Guidelines for Emergency Medical

Care in School
Committee on School Health

Abstract
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.

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.1Individual emergency care plans
should be in place for students and staff members whose health conditions may cause them to
experience emergencies (e.g., known food or insect anaphylaxis, asthma, diabetes,
haemophilia). 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 blood borne pathogens,
including the onsite availability of exposure control plans

Emergency lifesaving 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). 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. Additional description and
classification of school medical emergencies and sports injuries and their treatment may be
found in School Health: Policy and Practice and Sports Medicine: Health Care for Young
Athletes.
 Committee on School Health, 20002001
Howard L. Taras, MD, Chairperson Jerald L. Newberry

David A. Cimino, MD National Education Association, Health

Information Network
Jane W. McGrath, MD
Evan Pattishall III, MD
Robert D. Murray, MD
American School Health Association
Wayne A. Yankus, MD
Mary Vernon, MD, MPH
Thomas L. Young, MD
Centers for Disease Control and
Liaisons Prevention
Missy Fleming, PhD Linda Wolfe, RN, BSN, MEd, CSN
American Medical Association National Association of School Nurses
Maureen Glendon, RNCS, MSN, CRNP
Consultant
National Association of Pediatric Nurse Paula Duncan, MD
Associates and Practitioners
Staff
Lois Harrison-Jones, EdD
Su Li, MPA, Manager
American Association of School
Administrators
Recommendation

The following recommendations are given for pediatricians and other health care
professionals:

Future research should examine interactions of patient factors and system factors, and
their effects on costs, clinical course, and outcomes rather than attempt straightforward
univariate comparisons of the sort suggested by question 2 above.

Studies of clinical interventions, health care delivery systems, and clinical course and
outcomes should examine clinical, demographic, ethnic, and other subsets of patients
with RA and SLE.

Does the model of managed care or integrated delivery system (e.g., fully capitated
managed care, gatekeeper-only model of managed care, discounted fee for service)
influence (a) the types of interventions provided to patients with chronic conditions such
as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and (b) the clinical
and health status outcomes of those interventions?
If so, are these effects quantitatively and clinically significant, compared to the effects
that other variables (such as income, education, or ethnicity) have on patient outcomes?
If the mode of health care delivery system appears to be related to patient care and
outcomes, can specific organizational, financial, or other variables be identified to
account for the relationships?
If not, what research agenda should be pursued to provide critical information about the
relationship between types of health care systems and the processes and outcomes of care
delivered to populations with serious chronic conditions?
Health care professional schools and organizations should enhance educational programs
for students and practitioners in the use of computers, CPRs, and CPR systems for patient
care, education, and research.
Health care professionals and organizations should adopt the computer-based patient
record (CPR) as the standard for medical and all other records related to patient care.
 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
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;161162
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

Copyright 2001 American Academy of Pediatrics

 POSITIVE AND NEGATIVE IONS:
CATIONS AND ANIONS
Cations (positively-charged ions) and anions (negatively-charged ions) are
formed when a metal loses electrons, and a non-metal gains those electrons. The
electrostatic attraction between the positives and negatives brings the particles
together and creates an ionic compound, such as sodium chloride.

A metal reacts with a nonmetal to form an ionic bond. You can often determine the
charge an ion normally has by the elements position on the periodic table:

The alkali metals (the IA elements) lose a single electron to form a

cation with a 1+ charge.

The alkaline earth metals (IIA elements) lose two electrons to form a
2+ cation.

Aluminum, a member of the IIIA family, loses three electrons to form a

3+ cation.

The halogens (VIIA elements) all have seven valence electrons. All the
halogens gain a single electron to fill their valence energy level. And all
of them form an anion with a single negative charge.

The VIA elements gain two electrons to form anions with a 2- charge.

The VA elements gain three electrons to form anions with a 3- charge.

The first table shows the family, element, and ion name for some common
monoatomic (one atom) cations. The second table gives the same information for
some common monoatomic anions.
Some Common Monoatomic Cations

Family Element Ion Name

IA Lithium Lithium cation

Sodium Sodium cation

Potassium Potassium cation

IIA Beryllium Beryllium cation

Magnesium Magnesium cation

Calcium Calcium cation

Strontium Strontium cation

Barium Barium cation

IB Silver Silver cation

IIB Zinc Zinc cation

IIIA Aluminum Aluminum cation

Some Common Monoatomic Anions

Family Element Ion Name

VA Nitrogen Nitride anion

Phosphorus Phosphide anion

VIA Oxygen Oxide anion

Sulfur Sulfide anion

VIIA Fluorine Fluoride anion

Chlorine Chloride anion

Bromine Bromide anion

Iodine Iodide anion

Its more difficult to determine the number of electrons that members of the transition

metals (the B families) lose. In fact, many of these elements lose a varying number of electrons

so that they form two or more cations with different charges.

The electrical charge that an atom achieves is sometimes called its oxidation state.

Many of the transition metal ions have varying oxidation states. The next table shows some
common transition metals that have more than one oxidation state.
Some Common Metals with More than One Oxidation State

Family Element Ion Name

VIB Chromium Chromium(II) or chromous

Chromium(III) or chromic

VIIB Manganese Manganese(II) or manganous

Manganese(III) or manganic

VIIIB Iron Iron(II) or ferrous

Iron(III) or ferric

Cobalt Cobalt(II) or cobaltous

Cobalt(III) or cobaltic

IB Copper Copper(I) or cuprous

Copper(II) or cupric

IIB Mercury Mercury(I) or mercurous

Mercury(II) or mercuric

IVA Tin Tin(II) or stannous

Tin(IV) or stannic

Lead Lead(II) or plumbous

Lead(IV) or plumbic

Notice that these cations can have more than one name. The current way of naming

ions is to use the metal name, such as Chromium, followed in parentheses by the ionic
charge written as a Roman numeral, such as (II).