Godolphin&Latymer
First Aid Policy
Reviewer: JH reviewed June 2013 Next review date July 2014
The Godolphin and Latymer School First Aid Policy Contents: Page No. 1. Policy Statement 1 2. Emergency Procedures at the point of need 2 3. Responsibility under the policy 3-‐-‐-‐5 4. Provision of first aid personnel and equipment 6 5. First Aid Kits 6 6. Information 6 7. Training 6-‐ -‐ ‐ 8 8. Reporting and Record Keeping 9-‐-‐-‐10 9. Review and Monitoring of First Aid provision 11 10 Hygiene procedures when dealing with a spillage of bodily 11 11 Appendices: 12
Appendix I -‐ -‐ ‐ Appendix II -‐ -‐ ‐ Appendix III -‐ -‐ ‐ Appendix IV -‐ -‐ ‐ Appendix V -‐ -‐ ‐
Anaphylaxis Asthma Diabetes Epilepsy Wound Management
1. Policy Statement The Health and Safety (First-‐-‐ -‐ Aid) Regulations 1981 place a duty on employers to provide adequate first aid equipment, facilities and personnel to their employees. In its guidance, HSE strongly recommends that employers include non-‐-‐ -‐ employees in their assessment of first aid needs and that they make provision for the needs of visitors to the school site. In order to ensure that adequate First Aid provision is provided, it is The Godolphin and Latymer School’s policy that: • there is a full time school nurse in attendance during the school’s normal working hours and if she is absent, that the school puts adequate first aid cover in place. (The school e m p l o y s t w o part-‐-‐ -‐ time nurses w h o share this responsibility). This involves a notice on her door telling pupils and staff to go to the school office in case of an emergency where a first aider will be called to attend to their needs. If the nurse is away, the school office will cover the absence for the day. If it is a long term absence the bursar will organise for a replacement/agency nurse to be available. The school Doctor is in school on a Wednesday each week and can cover absence should it arise on that day. The Physical Education Department is adjacent to the nurses’ area and members of the department are first aid trained and can be called upon in case of an emergency.
• sufficient numbers of trained first aid personnel together with appropriate equipment are available to ensure that there is someone competent in basic first aid techniques who can attend an incident during times when the school is occupied (the list of trained first aiders can be found on page 3 a nd 4 o f t his d o c u m e n t , in t he s t a f f handbook as an electronic copy in the staff shared area).
• appropriate first aid arrangements are in place whenever staff and pupils are engaged in offsite activities and visits. Refer t o t h e s c h o o l ’ s Policy for Educational Visits and other off-‐-‐ -‐ site activities.
• A qualified first aider is always available when children are present on-‐-‐ -‐ site. During the school day the school nurse is available or in her absence a qualified f i r s t a ider i s notified t o b e a v a i l a b l e . A list of First Aiders is pinned to her door and a member of the school office is First Aid qualified and contactable in case of emergency. The School Nurse informs the Senior Teacher who organises cover if she is going to be absent and she in turn alerts the school office.
2. Emergency Procedures-‐-‐ -‐ ‐ including w h e n to call an ambulance • depending on the severity of the illness/injury, a casualty should either go and see the nurse at the next appropriate opportunity, e.g. break or lunch time or go immediately to the medical room. If t h e c o n d i t i o n involves the casualty feeling dizzy or unstable then the nurse should be sent for and she will bring the wheelchair to transport the casualty to the medical room if appropriate • the nurse can be contacted via the nurses’ mobile number which is 07981 765133 (the nurses’ mobile number is on each phone in the school and is also located in a prominent position on the staffroom notice board) • in cases of emergency (where there is a breathing difficulty, compromised breathing, unconsciousness (excluding a faint) major bleeding obvious fracture or severe burn) an ambulance should be called without delay. • during lesson times pupils should have a note signed by their teacher giving permission to leave the lesson and they should if necessary be accompanied by a responsible friend • if the nurse is not available , one of the qualified first aiders should be called (see list on the staff room board or in the staff handbook) and if they are not available the school office should be notified • whenever possible someone should remain with the casualty until help arrives and other staff can be called upon to help with the remaining pupils • if an ambulance is called the receptionist should be notified immediately in order to alert the school keepers in order to open the relevant gates and direct the ambulance crew to the casualty’s location on the premises
• parents/next of kin of the casualty should be notified and a responsible adult should go to hospital with the casualty • parents are informed if a girl visits the medical room and the nurse feels they should receive further care. The girl is issued with a ‘further care advice’ slip for a head injury a separate letter is sent by the nurse
3. Responsibility under the policy The Head Mistress is responsible, through the Deputy Head to whom she gives delegated authority, for: • putting the governing body’s policy into practice and for ensuring that detailed procedures are in place • ensuring that the parents are aware of the school’s Health and Safety Policy including the arrangements for First aid • this policy is available on the school’s website • overseeing the adequacy of First Aid cover including organisation of qualified staff training • programmes and equipment The Health and Safety Committee is responsible for reviewing the policy annually for all departments of the school ensuring that first aid needs are assessed and addressed
The Senior Teacher with responsibility for First Aid is responsible for ensuring: • suitable numbers of first aiders are available at all times when any children are on-‐-‐ -‐ -‐ site The Compliance Officer: • that appropriate arrangements are followed for offsite activities/trips and out of hours activities
The School Nurse on behalf of the Health and Safety Committee is responsible for: • assessing the first aid needs throughout the school in consultation with the Deputy Head • deciding on first aid issues with the Deputy Head a n d the Bursar • providing first aid cover during normal school hours • organising ordering, provision and replenishment of first aid equipment • maintaining accurate records of first aid or any treatment given in the medical room and filing relevant paperwork in the girls’ files • ensuring that the photo board detailing girls with existing conditions that require prompt action such as severe allergies, epilepsy and diabetes is kept up to date and posted on the staff room board and also in the kitchen area and Physical Education Department. Ensuring that the board is available for staff from the beginning of term and before they meet their classes.
The Bursar on behalf of the Health and Safety Committee is responsible for: • maintaining records of accident reports The Senior Teacher (Staff Development) is responsible for: • organising and carrying out first aid training for staff after advisement from the Deputy Head • ensuring that up to date lists of first aiders are kept and that this section of the staff handbook is updated annually • preparing the school’s First Aid Policy • submitting the First Aid policy to The Health and Safety Committee for annual review Teachers of PE are responsible for: • ensuring that they have an increased awareness that their subjects have potential risks that could result in First Aid situations • ensuring that First aid kits are taken on all home/away matches and also during practice sessions • ensuring that they have spare epi-‐-‐ -‐ pens for girls who require them on home and away matches • ensuring that they have full awareness and knowledge of the medical needs of members of their squads and practice groups Science staff are responsible for: • ensuring that they are aware of the location of the first aid kits in their laboratories • ensuring that risk assessments are done for any practical work taking place in their laboratories
Technology staff are responsible for: • ensuring risk assessments are in place for times when they are incorporating practical work into their lessons for example, the use of the saws and other potentially high risk equipment All staff have a duty of care towards the pupils and should respond accordingly when First Aid situations arise. All staff are alerted to the specific medical needs of pupils within the school community and they are reminded to familiarise themselves with the photo list on the board in the staffroom detailing girls with medical needs that require the use of epi-‐-‐ -‐ pens and pupils who could require first aid due to medical conditions such as epilepsy and diabetes. The list of qualified First Aiders is kept in the staff handbook/recorded in this policy and should be updated annually. Teachers’ conditions of service do not include giving First Aid, although any member of staff may volunteer to undertake these tasks. The employer must ensure that there are sufficiently trained staff to meet the statutory requirements and assessed needs. (Guidance on First Aid for Schools DfEE, now DCSF)
In general the consequences of taking no action are likely to be more serious than those of trying to assist in an emergency (Guidance on First Aid for Schools DfEE, now DCSF)
4. Provision of first aid personnel and equipment
The school has a well equipped medical room and 2 part-‐-‐ -‐ time nurses, and a part-‐-‐ -‐ time school doctor. The medical room is open during the school day and is fully equipped to deal with minor accidents and injuries. The school nurse carries a mobile phone and is contactable at any time during the school’s working hours and the doctor is there for one day a week. If the school nurse has to leave the school site for any reason the school office is informed and a notice will be displayed on the door of the medical room detailing the course of action in the case of an emergency. Staff are informed of the nurses’ absence via the lesson supervision list on the board in the staff room. The Bursar/ Senior teacher with responsibility for cover are informed by the school nurse in case of absence. In school holidays there should be a qualified first aider during working hours if there are any pupils present. Pupils who take part in the Duke of Edinburgh’s Award are given basic first aid training as part of the programme and the members of staff accompanying them have appropriate first aid qualifications (Wilderness Expertise) 5. First Aid Kits • first aid kits are located in many areas of the school and are clearly labeled with a white cross on a green background in accordance with Health and Safety regulations. A list of these areas is also in the staff handbook – the school nurse is responsible for updating the list and notices • first aid kits should be accessible to PE staff during lessons and also taken to matches and out to practices – the school nurse will restock these at regular intervals • a first aid kit should be taken to all off-‐-‐ -‐ -‐site activities and visits. The school nurse will provide these kits and the trip organiser should liaise with her – reference school visit checklist • a first aid kit should be provided in the school mini bus • the school nurse is responsible for checking and restocking kits but staff should inform her when items have been used • Location of First Aid boxes: (The staff and girls have access to these First Aid kits and in case of emergency would be able to access appropriate First Aid equipment to support their treatment
Art Department, Biology Prep, Chemistry Corridor, Design Tech, Drama, Finance, Food Tech, Gym, Kitchen, Library, Lobby nr Security, Lobby old entrance outside Premises Manager office, Margaret Gray Building, PE Office x 3 grab bags, Astro-‐-‐-‐Turf, Netball Courts, Pottery, Reception, School Office, Staff Dining Room, Staff Room, Wash-‐-‐ -‐ up Area Girls’ Dining Hall, Bishop Centre x 2, Rudland Music School x 2. Emergency grab bag hanging outside Medical Room by door, Physics, Staff Rest Room, School Keepers’ Hut, VIth form common room, School Dining Room, top of stairs middle of bottom corridor Automatic Electronic Defibrillator -‐-‐-‐ reception on wall Eye Wash Stations -‐-‐-‐ Biology, Chemistry and Physics Location of Epi-‐-‐ -‐ ‐ Pens for individual girls – in the medical room in named individual packs. The door is unlocked for fast and easy access. 6. Information It is essential that there is accurate, accessible information about how to obtain emergency aid • all new staff receive information on how to obtain first aid assistance during their induction programme. This includes: • location of the medical room • how to contact the nurse in an emergency • the procedure for dealing with an emergency in the nurse’s absence • the names of qualified first aiders and appointed persons • location of the first aid kits • how to call an ambulance, current staff are reminded of these procedures annually
7. Training First aid training is provided in-‐-‐ -‐ ‐ house by the Senior Teacher (with responsibility for staff training) • a qualified first aider is someone who holds a valid certificate of competence in First Aid at Work. These qualifications expire after a period of three years and must be renewed • regular annual update courses are provided for staff qualifying from November 2009 • an Emergency First Aider is someone who has attended a minimum of 6 hours first aid training (renewable every three years) and is competent to give emergency aid until further help arrives • additional training for other medical conditions for example; use of the epi-‐-‐ -‐ pen, is provided by the nurse or doctor when necessary
HSE First Aid at Work Certificate
Name
Requalification R equired
Christine Owen Ellen Elfick Madeline Row Matthew Berridge James Carey Gary Martin Natalie Newell
17.04.16 07.03.16 24.04.16 04.02.16 23.01.16 23.01.16 01.02.16
Anthony Sullivan Victoria Dickins Victoria Juckes Christine Lee Nicola Bishop Mags Bukaty Louise Boone
20.03.16 17.11.13 22.06.14 22.06.14 22.06.14 22.06.14 22.06.14
Simon Eustice Miles G olland Susan Adey Fred Bosanquet Justin M cGrath Penny Broadhurst Emma Lorys N icola Cooper M ark Braine
20.03.16 20.03.16 20.03.16 20.03.16 20.03.16 20.03.16 20.03.16 20.03.16 01.02.16
EFAW (1 Day Course) Sue Adey Katie Blatt Morven Creagh Gill Dawson Isabell Jacobson Nicola McDonald Caroline Osborne Jeff Birnberg Adrian Davies Tara Dean
15.03.15 15.03.15 15.03.15 15.03.15 15.03.15 15.03.15 15.03.15 13.12.14 13.12.14 13.12.14
Nicola Hanger Mark Laflin Frances Lee Sarah Main Fiona Meyers Luigia Padalino Alice Weldon
13.12.14 13.12.14 13.12.14 13.12.14 13.12.14 13.12.14 13.12.14
FAW Instructor and AED Trainer
Julia Hodgkins
13.05.14
FAW + AED Qualified First Aiders
Peter Cosgrove Kate Healy Kuljit Jutla Frances Lee Amanda Newton Sophie Nicholas
8. Reporting and Record Keeping
14.06.15 14.06.15 14.06.15 14.06.15 14.06.15 14.06.15
• a record must be kept of accidents and the first aid treatment given. This should be written into one of the accident report books kept in the school office, the PE Department or in the Goodison building • these records should be kept by the Bursar and regularly collected from the accident books. Copies of accident reports should be kept by the Bursar and the school nurse and a copy should also be kept on the individual staff/pupil file. Accident records should be kept for 7 years (see DSS The Accident Book B1510) The deadline by which the over-seven-day injury must be reported has also increased to fifteen days from the day of the accident
There is a statutory requirement that some accidents must be reported to the Health and Safety Executive within 3 working days under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. (0845 3009923). The following accidents must be reported to the HSE: Involving employees or self employed people working in the premises:
• •
•
•
The deadline by which the over-‐-‐-‐seven-‐-‐-‐day injury must be reported is fifteen days from the day of the accident
For definitions see HSC/E guidance on RIDDOR 1995, and information on Reporting School Accidents (Annex A) Involving pupils and visitors:
•
accidents resulting in death or major injury( including as a result of physical violence) accidents which prevent the injured person from doing their normal work for more than 7 days (not including the day that the accident happened.) Employers and others with responsibilities under RIDDOR must still keep a record of all over-‐-‐-‐three day-‐-‐-‐injuries – if the employer has to keep an accident book, then this record will be enough.
accidents resulting in the person being killed or being taken from the site of the accident to hospital and the accident arises out of or in connection with work
i.e. if it relates to • any school activity, both off and on the premises • the way the school activity has been organised and managed • equipment, machinery or substances • the design or condition of the premises
HSE must be notified of fatal and major injuries and dangerous occurrences without delay The Headmistress is responsible for ensuring that this happens, but may delegate this responsibility to the Health and Safety officer – the premises manager Mr Gary Martin. The form provided by RIDDOR 1995 entitled Report of an Injury or Dangerous Occurrence should be used
9. Review and Monitoring of First Aid provision
•
• •
10. Hygiene procedures when dealing with a spillage of bodily fluid (e.g. blood, vomit, urine etc.) •
•
•
first aid arrangements are under annual review by the school nurse and Health and Safety Committee to ensure that the provision is adequate and effective annual review will be carried out with regard to training by the Senior Teacher (responsible for staff training) the first aid policy will be reviewed annually by the Senior Teacher (responsible for staff training)
•
each first aid kit contains an avoidance of infection kit and within this there is a bag for the disposal of any items used during the treatment of the first aid incident. This should then be disposed of in the special bin located in the nurses’ office. The bin is clearly labelled for the disposal of AI kits If a first aider has had to deal with any incident involving the spillage of bodily fluids for example vomit they should call 251 and one of the school keeping team will come and attend to the clear up. The member of staff should not attempt to clean the area as this requires specialist treatment The PE department can provide spare clothes if required
All staff should take precautions to avoid infection and must follow basic hygiene procedures. Staff should have access to single-‐-‐ -‐ use disposable gloves and hand washing facilities, and should take care when dealing with blood or other body fluids and disposing of dressings or equipment. Further guidance is available in the DfEE, now DCSF, publication HIV and AIDS: A Guide for the Education Service (see Annex A). (Guidance on First Aid for Schools DfEE, now DCSF)
11. Information detailing the treatment of pupils with particular medical conditions follow in the appendices:
Appendix I -‐ -‐ -‐ Anaphylaxis Appendix II -‐ -‐ -‐ Asthma Appendix III -‐ -‐ -‐ Diabetes Appendix IV -‐ -‐ -‐ Epilepsy Appendix V-‐ -‐ -‐ Wound Management
Appendix I -‐ -‐ -‐ Anaphylaxis Anaphylaxis Key points • Always remember basic life support – Airway, Breathing and Circulation • Call for help early • Where possible remove the trigger e.g. the sting, food, wash hands/lips but do not induce vomiting • Use adjuncts available e.g. if they have an inhaler, steroid (prednisolone) antihistamine (piriton) – discuss this with your pupil in advance, find out if they have had an episode before, if so what happened? • Familiarize yourself with the pupil’s care plan • Remember any allergic reaction could be life threatening • Make hotels, restaurants, instructors/external coaches aware of pupil’s with specific allergies • Know the pupil’s triggers • Do they have a medical alert bracelet (recommended) • Check they have all their medication with them including their Epipen – everyday! Recognition • Sudden onset and rapid progression • Food allergy research shows you have 20 minutes until cardiac arrest! 15 minutes for bee and wasp stings, 2-‐ -‐ -‐15 minutes for medicines -‐ -‐ -‐ mainly in a hospital setting, e.g. penicillin • AIRWAY swelling, recession, tracheal tug, wheeze, stridor, blue around lips, panting, hoarse voice, dizzy, anxious. • BREATHING blue lips/finger nails, decreased level of consciousness, floppy, disorientated, finding it hard to take a breath, scared, tired, stops breathing. • CIRCULATION pale, sweating, clammy, rash, hives (uticaria), flushed appearance, weak but fast pulse, heart stops -‐ -‐ -‐ cardiac arrest What to do • Help Airway and Breathing difficulties by keeping the pupil sitting up • However if they start to loose consciousness, lie them down and elevate their feet (will help blood pressure which will be dropping) • Never move them or stand them up • Remove trigger if possible but do not induce vomiting • Call for help • Any sign of breathing difficulty give EpiPen • Call 999/112 say “Anaphylaxis” • Be prepared to resuscitate if necessary • Send for the emergency kit from the Medical Room (contains 2nd EpiPen) • 5-‐-‐ -‐ 15 minutes later if no improvement or symptoms return give second EpiPen • Paramedics will do the rest • Stay with pupil -‐ -‐ -‐ contact family, have their details with you • A person who has a good response will still need a further 24 hours observation in hospital as there is a risk of relapse
Appendix II -‐ -‐ -‐ Asthma Asthma Emergency Procedure
Triggers • Grass, hay, pollen, animal fur, dust, bacteria, cold, damp, infection, smoke Types of inhaler • Blue – Salbutamol (ventolin) -‐ -‐ -‐ reliever inhaler – generally delivered via a volumatic spacer device
• Brown – Beclometasone – preventer inhaler
Common signs of an asthma attack • • • • • •
Coughing Shortness of breath Wheezing Feeling tight in the chest Being unusually quiet Difficulty speaking in full sentences
What to do • Keep calm • Encourage the child or young person to sit up and slightly forward – do not hug or lie them down • Make sure the child or young person takes two puffs of their reliever inhaler (usually blue) immediately (preferably through a Volumatic spacer) • Ensure tight clothing is loosened • Reassure the child • Call the School Nurse If there is no immediate improvement Continue to make sure the child or young person takes one puff of their reliever inhaler every minute for five minutes or until their symptoms improve. Call 999 urgently if: • • • •
The child or young person’s symptoms do not improve in 5-‐ -‐ -‐10 minutes The child or young person is too breathless or exhausted to talk The child or young person’s lips are blue You are in any doubt
Caution • Do not give anything to eat or drink • Do not give ibuprofen or paracetamol
Ensure the child or young person takes one puff of their reliever inhaler every minute until the ambulance arrives. After a minor asthma attack • Minor attacks should not interrupt the involvement of a pupil with asthma in school. When the pupil feels better they can return to school activities. • The parents/guardian must always be told if their child has had an asthma attack.
Appendix III -‐ -‐ -‐ Diabetes Diabetic Care Protocol for Godolphin and Latymer Type 1 diabetes – what is it? The body has an inability to produce insulin, usually happens before the age of 40. Diabetes can occur following a virus or your body destroying the cells or from birth. This means the body can’t convert sugar into a usable form. So the sugar level in the blood becomes very high and the patient has to inject insulin regularly to break the sugar down. They are dependent on this medication for life. Symptoms Thirsty, increased micturition, extreme tiredness, weight loss, blurred vision, itching, thrush, slow wound healing Insulin • 2-‐-‐ -‐ 4 injection a day – vital for life • Has to be an injection as stomach acids destroys oral insulin • There are many different types of insulin. General examples • Novarapid -‐ -‐ -‐ 3 times a day which is short acting. This has to be given 15-‐-‐ -‐ 30 minutes before a meal – so that it can be in the system ready for action. • Levamir – long acting, slow absorption – given at night to last the whole night Storage • Unopened insulin should be stored at 2-‐ -‐ -‐6 ⁰c in a fridge. Travelling with diabetes • The pupil will need spare vials/cartridges in case of damage or loss. • Changes in climate, exercise and time zones can dramatically influence the amount of insulin required; therefore their daily routine and insulin requirements may change. • Freezing insulin causes it to become inactive – do not put insulin in the luggage hold. • It is also inactivated by heat so the pupil may need to pack her insulin in a cold bag for the flight. • In a hot environment, a rotation of ice packs would need to be organized to keep the insulin at the correct temperature. • In cold weather, insulin is absorbed more slowly therefore the pupil may need to reduce her dose of insulin (if higher levels of insulin are in the body it will use up all her sugar and she may have a hypoglycemic episode). However, when she comes indoors and gets warmed up it will be absorbed quicker; so theoretically she may have to adjust her earlier doses, but not the evening doses if indoors. • However, in a hot climate the pupil may need to increase all doses. • The pupil needs to test her blood sugars frequently for the first 2 days whilst her body adjusts to these changes. • Pupils travelling with insulin and glucometers/autopens/pumps require a note from the school explaining the medical need for them to carry this equipment on a plane – this should be requested from the school office.
Complications Hypoglycemia (Hypo) Low blood sugar Normal glucose range is 4-‐ -‐ -‐7mmols Diabetics tend to run blood sugars at 4-‐ -‐ -‐8mmols before meals and under 10mmols 2 hours after eating Hypoglycemia occurs when the blood sugar is below 4mmols There is too much insulin in the blood therefore we need to add sugar to correct the problem. Signs • Shaky • Sweating • Tingling lips • Pale • Pounding heart rate • Confusion • Irritability All diabetic pupils are asked to attend the Medical Room if they feel they are having a hypoglycemic episode. They may treat the hypo themselves but must make the School Nurse aware of the situation and inform her of the blood sugar levels so they can be documented in the daily diary in the Medical Room. Treatment • Give a fast acting carbohydrate e.g. sugary drink (apple juice – as natural as possible – aspartame free!) chocolate, glucose tablets. • Follow this with a longer acting carbohydrate e.g. cereal bar, sandwich, fruit, biscuits or milk. • The pupil should carry at least 2 of each of these and they must be replenished at the earliest opportunity. • Stores of all snacks should be kept in the Medical Room fridge/diabetic box for easy access for the diabetic pupils. The pupil must not miss out on her snack times and may need to snack more regularly according to activities. If travelling, her system is going to be out of sync on arrival for a few days due to the time changes and weather and increased level of activity. The pupil should check her blood sugar 15 minutes after the “hypo” and should not resume school/activities until her blood sugar is normalized. Activity will use up her sugar and cause her blood sugar to drop even further. If the “hypo” continues the pupil carries glucogel (Hypostop) with her. (At this point staff should get her to a medical site if travelling with a diabetic). Glucogel (Hypostop) is a concentrated form of glucose that is rubbed onto the gums and is rapidly absorbed. This can be used as frequently and as much as required to correct the hypo. A “hypo” should correct with treatment after approx 30 minutes. If this is not correcting her blood sugar and her blood sugar is remaining below 4 mmols, staff should get the pupil to a hospital setting. If at any point she becomes disorientated or her conscious level drops she should go to hospital immediately by ambulance.
Any prolonged hypo must be telephoned through to the parents. In school The medical room fridge carries a glucagon injection this should be given to paramedics when they arrive. It can only be given by the School Nurses or Doctor if on school grounds. In hospital you would be asked questions about the onset of the “hypo” if you can write down the time of the onset, symptoms, blood sugar levels and what she has eaten. Keep the sheet of the pupil’s details with you at all times for this situation. The pupil’s updated care plan can be found in the Diabetic’s Care Plan folder in the Medical Room office. Hyperglycemia (Hyper) High blood sugar – generally greater than 15mmols Too much sugar is in the blood therefore they will need to increase insulin to breakdown the excess sugar. You are much less likely to have a problem with this. The young person will generally titrate her insulin according to her blood sugars. There are not any signs or symptoms unless they are really high and have been high for a few days. Usually only found in undiagnosed diabetics or in someone who is not conforming to treatment. The pupil will let you know or should be asked if they have remained persistently high. This can then proceed to diabetic ketoacidosis (DKA) which for a diabetic is a medical emergency. When there is no insulin to convert sugar the body utilizes sugar stored in fat to get its energy. This leaves a by-‐-‐ -‐ product called ketones in the blood stream. The unconverted sugar also remains in the blood stream. They get ketone breath (smells like nail polish or pear drops), they become very thirsty in an effort to flush ketones out of the body. The body becomes more acidic which causes vomiting. They become more dehydrated and therefore more acidic; this is an uncontrollable downward spiral without urgent medical attention. Glucometer The glucometer is kept in the diabetes box in the cupboard above the sink in the Medical Room. There is also a small sharps bin. This box is clearly labelled, so the diabetic pupils can use this equipment when necessary. Glucagon injection The expiry date is checked at the beginning of each term. The injection is kept in the unlocked fridge in the Medical Room in case of emergencies. Communication The School Nurse should try to chat to the pupil informally and regularly about the management of their diabetes in school. The pupil and family must inform the School Nurse and Doctor of any changes in their child’s diabetic management. The School Nurse ensures that the parents provide an up to date individual care plan for their daughter at the beginning of each school year.
Appendix IV -‐ -‐ -‐ Epilepsy
Epilepsy
An epileptic seizure progresses through the following stages: a trance-‐-‐ -‐ like state for a few seconds or minutes and loss of consciousness. The body becomes rigid, the back arches, the jaw is clenched, the eyes roll upwards and the tongue may be bitten. The breathing becomes noisy. Convulsive shaking movements of the body may then follow and may last from 1 – 3 minutes. The person usually regains consciousness within a few minutes but is left dazed and very sleepy. What to do during the seizure: • Try to stay calm. Send for assistance from the Medical Room – giving the pupil’s name (they may be prescribed emergency medication for prolonged seizures) • Note the time to check how long the seizure is going on for • Attempt to support the person if you see him or her falling. Move objects such as furniture, away from the person if there is a risk of injury. Only move the person if they are in a dangerous place, e.g. at the top of the stairs or in the road • Put something soft (jacket or cushion) under their head, or cup their head in your hands, to stop their head hitting the ground • Try to stop other people from crowding around and ask them to move away • Do not restrain the person – allow the seizure to happen • Do not put anything in the person’s mouth – there is no danger of them swallowing their tongue during the seizure. Do not give them anything to eat or drink When the seizure has finished: • Place the person in the recovery position. Check the person’s breathing and pulse at regular intervals. • Be prepared to resuscitate if necessary • Wipe away any spit and if their breathing is difficult check their mouth to see that nothing is blocking their airway, like food • Try to minimize any embarrassment. If they have been incontinent, deal with this as privately as possible • Stay with them, giving reassurance, until they have fully recovered • Try to prevent them from standing/moving around. They will be unstable and confused You should call the ambulance if: • It is the person’s first seizure or you do not know that the person has epilepsy • They have injured themselves badly • They have trouble breathing after the seizure has stopped • The seizure lasts for more than 5 minutes • The are given emergency medication for the first time • The person has repeated seizures • The person does not regain consciousness for more than 10 minutes
Appendix V -‐ -‐ -‐ Wound Management Wound Management Protocol
Wounds There are 4 categories of wounds: • ABRASION -‐ -‐ -‐ graze caused by friction, superficial and partial thickness • CUT -‐ -‐ -‐ break in the skin caused by a sharp object e.g. knife, glass – easy to close • LACERATION -‐ -‐ -‐ blunt force, the skin has burst rather than been cut • PENETRATING WOUND – unable to visualize the base. These require examination in an Accident and Emergency Department. Cover wound with a temporary dry dressing and refer Minor wounds do not require referral to a doctor/ accident or emergency dept. Exclude complications: • Problems with exploration – excessive pain, unable to visualize all of the wound • Cleaning or closure of the wound – unable to remove all of the debris/harmful debris e.g. glass, grit, difficult shape of wound • Concern about size or depth or site • Mechanism of wound sustained – human bite, extreme violence • Check pupil is covered for Tetanus A thorough assessment reduces the risk of complications after closure.
Cleaning Place patient in a quiet appropriate place and position. Keep them comfortable and calm. Use appropriate sterile field to protect the patient, environment and yourself. Wear protective gloves and apron (PPE). • Tap water – if drinking water is used there is no evidence to suggest that infection levels are increased. It is readily available, convenient for exploration and cleaning using the tap pressure. Alternatively use boiled and cooled water. The infection rate remains 5-‐ -‐ -‐10% approximately (Fernandez and Griffiths 2007). • Saline – Sodium Chloride 0.9%w/vPh.Eur -‐ -‐ -‐ non-‐-‐ -‐ irritant, no antiseptic effect. Procedure • Irrigate wound – use tap pressure or 20/50ml syringe preferably with a 19 gauge needle to increase pressure. Hold at 45 degree angle to the wound. Squirt water using pressure to remove debris. Use gloved finger to explore wound or gauze swab. Irrigate until all debris is removed. • Dry using gauze swab. Closure • Steristrips-‐-‐ -‐ good for superficial wounds – cuts and lacerations. Painless, noninvasive; excellent on frail skin. Place Steristrips 3mm apart. Place anchor strips either side of the wound • Skin adhesive – glue -‐ -‐ -‐ expensive, reduced trauma, good cosmetic results. Simple cuts and lacerations – acute/linear (not jagged). Use only on low tension wounds. Removes need for dressing; particularly good for young children
• Hair ties – use child’s own hair to tie a cut together, where possible use with skin glue – extra security Dressings • Jelonet – 3 or 4 layers needed, soft paraffin based, soothing, allows wound to drain freely , cover with mefix or sterile gauze– change after 48 hours • Plasters – range of sizes, short term, and use until bleeding has stopped. They do not allow the wound to breathe particularly well. Be aware of patients with latex allergy • Bactigras -‐ -‐ -‐ suitable for lacerations, abrasions and other skin loss wounds. Medicated paraffin gauze dressing. Contains Chlorhexidine acetate 0.5%, an antiseptic with a broad spectrum. Proven antiseptically active against a wide range of Gram positive and Gram negative organisms. Soothing and low-‐-‐ -‐ adherent and allows the wound to drain. Cover with sterile gauze and a bandage. Leave in place for 4-‐ -‐ -‐5 days. Warning: Do not use with known Chlorhexidine allergy • Mepitel – slightly more expensive, range of sizes, single layer can stay in place for up to 7 days – dry dressing required on top which is replaced as needed without disturbing wound healing Record keeping • Record all wound cleansing and dressings in daily diary along with patient details and information about aftercare and review date • Ensure appropriate aftercare advice is discussed and recorded and where appropriate parents informed