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Introduction to Medical Emergencies During School

As a school nurse, you oversee hundreds, possibly thousands of students and faculty. You must remember you are responsible for children, adult staff members, and faculty. You are typically the only trained healthcare provider in the building saddled with the responsibility of triaging, medicating, treating, assessing, and discharging students and faculty from your office.

Performing the role of caregiver for such a large population can seem like an impossible and overwhelming responsibility. Injuries or illness emergencies can happen at any time during the school day. In addition, school nurses are also prepared to assist in more significant emergency events or disasters that affect multiple students and staff, such as weather-related events, environmental exposures, infectious disease outbreaks, or violent crimes.  

A national survey of 573 school nurses (1) was conducted to determine the number of 911 calls placed from K-12 school campuses. It was determined that 68% of all 911 calls placed by schools in one year were related to life-threatening emergencies. It was further determined that injuries accounted for two-thirds of all EMS activation at schools, the remaining one-third being medical emergencies (1).  

Recognizing and understanding what actions must be taken during medical emergencies in schools is vital for every school nurse. Quick actions, followed by confident treatment, can differentiate between life and death for a student or faculty member. This course aims to teach you what medical emergencies look like in schools and what your role is during those emergencies.  

Allergic Reactions 

Allergic conditions affect approximately 50 million children and adults in the United States, including allergic rhinitis, asthma, eczema, allergic reactions, and many other allergic disease processes (15). In the United States, food allergies affect about 32 million people, medication allergies affect about 7% of the population, and stinging insect allergies can result in life-threatening allergic reactions in 0.4% – 0.8% of children and 3% of adults. In the pediatric population, latex allergy can also be problematic, specifically in children with spina bifida, as latex allergy affects 40-65% of children with this condition. Regardless of the allergen, identifying symptoms consistent with an allergic reaction and anaphylaxis is critical to ensure timely treatment and care of the individual experiencing the reaction. About 16-18% of students will experience their first food allergic reaction at school, and up to 25% of epinephrine administered in schools is for students and staff with an unknown allergy (15).  

The guardians should fill out a health form at the beginning of the school year or when the student is first enrolled. This form should include questions about the student’s health and any pertinent information necessary for the school nurse to know. One of these questions should be related to the student’s allergies. The guardians should explain the type of allergy or allergies the student has and what they do at home when they begin to have an allergic reaction. This information will help the nurse create an individualized healthcare plan for the student.  

Symptoms of Allergic Reaction 

An allergic reaction can be categorized as IgE- or non-IgE-mediated. Depending on the type of reaction, It can cause immediate or delayed signs and symptoms that can affect the nasal mucosa, eyes, skin, respiratory system, circulatory system, and gastrointestinal tract. It is essential to understand the difference to treat and prevent allergic reactions from occulting (15). Non-IgE-mediated reactions tend to be delayed, with the onset of signs and symptoms beginning hours to days after exposure to an allergen. Signs and symptoms typically include gastrointestinal-related complaints, such as stomach pain, nausea, vomiting, diarrhea, and bloody stools (15). At the same time, IgE-mediated reactions cause the immune system to produce IgE antibodies in response to a trigger, often occurring within minutes to 2 hours after exposure (15). An IgE-mediated reaction can be unpredictable, and symptoms can range from mild to moderate to severe. We will take a closer look at the signs and symptoms based on the severity of the reaction. 

Mild and moderate allergic reaction symptoms (2): 

• Runny nose
 

• Itchy/watery eyes
 

• Itchy throat
 

• Coughing/wheezing 
 

• Rashes/hives
 

• Tissue swelling 
 

If a student presents with mild to moderate reactions, monitor the student for further signs of severe reactions. Inquire with the student if they touched/ate something that could have caused the reaction. If the answer is yes, remove that allergen if possible. If a student demonstrates signs of an itchy throat, coughing/wheezing, rashes/hives, or tissue swelling, administer emergency Benadryl and contact the student’s guardians.  

Severe allergic reactions (anaphylaxis) symptoms (2): 

• Swelling of face, lips, tongue, mouth or airway
 

• Wheezing/shortness of breath
 

• Tightness in the chest
 

• Dizziness
 

• Blue/gray discoloration around lips
 

• Nausea/vomiting
 

• Itchy skin/hives/other rashes that appear quickly
 

Students with a known history of severe allergic reactions should be seen and treated immediately to prevent further injury or death. If a student presents to the nurse’s office with anaphylaxis, administer epinephrine, call 911, and then the student’s guardians. The nurse should also call for help from another adult in the building. This will allow the nurse to focus on the student while the other adult present can place the 911 call and call the student’s guardians. It is also essential to have an additional adult present if the student becomes unresponsive. This will allow for 2-person, high-quality CPR.  

Asthma Attack 

Asthma is the number one cause of chronic disease among children and adolescents in the United States and accounts for the leading cause of absenteeism in schools (4). Children are prone to asthma attacks due to narrow airways and increased inhalation compared to adults (5). Studies have estimated that 8.4% of children in the United States are diagnosed with asthma. This equates, on average, to 3 out of 30 children (10). Low-income populations, minorities, and children living in inner cities are more likely to suffer from asthma than the general population (16).   

Like allergies, the student’s guardians should have indicated on the student’s health form if the child has been diagnosed with asthma. If the student has been diagnosed with asthma, the family should provide the school nurse with a rescue inhaler and a note from the student’s doctor indicating when the inhaler should be utilized.  

Early signs of an asthma attack (2): 

• Coughing
 

• Shortness of breath while walking
 

• Tickle in throat
 

Moderate to severe symptoms of an asthma attack (2): 

• Tightness in chest
 

• Wheezing/grunting
 

• Unable to speak in complete sentences, or at all, without stopping to breathe
 

• Gasping/rapid breathing
 

• Nostril flaring
 

• Feelings of fear or confusion
 

• Blue/gray discoloration to lips or skin
 

• Changes in mental status 
 

For any student presenting with asthma signs, check their oxygen level and listen to their lung sounds. If the student’s oxygen saturation is below 92%, call 911. An oxygen saturation lower than 92% indicates that the student needs oxygen. While listening to lung sounds, be alert of wheezing or diminished breath sounds; these indicate the need for an inhaler. If you have given the student their rescue inhaler, but they do not show signs of improvement in their overall symptoms within 20 minutes of inhaler administration, call 911 and the student’s guardians.  

In addition to treatment and identification, prevention is essential in asthma management (16). It is also vital for schools to be asthma-friendly by making an effort to create safe and supportive learning environments for students with asthma. Schools need to have policies and procedures in place that allow students to manage their asthma successfully. This includes things such as: 

• Ensuring students are receiving ongoing medical care 

• Providing asthma education for students and faculty 

• Ensuring students take their medication as prescribed 

• Providing an environment that reduces triggers 

• Offer safe and enjoyable physical education and activities for students 

Choking 

Choking occurs when food or other foreign objects become stuck in the airway. When this happens, the object or food prevents oxygen from reaching the lungs and the brain. Lack of oxygen to the brain for more than 4 minutes may cause brain damage or death. School nurses must recognize and know how to handle choking at schools and teach faculty how to identify and handle choking. Experts advise using back blows and abdominal thrusts to treat an adult or child over the age of one year who is choking. 

Staff should be educated on how to perform the Heimlich maneuver in the event of a student choking. If a student begins choking at school and is not in the nurse’s office, the staff member with that student should start attempting to clear their airway. The staff member should also send another student or adult to get the nurse.  

The steps to clearing a blocked airway for older students (2): 

1. Get behind the student, make a fist with one hand, and grasp the fist with the other hand
 
2. Position your fisted hand slightly above the student’s navel, pull the student close to you, and then give a hard thrust with your fist in an upward motion against the student’s abdomen.
 
3. Continue hard thrusts into the student’s abdomen until the object becomes dislodged or the student becomes unresponsive.  
 
4. If a student becomes unresponsive, begin high-quality CPR and have someone call 911 and the student’s family.
 
5. Continue CPR until the student becomes responsive or until EMS arrives and takes over.
 

If the object was dislodged and the student remained responsive, bring the student to the nurse’s office to monitor the student for signs of distress. Ensure the student’s family has been called and updated on the situation. Inform the guardians that the student should be seen by their healthcare provider.  

Severe Bleeding 

Severe bleeding in a school setting can come from many different environments: playground accidents, altercations with other students, equipment failure, or nosebleeds. All severe bleeding requires the same steps to be taken to slow or stop the bleeding. 

Unintentional and uncontrolled bleeding is the leading cause of death in people ages 1–44 in the United States (18). Per the U.S. Centers for Disease Control and Prevention, uncontrolled hemorrhaging is one of the leading causes of death among pediatric populations (18). The Stop the Bleed (STB) campaign has emerged as a public health initiative to motivate participants by teaching them how to distinguish between life-threatening and non-life-threatening bleeding and then slow it down (18). The STB campaign had two main goals: 

1. To inform and empower laypersons to be trained in primary trauma care to stop or slow bleeding during an emergency 
2. To increase bystanders’ access to bleeding control kits.  

Participants may be more likely to intervene in a time of need using these skills. These techniques were initially used in mass casualty settings but have not been utilized in schools due to the recent rise in mass shootings.  

First aid for severe bleeding (2): 

• Have the student lie down
. 

• Apply direct pressure to the wound for at least 5 minutes to slow the bleeding. If blood seeps through, apply more dressings (do not remove old dressings). 

• If you notice an object protruding from the student’s skin, do not remove it.  
 

• Monitor the student for symptoms of shock due to blood loss. These include pale or cold skin, confusion, rapid heart rate, rapid/shallow breathing, and weakness.
 

• If you are unable to stop the bleeding after 5-10 minutes of pressure, call 911 and the student’s guardians. 
 ​

Back and Neck Injuries 

Back and neck injuries typically occur after a student falls. They can also occur during a sporting event if the student collides with another student or outside of the school setting at home. If the student’s guardians have given the nurse permission to administer medication to their student, a hot pack and an NSAID can remedy simple back and neck pain. 

If the student experiences serious back pain (e.g., they fell from the monkey bars and landed on their back), ensure that the student is not moved and remains still. Also, gently hold the student’s head and immobilize the neck. While keeping the student immobilized, call 911 and the student’s family.  

Signs to watch for in the student (2): 

• Inability to move arms or legs
 

• Tenderness, swelling, or bruising to the back or neck
 

• Headache, or pain radiating through shoulders
 

• Desire to keep their neck still
 

Broken Bones 

Broken bones are one of the most common medical emergencies in a school setting. They typically occur at recess or during the student’s gym time. Depending on your school’s policy, not all students suffering from broken bones must be transported to the hospital by EMS. However, all compound fractures must be transported to the hospital via EMS.  

Steps for compound fractures (2, 3): 

• Control the bleeding by applying pressure to the site of the injury
 

• Do not move the affected limb unless the student must be moved, then splint the limb with a folded blanket, magazine, or piece of cardboard.
 

• Watch for signs of vascular injury:
 

• Lack of pulse
 

• Continued blood loss
 

• Expanding hematoma 
 

A student may present to your office with what appears to be a sprain but is a fracture. Since you will not be able to assess fracture vs. sprain, you can complete the following steps (2): 

1. Rest: allow the student to find a comfortable position to rest in
 

1. Ice: provide ice to injured extremity. Do not allow the student to use ice for more than 30 minutes
 

1. Elevation: if swelling is noted, elevate the affected extremity above the level of the heart
 

1. Call the student’s guardians and explain the injury. 
 

Burns 

Burns are not as common in a school setting but should still be reviewed in the event it should occur, as it can be one of the more extreme medical emergencies. Burns are categorized into three degrees: first (superficial), second (partial thickness), and third (full-thickness). A first-degree burn involves the top layer of skin. A second-degree burn involves several layers of skin and can cause blisters. A third-degree burn involves damage to the full depth of skin, muscles, and nerves.  

For any degree of burn, the first course of action is to cool the burn. This is accomplished by placing the burn in cool water. If the burn is in an area that is not easily accessible, put a cool, wet cloth on the area. Do not fully submerge a student in cool water to avoid dropping the student’s core temperature too low (2). 

There are two types of burns a nurse may encounter in the school setting: chemical and electrical. For both types, ensure the area is safe before attempting to remove the student from it. Burns involving the face, genitals, eyes, hands, or feet should be assessed at the closest hospital via EMS transportation. EMS should also be called if the burn is more significant than 1% of the student’s body surface (or the size of the student’s palm) (2). 

Chemical burn first aid (2): 

• If in eyes – immediately rinse chemical from eyes
 

• If the chemical is dry – brush off the skin, then rinse under water for 15-20 minutes
 

• If the chemical is wet – wash the affected area for 20 minutes
 

Electrical burn first aid (2): 

• Power MUST BE shut off before attempting to rescue the student. If a powerline is down, you must wait for the fire department or power company
 

• All electrical burns should be assessed at the nearest hospital
 

Diabetes 

Diabetes is a chronic condition where a person’s blood glucose (blood sugar) is too high. Diabetes is the second most common chronic condition in children, with type 1 diabetes being more prevalent than type 2 diabetes (9). With type 1 diabetes, the body does not produce insulin, so the glucose cannot effectively enter cells. This causes individuals with type 1 diabetes to have abnormally high sugar levels, resulting in them taking insulin every day, multiple times a day (8).  

The onset of type 1 diabetes is difficult to diagnose. The student will typically present with several weeks’ worth of increasing fatigue or intermittent polydipsia and polyuria, and any recent illness or travel can exacerbate the symptoms (9). Suppose diabetes is not recognized during this early stage of presentation. In that case, the student is likely to go into a hyperglycemic crisis that ultimately requires treatment and possible admission to a hospital.  

A child diagnosed with type 1 diabetes will require several interventions in a school setting. Three types of health care plans should guide the student’s diabetes management: a Diabetes Medical Management Plan (DMMP), an Individualized Health Care Plan (IHP), and Emergency Care Plans for Hypoglycemia and Hyperglycemia (8). 

Diabetes Medical Management Plan (8):
 

• Completed by the student’s health care team
 

• Contains medical orders that outline the student’s health care and education plans
 

• When to review/change the DMMP
 

• Start of each school year
 

• After a change in the student’s prescribed plan of care
 

• Upon request by the guardians or physician
 

Individualized Health Care Plan (8):
 

• The school nurse prepares this plan
 

• Lists out strategies for carrying out the student’s DMMP while at school
 

• A nurse prepares the IHP based on the student’s medical orders in the DMMP and then reviews the IHP with the student’s guardians 

Emergency Care Plans for Hypo/Hyperglycemia (8):
 

• Must be based on the student’s DMMP
 

• Plans provide details on how to recognize and treat hypoglycemia and hyperglycemia and who to contact for help.
 

• The school nurse in charge of developing these plans
 

• Plans will be reviewed with the student’s guardians, and copies of the plan will be provided to the student’s guardians, all school personnel in charge of a student during the day and school-sponsored activities
 

A school nurse and personnel must recognize the signs of a hypoglycemic and hyperglycemic emergency. Hypoglycemia is blood sugar below 70mg/dl, whereas hyperglycemia is blood sugar above 240mg/dl (2). 

Hypoglycemia (2) 

• Symptoms:
 

• Irritability
 

• Shakiness
 

• Excessive sweating
 

• Paleness
 

• Weakness
 

• Lethargy
 

• Fatigue
 

• Confusion 
 

• Trembling
 

• Slurred speech
 

• Blurred vision
 

First aid for mild to moderate low blood sugar:
 

• Follow the student’s IHP
 

• Have student consume 15 grams of a quick-acting carbohydrate
 

• Examples: 4 oz of juice, 3 tsp of glucose gel, 3-4 glucose tabs
 

• Wait and monitor the student for 15 minutes
 

• The nurse or student will recheck the student’s blood glucose; if blood glucose is still below 70mg/dl, have the student consume another 15 grams of a quick-acting carbohydrate.
 

• Wait and monitor the student for another 15 minutes
 

• If a student’s blood sugar is above 70mg/dl, and the student’s next meal is more than 30 minutes away, have the student consume a protein/complex carbohydrate snack
 

• Example: cheese and crackers
 

• If the student’s blood sugar is below 70mg/dl, follow the student’s emergency instructions on the IHP.
 

First aid for severe low blood sugar:
 

• If the student’s blood sugar is severely low, they may be unable to swallow, they may be unconscious, or they may have a seizure.
 

• It is essential not to give the student anything orally
 

• Call EMS and the student’s guardians
 

• If there is a healthcare provider order, give Glucagon
 

• If the student becomes unresponsive, be prepared to perform CPR
 

Hyperglycemia (2) 

• Symptoms:
 

• Extreme thirst
 

• Rapid breathing
 

• Frequent urination
 

• Warm, dry skin
 

• Drowsiness
 

• Nausea/vomiting
 

• Headache
 

• The fruity smell on my breath
 

• Loss of responsiveness 
 

First aid:
 

• Follow the student’s IHP
 

• Have the student consume water or a sugar-free liquid
 

• If stated in the student’s IHP, have the student dose themselves with insulin
 

• Check the student’s urine for ketones
 

• If the student becomes unresponsive, call EMS and the student’s guardians and be prepared to perform CPR.
 

Head Injuries 

Head injuries can be classified as minor or severe and can occur during an athletic activity, physical altercation, or by accident (17). School nurses should have an emergency action plan for dealing with head trauma and concussions. School nurses are responsible for educating stakeholders about concussion recognition and management.   

Concussions are described as a type of traumatic brain injury resulting from a blow to the head or a hit to the body that causes the brain to rapidly move in a back-and-forth motion inside the skull (11). Although they may not always be extreme, in some cases, they can present as one of the most dangerous medical emergencies in a school setting. When attending to a child with a head injury and concussion, ensure that you do not move them unless necessary.  

Signs of a concussion (2): 

• Symptoms:
 

• Unresponsiveness for any length of time
 

• Confusion and memory loss
 

• Sleepiness
 

• Listless
 

• Agitation/irritability/combativeness
 

• Pale or sweaty skin
 

• Nausea and vomiting
 

• Severe headache or dizziness
 

• Blurred vision
 

• Trouble walking or balance
 

• Slurred speech
 

• Seizure
 

• Blood or clear fluid dripping from the nostril or ear canal
 

• Clear fluid typically indicates cerebral spinal fluid
 

• Loss of bowel or bladder function 

First aid:
 

• If vomiting after a head injury, immediately call EMS and the student’s guardians. 
 

• Watch the student for signs of a concussion.
 

• Give the student an ice pack to place on the injury site to reduce swelling.
 

• If a concussion is suspected, do not allow the student to continue to play sports or any physical activity.
 

• Contact the student’s guardians and advise them to consult their healthcare provider.
 

Loss of Consciousness  

Fainting or loss of consciousness is typically brief, lasting no longer than a minute. Several causes can occur, ranging from lack of food or water to diabetes and low blood sugar. However, fainting is generally treated the same way, regardless of the cause.  

First aid (2): 

• Lay the student on their back and assess their breathing
 

• If the student is not breathing, begin CPR. Have someone contact EMS and the student’s guardians
 

• If the student is breathing, prop their legs up to increase blood flow to the brain
 

• Loosen any tight clothing the student may have on
 

• Do not administer anything orally
 

• Inform the student’s guardians of the incident and advise them to consult their healthcare provider.
 

Jaw Injury 

A jaw injury can occur in any situation; however, it mainly occurs when the student is physically active (at recess, during gym time, or while participating in a sporting event). Due to the potential for breathing problems, school nurses must consider broken or dislocated jaws as medical emergencies, and EMS must be called.  

Symptoms (2): 

• Bleeding from the mouth
 

• Difficulty opening the mouth widely
 

• Facial bruising or swelling
 

• Jaw stiffness, tenderness, or pain
 

• Loose or damaged teeth
 

• A lump or abnormal appearance on the cheek or jaw
 

• Numbness to the face, mainly the upper lip
 

• Minimal movement of the jaw (seen with severe fractures)
 

First aid (2): 

• Apply a temporary bandage to the jaw by wrapping gauze around the top of the head and under the jaw. This will prevent movement of the jaw
 

• Ensure the student’s guardians are away that they are being transported to a medical facility 
 

Seizures 

Epilepsy is a common brain disorder that causes recurring seizures and is most likely seen in children and older adults. It is estimated that around 470,000 children are diagnosed with epilepsy (12). Around 12% of children with epilepsy under 16 fall under the category of absence epilepsy, which presents as situational apathy (6). Daily medications typically control childhood epilepsies. 

There are several actions school nurses can take to help regulate a student’s epilepsy. One of those actions is to initiate a Seizure Action Plan. This action plan details what the student’s epilepsy looks like, first-aid measures, and when the student is to receive their rescue seizure medication. This plan will be discussed with the student’s guardians to ensure accuracy. Once approved, the plan should be distributed to the student’s teacher(s) and explained. Allow the teacher(s) to ask questions regarding the plan and ensure they are comfortable with their role.  

Convulsive Seizure (2): 

• First aid:
 

• Follow the student’s IHP and Seizure Action Plan
 

• Move toys and furniture out of the way so the student does not get injured
 

• Protect the student’s head with a towel, blanket, or clothing
 

• Monitor how long the seizure lasts and what the student’s body looks like while they are having a seizure 
 

• Eyes blinking, rolling up, staring off
 

• Lip-smacking
 

• Head movement
 

• Vocalizations  
 

• Legs stiff or kicking
 

• Arms in a locked position or jerking
 

• Have student rest on their side once the seizure subsides
 

• Stay calm and try to offer privacy 
 

• Do not restrain the student or put anything into the student’s mouth during a seizure
 

• Inform the student’s guardians after the seizure

  

• When to call 911:
 

• If the seizure lasts longer than three to five minutes
 

• If the student has difficulty breathing
 

• If the student is seriously injured
 

• If the student does not have a history of seizures
 

Nonconvulsive Seizure (2) 

• First aid:
 

• Monitor how long the seizure lasts
 

• Stay with students and reassure them
 

• Let the student rest
 

• Follow the student’s IHP and Seizure Action Plan
 

• Inform the student’s guardians after the seizure

  

• What to look for in a nonconvulsive seizure:
 

• A blank look on the student’s face
 

• Student unable to speak or move
 

• Students acting in odd ways
 

• Students chewing or smacking their lips
 

• Student toying with their clothing
 

Sudden Cardiac Arrest  

According to the National Collegiate Athletic Association, the United States has roughly 8 million student high school athletes (17). In the United States, athletic death rates are the highest among high school athletes. Sudden cardiac death, along with head and neck injuries and heart stroke, are the major causes (17). Sudden cardiac death accounts for 75% of sudden deaths in young athletes and 5% to 10% of all deaths in children aged 5 to 19 years (17). Many of these catastrophic events can be prevented through prompt identification and treatment through CPR and early defibrillation (17). 

CPR/AED 

At least the school nurse and one other staff member must be trained in providing CPR and operation of the AED. This ensures that if the school nurse cannot be there, the other staff member can perform CPR until EMS arrives. CPR will vary depending on whether it is a child or an adult. The following steps are for an adult.  

AED stands for automated external defibrillators and can help save the lives of those experiencing cardiac arrest. It is estimated that early defibrillation (3-5 minutes of collapse) can increase the survival rate to 50%-70%. These AED steps should be used when caring for a non-breathing eight-year-old or older adult weighing more than 55 pounds. After checking the scene and ensuring that the person needs help, you should ask a bystander to call 911, then proceed to use the AED as instructed.  

Mental Health Emergencies  

In today’s day and age, most schools assist children with mental and behavioral management related to depression, anxiety, and aggression. Mental health challenges for students K-12 have increased significantly in the past several years. The number of adolescents suffering from poor mental health is highest among LGBTQ+, female, and black students (13). Often, nurses are the first to identify students with symptoms of stress, anxiety, depression, and other behavioral health challenges. Nurses must be familiar with protocols for the emergency management of acute flare-ups of violent, homicidal, and suicidal behaviors and severe depression (17). Management typically involves crisis intervention and EMS activation to stabilize the student and provide medical treatment as needed. Children who have mental health problems are more likely to experience violence, engage in risky behavior, and struggle with school. School nurses can assist and support mental and behavioral health before it becomes an emergency by doing the following (13): 

• Provide direct care, including coaching, counseling, and medication management.  

• Support emergency preparedness and crisis response 

• Conduct screenings to identify student needs  

• Manage referral and care coordination and community providers 

• Collaborate with school personnel to assess, identify, and implement interventions.  

• Follow up with children who are known to have behavioral health or mental health needs 

• Implement mental health and stress wellness management programs for staff and students. 

Substance Use and Overdose 

According to the 2018 Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, 1.7 million adolescents aged 12 to 20 years were current illicit drug users (17). Often, students are misusing prescription opioids, and therefore, school nurses need to be familiar with the administration of naloxone hydrochloride in cases of intentional and unintentional drug overdoses (17). Proper administration of naloxone care is life-saving, as is related to training and education. School nurses who may respond to a suspected opioid overdose would be best prepared if trained to follow the following 5-step process (17):  

• Look for the presence of signs of opioid overdose 
• Unconscious and unarousable 
• Shallow or no breathing  
• Clammy skin  
• Slow or no heartbeat 
• Activate EMS 
• If the patient is not breathing, give rescue breaths and CPR. If there is no pulse 
• Administer naloxone 
• Do not leave the patient unattended; monitor the response until EMS arrives. 
• If the patient is not breathing or awake, repeat naloxone after 5 minutes 
• If respiratory depression recur, repeat naloxone after 30-90 minutes  

Communicable Diseases 

Infectious disease emergencies often involve exposure, so nurses need to be familiar with contact tracing and management (17). Protocols for varicella, pertussis, measles, methicillin-resistant Staphylococcus aureus, tuberculosis, influenza, and meningococcal meningitis exposures are developed with local health departments. School nurses are responsible for preventing and managing the spread of infection in schools. They must be knowledgeable about epidemics that can result from infectious diseases by using standard precautions and proper infection control practices.  

Signs and symptoms of an infectious disease: 

• Oral temperature over 100.3° Fahrenheit 

• Unexplained diarrhea or vomiting 

• Unexplained rash 

• Lethargy, loss of appetite 

• Pallor 

• Sudden onset of pain 

• Severe cough 

• Sore throat 

• Blood or pus drainage from the ear 

Conclusion
 

School nursing provides autonomy to which most nurses are not accustomed. The school nurse is responsible for triaging, medicating, treating, assessing, and discharging students from their office. Understanding what medical emergencies may present to the nurse’s office and what you need to do for those emergencies is crucial. Quick actions and treatment can be the difference between life and death for a student. The school nurse plays a key role in providing emergency care to students and developing prevention strategies.

Many emergencies are avoided in schools each day because school nurses have assisted in the education of teachers/school staff, parents/guardians, and students in the prevention and utilization of early intervention techniques. Proactive development of individualized health care plans and emergency care plans can also play a key role in prevention. At the end of the day, seeing every student home safely is the sole purpose of school nursing.  

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