File: JLCE - 1
MEDICAL EMERGENCY RESPONSE PREPAREDNESS POLICY
Introduction
The School Committee for the Milford Public Schools is committed to the development of practices that will help to create an environment as safe as reasonably possible for all individuals in the school community.
The Milford School Committee will follow, to the extent such is deemed appropriate to the Milford School System, the Massachusetts Department of Education (DOE) guidelines, Managing Life Threatening Food Allergies in Schools published in the fall of 2002.
Purpose
1. To promote a community approach in the management of life-threatening allergies;
2. To develop strategies that will protect children with life-threatening allergic reactions to the extent possible;
3. To create a safer place for children to eat, learn, and play;
4. To heighten employee awareness in the recognition of signs and symptoms of anaphylaxis, that will aid in the timely activation of the Emergency Medical System (EMS) for those individuals known or not previously known to experience anaphylactic reaction;
5. To have school personnel cardio-pulmonary resuscitation (CPR) trained in each school building; and
6. To provide direction for school personnel in the management of severe respiratory distress, the presence of a head, neck and back injury, when heavy bleeding or seizures occur.
7. This policy is for activities during school hours: Elementary School 8:05AM to 3:05PM
Friday 8:05AM to 2:50PM
Middle School 7:45AM to 2:45PM
Friday 7:45AM to 2:30PM
High School 7:40AM to 2:40PM
Friday 7:40AM to 2:25PM.
Training of School Personnel
The School Committee will ensure there is a person certified in cardio-pulmonary resuscitation (CPR) in each school building. CPR includes training in the Automated External Defibrillator.
The names of the CPR-certified staff members will be placed in the inside cover of the Emergency Health Care Plan Book located in the main office of each building during the fall.
Each building administrator will provide the Milford Fire Department with a building floor plan identifying individual building egresses to aid in the quick arrival of the emergency personnel when a 9 – 9 – 1 –1 call has been initiated.
The Director of Nursing and/or designee will follow the Nursing Standard II, Anaphylaxis
Staff Education, to provide a policy implementation in-service for all staff employed by the Milford Public Schools including substitutes.
5. A Medical Emergency Preparedness in-service will be offered throughout the school year and individuals will be scheduled by the Central Office and/or building principals at the time of employment.
6. The Director of Nursing will distribute the Medical Emergency Preparedness, QUICK REFERENCE Flip Chart to each employee at the initial training. Conditions addressed on
the Flip Chart will be reviewed. Staff will be asked to post the chart and review periodically to keep information foremost in mind.
7. Principals and the school nurse(s) shall update staff on Medical Emergency Preparedness at the annual meeting at the beginning of the school year. The Director of Nursing will identify areas to be covered during these meetings to provide consistency in training staff.
8. School personnel will be cognizant of the life threatening allergens and not include these allergens in the development of 504 and IEP’s whenever possible.
9. It is the responsibility of the nurse and/or principal/designee to inform the substitute teacher who has yet to attend the Medical Emergency Preparedness in-service of students in his/her classroom with medical problems and the location of the Individual Health Care Plans for each student.
10. The following Nursing Department Policies and Procedures and Nursing Standards located in the school nurses Nursing Policy and Procedure manuals will be consulted for guidance for the training and education of school personnel in EpiPen administration:
Anaphylaxis Staff Education, Standard II
Medication Administration Policy, D-NUR-200
EpiPen for Emergency Use Policy, D-NUR-201
Administration of EpiPen by School Personnel Policy, D-NUR-005
Training Program for the Administration of EpiPen by School Personnel, Standard I.
11. Nursing Department Policies and Procedures will supplement nursing practice in medication administration:
Medication Variance, Policy, D-NUR-004
Temperature Monitoring for Medication Refrigeration Policy, D-NUR-003
Department Standards of Practice, Format and Revision Policy, D-NUR-006
Departmental Policy and Procedure, Format, and Revision, D-NUR-001.
Individual Health Care Plan
1. As part of the enrollment process, the parent/guardian of students with allergies or pre-existing anaphylactic reactions as well as other medical problems will meet with the school nurse to develop the IHCP, initiate medication orders, medication administration plans and parent/guardian authorizations for each medication received. The Annual Health Update Card, Form #NU234 will have emergency information such as people to contact, phone numbers and physicians and will be in the nurse’s office. Student emergency cards are located in the building’s main office also.
2. The Nursing Department Policy, Individual Health Care Plan, D-NUR-203 is followed in the development of Individual Health Care Plans (IHCP’s) for those students with identified allergies. A recent photo for the student with an EpiPen order will be placed on the
Emergency Care Plan (one component of the IHCP).
School Bus Management
1. The Director of Nursing and/or designee will provide, when requested, an in-service for all staff employed by the contracted bus company(s) including substitute personnel on anaphylaxis (following the Nursing Standard II) and certification in cardio-pulmonary resuscitation (CPR) whenever possible.
2. The Director of Nursing will distribute the Medical Emergency Preparedness, QUICK REFERENCE Flip Chart each vehicle. Conditions addressed on the Flip Chart will be reviewed.
3. There shall be no eating of any foods on the school buses.
4. Gloves used on the buses must be non-latex, powder-free and low in protein allergens.
5. The school nurse will provide the Milford Public Schools Transportation Coordinator with
an Emergency Plan for each student with an EpiPen order for insect allergies and for other
medical conditions needing knowledge of during the bus ride. These Emergency Plans will
be forwarded to the bus company.
6. The school bus must have means of communication for emergency calls, e.g., 2-way radio,
cellular telephone.
7. For medical emergencies, the bus driver will activate the Emergency Medical System,
9 – 1 – 1 utilizing the two-way radio and announcing, “This is Bus ___ with a
9 – 1 – 1 medical emergency, dispatcher please respond “. The bus driver will then give the
bus location and will clearly state the problem . When the situation dictates, the bus driver
will follow the protocol on the Medical Emergency Preparedness, QUICK REFERENCE
Flip Chart.
8. The bus company management will notify the Transportation Coordinator and/or principal of the medical emergency and the school will call the student’s family.
Field Trips
1. The Milford Public School Field Trip policy will be followed for all field trips.
2. The Director of Nursing and/or designee will keep a copy of the current Board of Nursing license and CPR certification card on file for each person functioning in the role as school nurse on the field trip (e.g. school nurse, substitute nurse, parent, community nurse) whether receiving financial reimbursement for the trip or attending on a volunteer basis.
3. The school nurse will pack one EpiPen 0.15mg. Auto-Injector and one EpiPen 0.3mg. Auto-Injector as stock medications with field trip supplies.
4. The medication administered on day and overnight field trips will follow the Medication Administration Policy and Procedure, D-NUR-200. The school nurse will send the student’s original Medication Administration Record, Form #NU205, the Medication Order, Form #NU201, and
the Parent Medication Authorization with the Medication Administration Plan on the
reverse side, Form #NU202 and Form#NU202A. These orders will be placed in a Nurse’s Field Trip Book. The student’s Classroom Health Plans, Form #NU233 and/or Emergency Health Plans, Form #NU225. will be included in the book.
5. The pharmacy prescription bottle will be sent with the field trip nurse and returned to the school medication cabinet at the end of the field trip.
6. The attending field trip nurse will document medication administered and return the forms to the school at the close of the field trip.
7. The teacher responsible for the field trip will obtain the parent/guardians location and phones numbers where they can be reached in the event of an emergency. In addition to chaperone(s), parent/guardian(s) of student’s at risk for anaphylaxis will be invited to attend the field trip. This teacher will also have the name of and the phone number of the nearest hospital.
8. A cell phone and/or another communication device must be available on the trip for emergencies.
9. There will be no eating of any foods on the school buses. Consumption of food on long trips
will occur in eating establishments.
Building Administrator Responsibilities
1. Products containing natural rubber latex will no longer be purchased in the Milford Public Schools, when possible. Non-latex gloves must be powder-free and low in protein allergens. Present products with natural rubber latex will eventually be phased out of the buildings.
2. Classrooms with children with latex allergies will have no latex products to the best reasonable knowledge and ability and of the classroom teacher.
3. Animals with dander will not be allowed in school buildings as classroom or building
pets, eg: cats, dogs, rabbits, chicks, hamsters, guinea pigs, etc. For purposes of policy
clarity, dander is defined as “ tiny particles, as from feathers, skin or hair” (New World
Dictionary of the American Language).
4. Whenever possible, unscreened windows and doors will remain closed, especially during
the seasons when insects are prevalent.
5. During school hours, foods allowed for students at schools will be limited to:
a. Snacks and lunches brought by students for their personal consumption;
b. Food bought and served for breakfast and lunch by the school cafeteria personnel; and
c. Food brought in for curricular use under the control of the classroom teacher for
demonstration, student observation and handling (no consumption of foods) and only
after the approval process has been completed.
6. The approval process to have food for curricular use is as follows:
a. Teacher initiates form, Notification of Classroom Food Demonstration, Form #NU010;
b. School nurse reviews and approves/denies demonstration project. The school nurse will deny a project if he/she believes the project plans are inadequate to ensure the well being of students with a known allergy;
c. The school principal reviews and approves/denies demonstration project. The principal will deny a project if he/she feels the project is not associated with appropriate grade curriculum or does not ensure the well being of all students;
d. Teacher sends the form, Notification of Classroom Food Demonstration, Form #NU010, home to parents once the initial approval from the nurse and principal has been received;
e. Teacher may hold this class activity only when:
1) Parental approval has been received from all parents;
2) All parents agree to have their child participate. No student shall be excluded from the class activity; and
3) Teacher has sent the Notification of Classroom Food Demonstration back to principal indicating status of parental consent and receives form back with final approval.
7. This language will be included in the Middle and High School program of food studies as
follows and requires no prior parental notification:
Please be advised that this program of study includes the handling, preparation, and possible consumption of food items. Please note: Food items used in this program may contain allergens.
8. There will be no bake sales on school property during school hours (Publish in School
Handbook). For purposes of policy clarity, school hours are defined in the Agreement
between the Milford School Committee and the Milford Teachers Association.
9. All phones will be marked with emergency response phone numbers and how to access an
outside line (e.g. 9 – 9 – 1 – 1), the number for the Milford Regional Hospital and the Poison Control number. All phones should be checked annually to verify the presence of
these numbers.
10. Provide emergency communication devices (two-way radio, intercom, walkie-talkie, cell
phone) for all school activities. Verify that all staff is trained in their use.
11. The school nurse will submit a written report to the Massachusetts Department of Public
Health (MDPH) on a form provided by the Department for all EpiPen administrations.
12. Support the student and her/his family upon the return to school after a reaction.
13. In the rare but plausible event of a fatal reaction, the school’s crisis plan for dealing with
the death of a student should be implemented. Organizations such as Asthma and Allergy Foundation of America (AAFA) and Food Allergy and Anaphylaxis Network (FAAN) may be able to provide resources.
14. Educational sessions on allergy awareness will be offered to students, parents and the community.
Classroom Teacher/Specialist Responsibilities
1. Review any student Individual Health Care Plan (IHCP) with the school nurse. Place the IHCP(s) in a three-ring notebook under the appropriate alphabetical tab. The teacher will place a class list of students in the front of the alphabetical tabs. The names of students with IHCP’s will be highlighted. The notebook will be kept on the teacher’s desk, available for the substitute.
2. Obtain a functioning device for communicating with the school nurse when leaving
the school building for outside activities.
3. Never question or hesitate to act if a student reports signs of an allergic reaction.
4. Receive training in the administration of an EpiPen auto-injector and learn where the medication is located when working with children with EpiPen order whenever possible.
5. Follow general policies on latex products, management of food during school hours, window opening and animals in the building.
6. Educate students to avoid endangering, isolating, stigmatizing or harassing student with life-threatening allergies. Be aware of how the student with the allergy is being treated; enforce school rules about bullying and threats.
7. Handle all care of reptiles and amphibians, their cages or surfaces they come into contact with to minimize the risk of contracting salmonellosis. Thorough hand washing after handling reptiles and amphibians must be adhered to.
8. Snack and lunch time:
a. Avoid cross contamination of foods;
b. Reinforce hand-washing before and after eating, whenever possible;
c. Provide an allergen-free table when needed;
d. Encourage student to take advantage of an eating area in the classroom that is free of the
food that s/he is allergic to;
e. Establish practice that students do not share or trade foods brought from home;
f. Encourage parent(s) to provide a box of safe snacks and non-perishable lunch in case
they are forgotten for those students with life-threatening allergies.
9. Whenever possible, allow students who are anaphylactic to insect venom to remain indoors for recess during bee/wasp season.
10. If a bee/wasp gets in classroom, immediately remove child with this allergy from the room.
Food Services Manager Responsibilities
1. Review any student Individual Health Care Plan (IHCP) with the school nurse. Place the IHCP(s) in a three-ring notebook under the appropriate alphabetical tab. The names of students with IHCP’s for food allergies will be listed in alphabetical order on the front sheet of the notebook and the notebook will be kept with in the serving area.
2. Obtain a functioning communication device (e.g., 2-way radio, cellular telephone, etc.) for communication with the school nurse.
3. Never question or hesitate to act if a student reports signs of an allergic reaction.
4. Receive training in the administration of an EpiPen auto-injector and learn where the medication is located for children with EpiPen ordered whenever possible.
5. Products containing natural rubber latex will no longer be purchased in the Milford Public Schools, when possible. Non-latex gloves must be powder-free and low in protein allergens. Present products with natural rubber latex will be eventually phased out of the buildings.
6. Whenever possible, unscreened windows and doors will remain closed, especially during the seasons when insects are prevalent.
7. Read all food labels and recheck routinely for potential food allergens.
8. In the Milford Public Schools, when possible, train all food service staff and their substitutes to read product food labels and to recognize food allergens. Contact the Food Allergy Network for Reading Food Labels and refer to latest lists when ordering food.
9. Will take every precaution so as not to prepare or serve any menu options containing nuts.
10. Maintain contact information for manufactures of food products. (Consumer Hotline)
11. Train staff to follow sound food handling practices to avoid cross-contamination.
12. Train staff to strictly follow cleaning and sanitation protocol to avoid cross-contamination.
13. Create specific areas in the eating area that will be allergen safe. Communicate area to individuals with food allergies.
14. Thoroughly clean all tables, chairs and floors after each meal using a water and soap solution.
15. After receiving a doctor’s note, make appropriate substitutions or modifications for meals served to student’s with food allergies.
16. Provide a list of ingredients for all foods served in the cafeteria when requested.
17. Make available advance copies of the menu to parent(s)/guardian(s) if menu changes, when possible.
18. Parents will be directed to the Food Service Program Director when questions regarding food menu options arise.
Facility Director/Custodial Staff Responsibilities
1. Director will verify that the roof top exhaust fans are operational on an annual basis.
2. Director will replace all school building ventilation filters twice a year.
3. For activities involving food that occur during non-school hours, the custodial staff in the
absence of kitchen staff will clean the surfaces (e.g., table(s), counter(s) that food came into contact). Cleaning solution will be soap and water.
4. Products containing natural rubber latex will no longer be purchased in the Milford Public Schools, when possible. Non-latex gloves must be powder-free and low in protein allergens. Present products with natural rubber latex will be eventually phased out of the buildings.
5. Classrooms with children with latex allergies will have no latex products.
6. Whenever possible, unscreened windows and doors will remain closed, especially during the seasons when insects are prevalent.
7. Check for the presence of bees and wasps, especially nesting areas, and arrange for their removal. This is an on-going process throughout the season.
8. Ensure that garbage bags are securely tied prior to loading into the dumpster.
Parent/guardian(s) Responsibilities (Published in the Student Handbook)
1. Inform the school nurse of a child’s allergies prior to the opening of school (or as
soon as possible after a diagnosis).
2. Complete the Annual Health Card and return to school nurse on day two of the opening of school. Include a list of foods and ingredients to avoid, phone numbers and the name of the emergency contact person.
3. Provide school nurse with medication orders from the licensed provider and EpiPen
auto-injector(s) when appropriate.
4. Meet with the school nurse to complete the Individual Health Care Plan.
5. Consider providing child with a medical alert bracelet.
6. Provide the school nurse with the licensed provider’s statement if a child no longer
has allergies.
7. Provide a non-perishable lunch and/or snacks to keep in the classroom, in case child forgets lunch or snacks.
Milford Public School Employees, Substitutes and Volunteers Responsibilities
1. Encouraging students with allergies to:
a. Take as much responsibility for avoiding allergens as possible (age appropriate);
b. Not trade or share food;
c. Wash hands before and after eating;
d. Learn to recognize symptoms of an allergic reaction (work with school nurse);
e. Promptly inform an adult as soon as accidental exposure occurs or symptoms appear;
f. Know where your EpiPen auto-injector is located and who has access to the medication;
g. Carry own EpiPen when developmentally ready;
h. Take more responsibilities for allergies and safety as they get older;
i. Report teasing, bullying and threats to an adult authority;
j. Read food labels;
k. Avoid foods that may cross react such as bananas, kiwi fruit and avocados; and
l. Develop a relationship with the school nurse and/or another trusted adult in the school to assist in identifying issues related to the management of the allergy in school.
Approval process form is included below:
Notification of Classroom Food Demonstration
On ______________, I, ________________________, will conduct a classroom activity
Date of Class Teacher
requiring the use of food for demonstration, student observation and/or handling. There will be no consumption of that food. I plan to use the following food (s) for the following activity (please describe):
Approval:
School Nurse Signature/Date Principal Signature Principal