POLICY SUPPORTING STUDENTS WITH PREVALENT MEDICAL/ HEALTH CONDITIONS … · 2018-03-01 · 1.0 It is the policy of the Board to support students with prevalent medical/health conditions

Administered By: Learning Support Services

Amendment Date(s):

POLICY

Title: SUPPORTING STUDENTS Policy No.:

WITH PREVALENT MEDICAL/ Effective Date: HEALTH CONDITIONS IN SCHOOLS

Department: Learning Support Services Reference(s): - Authorization for Administration of Prescription Medications - Individual Student Log of Prescription Medication Administration - Individual Plan of Care - Ministry of Education Policy/Program Memorandum No. 81 - Ministry of Education Policy/Program Memorandum No. 149 - Ministry of Education Policy/Program Memorandum No. 161 - Ministry of Education Memorandum, April 1995 and May 2003 re: “Anaphylaxis in the School Setting” - Education Act Section 265 – Duties of Principal - Education Act Reg. 298 S.20 – Duties of Teachers - Ministry of Health, Regulation Health Professions Act, 1991 - Bill 3 – Sabrina’s Law – An Act to Protect Anaphylactic Pupils, 2006 - Ryan’s Law (Ensuring Asthma Friendly Schools), 2015 - Epilepsy Southwestern Ontario - Ontario Lung Association

1.0 It is the policy of the Board to support students with prevalent medical/health

conditions in all Thames Valley District School Board schools and off-site programs.

2.0 Students with special medical/health needs will be maintained in their neighbourhood

school whenever possible; however, when assistance or coping with special needs becomes a primary requirement, students should be supported in appropriate facilities strategically located within our board to address their individual needs.

2.1 Students with prevalent medical conditions should be enabled to

participate in school to their full potential as outlined in their Individual Plan of Care and that daily routine management activities are performed in such a way as to promote inclusion in a safe, accepting and healthy learning environment that supports well-being.

2.2 Students should be empowered as confident and capable learners, to

reach their full potential for self-management of their medical condition, according to their Individual Plan of Care.

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Replacing #4019 (Asthma and Students Policy) and #5001 (Medical/Health Support for Students)

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Name of Policy

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3.0 The designation of roles and responsibilities for prevalent medical/health

support services in school settings does not preclude, in emergency situations, the provision of assistance by school board personnel. Staff who provide health support to students under their supervision shall have full coverage under the Thames Valley District Board’s liability provisions.


Amendment Date(s):

PROCEDURE

Title: SUPPORTING STUDENTS WITH Procedure No.: PREVALENT MEDICAL/HEALTH Effective Date: CONDITIONS IN SCHOOLS

Department: Learning Support Services Reference(s): - Authorization for Administration of Prescription Medications - Individual Student Log of Prescription Medication Administration - Individual Plan of Care

- Ministry of Education Policy/Program Memorandum No. 81 (plus Catheterization Addendum)

- Ministry of Education Policy/Program Memorandum No. 149 - Ministry of Education Policy/Program Memorandum No. 161 - Ministry of Education Memorandum, April 1995 and May 2003 re: “Anaphylaxis in the School Setting” - Education Act Section 265 – Duties of Principal - Education Act Reg. 298 S.20 – Duties of Teachers - Ministry of Health, Regulation Health Professions Act, 1991 - Bill 3 – Sabrina’s Law – An Act to Protect Anaphylactic Pupils, 2006 - Ryan’s Law (Ensuring Asthma Friendly Schools), 2015 - Epilepsy Southwestern Ontario - Ontario Lung Association

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Replacing #4019a (Asthma and Students Procedure) and #5001a (Medical/Health Support for Students Procedure)

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Supporting Students With Prevalent Medical/Health Conditions in Schools

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INDEX

1.0 GENERAL GUIDELINES ............................................................................................................................3

2.0 SPECIALIZED HEALTH SUPPORT SERVICES IN SCHOOL SETTINGS ........................................4

2.1 Summary of Services Provided to the School Board (PPM #81) ......................................................4

2.2 School Health Support Services Process for Determining Eligibility for Professional Services ...5

2.3 Eligible for Specialized Health Supports ..............................................................................................6

2.4 Ineligible ....................................................................................................................................................6

2.6 Specialized Health Support Services ....................................................................................................7

3.0 MEDICATION ...............................................................................................................................................9

3.1 Prescription Medication ...........................................................................................................................9

3.2 Pro Re Nata (PRN) Medication .............................................................................................................9

3.3 Non-Prescription Medication ............................................................................................................... 10

4.0 EMERGENCY SITUATIONS ................................................................................................................... 10

5.0 PHYSICAL DISABILITIES ....................................................................................................................... 11

6.0 PREVALENT MEDICAL CONDITIONS (Anaphylaxis, Asthma, Diabetes, Epilepsy) ..................... 11

6.1 Roles and Responsibilities .................................................................................................................. 11

6.2 Individual Plan of Care ......................................................................................................................... 14

6.3 Training ................................................................................................................................................... 15

6.4 Privacy and Confidentiality .................................................................................................................. 15

6.5 Reporting ................................................................................................................................................ 15

6.6 Liability .................................................................................................................................................... 15

7.0 ANAPHYLAXIS ......................................................................................................................................... 16

8.0 ASTHMA .................................................................................................................................................... 21

9.0 DIABETES ................................................................................................................................................. 26

10.0 EPILEPSY .................................................................................................................................................. 32

11.0 FORMS ....................................................................................................................................................... 37


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1.0 GENERAL GUIDELINES It is recognized that in respect of students with special medical/health or physical needs:

The parent/guardian has the primary responsibility to inform school authorities about their child’s medical/health condition(s) and to communicate relevant information. School procedures must be cooperatively developed to address differentiated strategies for the purpose of addressing the student’s needs in a reasonable manner;

Medical/health or physical assistance may be necessary in order for students to take advantage of their right to attend school;

Following an initial review of a student’s unique medical/health needs, the principal shall consult with the appropriate Learning Coordinator; (e.g., Special Education) and if necessary the Superintendent of Student Achievement, to discuss options to best address the student’s needs;

Arrangements for the provision of health care services to school aged children is a shared responsibility of the Ministries of Children and Youth Services, Community and Social Services and Health and Long-Term Care. The primary responsibility for provision of the required health care services remains with the parent/guardian and health professionals;

Procedures related to health care needs of individual students will adhere to the physician’s prescribed care plans and relevant legislation and policies; Whenever feasible and authorized, the student or the student’s parent/guardian may accept the responsibility of performing the health care service, if required during school hours;

Where the student or the student’s parent/guardian cannot perform required health care service and where the parent/guardian so requests, the health care service is to be requested in accordance with the Provision of Health Support Services in school Settings, (Ministry of Education Policy/Program Memorandum No. 81.) See Section 2.0;

In responding to such circumstances, the principal or other staff performing such health care services, on a voluntary or emergency basis, is acting according to the principle of “in loco parentis” and not as a health professional; Failure to act as a prudent parent/guardian when a student is in distress, could result in legal liability for the harm that flows from failure to act. Staff who provide health care services to students under their supervision shall have coverage under the Thames Valley District School Board’s liability provisions. The Thames Valley District School Board shall not require any staff member to


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provide health care services to any student that might in any way endanger the safety of the student or subject the staff member to risk of injury or liability for negligence. With appropriate training, Educational Assistants shall assist with student medication and medical procedures as required, in accordance with Ministry of Education Policy/Program Memorandum No.81 (plus, Catheterization Addendum) and Bill 3 Sabrina’s Law with exception of injections (excluding auto injectors). It shall not be part of the duties and responsibilities of a staff member to examine pupils for communicable conditions or diseases or to diagnose such conditions or diseases.

Staff who volunteer to provide health care services that are “controlled acts” as defined by the Regulated Health Professionals Act (1991) shall be governed by that Act. Health care services which are the subject of this procedure and which are considered to be “controlled acts” by the Regulated health Professions Act (1991) are not considered to be a contravention of that Act (see subsection 29(1)).

All medication, Individual Student Log of Prescription Medication forms and Authorization for Administration of Prescription Medication forms will be stored together in a secure location. It is the obligation of the parent/guardian or student to ensure that information in the student’s file is kept current and includes the medication that the student is taking.

Any deviation from these procedures must have the prior written approval of the

Associate Director of Learning Support Services or designate.

2.0 SPECIALIZED HEALTH SUPPORT SERVICES IN SCHOOL SETTINGS

2.1 Summary of Services Provided to the School Board (PPM #81)

The provision of Health Support Services in school settings is addressed through Policy/Program Memorandum No. 81 (plus Catheterization Addendum). The responsibility for ensuring the provision of health support services is shared among the Ministries of Children and Youth Services, Community and Social Services and Health and Long-Term Care. At the local level, the responsibility is shared by Thames Valley District School Board, the Ministry of Children and Youth Services through the Thames Valley Children’s Centre (TVCC), and the Ministry of Health and Long-Term Care through the Local Health Integration Network (LHIN). The Ministry of Health and Long-Term Care through the LHIN, is responsible for assessing student needs, and for providing such services as injections of medication, sterile catheterization, manual expression of the bladder, stoma care, postural drainage, deep suctioning and tube feeding. The Ministry of


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Children and Youth Services through TVCC is responsible for intensive physiotherapy, occupational therapy and speech language pathology, and for assisting the Thames Valley District School Board in the training and direction of its staff performing certain other support services. The Ministry of Community and Social Services is responsible for ensuring the provision of health support services in children’s residential care and treatment facilities. School Health Support Services are provided to schools throughout Thames Valley District School Board by the following agencies who contract service providers:

The Local Health Integration Network (LHIN);

The Thames Valley Children’s Centre (TVCC).

2.2 School Health Support Services Process for Determining Eligibility for Professional Services

Local Health Integration Network (Nursing Care)

The parent/guardian contacts the principal/designate and requests Care Coordinator Assessment of Eligibility for School Health Services;

Should a parent/guardian contact the LHIN, the Care Coordinator will support the parent/guardian to initiate the Request for Assessment of Eligibility through the principal/designate;

Outside agencies should discuss Request for Eligibility Assessment with the parent/guardian, who in turn, contacts the principal/designate;

The school obtains the release of information consent and has it signed by the parent/guardian. This allows the school to release information to the LHIN that may assist in determining eligibility (e.g. reports on investigations/interventions from other agencies);

The school will then contact the LHIN Care Coordinator with a verbal Request for Assessment of Eligibility. The school then forwards the consent to the LHIN;

The Care Coordinator will call the designated school personnel and complete the eligibility assessment with said contact and the parent/guardian.

Thames Valley Children’s Centre (Occupational Therapy, Physiotherapy, Speech and Language Therapy)


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The parent/guardian contacts the principal/designate and requests an

Assessment of Eligibility for School Health Services ;

Should a parent/guardian contact the TVCC, the parent/guardian will be supported to initiate the Request for Assessment of Eligibility through the principal/designate;

Outside agencies should discuss Request for Eligibility Assessment with the parent/guardian, who in turn, contacts the principal/designate;

The school obtains the release of information consent and has it signed by the parent/guardian. This allows the school to release information to TVCC that may assist in determining eligibility (e.g. reports on investigations/interventions from other agencies);

The school will support and submit the referral package including parent/guardian consent and authorization to share information;

In the case of referrals for speech therapy the referral process is initiated by the school board Speech-Language Pathologist in consultation with the parent/guardian.

2.3 Eligible for Specialized Health Supports

Upon completion of the referral, the school personnel must have the referral signed and dated by the principal;

Referrals for speech therapy services must be signed by the Thames Valley District School Board Speech–Language Pathologist;

Completed referral packages are forwarded to TVCC;

2.4 Ineligible

For students deemed ineligible, TVCC will contact the school and inform the principal/designate and outline the reasons for ineligibility;

TVCC will contact the parent/guardian to inform them that the student is not eligible for service;

TVCC may provide additional information of possible alternative (non TVCC) services/resources;

A conflict resolution process is available for differences of opinion regarding eligibility. The parent/guardian may contact TVCC to inquire as to the appeal process.


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2.6 Specialized Health Support Services

Specialized Health Support Services

Agency or position of person who performs

the service (e.g., LHIN, TVCC, Board

staff, parent/guardian, student)

Eligibility criteria for students to receive

the service

Position of person who determines

eligibility to receive the service and the

level of support.

Criteria for

determining when the service is no longer

required.

Procedures for resolving

disputes about eligibility (If available)

Nursing

LHIN contracted service provider

As determined by LHIN Care Coordinator

LHIN Care Coordinator

As determined by LHIN Care Coordinator and service provider

Consultation with the principal and LHIN Care Coordinator Consultation between LHIN Care Coordinator or TVCC Clinical Coordinntor and School Principal

Occupational Therapy

TVCC contracted service provider, programming carried out by TVDSB staff, parent/guardian, student

As determined by TVCC

TVCC Intake Coordinator/TVCC Clinical Coordinator

As determined by TVCC and service provider

Consultation with the principal and TVCC Manager

Physiotherapy

TVCC contracted service provider, programming carried out by TVDSB staff, parent/guardian, student

As determined by TVCC

TVCC Intake Coordinator/TVCC Clinical Coordinator



Nutrition

LHIN


LHIN Care Coordinator LHIN Care Coordinator and service provider

Consultation with the principal and LHIN Care Coordinator

Speech and language

therapy (TVCC)

TVCC contracted service provider

As determined by TVDSB SLPs in consultation with TVCC (Speech Disorders)

Board SLP/TVSS-eligibility TVCC-level of support



Speech and

language intervention (school

board)

TVDSB SLPs

As determined by Speech and Language Services (Language and Speech Disorders that affect academics)

Board SLP

When student no longer has moderate/severe speech and/or language disorder or can be maintained by classroom teacher

TVDSB SLP in consultation with the principal, teacher and parent/guardian


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Agency or position of person who performs

the service (e.g., CCAC, Board staff,

parent/guardian, student)

Eligibility criteria for students to

receive the service

Position of person who determines

eligibility to receive the service and the

level of support.

Criteria for

determining when the service is no longer required.

Procedures for resolving disputes about eligibility (If

available)

Administering of

prescribed medications

TVDSB staff, the parent/guardian, student, LHIN contracted service provider

LHIN Care Coordinator, physician’s prescription


Physician, LHIN Care Coordinator and service provider


Catheterization

TVDSB staff-clean intermittent LHIN contracted service provider-sterile intermittent





Suctioning

TVDSB staff-shallow surface suctioning LHIN contracted service provider-deep suctioning





Lifting and positioning

TVDSB staff

TVCC service provider provides consultation at parent/guardian or principal request

TVDSB staff, TVCC Care Coordinator

TVDSB staff, TVCC service provider


Assistance with mobility

TVDSB staff


TVDSB staff, TVCC

TVDSB staff, TVCC service provider


Feeding

TVDSB staff, LHIN contracted service provider (enteral feeds)

TVDSB staff, LHIN Care Cordinator, parent/guardian

The principal, LHIN Care Coordinator

TVDSB staff, and LHIN service provider


Toileting

TVDSB staff


The principal, TVCC

TVDSB staff and TVCC service provider



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3.0 MEDICATION

The following defines the parameters within which medication is provided to students:

3.1 Prescription Medication

Prescription medication, within the limits of this procedure, is any prescription medication prescribed by a physician. In exceptional cases in which a student must have medication administered during school hours, the principal will arrange to have the medication administered at school with the following procedures:

An Authorization for Administration of Prescription Medication form will be

completed by the parent/guardian and the physician, and be forwarded to the principal prior to the administering of any prescription medication;

For each school year and whenever a modification of the prescribed medication is directed by the physician, a new Authorization for Administration of Prescription Medication will be completed by the parent/guardian and the physician, and be forwarded to the principal;

All authorization and log forms will remain on file one year beyond the

end of the school year to which the record pertains.

3.1.2 Medical Cannabis

The smoking and vaping of medical cannabis is prohibited on school premises and at school activities. Students will continue to be able to use medical cannabis on school premises, and at school related activities in a non-smoking and non-vaping manner, when prescribed by a physician.

3.2 Pro Re Nata (PRN) Medication

Prescription medication that is to be administered to students on an “as needed” (PRN) basis must be documented in the Individual Plan of Care in addition to an Authorization for Administration of Prescription Medication form completed by the parent/guardian and the physician.

3.2.1 The physician’s written instruction must include the following information:

Identification of specific symptoms experienced by the student that would necessitate the administration of the PRN medication;


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Specification of the frequency of doses or the time interval before a repeat dose of the medication is administered.

3.2.2 Before a PRN medication is administered to a student, designated staff

must validate when the medication was last given to determine that the administration time complies with authorized frequency of administration. This determination may be accomplished by taking one or all of the following actions:

Referring to the Individual Student Log of Prescription Medication

Administration for documentation of the time the last dose was administered;

Noting the time of the request and validating that the student has been in attendance at school for the length of time of the authorized frequency for PRN medication administration;

Calling the parent/guardian to validate when the medication was last given at home when the student has been in attendance at school less than the length of time of the authorized frequency for the administration of the PRN medication;

Before administering PRN medications, the staff member must validate the symptoms being experienced by the student as the symptoms identified by prescribing physician in allowing for the administration of the medication;

When a PRN medication is administered, the information recorded on the Individual Student Log of Prescription Medication Administration includes the symptoms for which the PRN medication was administered.

3.3 Non-Prescription Medication

Non-prescription medications are beyond the scope of this procedure and are not to be administered by school staff.

4.0 EMERGENCY SITUATIONS

In emergency situations, a staff member’s duty is to use reasonable care and judgement. If it appears that the illness or injury may be such as to require emergency treatment, a safe procedure is to arrange to have the student taken immediately by ambulance to a hospital. Staff should not drive students to meet the ambulance “en route”. The parent/guardian must be contacted as soon as possible.


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While ambulance personnel assume charge of the situation once they arrive, it is often helpful if a student being transported to hospital in the ambulance is accompanied by a staff member. The individual calling for the ambulance should indicate the location of the access door to the area where the student in distress is located. The student should not be moved.

A staff member should be assigned to meet the ambulance and bring ambulance personnel to the location of the student in distress. A copy of the Individual Plan of Care should be given to ambulance staff. This information, in particular situations, could also be given to the dispatch staff over the phone in advance of arrival of the ambulance.

The principal will establish a protocol within the school to access emergency services. When an emergency call is placed from another location, the main office must always be notified; office staff will advise the principal/designate.

5.0 PHYSICAL DISABILITIES

In circumstances where students with physical disabilities require lifting and positioning, or assistance with mobility, feeding, or toileting, an educational assistant will provide assistance to students as required. If staff training is required to safely provide this assistance, a referral to TVCC should be made. Appropriate aspects of occupational or physiotherapy treatments are incorporated into the student’s everyday activities. Outside agencies such as Thames Valley Children’s Centre may provide ongoing and/or consultative services.

6.0 PREVALENT MEDICAL CONDITIONS (Anaphylaxis, Asthma, Diabetes, Epilepsy)

The following sections 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7 relate to all prevalent medical conditions:

6.1 Roles and Responsibilities

6.1.1. Parent/Guardian

As primary caregivers of their child, the parent/guardian is expected to be active participants in supporting the management of their child’s prevalent medical condition while the child is in school. At minimum, parent/guardian should: Educate their child about their prevalent medical condition with support

from their child’s health care professional, as needed;

Guide and encourage their child to reach their full potential for self-management and self-advocacy;


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Inform the school of their child’s prevalent medical condition and co-create the Individual Plan of Care for their child with the principal/designate;

Communicate changes to the Individual Plan of Care, such as changes to the status of their child’s prevalent medical condition or changes to their child’s ability to manage their prevalent medical condition, to the principal/designate;

Confirm annually to the principal/designate that their child’s prevalent medical condition is unchanged;

Initiate and participate in meetings to review their child’s Individual Plan of Care;

Supply their child and/or the school with sufficient quantities of medication and supplies in their original, clearly labelled containers, as directed by a health care professional and as outlined in the Individual Plan of Care, and track the expiration dates if they are supplied;

Seek medical advice from a medical doctor, nurse practitioner, or pharmacist, where appropriate.

6.1.2 Students

Depending on their cognitive, emotional, social, and physical stage of development, and their capacity for self-management, students are expected to actively support development and implementation of their Individual Plan of Care. Students should: Take responsibility for advocating for their personal safety and well-

being that is consistent with their cognitive, emotional, social, and physical stage of development and their capacity for self-management;

Participate in the development of their Individual Plan of Care;

Participate in meetings to review their Individual Plan of Care;

Carry out daily or routine self-management of their prevalent medical condition to their full potential, as described in their Individual Plan of Care;

Set goals on an ongoing basis for self-management of their prevalent medical condition, in conjunction with their parent/guardian and health care professional(s);

Communicate with their parent/guardian and school staff if they are facing challenges related to their prevalent medical condition at school;


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Wear medical alert information (e.g., medic alert bracelet which

identifies specific allergens) that they and/or their parent/guardian deem appropriate;

If possible, inform the school staff and/or their peers if a medical incident or a medical emergency occurs.

6.1.3 School Staff

The school staff should follow the Thames Valley District School Board policy and the provisions in their collective agreements related to supporting students with prevalent medical condition in schools. The school staff should: Review the contents of the Individual Plan of Care for any student with

whom they have direct contact;

Participate in training, during the instructional day, on prevalent medical conditions, at a minimum annually, as required by the Thames Valley District School Board;

Share information, with student’s and parent’s/guardian’s permission, as well as written authorization by the principal, on a student’s signs and symptoms with other students, as outlined in the Individual Plan of Care;

Follow the Thames Valley District School Board strategies that reduce the risk of student exposure to triggers or causative agents in classrooms, common school areas, and co-curricular activities, in accordance with the student’s Individual Plan of Care;

Support a student’s daily or routine management, and respond to medical incidents and medical emergencies that occur during school and school related activities, as outlined in the Thames Valley District School Board policy and procedures;

Support inclusion by allowing students with prevalent medical conditions to perform daily or routine management activities in a school location (e.g., classroom), as outlined in their Individual Plan of Care, while being aware of confidentiality and the dignity of the student;

Enable students with prevalent medical conditions to participate in school to their full potential, as outlined in their Individual Plan of Care.

6.1.4 Principal/Designate

In addition to the responsibilities outlined above under “School Staff”, the


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principal/designate should: Clearly communicate to the parent/guardian and appropriate staff the

process for the parent/guardian to notify the school of their child’s prevalent medical condition, as well as the expectation for the parent/guardian to co-create, review, and update an Individual Plan of Care with the principal/designate. This process should be communicated to the parent/guardian, at a minimum: o During the time of registration; o Each year during the first week of school; o When a child is diagnosed and/or returns to school following a

diagnosis;

Co-create, review, or update the Individual Plan of Care for a student with prevalent medical conditions with the parent/guardian, in consultation with the staff (as appropriate) and with the student (as appropriate);

Maintain a file with the Individual Plan of Care and supporting documentation for each student with a prevalent medical condition;

Provide relevant information from the student’s Individual Plan of Care to the staff and others who are identified in the Individual Plan of Care (e.g., food service providers, transportation providers, volunteers, occasional staff who will be in direct contact with the student), including any revisions that are made to the Individual Plan of Care;

Communicate with the parent/guardian in medical emergencies, as outlined in the Individual Plan of Care;

Encourage the identification of staff who can support the daily or routine management needs of students in the school with prevalent medical conditions, while honouring the provisions within their collective agreements.

Consult with the physician, with consent from the parent/guardian for review of Individual Plan of Care, in the event that such a review is required.

6.2 Individual Plan of Care

An Individual Plan of Care is a form that contains individualized information on a student with a prevalent medical condition. The Individual Plan of Care for a student with a prevalent medical condition should be co-created, reviewed, and/or updated by the parent/guardian in consultation with the principal/designate, designated staff (as appropriate), and the student (as


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appropriate), during the first thirty school days of every school year and, as appropriate, during the school year (e.g., when a student has been diagnosed with a prevalent medical condition). The parent/guardian has the authority to designate who is provided access to the Individual Plan of Care. With authorization from the parent/guardian, the principal/designate should share the Individual Plan of Care with the school staff who are in direct contact with students with prevalent medical conditions and, as appropriate, others who are in direct contact with students with prevalent medical conditions (e.g., food service providers, transportation providers, volunteers).

6.3 Training

Annual training for all staff will include the following: Strategies for preventing risk of student exposure to triggers and causative

agents;

Strategies for supporting inclusion and participation in school;

Recognition of symptoms of a medical incident and a medical emergency;

Information on staff supports, in accordance with the Thames Valley District School Board policy and procedure;

Medical incident response and medical emergency response;

Documentation procedures.

6.4 Privacy and Confidentiality

Thames Valley District School Board will follow the Privacy and the Management of Personal Information Procedure(Procedure# 2014b).

6.5 Reporting

Subject to privacy legislation, the Thames Valley District School Board will collect data regularly, including but not limited to, data on the number of students with prevalent medical conditions at their schools.

6.6 Liability

In 2001, the Ontario government passed the Good Samaritan Act to protect individuals from liability with respect to voluntary emergency medical or first-aid services. Subsections 2(1) and (2) of this act state the following with respect to individuals:


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2.(1) Despite the rules of common law, a person described in subsection (2) who voluntarily and without reasonable expectation of compensation or reward provides the services described in that subsection is not liable for damages that result from the person’s negligence in acting or failing to act while providing the services, unless it is established that the damages were caused by the gross negligence of the person.

(2) Subsection (1) applies to, (b) an individual who provides emergency first aid

assistance to a person who is ill, injured or unconscious as a result of an accident or other emergency, if the individual provides the assistance at the immediate scene of the accident or emergency.

6.7 Board The Thames Valley District School Board will provide schools with appropriate

supplies to support safe disposal of medication and medical supplies (e.g. sharps containers).

7.0 ANAPHYLAXIS

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death (Canadian Paediatric Society). Susceptible students may die if exposed to even minute amounts of the substance that triggers their reaction. Immediate treatment in the form of an injection of epinephrine can be life-saving.

7.1 Triggers

Foods: While any food may cause anaphylaxis, peanuts, tree nuts, seafood, cow’s milk, eggs, wheat and soy seem more likely to trigger a reaction in students;

Non-food substances: Insect venom, medications, latex and rarely, vigorous exercise may involve a reaction.

7.2 Signs and Symptoms

The onset of anaphylaxis can begin within seconds of exposure or after several hours. Any combination of the following symptoms may signal the onset of a reaction:

System Signs and symptoms

General/CNS

Fussiness, irritability, drowsiness, lethargy, reduced level of consciousness, somnolence, anxiety, feeling of “impending doom”, headache, uterine cramps, metallic taste in mouth

Skin Hives, swelling, itching, warmth, redness, rash


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(

(Canadian Paediatric Society & Food

Allergy Canada websites)

The interval of time between onset of the first symptoms and death can be as short as a few minutes, if the reaction is not treated. Even when symptoms have subsided after initial treatment, they can return. Schools must recognize, and communicate to the parent/guardian that, in spite of their best efforts, accidents may occur. However, once reasonable precautions have been taken, the staff, parent/guardian or other students should not feel responsible for accidental exposure. If accidental exposure does occur, appropriate emergency procedures must be in place and acted upon immediately.

7.3 Emergency Response

Even when precautions are taken, a student with anaphylaxis may come into contact with an allergen while at school. In such an incident, staff are to follow the instructions within the Individual Plan of Care. Students with anaphylaxis usually know when a reaction is taking place. Staff should be encouraged to listen to the student. If the student complains of any symptoms, which could signal the onset of a reaction, staff should not hesitate to implement the emergency response. There is no danger in reacting too quickly, and grave danger in reacting too slowly. Epinephrine is a relatively harmless drug and is best administered when an allergic reaction is suspected. Emergency Procedure: Every Emergency Procedure on an Individual Plan of Care shall include procedures to:

● Administer the epinephrine auto-injector (NOTE: Although most students with

anaphylaxis learn to administer their own medication by about age eight, individuals of any age may require help during a reaction because of the rapid progression of symptoms, or because of the stress of the situation.);

● Take note of the time;

● Call 911 for an ambulance (inform the emergency operator that the student is having an anaphylactic reaction) ;

Upper/lower airway

Coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness/swelling, hoarse voice, nasal congestion, or hay fever-like symptons (runny nose and watery eyes, sneezing), trouble swallowing

Cardiovascular Pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock, cardiac arrest

Gastrointestinal Nausea, vomiting, diarrhea, abdominal pain


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● Contact the emergency parent/guardian;

● Give a second dose of epinephrine as early as five minutes after the first dose

if there is no improvement in symptoms while waiting for the ambulance. Subsequent doses to be administered under medical supervision;

● The student will be transported to the hospital by ambulance;

Location of Epinephrine Auto-Injectors: Epinephrine auto-injectors should be kept in a covered and secure area, but unlocked for quick access. Although epinephrine is not a dangerous drug, the sharp needle of the self-injector can cause injury, especially if injected into the fingertip. ● As soon as they are old enough, students should carry their own epinephrine

auto-injectors. Many young children carry an injection kit in a fanny pack around their waist at all times;

● The parent/guardian can identify on the Individual Plan of Care if they wish classmates to be aware of the location of the epinephrine auto-injector;

● An up-to-date supply of epinephrine auto-injectors, provided by the parent/guardian, shall be available in an easily accessible, unlocked area of the student’s classroom and/or in a central area of the school (office or staff room). At least two shall be provided by the parent/guardian in case one malfunctions, or additional treatment is necessary.

Note: Epinephrine auto-injectors are covered by OHIP+.

7.4 Field Trips

Field trips are an extension of the learning in the classroom and therefore, it is imperative that they are planned to include all students. The principal must ensure that all appropriate documentation is received in advance of the field trip and that plans are in place to accommodate students with prevalent medical conditions. The parent/guardian is required to complete the Medical or Special Concerns/Information section of the Parent/Guardian Permission Form for Specific School Field. Within this form the parent/guardian will identify allergies, dietary restriction and any other medical or special concerns. Teachers will ensure that this information is available during field trips and that the Individual Plan of Care accompany the student on the field trip. If it is necessary for the student to take prescription medication during the field trip, the parent/guardian and physician must complete the Authorization for Administration of Prescription Medication form. It must be forwarded to the


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principal prior to the administration of medication. If the student currently receives medication during the school day and a copy of this form is on file at the school, it is not necessary to complete another form.

With the permission of the parent/guardian of a student with anaphylaxis, inform all supervisors of the identity of the student with anaphylaxis, the allergens, symptoms and treatment. Ensure that a supervisor with training in the use of the epinephrine auto-injector is assigned responsibility for the student with anaphylaxis. The parent/guardian of the student with anaphylaxis shall provide at least two epinephrine auto-injectors for the trip. If the risk factors are too great to control, the decisions surrounding participation in the trip should be made in consultation with the parent/guardian.

7.5 Information and Awareness

Sharing Information with Other Students and the Parent/Guardian:

Consideration should be given to identifying students suffering life-threatening allergies to all students in the school, and enlisting their co-operation. This should be done in a way that is appropriate to the student’s age and maturity, without creating fear and anxiety, and in consultation with the parent/guardian of individual student with anaphylaxis or with the student themselves;

Identification of students with anaphylaxis to their peers in school settings should not take place without consultation with the student with anaphylaxis;

The risk of teasing or threatening students with anaphylaxis is reduced if classmates are introduced to the situation at a young age. The risk of ignorance is generally judged to be greater than the risks associated with sharing information;

A number of books and audio-visuals are available to help young classmates understand life-threatening allergies without frightening them;

Information may be included in health and family studies classes;

The parent/guardian of students with anaphylaxis, and older students with anaphylaxis, may be excellent resources in information sharing.

Anaphylaxis to Insect Venom: Food is the most common trigger of an anaphylactic reaction in students, and the


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only allergen which schools can reasonably be expected to monitor. The school cannot take responsibility for possible exposure to bees, hornets, wasps and yellow-jackets, but certain precautions can be taken by the student and the school to reduce the risk of exposure. If school personnel are aware of the presence of bees and wasps, especially nesting areas, they should notify the principal and custodian so arrangements can be made for their removal. Be aware that garbage containers can attract insects to student areas. Consult the custodian on prevention and placement of garbage containers.

7.6 Safety Considerations ● Students are allowed to carry their medications (including controlled

substances) and supplies, as outlined in the Individual Plan of Care;

● Schools are to support the storage (according to the item’s recommended

storage conditions) and safe disposal of medication and medical supplies;

● Administrators will ensure that a plan is established to support students with prevalent medical conditions in the event of a school emergency (eg. bomb threats, evacuation, fire, “hold and secure”, “lockdown” or for activities off school property (eg. field trip, sporting event). This process must also include considerations for occasional staff;

Review “Suggestions for Administrators when there are Students with Anaphylaxis in the School” reference located in electronic forms.

7.7 Facilitating and Supporting Routine Management

It is the responsibility of staff with daily contact with students with anaphylaxis to: Have instructions on the use of the epinephrine auto-injector posted in a

clearly visible location in the student’s classroom;

Keep information about the student with anaphylaxis allergies and emergency procedures occasional staff (i.e. teachers, educational assistants) and/ or volunteers.

7.8 Resources

Suggested Reading: http://www.allergyaware.ca/resources/ https://www.healthunit.com/teaching-anaphylaxis

http://www.allergyaware.ca/resources/

https://www.healthunit.com/teaching-anaphylaxis


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http://www.eworkshop.on.ca/edu/anaphylaxis/sc022.cfm?L=1 Educational Materials for Children http://foodallergycanada.ca/resources/resources-for-educators/

8.0 ASTHMA

Asthma is a very common chronic (long-term) lung disease that can make it hard to breathe (Ontario Lung Association). 8.1 Triggers

It is the Thames Valley District Board’s policy to provide a safe environment for students who are susceptible to allergens, but it is not possible to reduce the risk to zero. This is particularly the case with asthma triggers. Students with asthma have sensitive airways that react to triggers. A trigger is something that can make asthma worse, such as, but not limited to: air quality, mold, dust or dust mites, pollen, viral infections, animal and pet dander, smoke, scented products and cold air. Triggers vary widely from individual to individual and are sometimes situation-specific. To the extent possible, school staff will identify and minimize asthma triggers and implement strategies to reduce the risk of exposures in classrooms, common school areas and in planning field trips. Common Outdoor Triggers:

Cold air – susceptible students with asthma may need to use a scarf to cover

their mouth and nose, especially prior to and during physical activity; when outdoor cold temperatures are extreme, a well-ventilated indoor site should be used for physical activity;

Air Quality, Smog – outdoor air quality and smog alerts can be monitored through local news/air quality sites; well-ventilated indoor sites can be chosen for physical activity on days when air quality is poor. www.airhealth.ca;

Pollen, Leaves, Trees – May through August, (or until first frost) grassy or densely treed activity sites should be avoided for physical activity.

Common Indoor Triggers:

Physical activities indoors (e.g., classroom, gymnasium) should be planned to

eliminate or minimize common triggers that may cause asthma symptoms: strong smells (e.g., perfumes, strongly-scented markers or paints, cleaning products) dust, chalk, furry or feathered animals.

Strategies to Assist Schools and Classrooms to Minimize Common Triggers:

If area rugs or carpets are used, choose ones with low nap or ones easily

http://www.eworkshop.on.ca/edu/anaphylaxis/sc022.cfm?L=1

http://foodallergycanada.ca/resources/resources-for-educators/

http://www.airhealth.ca/


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washed. Remove furry or feathered animals (birds, gerbils, mice, etc.). Where possible, use scent-free products.


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Symptoms of asthma are variable and can include but are not limited to the following: coughing, wheezing, difficulty breathing, shortness of breath, chest tightness.


It is an emergency situation if the student: ● Has used a reliever medication and it has not helped within 5-10 minutes; ● Has difficulty speaking or is struggling for breath; ● Appears pale, grey or is sweating; ● Has greyish/blue lips or nail beds; ● Has skin on neck or chest sucked in with each breath. OR You have any doubt about the student’s condition: Emergency Procedure: ● Have the student use, or assist the student in using, fast-acting reliever

inhaler; ● If a staff member has reason to believe that a student is experiencing an

asthma exacerbation, they can administer asthma medication to the student for the treatment of the exacerbation, even if there is no preauthorization to do so;

● Call 911. Notify office. Remain with the student; ● Have the student sit upright or with arms resting on a table or other

support if possible. Continue to give the reliever inhaler every 5 - 10 minutes until the ambulance;

● Contact the parent/guardian as soon as possible; ● Stay calm and reassure the student. Tell the student to breathe slowly

and deeply. Note: Students are transported to hospital by ambulance only.


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8.4 Field Trips Field trips are an extension of the learning in the classroom and therefore, it is imperative that they are planned to include all students. The principal must ensure that all appropriate documentation is received in advance of the field trip and that plans are in place to accommodate students with prevalent medical conditions. The parent/guardian is required to complete the Medical or Special Concerns/Information section of the Parent/Guardian Permission Form for Specific School Field Trip. Within this form parent/guardian will identify allergies, dietary restriction and any other medical or special concerns. Teachers will ensure that this information is available during field trips and that the Individual Plan of Care accompanies the student on the field trip. If it is necessary for the student to take prescription medication during the field trip, the parent/guardian and physician must complete the Authorization for Administration of Prescription Medication form. It must be forwarded to the principal prior to the administration of medication. If the student currently receives medication during the school day and a copy of this form is on file at the school, it is not necessary to complete another form. In addition to the usual safety precautions applying to field trips, the following procedures must be in place to protect the student with asthma:

● Require all supervisors, staff and volunteers to be aware of the identity of the

students with asthma and to remind students to bring their inhalers on the trip;

● The parent/guardian of the student with asthma should provide an inhaler.


“Medication” refers to medications that are prescribed by a health care provider and, by necessity, may be administered to a student, or taken by the student during school hours or school-related activities (for example, rescue inhaler or disc). Medication can minimize or manage the symptoms. When an incident does occur, a reliever (rescue) inhaler can provide quick relief of asthma symptoms by relaxing the muscles around the airways and permitting the person to breathe more easily. The principal must permit a student to carry their asthma medication if the student has their parent/guardian permission. An additional inhaler may be kept in the office at the request of the parent/guardian. Asthma and Exercise: While exercise can be an asthma trigger, exercise is important for everyone. Teachers and coaches should be prepared to accommodate and modify activities to promote participation of students with asthma. Guidelines for supporting students with asthma include the following:


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● Have the student warm-up 10 – 15 minutes prior to exercising and cool down

afterward;

● Some students may need to use their inhaler prior to exercise, as advised by the physician;

● Be aware of environmental triggers (e.g., extreme temperature, air quality , high pollen count) and be prepared to relocate or reschedule as required;

● The student should not participate in physical activity if already experiencing asthma symptoms. If the student has asthma symptoms during exercise, they should stop until they feel better and use reliever inhaler as necessary;

● Detailed guidelines are located in the form, Responsibilities for Teachers / Coaches Providing Physical Activity. Responding to Asthma Symptoms - Action:

● Have the student use reliever inhaler as prescribed (use a spacer if provided);

● Remove the student from the trigger;

● Have the student remain in an upright position;

● Have the student breathe slowly and deeply;

Check symptoms. When all the student’s symptoms are gone, then the student can resume school activities, but should be monitored closely. The student may require additional reliever medication.

If symptoms get worse or do not improve within 5 – 10 minutes, follow the steps for an emergency response.

8.6 Safety Considerations

Students are allowed to carry their medication(s) and supplies, as outlined in

their Individual Plan of Care;

The principal will make arrangements to support the storage (according to the item’s recommended storage conditions) and safe disposal of medication and medical supplies;

The principal will ensure that a plan is established to support students with prevalent medical conditions in the event of a school emergency (eg. bomb threats, evacuation, fire, “hold and secure”, “lockdown” or for activities of school property (field trip, sporting event).


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8.7 Facilitating and Supporting Routine Management The principal must permit a student to carry their asthma medication if the student has their parent/guardian permission. An additional inhaler may be kept in the office at the request of the parent/guardian. Where possible, facilitating and supporting daily or routine management involves, but is not limited to, supporting inclusion by allowing students with prevalent medical conditions to perform daily or routine management activities in a school location (e.g., within the classroom), as outlined in their Individual Plan of Care.

9.0 DIABETES

Diabetes is a disease resulting from a lack of insulin action. Insulin is a hormone produced by the pancreas. Without insulin, carbohydrates (starch and sugars) in the food we eat cannot be converted in the energy (called blood glucose or “blood sugar”) required to sustain life. Instead, unused glucose accumulates in the blood and spills out into the urine. 9.1 Triggers

Low blood sugar is also called hypoglycemia. Low blood sugar occurs when the amount of blood glucose (sugar) falls below 4 mmol/L. It can develop quickly – within minutes of a student appearing healthy – and must be treated right away. It can be caused by: • Too much insulin, and not enough food; • Delaying or missing a meal or a snack; • Not enough food before an activity; • Unplanned activity, without adjusting food or insulin. High blood sugar or hyperglycemia occurs when a student’s blood sugar is higher than the target range. It is usually caused by: • extra food, without extra insulin; • not enough insulin; • decreased activity; • illness, stress, excitement or other factors;


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• insulin pump malfunction.

Usually, it is caused by a combination of factors.


Hypoglycemia (Low Blood Glucose) Symptoms: ● Cold, clammy or sweaty skin;

● Paleness;

● Shakiness, tremor, lack of coordination;

● Dizziness;

● Hunger;

● Irritability, hostility, poor behaviour, tearfulness;

● A staggering gait;

● Confusion;

● Headache;

● Blurred vision;

● Weakness/fatigue;

● Loss of consciousness and possible seizure if not treated early.

Mild to moderate hypoglycemia (low blood sugar) is common in the school setting, so it is important for staff to know its signs/symptoms, treatment, and prevention. Hyperglycemia (high blood sugar) Symptoms:

Extreme thirst;

Frequent urination;

Headache;

Hunger;

Abdominal pain;


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Blurry vision;

Warm, flushed skin;

Irritability.


In the event that rescue medication is prescribed, it is essential that the Individual Plan of Care include the emergency response protocol, and that all staff are aware of how it is to be implemented. The Individual Plan of Care will clearly identify individual roles and be respectful of all applicable legislation, policies and collective agreements. Emergency Responses: Severe hypoglycemia is an emergency. If mild to moderate hypoglycemia is not treated right away, it can become severe. This is an emergency and immediate action is needed. Symptoms: Uncooperative;

Unresponsive;

Loss of consciousness;

Seizure.

Severe low blood sugar is an emergency situation and the following emergency protocol is to be followed:

Roll student on left side (recovery position);

Call 911 immediately;

Notify parent/guardian;

Do not put anything in the student’s mouth, such as food or drink (choking

hazard).

9.4 Field Trips Field trips are an extension of the learning in the classroom and therefore, it is imperative that they are planned to include all students. The principal must


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ensure that all appropriate documentation is received in advance of the field trip and that plans are in place to accommodate students with prevalent medical conditions. The parent/guardian is required to complete the Medical or Special Concerns/Information section of the Parent/Guardian Permission Form for Specific School Field Trip. Within this form parent/guardian will identify allergies, dietary restriction and any other medical or special concerns. Teachers will ensure that this information is available during field trips and that the Individual Plan of Care accompanies the student on the field trip. If it is necessary for the student to take prescription medication during the field trip, the parent/guardian and physician must complete the Authorization for Administration of Prescription Medication form. It must be forwarded to the principal prior to the administration of medication. If the student currently receives medication during the school day and a copy of this form is on file at the school, it is not necessary to complete another form.

9.5 Information and Awareness The majority of people with diabetes develop this condition in adulthood. They can still produce some insulin and may be able to control their diabetes by diet alone or with oral medication. Three Main Types of Diabetes:

Type 1 Diabetes: Usually affects children and adolescents. In Type 1

Diabetes, the pancreas is unable to produce insulin and injections of insulin are essential;

Every child diagnosed with Type 1 Diabetes must have an up-to-date Individual Plan of Care;

Type 2 Diabetes: Comprises 90% of diabetes in Canada. It usually develops

in adulthood, although recently increasing numbers of children in high-risk populations are being diagnosed. In Type 2 Diabetes the pancreas may produce some insulin, but the body is unable to use the insulin that is produced effectively. Type 2 Diabetes may be controlled with diet and exercise or with oral medication. Children with Type 2 Diabetes often need insulin;

Gestational Diabetes: Gestational Diabetes affects 4% of pregnant women

and usually goes away after the birth of the baby. Diabetes and Exercise:

● Students with diabetes should be encouraged to participate in as many

activities as they choose. They should not be excluded from school field trips.


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School sports and other activities can promote self-esteem and sense of well-being;

● For students who wish to participate in vigorous physical activity, good planning is essential so that the blood glucose balance is maintained. The major risk of unplanned vigorous activity is low blood glucose. Eating additional food can prevent this. The parent/guardian should be notified of special days that involve extra activity so that they can ensure that the student has extra food to compensate;

● Sports or other activities that take place during mealtime require extra planning. Timing of meals and snacks may be varied and the insulin dose adjusted so that children with diabetes can safely participate. It is advisable that both the parent/guardian and the student with diabetes carry some form of fast-acting sugar such as glucose tablets or juice boxes on outings or sports events;

● It is critical that the student’s teachers and coaches are familiar with the symptoms, treatment and prevention of hypoglycemia and hyperglycemia. It is also important for teachers to communicate in advance any changes in the student’s routine and schedule that may impact insulin testing and insulin levels.

9.6 Safety Considerations

Students are allowed to carry their medication(s) and supplies, as outlined in

their Individual Plan of Care;

The principal will make arrangements to support the storage (according to the item’s recommended storage conditions) and safe disposal of medication and medical supplies;

The principal will ensure that a plan is established to support students with diabetes in the event of a school emergency (e.g. bomb threats, evacuation, fire, “hold and secure”, “lockdown” or for activities of school property (field trip, sporting event).

Other Considerations:

Ensure the student has easy access to supplies for blood glucose monitoring

and treating low blood sugar;

Ensure the student eats meals and snacks on time;

Provide the parent/guardian with as much notice as possible about field trips, special events and changes to the school routine, especially where food or activity is involved;


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If a student experiences low blood sugar before or during an assessment,

allow a reasonable amount of time to treat and recover from the low (they may need up to an additional 30 to 60 minutes to complete the task);

Ensure that information about the student is available to occasional staff;

Support the student’s self-care by allowing blood sugar monitoring at any time or anywhere, respecting the student’s wish for privacy;

Know that a student may need to eat outside a planned meal or snack time;

Ensure that the student has unrestricted bathroom access, as well as access to water at all times. This is especially important when blood sugar is high.

9.7 Facilitating and Supporting Routine Management Where possible, facilitating and supporting daily or routine management involves, but is not limited to, supporting inclusion by allowing students with prevalent medical conditions to perform daily or routine management activities in a school location (e.g., within the classroom), as outlined in their Individual Plan of Care. The ultimate goal of diabetes management within the school setting is to have the student feel safe and supported with their diabetes care and to be encouraged towards independence in age-appropriate steps. This independence includes the specific management of diet, activity, medication (insulin) and blood sugar testing, as required. Independence of care also includes the development of self-advocacy skills and a circle of support among persons who understand the disease and can provide assistance as needed. Children are diagnosed with diabetes at various stages of their lives. Some will be very young, and others older and more mature, some will have special needs. The goal for all children is to become as independent as possible, as soon as possible, in managing their diabetes. The role of the school is to provide support as the student moves from dependence to independence and to create a supportive environment in which this transition can occur. Nevertheless, the ultimate responsibility for diabetes management rests with the parent/guardian and the student. Staff members can help by:

● Learning as much as possible about diabetes;

● Communicating openly with the parent/guardian;

● Helping other students in the class understand diabetes.

Independence Versus Protection:

https://www.diabetesatschool.ca/schools/managing


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● The parent/guardian and staff members need to protect the student’s health

while encouraging them to develop independent diabetes management skills;

● Even very young children can share the work of managing diabetes. How much a student can do depends on their age, how long they have had diabetes and any disabilities or special needs.

Hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) result from difficulties in managing blood sugar. Both conditions are known to affect students’ learning, behaviour and participation in activities. Hyperglycemia is not necessarily an emergency condition. Students with diabetes sometimes experience high blood glucose. The earliest and most obvious symptoms of high blood glucose are increased thirst and urination. These symptoms, if noticed, should be communicated to the parent/guardian to assist them in the long-term treatment. High blood glucose is usually managed by the parent/guardian while at home through adjusting the insulin dose and/or diet.

9.8 Resources

Diabetes fact sheet – Ministry of Education www.edu.gov.on.ca/eng/healthyschools/pmc_diabetes_fact_sheet_en.pdf Diabetes at School – Canadian Paediatric Society, in partnership with Diabetes Canada & Canadian Pediatric Endocrine Group – includes printable resources and short animated videos www.diabetesatschool.ca Position Statement & Guidelines for the Care of Students Living with Diabetes at School – Diabetes Canada http://www.diabetes.ca/kidsatschool

10.0 EPILEPSY

Epilepsy is a common brain disorder characterized by recurrent seizures. Most seizures are brief events that last from several seconds to a couple of minutes and normal brain function will return after the seizure ends. Recovery time following a seizure will vary. Sometimes recovery is immediate as soon as the seizure is over. Other types of seizures are associated with an initial period of confusion afterwards. Following some types of seizures there may be a more prolonged period of fatigue and/or mood changes. A health care professional may consider epilepsy as a possible diagnosis when a person has had two or more seizures starting in the brain.

10.1 Triggers

http://www.edu.gov.on.ca/eng/healthyschools/pmc_diabetes_fact_sheet_en.pdf

http://www.diabetesatschool.ca/

http://www.diabetes.ca/kidsatschool

http://epilepsyontario.org/about-epilepsy/types-of-seizures/myoclonic-seizures/



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● Medication:

● Not taking one’s anti-epileptic medication; ● Other medications that are taken in addition to anti-epileptic

medication.

● Internal Factors:

● Stress, excitement and emotional upset; ○ This type of over-stimulation may lower the student’s resistance to

seizures by affecting sleeping or eating habits; ● Lack of sleep can change the brain’s patterns of electrical activity and

can trigger seizures; ● Fevers may make some students more likely to have a seizure; ● Menstrual cycle;

○ Many females find their seizures increase around this time of their period. This is referred to as catamenial epilepsy and is because of changes in hormone levels, increased fluid retention and changes in anti-epileptic drug levels in the blood.

● External Factors:

● Alcohol can affect the rate at which the liver breaks down anti-epileptic medication; ○ This may decrease the blood levels of anti-epileptic medications,

affecting an individual’s seizure control; Poor diet can affect blood sugar levels causing seizures;

○ Stimulants such as tea, coffee, chocolate, sugar, sweets, soft drinks, excess salt, spices and animal proteins may trigger seizures by suddenly changing the body’s metabolism;

○ Parents/Guardians have reported that allergic reactions to certain foods (e.g. white flour) also seem to trigger seizures in their children; ○ Certain nutrient shortages, such as a lack of calcium, have also

been found to trigger seizures; ● Very warm weather, hot baths or showers, especially when there is a

sudden change in temperature; ● Television, videos and flashing lights;

○ The “strobe effect” from fast scene changes on a bright screen, rapidly changing colours or fast-moving shadows or patterns can all be trigger seizures;

● Lack of physical activity.


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10.3 Emergency Response In the event that rescue medication is prescribed, it is essential that the Individual Plan of Care include the emergency response protocol, and that all staff are aware of how it is to be implemented. Medication must be provided to the school in a premeasured format. The plan will clearly identify individual roles and be respectful of all applicable legislation, policies and collective agreements. Emergency Procedure: Emergency response should be detailed for individual students in the Individual Plan of Care. In general, if someone is having a seizure: ● Stay calm:

● Seizures usually end on their own within seconds or a few minutes.

● Time It:

Motor Symptoms: Non-motor Symptoms:

Autonomic Symptoms:

Autonomic Symptoms:

● Jerking (clonic) ● Limp or weak

muscles ● Rigid or tense

muscles ● Brief muscle

twitching (Myoclonus)

● Epileptic spasms

● Automatisms or repeated automatic movements (clapping, rubbing hands, lip smacking, chewing, running)

● Lack of movement (behaviour arrest)

● Changes in thinking or cognition

● Loss of Memories

● Blank stares ● Repeated

words ● Appearing

dazed ● Laughing,

screaming or crying

● Abdominal discomfort

● Stomach pain

● Belching ● Flatulence ● Vomiting ● Pallor ● Sweating ● Dilation of

pupils ● Alteration in

heart rate and respiration

● Fear, sadness, anger or joy

● Sensory ● Sees lights ● Hears

buzzing ● Feels

tingling or numbness

● Smells a foul odour

● Bad taste in the mouth

● Funny feeling in the pit of the stomach

● Choking sensation


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● Note the time the seizure begins and ends.

● Create a safe space:

● Move sharp objects out of the way; ● If the student falls, place something soft under their head and roll them

on their side as the seizure subsides; ● If the student wanders, stay by their side and gently steer them away

from danger; ● If the student is in wheelchair, remain in the wheelchair, secure

harness and recline if available.

● Call 911:

● If the seizure lasts more than 5 minutes; ● If it repeats without full recovery between convulsive seizures or as

directed by neurologist; ● If consciousness or regular breathing does not return after the seizure

ends; ● If the student is pregnant, has diabetes, appears injured or is in water; ● If you are not sure the student has epilepsy or a seizure disorder.

Provide Assurance:

● When the seizure ends, stay with them until complete awareness

returns.

Do not: ● Restrain the student; ● Put anything in their mouth.

10.4 Field Trips Field trips are an extension of the learning in the classroom and therefore, it is imperative that they are planned to include all students. The principal must ensure that all appropriate documentation is received in advance of the field trip and that plans are in place to accommodate students with epilepsy. The parent/guardian is required to complete the Medical or Special Concerns/Information section of the Parent/Guardian Permission Form for Specific School Field Trip. Within this form the parent/guardian will identify allergies, dietary restriction and any other medical or special concerns. Teachers will ensure that this information is available during field trips and that the Individual Plan of Care accompanies the student on the field trip. If it is necessary for the student to take prescription medication during the field


Page 36 of 38

trip, the parent/guardian and physician must complete the Authorization for Administration of Prescription Medication form. It must be forwarded to the principal prior to the administration of medication. If the student currently receives medication during the school day and a copy of this form is on file at the school, it is not necessary to complete another form.


A medical diagnosis of epilepsy is based on multiple pieces of information: the description of the episodes; the student’s medical and family history; and the results of diagnostic tests. Fortunately, epilepsy is a treatable condition. Many people with epilepsy (two out of three) will achieve good seizure control with medication. When medication is not effective in preventing seizures there are other treatment options available. Types of Seizures:

Focal (or partial) seizures occur when seizure activity is limited to a part of

one brain hemisphere. There is a site, or a focus, in the brain where the seizure begins. There are two types of focal seizures:

Focal Onset Aware Seizures (previously known as a Simple Partial

Seizure); Focal Onset Impaired Awareness Seizures (previously known as Focal

Dyscognitive Seizure or Complex Partial Seizures);

Generalized seizures occur when there is widespread seizure activity in the left and right hemispheres of the brain. The different types of generalized seizures are:

● Absence seizures (formerly known as petit mal); ● Tonic-clonic or convulsive seizures (formerly known as grand mal); ● Atonic seizures (also known as drop attacks); ● Clonic seizures; ● Tonic seizures; ● Myoclonic seizures;

● Psychogenic non-epileptic seizures are not due to epilepsy but may look very

similar to an epilepsy seizure.

10.6 Safety Considerations Ensure that consideration is made on behalf of students with Epilepsy in the

planning of school events and field trips (e.g., lighting effects for school dances, bleacher seating for athletic events);

http://epilepsyontario.org/about-epilepsy/treatments/medications

http://epilepsyontario.org/about-epilepsy/types-of-seizures/focal-or-partial-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/simple-partial-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/absence-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/tonic-clonic-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/atonic-drop-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/atonic-drop-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/clonic-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/clonic-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/tonic-seizures/

http://epilepsyontario.org/about-epilepsy/types-of-seizures/tonic-seizures/



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Be aware that during physical activities, where climbing is involved, that the student is properly assisted and does not climb to great heights;

Monitor that fluorescent light fixtures in the classroom/school are working correctly (not flickering);

Minimize the use of videos in class, if possible;

Avoid loud noise as much as possible;

Avoid using the “lights out” technique for class control;

Ensure that the information provided for occasional teachers include the Individual Plan of Care;

The principal will ensure that a plan is established to support students with epilepsy in the event of a school emergency (e.g. bomb threats, evacuation, fire, “hold and secure”, “lockdown” or for activities off school property (e.g. field trip, sporting event).

10.7 Facilitating and Supporting Routine Management

Students are allowed to carry their medications (including controlled

substances) and supplies, as outlined in the Individual Plan of Care;

Where possible, facilitating and supporting daily or routine management involves, but is not limited to, supporting inclusion by allowing students with epilepsy to perform daily or routine management activities in a school location (e.g., within the classroom), as outlined in their Individual Plan of Care.

10.8 Resources

Resources are available from the Epilepsy Southwestern Ontario Website. Staff are encouraged to reference the Epilepsy Student Toolkit. Epilepsy Southwestern Ontario also offers Epilepsy Educators who are available to provide staff training, classroom presentations and individualized student support.

11.0 FORMS

All forms FOR USE BY Thames Valley District School Board staff can be accessed through the Employee Portal under Electronic Forms. All forms for use by Thames Valley District School Board students and parents are available in the Student Portal and Parent Portal on the Thames Valley District School Board website.


Page 38 of 38

Forms related to this procedure:

Individual Plan of Care; Authorization for Administration of Prescription Medication; Individual Student Log of Prescription Medication Administration.


Amendment Date(s):

POLICY

Title:

ASTHMA AND STUDENTS

Policy No: 4019 Effective Date: 2016 Sept. 01

Department:

Learning Support Services

Reference(s): - Ryan’s Law (Ensuring Asthma Friendly Schools), 2015 - Education Act, Sec. 265 - Duties of Principal - Education Act, Reg. 298 s.20 – Duties of Teachers - Ontario Lung Association - www.on.lung.ca - Creating Asthma Friendly Schools, Ophea, 2015 - Halton District School Board Asthma Protocol, 2015

It is the policy of the Board to promote awareness of safety in schools and recognize that the health and safety of students are essential preconditions of effective learning. All partners in education, including school boards, administrators, educators, school staff, students, parents, school volunteers and community organizations have important roles to play in promoting student health and safety and in fostering and maintaining healthy and safe environments in which all students can learn. This policy is developed in accordance with Ryan’s Law (Ensuring Asthma Friendly Schools), 2015. 1.0 The Board’s procedure shall include:

the Board policy; processes to share information with all employees and others who are in direct contact

with students on a regular basis, in order to develop awareness of the seriousness of asthma, recognize and prevent triggers, recognize when symptoms are worsening, and minimize asthma exacerbations;

processes for identifying students with asthma and managing information and communication with teachers and other staff who are in direct contact with students;

processes for identifying asthma triggers in classrooms, common school areas, and in planning field trips;

strategies for all employees, students and others who are in direct contact with students on a regular basis to reduce the risk of exposure to asthma triggers;

management and communication procedures regarding access to prescribed reliever inhalers for students;

ongoing training and monitoring for school administration, staff, and volunteers.

2.0 The Board commits to ensuring that:

2.1.1 Information on asthma awareness, reduction of asthma triggers, and management is accessible to all board employees, school administrators and

staff, students, parents and school volunteers. 2.1.2 Every school follows an asthma management plan that is consistent with Board

policy.

TO BE RESCINDED

http://www.on.lung.ca/


Amendment Date(s):

PROCEDURE

Title:

ASTHMA AND STUDENTS

Procedure No.: 4019a Effective Date: 2016 Sept. 01

Department:

Learning Support Services

Reference(s): - Ryan’s Law (Ensuring Asthma Friendly Schools), 2015 - Education Act, Sec. 265 - Duties of Principal - Education Act, Reg. 298 s.20 – Duties of Teachers - Ontario Lung Association – www.on.lung.ca - Creating Asthma Friendly Schools, Ophea, 2015 - Halton District School Board Asthma Protocol, 2015

Definition:

Asthma is a very common chronic (long-term) lung disease that can make it hard to breathe. (Ontario Lung Association).

Parent, Board and School Responsibilities:

Parent Responsibilities

It is the responsibility of parents who have children with asthma to identify their children to the school principal and provide information regarding:

The conditions or allergens which are likely to trigger a reaction. Use of medications and the management of asthmatic attacks. Any changes in the child’s condition from previous years or since last reported.

Board Responsibility

The Board will provide asthma education and regular training opportunities for all employees and for others who are in direct contact with students on a regular basis on recognizing and preventing asthma triggers, recognizing when symptoms are worsening, and managing asthma exacerbations.

School Responsibility

Schools must communicate to parents that, in spite of their best efforts, asthma triggers may be present and asthma episodes may occur.

Multiple individual, environmental, and situational factors can trigger asthma. To the extent that it is possible to establish, an asthma-friendly environment in schools will help students to maximize their learning opportunity and minimize asthma-related incidents.

Ensure that all students have timely access to their prescribed reliever inhaler(s) medications.

TO BE RESCINDED

http://www.on.lung.ca/

Asthma and Students Procedure

Page 2 of 7

The school’s responsibility is divided into three distinct categories: 1. Information and Awareness 2. Strategies to Reduce Risk of Exposure to Asthma Triggers and to Increase the

Awareness of Symptoms 3. Management and Emergency Response

1.0 Information and Awareness:

1.1 Identification of Students with Asthma to School Authorities

This identification can be completed through the school registration process and student information updates. Parents are required to update the school immediately if conditions change.

1.2 Asthma Management Plan

For students identified as having an asthma diagnosis, the principal is required to develop and ensure the maintenance of an asthma management plan.

The principal will maintain information on file using the form – Individual Asthma Management Plan - outlining current treatment and other information for each pupil with asthma, including a copy of any notes and instructions by the health care provider and current emergency contact information.

1.3 Identification of Students with Asthma to Staff

All staff members (teaching and non-teaching) must be made aware that children with asthma are attending their school.

For any student who has an asthma management plan, all staff members (teaching and non-teaching) and other adults who regularly come in contact with that student during school activities must be made aware of the plan.

The student’s classroom teacher must ensure that information is kept in a place where it is readily available to occasional teachers.

1.4 Identification of Students with Asthma who also have Anaphylaxis

People with asthma who are also diagnosed with anaphylaxis are more susceptible to severe breathing problems when experiencing an anaphylactic reaction. It is extremely important that students with asthma who also have anaphylaxis keep their asthma well controlled. In cases when an anaphylactic reaction is suspected but there is uncertainty whether or not the person is experiencing an asthma attack, epinephrine should be used first. Epinephrine can be used to treat life-threatening asthma attacks as well as anaphylactic reactions. People with asthma that are at risk of anaphylaxis should carry their asthma medications (e.g., puffers/inhalers) with their epinephrine auto-injector (e.g., EpiPen). For procedures regarding Anaphylaxis, see Board Policy # 5001, Medical / Health Support for Students.

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1.5 Field Trips

In addition to the usual safety precautions applying to field trips, the following procedures must be in place to protect the student with asthma: Require all supervisors, staff and volunteers to be aware of the identity of the

students with asthma and to remind students to bring their inhalers on the trip. If practical, consider a cell phone for buses used on field trips. The parent of the student with asthma should provide an inhaler.

1.6 Communication Plan

Establish a communication plan to share information on asthma with parents/guardians, students, employees and others who have direct contact with students with asthma.

1.7 In-service for Teachers and Other School Staff

Provide asthma education and regular training on recognizing and preventing asthma triggers, recognizing when symptoms are worsening, and managing asthma exacerbations for all employees and others who are in direct contact with students on a regular basis.

2.0 Strategies to Reduce Risk of Exposure to Asthma Triggers and To Increase the

Awareness of Symptoms:

2.1 Asthma Symptoms

Symptoms of asthma are variable and can include but are not limited to the following: coughing, wheezing, difficulty breathing, shortness of breath, chest tightness.

2.2 Asthma Triggers

It is the Board’s policy to provide a safe environment for students who are susceptible to allergens, but it is not possible to reduce the risk to zero. This is particularly the case with asthma triggers. Triggers: People with asthma have sensitive airways that react to triggers. A trigger is something that can make asthma worse, such as, but not limited to: air quality, mold, dust or dust mites, pollen, viral infections, animal and pet dander, smoke, scented products and cold air. Triggers vary widely from individual to individual and are sometimes situation-specific.

To the extent possible, schools will identify and minimize asthma triggers and implement strategies to reduce the risk of exposures in classrooms, common school areas and in planning field trips.

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Page 4 of 7

Common Outdoor Triggers

Cold air – susceptible students with asthma may need to use a scarf to cover their mouth and nose, especially prior to and during physical activity; when outdoor cold temperatures are extreme, a well-ventilated indoor site should be used for physical activity.

Air Quality, Smog – outdoor air quality and smog alerts can be monitored through local news/air quality sites; well-ventilated indoor sites can be chosen for physical activity on days when air quality is poor. www.airhealth.ca

Pollen, Leaves, Trees – May through August, (or until first frost) grassy or densely treed activity sites should be avoided for physical activity.

Common Indoor Triggers

Physical activities indoors (e.g., classroom, gymnasium) should be planned to eliminate or minimize common triggers that may cause asthma symptoms:

strong smells (e.g., perfumes, strongly-scented markers or paints, cleaning products)

dust chalk furry or feathered animals

Strategies to Assist Schools and Classrooms to Minimize Common Triggers

If area rugs or carpets are used, choose ones with low nap or ones easily washed.

Remove furry or feathered animals (birds, gerbils, mice, etc.). Consider a no-scent policy in the workplace. Where possible, use scent-free products.

3.0 Management and Emergency Response:

3.1 Medication

“Medication” refers to medications that are prescribed by a health care provider and, by necessity, may be administered to a student, or taken by the student during school hours or school-related activities (for example, rescue inhaler or disc).

Medication can minimize or manage the symptoms. When an incident does occur, a reliever (rescue) inhaler can provide quick relief of asthma symptoms by relaxing the muscles around the airways and permitting the person to breathe more easily.

Every school principal must permit a student to carry their asthma medication if the student has their parent’s or guardian’s permission.

An additional inhaler may be kept in the office at the request of the parent.

TO BE RESCINDED

http://www.airhealth.ca/


Page 5 of 7

3.2 Asthma and Exercise

While exercise can be an asthma trigger, exercise is important for everyone. Teachers and coaches should be prepared to accommodate and modify activities to promote participation of students with asthma. Guidelines for supporting students with asthma include the following:

Have the student warm-up 10 – 15 minutes prior to exercising and cool down afterward.

Some students may need to use their inhaler prior to exercise, as advised by physician / primary care provider.

Be aware of environmental triggers [e.g., extreme temperature, air quality (smog), high pollen count] and be prepared to relocate or reschedule as required.

The student should NOT participate in physical activity if already experiencing asthma symptoms.

If the student has asthma symptoms during exercise, they should stop until they feel better and use reliever inhaler as necessary.

Detailed guidelines are located in the form, “Responsibilities for Teachers / Coaches Providing Physical Activity.”

3.3 Responding to Asthma Symptoms

Action:

Have student use reliever inhaler as prescribed. (Use a spacer if provided.) Remove student from the trigger. Have student remain in an upright position. Have student breathe slowly and deeply.

Check symptoms. When all the student’s symptoms are gone, then the student can resume school activities, but should be monitored closely. The student may require additional reliever medication.

If symptoms get worse or do not improve within 5 - 10 minutes, follow the steps

for an emergency response, 3.4.


It is an EMERGENCY SITUATION if the student:

Has used a reliever medication and it has not helped within 5-10 minutes. Has difficulty speaking or is struggling for breath. Appears pale, grey or is sweating. Has greyish/blue lips or nail beds. Has skin on neck or chest sucked in with each breath. OR

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Page 6 of 7

You have any doubt about the student’s condition:

Action

Have student use or assist student in using fast-acting reliever inhaler. If an employee has reason to believe that a pupil is experiencing an asthma

exacerbation, the employee may administer asthma medication to the pupil for the treatment of the exacerbation, even if there is no preauthorization to do so.

Call 911. Notify office. Remain with the student. Have the student sit upright or with arms resting on a table or other support if

possible. Continue to give the reliever inhaler every 5 - 10 minutes until help arrives.

Contact parent/guardian as soon as possible. Stay calm and reassure the student. Tell child to breathe slowly and deeply.

Note: Students are transported to hospital by ambulance only.

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APPENDIX A

Forms Available on Electronic Forms:

Individual Asthma Management Plan Responsibilities for Teachers / Coaches Providing Physical Activity Checklist for Parents and Guardians of Students with Asthma

TO BE RESCINDED

Administered By LEARNING SUPPORT SERVICES

Board Resolution No. 32-B Rec. 6

Amendment Date(s) 2005 12 20 Amendment Resolution No.

Page 1 of 1

Thames Valley District School Board

POLICY

Title

MEDICAL/HEALTH SUPPORT FOR STUDENTS

Policy No.

5001

Department

LEARNING SUPPORT SERVICES

Reference(s)

Ministry of Education Policy/Program

Memorandum No. 81 Education Act, Section 265 Ministry of Education Memorandum, August 17,

1989 re: “Catheterization and Suctioning” Ministry of Health, Regulated Health

Professions Act, 1991 Managing Food Allergies: A Resource

Package for Schools (2004) Bill 3 – Sabrina’s Law – An Act to Protect

Anaphylactic Pupils

Effective Date

1999 12 21

1.0 It is the policy of the Board that the Director of Education or designate develop all

procedures related to medical/health support. Such procedures include but are not limited to: Consultation processes with appropriate service providers including the School

Health Support Program (Community Care Access Centres). Development of procedures for dealing with reportable and communicable

diseases. Approval of agreements, at the request of parents/guardians and their physician

on behalf of an individual student, relating to the medical treatment and provision of medical services including emergency care plans where the physician and parent/guardian request exemption for a child from the Board’s normal emergency practices. This applies when standard emergency intervention procedures could worsen the circumstance of the student.

2.0 Students with special medical/health needs will be maintained in their neighbourhood

school whenever possible; however, when assistance or coping with special needs becomes a primary requirement, students should be supported in appropriate facilities strategically located within the system to address their individual needs.

3.0 The designation of roles and responsibilities for medical/health support services in school

settings does not preclude, in emergency situations, the provision of assistance by school board personnel. Staffs who provide health support to students under their supervision shall have full coverage under the Board’s liability policies.

TO BE RESCINDED

1

Thames Valley District School Board

PROCEDURE

Title

MEDICAL/HEALTH SUPPORT FOR STUDENTS

- General Guidelines and Procedures - School Health Support

Policy No.

5001a

Department

LEARNING SUPPORT SERVICES

Resource(s) - Authorization for Administration of Prescription

Medications - Individual Student Log of Prescription

Medication Administration - Individual Medical Emergency Plan

Effective Date

1999 12 21

References:

- Board Policy: Medical/Health Support for Students - Ministry of Education Policy/Program Memorandum No. 81 - Ministry of Education Memorandum, April 1995 and May 2003 re “Anaphylaxis in the School Setting” - Education Act Section 265 - Ministry of Education Memorandum, August 17, 1989 re: “Catheterization and Suctioning” - Ministry of Health, Regulation Health Professions Act, 1991 - Bill 3 – Sabrina’s Law – An Act to Protect Anaphylactic Pupils

1.0 GENERAL GUIDELINES

It is recognized that in respect of students with special medical/health or physical needs:

1.1 The parent/guardian has the primary responsibility to inform school authorities about their

child’s medical/health conditions and to transmit relevant information. School procedures must be cooperatively developed to address differentiated strategies for the purpose of addressing the student’s needs in a reasonable manner.

1.2 Medical/health or physical assistance may be necessary in order for students to take advantage of their right to attend school.

1.3 Following an initial review of a student’s unique medical/health needs but prior to registering a particular student, a principal shall consult with the appropriate Learning Coordinator; (e.g., Special Education_ and if necessary the Superintendent of Student Achievement to discuss placement options to best address the student’s needs. Final determination of school location is the responsibility of the Associate Director of Learning Support Services.

1.4 Arrangements for the provision of medical/health support services to school aged children is a shared responsibility of the Ministries of Children and Youth Services, Community and Social Services, Health and Long-term Care. The primary responsibility for provision of the required services and medical/health procedures remains with parents/guardians and health professionals.

Administered By LEARNING SUPPORT SERVICES

TO BE RESCINDED

2

Amendment Date(s) 2004 May 04 2005 Dec.20

Procedure: Medical Health Supports for Students, cont.

1.5 Procedures related to medical/health needs of individual students will address physician or health professional prescribed care plans and relevant legislation and policies.

1.6 Whenever feasible and authorized, the pupil or the pupil’s parent/guardian may accept the responsibility of performing the medical service, if required during school hours.

1.7 Where the pupil or the pupil’s parent/guardian cannot perform required service and where the parent/guardian so requests, the service is to be requested in accordance with the Provision of Health Support Services in school Settings, (Ministry of Education Policy/Program Memorandum No. 81.) (See Section 3.0).

1.8 In responding to such circumstances, principals or other staff performing such services, on a voluntary or emergency basis, is acting according to the principle of “in loco parentis” and not as a health professional. Failure to act as a prudent parent would do when a student is in distress, could result in legal liability for the harm that flows from failure to act. (See also 2.5 Emergency Procedures.) Staff who provides health support to students under their supervision shall have the coverage under the Board’s liability policies. The Board shall not require any teacher to administer medication or perform any medical or physical procedure on any pupil that might in any way endanger the safety of the pupil or subject the teacher to risk of injury or liability for negligence. With appropriate training, Educational Assistants shall assist with student medication and medical procedures as required, in accordance with Ministry of Education Policy/Program Memorandum No.81, Memorandum of August, 1989, and Bill 3 Sabrina’s Law. It shall not be part of the duties and responsibilities of a teacher to examine pupils for communicable conditions or diseases or to diagnose such conditions or diseases

1.9 Staff who volunteer to provide health support services shall be governed by the Regulated Health Professionals Act (1991), available at http://192.75.156.68/DBLaws/Statutes/English/91r18_e.htm#p227_13534 Note especially the following sections: 27.(1) No person shall perform a controlled act set out in subsection (2) in the course of providing health care services to an individual unless, a) the person is a member authorized by a health profession Act to perform the

controlled act; or b) the performance of the controlled act has been delegated in accordance with

section 28 to the person by a member described in clause (a), c. 18, s. 27(1); 1998, c. 18, Sched. G, s.6.

29 (1) An act by a person is not a contravention of subsection 27(1) if it is done in the course of, a) rendering first aid or temporary assistance in an emergency; b) assisting a person with his or her routine activities of living and the act is a

controlled act set out in paragraph 5 or 6 of subsection 27(2).

TO BE RESCINDED

http://192.75.156.68/DBLaws/Statutes/English/91r18_e.htm#p227_13534

3

TO BE RESCINDED

4

Controlled Acts

29.(2) A “controlled act” is any one of the following done with respect to an individual: 1. Communicating to the individual or his or her personal representative a

diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.

2. Performing a procedure on tissue below the dermis, below the surface of a

mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.

3. Setting or casting a fracture of a bone or a dislocation of a joint.

4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.

5. Administering a substance by injection or inhalation.

1.10 All medication and an INDIVIDUAL STUDENT LOG OF PRESCRIPTION MEDICATION

and an AUTHORIZATION FOR ADMINISTRATION OF PRESCRIPTION MEDICATION will be stored together in a secure location. It is the obligation of the parent; guardian or student to ensure that information on the student’s file is kept current and includes the medication that the student is taking.

1.11 Any deviation from these Procedures must have the prior written approval of the Associate Director of Learning Support Services.

2.0 PROCEDURES FOR THE PROVISION OF MEDICAL/HEALTH SUPPORT SERVICES

The following procedures define the parameters within which the assistance is provided to students. 2.1 PRESCRIPTION MEDICATION

Prescription medication, within the limits of this policy, is any prescription medication prescribed by a physician. In exceptional cases in which a student must have medication administered during school hours, the principal will arrange to have the medication administered at school with the following procedures: 2.1.1 An “Authorization for Administration of Prescription Medication” form will be

completed by the parent/guardian and the physician, and be forwarded to the Principal prior to the administering of any prescription medication. At this time the parent/guardian will receive a copy of this policy.

2.1.2 For each school year and whenever a modification of the prescribed medication is

directed by the physician, a new Authorization Form will be completed by the parent/guardian and the physician, and be forwarded to the Principal.

2.1.3 All authorization and log forms will remain on file one year beyond the end of the

school year to which the record pertains.

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5

2.2 NON –PRESCRIPTION MEDICATION 2.3 INJECTIONS NON-EMERGENCY INJECTIONS (e.g., INSULIN)

The injection of medication in non-emergency situations will be administered only by a health professional or by the parent/guardian or authorized pupil. The injection of medication should be administered in a manner that allows for sensitivity and privacy. School personnel must ensure that the student has time and a clean, private space to self-inject insulin. If necessary, school personnel must make arrangements for the safe storage of for example insulin and syringes/pens. School personnel must arrange for the safe disposal of lancets, syringes, test strips, etc. this may mean that a container is provided by a school nurse or parents so that the student transports them home for disposal. EMERGENCY INJECTIONS (e.g., EPIPEN/ADRENALINE) These are administered only when failure to do so would result in a life threatening situation (i.e. anaphylactic reaction to insect bite/food allergy). For example, an employee who has reason to believe that a student is experiencing an anaphylactic reaction, may administer an epinephrine auto-injector or other prescribed medication, if there is no pre-authorization to do so. When a student has been diagnosed with a life threatening allergy, the courts have indicated in particular cases that staff must exercise the degree of care that an ordinary prudent parent would exercise in relation to their own child. (“in loco parentis”). Records of authorization are to be filed for each student by the Principal.

2.4 INHALED MEDICATIONS

Inhaled medications are used by students with Asthma to help control breathing difficulties. Inhaling devices include puffers, aerochambers, powdered inhalers and compressors. An authorization for Administration of Prescription Medication is to be completed if students require assistance from Board staff in using these devices. Students requiring regular inhalation therapy (administration of medication through a mask using a compressor) can be referred to Community Care Access Centre (CCAC) to request nursing support.

2.5 BLOOD GLUCOSE MONITORING

School personnel are not expected to participate in blood glucose monitoring unless there is mutual agreement, and separate training has been provided for identified school personnel in contact with special needs who cannot do blood testing by themselves. Students who are able can do blood glucose monitoring as necessary in a designated area in the school or classroom. Students must be allowed enough time and have access to a clean, private space to test their blood. Arrangements must be made for safe disposal of lancets and needles. This may mean a container is provided by a school nurse or parent(s)/guardian so that a student transports them home for disposal.

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2.6 EMERGENCY PROCEDURES

In emergency situations, a teacher’s duty is to use reasonable care and judgement. If it appears that the illness or injury may be such as to require emergency treatment, a safe procedure is to arrange to have the student taken immediately by ambulance to a hospital. Staff should not drive students to meet the ambulance “en route”. Only “stable” children may be driven by staff to the hospital. The parent/guardian should be contacted as soon as possible. It is often helpful if a person being transported to hospital by ambulance is accompanied in the ambulance by a staff member or other person. While ambulance personnel assume charge of the situation once they arrive, it can be useful if someone who knows the circumstances of the onset of the emergency or who knows the student accompanies the individual in the ambulance. This may also provide comfort and assurance to a person in distress. The individual calling for the ambulance should indicate the location of the access door to the area where the person in distress is located. The person should not be moved. A person should be assigned to meet the ambulance and bring ambulance personnel to the location of the person in distress. A copy of the medical information sheet should be given to ambulance staff. This information, in particular situations, could also be given to the dispatch staff over the phone in advance of arrival of the ambulance. If An Individual Emergency Care Plan should accompany the student in the ambulance. (See Resource Material and Appendix A.) The principal will establish a protocol within the school to access emergency services and will ensure necessary inservice for staff on specific procedures e.g. use of epipen. When an emergency call is placed from another location, the main office must always be notified. Office staff will advise the principal and/or designate.

2.7 PHYSICAL DISABILITIES

In circumstances where students with physical disabilities require lifting and positioning, or assistance with mobility, feeding, or toileting, an educational assistant or an attendant will provide assistance to students as required. If staff training is required to safely provide this assistance, a referral to the CCAC should be made. Appropriate aspects of Occupational or Physical Therapy treatment are incorporated into the child’s everyday activities. Outside agencies such as Thames Valley Children’s Centre may provide ongoing and/or consultative services.

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3.0 SPECIALIZED HEALTH SUPPORT SERVICES IN SCHOOL SETTINGS 3.1 Summary of Services Provided to the School Board (P/PM #81)

The provision of Health Support Services in school settings is addressed through Policy/Program Memorandum No. 81 issued July 19, 1984 and the Ministry of Education Office Memorandum issued August 17, 1989 with regards to clarifications around catheterization and suctioning. The responsibility for ensuring the provision of health support services is shared among the Ministries of Children and Youth Services, Community and Social Services, Health and Long-Term Care. At the local level, the responsibility is shared by school boards, the Ministry of Community and Social Services/Ministry of Children’s Services (Community Care Access Centre), and agencies operating under the Ministry of Community, Family and Children’s Services. The Ministry of Community and Social Services/Ministry of Children’s Services through the Community Care Access Centre, is responsible for assessing student needs, and for providing such services as injections of medication, sterile catheterization, manual expression of the bladder, stoma care, postural drainage, deep suctioning and tube feeding. The Ministry of Community and Social Services/Ministry of Children’s Services is also responsible for intensive physio, occupational and speech therapies, and for assisting school boards in the training and direction of school board staff performing certain other support services. The Ministry of Community, Family and Children’s Services is responsible for ensuring the provision of health support services in children’s residential care and treatment facilities. School Health Support Services are provided to schools throughout the District by the following Community Care Access Agencies:

London/Middlesex Community Care Access Centre (519) 473-2222 Elgin Community Care Access Centre (519) 631-9907 Oxford Community Care Access Centre (519) 539-1284

3.2 School Health Support Services Process for Determining Eligibility for Professional

Services

Parent(s)/legal guardian(s) contacts principal or designated school personnel and requests Case Manager Assessment of Eligibility for School Health Services.

Should a parent(s)/legal guardian(s) contact the CCAC, the Case Manager will support the parent(s)/legal guardian(s) to initiate the Request for Assessment of Eligibility through the school principal.

Outside agencies should discuss Request for Eligibility Assessment with the parent(s)/legal guardian(s), who in turn, contacts the principal.

School obtains the Board/School Release of Information consent and has it signed by parent(s)/legal guardian(s). This allows the school to release information to the CCAC that may assist in determining eligibility – (e.g. Reports on investigations/Interventions from other agencies).

The school will then contact the CCAC Manager with a verbal Request for Assessment of Eligibility. The school then forwards the consent to the CCAC.

The Case Manager will call the designated school personnel contact and complete the eligibility assessment with said contact and parent(s)/legal guardian(s).

In the case of referrals for speech therapy the referral process is initiated by the school board Speech-Language Pathologist in consultation with the parent(s)/legal guardian(s).

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3.3 Eligible

If the student is deemed to be eligible for CCAC services, the Case Manager will forward a referral package to the school.

Upon completion of the referral, the school personnel contact MUST have it signed and dated by the principal.

Referrals for speech therapy services must be signed by the School Board Speech – Language Pathologist.

Upon completion of the referral, it is returned to the appropriate CCAC. Upon receipt of the completed referral, the Case Manager will contact the

parent(s)/legal guardian(s) to obtain a medical/social history and additional pertinent information. The Case Manager will also obtain CCAC consent to provide service/share information. A notice o CCAC involvement with the child will be forwarded to the Physician of Record.

3.4 Ineligible

For children deemed ineligible, the Case Manager will contact the school and inform the designated school personnel/contact and outline the reasons for ineligibility.

The School and/or Case Manager then contacts the parent(s)/legal guardian(s) to inform them that the child is not eligible for service.

The Case Manager may contact the parent(s)/legal guardian(s) for further discussion of possible alternative (non CCAC) services/resources.

A conflict resolution process is available for differences of opinion regarding the agency responsible for service delivery. Parents may contact CCAC to inquire as to the appeal process.

3.5 Speech referrals to CCAC are submitted through the school’s designated

Speech-Language Pathologist.

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9

3.6 Specialized Health Support Services


Agency or position of person who performs the service (e.g., CCAC, Board staff, parent(s)/legal guardian(s), student)

Eligibility criteria for students to receive the service

Position of person who determines eligibility to receive the service and the level of support.

Criteria for determining when the service is no longer required.

Procedures for resolving disputes about eligibility (If available)

Nursing CCAC contracted service provider

As determined by CCAC case manager CCAC case manager

As determined by CCAC case manager and service provider

Consultation between Case Manager and School Principal

Occupational Therapy

CCAC contracted service provider, programming carried out by Board staff, parent(s)/legal guardian(s), student



Physiotherapy

CCAC contracted service provider, programming carried out by Board staff, parent(s)/legal guardian(s), student



Nutrition CCAC CCAC Case Manager CCAC case manager CCAC case manager and service provider

Speech and language therapy (CCAC)

CCAC contracted service provider

As determined by Board SLPs in consultation with CCAC (Speech Disorders)

Board SLP-eligibility CCAC-level of support

CCAC case manager and service provider – when student no longer has moderate/severe speech disorder

Speech and language intervention (school board)

Board SLPs

As determined by Speech and Language Services (Language and Speech Disorders that affect academics)

Board SLP

When student no longer has moderate/severe speech and/or language disorder or can be maintained by classroom teacher

Board SLP in consultation with Principal, teacher and parent(s)/legal guardian(s)

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Agency or position of person who performs the service (e.g., CCAC, Board staff, parent(s)/legal guardian(s), student)

Eligibility criteria for students to receive the service

Position of person who determines eligibility to receive the service and the level of support.

Criteria for determining when the service is no longer required.

Procedures for resolving disputes about eligibility (If available)

Administering of prescribed medications

Board staff, parent(s)/legal guardian(s), student, CCAC contracted service provider

CCAC case manager physician’s prescription

CCAC case manager Physician, CCAC case manager and service provider

Consultation between Case Manager and School Principal

Catheterization

Board staff-clean intermittent CCAC contracted service provider-sterile intermittent

CCAC case manager CCAC case manager Physician, CCAC case manager and service provider

Suctioning

Board Staff-shallow surface suctioning CCAC contracted service provider-deep suctioning

CCAC case manager CCAC case manager Physician, CCAC case manager and service provider

Lifting and positioning Board Staff CCAC case manager, family/principal request

Board staff, CCAC case manager

Board staff, CCAC service provider

Assistance with mobility Board staff

CCAC case manager, family/principal request

Board staff, CCAC case manager

Board staff, CCAC service provider

Feeding

Board staff, CCAC contracted service provider (enteral feeds)

Board staff, CCAC case manager, parent(s)/legal guardian(s)

Principal, CCAC case manager

Board staff, and CCAC service provider

Toileting Board staff

Board staff, CCAC case manager, parent(s)/legal guardian(s)

Principal, CCAC case manager

Board staff and CCAC service provider

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4.0 FORMS – All forms can be accessed through the Employee Portal under Electronic Forms

Authorization for Administration of Prescription Medication Individual Student Log of Prescription Medication Administration Individual Medical Emergency Plan

5.0 RESOURCE MATERIAL

a) Managing Life Threatening Allergies b) Managing Food Allergies: A Resource Package for Schools (A copy of this package should be

located in the office or can be obtained from the local Health Unit) c) Kids with Diabetes in School (A copy of this package should be located in the office or can be

obtained from the local Health Unit) 6.0 APPENDICES

a) Sample Emergency Protocol b) Sample Letter to Parents c) Sample item for Newsletters d) A checklist for Creating Safe and Healthy Schools for Children with Food Allergies e) A checklist for Secondary Schools

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[Procedure B Medical/Health Support for Students] Appendix A MANAGING LIFE THREATENING ALLERGIES Introduction: Anaphylaxis or Aallergic shock@ is a severe, life-threatening allergic reaction. Susceptible students may die if exposed to even minute amounts of the substance that triggers their reaction. Immediate treatment in the form of an injection of epinephrine can be life-saving. The most common causes of anaphylaxis are:

$ foods: While any food may cause anaphylaxis, peanuts, tree nuts, seafood, cow=s milk, eggs, wheat and soy seem more likely to trigger a reaction in students. Most individuals lose their sensitivity to milk, eggs, wheat and soy by school age.

$ non-food substances: Insect venom, medications, latex and rarely, vigorous exercise

may involve a reaction. The onset of anaphylaxis can begin within seconds of exposure or after several hours. Any combination of the following symptoms may signal the onset of a reaction:

$ hives $ itching (on any part of the body) $ swelling (of any body part, especially eyes, face, tongue) $ red watery eyes $ runny nose $ vomiting $ diarrhea $ stomach cramps $ change of voice $ coughing $ wheezing $ throat tightness or closing $ difficulty breathing $ fainting or loss of consciousness $ change of colour $ sense of doom

The interval of time between onset of the first symptoms and death can be as short as a few

minutes, if the reaction is not treated. Even when symptoms have subsided after initial treatment,

they can return. Schools must recognize, and communicate to parents that, in spite of their best efforts, accidents may occur. However, once reasonable precautions have been taken, staff, parents or other students should not feel responsible for accidental exposure. If accidental exposure does occur, appropriate emergency procedures must be in place and acted upon immediately. Most literature about anaphylaxis in school settings divides the school=s responsibility into three distinct categories: information and awareness; avoidance; and emergency response.

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1.0 Information and Awareness:

1.1 Identification of Anaphylactic Students to School Authorities:

$ It is the responsibility of parents with anaphylactic children to identify their children to the

school principal and provide information regarding: $ the foods or allergen which trigger an anaphylactic reaction $ a treatment protocol, signed by the child=s physician $ any changes in the child=s condition from previous years or since last reported $ information to be posted in key locations like the classroom, school bus, staff room,

office, nurse=s room, etc.

$ This identification can be completed through the school registration process and student information updates. Parents are required to update the school immediately if

conditions change in order for the school to provide appropriate emergency treatment.

$ Identifying children with life-threatening allergies is more difficult in a secondary school setting. Although parents must still bear the burden of responsibility for reporting the condition to the school, schools may wish to explore ways of encouraging and reminding them to do so, particularly with older students, those who have moved into the system, and those who have been recently diagnosed.

1.2 Identification of Anaphylactic Students to Staff:

$ All staff members (teaching and non-teaching) must be made aware that a child with

anaphylaxis is attending their school, and the child must be identified, preferably before the school year begins. This information must be included in the OSR and the office files.

$ The board policy on Medical/Health Support For Students must be provided to all

staff, along with specific information about each anaphylactic child in attendance.

$ An allergy-alert form, with photograph, description of the allergy, treatment and action plan should be placed in key locations, such as the office, staff room, etc. and wherever the child=s epinephrine auto-injector is stored. (See Appendices).

$ Parents must be included in a decision about whether posters should also be placed in

the child=s classroom and other public places, like school buses. For younger children, this may be advisable. For older children and adolescents, issues of personal privacy must be considered.

$ Instructions on the use of the epinephrine auto-injector, along with a list of symptoms and

emergency procedures, should be posted in a clearly visible location in the child=s classroom and other key areas e.g. staff room, office. (See Appendices)

$ The child=s classroom teacher should ensure that information is kept in a place where it

will be highly visible and readily understood by supply teachers. If not posted in the classroom, it should be kept with the teacher=s day book.

$ The student should wear a medic-alert bracelet which identifies specific allergens.

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1.3 Inservice for Teachers and Other School Staff:

$ The principal must ensure that training is provided annually to school personnel,

substitute teachers and volunteers on how to recognize and treat anaphylactic reaction, on school policies that protect anaphylactic children from exposure, and on school protocol for responding to emergencies.

$ All teachers and staff who may be in a position of responsibility for children with

anaphylaxis (including noon-hour supervisors, cafeteria staff and bus drivers) must receive personal training in the use of the epinephrine auto-injector.

$ It is the responsibility of parents/guardians to ensure that the specific information about

their child is made available to school personnel to be included in the in-service training programs.

$ Where possible, parents should be encouraged to participate directly in training staff in

emergency response and the use of the epinephrine auto-injector, either as part of formal in-service, or in brief, one-on-one sessions with individual staff.

$ Public health nurses and representatives of allergy groups or local medical professionals

should play a role in delivering in-service and/or invited to share their expertise with school staff.

1.4 Substitute Teachers, Parent Volunteers and Other Classroom Assistants:

All schools involve adults in their classroom who are unfamiliar with individual students and school procedures. The following guidelines should help to prepare them to handle an anaphylactic emergency.

$ Require the classroom teacher to keep information about the anaphylactic student's

allergies and emergency procedures in a visible location.

$ Ensure that procedures are in place for informing substitute teachers and volunteers and older students about anaphylactic students.

$ Involve substitute teachers and volunteers and older students, in regular in-service

programs, or provide separate in-service for them.

1.5 Sharing Information with Other Students and Parents:

$ Consideration should be given to identifying students suffering life-threatening allergies to all students in the school, and enlisting their co-operation. This should be done in a way that is appropriate to the student=s age and maturity, without creating fear and anxiety, and in consultation with the parents of individual anaphylactic children.

$ Identification of anaphylactic students to their peers in secondary school settings should

NOT take place without consultation with the anaphylactic student. $ The risk of teasing or threatening anaphylactic children is reduced if classmates are

introduced to the situation at a young age. The risk of ignorance is generally judged to be greater that the risks associated with sharing information.

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$ A number of books and audio-visuals are available to help young classmates understand life-threatening allergies without frightening them.

$ Information may be included in health and family studies classes.

$ Parents of anaphylactic children, and older anaphylactic children, may be excellent

resources in information sharing.

1.6 Strategies to Enlist Community Support

Sharing Information with Parents and Parent Organizations:

$ Develop a communication strategy to inform parents of the presence of a student with life-threatening allergies in their child=s school and the measures being taken to protect the student.

$ Send home letters at the beginning of the year asking parents to avoid sending the

allergen in school lunches and snacks. Do not Aban@ the substance, instead ask for

co-operation.

$ When the allergen is a common item in school lunches, like peanut butter, provide parents with suggestions for alternative foods.

$ Provide parents with information about food labelling, as it applies to the allergen in

question.

$ Parent organizations could be encouraged to plan an information night on life-threatening allergies in school children.

$ Reminders or information articles in school newsletters are a way of reaching most

parents.

All concerns MUST be directed to the principal or Public Health Nurse, not to the parents of the anaphylactic child.

1.7 Maintaining Open Communications between Parents and the School:

$ The school should maintain open lines of communication with the parents of

anaphylactic students.

$ Parents should be involved in establishing specific programs for their own children, and in training staff in emergency procedures.

$ Parents should be invited to review and provide input into school protocol to reduce the

risk of exposure to allergens. 2.0 Avoidance:

It is the Board's policy to provide a safe environment for children who are susceptible to anaphylactic reactions, but it is not possible to reduce the risk to zero. The following procedures and resources allow schools and classrooms to adapt to the needs of individual children and avoidance of the allergen which triggers reactions as well as the organizational and physical

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environment in different schools. It should also be noted that precautions may vary depending on the properties of the allergen, (i.e., peanut butter poses additional cross-contamination and cleaning concerns due to its particular viscosity).

All of the following recommendations should be considered in the context of the anaphylactic child's

age and maturity.

In the earlier elementary school grades where there are peanut allergic children peanuts, peanut butter or peanut containing foods should be discouraged, since it is extremely difficult to avoid accidental ingestion. In the higher elementary school grades and secondary school settings, complete avoidance policies, while desirable, may not be practical. If there are common eating areas, peanut foods should be discouraged if there are peanut allergic children. Allergy-free classrooms may need to be instituted when appropriate. Public education of the dangers of peanut allergy and requests for cooperation limiting peanut use at school are important.

2.1 Providing Allergen-free Areas:

The following are options to consider when deciding on an appropriate eating environment:-

$ The allergic child could return home for lunch, if possible

$ If the allergic child must stay at school for lunch, provisions must be made to ensure the

child's safety by providing an allergen-free eating area.

$ The established allergen-free classroom must not be used as a common lunch room. If the classroom is used, then establish it as an "allergen-free" eating area using a cooperative approach with students and parents.

$ Establish at least one common eating area as allergen-free. In a high school setting a

section of the single common eating area could be designated as "allergen-free."

$ Develop strategies for monitoring allergen-free areas, and for identifying high risk areas for anaphylactic students.

$ As a last resort, if allergen-free eating areas cannot be established, provide a safe eating

area for the anaphylactic child and a buddy.

2.2 Establishing Safe Lunchroom and Eating Area Procedures: It should be stressed that minute amounts of certain foods like peanut when ingested, touched or inhaled, can be life threatening. Children have had skin reactions just from simply contacting residual peanut butter on tables wiped clean of visible material. Therefore, protection of the anaphylactic child requires the school to exercise reasonable control over all food products, not only those directly consumed by the anaphylactic student.

$ The anaphylactic child should eat only food that has been prepared specifically for them,

usually at home.

$ There should be no trading or sharing of food, food utensils, or food containers.

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$ Establish a hand washing routine before and after meals. $ Ensure that tables and other eating surfaces are cleaned before and after eating, using a

cleansing agent approved for school use. This is particularly important for peanut-allergic students because of the adhesive nature of peanut butter.

$ Careful supervision of lunch rooms and food celebrations will help to prevent accidental

exposure to an anaphylactic child. 2.3 Allergens Hidden in School Activities:

Not all allergic reactions to food are a result of exposure at meal times.

$ Teachers should be made aware of the possible allergens present in: Curricular material (i.e.): play dough, birdseed, beanbags, stuffed toys (peanut

shells or walnut shells are sometimes used), toys, books, and other items which may have become contaminated in the course of normal use.

Art and craft projects: The use of food in crafts and cooking classes may need to

be restricted depending on the allergies of the student.

$ Musical instruments should be sterilized as per standard procedures.

$ Anaphylactic children should not be involved in garbage disposal, yard clean up or other activities which could bring them into contact with food wrappers or debris.

$ Eating should only take place in designated areas within the school. This will reduce the

risk of accidental exposure in the schoolyard to the allergen.

$ Since foods are stored in lockers or desks, the anaphylactic child should be allowed to keep the same locker or desk all year.

2.4 Holidays and Special School Celebrations:

$ Focus on activities rather than food to mark special occasions

$ The anaphylactic child should eat only food that has been prepared specifically for them,

usually at home.

$ If foods are to come into the classroom from home, remind parents that the classroom is allergen-free, name the allergen(s) and insist on ingredient lists.

$ Encourage the use of non-food rewards (stickers, pencils, books) as opposed to food

rewards.

$ Fund-raising activities should attempt to exclude allergen containing products.

$ Check the ingredients of any food supplied by commercial sources (i.e. Pizza, cakes, cookies)

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$ Consider cleanliness and risk of contamination when food is prepared, handled or served on school premises.

2.5 Field Trips:

In addition to the usual safety precautions applying to field trips, the following procedures should be in place to protect the anaphylactic child.

$ Include a separate "serious medical conditions" section as a part of the school=s

registration permission form for all field trips in which the details of the anaphylactic student’s allergens, symptoms and treatments can be recorded. A copy of this should be

available on site at any time during the field trip.

$ Require all supervisors, staff and parents to be aware of the identity of the anaphylactic child, the allergens, symptoms and treatment.

$ Ensure that a supervisor with training in the use of the epinephrine auto-injector is

assigned responsibility for the anaphylactic child

$ If practical, consider a cell phone for buses used on field trips.

$ The parent of the anaphylactic child should provide at least two epinephrine auto injectors to be administered every 10 to 15 minutes en route to the nearest hospital, if breathing problems persist or if symptoms recur.

$ If the risk factors are too great to control, the anaphylactic child may be advised not to

participate in the field trip or the parents of the anaphylactic child could be encouraged to attend the field trip.. This decision should be made in consultation with the parents.

2.6 Anaphylaxis to Insect Venom:

Food is the most common trigger of an anaphylactic reaction in school children, and the only allergen which schools can reasonably be expected to monitor. The school cannot take responsibility for possible exposure to bees, hornets, wasps and yellow-jackets, but certain precautions can be taken by the student and the school to reduce the risk of exposure.

$ Students should avoid wearing loose, hanging clothes, floral patterns, blue and yellow

clothing and fragrances.

$ School personnel should check for the presence of bees and wasps, especially nesting areas, and arrange for their removal.

$ Eating areas should be restricted to indoors, as this decreases attraction of bees and

wasps, etc. This also reduces the amount of garbage in the schoolyard which also attracts insects.

$ Ensure that garbage containers are not attracting insects to student areas. Consult your

custodian on prevention and placement of garbage containers.

$ Caution children not to disturb insect nests.

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$ Allow students who are anaphylactic to insect stings to remain indoors for recess during bee/ wasp season.

$ Immediately remove a child with an allergy to insect venom from the room, if a bee or

wasp gets in.

3.0 Action: Emergency Response Protocol

Even when precautions are taken, an anaphylactic student may come into contact with an allergen while at school. It is essential that the school develop a response protocol, and that all staff are aware of how to implement it. A separate emergency plan should be developed for each anaphylactic child, in conjunction with the child=s parents and physician, and kept in a readily accessible location. The plan should clearly identify individual roles.

Anaphylactic children usually know when a reaction is taking place. School personnel should

be encouraged to listen to the child. If he or she complains of any symptoms, which could signal the onset of a reaction, they should not hesitate to implement the emergency response. There is no danger in reacting too quickly, and grave danger in reacting too slowly. Epinephrine is a relatively harmless drug and is best administered when you suspect a reaction.

3.1 Emergency Plans:

Every emergency plan should include procedures to:-

$ administer the epinephrine auto-injector (NOTE: Although most anaphylactic children

learn to administer their own medication by about age 8, individuals of any age may require help during a reaction because of the rapid progression of symptoms, or because of the stress of the situation Adult supervision is required.)

$ telephone 911 or an ambulance (Inform the emergency operator that a child is having an

anaphylactic reaction)

$ telephone the parents

$ transport the child to hospital at once

$ if transporting by personal vehicle, take another trained adult and extra epinephrine auto-injectors with you.

$ if breathing does not improve or if symptoms reoccur re-administer epinephrine every 10

to 15 minutes while waiting for the ambulance and en route to the hospital 3.2 Location of Epinephrine Auto-Injectors:

$ Epinephrine Auto-injectors should be kept in a covered and secure area, but unlocked for quick access. Although epinephrine is not a dangerous drug, the sharp needle of the self-injector can cause injury, especially if injected into the fingertip.

$ As soon as they are old enough, students should carry their own epinephrine

auto-injectors. Many young children carry an injection kit in a fanny pack around their waist at all times.

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$ An up-to-date supply of epinephrine auto-injectors, provided by the parents, should be available in an easily accessible, unlocked area of the child=s classroom and/or in a central area of the school (office or staff room). At least 2 should be provided by parents in case one malfunctions or additional treatment is necessary. Note: Epinephrine

Auto-injectors are expensive. If families have difficulty supplying the school with

an adequate supply, the family should consider seeking financial assistance to

ensure that medication is available, whenever and wherever it is required.

$ All staff should know the location of the auto-injectors. Classmates should be aware of

the location of the auto-injector in the classroom and in the school.

3.3 Training Older Students to Assist:

$ Older students may be trained to administer the epinephrine auto-injector, and can play a

role in the emergency response, particularly in a secondary school setting. Information about anaphylaxis and auto-injector training may be included in the health curriculum.

3.4 Role Playing:

$ The school could occasionally simulate an anaphylactic emergency -- similar to a fire drill

-- to ensure that all elements of the emergency plan are in place.

3.5 Review Process:

$ School emergency procedures for each anaphylactic student should be reviewed annually with staff and parents. In the event of an emergency response, an immediate evaluation of the procedure should be undertaken.

$ All staff and volunteers, etc. new to the school should be in-serviced.

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Appendix B

SAMPLE EMERGENCY PROTOCOL

Child=s Name - SAFETY PLAN ALLERGIES: Anaphylactic reaction (life threatening) to peanuts, peanut butter, and nuts. SYMPTOMS: Difficulty swallowing, swollen tongue, coughing (could sound like throat clearing),

drooling, burning or itching throat, hives, generalized swelling, redness, itching, vomiting, breathing difficulties.

ACTION: If ANY suspicions that child may have consumed peanuts (or any other type of nuts):

DO NOT WAIT FOR VOMITING OR BREATHING TO CHANGE. Send a runner to immediately notify the child=s classroom teacher and the

principal or designate. Lie the child on the floor. Get EpiPens from TOP RIGHT HAND DRAWER of teacher=s desk or other

EpiPen storage location established in the school plan. Use EpiPen. Proceed immediately to Hospital.

TO INOCULATE: Remove needle from case.

Pull off grey safety cap. Firmly strike OUTER MID-THIGH of child=s leg with the black tip end of the

needle (This may be injected through the child=s clothing, if necessary). Wait for fluid to enter body (10 seconds) (an accurate way to count: one-one

thousand, two-one thousand, etc). Massage area for 10 seconds. If breathing once again becomes laboured, administer the second EpiPen. Rush the child to the hospital, bringing the second EpiPen along for a possible

second injection. PHONE: Call ambulance - 911 or go immediately to the hospital.

Call parents: Mother Father or Emergency Contact

DO NOT HESITATE TO ADMINISTER MEDICATION

OR CALL AMBULANCE EVEN IF PARENTS CANNOT BE REACHED

Photo

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Appendix C SAMPLE LETTER TO PARENTS Dear Parent: I am writing to you on behalf of our student __________________________________ and his parents(s) __________________________________. ___________________________ is 5 1/2 years old in Mrs. ___________________________________________________ Grade 1/2 class. He has a life threatening reaction to peanuts and all types of nuts. If peanut butter or even the tiniest amount of peanut or any type of nut enters his body (through his eyes, nose or mouth), his body triggers an immediate defense and sends out extra antibodies to fight the allergen. Within his body he experiences very strong reactions: his face swells and breaks out in hives, his throat swells and tightens. Without immediate medical treatment he could die within minutes. After discussions with school staff and other knowledgeable parties in the medical community, it has been suggested that the best way to provide a safe environment for __________________________ would be to enlist the support of the grade 1/2 parents to help make his classroom a Apeanut and nut free environment@. This means that each child entering this grade 1/2 is asked to bring a peanut and nut free snack and lunch. Though it sounds simple, it means no peanut butter sandwiches or peanut butter cookies. Other foods like muffins, granola bars and cereals will require reading labels before being packed in your child=s snack. Our concern is for foods where peanuts or other nuts might be a Ahidden@ ingredient. I realize this request poses an inconvenience for you when packing your child=s snack and lunch, however, I wish to express sincere appreciation for your support and understanding of this potentially life-threatening allergy. In the very near future the school will announce a parent meeting for you to become acquainted with this situation. Literature will be provided suggesting healthy and nutritional alternatives to nuts and their by-products. Sincerely, Vice-Principal

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Appendix D

Sample Item for Newsletters

Watch out for life-threatening allergies Many children have allergies. A few, however, are life threatening. Some children, for example, are severely allergic to peanut butter. Even a tiny bit can be fatal within minutes. Nuts, shellfish, fish, eggs and milk are also known to cause severe reactions. Knowing that your child has allergies and knowing how to deal with them is your best defence. If your child is allergic to peanut products, please tell us. With your help, we will do our best to prevent mishaps and to make sure that all of our students are safe, healthy and able to concentrate on learning. If you would like further information about our policies and practices, please call the school. 8 NORTH YORK BOARD OF EDUCATION. 1995

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Appendix E

A CHECKLIST FOR CREATING

SAFE AND HEALTHY SCHOOLS

FOR CHILDREN WITH FOOD ALLERGIES School staff and parents are responsible for creating safe and healthy environments for students. This is an extra challenge for schools attended by children with life-threatening food allergies. For some children, severe allergic reactions can be triggered not only by eating foods, but also by their touch and smell. This has implications for the whole school, not just individual classrooms. It is important to review your school=s use of foods. If foods pose health risks for some children, try not to make them the focus of all your special events. It will be safest to use non-food fundraisers. Discourage the use of food as a reward for good behaviour. Too often these rewards are unhealthy or unsafe food choices. When food is a part of your school=s activities, emphasize healthy and wholesome foods like fresh fruits and vegetables. They can be safely enjoyed by most children because they are easily identified and have no added ingredients. Highly processed foods contain hidden ingredients which cannot be enjoyed freely by children with special dietary needs. While it is impossible to create a risk-free environment, school staff and parents can take important steps to minimize potentially fatal allergic reactions. Accurate records, written protocols, staff education, parental support, and classroom and school rules should all be considered. Use this checklist to develop and implement your school=s plan. Q Have you received written notification from the allergic child=s physician regarding specific

foods to avoid, as well as authorization for emergency treatment?

Q Have you established a written protocol with the parent of the allergic child which includes:

Q a picture of the child? Q specific information on the child=s food restrictions? Q use of a Medic Alert bracelet to identify the child=s specific allergies? Q authorization and directions for administration of emergency medications? Q at least 2 doses of the emergency medication, labelled with the child=s name, and expiry date

(children who are old enough can carry 1 dose with them at all times)? Q unlocked, safe, and accessible storage of emergency medication, in locations which are known to

all appropriate staff? Q plan for transportation to hospital? Q telephone numbers for parents and alternate emergency contacts? Q posting of an Emergency Protocol, with parental consent, in accessible location in the school (See

Appendix A)? Q annual review of this protocol to ensure that it is still current?

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Q Have you worked with the parent of the allergic child and the Public Health Nurse assigned to

your school to educate and update your school staff, lunchroom/playground supervisors, bus

drivers, parents, parent-teacher association, volunteers and other students about:

Q food allergies and their potential severity? Q recognizing symptoms of an allergic reaction? Q administering emergency medications? Q the emergency plan?

Q Have you gained the cooperation of other parents in the school by working with the parent of

the allergic child to:

Q organize information sessions? Q set up information displays? Q send out letters explaining the need for special food rules (see Appendix B)?

Q Have you taken steps to create safe classrooms where:

Q allergic children are encouraged to eat the foods they bring from home? Q trading and sharing of food is discouraged? Q the use of food in crafts and activities is reviewed? Q hand washing is encouraged before and after eating? Q clean desks or other eating surfaces are promoted? Q the banning of food allergens from the classroom is considered? Q adequate controls are in place if food allergens are allowed in the classroom? Q parents are asked to provide detailed labelling on foods they send into the classroom for sharing? Q there is appropriate training for older students who may be responsible for supervising classrooms?

Q Have you taken steps to create safe conditions outside the classroom:

Q do you have plans in place to ensure safe field trips or extra-curricular activities? Q do your permission slips for off-site activities include information on food allergies? Q can children take foods outside at recess? Q are they encouraged to wash their hands after eating? Q what types of foods are available at special events? If foods are ordered in from commercial

sources, do you ask for a list of ingredients? Q are food preparation/handling areas kept clean? Q are staff/parents reminded to use clean utensils when preparing foods for the allergic child? Q is garbage disposal handled safely?

Q Have you been sensitive to the needs of the child? Each child=s need will be different. Make

sure that you have taken all the information you need about their specific food allergies, as

well as their severity. Take realistic and practical actions which will be well-supported by

everyone involved.

Developed by staff of Middlesex-London Health Unit in collaboration with the

London Chapter of the Allergy Asthma Information Association. November 1994

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Appendix F

A CHECKLIST FOR SECONDARY SCHOOLS Check registration forms for medical information.

Develop an emergency protocol with the assistance of the parent and the student who has a

severe allergy (see protocol items in previous checklist).

Work with the parent, allergic student and Public health Nurse to ensure that school personnel

and other students are educated and updated regarding anaphylaxis and the emergency plan.

Remind students with severe allergies to provide the office with information about their

specific allergy early in the school year.

Include an article about allergies and anaphylaxis in your first newsletter to educate parents

and students.

Review student emergency protocols every year for accuracy.

Establish an allergen-free section in the lunchroom or other area.

Adapted from: Guidelines for Creating Safe and Healthy Schools for Children With Food Allergies, Carleton Board, of Education, February 16, 1995.

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Appendix G

Educational Materials for Children Videos AAlexander, The Elephant Who Couldn’t Eat Peanuts@ AIt Only Takes One Bite@ Both available from: The Food Allergy Network 4744 Holly Avenue Fairfax, VA. USA 22030-5647 Phone: (703) 691-3179 Fax: (703) 691-2713 Books A Preschooler=s Guide to Peanut Allergy The Ticketar Company 799 Deveron Cres. London, Ontario. N5Z 5B4 (519) 685-0897 No Nuts for Me! By Aaron Zevy Tumbleweed Press 401 Magnetic Dr., Unit 11 Downsview, Ont. M3J 3H9

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Appendix H

Suggested Reading AAnaphylaxis@ by Susan Daglish . B.A. AAIA Infoletter Anaphylaxis in Schools and Other Child Care Setting by Drs. Milton Gold, Gordon Sussman, Michael Loubser and Karen Binkley Published jointly by the Canadian Society of Allergy and Clinical Immunology, The Ontario Allergy Society, and The Allergy, Asthma Information Association, 1995. The Canadian Allergy and Asthma Handbook by Dr. Barry Zimmerman, Dr. Milton Gold, Dr. Sasson Lavi, Dr. Stephen Feanny Random House/Lorraine Greey, 1991. AFatal Anaphylactic Reactions to Food in Children.@ Position Statement, Allergy Section, Canadian Pediatric Society, Canadian Medical Association Journal, 1994. AFatal and Near Fatal Anaphylactic Reactions to Food in Children and Adolescents@ by Hugh A. Sampson, M.D., Louise Mendelson, M.D., James P. Rosen, M.D. New England Journal of Medicine, 6 August 1992. AMedication of Pupils and Related Issues@ by William F. Foster, 1995. ASurviving Anaphylaxis@ by Dr. Karen Binkley Ontario Medicine, 5 October 1992 AFoods That Can Kill@ by Sidney Katz Reader=s Digest, September 1991

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Date of Issue: DRAFT: October 24, 2017 Effective: September 1, 2018

Subject: SUPPORTING CHILDREN AND STUDENTS WITH PREVALENT MEDICAL CONDITIONS (ANAPHYLAXIS, ASTHMA, DIABETES, AND/OR EPILEPSY) IN SCHOOLS

Application: Directors of Education Supervisory Officers and Secretary-Treasurers of School Authorities Principals of Elementary Schools Principals of Secondary Schools Principals of Provincial and Demonstration Schools

INTRODUCTION

To promote the safety and well-being of students,1 the Ministry of Education expects all school boards2 in Ontario to develop and maintain a policy or policies to support students in schools3 who have asthma, diabetes, and/or epilepsy, and/or are at risk for anaphylaxis. These medical conditions, hereafter referred to as prevalent medical conditions,4 have the potential to result in a medical incident5 or a life-threatening medical emergency.

The purpose of this memorandum is to provide direction to school boards about the components that should be included in their policy or policies to support students with prevalent medical conditions in schools. This memorandum must not be implemented in a manner that violates existing provisions of collective agreements and related memoranda of understanding among parties to such agreements.

School board policies should be implemented as soon as possible, but no later than September 1, 2018.

As stipulated in Sabrina’s Law, 2005, and Ryan’s Law, 2015, all school boards must have policies to support students at risk for anaphylaxis and students with asthma. School boards should review their policies on anaphylaxis and asthma and ensure that their policies, at a minimum, meet the expectations outlined in this memorandum.

If school boards currently have policies to support students with diabetes or epilepsy, boards should ensure that their policies, at a minimum, meet the expectations outlined in this memorandum.

1. In this memorandum, unless otherwise stated, student(s) includes children in Kindergarten and students in Grades 1 to 12. 2. In this memorandum, school board(s) and board(s) refer to district school boards and school authorities.3. In this memorandum, school refers to all school and school-board activities, including field trips, overnight excursions, board-sponsored sporting events, and board-operated before- and after-school programs for children aged 4 to 12 years.4. In this memorandum, unless otherwise stated, prevalent medical conditions are limited to asthma, diabetes, epilepsy, and anaphylaxis, when diagnosed for a student by a medical doctor or a nurse practitioner.5. A medical incident is a circumstance that requires an immediate response and monitoring, since the incident may progress to an emergency requiring contact with Emergency Medical Services. See also “Emergency Response” on page 8.

Ministry of Education Policy/ProgramMemorandumNo. 161 (Draft)

Ministry of Education Policy/ProgramMemorandumNo. 161 (Draft)Page 2

This memorandum complements other Ministry of Education policies and programs, including those that serve students with special education needs. Its implementation should be aligned with that of other memoranda, including Policy/Program Memoranda Nos. 81and 149.6

ROLES AND COLLECTIVE RESPONSIBILITIESSupporting students with prevalent medical conditions in schools is complex. A whole-school approach is needed where education and community partners, including health care professionals,7 have important roles to play in promoting student health and safety and in fostering and maintaining healthy and safe environments in which students can learn.

To support school boards, the Ministry of Education is providing evidence-based resources online, on the ministry’s Prevalent Medical Conditions web portal. These resources have been developed by various health and education partners (Asthma Canada, Diabetes Canada, Canadian Paediatric Society, Epilepsy Ontario, Food Allergy Canada, The Lung Association – Ontario, Ophea, and Ontario Education Services Corporation).

The ministry will continue to engage in dialogue with school boards and education partners, sharing information and best practices, to ensure successful implementation of board policies.

SCHOOL BOARD POLICIES ON PREVALENT MEDICAL CONDITIONS In developing, revising, implementing, and maintaining their policies to support students with prevalent medical conditions, school boards must respect their obligations under all applicable legislation, policies, and collective agreements. School boards should also take into account local needs and circumstances, such as geographical considerations, demographics, and cultural considerations, as well as the availability of supports and resources, including school staff,8 within the school board and the community.

A culture of collaborative professionalism is grounded in a trusting environment where schools, school boards, federations, unions, and the ministry create the necessary conditions, including consideration of time and resources, that enable education stakeholders to learn with, and from, each other.

In developing or revising their policies, school boards should consult with students, parents,9 principals’ associations, teachers’ federations, education workers’ unions, school staff, volunteers working in the schools, their school councils, Joint Health and Safety Committees, and community health care

6. Policy/Program Memorandum No. 81, “Provision of Health Support Services in School Settings”, July 19, 1984, and Policy/Program Memorandum No. 149, “Protocol for Partnerships with External Agencies for Provision of Services by Regulated Health Professionals, Regulated Social Service Professionals, and Paraprofessionals”, September 25, 2009. 7. In this memorandum, health care professional refers to a member of a College under the Regulated Health Professions Act, 1991 (e.g., medical doctor, nurse practitioner, registered nurse, pharmacist).8. In this memorandum, unless otherwise noted, school staff refers to all school staff, including occasional staff. This memorandum does not intend to prescribe, duplicate, or remove any duties already performed by these staff.9. In this memorandum, parent(s) refers to parent(s) and guardian(s).


professionals. This consultation should also include Parent Involvement Committees10 and Special Education Advisory Committees.

Components of School Board Policies All school board policies on supporting students with prevalent medical conditions are expected to contain, at a minimum, the following components.

1. Policy Statement The school board policy statement on supporting students with prevalent medical conditions should, at a minimum, include the following goals:

to support students with prevalent medical conditions to fully access school in a safe, accepting, and healthy learning environment that supports well-being to empower students, as confident and capable learners, to reach their full potential for self-management11 of their medical condition(s), according to their Plan of Care12

2. Roles and Responsibilities School board policies should clearly articulate the expected roles and responsibilities of parents and school staff in supporting students with prevalent medical conditions, as well as the roles and responsibilities of the students themselves. School board policies should also contain a requirement that schools communicate the roles and responsibilities clearly to parents, students, and school staff.

a) Parents of Children with Prevalent Medical ConditionsAs primary caregivers of their child, parents are expected to be active participants in supporting the management of their child’s medical condition(s) while the child is in school. At a minimum, parents should:

educate their child about their medical condition(s) with support from their child’s health care professional, as needed; guide and encourage their child to reach their full potential for self-management and self-advocacy;inform the school of their child's medical condition(s) and co-create the Plan of Care for their child with the principal or the principal’s designate;

10. Parent Involvement Committees are established under O. Reg. 612/00.11. “Self-management” of medical conditions can be understood to exist along a continuum where students’ cognitive, emotional, social, and physical capacity and stage of development are determinants of their ability to confidently and independently manage their medical condition(s). The students’ journey to reach their full potential along the self-management continuum is not linear and can require varying levels of support over time. A student’s capacity for self-management may be compromised during certain medical incidents, and additional support will be required. As a student’s needs change, the Plan of Care would need to be adjusted accordingly.12. A Plan of Care is a form that contains individualized information on a student with a prevalent medical condition. See section 3 for details.


communicate changes to the Plan of Care, such as changes to the status of their child’s medicalcondition(s) or changes to their child’s ability to manage the medical condition(s), to the principal or the principal’s designate;confirm annually to the principal or the principal’s designate that their child’s medical status is unchanged; initiate and participate in meetings to review their child’s Plan of Care;supply their child and/or the school with sufficient quantities of medication and supplies in their original, clearly labelled13 containers, as directed by a health care professional and as outlined in the Plan of Care, and track the expiration dates if they are supplied; seek medical advice from a medical doctor, nurse practitioner, or pharmacist, where appropriate.

b) Students with Prevalent Medical Conditions Depending on their cognitive, emotional, social, and physical stage of development, and their capacity for self-management, students are expected to actively support the development and implementation of their Plan of Care. Students should:

take responsibility for advocating for their personal safety and well-being that is consistent with their cognitive, emotional, social, and physical stage of development and their capacity for self-management;participate in the development of their Plan of Care;participate in meetings to review their Plan of Care;carry out daily or routine self-management of their medical condition to their full potential, as described in their Plan of Care (e.g., carry their medication and medical supplies; follow school board policies on disposal of medication and medical supplies); set goals on an ongoing basis for self-management of their medical condition, in conjunction with their parent(s) and health care professional(s);communicate with their parent(s) and school staff if they are facing challenges related to their medical condition(s) at school; wear medical alert identification that they and/or their parent(s) deem appropriate; if possible, inform school staff and/or their peers if a medical incident or a medical emergency occurs.

c) School Staff School staff should follow their school board’s policies and the provisions in their collective agreements related to supporting students with prevalent medical conditions in schools. School staff should, for example:

review the contents of the Plan of Care for any student with whom they have direct contact; participate in training, during the instructional day, on prevalent medical conditions, at a minimum annually, as required by the school board;

13. In Ontario, the labelling requirements, i.e., identification markings on a container in which a drug is dispensed, are set outin section 156(3) of the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4.


share information on a student’s signs and symptoms with other students, as outlined in the Plan of Care and authorized by the principal in writing; follow school board strategies that reduce the risk of student exposure to triggers or causative agents in classrooms, common school areas, and extracurricular activities, in accordance with the student’s Plan of Care; support a student’s daily or routine management, and respond to medical incidents and medical emergencies that occur during school, as outlined in board policies and procedures (in situations where school board staff already provide supports to students with prevalent medical conditions, and are already trained appropriately, this memorandum does not intend to prescribe, duplicate, or remove those duties or training); support inclusion by allowing students with prevalent medical conditions to perform daily or routine management activities in a school location (e.g., classroom), as outlined in their Plan of Care, while being aware of confidentiality and the dignity of the student; enable students with prevalent medical conditions to participate in school to their full potential, as outlined in their Plan of Care.

d) PrincipalIn addition to the responsibilities outlined above under “School Staff”, the principal should:

clearly communicate to parents and appropriate staff the process for parents to notify the school of their child’s medical condition(s), as well as the expectation for parents to co-create, review, and update a Plan of Care with the principal or the principal’s designate. This process should be communicated to parents, at a minimum:

during the time of registration; each year during the first week of school;when a child is diagnosed and/or returns to school following a diagnosis;

co-create, review, or update the Plan of Care for a student with a prevalent medical condition with the parent(s), in consultation with school staff (as appropriate) and with the student (as appropriate); maintain a file with the Plan of Care and supporting documentation for each student with a prevalent medical condition; provide relevant information from the student’s Plan of Care to school staff and others who are identified in the Plan of Care (e.g., food service providers, transportation providers, volunteers, occasional staff who will be in direct contact with the student), including any revisions that are made to the plan; communicate with parent(s) in medical emergencies, as outlined in the Plan of Care;encourage the identification of staff who can support the daily or routine management needs of students in the school with prevalent medical conditions, while honouring the provisions within their collective agreements.


e) School Board School boards are expected to communicate, on an annual basis, their policies on supporting students with prevalent medical conditions to parents, school board staff, and others in the school community who are in direct contact with students (e.g., food service providers, transportation providers, volunteers). At a minimum, school boards are expected to make their policies and their Plan of Care templates available on their public website in the language of instruction.

School boards are also expected to: provide training and resources on prevalent medical conditions on an annual basis; develop strategies that reduce the risk of student exposure to triggers or causative agents in classrooms and common school areas; develop expectations for schools to support the safe storage14 and disposal of medication and medical supplies, and communicate these expectations to schools and support schools in the implementation of the expectations;communicate expectations that students are allowed to carry their medication and supplies to support the management of their medical condition, as outlined in their Plan of Care; consider this memorandum and related board policies when entering into contracts with transportation, food service, and other providers.

3. Plan of Care A Plan of Care is a form that contains individualized information on a student with a prevalent medical condition. School board policies and procedures must include a Plan of Care form. The ministry is providing school boards with a sample Plan of Care, which is available online through the ministry’s Prevalent Medical Conditions web portal. This sample has been developed in consultation with health and education partners.

If they are adapting the sample Plan of Care, school boards should include, at a minimum, all of the following elements:

preventative strategies to be undertaken by the school to reduce the risk of medical incidents and exposure to triggers or causative agents in classrooms and common school areas identification of school staff who will have access to the Plan of Care identification of routine or daily management activities that will be performed by the student, parent(s), or staff volunteer(s), as outlined in school board policy, or by an individual authorized by the parent(s)a copy of notes and instructions from the student’s health care professional, where applicable information on daily or routine management accommodation needs of the student (e.g., space, access to food) (where possible, a student should not be excluded from the classroom during daily or

14. Safe storage includes the recommended storage condition(s) for medication and medical supplies. Part of the purpose of safe storage is to enable students to have ready access to their medication and medical supplies when they are not carrying the medication and supplies with them. Safe storage should also include storage considerations when the student is attending board-sponsored activities and travelling to and from such activities.


routine management activities, unless the student or the parent(s) indicate they prefer exclusion) information on how to support or accommodate the student to enable participation to their full potential in all school and school board activities (e.g., field trips, overnight excursions, board-sponsored sporting events) identification of symptoms (emergency and other) and response emergency contact information for the student clear information on the school board’s emergency policy and procedures details related to storage and disposal of the student’s prescribed medication(s) and medical supplies, such as:

parental permission for the student to carry medication and/or medical supplies location of spare medication and supplies stored in the school, where applicable information on the safe disposal of medication and medical supplies

requirements for communication between the parent(s) and the principal (or the principal’s designate) and/or school staff, as appropriate, including format and frequency parental consent to share information on signs and symptoms with other students

The Plan of Care for a student with a prevalent medical condition should be co-created, reviewed, and/or updated by the parent(s) in consultation with the principal or the principal’s designate, designated staff (as appropriate), and the student (as appropriate), during the first thirty school days of every school year and, as appropriate, during the school year (e.g., when a student has been diagnosed with a prevalent medical condition).

Parents have the authority to designate who is provided access to the Plan of Care. With authorization from the parents, the principal or the principal’s designate should share the Plan of Care with school staff who are in direct contact with students with prevalent medical conditions and, as appropriate, others who are in direct contact with students with prevalent medical conditions (e.g., food service providers, transportation providers, volunteers).

4. Facilitating and Supporting Daily or Routine Management In their policies, school boards should outline board expectations for providing supports15 to students with prevalent medical conditions in order to facilitate their daily or routine management activities in school.

Where possible, facilitating and supporting daily or routine management involves, but is not limited to, supporting inclusion by allowing students with prevalent medical conditions to perform daily or routine management activities in a school location (e.g., within the classroom), as outlined in their Plan of Care.

15. In situations where school board staff already provide supports (daily or routine management or other support) to students with diabetes and/or epilepsy, and are already trained appropriately, this memorandum does not intend to prescribe, duplicate, or remove those duties or training.


5. Emergency Response In their policies, school boards should outline board expectations for school staff responses to medical incidents and/or medical emergencies at school that involve students with prevalent medical conditions. At a minimum, the response should align with existing school board medical emergency procedures (e.g., immediate response, including use of emergency medication, and monitoring and/or calling Emergency Medical Services). The response should also align with the Plan of Care established for the student.

School boards should review their medical emergency procedures, consulting evidence-based materials that have been developed by health and education partners. See the resources available online through the ministry’s Prevalent Medical Conditions web portal, referred to on page 2 of this memorandum.

6. Raising Awareness of Board Policy and of Evidence-Based ResourcesSchool boards should raise awareness of their policies on prevalent medical conditions. They should also raise awareness of the range of evidence-based resources that provide information on various aspects of prevalent medical conditions, including triggers or causative agents, signs and symptoms characteristic of medical incidents and of medical emergencies, and school board emergency procedures. As stated above, such resources have been developed by health and education partners, and are available through the ministry’s Prevalent Medical Conditions web portal.

Schools, also, should raise awareness of prevalent medical conditions that affect students. They can do so, for example, through curriculum content in classroom instruction, other related learning experiences, and classroom leadership opportunities. Awareness is especially important at times of transition (e.g., the move to a new school, the move from elementary to secondary school), when students have to face social, physiological, and environmental changes.

School boards should also make appropriate resources available to occasional staff and service providers, such as food service and transportation providers.

7. Training School board policies should include strategies for providing training related to prevalent medical conditions,16 at a minimum annually, for school staff who have direct contact with students with medical condition(s). Particular consideration should be given to the training needs of occasional staff. Training should take place within the student’s first thirty days of school, where possible, to ensure the safety and well-being of the student, and should be reviewed as appropriate.

The scope of training should include the following: strategies for preventing risk of student exposure to triggers and causative agents strategies for supporting inclusion and participation in school recognition of symptoms of a medical incident and a medical emergency information on school staff supports, in accordance with board policy

16. As set out in Sabrina’s Law, 2005, and Ryan’s Law, 2015.


medical incident response and medical emergency response documentation procedures

It is expected that school boards, in consultation with teachers’ federations, principals’ associations, and education workers’ unions, will determine the scope of training required to support implementation of their policies, as well as the mode of delivery of the training and any privacy implications that may arise. The scope of training should be consistent with expected duties of school board staff, as outlined in school board policy.

To support school board training needs, evidence-based materials are available online through the ministry’s Prevalent Medical Conditions web portal.

8. Safety Considerations School board policies should:

allow for students to carry their medication(s) (including controlled substances17) and supplies, as outlined in the Plan of Care; set expectations for schools to support the storage (according to the item’s recommended storage conditions) and safe disposal of medication and medical supplies; include a process and appropriate resources to support students with prevalent medical conditions in the event of a school emergency (e.g., bomb threats, evacuation, fire, “hold and secure”, lockdown)18

or for activities off school property (e.g., field trip, sporting event) (this process should also include considerations for occasional staff).

School boards are expected to provide schools with appropriate supplies to support safe disposal of medication and medical supplies.

In accordance with the requirement of the Child and Family Services Act, 1990, where board employees have reason to believe that a child may be in need of protection, board employees must call the Children’s Aid Society and file a formal report.

9. Privacy and Confidentiality School boards should have a policy in place regarding the confidentiality of students’ medical information within the school environment, including practices for accessing, sharing, and documenting information. School boards must comply with applicable privacy legislation and obtain parental consent in the individual Plan of Care prior to sharing student health information with school staff or other students. Parents and school staff should be informed of the measures to protect the confidentiality of students’ medical records and information.

17. A controlled substance is a drug or narcotic, as set out under the federal Controlled Drugs and Substances Act. 18. The process should be aligned with the requirements set out in “Appendix B: Provincial Policy for Developing and Maintaining Lockdown Procedures for Elementary and Secondary Schools in Ontario” of the ministry document Provincial Model for a Local Police/School Board Protocol, revised 2015.


10. ReportingSubject to relevant privacy legislation, school boards should develop a process to collect data regularly, including, but not limited to, data on the number of students with prevalent medical conditions at their schools, and should monitor the number of occurrences of medical incidents and medical emergencies, as well as the circumstances surrounding these events. School boards should use these data as part of their cyclical policy reviews.

Under the authority of paragraph 27.1 of subsection 8(1) of the Education Act, school boards will be required to report to the Minister of Education upon implementation and, upon request thereafter, on their activities to achieve the expectations outlined in this memorandum.

11. Liability In 2001, the Ontario government passed the Good Samaritan Act to protect individuals from liability with respect to voluntary emergency medical or first-aid services. Subsections 2(1) and (2) of this act state the following with regard to individuals:

2. (1) Despite the rules of common law, a person described in subsection (2) who voluntarily and without reasonable expectation of compensation or reward provides the services described in that subsection is not liable for damages that result from the person’s negligence in acting or failing to act while providing the services, unless it is established that the damages were caused by the gross negligence of the person.

(2) Subsection (1) applies to, … (b) an individual … who provides emergency first aid assistance to a person who is ill, injured

or unconscious as a result of an accident or other emergency, if the individual provides the assistance at the immediate scene of the accident or emergency.

As well, Sabrina’s Law and Ryan’s Law each include provisions limiting the liability of individuals who respond to an emergency relating to anaphylaxis or asthma, respectively, as cited below.Subsection 3(4) of Sabrina’s Law states:

No action for damages shall be instituted respecting any act done in good faith or for any neglect or default in good faith in response to an anaphylactic reaction in accordance with this Act, unless the damages are the result of an employee’s gross negligence.

Subsection 4(4) of Ryan’s Law states:

No action or other proceeding for damages shall be commenced against an employee for an act or omission done or omitted by the employee in good faith in the execution or intended execution of any duty or power under this Act.

Documents

POLICY SUPPORTING STUDENTS WITH PREVALENT MEDICAL/ HEALTH CONDITIONS … · 2018-03-01 · 1.0 It is the policy of the Board to support students with prevalent medical/health conditions