School Bus Driver Training

1. School Bus Driver Training Unit I Student Emergencies

2. Objectives • At the end of this session school bus operators will be able to: • Describe their role in providing first aid emergency situations on the bus • Demonstrate good assessment skills in setting priorities when managing a medical emergency on the bus • Describe required contents of the first aid kit and body fluid clean up kit

3. Student Emergencies • WHAT IS CONTAINED IN THIS UNIT ARE ONLY GENERAL GUIDELINES. YOU MUST FOLLOW YOUR LOCAL SCHOOL DISTRICT PROCEDURES AND GUIDELINES REGARDING RECEIVING FIRST AID TRAINING AND ADMINISTERING FIRST AID ON YOUR SCHOOL BUS.

4. Student Emergencies • FIRST AID AND EMERGENCY CARE ARE ONLY TEMPORARY STEPS TAKEN UNTIL MORE ADVANCED TREATMENT CAN BE OBTAINED, EITHER AT THE SCENE OF AN INCIDENT OR AT A HOSPITAL

5. Procedural Overview • Control hazards at the scene • Evaluate injuries or illnesses • Enlist the help of others • Contact emergency medical services • Maintain control of the situation

6. Medical Liability • Anyone who gives first aid should be concerned about liability • PA Good Samaritan Act protects well intentioned acts and omissions from civil liability for those with first aid training • There are several first aid courses that would meet this requirement • Pennsylvania Department of Health EMS Information Bulletin #051

7. First Aid Procedures • Setting priorities: What to do first? • Hazard control • Existing or imminent smoke or fire condition • Hazardous materials • Unsafe site • Distractions • Obtaining emergency medical assistance • Use a cell phone • Give specific instructions: • Exact location or precise directions • Exact nature of problem • Number of people injured • Description of vehicles involved

8. Reporting Report ALL Incidents to your Supervisor

9. Using Responsible Helpers • Adult bystanders are best • Know your passengers • ONLY IN EXTREME EMERGENCIES SHOULD OLDER RESPONSIBLE STUDENTS BE SENT FOR HELP • Follow local policy and procedures • Do NOT send elementary school students • If policy allows sending students, send two together

10. Assessing Injuries or Illnesses • Prioritize injuries if more than one • Always follow local procedures on performing first aid treatment • Be organized and do one thing at a time

11. Treatment Procedures WHAT IS CONTAINED IN THE FOLLOWING SLIDES ARE ONLY GENERAL GUIDELINES. YOU MUST FOLLOW YOUR LOCAL SCHOOL DISTRICT PROCEDURES AND GUIDELINES REGARDING RECEIVING FIRST AID TRAINING AND ADMINISTERING FIRST AID ON YOUR SCHOOL BUS.

12. Seizures • Don’t panic, let it run its course • If not already done, lay the student down • Protect student from injury as much as possible. • Move any objects • Cushion head • Monitor airway • Do NOT put anything in the mouth • Do NOT restrain • Afterwards, always call dispatcher

13. Fractures • Signs and symptoms • Pain at site • Pain on movement • Swelling • Discoloration • Misaligned bones • Care and treatment • Call dispatcher and 911 • Prevent movement

14. Allergic Reaction: Bites and Bee Stings • Signs and symptoms • Puncture marks • Anxiety • Pale, cool skin with progressive onset of sweating • Rapid, weak pulse • Rapid, shallow breathing or breathing difficulties • Difficulty swallowing and speaking • Blurred vision • Abdominal pain • Nausea and/or vomiting • Headache • Intense pain at site of bite • Localized redness and swelling

15. Allergic Reaction: Bites and Bee Stings • Care and treatment • Apply direct pressure over bitten area • Find out if the student has any allergies to stings or bites • Use cold compress, if available, to reduce swelling

16. Allergic Reaction: Anaphylactic Shock • Can be life threatening • Follow district policy • Know and use appropriate emergency numbers: CALL FOR HELP • Enforce “No Food on Bus” • Follow local policies and procedures for EpiPen/epinephine use

17. Allergic Reaction: Anaphylactic Shock • Signs and symptoms • Itching • Red, raised, blotchy skin (hives) • Wheezing • Confusion • Weakness • Pale color • Unconsciousness • Unable to speak more than one or two words • Sitting straight up or with hands on knees • Gasping for breath • Pursing lips to breathe • Using neck muscles to take breaths

18. Allergic Reaction: Anaphylactic Shock • Care and treatment • Call your dispatcher and report the situation • Call 911 immediately • If you district procedures and guidelines allow, you are qualified, and you have received training, administer epinephrine

19. Asthma • Can be life threatening • FOLLOW LOCAL PROCEDURES AND GUIDELINES • Signs and symptoms • Pale, cool, clammy skin • Shortness of breath • Wheezing • Anxiety, exhaustion, rapid or weak pulse • Collapse • Care and treatment • Call dispatcher and report • Sit student upright • Be calm and reassuring • Assist using inhaler

20. Bites from Other Students • Clean bites with antiseptic wipe • Cover with band aid • Report incident

21. External Bleeding • Types of wounds • Incision • Laceration • Abrasion • Puncture • Amputation • Care and treatment • Get help • Call dispatcher • Call EMS for serious wounds • Use universal precautions • Apply pressure using sterile bandage • Raise and support above the heart

22. Internal Bleeding • Signs and symptoms • Visible internal bleeding • Blood coughed by student (bleeding in lungs or stomach) • Pale, cool, clammy skin • Thirst • Rapid, weak pulse • Rapid, shallow breathing • Guarding of the abdomen, in fetal position • Pain or discomfort • Nausea and/or vomiting • Swelling

23. Internal Bleeding • Care and treatment • Get expert medical help • If possible, position student on back • Elevate legs • Give nothing by mouth

24. Choking • Do NOT slap them on the back • Best not to do anything if person is coughing forcefully and not turning bluish color • Signs and symptoms • Difficulty or absence of breathing • Inability to speak or cough • Distress – grabbing the throat, collapse • Someone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help.

25. Choking • Care and treatment • Check mouth and clear any obstructions • Stand behind the student and wrap your arms around the their waist • Make a fist with one hand • Place the thumb side of the fist against the student’s abdomen in the midline and slightly above the navel • Grasp the fist with the other hand and press the fist into the student’s abdomen with a quick upward thrust • Each new abdominal thrust should be a separate and distinct movement • Repeat thrusts until student expels the obstruction

26. Dehydration • Be careful of this during afternoon routes in warm weather • Signs and symptoms • Pale, cool, clammy skin • Rapid breathing • Profuse and prolonged sweating • Thirst • Loss of skin elasticity • Sunken eyes • Care and treatment • Give cool water, if available

27. Diabetes • Imbalance of sugar in blood • You (driver) are not expected to manage student diabetes by checking blood glucose levels or administering medication • Recognize signs and symptoms • Know what to do • Be especially aware at the end of the day

28. Diabetes • Signs and symptoms • Hot, dry skin • Smell of acetone (nail polish remover) on the breath • Drowsiness or change in mood • Unconsciousness, progressing to coma • Profuse sweating • Grayish skin color • Hunger • Confused or aggressive behavior • Rapid pulse • May appear drunk • May have seizures

29. Diabetes • Care and treatment • DO NOT give insulin injections • Give sweet drink, if available • Be familiar with Quick Reference Emergency Plan if available • Be aware of where students keep supplies • Provide input to school health team when requested • Communicate with parents and school nurse • Respect student confidentiality

30. Heat Stroke • Be particularly aware on afternoon runs in hot weather • More dangerous than sunstroke • Signs and symptoms • Flushed, hot, dry skin • The student has stopped sweating • Rapid pulse, gradually weakening • Irrational or aggressive behavior • Staggering or fatigue • Visual disturbances, headache, vomiting • Collapse and seizure •  Care and treatment • Cool the student as much as possible • Give fluids and water if the person is conscious

31. Hyperventilation • Signs and symptoms • Rapid respirations and pulse • Shortness of breath • Pressure, tightness or pain across the chest • Anxiety • Blurred vision • Tingling in fingers and toes • Hand and finger spasms • Fainting

32. Hyperventilation •  Care and treatment • Reassurance • Remove the cause of anxiety, if possible • If the student has fainted, lay student down with legs elevated.

33. Nose Bleeds • Keep trunk of body higher than heart • Tilt head forward • Compress nostril for 5-10 minutes

34. Report All Incidents • As with all of the above emergencies, FOLLOW LOCAL PROCEDURES • Report EVERYTHING to proper authorities • Work with your Supervisor and parents to inform substitute drivers on medical issues – keep confidentiality in mind! • Watch for after-affects from a crash

35. First Aid Kit • Inspect • Replace items as used • Placement • Clearly marked • Mounted in accordance with manufacturer’s instructions • Removable • Easily accessible

36. Body Fluid Clean Up Kit • Inspect • Replace items as used • Placement • Clearly marked • Mounted in accordance with manufacturer’s instructions • Removable • Easily accessible

37. Cleaning Body Fluid Spills • Always wear disposable gloves • Small spills can be cleaned with paper towels or tissues • Clean with disinfecting solution • Remove gloves and place into plastic bag with waste and other cleaning materials • Wash hands • Soap • Running water for at least 30 seconds • If possible, carry hand sanitizer, extra gloves, and band aids