Download special health care needs

SPECIAL HEALTH CARE NEEDS
PARAPROFESSIONAL TRAINING
HANDOUTS
OVERHEAD/ HANDOUT H1
PARAPROFESSIONAL COMPETENCIES
Children with Special Health Care Needs
1.
Understanding the legal basis for providing safe and health-related services to
students.
2.
Knowledge about prevention measures, medication administration,
and treatment procedures to meet the special health care needs of
students.
3. Ability to use infection control and universal precautions, basic first aid, and proper
lifting, carrying, and transferring techniques.
4. Knowledge about the use and maintenance of assistive technology and adaptive
equipment.
5. Ability to collect, report and document data related to the health care of students.
6. Ability to make educational environments barrier-free and accessible.
7. Knowledge about the development and implementation of emergency and disaster
plans specific for students with special health care needs.
8. Knowledge about the safe transportation of students with special health care needs.
9. Ability to advocate for oneself in an appropriate manner which ensures the safety of
the paraprofessional and student.
10. Knowledge about the confidentiality of student information.
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OVERHEAD/HANDOUT H2
TERMINOLOGY
Students with Special Health Care Needs
Chronically Ill
Medically Fragile
Technology Dependent
Other Health Impairments
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HANDOUT H3
SPECIAL HEALTH CARE TERMS
Choose from the following terms.
A.
B.
C.
D.
E.
Students with special health care needs
Chronically Ill
Medically fragile
Technology dependent
Other health impairment
_____ Term referring to a student with a condition that is long-term and results in
decreased strength, vitality, and alertness. Conditions may include: asthma, diabetes,
rheumatoid arthritis, cancer, or epilepsy.
_____ Term referring to a student who requires a medical or mechanical device to
compensate for the loss of a vital body function including mechanical ventilation,
tracheotomies oxygen, and respirator.
_____ Student’s condition such that the absence of immediate, health-related, specialty
skilled care threatens his/her life or health.
_____ Term used in the educational setting to identify a student who requires special
education and related services because of a health condition resulting in limited
strength, vitality, or alertness due to chronic or acute health problems such as a heart
condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle-cell anemia,
hemophilia, epilepsy, lead poisoning, leukemia or diabetes that adversely affects a
child’s educational performance.
_____Students requiring and individualized health care intervention to enables them to
participate in the educational process.
4
HANDOUT H4
(1 of 5 pages)
GLOSSARY OF TERMS
Allergic reactions result from abnormal sensitivity to foreign material - for example, dust, pollen, insect stings
and certain foods. In severe allergic reactions, symptoms may include: swelling, flushing and itching skin;
irritability; tightness of the throat; rash; breathing difficulty; seizures; and loss of consciousness.
Allergens are materials that, for certain people, cause asthma attacks or allergic reactions. Dust, pollens, dust
mites, animal dander, medications, molds and food can all be allergens.
Ambulatory is a term referring to the ability to walk.
Anaphylactic reaction - see allergic reactions.
Artificial respiration is a means of inducing breathing when it has stopped. A common technique for artificial
respiration is “mouth to mouth” resuscitation, where air is breathed into the mouth and lungs and then allowed
to escape.
An audiometer is an instrument for testing hearing; the test itself is called audiometry.
Autonomic hyperreflexia is a sudden increase in blood pressure associated with certain kinds of spinal cord
injury.
The bladder is the organ that acts as a receptacle for urine.
Body alignment refers to placing the body in correct anatomical position.
Bronchitis is an inflammation of bronchial membranes of the lungs.
Cardiac arrest (also known as cardiopulmonary arrest) occurs when the heart suddenly stops beating.
Cardiopulmonary resuscitation (CPR) refers to the rapid sequence of actions performed in an emergency to
stimulate breathing and blood circulation.
A catheter is a tube for draining or injecting fluids.
Cerebral palsy is composed of a group of disorders resulting from central nervous system damage before,
during, or after birth. Although nonprogressive, these disorders may become more obvious as the infant grows
older.
Clean technique refers to procedures that reduce the number of disease-causing agents, such as bacteria,
viruses and other microorganisms. In contrast, sterile technique destroys all these agents.
A colostomy is an incision of the colon that makes a permanent opening (stoma) in the abdomen wall. This
opening is used for eliminating body waste. In this surgical procedure, part of the colon is removed or
disconnected and all or part of the rectum may be removed.
5
HANDOUT H4
(2 of 5 pages)
Conductive hearing loss is an interference with sound transmission in the middle part of the ear. Causes
include wax accumulation and chronic ear infections.
Congenital hip dysplasia is an abnormality of the hip joint present from birth. It is the most common disorder
that affects hip joints of children under age 3. Congenital hip dislocation can cause abnormal joint development
and permanent disability.
CPR - see cardiopulmonary resuscitation.
Cystic fibrosis is a hereditary disease of infants, children and young adults that causes abnormal gland
secretions. This condition can be associated with lung disease, malnutrition and diseases of the liver.
Digital stimulation is done to relax the sphincter and stimulate a bowel movement. It is done by inserting a
gloved finger about 1 inch into the rectum.
Distal movement indicates movement situated away from the center of the body of away from the point of
origin.
Duchenne’s muscular dystrophy is progressive muscle deterioration that usually starts between ages 3 and 5.
It begins with leg weakness and progresses to generalized muscle weakness.
Emphysema is a disorder of the lung that causes breathing problems and destruction of lung tissue.
Encopresis is the incontinence of feces not due to organic defect or disease.
Etiology refers to the causes of a specific condition.
An external cannula, used in metal tracheostomy tubes, holds the airway open when the inner cannula is
removed for cleaning.
Gastrostomy is surgical formation of an opening through the abdominal wall into the stomach.
Hearing impairment is any condition that interferes with the transmission or perception of sound waves.
In an ileostomy, the entire colon is removed, and a portion of the ileum or small intestine is brought through the
abdominal wall for elimination of body waste.
An inner cannula is used in metal tracheostomy tubes. It fits inside a larger tube (called the external cannula).
The inner cannula acts as a lining that can be removed for cleaning while the external cannula holds the airway
open.
The intake and output ratio (I:O ratio) is a measure of how long an inhalation lasts, as compared to an
exhalation. To get the feel of another person’s I:O ratio, breathe in and out with the person. In a normal
breathing pattern, inhalation lasts 50 percent longer than exhalation - and I:O ratio of 1.5:1.
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HANDOUT H4
(3 of 5 pages)
Labia minora are two folds of tissue lying on either side of the vaginal opening and forming the borders of the
vulva.
To lavage is to irrigate or wash out an organ or body cavity.
Legg Perthes disease is a usually one-sided condition in which changes take place in the head of the thighbone.
It occurs most frequently in boys aged 4 to 10 and tends to occur in families.
Manual evacuation is performed by inserting a gloved finger into the rectum to remove feces.
The meatus is the external opening of the urethra.
Myelomeningocele is another name for spina bifida, a defect in the walls of the spinal canal.
Nasogastric tube means relating to, being, or performed by intubation of the stomach by way of the nasal
passages.
An obturator is a tube that guides the insertion of a tracheostomy tube. The obturator fits inside the
tracheostomy tube. Once the tracheostomy tube is in place, the obturator is removed. This may also refer to an
object used to close an opening in the palate.
Orthopedics is a branch of medicine that aims to correct or prevent irregularities in bone and skeleton structure.
An orthosis is a mechanical appliance used to provide support or stability to a limb or joint.
An ostomy is a surgical procedure that creates an opening (stoma) in the gastrointestinal or urinary systems. It
allows for the elimination of body wastes.
Otitis media is an inflammation of the middle ear (acute otitis media). Prolonged inflammation (chronic otitis
media) can cause prolonged fluid accumulation in the middle ear, leading to scarring, eardrum damage or
hearing loss.
An otoscope is an instrument used to visualize the ear canal and eardrum.
Paraplegia is a paralysis of the lower part of the body and both legs.
Percussion is a technique used in respiratory therapy to loosen secretions from the lungs. It is done by clapping
with cupped hands on the rib cage.
The perineum is the mass of skin and muscle located between the vulva and anus in the female and between the
scrotum and anus in the male.
Postural drainage involves putting a person in certain positions that use gravity to drain secretions from the
lungs.
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HANDOUT H4
(4 of 5 pages)
Pressure sores are the breakdown of skin caused by pressure from the body itself when it has remained
immobile for an extended period of time.
A prosthesis is an artificial replacement for a missing body part.
Retractions are the sucking-in of the soft tissues in the chest that occur with breathing difficulty. These are
first seen below the rib cage and in the soft part of the neck above the breastbone, as well as in the soft tissue
over the collarbone.
Sensorineural hearing loss is a loss of function in the inner ear or the path from the ear to the brain. Causes
include birth defects, some diseases, drugs, and prolonged exposure to noise.
Spasticity is increase tension of muscles causing stiff and awkward movements.
Spirometer is an instrument for measuring the air entering and leaving the lungs.
Sterile technique refers to procedures that destroy all disease-causing agents, such as bacteria, viruses, and
other microorganisms. In contract, clean technique reduces the number of these agents.
A stoma is an artificially created opening between two passages or between a passage and the body’s surface.
Suctioning is a procedure done to loosen secretions that accumulate in the airway or in a tracheostomy tube. It
consists of inserting a small catheter in the airway or tube. The catheter, in turn, is connected to a machine that
helps drain the secretions.
Supportive sitting devices are used by people with physical disabilities that make standing difficult. Examples
include standers, parapodiums, and crutchless standing orthoses.
Syntax is the way in which words are put together to form phrases and sentences.
Tactile deficit refers to any condition that interferes with the sense of touch. Examples are hyperesthesia
(exaggerated sensitivity to touch) and hypoesthesia (reduced sensitivity to touch).
Trachea is another name for the windpipe, the passageway that carries air from the nose and mouth into the
lungs.
A tracheostomy keeps a person breathing when a chronic health condition makes breathing through the nose,
mouth, and airway difficult. In this surgical procedure, an incision is made through the neck into the windpipe
(trachea). A tube is then inserted into the incision.
A tympanometer is an instrument for testing eardrum mobility
The urethra is a canal for discharge of urine, extending from the bladder to the outside of the body. (See
meatus.)
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HANDOUT H4
(5 of 5 pages)
A urostomy is a surgical procedure where the bladder is removed or bypassed and urine is directed to an
external pouch.
Vibration is a technique used in respiratory therapy to help loosen secretions. It is done by firmly pressing
your hands against the wall of another person’s chest, then tensing your arms and shoulders to send fine
vibrations through the chest.
Wheezing is the high-pithed whistling sound that occurs when air flows through narrowed bronchial tubes.
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OVERHEAD/HANDOUT H5
SPECIAL HEALTH CARE TEAM:
DETERMINING NEED FOR HEALTH CARE PLAN
Does the student….
1. Have a medical diagnosis of a chronic health problem?
2. Receive medical treatment during or outside of school day?
3. Experience frequent absences due to illness?
4. Experience frequent hospitalizations?
5. Receive ongoing medication for health problems?
6. Require environmental adjustments to classroom?
7. Require adjustments of the classroom schedule due to a health condition?
8. Require major safety consideration?
10
OVERHEAD/HANDOUT H6
COMPONENTS OF A HEALTH CARE PLAN
REQUIRED COMPONENTS:




Brief medical history
Results of assessment of medical problems
Physician’s order for procedures
Standards for implementation of care actions and procedures
1. Care goals
2. Person responsible for the care action/procedure
3. Identification of equipment to be used
4. Person responsible for equipment maintenance
5. Supervisor of care action/procedure implementation
6. Authorized persons for performing care actions/procedures
 Prescription for medication and procedures administration
 Physician ordered diet
 Transportation plan/procedures
 Classroom/school modifications (including adaptive physical education)
 Equipment and supplies provided by parent
 Equipment and supplies provide by school
 Emergency procedures
 Safety measures
 Contingency plans: emergency, transportation, and training
 Substitute/backup staff
 Authorizations/signatures (all parties including parent/guardian)
 Effective dates
OPTIONAL COMPONENTS:






Student and family strengths
Academic/achievement profile
Specialized training/education for staff
Student participation in procedures
Possible problems to be expected
Other relevant information
11
HANDOUT H7
(1 0f 3)
Sample
Health Care Plan
Student=s Name:
Date of Birth:
Diagnosis:
Handicapping
Condition:
School:
Grade:
Nurse:
Therapist(s):
Teacher:
Doctor=s
Name & Telephone #:
Date:
Potential Needs
Nursing
Assessment/Diagnosis &
Goal
Nursing Instructions
Equipment Needed: where
& by whom provided
I. General
A. Medical
B. Allergies
C. Dental
II. Medication
III. Communication
IV. Eating &
Drinking
V. Elimination
A. Bladder
B. Bowel
VI. Mobility &
Coordination
A. Posturing
B. Ambulation
12
VII. Equipment
A. Wheelchairs
B. Adaptive
C. Modifications
VIII. Academic &
Classroom Needs
IX. Physical
Education
Adaptations
X. Physical &
Emotional Needs
(therapy )
Additional Comments:
___________________________________
Parent=s Signature
___________________________________
Nurse=s Signature
___________________________________
Staff (Name & Title)
___________________________________
Staff (Name & Title)
13
HANDOUT H7
(3 of 3)
STUDENTS WITH SPECIAL HEALTH CARE NEEDS
EMERGENCY PLAN
Student ___________________________________________ Date________________
Preferred hospital in case of emergency_______________________________________
Physician__________________________________ Phone #______________________
STUDENT – SPECIFIC EMERGENCIES
If you see this
Do this
IF AN EMERGENCY OCCURS:
1. If the emergency is life-threatening, immediately call 9-1-1.
2. Stay with the student or designate another adult to do so.
3. Call or designate someone to call the principal and/or health care coordinator.
a. State who you are.
b. State where you are.
c. State problem.
4. If the school liaison is unavailable, the following staff members are trained to deal with an emergency,
and to initiate the appropriate procedures:
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HANDOUT H8
(1 of 6)
STUDENTS WITH SPECIAL HEALTH CARE NEEDS
HEALTH CARE PLAN
Please attach forms if room is insufficient.
Student Identification
Student Name __________________________________Date of Birth _______________
Background Information – Nursing Assessment (complete all necessary sections)
Brief Medical History / Specific Health Care (attach all additional information)
Psychosocial Concerns (attach all additional information)
Student and Family Strengths (attach all additional information)
Academic / Achievement Profile (attach all additional information)
Goals and Actions
Skills Checklist (attach all additional information)
Procedures and interventions (student specific)
Procedure
Administered by
Equipment
Maintained by
Auth/trained by
1.
2.
3.
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HANDOUT H8
(2 of 6)
Medications (attach medication guideline and administration log)
Diet (attach any additional information)
Transportation (attach any additional information)
Classroom School Modifications (including adaptive PE)
Equipment and Supplies
___Parent Provided ___District Provided ___None
List Equipment
Training / Education (staff, CPR, Skills checklist) (peers, students)
Student Participation in Procedures (student skills checklist) (attach additional information)
Safety Measures (attach any additional information)
Contingencies
___Emergency Plan attached ___Transportation Plan attached ___Training Plan Attached
Substitute / Backup Staff (when primary staff is not available)
Possible Problems to be expected
16
HANDOUT H8
(3 of 6)
Authorizations
I have participated in the development of the Health Care Plan and agree with the content
Parent
Date
Teacher
Date
School Liaison
Date
Teacher
Date
School Nurse
Date
Other
Date
LEA Representative
Date
Other
Date
Physician: order for medications/specialized procedure (if pertinent)
Signature________________________________________Date____________________
Administrative Comments
Effective Beginning Date _______________Date Health Care Checklist Completed___________
IEP if appropriate ________________________________Date___________________________
Next Review Date _____________________________________
17
HANDOUT H8
(4 of 6)
Students with Special Health Care Needs
HEALTH CARE PLAN LOG
Student Name _____________________________Date of Birth ____________________
Date/Time
Procedure Notes
Observations
Name
18
HANDOUT H8
(5 of 6)
Students with Special Health Care Needs
EMERCENCY PLAN
Student ____________________________________Date_________________________
Preferred hospital in case of emergency________________________________________
Physician ______________________________Phone #___________________________
STUDENT SPECIFIC EMERGENCIES
If you see this
Do this
If An Emergency Occurs:
1. If the emergency is life-threatening, immediately call 9-1-1.
2. State with student or designate another adult to do so.
3. Call or designate someone to call the principal and/or health care coordinator.
a. State who you are
b. State where you are
c. State problem
4. If the school liaison is unavailable, the following staff members are trained to deal with an
emergency, and to initiate the appropriate procedures:
Salmon - 1992
19
HANDOUT H8
(6 of 6)
Students with Special Health Care Needs
TRANSPORTATION PLAN
Bus Number _________
a.m.
p.m.
Bus Driver______________________________________
Student’s Name__________________________________
Student Photo
Address________________________________________
________________________________________
Home Phone ____________________________________
Father’s Work Phone _____________________________
Mother’s Work Phone ____________________________
Babysitter’s Name _______________________________Phone____________________
Address_________________________________________________________________
School_________________________________Teacher___________________________
Disability/Diagnosis_______________________________________________________
Medications_____________________________________________________________
Side Effects_____________________________________________________________
1. Mode of transportation on bus
___Wheelchair
___Car Seat
2. Walks up bus stairs independently
___Seat Belt
___yes
___Chest Harness
___No
3. Student method of communication________________________________________
4. Behavioral difficulties student displays____________________________________
20
5. Equipment that must be transported on bus (including oxygen, life-sustaining equipment,
wheelchair equipment, climate control, etc)
_____________________________________________________________
____________________________________________________________
6. Procedures for failure of life-sustaining equipment (if any) ___________________
__________________________________________________________________
__________________________________________________________________
7. Wheelchair restraint checklist (check all that apply)
Seat belt
___on ___off
___Headrest up
Chest harness
___on ___off
___Abductor in place
Wheelchair brakes
___on ___off
___Other________________
Tray
___on ___off
________________________
8. Positioning and handling requirements ______________________________________
_____________________________________________________________________
9. Substitute bus drivers
Name __________________________________Phone________________________
Name__________________________________Phone_________________________
10. The bus driver and substitute(s) received training regarding the student’s special needs.
____yes
____no
Date trained___________________
Student Specific Emergencies
If you see this
Do this
21
HANDOUT H10
(1 OF 2)
CASE STUDY
A meeting was held to develop a Health Care Plan for Jane D. The school nurse, paraprofessional, parent,
student, and teacher discussed the day-to-day medical and personal health care procedures for Jane.
Jane is a 14 year old with cerebral palsy. She is non-ambulatory and non-verbal with a tracheotomy and
Gastrostomy. With these conditions, she requires medical care and a plan that will include the following:





Protocol for tracheotomy care and suctioning
Protocol for Gastrostomy care
Mobility and an exercise program
Augmentative communication device
Medication for stimulation of food digestion
In addition, Jane’s personal care needs to be addressed in her health care plan:






Toileting (brief changes)
Range of motion exercises
Washing hands and body, as needed
Positioning in a wheelchair
Feeding (via gastric tube)
Care of body excretions (drooling, menstrual, tears, and others)
Documentation including procedures for keeping a daily log need to be identified in the Health Care Plan.
After the daily care procedures have been described, Susan the paraprofessional indicates to the registered nurse
that she will need intensive instruction on all aspects of tracheotomy care. The nurse says she will demonstrate
the care on the student. The nurse reviews the nursing goals to ensure proper air flow through the trachea. The
team’s decision for Susan included the following goals:
Nursing goals:
1. The student’s lungs will receive adequate oxygen
2. The student will participate as fully as possible in all school activities
3. The student will achieve maximum independence
4. The student’s psycho-social needs will be met
With the student and parent’s assistance the nurse describes the reason the student has the trachea tube and
identifies the parts of the trach with information on how it assists the students’ breathing. The paraprofessional
asks, “What needs to be done and how do I know when to do it?” With regard to suctioning, the nurse and
parent explain this student’s normal reactions and body language which indicates need for suctioning. The
nurse explains when the cannula would need to be changed and demonstrates the suctioning and cannula
procedures for the
22
HANDOUT H10
(2 OF 2)
paraprofessional. The paraprofessional then performs these procedures with the help of the nurse until the nurse
is confident that Susan, The health care paraprofessional, can perform these procedures. At that point the nurse
and the paraprofessional sign Susan (the paraprofessional’s) Personal Training Plan for Suctioning and Cannula
Procedures Training.
Susan’s Personal Training Plan verifies that she has been trained on the Protocols for Gastrostomy and Mobility
& Exercise Procedures. She and the nurse discuss paraprofessional’s additional training needs for taking care
of this student. Susan has not previously handled a non-verbal student with an augmentative device. The nurse
made arrangements with the speech pathologist to help the students and parent show Susan how Jane
communicates with her device. The Speech Pathologist helps Susan learn to program the device to support Jane
in the classroom. The nurse also shares tips on how to make this device available for the student and Jane’s
non-verbal mannerisms that show emotions and expressions to make the paraprofessional more sensitive to
Jane’s needs. The paraprofessional is responsible for activating the augmentative device for the student’s
communication throughout the day.
Susan and the nurse discussed the administration of medicine and her responsibilities for personal care as
outlined on the health care plan. The transition meeting concludes with all parties signing off on the plan for
the first week of school. The nurse and Susan decide on a routine method for feedback and documentation by
using a daily log sheet/checklist.
Susan now takes time to visit one-on-one with Jane and tell her she will look forward to meeting the bus on
Monday morning.
New Hampshire Department of Education, Special Education Bureau (1990). A compilation of information and
procedures for meeting special physical health needs of students.
23
OVERHEAD/HANDOUT H12
(1 OF 2)
SPECIAL HEALTH CARE TEAM
STUDENT NEEDS QUESTIONNAIRE
YES
NO
1. Does the student have a health condition which will require
inservice training?
___
___
2. Does the student have a health condition which will require
changes or modifications outside the classroom (lunchroom,
playground, gym, bus)?
___
___
3. Does the student have a health condition which will require
changes in or modification of the classroom environment?
___
___
4. Does the student have a health condition which will require
safety precautions on the bus, playground, gym, etc.?
___
___
5. Does the student have a health condition which would result
in pain?
___
___
6. Does the student have a health condition which would require
a special diet?
___
___
7. Does the student have a health condition which will require
medication?
___
___
8. Does the student have a health condition which will require
rehabilitative treatment?
___
___
9. Does the student have a health condition which will require
regular contact with a doctor?
___
___
10. Does the student have a health condition which will require
training someone else (fellow student, classroom teacher,
paraprofessional)?
___
___
11. Will the student require an adapted health education program
___
___
12. Will the student require special equipment for learning because
of a health problem?
___
___
13. Will the student require assistance of a personal nature (toileting,
feeding, positioning)?
___
___
14. Does the student have to take medication?
___
___
24
OVERHEAD/HANDOUT H12
(2 OF 2)
Yes
No
15. Does the student require health maintenance care (immunizations,
exercise, dental care)?
___
___
16. Does the student require health related procedures?
___
___
17. Are there any other needs?
___
___
What are they?____________________________________________________________
_________________________________________________________________________
New Hampshire Department of Education, Special Education Bureau (1990). A compilation of information and
procedures for meeting special physical health needs of students.
25
HANDOUT H13
UNIVERSAL
PRECAUTIONS
Universal precautions should be used in the care of all patients especially those in emergency
situations.
Appropriate barrier precautions should be used to prevent skin and mucous membranes (eyes, nose,
mouth) from coming in contact with the other person=s blood or body fluids.
1.
Latex/vinyl gloves should be worn. (vinyl gloves if latex sensitive)
2.
Gloves should be changed after contact with each patient.
3.
Masks should be worn to prevent exposure of nose and mouth.
4.
Protective eye wear may be worn.
5.
Hands and other skin surfaces should be washed immediately and thoroughly if contaminated
with blood or other body fluid.
6.
Remove gloves in a safe manner that will not contaminate you with fluids on gloves.
7.
Wash hands after gloves are removed.
8.
Gloves should also be worn during any cleaning procedure.
*****If CPR is performed, the risk of transmission is reduced by using mouth-to-mouth face shield or
masks.
Cleaning and Decontaminating Spills of Blood or Other Body Fluids
1.
Gloves should be worn during the cleaning and decontaminating procedures.
2.
Chemical germicides that are approved for use as Ahospital disinfectants@ can be used to
decontaminate spills of blood and other body fluids.
3.
Bleach and water combinations mixed at 1/4 cup bleach to 1 gallon tap water can be used to
decontaminate spills of blood and other body fluids.
4.
Use absorbent material to soak up fluid. Then spray or pour Adisinfectant@ on area or object,
wipe dry. Repeat, if necessary.
5.
Place disposable gloves and absorbent material in plastic garbage bag and tie bag off. Double
bag, if necessary.
Recommended Contents of Body Spills Kit
Spray Bottle Containing Germicidal Cleaner
(Mix 1/4 oz. Germicidal Cleaner to 32 oz. Water)
Paper Towels
Latex/Vinyl Gloves
Brush or Broom
Plastic Bags
Dust Pan
Moisture Absorbing Agent
(use minimal amount)
“Crash Course in First Responder”
26
OVERHEAD/HANDOUT H14
WHEN SHOULD WE WASH OUR HANDS?
Before & After Contact with Student
Before & After Contact with Equipment
After Using Gloves
27
HANDOUT H15
GUIDELINES FOR THE HANDLING OF BODY FLUIDS
IN THE SCHOOL ENVIRONMENT
I. Contact with body fluids
A. If possible, avoid contact with body fluids. Allow student or staff to clean him or herself. If this is not
possible, a barrier must be worn when direct hand contact with the body fluid is anticipated (e.g., changing
diapers, cleaning wounds, handling soiled clothing, or cleaning mops used for vomit, blood, urine, or
stool). The barrier should be discarded in a double lined gab or trash container. Hands must always bed
washed vigorously with soap and water under a stream of running water for 15-20 seconds. Rinse under
running water. Use a paper towel to turn off faucet. Dry hands thoroughly with a paper towel.
B. Clothing and other nondisposable items which are soaked with body fluids should be rinsed and placed in
plastic bags. If pre-soaking is required, use gloves to rinse or soak the item in cold water prior to bagging.
Clothes contaminated with body fluids should be washed separately from other items. Wash as usual. If
the item is bleachable, add ½ cup of bleach to the wash cycle. If the item cannot be bleached, add ½ cu
non-chlorine bleach to the wash cycle.
C. Rugs which are contaminated by body fluids may be cleaned by applying a sanitary absorbent agent.
Allow the agent to dry according to the directions, then vacuum. If needed, mechanically remove with a
dust pan and broom, then apply rug shampoo (containing a germicidal detergent) with a brush and revacuum.
II. Disinfection/cleaning of hard surfaces and care equipment
A. Disinfectants should be used to clean surfaces contaminated with body fluids. These disinfectants
should kill vegetative bacteria, fungi, tubercle bacillus, and virus. These disinfectants should be
registered with the U.S. Environmental Protection Agency for use as a disinfectant in medical facilities
and hospitals.
B. Remove soil from surface, then apply disinfectant.
C. Mops should be soaked in the disinfectant after use, then washed in hot water prior to rinsing. Gloves
should be worn.
D. Disposable equipment should be double bagged and placed in trash receptacle.
E. Nondisposable equipment (dust pans, buckets) should be rinsed thoroughly in the disinfectant.
F. Discard used solution promptly in drain pipe; rinse pail or container.
G. Gloves are removed after all clean up is completed and are placed in a double trash bag.
Arkansas Department of Education, Special Education Section. (1996). Resource guide: Developing school
policies on children with special health care needs.
28
OVERHEAD/HANDOUT H16
Disposable Gloves Procedures
1. Maintain supply of latex and/or vinyl disposable gloves
of various sixes in accessible locations.
2. Do not reuse gloves. Use fresh gloves for each student
and task.
3. Slip each hand into a clean glove, pulling it snugly over
the fingers for a good fit. Pull glove over wrist as far as
it will go.
4. Remove first glove by turning it inside out as it is pulled
over the hand. Grasp the glove in the remaining gloved
hand.
5. During removal of second glove, avoid touching the
outer surface. Slip fingers of the un-gloved hand under
the glove and pull it inside out, effectively sealing the
first glove inside.
6. Dispose of the used gloves in a lined waste container.
7. Wash hands thoroughly, following hand washing
procedure.
29
OVERHEAD/HANDOUT H17
Basic Guideline in Preventing
Exposure & Transmission of Infectious Disease
Avoid direct contact with body fluids
Encourage student to do own care
Wear gloves
Have first aid & other supplies available
Playground staff to carry first aid supplies
Do not eat or touch your mouth or eyes while giving first aid
30
HANDOUT H18
CRASH
COURSE
IN
FIRST
RESPONDER
Alysia Weiss-Cover, B.S.E., M.Ed.
Health Education Consultant
Ann Davis, B.S.E., M.Ed.
Special Education, Transition
31
Table of Contents
First Aid Kit ..................................................................................................... 1
General Rules of Thumb. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
In an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pressure Points ............................................................................................ . . 4
Fainting, Seizures, Diabetes ........................................................................... 5
Diabetic Emergencies ...................................................................................... 6
Shock ............................................................................................................... 7
Head and Spinal Injuries ................................................................................. 8
Bites ................................................................................................................. 9
Dental Injuries ............................................................................................... 10
Eye injuries .................................................................................................. . 10
Choking. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12
Heat related emergencies. . . . . . . . . . . . . . . . 13
References made from Brady First Responder
ii
First Aid Kit
YOU MAY WANT SOME OF THESE ITEMS IN YOUR FIRST AID KIT:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Mild soap
Band aids
Cotton balls
Sterile gauze dressing
Latex gloves and other barrier equipment
Adhesive tape
Small scissors
Syrup of Ipecac (keep an eye on the expiration date)
Ace bandage
Triangular bandages
Disposable instant cold packs
Tweezers
Roller bandages
Any other supplies needed to conform to written medical policies
NOTE:
Ointments, :first aid sprays, or other medications should not be used without the written signed
authorization of a physician or parent. Most of these products are of no proved value in preventing
infection or promoting healing, and they may cause allergic reactions or tissue damage in some
cases.
General Rules of Thumb...
Rules
ACTUAL CONSENT
If patient is conscious with clear mind, ask if you can give care.
You must tell the patient:
a. your level of training
b. why you think care is needed
c. what you are going to do
d. if there is any risk in the care you give or if there is any risk in refusing
IMPLIED CONSENT
When the adult is unable to give actual consent, the law assumes they want care.
MINOR’S CONSENT
Parents cannot be reached quickly, implied consent is used
ABANDONMENT
If you volunteer to help someone, you must stay with them until someone else that is more qualified
or equally as qualified gets to you. DO NOT LEAVE!
NEGLIGENCE
When you give care and further unnecessary injury results.
IN GIVING CARE...
PRIMARY SURVEY: Three important things to look for FIRST
1. Respiration: are they breathing?
2. Circulation: is there a pulse (carotid or radial or other?)
3. Bleeding: any major bleeding? control it!!
Rules to follow...
1. Note state of consciousness. Keep patient conscious!
2. Be alert of all changes in a patients condition
3. Watch for skin color changes- fingertips and lips are first to show color change
4. Note if something looks wrong- IE: swelling
5. Assume spinal injuries!!! DO NOT MOVE UNLESS PERSON IS IN IMMINENT DANGER
OF FATAL INJURY.
2
IN AN EMERGENCY . . .
Controlling Bleeding
1.
2.
3.
4.
Expose entire wound and apply direct pressure--keep adding towels if needed
Elevate the wound
Apply pressure to a pressure point if bleeding won’t stop
EMERGENCY ONLY: apply a tourniquet to closest pressure point
Nose Bleeds
1. Pinch nostrils

If head injury is suspected, hold dressing to nose; DO NOT pinch nostrils
Broken Bones
1. Splint- using what is available, IE: books, umbrellas, boards, etc.
2. Using material, secure splint to bone--DO NOT cut off blood flow
3. Immobilize until medical help
Puncture Wounds
1.
2.
3.
4.
Look for exit wound
DO NOT remove the object, unless it is in the cheek
Expose the entire wound and control bleeding AROUND the site--not on it
Immobilize the object so it will NOT tear, using bulky dressing
Avulsions--flaps of skin torn loose
1. Clean wound area under the skin with peroxide
2. Fold skin back over
3. Seek medical help if necessary
Amputations--body parts separated from the body
1. Gather and save parts in a plastic bag, keeping the parts COOL--not cold
2. Apply direct pressure to wound to control bleeding
3. Seek medical help
Protruding Organs--organs outside of the body
1. Cover organs and body area with plastic or foil
2. Overlap with a towel to keep in heat
3. Don’t try to shove back into the body; don’t feed the patient
Burns
1.
2.
3.
4.
Minor: rinse under cold water--apply clean dressing
Major: wrap loosely with clean dressing, seek medical help NO COLD WATER
Chemical: flood with water for twenty minutes
Electrical: watch pulse, breathing, perform CPR if necessary
Poisoning
1. Call Arkansas Poison Control Center immediately 1-800-376-4766
2. IF told to induce vomiting...
a. Give 1 to 2 tablespoons of syrup of ipecac
b. Give 1 cup of water
c. Have person on their stomach so they do not choke on vomit
d. In 15 to 20 minutes they will vomit
e. Save vomit and take person and vomit to the emergency room
3
4
WATCHING FOR AND CARING FOR a) Fainting b) Seizures c) Diabetes
FAINTING:
To prevent: Lower the head, put patients head between knees (sitting) keep patient from
falling
If patient has been injured assume a spinal injury and do not move unless patient is in
imminent danger.
If patient has already fainted, monitor breathing and pulse and keep at rest.
SEIZURES:
Signs and Symptoms:
1. Sudden loss of consciousness
2. Body will stiffen
3. May stop breathing, may lose bladder control
4. Go into convulsions
5. Then body will relax
6. Person will be tired and confused
Care:
1. Place patient on floor, clear of all objects, holding their head
2. Loosen restrictive clothing
3. After convulsions, keep at rest with head turned to side for drainage in case of
vomiting.
4. Keep privacy for patient
5. Call doctor or EMS depending on history of seizures
DIABETES:
5
This is a condition in which there is an increase or absence of insulin produced by the
pancreas.
Diabetic Coma:
Takes several days to develop. Severe hyperglycemia: Sugar level in
the blood goes up and the sugar level in the tissues goes down.
Insulin Shock:
Comes on suddenly. Severe hypoglycemia: A form of shock caused by
too high insulin in the blood, producing a drop in blood sugar.
6
Diabetic Emergencies
Diabetic Coma (Hyperglycemia)
Causes:
Insulin Shock (Hypoglycemia)
Cause:
The diabetic’s condition has not been diagnosed
and/or treated.
The diabetic has not taken his insulin.
The diabetic has overeaten, flooding the body
with a sudden excess of carbohydrates.
The diabetic suffers an infection that disrupts his
glucose/insulin balance.
The diabetic has taken too much insulin.
The diabetic has not eaten enough to provide his
normal sugar intake.
The diabetic has overexercised, or overexerted
himself thus reducing his blood glucose level.
The diabetic has vomited a meal.
Symptoms and signs:
Symptoms and signs:
Gradual onset of symptoms and signs, over
a period of days.
Patient complains of dry mouth and intense
thirst.
Abdominal pain and vomiting common.
Gradually increasing restlessness, confusion,
followed by stupor.
Coma, with these signs:
Signs of air hunger—Deep, sighing
respirations.
Weak, rapid pulse.
Dry, red, warm skin.
Eyes that appear sunken.
Breath smell of acetone—Sickly sweet,
like nail polish remover.
Rapid onset of symptoms and signs, over a
period of minutes.
Dizziness and headache.
Abnormal, hostile, or aggressive behavior,
which may be diagnosed as acute alcoholic
intoxication.
Fainting, convulsions, and occasionally coma.
Full rapid pulse.
Patient intensely hungry.
Skin pale, cold, and clammy; perspiration may be
profuse.
Drooling.
Emergency care:
Emergency care:
Immediately transport to a medical facility.
Conscious patient—administer sugar, granular
sugar,
honey, lifesaver or other candy placed
under the tongue,
or orange juice.
Avoid giving liquids to the unconscious patient.
Provide
“sprinkle” of granulated sugar under
tongue.
Turn head to side or place on side.
Transport to the medical facility.
8
Special Notes: Diabetic Coma and Insulin Shock
When faced with a patient who may be suffering from one of these conditions:
Determine if the patient is diabetic. Look for medical alert medallions or information cards; interview patient and family members.
If the patient is a known or suspected diabetic, and insulin shock cannot be ruled out, assume that it is insulin shock and administer
sugar.
Often a patient suffering from either of these conditions may simply appear drunk. Always check for other underlying conditions—such
as diabetic complications—when treating someone who appears intoxicated.
9
When someone goes into shock...
First symptoms of shock:
1. weakness
2.
3.
4.
5.
nausea with possible vomiting
thirst
dizziness
patient indicates restlessness and fear
First signs of shock:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Combativeness
Profuse external bleeding
Vomiting or loss of body fluids
Shaking or trembling
State of awareness
Shallow/rapid breathing
Rapid/weak pulse (100 b/m +)
Skin: pale, cool, clammy
Face: pale, blue color
Eyes: pupils are dilated
CARE FOR SHOCK
ACTIVATE EMS IF AVAILABLE
1.
2.
3.
4.
5.
6.
7.
8.
Lie down and rest
Keep airway open
Control bleeding
Keep warm with covers (don’t overheat)
Be alert for vomiting
Elevate lower extremities: 8-12 inches on legs unless injured
Don’t allow any food or drink
Watch vitals at least every 5 minutes
TRANSPORT TO MEDICAL FACILITY AS SOON AS POSSIBLE
HEAD AND SPINAL INJURIES
HEAD INJURIES: What to look for
1. Any visible head injuries
2. Black eyes or under eyes
3. Unequal pupils
4. Clear or bloody fluid coming from ears or nose
BRAIN INJURIES:
1. Unequal or unresponsive pupils
2. Loss of sensations
3. Headache
4. Personality changes
5. Hearing or balance off
CARE FOR HEAD INJURIES...
1. Keep airway open
6. Dress/bandage wounds
2. Keep at rest
7. Provide care for shock
3. Control bleeding ( no pressure
8. Monitor vitals
if depression of bone or brain
9. Be prepared for vomiting
exposed)
4. Don’t stop blood flow or cerebral spinal fluid
5. Talk to patient
SIGNS AND SYMPTOMS FOR SPINAL INJURIES:
1. Weakness, numbness or tingling or loss of feeling in arms and legs
2. Paralysis to arms and legs
3. Painful movement of arms and/or legs
4. Pain along backbone or neck bone
5. Burning along spine
6. Deformity: angle of head and neck
7. Bruises to neck or shoulders or injury to head
8. Loss of bladder or bowel control
9. Persistent erection of penis (affects nerves= known as priapism)
10. Difficulty breathing- little or no chest movement
11. Position of arms over head
CARE FOR SPINAL INJURIES:
1. Treat all victims as possible spinal injuries Assume neck and spinal injuries
DO NOT MOVE!!!!!!
UNLESS
A. Airway is obstructed--- then roll to side, as carefully as possible, to allow airway to
clear
B. If fatal injury is imminent in present location meaning
ONLY TO SAVE THE LIFE OF VICTIM
2. Activate EMS
3. Control serious bleeding - don’t attempt to splint.
4. Keep at rest, tell patient not to move. Try to keep calm.
5. Will OFTEN go into shock; monitor carefully.
11
BITES
MAN BITES
A. Cleanse area thoroughly with soap and water. Rinse and dry well. Clean with alcohol.
B. Apply sterile dressing if needed.
C. Notify parent if child is involved.
IMAL BITES
A. Cleanse wound thoroughly with soap and water unless there is tissue loss or severe
bleeding. In that case follow severe wound first aid.
B. Apply a sterile dressing and immobilize bitten area.
C. If possible apprehend and isolate animal to be held by Animal Control - Contact Animal Control.
D. Notify parent if child is involved.
SECT BITES
BEE/WASP STINGS
A. Remove stinger if present using a credit card, dull knife or tongue depressor to scrape
the stinger out of the point of entry.
B. Cleanse with soap and water.
C. Apply cold-do not elevate.
D. Watch for allergic reactions.
E. Notify parent if child is involved.
TICKS
A. Remove all of the tick with tweezers by grasping close to point of insertion. A small
tag of skin may be attached.
B. Wash area well with soap and water.
C. Notify parent if child is involved.
12
13
Dental Injuries
A. Save any knocked out teeth. Wrap the tooth in gauze moistened with water or milk to send
with person to the dentist.
B. Apply cold compress to affected area.
C. See dentist quickly.
D. Notify parent if child is involved.
Eye Injuries
I. Small objects blown or rubbed into the eye
A.
B.
C.
D.
E.
ALWAYS WASH HANDS BEFORE EXAMINING EYE
DO NOT RUB EYE
Encourage person to try to blink objects out of eye
Flush GENTLY with small amount of water
Apply loose bandages to both eyes and get medical attention if person cannot get
object out of eye
F. Notify parent if child is involved
II. Penetration eye injuries
A.
B.
C.
D.
E.
DO NOT ATTEMPT REMOVAL OF OBJECT
Cover both eyes with loose bandage
Keep person clam, quiet and as still as possible
Transport to emergency medical care sitting upright
Notify parent if child is involved
III. Blunt injury or blow to eye and surrounding area
A. Commonly results in a black eye
B. Should be seen by a doctor because injury may be more serious than it appears and
could result in loss of vision and other problems
C. Apply sterile dressing to any bleeding
D. Notify parent if child is involved
CHOKING
y will not be able to cough, talk or breathe. As long as someone is coughing, do not touch the person. Verbally
encourage them to continue coughing. If the person is fully obstructed begin steps below.
14
Infant (under one year of age)
A.
B.
C.
D.
E.
F.
Hold infant in position shown (illustration A)-give 5 rapid back blows between
blades using the heel of your hand.
Carefully turn baby over, supporting head well. Push in mid chest 5 times with 2
imaginary line one finger width below the nipples (illustration B).
Look in mouth for object.
Repeat above until object is expelled, or infant becomes unconscious.
If infant is unconscious give one rescue breath after looking in mouth.
Repeat steps A, B, C and E until help arrives or object is expelled.
the shoulder
fingers on an
Conscious Child or Adult
C.
D.
E.
F.
G.
A.
If person is conscious but
cannot cough or speak. Perform the
abdominal
thrust or Heimlich Maneuver.
B.
Stand behind standing or
seated person and wrap arms around
person’s
waist.
Make a fist with a hand, place thumb side against person’s mid-abdomenbetween the
navel and breast bone.
Grasp your fist with your other hand.
Press fist into abdomen with quick upward and inward thrusts. Each thrust
should be
distinct in an attempt to remove obstruction. (Figure 44)
Repeat thrusts until object is expelled or person becomes unconscious and
emergency
help arrives.
Notify parent if child is involved.
Unconscious Child or Adult
A.
B.
C.
D.
Lay person on back on floor.
Look into mouth, if you see object remove and check for return of
If object is not seen give 2 rescue breaths.
Straddle victims thighs, place hands against persons mid-abdomen (between
breast bone) and apply 5 abdominal thrusts.
breathing.
navel and
15
hrust (the Heimlich maneuver )
Administered to a conscious
victim of
airway obstruction.
Repeat step B, C and D until
removed or
arrives.
Notify parent if child is
(standing)
foreign body
object is
emergency help
involved
16
AT RELATED
EMERGENC
IES
tion
Muscle Cramps Breathing
Yes
ps
Exhaustion No
e
No
Pulse
Weakness
Skin
Perspiration
Varies
Varies
Yes
Heavy
Rapid,
Shallow
Deep, then
shallow
Weak
Yes
Heavy
Sometimes
Full rapid
Yes
Moist, Warm,
no change
Cold,
Clammy
Dry, hot
Loss of
Consciousness
Seldom
Little or
none
Often
17
A. Heat Cramps
1.
Move to a cool place.
2. Give salted water.
3. Massage muscle with
pressure.
4. Apply warm moist
towels to forehead and
cramped muscles.
5. Alert EMS.
B. Heat Exhaustion
1.
Move to a cool place.
2.
Keep at rest.
3.
Give salted water.
4.
Provide care for shock but
don’t overheat.
5.
May become unconscious.
6.
Alert EMS.
C.
Heat Stroke
1.
Cool rapidly with wet towels
or sheets and pour cold water over them.
2.
Wrap cold packs and place
on under arms, on wrists, on ankles on each
side
of neck.
3.
If transport is delayed - put
victim in tub of cold water up to face.
4.
Monitor vitals
5.
Provide care for shock.
18
Diabetic Coma (Hyperglycemia)
Causes:
The diabetic’s condition has not been diagnosed
and/or treated.
The diabetic has not taken his insulin.
The diabetic has overeaten, flooding the body
with a sudden excess of carbohydrates.
The diabetic suffers an infection that disrupts his
glucose/insulin balance.
Symptoms and signs:
Gradual onset of symptoms and signs, over
a period of days.
Patient complains of dry mouth and intense
thirst.
Abdominal pain and vomiting common.
Gradually increasing restlessness, confusion,
followed by stupor.
Coma, with these signs:
Signs of air hunger—Deep, sighing
respirations.
Weak, rapid pulse.
Dry, red, warm skin.
Eyes that appear sunken.
Breath smell of acetone—Sickly sweet,
like nail polish remover.
Emergency care:
Immediately transport to a medical facility.
Cause:
The diabetic has taken too much insulin.
The diabetic has not eaten enough to provide his
normal sugar intake.
The diabetic has overexercised, or overexerted
himself thus reducing his blood glucose level.
The diabetic has vomited a meal.
Symptoms and signs:
Rapid onset of symptoms and signs, over a
period of minutes.
Dizziness and headache.
Abnormal, hostile, or aggressive behavior,
which may be diagnosed as acute alcoholic
intoxication.
Fainting, convulsions, and occasionally coma.
Full rapid pulse.
Patient intensely hungry.
Skin pale, cold, and clammy; perspiration may be
profuse.
Drooling.
Emergency care:
Conscious patient—administer sugar, granular
sugar, honey, lifesaver or other candy placed
under the tongue, or orange juice.
Avoid giving liquids to the unconscious patient.
Provide “sprinkle” of granulated sugar under
tongue.
Turn head to side or place on side.
Transport to the medical facility.
Insulin Shock (Hypoglycemia)
19
20
Special Notes: Diabetic Coma and Insulin Shock
When faced with a patient who may be suffering from one of these conditions:
Determine if the patient is diabetic. Look for medical alert medallions or information cards; interview patient and
family members.
If the patient is a known or suspected diabetic, and insulin shock cannot be ruled out, assume that it is insulin shock
and administer sugar.
Often a patient suffering from either of these conditions may simply appear drunk. Always check for other underlying
conditions—such as diabetic complications—when treating someone who appears intoxicated.
21
When someone goes into shock...
First symptoms of shock:
1.
2.
3.
4.
5.
weakness
nausea with possible vomiting
thirst
dizziness
patient indicates restlessness and fear
First signs of shock:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Combativeness
Profuse external bleeding
Vomiting or loss of body fluids
Shaking or trembling
State of awareness
Shallow/rapid breathing
Rapid/weak pulse (100 b/m +)
Skin: pale, cool, clammy
Face: pale, blue color
Eyes: pupils are dilated
CARE FOR SHOCK
ACTIVATE EMS IF AVAILABLE
1.
2.
3.
4.
5.
6.
7.
8.
Lie down and rest
Keep airway open
Control bleeding
Keep warm with covers (don’t overheat)
Be alert for vomiting
Elevate lower extremities: 8-12 inches on legs unless injured
Don’t allow any food or drink
Watch vitals at least every 5 minutes
TRANSPORT TO MEDICAL FACILITY AS SOON AS
POSSIBLE
HEAD AND SPINAL INJURIES
HEAD INJURIES: What to look for
1. Any visible head injuries
2. Black eyes or under eyes
3. Unequal pupils
4. Clear or bloody fluid coming from ears or nose
BRAIN INJURIES:
1. Unequal or unresponsive pupils
2. Loss of sensations
3. Headache
4. Personality changes
5. Hearing or balance off
CARE FOR HEAD INJURIES...
1. Keep airway open
6.
2. Keep at rest
7.
3. Control bleeding ( no pressure
8.
if depression of bone or brain
9.
exposed)
4. Don’t stop blood flow or cerebral spinal fluid
5. Talk to patient
Dress/bandage wounds
Provide care for shock
Monitor vitals
Be prepared for vomiting
SIGNS AND SYMPTOMS FOR SPINAL INJURIES:
1. Weakness, numbness or tingling or loss of feeling in arms and legs
2. Paralysis to arms and legs
3. Painful movement of arms and/or legs
4. Pain along backbone or neck bone
5. Burning along spine
6. Deformity: angle of head and neck
7. Bruises to neck or shoulders or injury to head
8. Loss of bladder or bowel control
9. Persistent erection of penis (affects nerves= known as priapism)
10. Difficulty breathing- little or no chest movement
11. Position of arms over head
CARE FOR SPINAL INJURIES:
1. Treat all victims as possible spinal injuries Assume neck and spinal injuries
DO NOT MOVE!!!!!!
UNLESS
A. Airway is obstructed--- then roll to side, as carefully as possible, to allow airway
to clear
B. If fatal injury is imminent in present location meaning
ONLY TO SAVE THE LIFE OF VICTIM
2. Activate EMS
3. Control serious bleeding - don’t attempt to splint.
4. Keep at rest, tell patient not to move. Try to keep calm.
5. Will OFTEN go into shock; monitor carefully.
23
BITES
HUMAN BITES
A.
Cleanse area thoroughly with soap and water. Rinse and dry
alcohol.
B.
Apply sterile dressing if needed.
C.
Notify parent if child is involved.
well. Clean with
ANIMAL BITES
A.
B.
C.
D.
Cleanse wound thoroughly with soap and water unless there is
tissue loss or severe bleeding. In that case follow severe wound first
aid.
Apply a sterile dressing and immobilize bitten area.
If possible apprehend and isolate animal to be held by Animal
Controlcontact Animal Control
Notify parent if child is involved.
INSECT BITES
BEE/WASP STINGS
A.
Remove stinger if present using a credit card, dull knife or
to scrape the stinger out of the point of entry.
B.
Cleanse with soap and water.
C.
Apply cold-do not elevate.
D.
Watch for allergic reactions.
E.
Notify parent if child is involved.
TICKS
A.
Remove all of the tick with tweezers by grasping close to point
small tag of skin may be attached.
B.
Wash area well with soap and water.
C.
Notify parent if child is involved.
tongue depressor
of insertion. A
24
25
DENTAL INJURIES
Save any knocked out teeth. Wrap the tooth in gauze moistened with water or milk to
the dentist.
send with person to
Apply cold compress to affected area.
See dentist quickly.
Notify parent if child is involved.
EYE INJURIES
Small Objects Blown or Rubbed Into the Eye
A.
B.
C.
D.
E.
F.
ALWAYS WASH HANDS BEFORE EXAMINING EYE.
DO NOT RUB EYE.
Encourage person to try to blink objects out of eye.
Flush GENTLY with small amount of water.
Apply loose bandages to both eyes and get medical attention if person
object out of eye.
Notify parent if child is involved.
cannot get
Penetration Eye Injuries
A.
B.
C.
D.
E.
DO NOT ATTEMPT REMOVAL OF OBJECT
Cover both eyes with loose bandage.
Keep person calm, quiet and as still as possible.
Transport to emergency medical care sitting up.
Notify parent if child is involved.
Blunt Injury or Blow to Eye and Surrounding Area
A.
B.
C.
D.
Commonly results in a black eye.
Should be seen by a doctor because injury may be more serious than it
could result in loss of vision and other problems.
Apply sterile dressing to any bleeding.
Notify parent if child is involved.
appears and
CHOKING
y will not be able to cough, talk or breathe. As long as someone is coughing, do not touch the person. Verbally
encourage them to continue coughing. If the person is fully obstructed begin steps below.
Infant (under one year of age)
26
A.
B.
C.
D.
E.
F.
Hold infant in position shown (illustration A)-give 5 rapid back blows between
blades using the heel of your hand.
Carefully turn baby over, supporting head well. Push in mid chest 5 times with 2
imaginary line one finger width below the nipples (illustration B).
Look in mouth for object.
Repeat above until object is expelled, or infant becomes unconscious.
If infant is unconscious give one rescue breath after looking in mouth.
Repeat steps A, B, C and E until help arrives or object is expelled.
the shoulder
fingers on an
Conscious Child or Adult
A.
B.
F.
G.
If person is conscious but cannot cough or speak. Perform the abdominal
thrust or
Heimlich Maneuver.
Stand behind standing or seated person and
wrap arms around person’s
C.
Make a fist with a hand,
place thumb side against person’s
mid-abdomenbetween the navel and breast bone.
D.
Grasp your fist with your
other hand.
E.
Press fist into abdomen with
quick upward and inward thrusts.
Each thrust
should be distinct in an attempt to remove obstruction. (Figure 44)
Repeat thrusts until object is expelled or person becomes unconscious and
emergency
help arrives.
Notify parent if child is involved.
Unconscious Child or Adult
A.
B.
C.
D.
Lay person on back on floor.
Look into mouth, if you see object remove and check for return of
If object is not seen give 2 rescue breaths.
Straddle victims thighs, place hands against persons mid-abdomen (between
breast bone) and apply 5 abdominal thrusts.
breathing.
navel and
27
hrust (the Heimlich maneuver )
Administered to a conscious (standing) victim of foreign body
airway obstruction.
Repeat step B, C and D until
removed or
arrives.
Notify parent if child is
object is
emergency help
involved
28
AT RELATED
EMERGENC
IES
tion
Muscle Cramps Breathing
Yes
ps
Exhaustion No
e
No
Pulse
Weakness
Skin
Perspiration
Varies
Varies
Yes
Heavy
Rapid,
Shallow
Deep, then
shallow
Weak
Yes
Heavy
Sometimes
Full rapid
Yes
Moist, Warm,
no change
Cold,
Clammy
Dry, hot
Loss of
Consciousness
Seldom
Little or
none
Often
29
A. Heat Cramps
1.
Move to a cool place.
2. Give salted water.
3. Massage muscle with
pressure.
4. Apply warm moist
towels to forehead and
cramped muscles.
5. Alert EMS.
B. Heat Exhaustion
1.
Move to a cool place.
2.
Keep at rest.
3.
Give salted water.
4.
Provide care for shock but
don’t overheat.
5.
May become unconscious.
6.
Alert EMS.
C.
Heat Stroke
1.
Cool rapidly with wet towels
or sheets and pour cold water over them.
2.
Wrap cold packs and place
on under arms, on wrists, on ankles on each
side
of neck.
3.
If transport is delayed - put
victim in tub of cold water up to face.
4.
Monitor vitals
5.
Provide care for shock.
30
Diabetic Coma (Hyperglycemia)
Causes:
The diabetic’s condition has not been diagnosed
and/or treated.
The diabetic has not taken his insulin.
The diabetic has overeaten, flooding the body
with a sudden excess of carbohydrates.
The diabetic suffers an infection that disrupts his
glucose/insulin balance.
Symptoms and signs:
Gradual onset of symptoms and signs, over
a period of days.
Patient complains of dry mouth and intense
thirst.
Abdominal pain and vomiting common.
Gradually increasing restlessness, confusion,
followed by stupor.
Coma, with these signs:
Signs of air hunger—Deep, sighing
respirations.
Weak, rapid pulse.
Dry, red, warm skin.
Eyes that appear sunken.
Breath smell of acetone—Sickly sweet,
like nail polish remover.
Emergency care:
Immediately transport to a medical facility.
Cause:
The diabetic has taken too much insulin.
The diabetic has not eaten enough to provide his
normal sugar intake.
The diabetic has overexercised, or overexerted
himself thus reducing his blood glucose level.
The diabetic has vomited a meal.
Symptoms and signs:
Rapid onset of symptoms and signs, over a
period of minutes.
Dizziness and headache.
Abnormal, hostile, or aggressive behavior,
which may be diagnosed as acute alcoholic
intoxication.
Fainting, convulsions, and occasionally coma.
Full rapid pulse.
Patient intensely hungry.
Skin pale, cold, and clammy; perspiration may be
profuse.
Drooling.
Emergency care:
Conscious patient—administer sugar, granular
sugar, honey, lifesaver or other candy placed
under the tongue, or orange juice.
Avoid giving liquids to the unconscious patient.
Provide “sprinkle” of granulated sugar under
tongue.
Turn head to side or place on side.
Transport to the medical facility.
Insulin Shock (Hypoglycemia)
Special Notes: Diabetic Coma and Insulin Shock
When faced with a patient who may be suffering from one of these conditions:
Determine if the patient is diabetic. Look for medical alert medallions or information cards; interview patient and
family members.
If the patient is a known or suspected diabetic, and insulin shock cannot be ruled out, assume that it is insulin shock
and administer sugar.
Often a patient suffering from either of these conditions may simply appear drunk. Always check for other underlying
conditions—such as diabetic complications—when treating someone who appears intoxicated.
31
When someone goes into shock...
First symptoms of shock:
1.
2.
3.
4.
5.
weakness
nausea with possible vomiting
thirst
dizziness
patient indicates restlessness and fear
First signs of shock:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Combativeness
Profuse external bleeding
Vomiting or loss of body fluids
Shaking or trembling
State of awareness
Shallow/rapid breathing
Rapid/weak pulse (100 b/m +)
Skin: pale, cool, clammy
Face: pale, blue color
Eyes: pupils are dilated
CARE FOR SHOCK
ACTIVATE EMS IF AVAILABLE
1.
2.
3.
4.
5.
6.
7.
8.
Lie down and rest
Keep airway open
Control bleeding
Keep warm with covers (don’t overheat)
Be alert for vomiting
Elevate lower extremities: 8-12 inches on legs unless injured
Don’t allow any food or drink
Watch vitals at least every 5 minutes
TRANSPORT TO MEDICAL FACILITY AS SOON AS
POSSIBLE
HEAD AND SPINAL INJURIES
HEAD INJURIES: What to look for
1. Any visible head injuries
2. Black eyes or under eyes
3. Unequal pupils
4. Clear or bloody fluid coming from ears or nose
BRAIN INJURIES:
1. Unequal or unresponsive pupils
2. Loss of sensations
3. Headache
4. Personality changes
5. Hearing or balance off
CARE FOR HEAD INJURIES...
1. Keep airway open
6.
2. Keep at rest
7.
3. Control bleeding ( no pressure
8.
if depression of bone or brain
9.
exposed)
4. Don’t stop blood flow or cerebral spinal fluid
5. Talk to patient
Dress/bandage wounds
Provide care for shock
Monitor vitals
Be prepared for vomiting
SIGNS AND SYMPTOMS FOR SPINAL INJURIES:
1. Weakness, numbness or tingling or loss of feeling in arms and legs
2. Paralysis to arms and legs
3. Painful movement of arms and/or legs
4. Pain along backbone or neck bone
5. Burning along spine
6. Deformity: angle of head and neck
7. Bruises to neck or shoulders or injury to head
8. Loss of bladder or bowel control
9. Persistent erection of penis (affects nerves= known as priapism)
10. Difficulty breathing- little or no chest movement
11. Position of arms over head
CARE FOR SPINAL INJURIES:
1. Treat all victims as possible spinal injuries Assume neck and spinal injuries
DO NOT MOVE!!!!!!
UNLESS
A. Airway is obstructed--- then roll to side, as carefully as possible, to allow airway
to clear
B. If fatal injury is imminent in present location meaning
ONLY TO SAVE THE LIFE OF VICTIM
2. Activate EMS
33
3. Control serious bleeding - don’t attempt to splint.
4. Keep at rest, tell patient not to move. Try to keep calm.
5. Will OFTEN go into shock; monitor carefully.
34
BITES
HUMAN BITES
A.
Cleanse area thoroughly with soap and water. Rinse and dry
with alcohol.
B.
Apply sterile dressing if needed.
C.
Notify parent if child is involved.
well. Clean
ANIMAL BITES
A.
B.
C.
D.
Cleanse wound thoroughly with soap and water unless there is
tissue loss or severe bleeding. In that case follow severe
wound first aid.
Apply a sterile dressing and immobilize bitten area.
If possible apprehend and isolate animal to be held by Animal
Control-contact Animal Control
Notify parent if child is involved.
INSECT BITES
BEE/WASP STINGS
A.
Remove stinger if present using a credit card, dull knife or
depressor to scrape the stinger out of the point of entry.
B.
Cleanse with soap and water.
C.
Apply cold-do not elevate.
D.
Watch for allergic reactions.
E.
Notify parent if child is involved.
TICKS
A.
Remove all of the tick with tweezers by grasping close to point
A small tag of skin may be attached.
B.
Wash area well with soap and water.
C.
Notify parent if child is involved.
tongue
of insertion.
35
DENTAL INJURIES
Save any knocked out teeth. Wrap the tooth in gauze moistened with water or milk to
the dentist.
send with person to
Apply cold compress to affected area.
See dentist quickly.
Notify parent if child is involved.
EYE INJURIES
Small Objects Blown or Rubbed Into the Eye
A.
B.
C.
D.
E.
F.
ALWAYS WASH HANDS BEFORE EXAMINING EYE.
DO NOT RUB EYE.
Encourage person to try to blink objects out of eye.
Flush GENTLY with small amount of water.
Apply loose bandages to both eyes and get medical attention if person
object out of eye.
Notify parent if child is involved.
cannot get
Penetration Eye Injuries
A.
B.
C.
D.
E.
DO NOT ATTEMPT REMOVAL OF OBJECT
Cover both eyes with loose bandage.
Keep person calm, quiet and as still as possible.
Transport to emergency medical care sitting up.
Notify parent if child is involved.
Blunt Injury or Blow to Eye and Surrounding Area
A.
B.
C.
D.
Commonly results in a black eye.
Should be seen by a doctor because injury may be more serious than it
could result in loss of vision and other problems.
Apply sterile dressing to any bleeding.
Notify parent if child is involved.
appears and
CHOKING
36
ot be able to cough, talk or breathe. As long as someone is coughing, do not touch the person. Verbally
encourage them to continue coughing. If the person is fully obstructed begin steps below.
Infant (under one year of age)
A.
B.
C.
D.
E.
F.
Hold infant in position shown (illustration A)-give 5 rapid back blows between
blades using the heel of your hand.
Carefully turn baby over, supporting head well. Push in mid chest 5 times with 2
imaginary line one finger width below the nipples (illustration B).
Look in mouth for object.
Repeat above until object is expelled, or infant becomes unconscious.
If infant is unconscious give one rescue breath after looking in mouth.
Repeat steps A, B, C and E until help arrives or object is expelled.
2.
B.
C.
D.
E.
F.
G.
the shoulder
fingers on an
Conscious Child or Adult
A.
If person is conscious but
cannot cough or speak. Perform
the abdominal
thrust or Heimlich Maneuver.
Stand behind standing or seated person and wrap arms around person’s
waist.
Make a fist with a hand, place thumb side against person’s mid-abdomenbetween the
navel and breast bone.
Grasp your fist with your other hand.
Press fist into abdomen with quick upward and inward thrusts. Each thrust
should be
distinct in an attempt to remove obstruction. (Figure 44)
Repeat thrusts until object is expelled or person becomes unconscious and
emergency
help arrives.
Notify parent if child is involved.
Unconscious Child or Adult
A.
B.
C.
D.
Lay person on back on floor.
Look into mouth, if you see object remove and check for return of
If object is not seen give 2 rescue breaths.
Straddle victims thighs, place hands against persons mid-abdomen (between
breast bone) and apply 5 abdominal thrusts.
breathing.
navel and
37
the Heimlich maneuver )
Administered to a conscious
victim of
airway obstruction.
Repeat step B, C and D until
removed or
arrives.
Notify parent if child is
(standing)
foreign body
object is
emergency help
involved
38
LATED
Condition
EMERGENCIES
Muscle Cramps Breathing
Heat
Yes
Cramps
Heat Exhaustion No
Heat
Stroke
No
Pulse
Weakness
Skin
Perspiration
Varies
Varies
Yes
Heavy
Rapid,
Shallow
Deep, then
shallow
Weak
Yes
Heavy
Sometimes
Full rapid
Yes
Moist, Warm,
no change
Cold,
Clammy
Dry, hot
Loss of
Consciousness
Seldom
Little or
none
Often
39
A. Heat Cramps
1.
Move to a cool place.
2. Give salted water.
3. Massage muscle with pressure.
4. Apply warm moist towels to forehead and cramped muscles.
5. Alert EMS.
B. Heat Exhaustion
1.
2.
3.
4.
5.
6.
Move to a cool place.
Keep at rest.
Give salted water.
Provide care for shock but don’t overheat.
May become unconscious.
Alert EMS.
C.
Heat Stroke
1.
2.
side
3.
4.
5.
Cool rapidly with wet towels or sheets and pour cold water over them.
Wrap cold packs and place on under arms, on wrists, on ankles on each
of neck.
If transport is delayed - put victim in tub of cold water up to face.
Monitor vitals
Provide care for shock.
40