JEFFERSON TOWNSHIP PUBLIC SCHOOLS AUTHORIZATION OF EMERGENCY TREATMENT (All Areas Must Be Completed) ________________________________________ is allergic to: ______________________ Allergic Reaction Risk Level: _____ Low _____ Moderate _____ High If you suspect that a food allergen has been ingested (or insect sting), immediately determine the symptoms and treat the reaction as follows:
Symptoms: Give Medication checked “X” Mouth Itching, tingling, or swelling of lips, tongue, mouth Benadryl Epinephrine Skin Hives, swelling on face or extremities, itchy rash Benadryl Epinephrine Gut Nausea, abdominal cramps, vomiting, diarrhea Benadryl Epinephrine Throat Tightening of throat, hoarseness, hacking cough Benadryl Epinephrine Lung Shortness of breath, repetitive coughing, wheezing Benadryl Epinephrine Heart Thready pulse, passing out, fainting, pale, blueness Benadryl Epinephrine General: Panic, sudden fatigue, chills, fear of impending doom Benadryl Epinephrine If a food allergen has been ingested, but no symptoms: x Benadryl Epinephrine Other_________ If a reaction is progressing (several of the above areas affected) x Benadryl x Epinephrine Medication Dosages: Nurses Only Antihistamine: (liquid diphenhydramine, Benadryl™): Give __________________________ Teaspoon(s) _______cc (_______mg) by mouth. NURSE OR DELEGATE: Epinephrine: EpiPen™: Epi-Pen ______ Epi-Pen Jr. _____ (______mg) injected once into upper outer thigh Epinephrine injection many need to be repeated if the child’s symptoms persist or get worse. Call 911 and phone number: ________________________________ State that the child had a severe allergic reaction, and additional epinephrine doses may be needed. Additional contact information: Nearest Hospital: Name: ______________________________ Phone: ______________ Address: _________________ Allergist Name: _____________________________ Phone: _________________________ Pediatrician Name: __________________________ Phone: __________________________ Parent’s Name (other contacts) and Contact Numbers: Name: _________________________________________ Phone (1) ___________________________________ Phone (2) _______________________ Name: _________________________________________ Phone (1)_____________________________________Phone (2) Other allergies, medication allergies, medical conditions: _______ Approximate Weight ____lbs. DO NOT HESITATE TO ADMINISTER MEDICATION OR TAKE THE CHILD TO A MEDICAL FACILITY EVEN IF THE PARENTS CANNOT BE REACHED! This student may _____ may not _____ self-administer epinephrine auto injector. Medication Located: _____ Nurse’s Office ______Classroom _____With Student_____Other (Specify)
______________________ __________________ ____ ________________ Physician’s Printed Name Physician’s Signature Date Parent’s Signature TRAINED DELEGATE _________________________________ Room #________________ JGK-2010
"Effective Protection" in Australian Law by David Bitel* This article was originally published as part of ‘UNHCR Discussion Paper: The principle of effective protection elsewhere,’ in Newsletter No 1/2004 of the United Nations High Commissioner for Refugees Regional Office for Australia, New Zealand, Papua New Guinea and the South Pacific. In the lead-up to the Octobe
Abuse of Substances (Alcohol, Drugs, Smoking) This Policy addresses the following categories of substance: b) Prescribed/over the counter medicines c) Solvents d) High caffeine based products and stimulants e) Smoking At Bruton School for Girls we abhor the misuse of substances, and their illegal supply. The School is committed to the Health and Safety of its pupils, and will take
JEFFERSON TOWNSHIP