Ensure that at least one adult with current training in basic first aid and lifesaving techniques is available to students and staff on site and at all off-site school-sponsored activities. Skills include cervical spine protection, Heimlich maneuver, cardiopulmonary resuscitation (CPR), use of an automated external defibrillator (AED), and specialized emergency procedures for those who need them.

Schools are responsible for handling medical emergencies for all students including students with special needs who may be prone to certain emergencies and/or require specific emergency equipment. A written plan and trained personnel are essential to the successful handling of medical and dental emergencies.

The required number of staff trained to handle medical emergencies should be gauged by the number necessary to meet the anticipated needs of all students attending school. Having only one staff member trained for emergency response will be inadequate in mid-sized or large schools and on many field trips because students are spread around a large geographic campus and programs take sub-populations of students off campus. Calculations of staffing for emergency situations should include estimated days when trained staff will be absent.

Provide training to handle first aid for minor trauma and for serious problems such as bleeding, choking, musculoskeletal injuries, dental emergencies, and allergic reactions. Knowledge of emergency assistance numbers and their appropriate use is necessary (e.g., poison control at 800-222-1222, emergency assistance at 911). The Ohio Chapter of the American Academy of Pediatrics (107) and Emergency Medical Services for Children (EMS-C) jointly developed emergency guidelines for schools. Many state departments of health or education have written guidelines on common emergency procedures. During the school day, a trained person should be designated to provide emergency assistance. Optimally, the school nurse fills this role. In many schools, staff who are not health professionals provide designated emergency assistance.

In some cases, a student's need demands that a nurse be available at the school site at all times. In rare cases, a nurse dedicated to one student is required for close observation and nursing procedures (e.g., to detect and treat a blocked airway for a child with a tracheostomy). When it is determined that a nurse is not required to provide a specialized emergency procedure (e.g., glucagon injections for students with diabetes and low blood sugar), then the school administrator should specify the person(s) designated to the task. Also, school policy should indicate for such procedures how and when a trained nurse will provide education and indirect supervision (Guideline 4-05). All emergency procedures require training (e.g., use of pre-drawn epinephrine syringes and allergy kits for many students with insect or food allergies), and designated staff must know how to recognize symptoms and have written steps to follow. A prescribing physician must sign emergency plans (Guideline 4-20). Organizations such as the American Diabetes Association and the Asthma and Allergy Foundation of America have developed sample emergency protocols specifically for use by schools.

Adams RM. School Nurse's Survival Guide: Ready-to-Use Tips, Techniques and Materials for the School Health Professional. Englewood Cliffs, NJ: Prentice Hall; 1995.

American Academy of Pediatrics, Council on School Health. Role of the school nurse in providing school health services. Pediatrics. 2008;121(5):1052–1056.

American Academy of Pediatrics, Committee on School Health. Guidelines for emergency care in school. Pediatrics. 2001; 107:435-436.

American Red Cross, Community First Aid and Safety. Washington DC: American Red Cross; 2002.

Bernardo LM, Anderson L. Preparing a Response to Emergency Problems: A Self-Study Module. Scarborough, ME: National Association of School Nurses; 1998.

Centers for Disease Control and Prevention. Strategies for Addressing Asthma Within a Coordinated School Health Program. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2006. Available at: www.cdc.gov/HealthyYouth/asthma/strategies.htm.

Nebraska Department of Health and Human Services. Emergency Guidelines for School Personnel. Lincoln, NE: Nebraska Department of Health and Human Services, 1997.

Newton J, Adams R, Marcontel M. The New School Health Handbook: A Ready Reference for School Nurses and Educators. 3rd ed. Paramus, NJ: Prentice Hall, 1997.

Passarelli C. Are you prepared for an emergency? J Sch Nurs. 1995;11:4, 6.