216 R.I. Code R. 216-RICR-20-10-4.21

Current through December 26, 2024

Section 216-RICR-20-10-4.21 - First Aid and Emergencies

A. Each school must have written protocols and standing orders available in the event of injuries and acute illnesses, including anaphylaxis and cardiac arrest.

B. Protocols and standing orders must be prepared, dated, signed, reviewed and updated, as appropriate, but at least on an annual basis by the school physician(s).

C. Protocols must also be reviewed annually by all school personnel designated by the school principal (or other designated school authority), who might be involved in managing an emergency in a school, including anaphylaxis, prior to the arrival of more fully trained persons.

D. No requirement in this Part shall be construed as prohibiting the issuance of a standing order by a school physician for the administration of an epinephrine auto-injector by a school nurse to a student who has not been previously medically identified for the prevention or treatment of anaphylaxis. This standing order must be reviewed in accordance with § 4.21(B) of this Part.

4.21.1Basic First Aid Training

A. In-service basic first aid training must be provided for school personnel who might be involved in managing an injury or other medical emergency.

B. Personnel must be identified by the school principal, or other designated school authority, and listed in the emergency protocol described in §§ 4.21(B) through (D) of this Part.

C. First aid subjects to be covered must include, but not be limited to: control of major bleeding, use of universal/standard precautions, management of ocular trauma and emergencies, management of burns, diabetes-related signs and symptoms, accessing the "911" emergency medical system, proper application and removal of disposable gloves and equipment, and movement and transportation of an injured person.

D. No less than one (1) hour of basic first aid training or current certification for the allotted term of said certification in basic first aid by a nationally recognized organization shall be required of school personnel designated by the school administrator during every school year.

E. The school principal, or other authorized school personnel, must maintain a record-keeping system documenting that the basic first aid training (as required under § 4.21.1(D) of this Part) has been provided to all designated school personnel.

F. The training must be delivered by a school nurse, or other designated instructor, utilizing a training curriculum that adheres to standards established by a nationally-recognized body.

G. Students engaged in potentially hazardous tasks (including, but not limited to, activities during normal school hours in science laboratories, industrial arts, physical education, and family/consumer science classes) should be directly supervised by teachers or instructors who are trained in the administration of basic first aid, and who have posted and discussed safety rules with the students.

4.21.2Cardiopulmonary Resuscitation Training

A. At all times, during normal school hours and at on-site school-sponsored activities, each school must have available at least one (1) person other than the school nurse who is trained, competent and responsible for the administration of basic first aid, child/adult cardiopulmonary resuscitation (CPR), including emergency procedures for obstructed airways (choking) and drowning, and administration of the epinephrine auto-injector.

B. Requirements for automated external defibrillators (AEDs) in high schools and middle schools are pursuant to R.I. Gen Laws § 16.21-33.1(b).

4.21.3Anaphylaxis Training

Training must be provided for school personnel who might administer an epinephrine auto-injector in a case of anaphylaxis. Subjects to be covered must include, but not be limited to,: signs and symptoms of anaphylactic shock, proper epinephrine auto-injector administration, adverse reactions, accessing the "911" emergency medical system, and preparation for movement and transport of the student.

4.21.4Response to and Treatment for Anaphylaxis

A. To prevent or treat a case of anaphylaxis (as defined in § 4.3(A)(2) of this Part), the school nurse or trained school personnel must administer the epinephrine auto-injector to an identified student. School nurses must administer the epinephrine auto-injector in accordance with standard nursing practice.

B. In the event of a suspected case of anaphylaxis, school personnel may administer the emergency protocol, including an epinephrine auto-injector to a medically identified student when authorized by a parent/guardian and when ordered by a physician or other licensed prescriber.

C. School health programs must develop and adopt a procedure for addressing incidents of anaphylaxis and the use of the epinephrine auto-injector on previously medically identified students. Such procedures must pertain to no less than the requirements described in this Part and must include the following:

1. Parents must provide a physician's or other licensed prescriber's order, parent authorization, and filled prescription(s) such as, the epinephrine auto-injector(s)) notifying the school of the student's allergy and the need to administer the epinephrine auto-injector in a case of anaphylaxis.

2. School administrators must communicate the required medical information from the parent to the appropriate school personnel, including the school nurse, teachers, food service workers, and school bus drivers and bus monitors.

3. The school physician must review these procedures on an annual basis.

4. Such procedures must stipulate that the epinephrine auto-injector be used only on the student for whom it was prescribed, in accordance with the provisions of R.I. Gen. Laws Chapter 21-28.2.

5. Such procedures must provide for the development of an individualized emergency care plan for a student at risk for anaphylaxis.

6. Procedures for accessing the community's emergency medical system, also known as, "911".

D. Students who are treated for anaphylaxis at the school must be transported by a licensed ambulance/rescue service promptly to an acute care hospital for medical evaluation and follow-up.

E. If appropriate, a student identified as being at risk for anaphylaxis should carry the epinephrine auto-injector at all times. If this is not appropriate, the epinephrine auto-injector must, if necessary for the student's safety, as determined by the physician, or other licensed prescriber, be available in the classroom, cafeteria, physical education facility, health room and/or other areas where the epinephrine auto-injector is most likely to be used. Reasonable provisions must be made for the availability, safekeeping and security of the epinephrine auto-injector. The school must develop protocols and procedures related to the availability, safekeeping and security of the epinephrine autoinjector.

F. School personnel who have been trained in accordance with §§ 4.21.1, 4.21.2, and/or 4.21.3 of this Part are authorized to administer the epinephrine autoinjector to an identified student. If trained school personnel are not available, any willing person may administer the epinephrine auto-injector to a medically identified student. None of the requirements of this Part shall preclude the self administration of an epinephrine auto-injector by a medically identified student.

G. In accordance with R. I. Gen Laws § 16-21-22(e), school districts may permit schools to maintain epinephrine auto-injectors for emergency first aid to students who experience allergic reactions.

4.21.5Good Samaritan Provisions

School personnel who voluntarily assist persons suffering from anaphylaxis are immune from liability for ordinary negligence in accordance with R.I. Gen Laws §§ 9-1-27.1 and 16-21-22(d).

4.21.6Food Allergy Management

A. Schools that have students with peanut/tree nut allergies are required to post a notice in accordance with R.I. Gen Laws § 16-21-31.

B. In all public and non-public elementary, middle or junior high schools, the school authority shall develop a policy designed to provide a safe environment for students with peanut/tree nut allergies pursuant to R.I. Gen Laws § 16-21-32.

C. Students with peanut/tree nut allergies, must have an IHCP and EHCP developed in accordance with R.I. Gen Laws § 16-21-32 prior to entry into school or immediately thereafter for students diagnosed with an allergy.

D. In addition to the requirements of R.I. Gen Laws § 16-21-32, the IHCP and EHCP must be part of the student's permanent record, include both preventative measures to help avoid accidental exposure to allergens, and emergency measures in case of exposure. Additional measures shall include:

1. Educating school personnel, students, and families about food allergies; and,

2. Implementing protocols around cleaning surfaces touched by food products, washing of hands after eating, etc.

E. The EHCP must be consistent with applicable provisions contained in this Part, including, but not limited to, training, communication, plan review, Good Samaritan protections in accordance with R.I. Gen Laws § 9-1-27.1, and followup and documentation.

F. All school personnel who may be involved in the care of a student who has been diagnosed with a peanut/tree nut allergy must be informed of the IHCP and the EHCP, as appropriate.

4.21.7Follow-up && Documentation Requirements

A. Following a traumatic injury, an episode of anaphylaxis, or other emergency, a written report must be completed and filed in the student health record and verbal notification made to the student's parents as soon as possible by the school principal or designee.

B. Following a minor injury, the school nurse, or other appropriate school authority, must make a notation of the minor injury in a log book maintained by the school specifically for this purpose. At a minimum, the following items must be noted:

1. Date and time of injury;

2. Location where injury occurred;

3. Chief complaint;

4. Treatment administered;

5. Disposition (e.g., back to class);

6. Signature of responder.

C. For each student, emergency information must be documented and updated on an annual basis. Such emergency information must include no less than the following:

1. Name and telephone number of the student's parent and additional contact person(s) in the event of an emergency;

2. Name and telephone number of the student's primary care provider;

3. Health insurance (optional);

4. Known allergies (including drug, food, insect bite and chemical allergies);

5. Medical conditions that may need attention, such as, past surgeries, heart problems, seizure disorders, nosebleeds, or diabetes;

6. Current, routine prescription medications and authorized OTC medications.

D. Protocols or procedures shall be developed to require an individualized emergency care plan for a student at risk for anaphylaxis, asthmatic conditions and/or any other medical emergencies, as defined in § 4.3 of this Part.

4.21.8Concussions/Head Injuries in Recreational and/or Athletic Competition

A. A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game related to recreational and/or athletic competition must be removed from that practice or competition at that time.

B. A youth athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed physician and until the athlete receives written clearance to return to play from that licensed physician.

C. A report of a concussion or head injury and written clearance to return to play should be logged in the student's health record.

D. All coaches, trainers and volunteers involved in youth recreational and/or athletic competition must complete a training course, and a refresher course annually thereafter, in concussions and traumatic brain injuries.

E. All school nurses must complete a training course and an annual refresher course in concussions and traumatic brain injuries.

F. School districts and schools are required to use training materials of the US Center for Disease Control and Prevention entitled "Heads Up: Concussion in High School Sports/Concussion in Youth Sports" or materials substantially equivalent.

4.21.9Opioid-related Drug Overdose in School Settings

A. All public and private elementary, middle, junior, and high schools must develop policies and procedures for the provision and maintenance of a supply of opioid antagonists (Naloxone) in the school setting to treat suspected opioid overdose in accordance with R.I. Gen. Laws. § 16-21-35.

1. School nurses and other school personnel are immune from liability for ordinary negligence for acts or omissions relating to the use of the opioid antagonist in accordance with R.I. Gen. Laws § 16-21-35.

216 R.I. Code R. 216-RICR-20-10-4.21

Amended effective 4/11/2022