EMERGENCY PLAN 2008-09
STUDENT Student One SCHOOL XX Elementary
RESTRICTIONS Avoid activities that present a risk of falling. No rock CLASSROOM teacher wall climbing. Elevated play structure activities with railings are OK.
CONDITION Seizure disorder - Has absence and myoclonic seizures. GRADE 3 Absence seizure ñ appears to stare into space for a few seconds, but does not typically fall. There may be slight rhythmic movements of the eyelids, hands, head, or other body part. Recovery is immediate after the seizure, with no lingering confusion. Myoclonic seizure ñ rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot. In the past, Student One's myoclonic seizures have involved both arms. Student One has not had a tonic clonic (generalized) seizure to date.
ACTION PLAN FOR EMERGENCY
1. Call health office by phone (XXXX) stating Student One's name, problem and location. Contact school nurse via walkie-talkie, if outside of the building.
2. Prevent or minimize injury during absence or myoclonic seizure: 3. a. note time of onset and end of seizure. b. do not put anything in Student One's mouth. c. observe Student One's behavior/movements/color; and share with nurse. d. remove objects in the immediate area. e. do not restrain, but protect from injuring himself. f. observe for breathing difficulty, repositioning Student One if needed so that his airway is unobstructed. g. offer reassurance. h. if vomiting occurs, try to turn head to one side to facilitate drainage of oral secretions. Ask someone to document observations on seizure observation log or complete seizure observation log after your assistance is no longer needed. 4. Nurse will bring oxygen and assess Student One’s status. 5. If absence or myoclonic seizure lasts less than three minutes: a. nurse will move Student One to health office when feasible; reassess and monitor status. b. nurse will notify parent and doctor. 6. If absence or myoclonic seizure lasts more than three minutes, or a tonic clonic seizure lasts more than five minutes: a. nurse will direct someone to call EMS (9-9-1-1), main office and parent b. nurse will monitor status until EMS arrives.
School Health Services: Rev: 9/05 PUBLIC SCHOOLS Side 1 of 2 EMERGENCY PLAN 2008-09 EMERGENCY CONTACTS PHYSICIAN INFORMATION 1. Name XXXXXXXX 1. Name Dr. XXXXX Relation mother Specialty pediatrician Phone h. 203-XXXXX c. 203-XXX- Phone XXXXX XXXX 2. Name XXXXXXX 2. Name Dr. XXXXX Relation father Specialty pediatric neurology Phone w. 212-XXX-XXXX c. 917-XXX- Phone XXXXXXX XXXX 3. Name XXXXXX 3. Name Relation grandmother Specialty Phone c. 203-XXX-XXXX Phone
Period of plan from: X/XX/XX to X/XX/XX Projected date for review: X/XX
______Parent Student (if applicable) School Nurse
School Health Services: Rev: 9/05 PUBLIC SCHOOLS Side 2 of 2