Acute Illness, Injury, and Emergency Care
Triage and first actions
Assess ABCs and level of consciousness first; a student who is talking has a patent airway. Then decide: treat in the clinic, activate EMS, or release to a parent (rarely appropriate alone). Standing orders should be written, signed by the medical advisor, reviewed annually, and limited to what the nurse is licensed to do.
High-frequency emergencies
- Anaphylaxis: epinephrine IM into the vastus lateralis first, then call 911, position supine with legs elevated (sitting if in respiratory distress), and monitor for a biphasic reaction.
- Asthma: quick-relief bronchodilator per action plan, oxygen if available; 911 for poor response, cyanosis, or inability to speak.
- Seizure: protect the head, do not restrain or put anything in the mouth, time it, and call 911 for longer than 5 minutes or a first-ever seizure.
- Head injury: assess for concussion with a validated tool; red flags (vomiting, worsening headache, unequal pupils, drowsiness, clear fluid from ear or nose) mean emergency referral.
- Suspected spinal injury: do not move the student; stabilize and activate EMS.
- Bleeding: gloves, direct pressure, standard precautions; tourniquet for life-threatening extremity bleeding.
- Musculoskeletal: RICE for sprains; no same-day return to play after suspected concussion.
- Heat illness: move to shade, cool actively, hydrate; heat stroke is an emergency.
Traps
Giving an antihistamine before epinephrine. Sending a student with anaphylaxis home in a private car. Documenting only the treatment without the assessment and notification. Forgetting exposure documentation and post-exposure follow-up.
Rule of thumb
When in doubt, call 911 and keep the student supervised. Document assessment, intervention, response, and notification times.