Dr Adesewa Ademola shares tips on how common children’s emergency conditions can be managed in schools.

Just like that, children’s emergencies can suddenly happen causing immense pain and distress.

Now, children have so much to do in their day-to-day schedule – playing, learning and exploring.

Most of the time, they are usually doing so happily and energetically.

While parents and caregivers try to protect children from danger most of the time, they can’t always be there to watch over them.

Statistics show that 10 to 25 % of injuries in children occur in schools.

Common Types of Childhood Emergencies

Children’s emergencies in schools can occur without warning. Sometimes they can’t be prevented.

So, the best way to deal with such emergencies is to anticipate and be prepared.

This is one of the core elements now considered in schools.

Now, a key component of preparedness is the availability of medical personnel in schools.

And here are some examples of emergencies that may easily occur in schools:

• acute asthmatic attack
• acute allergy reaction to ingested food,
• collapse from different causes
• Fit and/or an epileptic seizure,
• Bleeding – can be from trauma or injury (accidental or provoked) or unprovoked nose bleeds
• poisoning,
• burns from fire and choking from smoke inhalation.

Dealing With Children’s Emergencies in Schools

The starting point for dealing with children’s emergencies is knowing the medical history of every child – in advance.

Every school should initiate an “Individual healthcare plan (IHP)”, which is:

• a detailed medical history of the child,
• the medications the child is taking,
• ways of preventing triggers
• ways to handle an emergency.  

It also helps to ensure that the appropriate basic medication each child may require is quick to hand.

This could be an inhaler for asthmatics or an EpiPen for severe allergy reactions.

Staff should be trained – including the teachers and teaching support staff – on basic health care and first aid for common scenarios; and how to access help and support from medical staff and an adequately equipped medical facility in the case of an emergency.

Below are some simple guidelines for managing specific conditions (with fictional examples given):

1. Acute Asthma

Ada is a 5-year-old known asthmatic girl who developed breathing difficulties in class.

What to do: –

• Make sure Ada sits upright and is not left alone.
• Next, give her 4 puffs of her blue inhaler (i.e. Ventolin).
  • Give one puff at a time, with 4 breaths after each puff.
• Use a spacer device if available.
• Wait 4 minutes.
  • If still unable to breathe normally, give Ada 4 more puffs.
• If that doesn’t help, call an ambulance immediately.
• And keep giving 4 puffs every 4 minutes till the ambulance arrives.

2. Bleeding

Outside, the kids are so excited, it is break time.

Toyin is playing on the metallic slide and suddenly gets a cut.

It is bleeding profusely, and the nurse is called.

What to do:-

• Stop the bleeding:
  • Apply pressure with a clean cloth/towel/bandage if available
  • Elevate the affected part above the level of the heart.
  • Maintain constant firm pressure over the area – avoid frequently lifting the cloth to check if the bleeding has stopped.
• Next, once it is obvious the bleeding has stopped, clean the wound with clean water.
  • (Do not use soap, iodine or hydrogen peroxide)
• Cover the wound

 Seek urgent professional help:

• When the wound keeps bleeding despite all measures.
• If there is, a jagged edge or fat/muscle is visible.
• When the wound is more than ¼ inch deep or gaping.
• If the wound is dirty
• When the child has not received a tetanus shot.
• If there is an amputated part (which must be wrapped and placed over ice in a container and transported to the hospital within 2 hours)

3. Food Allergy

Some people often do not know all the food they are allergic to until they eat it.

Chika, a 7-year-old boy, is allergic to nuts and avoids them even when offered.

Daniel, Chika’s friend, offered him part of his meal which contains egg.

Chika isn’t aware of an egg allergy because he doesn’t eat them at home. 

5 minutes after eating the meal, he develops a swollen lip and tongue. The nurse is called.

Luckily, Chika has an auto-injector pen containing adrenaline for an allergic reaction.

The nurse administers quickly the injection, and he gets better.

Other food allergy symptoms include an Itchy sensation in the mouth, throat or ears, raised, itchy red rash and vomiting.

4. Choking

Jennifer is an 8-year-old girl in the school restaurant chatting with her friends while eating.

But suddenly, she begins to cough continuously, is unable to speak, and holding her throat. The nurse is called.

What to do: –

• Quickly, the nurse encourages Jennifer to continue coughing, which may help get the food out.
• And when that didn’t seem to help, the nurse goes behind Jennifer;
  • She gives her 5 back blows with the heel of her palm between the shoulder blades.
• However, this still didn’t work.
  • So the nurse, while standing behind Jennifer, makes a fist around Jennifer’s belly button.
  • She then firmly pushes her hand upward and outward into her abdomen.
  • This (known as the Heimlich manoeuvre) is repeated 5 times, and if successful, allows the food object causing her to choke to be dislodged from her windpipe.

The Heimlich manoeuvre (Abdominal Thrust) can be used in children aged from 1 year and in adults.

Be watchful and call the ambulance if Jennifer goes unconscious or becomes unresponsive.

Immediately Start Cardiopulmonary resuscitation (CPR) before an ambulance arrives.

5. Fire

Firstly, the appropriate thing to do in an event of a fire is to evacuate all the children to the pre-arranged assembly point.

This is both an adult and children’s emergency, and the best practice is to have a well-defined plan to maintain everyone’s safety.

In such instances, Do not stop to collect their belongings.

6. Chemical Poisoning

This is when a child has accidentally ingested a toxic or poisonous substance.

You may be surprised to learn that toxic materials are quite commonly available.

Common examples include

• Bleaching agents
• Cleaning fluids
• Pesticides
• Vermin killers
• Machine repair or maintenance fluids – etc

Consequently, if the child becomes unconscious and has a cardiac arrest, start CPR immediately.

Do not:

• give anything by mouth
• try to neutralize the poison
• try to induce vomiting
• wait for symptoms to develop before seeking medical advice.

7. Fit/Seizure

• Firstly, try to put the child in a safe environment
• If the nurse is present, they may be able to use some medication to stop the seizure
• Secondly, try to loosen any closely fitting clothing and remove sharp or harmful objects like furniture
• Remain relaxed and do not panic
• Check for the duration of the seizure, and ensure they are breathing normally.
• When the seizure ends, keep the child in the recovery position – see below
• Following this, they will need to rest, and an ambulance is necessary to take them to the hospital.
  • This is especially so if the seizure lasts longer than a few minutes.

Do not:

• try to restrain movement;
• try to put anything in the mouth
• leave the victim

8. Sprain or Fracture

Sprains are commonly caused by falls or other injuries that could happen in schools. So, they involve injury to parts of the body such as the back, chest or arms and legs, affecting the ‘soft tissues’; ie, there are no injuries to the bones.

Now, in the care of sprains, remember P.R.I.C.E.:

• Give Painkillers
• Rest the affected area rather than taking on strenuous activity
• Put Ice over the area (wrapped in damp cloths but not directly on the skin)
• Put some Compression bandage but be careful to avoid tight application.
• Elevate the area affected to help reduce swelling and pain that may accompany the sprain injury.

If the child cannot bear weight on the injured area (in the case of the leg); or use the arm in usual activities, suspect a fracture and arrange for them to be urgently taken to the health facility.

Conclusion

Yes, it is difficult to prevent all emergencies.

But with proper planning, it may be possible to handle most of the quickly, avoiding the worst possible scenarios.

Have you other tips on minimising accidents and emergencies at school? Share in the comments.

More Reading:

• Some Heart-stopping medical emergencies that could happen at home
• Emergency Contraception – A Bridge Toward Regular Contraception
• The basics of Childhood Food Allergy
• What is an Allergy??
• Doc’s corner: ‘Pregnant despite Contraception’

Edited by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on various health care conditions to provide evidence-based guidance and to help promote quality healthcare. The advice in our material is not meant to replace a qualified healthcare practitioner’s management of your specific condition.
To discuss your condition, don’t hesitate to contact a health practitioner or reach us directly.