc.) Neurotic Traits (sleep disorders, inhibition of play) Psychoneurotic Reactions (hysteria, obsession, compulsion, phobias, hypochondria) Behavioral Extremes: Compliant, passive Aggressive, demanding Overly Adaptive Behavior: Inappropriately adult Inappropriately infant Developmental lags (mental, emotional) Attempted Suicide 11/11 MANDATORY ABUSE REPORTING (continued) ALL OTHER REPORTS Calls that are considered “not an abuse report” are as follows: 1. Complaints of harm perpetrated by someone other than a parent, adult household member or other person responsible for the child’s welfare. Transfer the caller to law enforcement. 2. Disputes concerning custody of a child. Refer the caller to an attorney or clerk of the circuit court. 3. Complaints of infants or children in automobiles who are not in legally-required restraining devices. Refer the caller to law enforcement. 4. Requests for service. Refer the caller to a number in the telephone reference list or the Hotline #211. Examples of services requested: Transportation Food or Food Stamps Housing Day Care Counseling Employment or public assistance Job Training or education Help with utilities or rent Homemaker services 5. Complaints of children running away from parents or legal custodians, persistently disobeying reasonable and or lawful demands of parents or legal custodians, and being beyond their control. Refer to school social worker. 6. Complaints that a child is not attending school. Refer the caller to the school social worker. 7. Complaints of children (depending on age of child) being denied access to the home because of disciplinary reasons or ungovernable behaviors. Refer the caller to the school social worker. 8. Complaints concerning head lice with no medical adverse effects. Refer the caller to the school nurse. 11/11 CLINIC VOLUNTEERS 1. 2. School health volunteers, when properly trained and supervised, can make major contributions to the delivery of school health services. School health volunteers function under the direct supervision of the principal and school nurse and must receive appropriate training to perform their duties. Training for school health volunteers should mirror that of school health paraprofessionals, with the exception of medication administration and medical treatment procedure training. Volunteers are not permitted to access student records, which would include health room records. Qualifications for volunteers should mirror that of school health paraprofessionals as well, although CPR and First Aid certification would be recommended rather than mandated, depending on the role of the volunteer. RESPONSIBILITIES OF HEALTH ROOM VOLUNTEERS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 11/11 School clinic volunteers giving care to students should be aware of their own abilities and limitations in providing care. Volunteers should work willingly with the school health coordinator and/or school health nurse. Volunteers should prepare a daily log of students visiting the clinic for the school nurse or principal Volunteer should alert designated school personnel concerning students that need to be referred to the school nurse. Volunteers should practice good hand washing techniques to prevent the spread of possible infection from student to student. Volunteers should receive in-service education regarding the proper way to handle body fluids. Volunteers should change paper sheets on clinic bed after being used by each student. Volunteers may take student’s temperatures by mouth, under the arm, or using a thermo-scan thermometer and record on Clinic Card and Health Services Log. Volunteers should use thermometer sheaths or probe covers over thermometers. Volunteers should report any elevated temperatures to designated school personnel or principal. Volunteers may apply ice, if indicated, after consulting with designated school personnel or principal. Volunteers should properly dispose of all soiled articles used by each student. Volunteers should keep the clinic clean and orderly. Volunteers DO NOT diagnose illness or disease. Volunteers DO NOT dispense medications, only trained school personnel or Registered Nurse (RN) Volunteer School Nurses (RN’s approved and participating in PCHD/DOH School Nurse volunteer program). Volunteers DO NOT recommend any medication. Volunteers DO NOT give continued care to any specific injury. Volunteers DO NOT contact parent/guardian, send students home, or excuse students from class participation. Volunteers DO NOT apply heat to any injuries received by students. Volunteers DO NOT probe for splinters or foreign objects with needles or tweezers. Volunteers DO NOT discuss students’ health outside the clinic setting. CLINIC PROCEDURES MEASUREMENT OF BODY TEMPERATURE Purpose: Evaluation of body temperature (fever) is one sign of an infectious disease. If a student complains of any of the following symptoms (the list is neither comprehensive or inclusive), the temperature can be one tool in the assessment process: 1. headache 2. watery eyes 3. nausea/stomachache 4. sore throat 5. vomiting 6. rash 7. chills 8. cough 9. runny nose 10. earache The parent should always be notified under the following conditions: 1. If the temperature is above 100.0. 2. If the student has an obvious rash. 3. If the student experiences repeated episodes of vomiting or diarrhea. 4. If the student has a headache accompanied by fever, vomiting, or stiffness of the neck. Students with serious communicable diseases do not always have a fever. Many students with temperature elevations above normal (below 100.8 in a normal environmental setting, when quiet) may not have a communicable disease. General Information and Recommendations 1. RECTAL TEMPERATURE SHOULD NEVER BE TAKEN. 2. GLASS THERMOMETERS ARE NOT RECOMMENDED FOR USE WITH STUDENTS. 3. ORAL temperatures should be taken only on student who can be trusted to keep the thermometer under their tongue with their mouth closed without biting on the instrument. 4. Always use disposable plastic sheaths with digital thermometers and disposable plastic tips with electronic and tympanic membrane sensor instruments. 5. The AXILLARY (under the arm), TYMPANIC, TEMPORAL or other non- invasive route should always be used under the following conditions: If the student is four (4) to six (6) years of age or developmentally delayed. If the student has been vomiting recently. If the student has had a recent seizure. If the student is crying or is upset emotionally. If the student has eaten or drunk hot or cold foods or liquids within the last 10 minutes. If the student is unconscious or does not respond to his/her surroundings. If an electronic, digital, or plastic strip thermometer or a tympanic membrane sensor (ear) instrument is used, instructions accompanying the thermometer should be followed. 11/11 CLINIC PROCEDURES (continued) Measurement of Body Temperature(continued) Equipment 1. 2. 3. 4. Thermometer Disposable plastic sheaths or tips Tissue, cotton balls Alcohol Procedure For Oral Temperature 1. Wash hands 2. Assemble equipment. Refer to operating manual for instructions on the use of the thermometer 3. Explain procedure to student. 4. Insert thermometer into plastic sheath or tip. 5. Place the thermometer in the student’s mouth, far back under either side of the tongue. 6. Instruct the student to breathe through the nose and not to talk. 7. Make sure the student does not bite the thermometer. 8. Tell the student the thermometer must stay in place until it beeps. 9. Remove the thermometer. Remove the plastic sheath or tip and discard into lined covered trash can. 10. Wash hands. 11. Document the reading on the Clinic Card. 12. Wipe thermometer down with alcohol on a cotton ball. Procedure For Auxiliary Temperature 1. Wash hands. 2. Assemble equipment. Refer to operating manual for instructions on the use of the thermometer. 3. Explain procedure to student. 4. Insert thermometer into plastic sheath or tip. 5. Place the thermometer under the student’s arm. 6. Hold the student’s arm firmly against his/her body. 7. Tell the student the thermometer must remain in place until it beeps. 8. Remove the thermometer. Remove the plastic sheath or tip and discard into lined, covered trash can. 9. Wash hands. 10. Document the reading on Clinic Card. 11. Wipe the thermometer down with alcohol on a cotton ball. 11/11 CLINIC PROCEDURES (continued) Measurement of Body Temperature (continued) Procedure for Tympanic Thermometers 1. Wash hands 2. Assemble equipment. Refer to operating manual for instructions on the use of the thermometer. 3. Explain procedure to student. 4. Make sure the student has been indoors for at least 10 minutes before taking temperature. 5. Slide a probe cover over the probe (use a new probe cover for each measurement). 6. Pull the ear pinna back and up to straighten the ear canal’s natural curve and provide a clear path to the tympanic membrane. 7. Place the probe in ear, aiming it toward the tympanic membrane. Insert the probe until it seals the ear canal. 8. Press the activation button on the thermometer and wait the time specified by the device’s manufacturer. 9. When you have a reading, remove the probe and dispose of the cover. 10. If reading seems too low, replace the probe cover and repeat the measurement. 11. Wash hands 12. Document reading on Clinic Card. 13. Wipe the thermometer down with alcohol on a cotton ball. Procedure for Thermofocus (Temporal) Thermometer 1. Wash hands 2. Thermo-focus is a “non-contact” thermometer. The device enables the temperature of students to be taken without touching the skin, simply by moving the thermometer close to the forehead at the distance indicated by the device. 3. Press the “FACE” button to turn the thermometer on. 4. Flip open the protective cap. 5. Press and hold the “FACE” button to light the pointing lights. 6. Hold the thermometer perpendicular to the middle of the forehead until a single point of light appears. 7. Release the “FACE” button and hold the thermometer steady until the aiming lights blink. 8. Read the value shown on the display. The thermometer goes onto standby after 30 seconds, displaying the surrounding air temperature. 9. Document temperature on Clinic Card. 10. Wipe the thermometer down with alcohol on a cotton ball or alcohol wipe. 11/11 CLINIC PROCEDURES (continued) MEASUREMENT OF PULSE DEFINITION: Direct measurement indicative of function of the cardiac system. PREPARATION 1. Explain procedure to student using appropriate developmental approach. 2. Use watch (or clock) with second hand and stethoscope. 3. Wash hands. PROCEDURE 1. Take pulse for one full minute. 2. Ausculate in the apical area of the heart with stethoscope or palpate the radial artery with the pads of your index and middle fingers. 3. Assess for rate and rhythm. If the rhythm is irregular, describe it in detail. 4. Document pulse rate on Clinic Card MEASURMENT OF RESPIRATIONS DEFINITION: Direct measurement indicative of function of the respiratory system. PREPARATION 1. Explain procedure to student using appropriate developmental approach. 2. Use watch (or clock) with second hand and stethoscope. 3. Wash hands. PROCEDURE 1. Count respirations for one full minute (one respiration consists of an inspiration and expiration.) 2. Observe chest rising and filling or osculate with stethoscope on chest and/or back. 3. Assess for rate, rhythm, and depth of respirations. 4. Note any abnormal breath sounds, such as wheezing. 5. Depth is described as shallow, moderate, or deep. 6. Document respiratory rate and any abnormal breath sounds on Clinic Card. 11/11 CLINIC PROCEDURES (continued) MEASURING BLOOD PRESSURE PURPOSE Blood pressure (BP) measurement reflects two cardiac cycle stages. Systolic pressure refers to the maximum pressure exerted on the arterial wall during systole (left ventricular contraction). Diastolic pressure refers to the minimum pressure exerted on the arterial wall during diastole (left ventricular relaxation). PREPARATION 1. Explain the procedure to the student using appropriate developmental approach. 2. Make sure the student is relaxed and has not eaten or exercised in the past 30 minutes. The student can sit, stand or lie down during the BP measurement. Remove all clothing from his/her arm (avoid an arm with paralysis, injury, edema). 3. Assemble equipment: a) Select the appropriate size cuff (air bladder should be at least 80% of the circumference of arm). b) Stethoscope PROCEDURE 1. Palpate brachial artery along inner upper arm. 2. Wrap cuff smoothly and snugly, centering the bladder over the brachial artery. The lower cuff edge should be one inch above the antecubital space. Tell the student not to talk. 3. Insert the stethoscope with the earpieces pointing forward. Apply the bell head lightly with complete contact over the palpable brachial artery. 4. Inflate the cuff rapidly to 30 mmHg above the point where you no longer feel the radial pulse. 5. Release the air so the pressure falls 2-3mmHg per second. 6. Listen for the onset of at least two consecutive beats. This is the systolic pressure. Note the closest mark on the manometer. Always record BP measurements in even numbers. 7. Listen for a muffling sound with children or the cessation of sound with adults. This is the diastolic pressure. Continue to listen for 10-20mmHg to confirm your reading. Deflate the cuff rapidly and completely. 8. Wait one to two minutes before repeating on the same arm. If the measurement is elevated, the American Heart Association recommends taking two more measurements at one to two minute intervals. Refer the student for treatment if the average of the second and third readings is elevated. 9. Record the pressure, position (sitting or standing), arm used, and action taken on Clinic Card. 11/11 CLINIC PROCEDURES (continued) APPLICATION OF ICE PURPOSE To reduce swelling, bruising, pain and/or bleeding. May be used for insect bites or stings, muscle strain or sprain, tooth trauma fractures, burns and nose bleeds. PREPARATION 1. 2. 3. 4. 5. Explain procedure to student using appropriate developmental approach. Wash hands and assemble equipment: Ice bag (could use ice or dampened frozen sponge sealed in a Ziploc bag) DO NOT USE ICE-FILLED LATEX GLOVES IF STUDENT IS ALLERGIC TO LATEX Clean cover for ice bag, such as a paper towel. DO NOT place ice bag directly on skin. PROCEDURE 1. 2. 3. 4. 5. 6. 7. 11/11 Put on gloves. Cover the ice bag before applying Leave on 20-30 minutes Leave ice off for 15 minutes before reapplying Dispose of ice bag. Remove gloves and wash hands. Document date, time, injury and student’s response on Clinic Card