Standard Procedures for First Aid Treatment in the Trenton Public Schools

TRENTON PUBLIC SCHOOLS

OFFICE OF SCHOOL HEALTH SERVICES

Central Services

108 North Clinton Avenue Trenton, New Jersey 08609

609-656-4900 Extension 5783

609-695-2432 FAX

STANDARD PROCEDURES FOR FIRST AID TREATMENT IN THE TRENTON PUBLIC SCHOOLS

Eric J. Williams, M.D. Chief Medical Inspector , MSN, RN

Micah Freeman

Supervisor of Nurses/504 Coordinator for Students mbfreeman@trenton.K12.nj.us

Board Approved August 28, 2023

No portion of the Standard Procedures for First Aid Treatment in the Trenton Public Schools may be reproduced or transmitted without written permission of the Medical Department of the Trenton Public Schools.

Goal: To implement nursing actions necessary to restore pupils’ or staffs’ health status or to prevent complications in the event of sudden illness or injury.

Objective: To assess a pupil’s or staff’s immediate health needs and to provide nursing intervention according to accepted protocols and make recommendations regarding appropriate medical services.

School

Micah

Micah

Board Policy 8462 - REPORTING POTENTIALLY MISSING OR ABUSED CHILDREN (M) states “Any employee of this district who has reasonable cause to believe a pupil of this district has been subject to abuse, abandonment, cruelty, or neglect, by any person, shall immediately report the same to the Division of Child Protection Permanency (DCP&P) The employee may release information to the Division of Youth and Family Services in accordance with law and district regulations

STAFF ILLNESS AND INJURY

A staff member with a personal illness will be referred to their attending physician. The school nurse and/or administrator will refer work related injuries incurred by staff while working to Board approved provider, Robert Wood Johnson Occupational Health Human Resources Workers Compensation Forms

School authorities have the responsibility to provide emergency care for illness and injury which occur while the individuals are under the jurisdiction of the school. Such care is limited to immediate first aid treatment only.

EMERGENCY RESPONDERS

The school nurse will respond to pupil/staff medical emergencies when on site. The emergency responders (designated staff members certified in cardiopulmonary resuscitation CPR will respond to pupils/staff in need of CPR when on site.

TRANSPORTATION

Pupils are to be transported by the parents/guardians or individuals designated by the parents/guardians. If unable to contact the parents/guardians by.telephone notify building administrators

EMERGENCY PROCEDURE

1. Staff/nurses stay with the individual until parents/guardians/emergency personnel arrive to take charge.

2. Delegate call to ambulance/parent/guardian/significant other8441 - CARE OF INJURED AND ILL PERSONS

3. Notify the building administrator

4. The staff/nurse/emergency responders will evaluate if the individual can be safely removed. When in doubt. DO NOT MOVE

5. Initiate first aid/CPR if knowledgeable.

6. Send emergency information (if available) and Print Powerschool Demographic information.

7. Complete Medical Pupil Incident Report

8. Notify Medical Department, 609-656-4900 ext 5783.

9. Employees compete Accident Report Form Human Resources Workers Compensation Forms

SPECIAL SITUATIONS

1. Activities outside school hours, overnight, summer shall be addressed by the school administrator or coordinator of the activity

2. Emergency medical procedures/athletic events will be the responsibility of the appropriate personal, i.e. athletic trainer, coach.

STAFF RESPONSIBILITY

FIRST AID IS THE RESPONSIBILITY OF EVERY STAFF MEMBER OF THE SCHOOL.

First Aid Guidelines for Staff

INDIVIDUALS EXPERIENCING CRUSHING CHEST PAIN, PROFUSE BLEEDING, DIFFICULTY BREATHING, LOSS OF CONSCIOUSNESS, SLURRED SPEECH, SUDDEN NUMBNESS OR WEAKNESS IN FACE, ARM, OR LEG, SUDDEN CONFUSION, OR DIFFICULTY SPEAKING/SLURRED SPEECH, MUST RECEIVE IMMEDIATE ATTENTION. 911 is activated 8441 - CARE OF INJURED AND ILL PERSONS (M)

IN ABSENCE OF SCHOOL NURSE

Activities in which a school nurse is not available (before or after school hours), including but not limited to sports/field trips/before and after school programs should obtain first aid fanny packs from the nurse. Staff coordinating the activity is responsible for first aid and safety of the students’/staff. In the event an injury/illness/ injury occurs the incident is reported to the parent/guardian, building administration as soon as possible and the school nurse during normal school hours of the building.

SERIOUS INJURIES:

1. Attempt to determine the extent of the injury prior to moving the individual (refer to STANDARD PROCEDURE for recognition of injury)

2. Stay with the individual.

3. Call for help.

4. Observe bloodborne pathogens procedures (universal precautions) when body fluids are involved.

5. Avoid movement of suspected fracture or dislocation.

6. Delegate call to activate Emergency Medical Services (EMS) dial 911.

7. Notify parent/guardian.

8. Notify building administrator or person in charge of building.

9. Administration will designate staff members to accompany the individual to the hospital, if parent/guardian cannot be reached (hospital policy requires that treatment cannot be started until parental permission has been obtained).

8441 - CARE OF INJURED AND ILL PERSONS (M)

10.Remain with the individual if it is necessary for a child to be left at an out-of-town medical facility and the parent/guardian has not arrived.

11.Complete MEDICAL PUPIL INCIDENT REPORT and submit to the school nurse.

OTHER INJURIES:

● Bruises, bumps, finger injuries: apply cold covered compress for 20 minutes; elevate affected limb/part.

● Minor cuts, abrasions: cleanse with soap and water, rinse well and apply adhesive bandage.

● Minor burns: Immediately immerse in cold water for about 10 minutes or until pain subsides. If blisters present, allow to heal and DO NOT POP. Apply petroleum jelly (no ointments/antibiotics) and cover with sterile non stick bandage. American Academy of Dermatology Association

● Bee stings: remove stinger if present, apply cold compress

REPORTING

Report ALL injuries/illness to the parent/guardian.

Report ALL injuries/illness to the school nurse.

Record ALL injuries/illness to the building administrator when the school nurse is not available. Report ALL injuries/illness to the nurse upon arrival to the building during normal business hours.

RECOGNITION OF INJURY

1. Assessment of injury

a. Investigate how injury occurred (blow, twist, fall, etc).

b. Observe injury (swelling, discoloration, deformity).

c. Inquire sounds heard (popping, snapping).

d. Pain assessment (sharp, dull, burning, etc).

e. Check range of motion.

2. Determine if first aid treatment is adequate and that the student may return to class.

3. Determine if medical consultation is warranted and notify parent/guardian.

ABDOMINAL

InjuryI (blow)

1. Allow to rest in a position of comfort (pillow under knees helps relax the abdominal muscles).

2. Control bleeding, if present (wear gloves and apply pressure).

3. Observe for signs of shock (anxiety, rapid pulse, low blood pressure) and if present, initiate EMERGENCY PROCEDURES.

4. Give nothing to my mouth.

5. Treat for shock if indicated (elevate feet, keep warm).

PAIN (stomach)

1. Rule out hunger pain.

2. Take temperature.

3. Offer bathroom is the student constipated or having diarrhea.

4. Assess bowel sounds (hyperactive, hypoactive or normal)

5. Palpate abdomen.

6. Right lower abdominal pain (may have appendicitis)

7. Female students assess their last menstruation.

ABRASION (scrape)

1. Wash gently with soap and water and rinse well.

2. Apply approved antiseptic when necessary

3. Cover with non-adherent dressing.

ANAPHYLACTIC SHOCK see SHOCK

Anaphylactic Action Plan

ASTHMA

SIGNS: Coughing, wheezing, anxiety, difficulty in breathing, retractions

1. Listen for high-pitched whistling wheezing heard with stethoscope on chest or by holding ear close to individual’s mouth.

2. Encourage sitting position.

3. Encourage drinking sips of warm water or tea.

4. Identify asthmatic children.

5. Administer medication (school nurse) if one has been prescribed by the individual’s doctor

6. Take vital signs.

7. Initiate EMERGENCY PROCEDURES if the individual is in distress.

8. Observe for shock.

Asthma Treatment Plan

5330 - ADMINISTRATION OF MEDICATION (M)

5335 - TREATMENT OF ASTHMA (M)

BACK INJURY (spine)

1. Initiate EMERGENCY PROCEDURES

2. Immobilize head between pillows or folded blankets.

3. DO NOT MOVE people unless in danger If necessary to move, support the head and pull in the direction of the long axis of the body without bending the spine. DO NOT DRAG SIDEWAYS.

4. DO NOT MOVE OR ELEVATE HEAD.

5. Keep warm and comfortable.

BITE (skin broken)

ANIMAL

1. Wear gloves if blood is present.

2. Apply pressure directly over bleeding areas and then to appropriate pressure points.

3. Cleans with plain soap and water and rinse for 3 to 5 minutes. .

4. Apply antiseptic.

5. Apply clean dry dressing.

6. Notify parent/guardian to see medical attention.

7. Complete EM-38.

8. May need tetanus if one has not been given in the last 5 years.

9. Call animal control 609-989-3254 or police if the animal is wild, exhibits behavior, or the animal has not been vaccinated for rabies.

Animal Bites Mount Sinai

BITE (skin broken)

HUMAN

1. Wear gloves if blood is present.

2. Apply pressure with a clean towel or dressing.

3. Wash the wound for at least 5 minutes under the faucet, do not scrub.

4. Dry the wound and apply clean dry dressing.

5. DO NOT use tape or butterfly bandages to close the wound.

6. Notify parent/guardian to see medical attention.

7. Complete EM-38.

Treatment for Human Bites, John Hopkins

BITE TICK

1. Grasp the tick’s mouth as close as possible to the skin using clean tweezers, and apply firm and steady pressure pulling upward (avoid its bloating abdomen).

2. Clean with alcohol or soap and water.

3. Apply antiseptic but not necessary.

4. Notify parent/guardian and monitor bite mark for rash for two weeks. Send home lyme disease information (need documentation)

5. Dispose of ticks in alcohol, flush down the toilet, wrapping tightly in tape, or placing it in a plastic container or bag.

CDC Tick removal

Lyme Disease Tick Alert Procedure Document

BLEEDING (severe)

Tongue, lip or cheek

1. Wear gloves

2. Apply pressure and cold compress. If uncontrolled after 15 minutes, refer to the doctor

3. Keep head elevated and maintain an adequate airway

4. Notify parent/guardian

WOUND

1. Wear gloves

2. Apply thick clean dry dressing and pressure.

3. Elevate affected part, unless there appears to be a fracture.

4. Reinforce dressing if necessary DO NOT REMOVE previous dressing.

5. Apply butterfly dressing or steri-strips if appropriate.

6. Refer for sutures if the wound is more than ½ inch long, and edges separated ⅛ of an inch.

7. Advise as needed for Tdap booster

8. Notify parent/guardian

9. Initiate EMERGENCY PROCEDURES if necessary

BLISTER

1. Leave intact if not broken.

2. When the blister breaks clean with soap and water

3. Leave the top layer of skin

4. Apply antibiotic ointment

5. Notify parent/guardian if blister is infected or very large (2 inches) and or complete EM 38

ABC of blister care

BRUISE (contusion)

1. Apply covered cold compress for 20 minutes

2. Elevate part.

BURNS

Major

1. Remove from harm if the area is safe.

2. Activate EMERGENCY PROCEDURES

3. Do not remove clothing from the struct area.

4. Assess ABC’s (Airway, Breathing, Circulation)

5. Remove jewelry, belts, or other items.

6. Cover with a clean towel or dressing.

7. Raise the area and watch for signs of SHOCK.

Minor

1. Run under cold water for 10 minutes.

2. If the burn is on the face, apply a cool wet towel/dressing until pain subsides.

3. For a mouth burn, apply ice for a few minutes.

4. Remove rings or other tight items as soon as possible.

5. DO NOT break blister

6. Apply lotion aloe vera or cocoa butter.

7. Apply clean dry dressing loosely

Burns First Aid

Chemical

1. Activate EMERGENCY PROCEDURES

2. Rinse chemicals off skin, use eye wash when applicable.

3. Assess ABC’s

Electrical

1. Activate EMERGENCY PROCEDURES

2. Assess ABC’s

3. Notify parent/guardian and or complete EM 38

Heat

1. Call for help

2. Smother flames (STOP DROP and ROLL)

3. Remove hot burned clothing that comes off easily, leave clothing alone if sticks.

4. Assess ABC’s.

5. Treat for SHOCK if necessary

6. Initiate EMERGENCY PROCEDURES if necessary

7. Notify parent/guardian and or complete EM 38

Sunburn

1. Apply cool wet compress.

2. Apply lotion such as aloe vera or calamine.

3. Leave blisters alone.

4. Clean with soap and warm water.

5. Apply antibiotic and non-stick bandages.

6. Notify parent/guardian and or complete EM 38 Sunburn Mayo Clinic

CHOKING

For picture references click links below.

First Aid Choking age 1-8

First Aid Choking Adult

Heimlich Maneuver article Cleveland Clinic

CONJUNCTIVITIS (pink eye)

SIGNS: Redness of whites of eyes, purulent (pus) or watery discharge; redness/swelling of eyelids; itching and rubbing of eyes; crust in inner corners of eyes, especially on waking from sleep.

ALLERGIC

1. Discharge remains watery without pus formation.

2. Wear gloves

3. Wash your eyes gently with cool compress.

4. Assessing vision should be normal.

5. Notify parent/guardian and issue EM 38.

INFECTIOUS (bacterial)

1. Usually more pus and crustacean.

2. Wear gloves.

3. Wash your eyes gently with a cool compress.

4. Assessing vision should be normal.

5. Check fingers and nose for impetigo.

6. Notify parent/guardian, issue EM 38 to seek medical attention and exclude for 24 hours until treatment has started.

VIRAL (associated with common cold)

1. Usually less severe, often no pus; runs 3-5 days course and will resolve.

2. Wear gloves and wash your eyes gently with a cool compress.

3. Assessing vision should be normal.

4. DO NOT exclude if mild with no visible pus and few symptoms.

5. Notify parent/guardian, issue EM 38.

IF SUBCONJUNCTIVAL HEMORRHAGE IS PRESENT, REFER FOR MEDICAL TREATMENT.

CONVULSION

1. Easy person to the floor

2. Remain calm.

3. DO NOT restrain individuals.

4. Loosen tight clothing.

5. Time seizure activity

6. Protect from injury keep the airway open (place of side to allow for any drainage).

7. Activate EMERGENCY PROCEDURE if the lasts longer than 5 minutes, difficulty breathing, injury occurred, happened in water, or chronic medical conditions/DM, heart disease, pregnancy, and there is no history of seizures.

8. Evacuate classroom/area for individual’s privacy

5530.05 - SEIZURE ACTION PLAN

5770 - PUPIL RIGHT OF PRIVACY

Seizure First Aid CDC

TYPES OF SEIZURES EPILEPSY FOUNDATION

CUT

MINOR CUT/SCRATCH

1. Wear gloves.

2. Cleanse with soap and water

3. Apply antiseptic but not necessary and clean dry dressing.

LARGE CUT/SCRATCH

1. Wear gloves.

2. Apply firm pressure until bleeding stops.

3. Irrigate/cleanse with water

4. Evaluate for sutures.

5. Apply butterfly dressing or steri-strips and clean dry dressing.

6. Advice for possible tetanus if less than 5 years.

7. Notify parent/guardian, issue EM 38.

CHEST PAIN

1. Evaluate vital signs.

2. Activate EMERGENCY PROCEDURE if necessary.

3. Refer for medical attention if symptoms are ongoing or persistant.

4. Notify parent/guardian, issue EM 38.

DENTAL

BRACES

DISCOMFORT

1. Assess area of discomfort.

2. Apply dental wax, if applicable.

3. Notify parent/guardian, issue EM 38 to seek medical attention and or orthodontic care.

BROKEN

1. Bend gently to relieve pressure and discomfort using tongue depressor

2. Cover ends with dental wax or a piece of gauze.

3. DO NOT remove any wire embedded in the cheeks, gums, or tongue.

4. Notify parent/guardian, issue EM 38 to seek medical attention and or orthodontic care.

ORAL INJURIES (tooth avulsion)

1. Calm the individual.

2. Rinse your mouth gently with warm water.

3. Find the knocked out tooth, hold by crown (do not touch root) and if dirty rinse milk. If milk is not available use salvia or sterile saline solution. DO NOT USE WATER.

4. If possible insert an adult tooth back into the socket. Stop when you hear a click and or the tooth is level. Have individuals bite down on clean cloth while traveling to the dentist.

5. If unable to return to socket place in an Emergency Tooth Preserving System (ETPS), or milk. DO NOT COVER WITH ANYTHING WHILE LOCATING ETPS OR MILK.

6. Notify parent/guardian, issue EM 38 to seek medical attention and or orthodontic care.

Dental Injury

CHIPPED TOOTH

1. Rinse your mouth gently with warm water

2. Find large fragments and follow steps for preserving tooth under tooth avulsion.

3. Cover sharp edges of broken tooth with gauze and hold in place keeping mouth closed.

4. Notify parent/guardian, issue EM 38 to seek medical attention and or orthodontic care.

TOOTHACHE

1. Rinse your mouth vigorously with warm water.

2. Floss gently to remove trapped debris.

3. Assess teeth.

4. Apply cold covered compress to check if swelling is present.

5. Provide Oragel as needed.

6. Notify parent/guardian, issue EM 38 to seek dental provider.

.

DIABETES

LOW BLOOD SUGAR (Insulin Reaction or HYPOGLYCEMIA)

Onset: Sudden

Signs: Staggering, poor coordination, anger, bad temper, pale color, confusion, disorientation, sudden hunger, sweating, eventually stupor or unconsciousness

Causes: Failure to eat before strenuous exercise. Delayed or missed meals

PROVIDE SUGAR if the individual can swallow without choking.

1. Administer (school nurse) entire contents of glucose gel according to Chief Medical Inspector's medical orders

2. If glucose gel is not available, offer any food or drink containing sugar, such as soft drinks, fruit juice, or candy

DO NOT USE DIET DRINKS WHEN BLOOD SUGAR IS LOW.

1. Initiate EMERGENCY PROCEDURES if the individual does not feel better in 10-15 minutes

HIGH BLOOD SUGAR (HYPERGLYCEMIA with Acidosis)

Onset: Gradual

Signs: Drowsiness, extreme thirst, very frequent urination, flushed skin, vomiting, fruity or wine-like odor on breath, heavy breathing, eventual stupor or unconsciousness

Causes: Undiagnosed diabetes, insulin not taken, stress, illness, or injury, too much food or drinks or both

1. Initiate EMERGENCY PROCEDURES

Diabetes Management Policy and Procedure Document

Diabetic Action Plan

5330 - ADMINISTRATION OF MEDICATION (M)

DISLOCATION

1. Do not attempt to put it back in place.

2. Immobilize the part in a comfortable position.

3. Notify parent/guardian to seek immediate medical care.

4. Initiate EMERGENCY PROCEDURES if the individual cannot be moved.

DROWNING

1. Initiate EMERGENCY PROCEDURES

2. Open airway.

3. Begin CPR.

DRUG USE/INTOXICATION

SIGNS: Bloodshot eyes, smell of alcohol, not responding in class, skipping class and/or school, constantly late for class, foul smelling odor, slurred speech, or staggered gate

1 Follow district policy No 5533 Substance Abuse/Alcohol, and policy No 5533 Student Smoking Substance use resource guide

EAR

EARACHE

1. Take temperature.

2. Assess the ear with an otoscope.

3. Notify parent/guardian, issue EM 38 to seek medical provider.

FOREIGN BODIES

1. Notify parent/guardian, issue EM 38 to seek medical provider.

EYE CHEMICAL

1. Complete eye irrigation as soon as possible.

2. Call Poison Control 1-800-222-1222.

3. Continue to flush eyes until Emergency Response personnel arrive.

4. Position head so the chemical does not watch into the unaffected area/eye.

5. Activate EMERGENCY PROCEDURE

6. Notify parent/guardian, issue EM 38.

CONTACT LENS

1. Solutions and disposable contact lens cases for storage of soft lenses available in the School Health Office.

FOREIGN BODY

1. Avoid rubbing the eye.

2. Lift upper eyelid outward and down over lower lid.

3. Flush with warm water or Eye Irrigation Solution.

4. Inspect for foreign bodies or tears in cornea (shine light from side).

5. Apply eye patch to close lid, if particle or pain remains.

6. Notify parent/guardian to seek medical attention, and issue EM 38.

INJURY

(blow, black eye)

1. Apply cold covered compress immediately for 20 minutes. DO NOT use chemical cold packs or ice near your eyes.

2. Check for double/blurred vision.

3. Assess pupil size and symmetry

4. Notify parent/guardian to seek medical attention, and issue EM 38. (cuts, puncture, abrasion, etc)

1. Do not wash with water

2. DO NOT attempt to remove an object stuck in your eye.

3. Cover your eyes loosely with clean dry dressing.

4. Notify parent/guardian to seek medical attention, and issue EM 38.

FAINTING

1. Position individuals on their back if no injuries are present.

2. Keep in a flat position with legs elevated about 12 inches.

3. Loosen tight clothing, collars, and belts.

4. Assess ABC’s and if the person is not breathing start CPR and EMERGENCY PROCEDURES.

5. DO NOT give anything by mouth unless fully conscious.

6. Monitor vital signs.

7. If an individual is diabetic assess blood sugar and treat as prescribed.

8. If a person was injured during fall treat injury

9. If a person is bleeding, wear gloves and apply pressure with a clean towel or dressing.

10.Notify parent/guardian and issue EM 38.

Fainting: First Aid-Mayo Clinic

FEVER

1. Exclude if the temperature is over 100 degrees Fahrenheit.

2. Students cannot return to school if they take fever-reducing medication in the last 24 hours.

3. Evaluate if fever is associated with abdominal pain, heat stroke, or heat exhaustion.

FRACTURE

DO NOT MOVE INDIVIDUAL IF FRACTURE OF NECK OR BACK IS SUSPECTED UNLESS INDIVIDUAL IS IN IMMEDIATE DANGER. Keep individuals still and activate EMERGENCY PROCEDURE.

SIMPLE

1. Keep the individual still, preferably lying down unless pain would be caused.

2. Immobilize the broken bone, adjacent joints by splints, pillows, or blankets.

3. DO NOT attempt to set a fracture.

4. Treat for shock if necessary (keep warm, elevated feet).

5. Notify parent/guardian to seek medical attention and issue EM 38.

COMPOUND

1. Wear gloves.

2. Cover the wound with large dressing and control any severe bleeding by direct pressure.

3. Apply ice above and around the fracture.

4. Elevate limbs if possible.

5. DO NOT attempt to set a fracture.

6. DO NOT probe the wound.

7. Notify parent/guardian to seek immediate medical attention and issue EM 38.

Compound Fracture Cleveland Clinic

COLLAR BONE/SHOULDER ELBOW

1. Place the arm in a sling to support the arm.

2. Tie to body

3. Notify parent/guardian to seek immediate medical attention and issue EM 38.

FROSTBITE

Signs: Numb, pale and shiny.

1. Bring the individual indoors quickly.

2. Warm the affected part with warm water, do not use a heat lamp or hot water.

3. Provide warm water for the individual to drink.

4. Cover loosely with clean dressing, if blisters appear DO NOT BREAK.

5. IF FEET WERE FROSTBITTEN, DO NOT ALLOW THE INDIVIDUAL TO WALK.

6. Notify parent/guardian to seek immediate medical attention and issue EM 38.

Frostbite Mayo Clinic

GROIN INJURY

1. Evaluate.

2. Apply cold covered compress.

3. Relieve pain by pulling knees to chest while lying down.

4. Apply pressure for severe bleeding (wearing gloves).

HEADACHE

1. Take temperature.

2. Evaluate for possible cause (flu, injury, hunger etc)

3. Apply cold covered compress, when appropriate.

4. Refer to parent/guardian for persistent and recurring.

5. Encourage fluids for hydration; when appropriate.

Urine hydration Chart English

HEAD INJURY

All head injuries should be treated as severe and should be suspected in any injury to the face, head, or neck.

1. Follow instructions for fighting if unconscious.

2. Maintain lying down position until evaluated.

3. Apply pressure with clean dry dressing if bleeding (wearing gloves).

4. DO NOT remove original dressing if blood soaked, add additional dressings.

5. Check for nausea/vomiting.

6. Check pupils are equal, round and react to light.

7. Monitor level of consciousness.

8. Evaluate if safe for the individual to resume any physical activity or sport that day.

9. Notify parent/guardian and provide EM-03 Head Injury Observation. (need document in English and Spanish)

10.Notify: Athletic Director/Athletic trainer and or coach if participating in sports with a diagnosis of concussion. Must be medically cleared to return to participate in sports and/or physical activity.

2431.4 - PREVENTION AND TREATMENT OF SPORTS-RELATED CONCUSSIONS AND HEAD INJURIES (M)

OBSERVE FOR THE FOLLOWING SYMPTOMS FOR AT LEAST

30 MINUTES

Headache, nausea, vomiting, irregular pulse, unequal pupils, double/blurred vision, drowsiness, twitching, bleeding or fluid from mouth/ears/nose/eyes, brief unconsciousness after injury If any symptoms present, refer to the doctor and/or emergency room immediately

HEART

CARDIAC ARREST

1. Initiate EMERGENCY PROCEDURES

2. Institute CPR if necessary.

HEAT EXHAUSTION

SIGNS: Check for pale appearance, sweaty skin, normal-subnormal body temperature, dilated pupils, shallow breathing.

1. Remove from direct sunlight.

2. Apply cold compress.

3. Notify parent/guardian and refer to medical attention, complete EM-38.

HEAT STROKE -SUN STROKE

HEAT STROKE IS A SEVERE MEDICAL EMERGENCY. DELAY CAN BE FATAL.

SIGNS: Check for flushed red appearance, dry skin, high body temperature, contracted pupil, deep rapid breathing, rapid and strong pulse.

1. REDUCE TEMPERATURE QUICKLY

a. Move to a cooler environment.

b. Sponge with cold water

c. Remove excess clothing.

2. Initiate EMERGENCY PROCEDURES

2431.3 - HEAT PARTICIPATION POLICY FOR STUDENT-ATHLETE SAFETY (M)

HYSTERIA

1. Reassure.

2. Provide rest and quiet.

3. Apply cold compress to the head, if appropriate.

IMPETIGO

See Rash

MENSTRUATION DISCOMFORT MILD

1. Encourage individuals to continue normal activities. SEVER

1. Allow to rest on cot.

2. Notify parent/guardian if persists.

NAUSEA

1. Evaluate and reassure.

2. Monitor vital signs.

3. In females assess last menstruation.

4. Notify parent/guardian if persists.

NOSE BLEED

1. Wear gloves.

2. Sitting, leaning forward, recommended position.

3. Firmly hold the end of the bleeding nostril(s) closed for a minimum of 5 minutes by the clock.

4. Initiate EMERGENCY PROCEDURES if bleeding continues.

OLD INJURY

1. Administer only urgent first aid for injury that occurs at home.

2. Reinforce bandage, do not change it.

3. Notify parent/guardian and complete EM 38.

OPIOID OVERDOSE

SIGNS: Unresponsive or unconscious, confusion, inability to speak, limbs arms and legs, slowed or stopped breathing, cold or clammy skin, discolored lips or fingernails, snoring or rattling sounds, vomiting or gurgling noise, small pupils, .

1. The school nurse or designated employee who volunteers and trained will administer Narcan in good faith to anyone whom they believe is experiencing an opioid overdose.

2 Start CPR if the individual is not breathing

3. Acctivate Emergency Procedures

4 Place the individual on their side with their top arm and leg crossed over the body to prevent choking

5. Do not leave the individual alone.

6 The individual is transported to the hospital or emergency room by medical responders even if symptoms resolve

5330.04

- ADMINISTERING AN OPIOID ANTIDOTE

Save a Life from Prescription Opioid Overdose CDC

PEDICULOSIS CAPITIS (head lice)

SIGNS: Persistent itching/scratching of the head and back of the neck. Red bite marks and scratch marks on scalp and neck. Nits (small, round or oval eggs) attached to individual hairs. Presence of lice in scalp and hair.

1. School nurse confirms the presence of nits/lice.

2. Notify parent/guardian, child may stay in school until the end of the day.

3. Child is excluded until treatment is provided.

4. Refer parent/guardian to medical provider

NJDOE Exclusion List page 2

POISON

1. Notify Poison Control 1-800-222-1222

2. Check Safety Material Data Sheet.

3. Administer first aid accordingly

4. Notify parent/guardian to seek medical attention and complete EM 38. NJ Poison Control

FOOD (suspected)

1. Monitor vital signs.

2. Evaluate.

3. Notify parent/guardian and complete EM 38.

POISON IVY, OAK, SUMAC (contact dermatitis)

1. Wear gloves.

2. Cleanse with soap and water

3. Apply appropriate approved external analgesic to dry lesions.

4. Apply cold compress for itching.

5. Notify parent/guardian to seek medical attention if infected or severe and complete EM 38.

PUNCTURE (pencil wound)

1. Encourage bleeding.

2. Wear gloves.

3. Cleanse with soap and water.

4. Apply approved antiseptic but not necessary.

5. Apply clean dry dressing.

6. DO NOT remove the object but call the parent/guardian for further treatment if deep.

7. Advice for possible Tetanus booster

RASH

1. Evaluate.

2. Apply cold compress if uncomfortable.

3. Apply appropriate approved external analgesic if itchy.

4. Exclude if it appears contagious. IMPETIGO

Signs: Vesicles that become pustular, honey-colored loosely adherent crusts, pustules may be wet or crusted. Itching, most frequently found on fingers and face;contagious on direct secondary contact.

1. Wear gloves.

2. Cleanse with soap and water

3. Cover with loose dressing or adhesive bandage.

4. Notify parent/guardian and complete EM 38.

5. May attend school if on medication for 24 hours and under treatment.

6. Check for siblings in other schools and notify the school nurse in that building. 8451 - CONTROL OF COMMUNICABLE DISEASE (M)

NJDOH Exclusion list page 3

RINGWORM

Signs: Tinea Pedis (athlete’s feet), scaly lesions between toes, tiny pimples or blisters and scaly lesions on sides of feet. Tinea Corporis (ringworm of body) small single or multiple reddish lesions of the body of the face, which gradually spread while clearing in the center Tinea Capitis (ringworm of scalp) small circle of baldness with broken off hairs in center

TINEA PEDIS

TINEA CORPORIS

1. Notify parent/guardian to seek medical attention and complete EM 38.

2. Exclusion is not necessary.

3. Watch for secondary infection.

4. Monitor the healing process.

Tinea Pedis NIH

Tinea Corporis NIH

TINEA CAPITIS

1. Notify parent/guardian to seek medical attention and complete EM 38.

2. Exclusion if no treatment.

3. May return after 24-48 hours of treatment.

4. Watch for secondary impetigo.

5. Check for siblings in other schools and notify the school nurse in that building. 8451 - CONTROL OF COMMUNICABLE DISEASE (M)

Tinea Capitis NIH

NJDOH Exclusion list, page 3

SCABIES

Signs: A tiny pale, irregular line (burrow) which marks the path of the scabies mite, tiny papules, vesicles, pustule, and scabby, usually in webs of fingers, wrists, elbows, armpits, beltline, and/or genitalia. Rarely found on face, mid back palms, and soles; intense itching.

1. Notify parent/guardian to seek medical attention and complete EM 38.

2. Exclusion if no treatment.

3. May return after treatment starts.

4. Check for siblings in other schools and notify the school nurse in that building. 8451 - CONTROL OF COMMUNICABLE DISEASE (M)

Scabies, Mayo Clinic

NJDOH Exclusion list, page 4

SHOCK

ALLERGIC SHOCK (anaphylaxis)

Allergic Anaphylactic Shock Action Plan

INSULIN SHOCK see DIABETES

TRAUMA SHOCK

Sings: Anxiety, rapid pulse, low blood pressure

1. Initiate EMERGENCY PROCEDURES

2. Elevate legs, if there are no head or neck injuries.

3. Keep the individual comfortable. Cover with a blanket if necessary to keep warm.

4. Monitor vital signs.

SORE THROAT

1. Review health history, allergies, etc.

2. Assess temperature

3. Assess tonsils for white patches, (if present must seek medical attention)

4. Students may gargle with 2-3 squirts of Chloraseptic Spray diluted in water

5. Notify parent/guardian for abnormal assessment finding and complete EM 38.

SPLINTER

1. Cleans with soap and water.

2. Remove gently with clean small forceps or tweezers.

3. Apply clean dry dressing.

SPRAIN/STRAIN

1. Immediate swelling =spain

2. I.C.E. (Ice, Compression, Elevation) appy cold covered compress 20-40 minutes.

3. Immobilize, if appropriate with sling, splint, ect if an individual cannot move normally. TAPING AND OTHER METHODS OF SUPPORT ARE NOT FIRST AID AND SHOULD NOT BE USED.

4. Notify parent/guardian and complete EM 38.

STING (insect bite)

1. Remove the stinger with scotch tape or tweezers very gently

2. DO NOT grasp the venom sac.

3. Clean with soap and water

4. Apply sting kill.

5. Apply cold covered compress.

6. Observe the reaction for one half hour Individuals identified as being allergic to stings should have a medication provided by the family following standard medication procedures.

5330 - ADMINISTRATION OF MEDICATION (M)

7. Initiate EMERGENCY PROCEDURES if necessary or stung inside mouth or throat.

8. Treat for ANAPHYLACTIC SHOCK if necessary.

9. If less than 5 years old, I recommend the Tetanus booster.

10.Notify parent/guardian and complete EM 38.

TAPEWORM EXPULSION

1. Assist and reassure individuals.

2. Provide privacy

3. Notify parent/guardian to seek medical attention and complete EM 38.

4. Have custodian disinfect toilet facilities.

5. May return with permission from the physician.

Tapeworm Mayo Clinic

VIOLENCE (wound body part)

1. Initiate EMERGENCY PROCEDURES

2. DO NOT remove objects, such as knives, or pieces of glass/metal impaled in wounds.

3. Place several dressings around to keep from moving.

4. Bandage the dressing in place around the object.

5. Apply tourniquet to arms and legs.

6. Wrap torn body parts with clean cloth and place in a plastic bag, and keep cool with ice DO NOT FREEZE.

VOMITING

1. Give nothing by mouth.

2. Assess temperature and if abdominal pain is present.

3. Females assess last menstruation.

4. Assist and reassure individuals.

5. Notify parent/guardian and exclude if necessary and complete EM 38.

THE FOLLOWING PRODUCTS ARE APPROVED FOR FIRST AID

Albuterol .083% (on hold until NJDOE approved nebulizer treatments)

Anbesol (oral analgesic)

Aquaphor

Bacitracin (antibiotic ointment)

Bactine (antiseptic plus pain reliever)

Calamine lotion

Chloraseptic (oral anesthetic)

Dental wax

Emergency tooth preserving system

EPIPEN ADULT, and JR EPINEPHRINE Auto-Injectors

Hydramine Elixir (Diphenhydramine HCL elixir/antihistamine)

Insta-Glucose (glucose gel)

Irrigate Eye Wash (sterile isotonic buffered solution)

Narcan (Opioid antidote)

Neosporin Ointment (antibiotic ointment)

Phisoderm (skin cleanser and conditioner)

Plain Soap

Sting Kill

Vaseline (while petroleum jelly)

*To be administered according to Dr Williams standing medical orders for school nurses.

Date:

Approved by Eric Williams, MD, Chief Medical Inspector

5305 - HEALTH SERVICES PERSONNEL

5307 - NURSING SERVICES PLAN (M)

8441 - CARE OF INJURED AND ILL PERSONS (M)

5300 - AUTOMATED EXTERNAL DEFIBRILLATORS (AEDS) (M)

7420 - HYGIENIC MANAGEMENT (M)

9230 - PARENTAL RESPONSIBILITIES

DISEASE PREVENTION

Certain precautions are recommended when coming in contact with bodily fluids, waste, including an individual's blood, semen, drainage from scrapes, cuts, feces, urine, vomitus, respiratory secretions, and saliva. Whenever possible, direct contact with body waste and fluids should be avoided and protective barriers should be used. The wearing of disposable gloves is recommended. If hands and other skin areas have come into contact with an individual’s body fluids or waste the area must be washed by the use of soap and water vigorously for at least twenty (20) seconds. A complete description of handling and disposal procedures may be found in the Districts Regulations/Procedure Policy for handling blood and other body fluids.

7420 - HYGIENIC MANAGEMENT (M)

7423 - GREEN AND HEALTHY SCHOOLS CLEANING POLICY

N.J. Department of Education Health Safety and School Health Services

SUBCHAPTER 2. SCHOOL HEALTH SERVICES

6:29-2.4 Attendance at school by pupils or adults infected by Human Immunodeficiency Virus (HIV)

6:29-2.5 Routine procedures for sanitation and hygiene when handling body fluids

See link below for specific NJDOE Health Safety and Physical Education Page 4

IT IS RECOGNIZED THAT THEY SYMPTOMS AND INTERVENTIONS LISTED IN “STANDARD PROCEDURES FOR BASIC FIRST AID TREATMENT IN THE TRENTON PUBLIC SCHOOLS” ARE NOT ALL INCLUSIVE. BECAUSE SPECIFICALLY THE TYPES OF INJURY/ILLNESS AND INTERVENTIONS FOR EVERY INJURY/ILLNESS AND INTERVENTION FOR EVERY POSSIBLE EMERGENCY SITUATION IS IMPRACTICAL, SOME JUDGMENT MUST BE EXERCISED.

The Medical Department is appreciative of the contributions from the following committee members: Micah Bradley-Freeman, MSN, RN, CSN, Pamela Kelly, MSN,MBA, BSN-RN, CSN, , MBA, BSN-RN, CSN, Tania C. Connors, BSN, Ritha Blain RN, CSN, Theresa Chukumba, MSN, BSN-RN, CSN , MMD, BSN, CSN. Ngozi Ubah

Updated August 2023