A few simple safety precautions can help ensure your summer fundoesn’t lead to the hospital emergency department, says Dr. Jeff Kalina, associate director of emergency medicine at the Methodist Hospital in Houston.

    Avoid overheating. If you’re playing/exercising outside in hot weather, drink water or beverages withelectrolytes. Don’t drink caffeinated beverages because they cause dehydration. Don’t drink alcohol. Itchanges the body’s thermal regulation center and makes your body think it’s cool when it’s not, which maycause you to stay outside much longer than you should.

    Pay attention when you’re at pools or beaches. Never leave a child unattended and avoid swimming at night,because most pools aren’t properly lit, which can make it difficult to see a person at the bottom of the pool.Never dive into water less than nine feet deep. Diving into shallow water can cause neck and spinal cordinjuries.

    Don’t scratch insect bites because doing so can break the skin and make you more vulnerable to antibioticresistantstaph infections. If insect bites are itchy, apply a topical anti-itch cream.

    If you take blood pressure medications or insulin, put it in a cooler and bring it with you on outings to thebeach or other locations.

    Don’t eat food that’s been left out in the sun/heat, because it could make you sick. Food should be keptcovered and cool until it’s eaten and then put away as soon as everyone is done eating.

    More information 

    The U.S. Food and Drug Administration has more about summer safety.


    Many lives are lost across USA because emergency services fail

    By Robert Davis, USA TODAY

    Health News1
    By Jack Gruber, USA TODAY Seattle paramedic Linda Lorentzen works to save a man whose heart had stopped. In Seattle, paramedics and firefighters work as a team, rasing chances of survival

    WASHINGTON — Help came too late for Julia Rusinek. The 21-year-old Yale sociology student, an accomplished runner, collapsed on a busy street corner in the nation’s capital on a summer evening in 1999 after working out at a nearby gym.

    Rusinek had more than a fighting chance to live: She was healthy except for a hidden condition that caused a sudden electrical short circuit in her heart. Her heart needed a zap — within six minutes — from a common medical device known as a defibrillator. Bystanders saw her fall, rushed to help and immediately called 911.

    But Rusinek’s life ticked away on the corner where she fell. Twelve minutes passed before an ambulance crew connected a defibrillator to her chest. Like thousands of others every year in cities across the country, Rusinek lost any chance she had to survive because of an emergency medical system that consistently fails to save as many lives as it should. (Related video: Odds of surviving cardiac arrest depend on where you are)

    In post-9/11 America, where war and fears of terrorist attacks have brought the need for effective emergency response into sharp focus, a USA TODAY investigation finds that emergency medical systems in most of the nation’s 50 largest cities are fragmented, inconsistent and slow.

    People die needlessly because some cities fail to make basic, often inexpensive changes in the way they deploy ambulances, paramedics and fire trucks. In other cities, where the changes have been made, people in virtually identical circumstances are saved. Those sharp differences surfaced in the 18-month investigation, which included a survey of city medical directors, analyses of dispatch and response data; interviews with fire and ambulance crews and on-site visits and ride-alongs with “first responders.”

    Rusinek’s case illustrates the failures of the system: She died of sudden cardiac arrest, a condition that serves as one of the truest measures of an emergency medical system’s effectiveness. Whether victims live or die depends primarily on how fast they get treatment. For years, the conventional wisdom was that help must come within 10 minutes. But new findings from the Mayo Clinic show that lives actually are saved or lost within six minutes.

    The USA TODAY survey and data analysis show that, of the 250,000 Americans who die outside of hospitals from cardiac arrest each year, between 58,000 and 76,000 suffer from a treatable short circuit in the heart and therefore are highly “saveable.” Yet nationwide, emergency medical systems save only a small fraction of saveable victims, and rates vary widely from city to city.

    The analysis shows:

    • The chance of surviving a dire medical emergency in the USA is a matter of geography. If you collapse from cardiac arrest in Seattle, a 911 call likely will bring instant advice and fast-moving firefighters and paramedics. Collapse in Washington, D.C., and — as one EMS official suggests — someone better call a cab for you. Seattle saves 45% of saveable victims like Rusinek; Washington, D.C., has no idea how many victims like Rusinek it saves. The city estimates it saves 4% of cardiac arrests, but inconsistent record-keeping makes it impossible for Washington to account accurately for its most saveable victims.
    • In the nation’s 50 largest cities, about 9,000 people collapse each year from cardiac arrest caused by a short circuit in the heart. Only an estimated 6% to 10%, or as few as 540, are rescued. If every major city increased its save rate to 20%, as a number of cities have done, a total of 1,800 lives could be saved every year.

    Like Rusinek, those who could have been saved are often young and vibrant: corporate executives who die at work, students who drop dead in school gymnasiums, commuters who never come home from their jobs.

    At the same time, Rusinek’s case was unusual. At least three people witnessed her collapse and the emergency response. Her family sought answers from rescuers, and details of her death were reported in the media. Most victims are hidden from public view by sealed medical records and a health care system that routinely tells families their loved ones “died instantly” and “we did everything we could.”

    What is not said — and what families often do not know to ask — is precisely how, and how quickly, emergency services responded to the call for help.

    Over the next three days, USA TODAY will delve into three major reasons that emergency services in most U.S. cities are saving so few people in life-or-death situations:

    • Many cities’ emergency services are undermined by their culture. Infighting and turf wars between fire departments and ambulance services cause deadly delays.
    • Most cities don’t measure their performance effectively,if at all. They don’t know how many lives they’re losing, so they can’t determine ways to increase survival rates.
    • Many cities lack the strong leadership needed to improve emergency medical services. Leadership — by the mayor, the city council and community health officials — can make a dramatic difference. Boston, for example, more than doubled its survival rate over 10 years under the direction of a strong mayor who demanded change and enlisted city officials, businesses and many residents in the drive to save lives.

    Tackling turf wars

    By Jack Gruber, USA TODAY Seattle firefighters and paramedics rescue a cardiac victim. Firefighter, arriving first, used a defibrillator to restart the man’s heart.

    Of these three problems, turf wars between paramedics and firefighters — the focus of today’s articles — arguably are the most challenging.

    The conflict has developed over time as rescuers’ roles have changed. Call for an ambulance today in a big city, and the first rescuers to arrive are often firefighters. Most cities have turned their firefighting teams into rescue squads as medical emergencies have become more common than fires.

    “The logic is obvious,” says J. David Badgett, an assistant chief with the Los Angeles Fire Department. “Geographically, fire stations are close. There are a lot of us in the fire department. We’re an emergency service agency.”

    Every major city has more fire engines than ambulances, and while both a fire engine and an ambulance are dispatched to the scenes of most serious medical calls, fire engines often are closer and able to get there first.

    Today’s average fire department answers twice as many calls for medical emergencies as for fires. The job of dealing with the sick has slowly nudged aside the task of dousing flames.

    The shift has been met with resistance in many fire departments, USA TODAY found. Many firefighters said they were unhappy because they signed on to fight fires, not to tend to sick people. Beyond that, fighting fires is sharply different from delivering emergency care.

    “The typical firefighter is a very linear person,” Badgett says. “They see a problem, they defeat the problem, they leave a winner. On a fire you do that. Emergency medicine isn’t like that.”

    It takes time and experience for firefighters to feel comfortable using some medical equipment without paramedics backing them up. So even though firefighters usually are trained to use defibrillators — the portable devices that shock a dying heart back to life — some admitted in interviews that they were hesitant at first to do it in a real crisis by themselves.

    Jeremy Gruber, a Montgomery County (Md.) Fire Rescue captain, paramedic and Washington D.C.-area defibrillator trainer, says delivering advanced medical care is often most difficult for the veteran firefighters. “We have people who have been on the job for 30 years, and they are used to doing it one way and they have never really evolved with the technology and the changes,” he says.

    Fire departments that want to deliver medical care, he says, should “hire people who are already medically trained so you know they have an interest in that. You’re not going to be able to force-feed somebody who doesn’t want to be there.”

    Failure in Washington, D.C.

    Health News3
    By Tim Dillon, USA TODAY Washington, D.C., paramedic Carlton Pinkney tends to an infant who was choking. Despite efforts to improve, Washington has one of the lwest save rates among big-city emergency medical services.

    The changing roles have caused resentment in many big-city fire houses, and resentment can affect performance. Washington, D.C., exemplifies the problem.

    First aid is part of a Washington firefighter’s job. A fire engine responds with an ambulance on serious medical calls. But the crews don’t always work well together.

    Over 18 months, a reporter visited Washington crews on the front lines dozens of times, sometimes scheduled, sometimes unannounced. During those visits, emergency workers were more likely to be at each other’s throats than watching each other’s backs.

    Ambulance crews made it clear they view firefighters as lazy; firefighters view ambulance crews as undisciplined. Every day in Washington, firefighters and the paramedics who back their ambulances into the same fire stations are likely to be quarreling over everything from where they park and what they eat to whose job it is to care for the sick and injured.

    In 2001, using stopwatches, city officials found that Washington firefighters don’t respond as quickly to medical calls as they should. Their finding prompted the city to buy global positioning equipment so officials could track the movement of rescue vehicles.

    USA TODAY reviewed more than 85,000 emergency calls to examine those delays more closely. The analysis of turnout time — the time it takes for firefighters to run to their rig and roll out the door toward an emergency — shows that Washington firefighters’ median response time was faster to a dumpster fire than to a report of a cardiac arrest.

    The fire crew responding to a report of a structure fire got rolling in 82 seconds, despite having to don protective boots, pants, coats and breathing apparatus. In response to a report of a cardiac arrest, which requires no special preparation, the crew took 124 seconds to reach the rig.

    Kenny Lyons, who heads Washington’s paramedic union, tells his loved ones not to waste time dialing 911 if they face a dire medical emergency. “If they can find someone to drive them to a hospital, drive them. If they can somehow catch a cab, go,” he says. The poor performance of the system, he says, “is haunting to the providers, and it should be chilling to the community.”

    Washington’s culture problems are not unusual. Most cities refused to answer USA TODAY’s question comparing response times on fires and emergency medical calls, but a few cities, including San Francisco, Mesa, Ariz., and Wichita, said their firefighters also are slower to respond to medical emergencies than to fires.

    Medical directors, doctors hired by the cities to supervise emergency medical care, are often aware of these delays, but many told USA TODAY in the survey and interviews that they are viewed as outsiders by firefighters. The directors can make suggestions to improve care, but the fire chiefs have the final say about how money will be spent and how resources will be deployed.

    In Los Angeles, fire department commanders and a powerful firefighters union view fire suppression as the main focus of the department, with medical services “a very distant second,” says medical director Marc Eckstein.

    He says many obstacles, including a “lack of attention to emergency medical systems issues, overwhelming priority in terms of training, and budget for fire-suppression activities instead,” stand in the way of better performance. Still, he says, “our department is much further along in merging the two cultures than most.”

    In St. Louis, tension between fire suppression and emergency medical crews results in fights over funds and misunderstandings about the other side’s jobs and concerns, says medical director Mark Levine. Within this embattled system, efforts to monitor performance have been “poor but improving,” he says.

    Of the 28 medical directors who answered USA TODAY’s question about what forces in their systems affect performance and patient outcomes, 16 cited fire department culture or unions as key

    Fernando Daniels, Washington, D.C.’s medical director, was one of them. “The traditional thinking was bad: ‘All we want to do is put fires out,’.” says Daniels, who is in his third year in the job. He has begun an ambitious plan that includes mass CPR training, getting defibrillators into more buildings and measuring the system’s performance accurately.

    But like the would-be reformers before him, Daniels has struggled to see his fixes take hold in a culture resistant to change. “To make the system work, you’ve got to get those barriers down,” he says.

    The firefighters union says the barriers go up in cities when fire and ambulance services are merged poorly. Firefighters now provide the vast majority of “pre-hospital” emergency medical service in the country, says Harold Schaitberger, president of the International Association of Fire Fighters. “And they do it with professionalism, commitment and esprit de corps that is unrivaled by any other public safety sector.”

    Where ambulance services and fire departments are merged “on a systematic basis with strong leadership, ample training and education, and effective response protocols,” the result is very successful, Schaitberger says. “What creates confusion are those cities, like Washington, D.C., that have EMS (ambulance service) under the fire department umbrella, but in actuality EMS is still a separate service with a separate command structure, separate training regimens, separate pay and benefit programs, and more transient employees.

    “In these cases, firefighters often feel no affinity with EMS. They wince when EMS is criticized by the public and the media because it reflects on the fire department, yet they have no control and little participation on the EMS side of operations.”

    Washington fire chief Adrian Thompson, who was named to the post by the mayor last November, says he is taking steps to address this problem. Over the next month, he says, the fire department will undergo a major change of structure. All ambulance crew members will have to apply to be firefighters to keep their jobs, a move aimed at establishing a uniform standard for all employees of the fire department. And in the future, he promises there will be a paramedic firefighter on all 33 of the city’s fire engines.

    “People don’t realize that with firefighters and EMS workers, one group seems to thumb their nose at the other group,” Thompson says. “We hope that this will bring some unity to the department.”

    Lyons, head of the paramedics union, has his doubts. Quality emergency care, he says, requires “full-time dedicated paramedics and emergency medical technicians that are committed — not forced — to provide patient care.”

    “While many will argue that dual-role cross-trained personnel will provide a bigger bang for your buck, what it will provide is more firefighters and few paramedics,” he says. “This attitude has forced many paramedics out of the profession and discouraged many others from pursuing EMS as a career.”

    Deadly delay

    Health News5
    By Jym Wilson, USA TODAY Jonathan Agronsky, a bystander who saw Julia Rusinek collapse on a Washington city street, rushed to nearby fire house to get help. He was told that a truck from another station was on the way.

    From his 16th Street apartment window in Washington, D.C., Jonathan Agronsky says, he saw Julia Rusinek on the ground on the evening of July 15, 1999. He rushed to the firehouse less than a block from where she fell.

    The firefighters there said a fire engine from another station farther away had been dispatched and was on the way. The ambulance crew was going off duty.

    “I was so mad I couldn’t see straight,” Agronsky recalls now. “I could have throttled those guys.”

    He and a fire official agree that only after another man ran into the station saying the woman down on the street corner was turning blue did Truck 9 roll. Lt. John Desautels, the officer in charge on Truck 9 that day, says he and his crew were following protocol designed to send smaller fire engines, not the long ladder trucks, to medical emergencies. “The initial call was a woman down,” Desautels says. “We get 100 of those a day,” and most are not life-threatening cases.

    When it became clear the situation was more critical, he says, they drove to the woman’s side. But they did not use their defibrillator, Desautels says, because his men reported that the woman had a pulse. Instead, they called for Ambulance 1, still in the station.

    Then the firefighters watched — along with anxious bystanders — as the ambulance rolled down the fire station driveway, then turned in the opposite direction and drove away, Desautels says. The crowd yelled at the Truck 9 firefighters, who called the dispatcher to tell the ambulance to turn around.

    Desautels says Rusinek’s heartbeat disappeared just as the ambulance arrived and that the firefighters performed CPR, but they still did not use their defibrillator. By the time the ambulance reached Rusinek, she had been down for 12 minutes. The ambulance crew shocked her repeatedly, but she was declared dead at a hospital a mile from where she fell.

    Rusinek’s mother, Roza, visited the fire station after her daughter died to try to learn what happened. “Many people there were totally unconcerned,” she says. But, she says, “one fireman there dared to look us in the eye, and he was crying.”

    That fireman was Desautels, who has been honored three times for heroics at the scene of fires, including for daring, lifesaving rescues. “I had to explain how sorry I was,” he says.

    But the mother, who immigrated from Poland, is still critical of the ambulance crew that initially refused to attend to her daughter because the shift was ending. “I can’t imagine how good an evening that person had to make up for our tragedy,” she says.

    Health News6
    Family photo Julia Rusinek, 21, a Yale student who competed as a runner, was visiting D.C. in 1999 when her heart short-circuited.

    Rusinek’s father, Henry Rusinek, a New York University Medical School radiology professor, says he wonders whether anything can be done to improve Washington’s emergency medical response.

    Agronsky, an author who went on to write about the woman’s death in Washington’s alternative City Paper, is still angry. “I could have put her on my back and walked her to the hospital, and she would have had a better chance of surviving,” he says.

    Rusinek’s death should have been a wake-up call for Washington’s emergency medical system. It was an opportunity to study the flaws in the system and make improvements.It’s rare when a victim collapses so close to help, goes so long without having a defibrillator applied and still is a candidate for a shock more than 10 minutes after collapse. It is even more rare when such an episode becomes public knowledge.

    But her death didn’t change things much. The city’s average response time for fire engines going to medical emergencies was slower in 2001, the year studied by USA TODAY, than in 1999. Ambulance response times improved only slightly in that interval.

    And problems remain. Last December, for example, a paramedic was dispatched to a report of a cardiac arrest at 6:01 p.m., but his shift ended at 6, so he drove back to his firehouse to go off duty, according to news reports. Firefighters performed CPR on the victim for 25 minutes until the new paramedic crew climbed into the rig and drove to the scene from the firehouse about five miles away.

    Unlike Rusinek, the victim had chronic health problems and was not a candidate for defibrillation. He wasn’t in the category of the most saveable, so his death was not shocking. But the response — which made local headlines — was.

    Success in Seattle

    In 2001, Seattle saved 45% of victims like Rusinek — those who are seen going down and who suffer from a treatable short circuit in the heart. And unlike Washington, D.C., Seattle is able to provide a detailed accounting of its victims.

    One of the biggest factors contributing to Seattle’s success is its culture. There, the medicine delivered in the streets comes from firefighters and fire department paramedics who have very different jobs but work on the same team. Each has a well-defined role to play in the patient’s care, with firefighters reaching victims first and performing basic care until paramedics arrive to administer advanced cardiac life support.

    Paramedics grade the firefighters’ care on critical trauma calls. They fill out a “blue sheet” that details what the less-trained emergency medical technicians on the fire department team have accomplished by the time the paramedics arrive.

    That accountability pushes first responders to deliver rapid treatment and have the patient ready for transport. It gives critical feedback on how they performed and what they can do better next time. It helps the paramedics spot the firefighters with a knack for emergency medicine as they look for new recruits. And the paramedics are scrutinized on every run by their medical director, Michael Copass. Copass reads every run report, and the paramedics know they will be called to task for any error. They say they feel him looking over their shoulders as they make care decisions.

    Seattle has led the nation’s big cities in emergency medicine research and provided the model that medical directors have followed in other cities, including Washington.

    Washington, D.C., Mayor Anthony Williams says his administration is rebuilding city agencies that long have been in disrepair, including the fire department. “We’re improving,” he says. “We’re just starting from way, way behind in so many areas. We’re moving our way up, and I think you’re going to see that improve.”

    His medical director hopes that changes come quickly.

    “These disparities shouldn’t exist,” says Daniels, who vows that Washington one day will have an emergency medical system as good as Seattle’s. “Folks need more scrutiny. We are here to save lives.”

    Contributing: Rati Bishnoi, Tracey Wong Briggs, Jacqueline Chong, Anthony DeBarros, Neal Engledow, Mary Grote, Erin Kirk, Jim Norman, Paul Overberg, Emma Schwartz, In-Sung Yoo

    Get burned over the weekend? RenovaCare has got your back. The New York-based biotech company has expertise in stem cells and organ regeneration, and has brought these skills to bear on wound care. One of the company’s most promising methodsuses a literal skin gun to spray skin stem cells on a burn or chronic wound to promote rapid healing. The healing is so rapid that you can walk into the hospital with a burn on a Friday night and return on Monday largely healed.

    The skin gun process uses a patient’s stem cells, which are collected from healthy skin. The stem cells are isolated from the skin sample and suspended in a water solution that makes them easy to spray. The computer-controlled skin gun works like the air brushes that are used by painters, but with much more precision.

    The treatment is stupidly simple — just spray the stem cells on the burned skin and wait for them to regrow. It is also extremely fast, taking only 1.5 hours to isolate the cells and and spray the skin. Once the skin cells are applied, it takes only a few days for the treatment to be effective. When state trooper Matthew Uram was burned in an unfortunate bonfire accident, he chose this experimental treatment and was entirely healed from his second-degree burns in four days.

    This skin gun approach offers a significant improvement over the current methods of in-lab skin growth and surgical grafting that takes weeks and sometimes even months to be effective. Those who undergo these conventional skin graft techniques often suffer from infections and other setbacks, rendering the treatment far from optimal. A technology like the skin gun that could promote complete healing in a matter of days would represent a clear advance.

    RenovaCare’s skin gun is still in the developmental stage and has not been approved by the FDA for sale in the United States, so you won’t be able to find it on the shelves of burn units quite yet. The company is making progress towards that goal, however, and has recently announced a successful round of testing that shows its gun is capable of dispersing the skin cell liquid in a very uniform and dense manner.

    Recent experiments conducted at Stem Cell Systems GmbH (Berlin, Germany) show that the gun can spray more than 20,000 evenly distributed droplets in a test area as compared to a conventional needle and syringe which produced only 91. The gun is not only capable of even dispersal, but it also is gentle on the skin stem cells, which retain 97.3 percent viability after SkinGun spraying. RenovaCare is continuing its research and development as it moves towards FDA approval and eventual commercial rollout. The company recently a filed a

    First Aid


    Prompt treatment of burns and scalds may help to limit damage and alleviate pain. Treatment is outlined below:

    Severe Burns

    • Start cooling the burn immediately under running water for at least 10 minutes
    • Dial 999 for an ambulance
    • Make the casualty as comfortable as possible, lie them down
    • Continue to pour copious amounts of cold water over the burn for at least ten minutes or until the pain is relieved
    • You should remove all jewellery or clothing from the affected area, unless it is sticking to the skin. However ensure that you are wearing disposable gloves before doing this.
    • Put a clean, non-fluffy material over the burn to protect from infection. Cloth, a clean plastic bag or cling film all make good dressings.
    • Treat for shock

    Minor Burns

    For minor burns, run cold water over the affected area for a minimum of 10 minutes or until the pain eases. Remove any jewellery etc. and cover the burn as detailed above.
    If a minor burn is larger than a postage stamp it requires medical attention. All deep burns of any size require urgent hospital treatment.

    Clothing on fire

    • Stop the casualty panicking or running – any movement or breeze will fan the flames.
    • Drop the casualty to the ground.
    • If you can, wrap a coat, blanket or curtain (not the nylon or cellular type), rug or other heavy-duty fabric tightly around the casualty. The best fabric is wool.
    • Roll the casualty along the ground until the flames have been smothered.

    On ALL burns DO NOT:

    • Use creams, lotions or ointments
    • Use adhesive dressings
    • Break blisters

    Burns – other info

    First Degree:

    1. Begins with pain and redness as in minimal sunburn. No blisters.
    2. Later, slight to no peeling of skin.

    Second Degree:

    1. Begins with pain, redness, and blisters as in moderate to severe sunburn.
    2. Later, skin peels in large pieces, scarring only if secondary infection ensues.

    Third Degree:

    1. Full thickness of skin is destroyed.
    2. Begins with little or no pain (nerves are gone), with red, black or white discoloration. Some unbroken blisters may be present.
    3. Third degree burns always scar and often need skin graft.



    1. Rapidly immerse burn in cold water. This not only helps stop the pain but it also stops destruction of tissue.  There is a correlation between how fast the area is cooled and how fast it heals.
    2. Wash gently but thoroughly with antiseptic soap, pat dry with sterile pad.
    3. Avoid Vaseline, butter, antibiotic or other greasy ointments.
    4. Avoid tight, air-excluding bandages. Check date of latest tetanus booster.

    First degree:

    1. Cool compress or submerge in cold water (not ice).
    2. No further treatment necessary.

    Second degree:

    1. Cool compress.
    2. Wash gently with antiseptic soap and dry.
    3. Do not break blister. Apply non-sticking dressing that does not exclude air.

    Third degree:

    1. Cover with clean or sterile dressing or sheet. Evacuate to emergency room or doctor’s office.

    Chemical burn:

    Flush with large amounts of cool water for 15 minutes.

    Special Instructions:

    1. All Facial burns must be referred to the doctor.
    2. All Chemical or Electrical burns must be referred to the doctor.
    3. Send date of last tetanus booster with all physician referrals.
    4. Be alert to possible child abuse, self-tattoo, or deliberate injury.
    5. Record shape and size of burns.


    Physical Findings:

    1. Bare area of skin resulting from a scrape on a rough surface.
    2. Amount of bleeding is greater when deeper layers of skin are scraped off.
    3. Most often seen on knees, elbows, and face.


    1. Wash gently with soap and water.
    2. During wash, try to remove loose skin tags and crusts by gently rubbing.
    3. Rinse with copious amounts of water to remove foreign material.
    4. Cover with non-adherent gauze, applied loosely so air can enter.
    5. Notify parent if abrasion is major.
    6. If no improvement the next day, refer to physician.
    7. Repeat cleansing at least daily.

    Animal and Human Bites (if skin is broken)

    Physical findings include pain and bleeding.  Puncture wounds and/or lacerations usually jagged.  Pieces of tissue may be torn away in severe bites.

    Unprovoked bites (especially from a dog) raise greater suspicion than if the animal is provoked or teased.  The biting animal must be confined and observed 10 days.

    Dog bites have a low infection rate and usually require no prophylactic antibiotics. Cat bites are usually deep puncture wounds and have a high infection rate.  They often require prophylactic antibiotics.

    Human bites that break the skin have the greatest potential for infection.  Also, consider transmission of Hepatitis B to both students. Check students immunization records for Hepatitis.


    1. Wash and irrigate with copious amounts of soap and water.
    2. Apply loose dressing.
    3. Topical Antibiotics may be applied if approved.
    4. Refer all but most minor bites (skin not broken) to physician.
    5. Record the date of last tetanus shot.


    Blisters are small unbroken water blisters, blood blister, or burn blisters.  They should not be opened.

    Treatment:  Wash gently with soap and water.  A cold pack may be applied for comfort.  Cover the blister with a bandaid in case it opens and drains.  If the blister has broken, keep the area clean and covered with a bandage.

    Procedure for Handling Spilled Blood and Body Fluids:

    1. Put on disposable gloves.
    2. Use paper towels to absorb spill.
    3. Place used towels in leak-proof plastic bag.  Extensive spills use a RED plastic bag.
    4. Flood area with bleach solution, alcohol, or a dry sanitary absorbent agent.
    5. Clean area with paper towels, vacuum, or broom and dustpan.
    6. Place used towels, vacuum cleaner bag, or waste in a leak-proof plastic bag.
    7. Remove gloves by pulling inside out.
    8. Place used gloves in bag and tie.
    9. Wash hands with soap and water for at least 10 seconds.


    A boil is a skin infection, usually staph, involving the entire hair follicle and the adjacent subcutaneous tissue.  They occur most commonly of the face, neck, armpit, buttocks, and thighs.

    Physical findings include pain, swelling, and redness.  The boil can get to be about the size of a marble or larger.  It progresses from redness to a yellowish center filled with pus.


    1. Usually must drain before they heal.
    2. Warm packs encourage drainage.
    3. Antibiotic ointment if approved.
    4. Gentle pressure to express pus, only if already draining.
    5. Draining lesions must be cleaned frequently to prevent spread of infection.
    6. If boil needs to be lanced, student should go to the doctor.
    7. Do not squeeze hard to express “core” or “head” as most boils do not have one.
    8. Oral antibiotics for multiple or recurrent abcesses.
    9. Try to keep hands off.
    10. Wash hands thoroughly after touching a boil.
    11. Do not reuse or share towels.  Linens in contact with boils should be washed in very hot water.
    12. Dressings should be discarded in a sealed plastic bag.


    Bruises are purple-red stains in the skin resulting from a blow or bump that ruptures small blood vessels near the skin’s surface.


    1. Swelling over the injury site.
    2. Tenderness to the touch that lasts 1 to 3 days.
    3. Redness that progress through several color changes-purple, green-yellow, and yellow-before it completely heals.


    1. I.C.E. – Rest, Ice, Compression, and Elevation.
    2. Ice packs to area 3 or 4 times a day.
    3. After 48 hours, localized heat promotes healing.
    4. Don’t massage the bruised area or the hematoma. You may trigger bleeding again.
    5. Be aware that bruises in different stages of healing on various parts of the body may be warning signals of child abuse.

    Canker Sore

    Canker sore is an ulcer occurring inside the mouth.  It is probably viral.  It is a papule which has a “burning” sensation and progresses into an ulcer with surrounding redness.  It can be treated with rinsing the child’s mouth 3 or 4 times a day with a salt solution (1/2 teaspoon salt to 8 oz. Water)  At home, the child can use topical anesthetics.  Avoid irritating foods/liquids (spicy, salty, or acidic).  See physician if it does not heal in 2-3 weeks.

    Dental Emergencies

    Avulsed Tooth (Knocked out):

    If a knocked out tooth is handled correctly, and little time has elapsed (half hour), there is a good possibility that the dentist can reimplant it.

    1. Don’t change the tooth’s protective coating by trying to clean it.  At most gently rinse off debris.
    2. Place the tooth in student’s mouth between check and gum (providing the student is old enough).  This natural environment is most protective to the tooth; use milk in the case of students < 7 years.
    3. If student is too young, wrap tooth in gauze and immerse in milk for transportation.
    4. Call parent and the dentist to arrange an immediate visit.
    5. Primary teeth which are avulsed are not replanted but the tooth should be taken to the dentist so that he or she can be sure the tooth was lost in its entirety and the root not broken.

    Dislocated Tooth

    1. Reposition tooth gently.
    2. Call parent and dentist for emergency visit.
    3. Put gauze around tooth and have student hold it during transportation to dentist.
    4. For permanent tooth, time is of the essence.

    Fractured tooth

    1. Call parent.
    2. Save fragment or large chip.
    3. Put gauze around tooth and have student hold it there during transportation to dentist.
    4. For permanent tooth, time is of the essence.

    Fractured Jaw

    1. Immobilize jaw placing a scarf, tie, or towel under the chin.  Tie the ends on top of the head
    2. Call parent and dentist.

    Protruding Braces Wire

    1. Protruding wire from a brace can be gently bent out of the way to relieve discomfort by using a tongue depressor or pencil eraser.  If wire cannot be bent easily, place small piece of gauze or cotton over the end to prevent irritation to cheek or gum.  Do not try to remove any wire embedded in the cheeks, gum, or tongue.
    2. Obtain orthodontic care same day.

    Red, Swollen, or Sore Gums

    1. Have student rinse mouth thoroughly with a warm salt water solution (1/4 tsp. Table salt to 4 oz. glass of water).
    2. Instruct student to repeat rinses every two hours, and after eating or toothbrushing, and before retiring.
    3. If no improvement in 1-2 days, refer to doctor or dentist.
    4. Check for abscesses below the tooth line.


    All toothaches should be referred to a dentist; severity will dictate the time frame.

    Bitten Lip or Tongue

    1. Apply direct pressure to the bleeding area with a clean gauze pad.
    2. If the lip is swollen, apply a cold compress.
    3. Obtain emergency medical care if bleeding persists or if the bite is severe.


    Although there is not a cure for asthma, it can be controlled.

    Asthma is a disease of the airways.  A person with asthma can have an asthma attack, which means that something has inflamed the inside of their lungs, making it hard to breathe.  This can happen when the person is exposed to an asthma trigger, like pollen or cigarette smoke.

    Warning signs of an asthma attack:

    • Coughing or wheezing.
    • Shortness of breath.
    • Rapid breathing.
    • Cannot talk well.
    • Child looks anxious or scared.
    •  Low energy.
    • Paleness or sweating.
    • Throwing up.
    • Nostrils flaring.
    • Chest Pain.
    • Hunched-over posture.

    During an attack:

    1. Have the child stop all activity.
    2. Sit the child in an upright position.
    3. Reassure the child in a calm voice.
    4. Assist the child in using the right medicine.
    5. Keep an eye on the child’s breathing.

    If you see that your child has:

    1. Wheezing, coughing, or shortness of breath that keeps getting worse.  Breathlessness may cause the child to talk in one-to-two word sentences or not at all.
    2. Exhaustion, restlessness, or confusion.
    3. A sucked in chest and neck with each breath.
    4. Grey or blue lips or fingernails.

    …Contact 911 Right Away!

    Provide the child with a normal classroom experience:

    • Treat the child with asthma as you would a normal.
    • Accept the child and understand his or her condition.
    • Do not label the child as “sick”.
    • Do not isolate the child.


    Diabetes is a condition in which insulin is insufficient in amount or has limited effectiveness to transport glucose from the blood stream into cells.  Unchecked, high glucose levels in the blood stream deprive the brain and muscles of glucose needed to function but the accumulation within the blood stream damages tissues and blood vessels, leading to kidney, eye and neuropathies, heart disease and risk of stroke.


    Hypoglycemia (Low Blood Glucose): 

    Caused from too little food, too much insulin or diabetes medicine, or extra exercise.  The onset is sudden, may progress to insulin shock.

    Symptoms include:

    1. Shaking.
    2. Fast Heartbeat.
    3. Sweating.
    4. Anxious.
    5. Dizziness.
    6. Hunger.
    7. Impaired Vision.
    8. Weakness Fatigue.
    9. Headache.
    10. Irritable.

    If low blood sugar develops suddenly, give candy, glucose tablets, orange juice, soft drink (non-dietetic).  Follow with ½ a meat sandwich plus a glass of milk.  If the student is unable to swallow or  has diminished consciousness, administer glucose gel between cheek/gums and massage.  If the student becomes unconscious, give glucagons IM per Dr.’s order, then call 911!

    Complications:  Hyperglycemia (High Blood Glucose)

    Caused by too much food, too little insulin or diabetes medicine, illness or stress.  Onset is gradual, may progress to diabetic coma.

    Symptoms include:

    1. Extreme Thirst.
    2. Frequent Urination.
    3. Dry skin.
    4. Hunger.
    5. Blurred Vision.
    6. Drowsiness.
    7. Nausea.

    If Hyperglycemia develops, give 8 ounces of water to hydrate.  Check urine ketones if blood sugar is high.  Additional insulin may need to be given so notify parent. Exercise only if ketones are less than moderate.


    Diarrhea is usually caused by viruses, are minor, and are of short duration.  It is very rare for children with diarrhea to have only one loose stool and stop; they usually have more.  Most cases are contagious.  Treatment at home should include foods in small quantities.  Liquids are important and should be urged to prevent dehydration.  Most cases are mild and do not need to be seen by a doctor.  However, severe cases with fever and cramps should be referred to a physician.


    Earaches may be reported by a student.  Inflammation of the middle ear may accompany a simple “cold”.  It often resolves with no lasting effect.  Severe pain or signs of a ruptured ear drum warrent prompt medical evaluation.  For comfort while awaiting the parent to take the child to the physician, a warm dry compress can be applied to the affected ear.


    Eczema is a form of dermatitis or inflammed skin.  Eczema may be difficult to distinguish from other rashes.  It most commonly affects the creases of elbow, wrists, knees, ankles, feet, and neck.  The rash is red and extremely itchy and can appear raw and weepy if scratched.


    1. Hydrate the skin by applying moisturizer after a bath and using a humidifier in your home.
    2. Use a nondrying soap.
    3. Cotton clothes can help by allowing the skin to breath.
    4. Avoid scratchy materials such as wool.
    5. Triggers that can cause the condition to flare up are excessive heat or cold, sweating, dry air, chlorine, harsh chemicals and soaps.
    6. The use of a steroid cream such as a hydrocortisone cream can aid the healing process of the affected areas.
    7. Consult a physician if the condition hasn’t greatly improved in few days or if the rash becomes infected.

    Eye Injuries

    1. The first question to ask the student is “Do you wear contacts?”
    2. Foreign bodies such as dirt, bug, or eyelash can cause discomfort.
    3. Keep the student from rubbing the eye. This can cause further pain and possibly
      a scratch to the eye.
    4. Wash you hands before touching the eyelid or face.
    5. Flush the eye with clean running water.  Sometimes just have the student gently close their eyes for a few minutes and the eye’s natural tears will flush the object out.
    6. If there is a scratch to the surface of the eye, the most common complaints are extreme sensitivity to light and excessive tearing.  This requires immediate medical attention.
    7. If a penetrating injury is suspected, do not attempt to remove the object or wash the eye.  Avoid any pressure on the eye.  Do not apply a cold pack or dressing.  Keep the student calm.  This requires immediate medical attention.
    8. If a chemical or other substance comes in contact with the eye(s), flush the     eye with large amounts of water for 15 minutes by holding the head to the affected side and holding eyelid open.  Do not rub the eye.  This requires immediate medical attention.


    Fainting can occur for a variety of reasons, such as weakness, hunger, strong emotional reactions, severe pain, or onset of an illness.  Some individuals are more prone to faint than others.  For unknown reasons, it is more common in girls.  Fainting must be differentiated from an epileptic attack.  In a simple fainting spell there are usually no twitching movements of the arms and legs.  If there is any twitching, a physician will be required to rule out epilepsy. Treatment includes laying the student on their back.  Check blood pressure, pulse, and respiration.  Loosen any restrictive clothing.  Monitor the student for further complaints.  Notify the parent.


    Fever is described as a temperature greater than 100°F and is a symptom, not a disease.  Fever is the body’s normal response to infection and plays a role in fighting infections.  Fever turns on the body’s immune system.  Most fevers are caused by viral illnesses and antibiotics are not used to treat viral infections.  If the doctor determines that your child has a bacterial infection, then most generally an antibiotic will be prescribed for the infection, not the fever.  In general, the height of the fever doesn’t relate to the severity of the illness.  Home care:  encourage extra fluids and light clothing (unless the child is shivering), acetaminophen (generic Tylenol) or ibuprofen (generic Advil) can lower the fever, and lukewarm sponge baths.  Never give aspirin or aspirin containing medications unless instructed by your physician.  Please read the label before giving any medication.  Some may contain aspirin such as Pepto-Bismol.  Several studies have linked aspirin to Reye’s Syndrome.  Contact your physician if the fever lasts 24 hours.

    Fifth Disease

    Bright red or rosy rash on both cheeks that lasts for 1 to 2 days (“slapped cheek” appearance).  There is no fever or a low-grade fever.  The rash on cheeks is followed by pink lacelike rash on extremities that comes and goes several times over 1 to 3 weeks.  The rash may come and go for up to 5 weeks, especially after warm baths, exercise, and sun exposure.  The disease is contagious during the week before the rash begins; therefore a child who has the rash is no longer contagious and does not need to stay home from school.  Inform any women who are pregnant that may have been exposed.


    No treatment is necessary.  The rash is harmless and causes no symptoms that need treatment.

    Fractures, Sprains, Strains, and Jammed Fingers

    All of these require attention:  “R.I.C.E”

    2. If you suspect a fracture, do not attempt to have the student “try it out” by putting weight on a leg or moving the arm.
    3. All fractures should be splinted in the position that it is found or is most comfortable.  Splint only if you can do it without causing more pain.
    4. When immobilizing a body part, the joint above and below the suspected injury should be stabilized as well.
    5. Check for proper circulation before and after splinting.
    6. If possible, apply a cold pack over the injury to aid in decreasing swelling.
    7. Jammed fingers can cause a great deal of pain and are usually accompanied by the ability to move and bend the finger.  Cold pack are helpful and immobilization of the finger will aid in the discomfort and prevent further injury.


    1. All injuries associated with moderate to marked bruises, severe pain or swelling.
    2. History of a “pop” or inability to bear weight.
    3. All possible fractures.
      1. Tenderness to pressure over medial or lateral malleolus (inner or out ankle).
      2. If limp continues after the first day.

    Head and Spine Injuries

    1. Changes in consciousness
    2. Severe pain or pressure in the head, neck, or back.
    3. Tingling or loss of sensation in the hands, fingers, feet, and toes.
      1. Unusual bumps or depressions on the head or over the spine.
      2. Blood or other fluids in the ears or nose.
      3. Heavy external bleeding of the head, neck, or back.
      4. Seizures.
      5. Impaired breathing or vision as a result of injury.
    4. Nausea or vomiting.
    5. Persistent headache.
    6. Loss of balance.
    7. Bruising of the head, especially around the eyes and behind the ears.

    General care for Head and Spine Injuries

    1. Minimize movement of the head and spine.
    2. Maintain an open airway.
    3. Check consciousness and breathing.
    4. Control any external bleeding.
    5. Keep the victim from getting chilled or overheated.

    Immediate care of the injured

    DO NOT MOVE A SERIOUSLY INJURED PERSON UNLESS ABSOLUTELY NECESSARY.    Any movement could cause further injury.  Let the professionals assess the victim and provide proper immobilization.

    Haste can be detrimental when caring for an injured person.  Take Your time!  Very often haste leads to poor methods of care.  Real haste is usually needed only in rare cases such as severe bleeding, heart attack, etc.


    Headaches are a common complaint of school-age children.  When a student complains of headache, do not say “Go to the nurse and get a Tylenol.”  In doing this, you are teaching the student to rely on drugs for a quick solution.  Some headaches go away just as quickly on their own as they come on.  Suggest to the student to lie their head down on the desk for a few minutes, get a drink of water, or apply a wet paper towel to the forehead.  If after 20 minutes the student complains again, you may want to send them to the nurse’s office to lie down.  Many headaches are due to hot classrooms or other outside influences that are not relieved with Tylenol.  Although a great many students complain of headaches, there are very few who have a true headache.

    Heat-Related Illness

    A heat-related illness requires getting the student out of the heat.  Place in a cool, shaded area.  Rest.  Give the student replacement of water by drinking, and cooling of the skin with cold water and/or a fan.  Heavy clothing should be loosened or removed.  Immediate medical attention is needed if the student refuses water, vomits, or starts to lose consciousness.


    Hives are an allergic reaction.  It could be from foods, medications, emotional factors, pollens, dust, contact substances such as plants, or physical factors such as sun or coldness.

    Physical findings:

    1. Round, reddish-pink wheals on skin surface varying in size from ½ cm to 2-3 cm.
    2. May run together causing irregular, larger wheal.
    3. Tend to be clear in center with surrounding redness.
    4. Not tender or painful, but itchy.
    5. Characteristically short-lived, but reappear often in other parts of body.
    6. May be accompanied by swelling.
    7. Never contagious.
    8. Laryngeal Edema (hoarseness and difficulty breathing is the most serious complication). Call 9-1-1


    Signs and Symptoms:

    1. Rapid breathing.
    2. Rapid pulse.
    3. Numbness of extremities.
    4. Prickly feeling of skin.
    5. Cramps in muscles.
    6. Redness of skin.


    1. Be calm and firm.
    2. Instruct student to breathe more slowly.
    3. If no improvement, have student breathe for a few minutes into a paper bag held tightly around mouth and nose.
    4. Notify parent and urge medical care.


    Impetigo is an infection of the skin caused by a staph or strep bacteria.  Open sores, cuts, scrapes, insect bits, chicken pox lesions can become infected.  The areas do not heal, usually increase in size, and then become covered with honey-colored crusted scabs.  The scabs may drain pus.


    1. Remove the crusts by soaking in warm soapy water and gently rub (a little bleeding is common when you remove the crusts by soaking) and then apply an antibiotic ointment.  Apply for 7 days or longer if necessary.
    2. Use an antibiotic soap.
    3. Contact your physician if the condition does not improve within 24 hours.

    Most students may stay in school if under treatment and lesions lightly covered while in school.  Children with multiple or very large impetigo lesions may need to be excluded for a least 24 hours after treatment begins if they are very young or significantly developmentally delayed and unable to keep the area covered or if there is a great deal of skin to skin contact between them and other children.


    Nosebleeds can be caused by a blow to the nose, dryness or irritation of the nasal lining, or vigorous nose blowing.  To stop the bleeding have the student do the following:  Sit upright with upper body leaning forward and breathe through the mouth.  Press the ends of the nose together quite firmly between thumb and forefinger for five minutes.  After the bleeding stops, the child should remain quiet for 15 minutes.  If bleeding does not occur, child may return to class.  Do not have the student tilt the head back as this causes the blood to run down the back of the throat.  This can obstruct the airway or cause nausea/vomiting.

    Pinkeye (Conjunctivitis)

    Pinkeye is an inflammation and/or an infection of the conjunctiva (mucous membrane lining the eye)

    It is cause by allergens, irritants (e.g., foreign object, dust, smoke), bacterial, or viral infections.

    Common Physical Findings:

    1. Redness of sclera.
      1. Discharge: purulent or watery.
      2. Itchiness: student rubs eye(s).
      3. Eyelids may be red and/or swollen.
      4. Crusts in inner corner of eyes, especially on waking from sleep.

    Prescription antibiotic eye drops are the course of treatment.  Bacterial eye infections are very contagious and spread easily.  Your child will be contagious and will not be allowed to attend school until after 24 hours of treatment.  Good hand washing is important to prevent the spread of infection to the other eye and other children or family members.

    Poison Ivy/Oak

    Contact Dermatitis is due to an irritant or allergen.  Poison ivy, oak, and sumac creates an allergic contact dermatitis.

    Physical findings:

    1. Reaction begins 1-4 days after exposure.
    2. Contents of blisters and weepy skin cannot cause rash in another student or even in another location on student.
    3. Itchy, redness, small papules and vesicles become larger blisters and have generalized weeping of skin.
    4. Healing may take 2-3 weeks.  Dryness will occur.  Gradual shedding of crusts and scabs occur.
    5. Refer to the physician if it is distracting, extensive, or involving the eye, face or mucous membrane.


    1. Do not exclude from school.
    2. Loose dressing may help discourage scratching.
    3. Cool packs.
    4. Plain Calamine lotion.
    5. Observe for infection.


    Ringworm is a fungal infection of the skin that is often transferred from puppies or kittens that presents with mildly itchy ring-shaped pink patch (about ½ – 1 inch in size).

    Symptoms include itchy, red, raised, scaly patches that may blister and ooze.  They are often redder around the outside with normal skin tone in the center.  This may create the appearance of a ring.


    1. Keep your skin clean and dry.
      1. Apply over-the-counter antifungal cream at least twice daily.
      2. Wash sheets and nightclothes every day while infected.

    Ringworm of the skin is not contagious enough to worry about.  After 48 hours of treatment, it is not contagious at all.  Your child does not need to miss any school.  You can simply cover the area loosely with a bandaid or a patch for the first 48 hours.  Contact your physician if the area has not cleared up in 4 weeks, the ringworm continues to spread, or if the scalp becomes involved.


    Scabies is a disease of the skin caused by a mite.  Scabies is contagious.

    Physical findings:

    1. Typical lesion is a “burrow”, a tiny, pale, irregular line which marks the path of the scabies mite.
    2. Rash on the back of hands, web of fingers, front of forearms, lower abdomen, chest, and axilla.
    3. Itching is intense, especially at night. It may persist a month after treatment.
    4. Frequently found in other family members.


    1. Exclude student from school. May return the next day after treatment.
    2. Instruct parent to wash clothes and bed linen at 120°F or hotter.
    3. Ask pharmacist for an over the counter medication or see physician for a prescription.
    4. Lotions should be applied to entire body from chin-line to toes. Always exclude face.  To be left on as recommended on the package or doctor, then wash thoroughly with soap and water.
    5. Watch each day for new lesions. A second treatment may be necessary.
    6. Check siblings.

    Seizure Recognition and First Aid


    1. Generalized, violent muscle contractions.
    2. Affects most of the body.
    3. Loss of consciousness.
    4. Incontinence of urine.
    5. Tongue or cheek biting.
    6. Sometimes seizure is preceded by aura of light, noise or odor.
    7. Post-convulsive state; drowsy to deep sleep.
      1. Frequency varies from daily, to monthly, to annually.

    First Aid:

    1. Look for medical identification.
    2. Protect from nearby hazards.
    3. Loosen ties or shirt collars
    4. Protect head from injury.
    5. Turn on side to keep airway clear.
    6. Reassure when consciousness returns.
    7. If single seizure lasted less than 5 minutes, ask if hospital evaluation is wanted.
    8. If multiple seizures, or if one seizure lasts longer than 5 minutes, call an ambulance. If person is pregnant, injured, or diabetic, call for an ambulance.


    1. Very brief (10-20 seconds) period of cessation of motion.
    2. Brief loss of consciousness. May fall.
    3. May drop glass or pencil.
    4. Occasional brief muscular twitches.
    5. May occur several times a day.
    6. Lack of attention (e.g., staring out the window) often mistaken for petit mal.

    First Aid:

    No first aid necessary, but if this is the first observation of the seizure(s), medical evaluation should be recommended.


    1. Seizure of one part of body, usually on one side only: hand, arm, face, tongue, foot, or leg.
    2. May “spread” to other muscle groups.
    3. Usually no loss of consciousness.
    4. May have nausea, sweating, or dilated pupils.

    First Aid:

    No first aid necessary unless seizure becomes convulsive, then first aid as above.  Give reassurance and emotional support.  Medical evaluation should be recommended.


    1. Purposeful but inappropriate motor acts, often repetitive: running, arm extension with slow turn of body, “fugue” or trancelike state.
      1. Often sleepy after seizure.
      2. Usually no tonic or clonic activity.

    First Aid:

    1. Speak calmly and reassuringly to student and others.
    2. Guide gently away from obvious hazards.
    3. Stay with person until completely aware of environment.


    1. Numbness, tingling, or pain. May originate in one part of body and spread.
    2. Visual images or sensations.
    3. Sudden tastes or smells.

    First Aid:

    No first aid is necessary, but medical evaluation should be recommended.


    1. Symptoms of headache, stomachache, vomiting, diarrhea, uncontrollable laugh and other symptoms associated with autonomic nervous systems.
    2. Behavior disorders and learning problems.
    3. Thought to be due to abnormal cerebral cortical discharges.
    4. The existence of this category of epilepsy is questioned: attributed to psychological origin.

    First Aid:

    No first aid is necessary, but medical evaluation is recommended.


    1. Rarely injured self.
    2. Incontinence rare.
    3. Consciousness regained quickly.
    4. Often preceded by anxiety.
    5. Cyanosis (blueness) absent or momentary.

    First Aid:

    No first aid is needed, but medical evaluation is recommended.


    This officially defined as a seizure lasting 30 minutes or a 30 minute period of serial seizures without regaining consciousness between each episode.  In this case there is the danger of brain damage.  After 5 minutes, call 911!


    1. Remain with the student during the seizure and provide privacy.
    2. Ease the student to the ground to prevent falling.
    3. Do no restrain the student.
    4. Move objects away from the student that could be hit.
    5. Do not Stimulate by rubbing chest, face, or arms or loosening clothing.
    6. Do not try to force mouth open.
    7. Do not move patient.
    8. Do not insert any padded object into the mouth.
    9. If patient is on floor, position on side with mouth toward floor so oral secretions or vomit flow out.
    10. Loosen tight clothing from around the neck.
    11. Document time seizure starts and stops, description of seizure, onset, precipitating factors, duration and behavior following seizure.
    12. Generalized seizures lasting more than 5 minutes  require emergency medical services/transport.


    Shock is likely to develop in any serious injury or illness.  Signals of shock are restlessness or irritability, altered consciousness, pale, cool, moist skin, rapid breathing and pulse.


    Have the student lie down or in a comfortable position, control any bleeding, keep the body warm, offer reassurance, elevate the legs (unless you suspect injury to head, neck, back, or legs), and give nothing by mouth even though the student may be thirsty.  Shock requires immediate medical attention.

    Spider Bites

    If possible, try to identify the type of spider by asking the student.  If black widow or brown recluse is suspected, the student must see a physician immediately.


    1. Wearing gloves, wash the bite with soap and water.
    2. Apply ice pack covered with a clean, dry cloth.
      1. Observe student for any unusual symptoms.
      2. Notify the parent.
      3. Contact poison control as needed.


    Splinters may be removed with tweezers if protruding from the skin.  Cleanse with soap and water.  If the splinter is embedded, notify the parent and urge medical care.


    If stung by an insect and there is no reported allergy, cleanse the sting with soap and water and apply a cold pack for comfort.  If the stinger is still present do not use tweezers to remove.  Simply us a scraping motion across the stinger with a flat edged object.

    Sting Allergy

    Students with a sting allergy must fill out a Allergy Reaction Form.  An instruction plan for allergic reaction will be made.

    Extreme hypersensitivity to insect sting is a potentially life-threatening condition.  Student with know allergy should have a written emergency care plan to receive their medication as soon as the sting is reported.  Do not wait to observe a reaction.

    Symptoms of a severe allergy include hives, pallor, weakness, thick tongue/lips, nausea, vomiting, tightness in chest, nose or throat.

    Emergency Action:

    1. Keep the student’s emergency adrenalin kit in a cool place known to all staff. Assure it is taken on outdoor field trips.
    2. The nurse or trained alternate will administer the medication.

    Give epi-pen shot immediately.  Do not hesitate!

    • Form fist around auto-injector with black tip down.
    • With other hand, pull off gray cap.
    • Hold black tip near out thigh.
    • Swing and jab firmly into outer thigh so auto-injector is perpendicular (at 90 degree angle) to thigh.
    • Hold firmly to thigh for several seconds.
    1. Other staff can assist to remove the stinger promptly by scraping with a hard edge (plastic card) or pulling with a tweezers (research indicated speed is more critical than method).
    2. Summon emergency medical services upon administering the first dose. If the student is still with staff and not emergency services 10-20 minutes after the first injection, do no delay, but give the second dose as medically ordered.
    3. Record the time of administration precisely and inform emergency staff.
    4. If the medication is not available or no one will administer, emergency medical services must be called as soon as is reported. Prepare to administer CPR.


    It can be difficult to judge when a wound should receive stitches from a doctor.  One rule of thumb is that stitches are needed when edges of skin do not fall together or when any wound is over an inch long.  Stitches speed the healing process, lessen the chance of infection, and improve the appearance of scars.  This should be placed within the first few hours after the injury.


    Stomachaches are by far the most common childhood complaint, and most of the time the condition is minor, needs no special treatment, and goes away by itself.  Stomachaches can also be caused by emotional distress.  A child with a stomachache without a fever could possibly have something serious, but it is much less likely.  Watch for facial expression.  If a child looks alert, does not seem worried, or does not frown as if in pain, let him rest on the nurse’s cot for 15 minutes, then he/she can return to class.

    Strep Throat

    Strep throat is an infection and inflammation of the pharynx by streptococcal bacteria.  Strep throat is contagious.


    1. Fever.
    2. Throat pain that is worse when swallowing.
    3. Very young children may complain of stomach pain rather than throat pain.
    4. Loss of appetite.
    5. Headache.
    6. General ill feeling.
    7. Ear pain when swallowing (sometimes).
    8. Swollen glands in the neck.
    9. Bright-red tonsils that may have specks of pus.


    1. Warm, salty (1/2 teaspoon to 1 glass of water) gargles.
    2. Warm fluids (broth; hot water with melted lemon drop or warm lemonade.
      1. Over-the-counter lozenges (do not advise lozenges at school for safety reasons).
      2. Refer for diagnosis by rapid strep test and culture.
      3. Take prescription as ordered.
      4. Return to school after 24 hours on antibiotic treatment and fever-free.

    Substance Abuse

    Note symptoms, such as dizziness, confusion, hallucinations, breath odor, drowsiness, unconsciousness, and watering of eye.

    If unconscious – Call 9-1-1.  Obtain information about the substance involved, such as what substance was used?  Time when substance was taken?  Method of administration?  Amount taken?

    Notify the parent.


    • If slow heart rate and respiration – a depressant may be involved.
    • If restlessness, anxiety, unclear heart rate, and dry mouth are present – a stimulant may be involve.
    • Fixed pin-pointed pupils, slow respiration and sleepiness. Coma. Narcotics such as Heroine may be involved.
    • Violent behavior – Hallucinogens
    • Loss of coordination, distortion of reality, increased heart rate, dream like state – Marijuana is suspected.


    1. If substance is injected, inhaled, or swallowed – contact Illinois Poison Control immediately.
    2. If individual is agitated – DO NOT leave him/her unattended.
    3. Put the individual on side to prevent aspiration.
    4. Notify the parent and urge medical care.

    If Alcohol Ingestion:

    1. Note symptoms.  If necessary lay on side.  Do not lay on back or let individual sleep.
    2. Notify parent and make arrangements for individual to be picked up.

    If Alcohol Overdose:

    1. If student has difficulty breathing or is unconscious, call 9-1-1.
    2. If student is conscious and large amounts of alcohol are known to have been ingested, treat as POISON and call Illinois Poison Control Center.


    When ticks bite, they inject a “cement” around their mouth parts which parts which makes it hard to remove them whole.  The separated mouth cannot be left in, as it will often cause an itchy nodule which becomes infected.


    1. Cleanse the site, then remove the tick with a small, blunt forceps or tweezers, pulling up with a firm, steady pressure to keep it whole.
    2. Re-cleanse the site.
    3. Flush the tick in toilet; do not burn it or dispose in waste can.
    4. Inform parents of signs following a tick bite that need a physician’s attention.
    5. Monitor student for signs of illness for up to one month.

    Signs of Tick-borne Disease

    1. Skin lesion, starting as red macule or papule, enlarging to a “bull’s eye” at least 5 cm.
    2. “Flu-like” fatigue.
    3. Chills.
    4. Muscle and joint pain.
    5. Swollen lymph nodes.

    Educate yourself about tick avoidance.  Wear protective clothing.  Use repellents.  Use tick protection for pets.  Frequently check yourself and use careful tick removal.


    Vomiting is a common childhood complaints.  There are literally hundreds of bacteria and viruses that cause gastrointestinal upsets.  Anxiety can be a cause.  One episode of vomiting does not necessarily mean the child needs to go to the home.  Vomiting one time only can be caused by too much exercise in the hot sun, strong emotional factors (fear, anxiety, etc.), or other factors that are not serious enough to send the child home.  The child should be allowed to lie down, take his/her temperature, and see how he/she feels in 15 minutes.  Then a decision should be made about whether to call the parent.


    Call Poison Control Immediately!
    261-3193 or 800-478-3193

    Any non-food item, including all medications and large quantities of vitamins can be toxic. Call Poison Control for any suspicious ingestion. Do not induce vomiting unless specifically instructed by Poison Control. All homes with small children should have ipecac syrup available to induce vomiting. Ipecac syrup can be purchased over the counter at most pharmacies. All medications and chemicals should be placed far out of the reach of children and secured with child safe fasteners. However, many poisonings occur outside the child’s home. Parents and caregivers should be alert for poisonings whenever a child is in an unfamiliar place.

    Fumes, gases, and smoke are also poisons. Remove the person from danger and support breathing if necessary. Then call Poison Control or 911 for EMS.

    Brush off any acids, lye, pesticides, or other potentially poisonous substance that come into contact with the skin using gloves. Remove any contaminated clothing. Flush with large quantities of clean water, or mild soap and water. Call Poison Control. If possible take the container with you if instructed to go to the emergency room.

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