EMERGENCY ILLNESS AND INJURY PROCEDURES
Resources for Child Care Givers
Provided by All Family Resources

When parents enroll their child, they should provide you with the contact information and consent that you will need if there is an emergency involving that child. A sample "Child Care Emergency Contact Information and Consent Form" is included in this section. The form includes a statement of parental consent for you to administer first aid and get emergency services for their child. You should request that parents update this form at least once every year.

All parents of children in your care should know your emergency procedures. Let parents know that you are trained in first aid and CPR as taught by the American Red Cross or any other nationally approved first aid training facility. Tell parents how often you take refresher courses. Tell them that in the event of an emergency, you will:

1. quickly assess the child's health,
2. call 911 or other appropriate emergency help as needed,
3. give first aid and CPR, if necessary, and
4. then contact them or the person they have listed to call in an emergency.

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At all times, you should:

• Have emergency numbers posted by the phone--police, ambulance (911), and poison control center. (A list of regional poison control centers is included in this handbook as Appendix 2.)
• Keep parents’ consent forms for emergency treatment and numbers for emergency contacts on file. (See sample on next page.)
• Take pediatric CPR and first aid training every year to maintain your American Red Cross certification.
• Post first aid procedures where they can be easily seen. You may want to copy and laminate the list of first aid measures included in this chapter.
• Write up an emergency procedure and evacuation route and make sure you are familiar with it.
• Keep a fully stocked first aid kit in easy reach of all providers, but out of reach of children. Check the first aid kit regularly and restock it as necessary. (See box for what your kit should contain.)
• In addition to the supplies listed for your first aid kit, you should also keep ice cubes or ice bags in the freezer to use to reduce swelling of some injuries.
• Place a stocked first aid kit in every vehicle used to transport the children. In addition to the items in your facility first aid kit, your vehicle kit should also include a bottle of water, soap, coins for a pay telephone, and a first aid guide.
• Don't use first aid sprays and ointments. They may cause allergic reactions or skin damage. Use alcohol or antiseptic wipes.
• Wear gloves if you might come in contact with blood.
• Have first aid supplies handy on the playground by keeping a zip-lock plastic bag stocked with disposable gloves, sterile wipes, gauze wrap, and bandaids in your pocket.

If an injury occurs:

1. Stay calm.
2. Check for life-threatening situations (choking, severe bleeding, or shock). Do not move a seriously injured child.
3. Call 911 or your local emergency number if the child is seriously hurt.
4. Give CPR or first aid, if necessary.
5. Contact the parent/emergency contact.
6. Record all injuries on a standard form developed for that purpose. The form below is an example of a standard injury report form. You may want to list on the back of the form the names of all of those who witnessed the injury.

Measures

First Aid Measures Note: Wear disposable gloves if coming in contact with blood. Dispose of gloves in a sturdy leakproof plastic bag. Wash hands. Condition Action Abdominal Pain (Severe) Notify parents. If the child has been injured and has severe or bloody vomiting and is very pale, call 911. Do not allow child to eat or drink. Abrasions (Scrapes) Wash abrasion with soap and water. Allow to dry. Cover with a sterile nonstick bandaid or dressing. Notify parents. Asphyxiation (Suffocation) Call 911. If the child is in a closed area filled with toxic fumes, move the child outside into the fresh air. Perform CPR if child is not breathing. Asthma Attack Give prescribed medication, if any, as previously agreed to by parents. If attack does not stop after the child is given the medication, and the child is still having difficulty breathing, call 911. If you have no medication and the attack does not subside within a few minutes, call the parents and ask them to come immediately and take the child for medical care. If the child has difficulty breathing, call 911. Bites and Stings     Animal: Wash the wound with soap and water. Notify parents to pick up the child and seek medical advice. If bite is from a bat, fox, raccoon, skunk, or unprovoked cat or dog, or any animal that may have rabies, call the health department, which will contact animal control to catch the animal and observe it for rabies. Do not try to capture the animal yourself. Make note of the description of the animal and any identifying characteristics (whether dog or cat had a collar, for example).     Human: Wash the wound with soap and water. Notify parents. If bite causes bleeding, contact the health department for advice.     Insect: Do not pull out stinger as it may break off; remove the stinger by scraping it out with a fingernail or credit card, then apply a cold cloth. Notify parents. Call 911 if hives, paleness, weakness, nausea, vomiting, difficult breathing, or collapse occurs.     Snake: Call local poison control center. Do not apply ice. Notify parents immediately, then the health department. If the child has difficulty breathing, call 911.     Ticks: Notify parents to seek preferences. If parents approve, try to remove tick with tweezers.     Waterlife: For stingray or catfish stings, submerge affected area in warm water to deactivate the toxin. For other stings, such as from jellyfish, rinse with clean water. Call parents to seek medical care. Bleeding     External: For small wounds, apply direct pressure with a gauze pad for 10-15 minutes. (Use gloves.) If bleeding continues or is serious, apply a large pressure dressing and call 911 immediately.     Internal: If child has been injured and vomits a large amount of blood or passes blood through the rectum, call 911. Otherwise, contact parents to seek medical care. If a child is a hemophiliac and has injured a joint through a minor bump or fall, call the parents. The child may need an injection of blood factor. Bruises Apply cold compresses to fresh bruises for the first 15 to 30 minutes. Note: A child with bruises in unusual locations should be evaluated for child abuse. Burns and Scalds     No blisters: Place burned extremity in cold water or cover burned area with cold, wet cloths until pain stops (at least 15 minutes).     With blisters: Same as for no blisters. Do not break blisters. Call parents to take child to get medical care.     Deep, extensive     burns: Call 911. Do not apply cold water. Cover child with a clean sheet and then a blanket to keep the child warm.     Electrical: If possible, disconnect power by shutting off wall switch, throwing a breaker in the electrical box, or any other safe way. Do not directly touch child if power is still on. Use wood or thick dry cloth (nonconducting material) to pull child from power source. Call 911. Start CPR if necessary. Notify parents. Note: A child with burns and scalds should be evaluated for child abuse. Croup and Epiglottitis     Croup: Call parents to pick up child and get medical care.     Epiglottitis: (Similar to croup, but with high fever, severe sore throat, drooling, and difficulty breathing): Transport child in upright position to medical care. Call 911 for ambulance if child has severe breathing difficulty. Dental Injuries     Braces (Broken) Remove appliance, if it can be done easily. If not, cover sharp or protruding portion with cotton balls, gauze, or chewing gum. If a wire is stuck in gums, cheek, or tongue, DO NOT remove it. Call parent to pick up and take the child to the orthodontist immediately. If the appliance is not injuring the child, no immediate emergency attention is needed.     Cheek, Lip, Tongue (Cut/ Bitten) Apply ice to bruised areas. If bleeding, apply firm but gentle pressure with a clean gauze or cloth. If bleeding continues after 15 minutes, call the parent to pick up the child and get medical care.     Jaw Injury Immobilize jaw by having child bite teeth together. Wrap a towel, necktie, or handkerchief around child's head under the chin. Call parent to pick up and take the child to the emergency room.     Tooth (Broken) Rinse dirt from the injured area with warm water. Place cold compresses over the face in the area of the injury. Locate and save any tooth fragments. Call the parent to pick up and take the child and tooth fragments to the dentist IMMEDIATELY.     Tooth (Knocked Out) Find the tooth. Handle tooth by the smooth, white portion (crown), not by the root. Rinse the tooth with water, but DO NOT clean it. Place tooth in a cup of milk or water. Call the parent to pick up and take the child and tooth to the dentist IMMEDIATELY. (Time is critical.)     Tooth (Bleeding Due to Loss of Baby Tooth) Fold and pack clean gauze or cloth over bleeding area. Have child bite on gauze for 15 minutes. Repeat again. If bleeding persists, call parent to pick up and take the child to the dentist.     Sores (Cold/ Canker) Tell parent and request physician examination if sore persists for more than a week. Eye Injuries If a chemical is splashed in the eye, immediately flush eye with tepid water, with the eyelid held open. Then remove contact lens, if present, and rinse eye with tepid water for at least 15 minutes. Do not press on injured eye. Gently bandage both eyes shut to reduce eye movement. Call parent to pick up and take child to get medical care. Fractures     Arm, Leg, Hand, Foot, Fingers, Toes Do not move injured part if swollen, broken, or painful. Call parent to pick up and take child to get medical care.     Neck or Back Do not move child; keep child still. Call 911 for ambulance. Frostbite/Freezing Warm arm, leg, hand, foot, fingers, or toes by holding them in your armpit. Warm ears and noses with a warm palm. For deeper freezing, hold extremity in warm water (105°-110° F) for 20 minutes. Protect involved area from further damage. Apply a sterile gauze and elevate injured area for 40 minutes. Call parents to pick up and take child to get medical care. If child is lethargic, call 911. Frozen to Metal Do not allow child to pull away from metal. Blow hot breath onto the stuck area or pour warm (not hot) water onto the object. Gently release child. If bleeding occurs, such as on the tongue, grasp tongue with folded sterile gauze and apply direct pressure. Call parents to pick up and take child to get medical care. Head Injuries Keep child lying down. Call parents Call 911 if the child is: complaining of severe or persistent headache less than 1 year old oozing blood or fluid from ears or nose twitching or convulsing unable to move any body part unconscious or drowsy vomiting Nosebleeds Have child sit up and lean forward. Loosen tight clothing around neck. Pinch lower end of nose close to nostrils (not on bony part of nose). Poisons Immediately, BEFORE YOU DO ANYTHING, call the local poison control center, hospital emergency room, or physician. (A list of regional poison control centers is included as Appendix 2.) Call parents. If child needs to go to for medical evaluation, bring samples of what was ingested. Bring with you all containers, labels, boxes, and package inserts that came with the material that the child took in. Look carefully for extra containers around the immediate area where the incident occurred. Try to estimate the total amount of material the child might have taken in, and whether the material was swallowed, inhaled, injected, or spilled in the eyes or on the skin. If possible, also bring with you the child’s health file, including consent forms and names and telephone numbers of parents/guardians. Do not make a child vomit if: the child is unconscious or sleepy, the child has swallowed a corrosive product (acid/drain cleaner/oven cleaner), or the child has swallowed a petroleum product (furniture polish/kerosene/gasoline). If instructed by the poison control center to make the child vomit: Use ipecac syrup: Children 1 year to 10 years old: 1 tablespoon or 3 teaspoons of ipecac and 4 to 8 ounces of water Children over 10 years old: 2 tablespoons of ipecac and 4 to 8 ounces of water Follow with another 4 to 8 ounces of water. Repeat dose ONCE if child has not vomited in 20 minutes. If a chemical is spilled on someone, dilute it with water and remove any contaminated clothing, using gloves if possible. Place all contaminated clothing and other items in an airtight bag and label the bag. If the chemical has been splashed int he eye, flush immediately with tepid water and follow instructions listed above for “Eye Injuries.” Some poisons have delayed effects, causing moderate or severe illness many hours or even some days after the child takes the poison. Ask whether the child will need to be observed afterward and for how long. Make sure the child’s parents/guardians understand the instructions. Seizures Remain calm. Protect child from injury. Lie child on his or her side with the head lower than the hips, or on his or her stomach. Loosen clothing. Do not put anything in the child's mouth. Call 911 if seizure lasts more than 5 minutes or if they are the result of a head injury. Notify parents.

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