This policy has been revised by the policy posted on October 1, 2008. POLICY STATEMENT

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PEDIATRICS Vol. 107 No. 2 February 2001, pp. 435-436

AMERICAN ACADEMY OF PEDIATRICS:
Guidelines for Emergency Medical Care in School

Committee on School Health

	ABSTRACT

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Minor and major illnesses and injuries can occur in children during the school day. This statement provides recommendations for emergency health care for children in school, including information about procedures, staff and their education, documentation, and parental notification.

	ARTICLE

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Children and youth can be injured or become ill during the school day. Such events may require nonurgent, urgent, or emergency health care at school. School administrators, in consultation with the school health nurse and school physician (a pediatrician or other physician knowledgeable about child and adolescent health and school health issues employed or designated by the school) should develop policies and guidelines for all these situations, including emergency health care.

The American Academy of Pediatrics recommends the following:

Procedures and Staff

• Procedures should be in place to summon help in emergency situations from local emergency medical service professionals and, where available, the 911 system. Transportation to a hospital or other medical facility should be accessible and appropriate for the level of care required en route.
• Every school district should identify the persons who are authorized and educated to make decisions when health emergencies occur. Names, telephone numbers, and locations of these persons should be provided to all staff members. Each school should have an emergency plan that specifies the responsibility for contacting these persons during an emergency.
• Ideally, the school health nurse in each building should be the key person to implement the emergency plan because the nurse is most familiar with the student's health problems and community resources. All nurses should be educated in emergency care through a program developed by physicians, nurses, emergency medical technicians, and others with special education in emergency care. This education should include basic life support, first aid, the use of metered-dose inhalers and nebulizers, and appropriate treatment for any student or staff member experiencing an anaphylactic reaction in school.¹ Individual emergency care plans should be in place for students and staff members whose health conditions may cause them to experience emergencies (eg, known food or insect anaphylaxis, asthma, diabetes, hemophilia). If a student with special health needs is likely to require emergency transport to the hospital during the year, prospective communication with local emergency medical service professionals and an emergency transport plan should be completed.
• Because school health nurses or physicians cannot always be available, 2 or more members of the school staff, depending on school size, should be identified and educated to handle emergencies according to established policies until the nurse, physician, or other emergency personnel can be contacted. Education should include first aid, basic life support, and the recognition and treatment of anaphylaxis. The school health nurse, the school physician, or both should supervise the education and activities of these staff members to assure pediatric content. Education should be on a voluntary basis with certificates provided. Periodic retraining in association with a current certificate of participation should be required to assure competence.
• Athletic trainers and other athletic staff members educated in sports medicine and emergency care should be prepared to handle the emergencies related to participation in athletics.²
• All staff members, including coaches and physical education staff members, should be educated about emergency response guidelines developed by the school administrator and school health team for the school. Education about immobilization of the cervical spine, airway management, and rescue breathing should be a part of this training. Staff members should also be encouraged to obtain additional emergency response education whenever possible. Education offered through the schools should be planned and supervised by the school health nurse, the school physician, or both.
• All staff should be educated in universal precautions, and every school should comply with regulations of the Occupational Safety and Health Administration for bloodborne pathogens, including the onsite availability of exposure control plans.
• Emergency life saving courses can be taught to students in school. One recommended curriculum is the "Basic Emergency Lifesaving Skills (BELS): A framework for teaching emergency lifesaving skills to children and adolescents" created and published by the Health Resources and Services Administration (HRSA).³ The course should be supervised by a pediatrician or other health care professional with the appropriate pediatric emergency expertise.

Manual and Emergency Kit

• A complete emergency medical kit should be kept in the secure location designated for medications in each school. The kits should be readily available to educated staff volunteers. A protocol for updating and monitoring the kit should be established. Autoinject epinephrine should be available by individual prescription for students or staff members with a history of anaphylaxis. In schools with staff members, such as a school health nurse or school physician or their designees, who are appropriately educated about the recognition and treatment of anaphylaxis in a person without a previous diagnosis of anaphylaxis, autoinject epinephrine should be a part of the emergency kit. The contents of the kit should be determined by the school health professionals. The child care guidelines kit contents can be used as a reference.⁴
• An emergency care manual for first aid should be available to school health nurses, athletic staff members, and other designated persons.^5,6

Notification and Documentation

• Parents, legal guardians, or designated emergency contact persons must be informed as quickly as possible about injuries to their children at school. The description and disposition of significant illnesses or injuries (including the illnesses or injuries for which a student, staff member, or visitor is released from school to visit a physician or hospital) should be documented on an illness and injury form. These forms are also used to review for patterns of injury, to inform parents of the circumstances and handling of the injury, to inform the child's usual source of health care or emergency medical service personnel, and as documentation for liability and insurance purposes.

A new form has been developed to facilitate the urgent and emergency care of children with special health care needs and should be used as appropriate.⁷

Additional description and classification of school medical emergencies and sports injuries and their treatment may be found in School Health: Policy and Practice⁸ and Sports Medicine: Health Care for Young Athletes.⁹

Committee on School Health, 2000-2001

Howard L. Taras, MD, Chairperson

David A. Cimino, MD

Jane W. McGrath, MD

Robert D. Murray, MD

Wayne A. Yankus, MD

Thomas L. Young, MD

Liaisons

Missy Fleming, PhD

American Medical Association

Maureen Glendon, RNCS, MSN, CRNP

National Association of Pediatric Nurse Associates and Practitioners

Lois Harrison-Jones, EdD

American Association of School Administrators

Jerald L. Newberry

National Education Association, Health Information Network

Evan Pattishall III, MD

American School Health Association

Mary Vernon, MD, MPH

Centers for Disease Control and Prevention

Linda Wolfe, RN, BSN, MEd, CSN

National Association of School Nurses

Consultant

Paula Duncan, MD

Staff

Su Li, MPA, Manager

	FOOTNOTES

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

	REFERENCES

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1. School Nurse Emergency Medical Services for Children (SNEMS-C) Program. University of Connecticut, College of Continuing Studies Web site. Available at http://www.ce.uconn.edu/CPD-SNEM.html. Accessed January 3, 2001
2. National Standards for Athletic Coaches. Dubuque, IA: National Association for Sport and Physical Education; 1995
3. Maternal and Child Health Bureau. Basic Emergency Lifesaving Skills (BELS): A framework for teaching emergency lifesaving skills to children and adolescents. Newton, MA: Children's Safety Network, Education Development Center, Inc. (www.nmchc.org), 1999
4. American Academy of Pediatrics. American Public Health Association. Caring For Our Children. Elk Grove Village, IL: American Academy of Pediatrics;1992;161-162
5. Emergency Care Guidelines for School Personnel. Lincoln, NE: Nebraska Department of Health and Human Services; 1997
6. Emergency Care of Adolescents. Ludwig S, Jay S, eds. Philadelphia, PA: Hanley & Belfus; 1993:4
7. American Academy of Pediatrics, Committee on Pediatric Medicine. Emergency preparedness for children with special health care needs. Pediatrics. 1999;104(4). URL: http://www.pediatrics.org/cgi/content/full/104/4/e53
8. American Academy of Pediatrics, Committee on School Health. School Health: Policy and Practice. Elk Grove Village, IL: American Academy of Pediatrics; 1993
9. American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Sports Medicine: Health Care for Young Athletes. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 1991

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Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics

The following policy statement is a revision:

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