Emergency Response Guide: Signs, Symptoms, & Treatment for Injuries & Illnesses, Exercises of Medicine

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First Aid Guide for School Emergencies

This flipchart is a quick reference guide for administering emergency care to an injured or ill individual. It contains practical, step-by-step instructions that describe what to do when caring for an injured or ill person. It replaces a previous addition published in 1998.

Who Should Use this Flipchart

This flipchart is designed for use by teachers, school nurses, clinic aides, and other staff members responsible for the health and safety of students and others in the school setting. Do not use treatment methods beyond your skill level or your scope of practice. When in doubt, call 911.

How to Use This Flipchart

This flipchart should be posted in a place that is easily accessible to all staff members. It is recommended that all staff become familiar with the contents of this flipchart prior to the necessity for handling an emergency situation.

This flipchart is designed to help the user handle emergency situations:

♦ The first section, Topical Index , is an alphabetical listing of all topics contained in this flipchart. ♦ The second section, General Emergency Guidelines , provides general guidance and information on the administration of emergency assistance to individuals who are ill or injured prior to the arrival of emergency medical personnel. ♦ The third section, Standard Precautions , provides an overview of handling blood and body fluids in the school setting. ♦ The fourth section, First Aid Procedures , describes specific procedures for treating an ill or injured individual. ◊ This section lists first aid procedures in alphabetical order. ◊ A procedure may refer to related first aid procedures. The related procedure is in bold type. ◊ A procedure also recommends when to call 911 or Poison Center. Parents always should be notified of a first aid emergency. (The term "parent" refers to the student's parent or legal guardian or the designated emergency contact person.) ♦ The fourth section, Poisonings , gives detailed instructions for handling an individual who has ingested or, in some way, come into contact with a poison or other hazardous substance. ♦ The fifth section, Chemical, Biological, Radiologic, Nuclear, or Explosive Events , gives instructions for who to contact in these emergencies. ♦ The sixth and final section, Emergency Care Procedures , describes procedures for handling emergency and life-threatening crisis medical situations including: ◊ Cardiopulmonary Resuscitation (CPR) ◊ Choking

GENERAL EMERGENCY GUIDELINES

1. Remain calm and communicate a calm, supportive attitude to the ill or injured individual.
2. Never leave an ill or injured individual unattended. Have someone else call 911 and the parent.
3. Do not move an injured individual or allow the person to walk (bring help and supplies to the individual). Other school staff or responsible adults should be enlisted to help clear the area of students who may congregate following an injury or other emergency situation.
4. If trained and if necessary, institute CPR.
5. Have 911 called immediately for:

♦ Anaphylactic reaction ♦ Amputation ♦ Bleeding (severe) ♦ Breathing difficulty (persistent) ♦ Broken bone ♦ Burns (chemical, electrical, third degree) ♦ Chest pain (severe) ♦ Choking ♦ Electrical shock ♦ Frostbite ♦ Head, neck, or back injury (severe) ♦ Heat stroke ♦ Poisoning ♦ Seizure (if no history of seizures) ♦ Shock ♦ Unconsciousness ♦ Wound (deep/extensive)

6. Do not use treatment methods beyond your skill level or your scope of practice. When in doubt, call 911. All persons working with students are encouraged to obtain training in CPR/First Aid through an authorized community agency.

STANDARD PRECAUTIONS: FOR HANDLING

BLOOD/BODY FLUIDS IN SCHOOL

♦ Anticipating potential contact with infectious materials in routine and emergency situations is the most important step in preventing exposure to and transmission of infections.

♦ Use Standard Precautions and infection control techniques in all situations that may present the hazard of infection.

♦ Precautions should be observed and appropriate protection used when caring for bleeding injuries or handling other body fluids in emergency situations. Body fluids include blood, drainage from cuts, scabs, skin lesions, urine, feces, vomitus, nasal discharge, and saliva. The body fluids of all persons should be considered to be potentially hazardous.

♦ Avoid direct contact with body fluids. Caregivers who anticipate assisting in first aid when body fluids are present (e.g., cleaning cuts and scrapes, treating a bloody nose) should use disposable gloves.

♦ Caregivers should use protective eyewear and masks in certain situations.

♦ If unanticipated skin contact occurs, hands and all other affected skin should be washed with soap and running water as soon as possible. The local procedures for blood and body fluid exposure should be followed.

♦ Diligent and proper hand washing, the use of barriers (e.g., gloves), appropriate disposal of waste products and needles, and proper care of spills are essential techniques of infection control.

♦ If it is necessary to perform CPR, a one-way mask or other infection control barrier should be used. However, CPR should not be delayed while such a device is located.

HAND WASHING PROCEDURE

1. Wash hands vigorously with soap under a stream of warm running water for at least 20 seconds.
2. Wash all surfaces including backs of hands, wrists, between fingers, and under nails.
3. Rinse hands well with running water and thoroughly dry with paper towels.
4. If soap and water are unavailable, an alcohol-based hand rub may be used.

GLOVES

1. Gloves must be worn when direct care may involve contact with any type of body fluid.
2. Disposable, single-use, waterproof gloves (e.g., latex or vinyl) should be used. (Vinyl gloves should be used with individuals who have a latex allergy or a high potential for developing a latex allergy, e.g., individuals with spina bifida.)
3. Discard gloves in the appropriate container after each use.
4. Hands should be washed immediately after glove removal.

DISPOSAL OF INFECTIOUS WASTE

1. All used or contaminated supplies (e.g., gloves and other barriers, sanitary napkins, bandages) except syringes, needles, and other sharp implements should be placed into a plastic bag and sealed. This bag can be thrown into the garbage out of reach of children or animals.
2. Needles, syringes, and other sharp objects should be placed immediately after use in a puncture- proof container that is leak proof on the bottom and sides. To reduce the risk of a cut or accidental puncture by a needle, NEEDLES SHOULD NOT BE RECAPPED, BENT, OR

FIRST AID PROCEDURES

ABDOMINAL INJURY

GENERAL WOUNDS

TREATMENT

1. Determine cause of injury.
2. Call 911.
3. Wear gloves. Use Standard Precautions (see Standard Precautions ).
4. Carefully position individual on back.
5. If movement of the legs does not cause pain, place a pillow under knees to help relax the abdominal muscles.
6. If movement of the legs causes pain, leave individual lying flat.
7. Control bleeding with a bulky dressing.
8. Do not give food or drink.
9. Do not give medication.
10. Call parent.

PROTRUDING WOUNDS

NOTE: A protruding abdominal wound is an injury to the abdomen causing internal organs to be exposed or protrude through the wound.

TREATMENT

1. Determine cause of injury.
2. Call 911.
3. Wear gloves. Use Standard Precautions (see Standard Precautions ).
4. Carefully position individual on back.
5. If movement of the legs does not cause pain, place a pillow under knees to help relax the abdominal muscles.
6. If movement of the legs causes pain, leave individual lying flat.
7. Do not apply any pressure to the protruding organs.
8. Do not attempt to push protruding organs back into the abdomen.
9. Remove any clothing from around wound.
10. Cover wound with clean cloth (preferably sterile).
11. If there is a delay in medical assistance:
    • Loosely drape sterile dressings or a clean cloth over the wound.
    • Use sterile saline to moisten the dressings.
    • Hold dressing in place with bulky bandage.
12. Treat for Shock (see Shock ).
13. Do not give food or drink.
14. Do not give medication.
15. Call parent.

ABDOMINAL PAIN

NON SEVERE/ STOMACH ACHE

TREATMENT

1. Take temperature.
2. Have individual rest 15-30 minutes.
3. If temperature is greater than 100 °F and/or pain intensifies, call parent and recommend contact with health provider.

SEVERE/ WITH OR WITHOUT VOMITING

TREATMENT

1. Call 911.
2. Do not give anything to eat or drink.
3. Do not give medication.
4. Take temperature.
5. Call parent.

WHEEZING

NOTE: Wheezing is an abnormally high-pitched noise resulting from a partially obstructed airway. Check for Asthma Emergency Care Plan and initiate treatment as directed. Airway obstruction is potentially life threatening.

TREATMENT

1. If breathing problem is severe, prolonged, or occurs with hives and/or swelling, call 911.
2. Place individual in comfortable position, usually sitting.
3. If necessary, certified personnel start CPR (see CPR ).
4. Call parent.

AMPUTATION

NOTE: Amputation is the severing (all or part) of a limb or digit of the body.

TREATMENT

1. Call 911 immediately.
2. Wear gloves. Use Standard Precautions (see Standard Precautions ).
3. Control bleeding by placing a clean dressing (preferably sterile) over the wound and apply pressure on a nearby artery.
4. Never complete the amputation.
5. Treat for Shock (see Shock ).
6. If complete amputation:
   • Place direct pressure on wound site.
   • Place indirect pressure on nearby arteries.
   • Locate severed body part.
   • Do not wash severed part.
   • Wrap part in clean (preferably sterile) dressing.
   • Place part in plastic airtight bag and lay bag in pan of water kept cool with ice packs. Do not put part directly on ice.
   • Give part to EMS personnel.
7. Call parent.

BEE and WASP STINGS

NOTE: Individuals with known allergy should have an Emergency Care Plan.

SIGNS AND SYMPTOMS

♦ Local Reaction ƒ Intense pain ƒ A whitish bump with a red dot in its center ƒ Swelling at the site of the sting ♦ Anaphylactic Reaction (see Allergic Reaction ) ƒ Apprehension ƒ Rash (particularly on face) ƒ Swelling of face and tongue ƒ Difficulty breathing, wheezing, gurgling, high pitched sounds ƒ Skin feels moist and or appears flushed, pale or bluish ƒ Rapid, weak pulse TREATMENT

1. If necessary, call 911 (see Allergic Reaction ).
2. If individual is known to have allergies to bee/wasp stings, consult the written emergency action plan on file and proceed with physician’s recommendations.
3. If necessary, certified personnel start CPR (see CPR ).
4. Remove stinger as quickly as possible.
5. Apply cold compress to reduce pain and swelling.
6. If the sting is on the arm or leg, keep extremity below the level of the heart.
7. Call Poison Center for additional treatment advice.
8. Call parent.

BITES

NOTE: For all bites, if there is any history of allergic reaction or if any of the following signs and symptoms are present, call 911.

SIGNS AND SYMPTOMS OF ALLERGIC REACTION

♦ Hives (raised blotches on the skin)

♦ Itching and swelling involving skin, nose, or eyes

♦ Throat tightness, swelling inside the mouth, metallic taste, and hoarseness

♦ Wheezing (high-pitched, whistling sound), difficulty breathing, chest tightness

♦ Person appears in shock

♦ Weakness, dizziness, headache, fainting

♦ Altered state of consciousness

♦ Nausea and vomiting

♦ Chills

♦ Fever

♦ Muscle cramps, joint pain

♦ Rapid pulse

ANIMAL BITE

TREATMENT

1. Wear gloves. Use Standard Precautions (see Standard Precautions ).
2. Remove rings and bracelets from bitten extremity.
3. Cleanse wound thoroughly with soap and water for 5 minutes.
4. Cover wound with clean bandage (preferably sterile).
5. Determine individual's tetanus immunization status.
6. If injury not severe, call parent and recommend contact with health provider.
7. Call Animal Control.
8. Report all animal bites to the local health department.

HUMAN BITE

TREATMENT

1. Wear gloves. Use Standard Precautions (see Standard Precautions ).
2. Remove rings and bracelets from bitten extremity.
3. Cleanse wound thoroughly with soap and water for 5 minutes.
4. Cover wound with clean bandage (preferably sterile).
5. Determine individual's tetanus immunization status.
6. Assess Hepatitis B vaccination status of involved individual.
7. Call parent and recommend contact with health provider.

BLEEDING

INTERNAL

NOTE: Internal bleeding is potentially life threatening.

SIGNS AND SYMPTOMS

♦ Bruising, swelling, or pain over a vital organ

♦ Painful, swollen extremity

♦ Bleeding from mouth, vagina, rectum, or other opening

♦ Tender, rigid, distended abdomen

♦ Signs of shock (see Shock )

TREATMENT

1. Determine cause of injury.
2. Call 911.
3. Wear gloves. Use Standard Precautions (see Standard Precautions ).
4. Maintain open airway. If necessary, certified personnel start CPR (see CPR ).
5. Control bleeding by applying pressure.
6. Monitor for signs and symptoms of shock (see Shock ).
7. If vomiting, lay individual on side.
8. Keep individual warm, comfortable, and calm.
9. Call parent.

SEVERE BLEEDING FROM A WOUND

TREATMENT

1. Determine cause of injury.
2. Call 911.
3. Wear gloves, mask, and protective eyewear. Use Standard Precautions (see Standard Precautions ).
4. Control bleeding by placing a clean covering (preferably sterile) over wound and applying direct pressure.
5. If injury does not appear to involve broken bone, elevate injured area above the level of the heart.
6. If necessary, add more dressings. Do not remove previous dressing. Secure dressing in place.
7. In case of amputation, see Amputation.
8. Treat for shock (see Shock ).
9. If necessary, certified personnel should start CPR (see CPR ).
10. Call parent.

BLISTERS

TREATMENT

1. Wear gloves. Use Standard Precautions (see Standard Precautions ).
2. Cleanse area with soap and water. Avoid breaking blister.
3. Apply a dry bandage.
4. If blister is broken, wash with soap and water and apply dry bandage.
5. If blistered area is red, swollen, and/or painful, call parent and recommend follow-up medical care.

3. Keep individual quiet, still, and warm.
4. Unless there is danger to life, do not move from place of accident until affected part has been properly supported or immobilized.
5. Immobilize extremity by supporting joints on either side of injury with pillows, blankets, broomstick, uninjured limb, etc., to reduce pain.
6. Assess and treat for shock (see Shock ).
7. If necessary, certified personnel start CPR (see CPR ).
8. Apply ice/cold pack for 15 minutes. ( Do not apply ice directly to skin.)
9. Call parent.

OPEN FRACTURE

NOTE: An open fracture is the complete break, crack, or chip in a bone in which the skin is broken. There is the risk of infection and severe bleeding with open fractures. Fractures may be potentially life threatening.

SIGNS AND SYMPTOMS

♦ Possible deformity or angulation

♦ Pain and tenderness

♦ Bone fragments sticking out of the wound

♦ Inability to use the affected part normally

♦ Bleeding

♦ Injured area is cold and numb

TREATMENT

1. Determine cause of injury.
2. Call 911.
3. Wear gloves. Use Standard Precautions (see Standard Precautions ).
4. Keep individual quiet, still, and warm.
5. Control bleeding by placing a clean cloth (preferably sterile) over the wound and applying pressure on a nearby artery.
6. Assess and treat for shock (see Shock ).
7. If necessary, certified personnel start CPR (see CPR ).
8. Unless there is danger to life, do not move from place of accident until affected limb has been properly supported or immobilized.
9. Immobilize extremity to reduce pain. Support with pillows, blankets, broomstick, uninjured limb, etc.
10. Apply ice/cold pack for 15 minutes. ( Do not apply ice directly to skin.)
11. Call parent.

BRUISES

SIGNS AND SYMPTOMS

♦ Skin appears deep red, purple, and/or bluish

♦ Swelling

♦ Pain

TREATMENT

1. Rest affected part.
2. If skin is broken, wear gloves. Use Standard Precautions (see Standard Precautions and Wounds ).
3. Apply cold compresses or ice/cold packs immediately. ( Do not apply ice directly to skin.)
4. If there is swelling or severe pain, call parent and recommend contact with health provider.