in the Classroom
by Anita G. Kinser,
In this section you will develop strategies for dealing with the
most common medical emergencies such as:
first step in dealing with emergencies is preparedness. There are
a few things that all instructors can and should do to be prepared
to handle potential medical emergencies:
Know and practice CPR . Keep your certification current so
that you are following the most current American Heart Association
Know first aid . Review the principles of first aid on a
regular basis so you can remember what to do if an injury occurs.
Know the emergency notification system for the room(s)
you are teaching in. Most classrooms do not have telephones. Know
where the nearest one is, and what the emergency medical system
(EMS) response number is. In many areas this number is 911,
but not in all areas. Some campuses also have internal emergency
numbers to use.
Know the specific location of your room (ie-building and
room number) and best directions to give someone to find it in
case you need to call for emergency help.
What about liability?
California, as in most states, a person who renders emergency care
is usually protected under the Good Samaritan Law as long as you
acted in good faith and within your scope of care or
abilities. In general, the Good Samaritan law says that
person who renders emergency care, first aid, or rescue at the scene
of an emergency, or moves the person receiving such care, first
aid, and rescue to a hospital or other place of medical care, shall
not be liable to such person for any civil damages as a result of
any acts or omissions in rendering the emergency care, first aid,
or rescue, or moving the person receiving the same to a hospital
or other place of medical care, except in acts or omissions intentionally
designed to harm or any grossly negligent acts or omissions which
result in harm of the person receiving the emergency care, first
aid, or rescue or being moved to a hospital or other place of medical
care (Margolis, 1999).
For more information about the Good Samaritan law and potential
liability, go to: http://firstaid.about.com/od/medicallegal/a/07_no_good_sam.htm
A good thing to keep
in mind is that there is usually very little liability for doing
something to help. There is actually much more liability for doing
nothing when you could have done something.
As in all emergencies,
stay calm. Even if youre shaking inside, you need
to remain in control and demonstrate a calm exterior to the students
in the classroom.
whenever possible. Its not a bad idea to keep a ziplock
bag of latex or vinyl disposable gloves in your desk drawer, briefcase,
or other easily accessible place.
*Due to the growing
number of people with severe allergies to latex, vinyl gloves
an injured person or severely ill person if you dont
know it is OK to do so. Wait for emergency medical help to do
If the person is conscious and alert, allow them to assume
the position of comfort. Most people who are having
difficulty breathing will do this naturally if allowed.
Talk to the person
in calm, firm, but reassuring tones. If a person is panicking,
you may have to use a slightly louder, firm manner to get their
attention, but shouting rarely helps.
Check their breathing . As CPR teaches, remember the ABCs-airway,
breathing, circulation. If the person is not getting air into
their lungs, nothing else matters. Be sure to continue to monitor
breathing until the person is alert, oriented, and appears to
be no longer in distress, or until emergency medical personnel
Look, listen and feel for breath. If they are not breathing, breath
If the person isnt breathing and you dont know CPR
call out for someone who does. In a college setting with adult
students, there is a strong likelihood that there is someone in
the class who knows CPR and can help.
While there is no
way I can deal with all emergencies here, there are a few that
are more likely to occur in the classroom setting. Those include
- Anxiety attacks
- Respiratory difficulties
- Loss of consciousness
- Diabetic reaction
- Heart attack
Attacks are more commonly
known as panic attacks. There are many misconceptions about anxiety
attacks. The most common misconception is that it is all
in your head. A person suffering from a panic attack is
experiencing very real physical symptoms which can lead to serious
consequences. As in all emergencies, what the person is feeling
is most important and should not be taken lightly. Many people
having panic attacks think they are having a heart attack. Symptoms
are very similar and it takes a trained medical provider to diagnose
the difference. As a lay person, you need to assume the worse
and react as you would for any other emergency.
Lightheadedness or dizziness
Nausea or stomach problems
Flushes or chills
Shortness of breath or a feeling of smothering or choking
Tingling or numbness
Shaking or trembling
Feelings of unreality
Send a student
to the nearest phone to call for emergency assistance.
You cannot know for sure that the person isnt
having a heart attack, so the EMS needs to be activated.
Make sure the student has the following information
location and directions to find you
number for further contact if needed
- What is
what is the person experiencing and
what if anything, has been done.
sending another student to a designated spot at the
entrance of the campus or building to guide the emergency
team to you.
Are they breathing?
If so, they are may be hyperventilating; breathing rapid and
shallow. This will exacerbate their symptoms of dizziness,
numbness/tingling and chest pain.
Place them in a position of comfort :
having difficulty breathing feel better sitting up. Try having
them sit on the floor with their back against the wall. Allow
them to position themselves the way that is most comfortable
Talk to them.
Talk to them
firmly, calmly, loud enough to be heard. Talk them into
breathing slower and deeper. You will need to talk them
through the steps over and over, possibly demonstrating
the breathing with them to help them focus. Try the following:
- Breathe slowly
through your nose to the count of 4
- Exhale through
your mouth to the count of 4.
- Repeat over
and over, Always breathing through your nose, slowly,
until breathing returns to normal.
Help them try
to focus on things outside of themselves. Internal focusing
pumps them up. Attempt to have them
- Listen to
what other people are saying
- Focus on things
in the room around them
- Count backwards
from 100 by 3
- Engage them
in conversation with you
- Imagine themself
in some pleasant place
the class if you cant find a quiet place to isolate
them. The embarrassment of others crowding around and watching
may make symptoms worse.
Even if they
appear better, do not leave them alone until trained help
arrives to take over their care. Continue to observe their
breathing and color, occasionally encouraging and reassuring
most likely problem to occur is an asthma attack. Many variables
can affect people with respiratory sensitivities and stress is definitely
one of them. A student who is anxious about an exam or impending
oral presentation may be more easily triggered into an asthmatic
episode. If not controlled immediately, asthma attacks can lead
to serious complications and even death.
Symptoms of an asthma attack:
Difficulty in breathing.
shallow and noisy breaths.
lips / skin
What to do:
How severe is their
breathing difficulty? How is their color-are they pale, white,
or blue around the mouth? This is the first place you will notice
a change in color if a person is not getting enough oxygen.
Place them in a position of comfort
They will be most
comfortable sitting up, possibly leaning slightly forward. Never
force a person having difficulty breathing to lie down. The
pressure of internal organs on the diaphragm make breathing
more difficult in this position.
Talk to them
Talk to them firmly,
Instruct them to
breath slowly, deeply as possible, and breath out slowly through
pursed lips (as if they are whistling, or blowing out a candle).
Ask if this has
ever happened before.
Call for help
If this is a first attack, or if the person does not
have an inhaler, call immediately for emergency help.
Use their inhaler
Most patients with
asthma carry an inhaler. Ask if they have an inhaler, help them
get it and encourage them to use it as soon as possible. They
should take 4 puffs initially. If after 10 minutes their condition
hasnt improved, have them take another 4 puffs and call
for emergency help.
Symptoms of a seizure
A seizure is characterized by uncontrolled jerking or thrashing
movements. Some people have an aura which is a warning
sign that a seizure may occur. Even though they may have this
warning, due to embarrassment, they may not alert you that a seizure
is going to occur. Others have no warning before the event.
What to do:
- The main focus
is to protect from falls and from head injury.
- If they give
you a warning that a seizure is going to occur, help them
lie down in an open area of the floor away from obstacles.
- If they are sitting
in a desk or at a table when the seizure occurs, assist them
to the floor while protecting their head and clear the area.
You may need someone else to help you move them.
Position for safety
- Leave them lying
on the floor, on their side. Lying on their side will allow
for drainage of secretions/emesis and prevent choking.
- Protect their
head: Clear the area of chair legs, table legs or other sharp
- If something
soft is available such as a small folded blanket, you may
place it under their head. Do not use anything with sharp
objects such as zippers or large snaps.
attempt to restrain the person in any way
put anything in the persons mouth
Protect their privacy
patients are frequently embarrassed after they come to.
seizure patients become incontinent during the seizure, which will
add to the embarrassment. It is a good idea to clear the classroom
except for essential help needed.
Sometimes breathing may
stop temporarily during a seizure, but it usually resumes without
assistance. The best way to keep the airway clear is to keep them
on their side.
If they still are not
breathing after the seizure stops, then follow the general rules
for CPR and airway management.
Some patients will be groggy
and not totally alert after a seizure. Stay with them, talk to them
calmly, and monitor their breathing until help arrives.
Loss of consciousness can happen for many reasons, but the most
common cause is usually fainting due to low blood sugar (hypoglycemia),
dehydration, or severe emotional stress.
What to do
- Are they breathing?
If not, follow the ABCs of CPR
- Are they responsive
to your questions? Most people who faint will come to
Call for help
- If they are not
alert, place them on the floor, lying on their side, with
the upper leg bent at the knee. This will facilitate drainage
of fluids from the mouth.
- If they regain
consciousness, allow them to assume the position that is most
comfortable for them. Do insist that they remain at rest until
they can be assessed by medical personnel.
- Provide good
air circulation. Remove onlooker crowds from the
area. Open a window, door, or provide a fan. Loosen restrictive
clothing from around the neck (ie-buttoned shirt color, necktie).
- Applying a cool,
moist cloth to face, neck, and head is soothing and sometimes
helps increase alertness.
Talk to them
calmly and try to get more information.
- What happened?
- What are they
- Has this happened
- If it has happened
before, what caused it? What helped?
- Are they taking
- Did they forget
to take their medication?
- Are they allergic
- When did they
eat last, and what?
them anything to eat or drink until they have been cleared by medical
personnel, unless they are diabetic. If the person is diabetic,
are two types of abnormal diabetic reactions; hypoglycemia (low
blood sugar) and hyperglycemia (high blood sugar). Either one can
cause a person to change behavior or exhibit an altered level of
consciousness, though hypoglycemia is probably more common.
Hypoglycemia occurs when the diabetic patient
Takes too much insulin or oral diabetic medication
Forgets to eat or doesnt eat enough after taking their medication
Exerts more energy than usual. Energy exerted may be physical
activity or emotional.
Symptoms of hypoglycemia
Weak, shaky, trembling
Cold, clammy, diaphoretic (sweaty)
Change in behavior
An easy way to remember
the symptoms is to memorize cold and clammy, need some candy.
What to do
Look for the signs
Are they unconscious, or unable to talk? If so, call
for help immediately. They need an injection of dextrose
(sugar) or glucagon, which requires medical personnel.
If they are still able to talk, ask them if they are diabetic.
- Did they take
- Did they take
other diabetic medication today?
- Did they eat
like they were supposed to?
If the diabetic
is able to swallow, they need sugar in their system. Need
some candy is actually incorrect. What they need is complex
carbohydrates, such as milk or bread. However, those things
are not usually readily available in a classroom. In a pinch,
anything with sugar will do to help them temporarily. Soda,
juice, candy are more likely to be available from another student
or a nearby vending machine. Remember, diet soda has no sugar
and will not help.
If they dont feel better within 10-15 minutes, give them
more sugar. Watch for difficulty breathing or decreased consciousness.
If these occur, call
for help immediately.
Hyperglycemia occurs when
A diabetic patient fails to take their insulin or oral diabetic
A diabetic patient eats too much, or the wrong foods
A diabetic patient experiences severe stress, trauma, or infection.
A diabetic patient has too little or no exercise
Symptoms of hyperglycemia
Hot, flushed, dry skin
Frequent urination in large amounts
Changes in behavior
May have fruity, acidic odor to breath (sometimes mistaken for
easy way to remember the symptoms is to memorize hot and dry,
What to do
Look for the above
Assess their breathing and respond accordingly.
Are they responsive? If so, ask if they have insulin with them
and allow them to administer the insulin if able. If not, wait
for someone trained in administration of insulin. They need
to follow up with medical personnel to determine the reason
behind the hyperglycemia and to manage the symptoms/causes.
heart attack will never happen in your classroom, but it can happen
anywhere, and stress can definitely be a predisposing factor, which
increases the chances of a heart attack occurring in a college classroom.
Symptoms/warning signs of a heart attack
Chest discomfort. Most heart attacks involve discomfort in
the center of the chest that lasts more than a few minutes, or
that goes away and comes back. It can feel like uncomfortable
pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can
include pain or discomfort in one or both arms, the back, neck,
jaw or stomach.
Shortness of breath. This feeling often comes along with
chest discomfort. But it can occur before the chest discomfort.
Other signs: These may include breaking out in a cold sweat,
nausea or lightheadedness.
you can see, these symptoms are similar to panic attacks. All symptoms
must be treated as an emergency until diagnosis is made by a medical
What to do
Call for help
As mentioned earlier,
it is a very good idea to know CPR. If you do not, call out
to the class and ask for anyone who knows CPR to come forward
Place the patient
flat on the floor, face up.
. Open the airway with a head-tilt chin-lift or jaw-thrust maneuver
LOOK-LISTEN-&-FEEL for breaths. CHECK BREATHING FOR 5-10
If they aren't breathing VENTILATE TWICE. Remember to cover
nose and mouth to make a good seal.
C-Circulation: Check for a pulse by palpating (feeling)
the carotid artery (in the neck, right below the jaw). CHECK
THE PULSE FOR 10 SECONDS.
If there is no pulse
BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS.
Recheck the pulse after ONE MINUTE
CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO
**It is a good idea to carry a pocket mask with
you, or have one in the classroom. Inexpensive, disposable,
keychain size masks are available.
you will never need any of these resources in your classroom. Being
prepared is the first step. Remember, stay calm, call for help, and
prevent injury whenever possible.