Children's Health
An Emergency Plan for Dealing
with Seizures in the School
By
Aug 21, 2006, 07:00
Back to School - An Emergency Plan for Dealing with Seizures in the
School
(HealthNewsDigest.com).. If you are a student with epilepsy, or the
parent of a student with epilepsy, you may be thinking about the
upcoming school year and wondering that if a seizure occurs in school
how will it be treated. The development of an emergency seizure
treatment plan is the best assurance that if you or your child has a
seizure in school the staff will treat it appropriately.
Almost 3 million people in the United States have epilepsy, a
neurological condition characterized by unprovoked seizures. Children
under the age of 15 represent 326,000 of these affected persons. Most
of these individuals will have complete seizure control by taking daily
antiepileptic medications; about 30 % however, will continue to have
seizures despite the use of these medications.
Seizure emergencies
are usually treated at the site with rescue medication and
occasionally, for those persons with a vagus nerve stimulator, with an
extra stimulation. The only FDA approved medication for at home
(or school) treatment by lay persons is rectal diazepam gel (Diastat
AcuDial). This medication has been proven safe and effective in the
treatment of prolonged and repetitive seizures.
When developing an individualized seizure emergency plan, the school
nurse must be apprised of the student’s seizure type, usual daily
medication, usual seizure semiology (or what the seizure looks like),
how long it usually lasts and any other effects that the child
experiences when having a seizure. A licensed medical provider must
order any medication or other treatment to be given in the case of a
seizure emergency. Medications must include name, dose and form, and
must specify the situation in which the medication should be
administered. For instance, if the child experiences a seizure lasting
longer than 5 minutes, administer 5 milligrams of diazepam gel
rectally.
Individual school systems may have a standardized form that the medical
provider must complete in relation to administering medication or other
treatments in school. The parent or guardian must supply the medication
to be administered. If the state and school district approves
administration of medication by a person other than a school nurse
there must be proper training provided to that person. There should be
a written protocol for them to review as necessary, as well as
documentation of training. This can be completed by the school nurse
with input from the treating physician, nurse or local epilepsy
affiliate.
Administering rectal medication in school presents some advanced
planning. Rectal diazepam gel should be contained in a secure, locked,
well-situated storage location. Other items that may be utilized during
a seizure emergency should be kept together and brought to the site
when needed. These include a small blanket (or other material suitable
to provide privacy for the student), under pad, gloves, small plastic
garbage bag, medication record form with pen and the seizure emergency
treatment plan/information. As in any emergency, staff should know at
what point 911 should be called. For seizures that do not stop with
treatment at the scene, the child will require an emergency department
visit. If seizures stop, the student may need to be observed or to rest
in the nurse’s office for some time.
For students with seizure disorders, the role of a school nurse is not
only to respond to seizure emergencies, but also to provide an
environment that enhances and encourages the student’s educational,
social, and personal growth. Generating an environment that allows for
a flow of communication between the student, parent/guardian, physician
or health care team, and the school nurse is an important factor for
appropriate and effective student health care.
The availability of a well-organized seizure emergency treatment plan
permits effective management of seizure emergencies at school and
decreases the potential for seizure-related complications. An
individualized treatment plan provides confidence to school nurses and
other trained personnel while minimizing the adverse effects of
seizures and potentially reducing the need for emergency hospital
visits. An effective and safe seizure rescue medication is a key
component in treating prolonged and repetitive seizures.
Parents and health care providers must advocate for children with
epilepsy to receive the care they need in school while assuring that
their education and extracurricular activities are not constrained by
seizures. Development of detailed protocols and a seizure emergency
treatment plan will enable a school nurse to give the best possible
treatment to students with seizures within the school environment.
Christine O'Dell, RN, MSN
Montefiore Hospital & Medical Center
Division of Pediatric Neurology
111 East 210 Street
Bronx NY
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