Planning for emergencies in school: the school nurse role

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

19. STANDARD TRIAGE PROTOCOLS(page 11)

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

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

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

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

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

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

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

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

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

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

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

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

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

33. QUESTIONS?