First Aid Procedureswithin the

San Diego Unified School District

Adrienne LenhoffRN, BSN, PHN

Revised 08/2008

General Rules of First Aid

•Stay calm•Be prepared•Use universal

precautions

Universal Precautions

• Handwashing

• Gloves

• Trash Disposal Biohazard

Examples of Serious Injury/Illness

• No breathing or pulse• Difficulty breathing• Chest pain• Amputation• Back/neck/head

injury• Burns to large area of

body• Penetrating injury

• Snake bite• Eye injury• Prolonged

seizures• Allergic reactions• Hemorrhage• Poison ingestion• Heatstroke

Treatment of Serious Injury or Illness

• Do not move the patient until s/he has been assessed

• Notify nurse (if on site), or principal• Render first aid according to district policy• Notify parent/guardian• Do not give food or drink• Provide constant assessment of airway,

breathing, circulation• Apply pressure to stop severe bleeding

If Unconscious:

• Assess ABC’s• Airway – position the patient to open it• Breathing – if absent, give mouth-to-

mouth• Circulation – check for pulse, if absent,

start CPR & make sure 911 has been called

Abrasions and Cuts

• Cleanse wound with antiseptic or soap & water

• Apply dressing if wound is bleeding• Do not cover puncture wounds• If dirt is embedded or stitches are

required, apply temporary dressing, notify parent and refer for medical care

Bleeding: Wounds

• Apply direct pressure via bandage and/or pressure points

• Do NOT use tourniquet• Elevate the injured part unless fracture

is suspected• Treat for shock and follow serious

injury routine as appropriate

Nosebleeds

• Have patient sit with head slightly forward

• Apply firm pressure to lower portion of nose for at least 5 minutes

• Advise against nose blowing and active play for 24 hours

• Notify parent of prolonged bleeding (>20 minutes)

Blisters

• Do not open or break the blister• If open, cleanse with antiseptic and

apply dry dressing• If closed, may apply bandage to

protect from further injury

Bee Sting

• If stinger is present, scrape it away• Apply ice for 15 minutes• Monitor for 20 minutes• Check for history of allergy• Notify parent of event• Administer prescribed medication if

available

Bee Sting -Anaphylaxis

• Rapid onset (15 –60 minutes)• Signs/symptoms

– Trouble breathing– Weakness– Feelings of anxiety– Nausea– Abdominal cramps– Loss of consciousness– Anaphylactic shock

Bee Sting Protocol –Anaphylaxis treatment

• Call 911 & student’s parent• Nurse to administer

Epinephrine 1:1000• Monitor vital signs every

5 minutes• Transport to emergency

room for further treatment

Animal Bites

• Cleanse wound thoroughly with soap and running water for 5 minutes

• Apply sterile dressing• Notify parent for

referral to physician• Notify Animal Control

(619.236.4250) if appropriate

Human Bites

• Wash with soap and running water for 5 minutes

• Apply sterile dressing• Notify parent and

recommend medical follow-up

• Complete “Report of Irregular Occurrence”

Snake Bites• Call 911• Have patient lie down & keep calm• Remove constrictive clothing/jewelry• Keep bite at or below heart level• Mark a line with ink at the most

proximal level of swelling and record the time. If swelling spreads, mark a new line and new time again

• Monitor pulse & respirations• Do NOT apply ice• Do NOT incise or suction wound• Monitor pulse & respiration• Identify snake, if possible

Burns

• Immerse/rinse in cool water 2-5 minutes or until pain subsides

• Do NOT apply ice, ointment, butter or salve

• Do not open blisters• Apply dry dressing• Refer for treatment as

indicated

Ear Problems

• Do not apply heat or cold to the ear

• Check temperature for fever• Check for drainage or

foreign bodies• Notify parent • Do not remove foreign

bodies

Eye – Foreign Body

• Flush with clear, tepid water for at least 5 minutes

• Do not attempt to remove embedded objects

• If pain persists, notify parent & advise immediate medical care

Eye – Chemical Burn

• Irrigate immediately with large amounts of clear, tepid water for at least 15 minutes

• Cover eye with sterile dressing

• Refer for immediate medical care & send with information on chemical type

Eye - Contusion

• If blurred vision, loss of vision, or pain with movement of eye – obtain immediate medical attention

• Apply cold compress

Eye - Penetrating Injury

• DO NOT WASH EYE OR ATTEMPT TO REMOVE OBJECT

• Cover both eyes loosely with sterile dressing

• Keep patient quiet – move via stretcher• Obtain immediate medical attention

Fainting/Dizziness

• Have patient lie down with feet elevated

• Keep airway open• Rest until recovered• Refer to physician if

cause is uncertain, head injury preceded fainting or unconscious greater than two minutes

Fractures

• Immobilize injured part• Do not attempt to straighten

deformity• Apply ice to decrease swelling• Elevate if possible• If back, neck or skull fracture is

suspected, call 911 & do not move the patient

• Notify parent for transport for medical care

• Complete accident report

Head Injury

• Notify parent, provide head injury information sheet & refer for medical care if indicated

• Keep patient lying down• Monitor for at least 30 minutes• Follow serious injury routine as necessary• Watch for change in level of consciousness,

blurred vision, bleeding from facial orifices, unequal pupils, trouble breathing, vomiting.

Heat Exhaustion

• Signs/symptoms– Cool, clammy skin– Weak, nausea, cramps– Feels faint

• Treatment– Rest, lying down– Keep cool– Give sips of water

Heat Stroke

• Signs/symptoms– Hot, dry, red skin– Rapid, strong pulse– Temperature >103

• Treatment– MEDICAL EMERGENCY– Loosen clothing– Quickly cool body– Sponge skin with cool water

Poisons

• Identify poison, amount consumed and time of ingestion

• Call Poison Control at (800)222-1222 & follow their directions

• Call parent• Send bottle of poison and

vomitus, if any, with child to hospital

Seizures

• Position patient on side and maintain open airway

• Do not insert anything in patient’s mouth• Prevent self-injury to patient• Allow rest period after seizure subsides• Notify parent & refer for medical care when

indicated• Call 911 if seizure activity lasts greater than 5

minutes or is first-time seizure

Shock

• Pale, cool, clammy skin, restless, thirsty or nauseated

• Have patient lie down with feet elevated

• Cover only to maintain body temperature

• Notify parent and refer for medical care

Skin Conditions

• If draining or weeping, cover with dressing

• If contagion is suspected, exclude from school, notify parent and refer to physician

Splinters

• Remove only if readily accessible• Apply antiseptic to wound• If deeply imbedded, notify parent

& advise physician visit

Sprains

• Treat as fractures until diagnosed

• Rest• Ice: apply cold compress• Compression: elastic

bandage• Elevate the injured part• Notify parent as

indicated

Swallowed Foreign Bodies

• Assess for choking• If unable to cough, speak or

breathe, administer Heimlich maneuver (see next slide)

• If unsuccessful, activate 911 and continue Heimlich maneuver

• If not choking, notify parent & refer for medical care

Heimlich Maneuver• Apply four rapid, sharp blows

between shoulder blades using heel of your hand

• Stand behind person, encircling with your arms

• Make fist & place thumb side up in area just below breastbone

• Grab fist with other hand & squeeze with quick, upward thrust

• Check if breathing is restored• Repeat entire process as needed

Teeth

• Toothache – refer for dental care

• Lost baby tooth – use gauze to stop bleeding

• Lost permanent tooth –place tooth in whole milk or student’s saliva & refer for immediate dental care

Field Trips

• Please notify the nurse a week prior to the field trip to determine if emergency medications & training are required

• A field trip first aid kit will be available for check out

In Summary

• Stay calm• Assess ABC’s• Control bleeding using universal

precautions• Protect from further injury• Notify parent as indicated