Rhode Island Code of Regulations
Title 216 - Department of health
Chapter 20 - Community Health
Subchapter 10 - Screening, Medical Services, and Reporting
Part 4 - School Health Programs
Section 216-RICR-20-10-4.21 - First Aid and Emergencies
Universal Citation: 216 RI Code of Rules 20 10 4.21
Current through March 20, 2024
A. Each school must have written protocols and standing orders available in the event of injuries and acute illnesses, including anaphylaxis and cardiac arrest.
B. Protocols and standing orders must be prepared, dated, signed, reviewed and updated, as appropriate, but at least on an annual basis by the school physician(s).
C. Protocols must also be reviewed annually by all school personnel designated by the school principal (or other designated school authority), who might be involved in managing an emergency in a school, including anaphylaxis, prior to the arrival of more fully trained persons.
D. No requirement in this Part shall be construed as prohibiting the issuance of a standing order by a school physician for the administration of an epinephrine auto-injector by a school nurse to a student who has not been previously medically identified for the prevention or treatment of anaphylaxis. This standing order must be reviewed in accordance with § 4.21(B) of this Part.
4.21.1
Basic First Aid
Training
A. In-service basic first aid
training must be provided for school personnel who might be involved in
managing an injury or other medical emergency.
B. Personnel must be identified by the school
principal, or other designated school authority, and listed in the emergency
protocol described in §§
4.21(B) through
(D) of this Part.
C. First aid subjects to be covered must
include, but not be limited to: control of major bleeding, use of
universal/standard precautions, management of ocular trauma and emergencies,
management of burns, diabetes-related signs and symptoms, accessing the "911"
emergency medical system, proper application and removal of disposable gloves
and equipment, and movement and transportation of an injured person.
D. No less than one (1) hour of basic first
aid training or current certification for the allotted term of said
certification in basic first aid by a nationally recognized organization shall
be required of school personnel designated by the school administrator during
every school year.
E. The school
principal, or other authorized school personnel, must maintain a record-keeping
system documenting that the basic first aid training (as required under §
4.21.1(D) of this Part) has been provided to all designated school
personnel.
F. The training must be
delivered by a school nurse, or other designated instructor, utilizing a
training curriculum that adheres to standards established by a
nationally-recognized body.
G.
Students engaged in potentially hazardous tasks (including, but not limited to,
activities during normal school hours in science laboratories, industrial arts,
physical education, and family/consumer science classes) should be directly
supervised by teachers or instructors who are trained in the administration of
basic first aid, and who have posted and discussed safety rules with the
students.
4.21.2
Cardiopulmonary Resuscitation Training
A. At all times, during normal school hours
and at on-site school-sponsored activities, each school must have available at
least one (1) person other than the school nurse who is trained, competent and
responsible for the administration of basic first aid, child/adult
cardiopulmonary resuscitation (CPR), including emergency procedures for
obstructed airways (choking) and drowning, and administration of the
epinephrine auto-injector.
B.
Requirements for automated external defibrillators (AEDs) in high schools and
middle schools are pursuant to R.I. Gen Laws § 16.21-33.1(b).
4.21.3
Anaphylaxis
Training
Training must be provided for school personnel who might administer an epinephrine auto-injector in a case of anaphylaxis. Subjects to be covered must include, but not be limited to,: signs and symptoms of anaphylactic shock, proper epinephrine auto-injector administration, adverse reactions, accessing the "911" emergency medical system, and preparation for movement and transport of the student.
4.21.4
Response to and Treatment for
Anaphylaxis
A. To prevent or treat a
case of anaphylaxis (as defined in §
4.3(A)(2) of
this Part), the school nurse or trained school personnel must administer the
epinephrine auto-injector to an identified student. School nurses must
administer the epinephrine auto-injector in accordance with standard nursing
practice.
B. In the event of a
suspected case of anaphylaxis, school personnel may administer the emergency
protocol, including an epinephrine auto-injector to a medically identified
student when authorized by a parent/guardian and when ordered by a physician or
other licensed prescriber.
C.
School health programs must develop and adopt a procedure for addressing
incidents of anaphylaxis and the use of the epinephrine auto-injector on
previously medically identified students. Such procedures must pertain to no
less than the requirements described in this Part and must include the
following:
1. Parents must provide a
physician's or other licensed prescriber's order, parent authorization, and
filled prescription(s) such as, the epinephrine auto-injector(s)) notifying the
school of the student's allergy and the need to administer the epinephrine
auto-injector in a case of anaphylaxis.
2. School administrators must communicate the
required medical information from the parent to the appropriate school
personnel, including the school nurse, teachers, food service workers, and
school bus drivers and bus monitors.
3. The school physician must review these
procedures on an annual basis.
4.
Such procedures must stipulate that the epinephrine auto-injector be used only
on the student for whom it was prescribed, in accordance with the provisions of
R.I. Gen. Laws Chapter 21-28.2.
5.
Such procedures must provide for the development of an individualized emergency
care plan for a student at risk for anaphylaxis.
6. Procedures for accessing the community's
emergency medical system, also known as, "911".
D. Students who are treated for anaphylaxis
at the school must be transported by a licensed ambulance/rescue service
promptly to an acute care hospital for medical evaluation and
follow-up.
E. If appropriate, a
student identified as being at risk for anaphylaxis should carry the
epinephrine auto-injector at all times. If this is not appropriate, the
epinephrine auto-injector must, if necessary for the student's safety, as
determined by the physician, or other licensed prescriber, be available in the
classroom, cafeteria, physical education facility, health room and/or other
areas where the epinephrine auto-injector is most likely to be used. Reasonable
provisions must be made for the availability, safekeeping and security of the
epinephrine auto-injector. The school must develop protocols and procedures
related to the availability, safekeeping and security of the epinephrine
autoinjector.
F. School personnel
who have been trained in accordance with §§ 4.21.1, 4.21.2, and/or
4.21.3 of this Part are authorized to administer the epinephrine autoinjector
to an identified student. If trained school personnel are not available, any
willing person may administer the epinephrine auto-injector to a medically
identified student. None of the requirements of this Part shall preclude the
self administration of an epinephrine auto-injector by a medically identified
student.
G. In accordance with R.
I. Gen Laws §
16-21-22(e),
school districts may permit schools to maintain epinephrine auto-injectors for
emergency first aid to students who experience allergic reactions.
4.21.5
Good Samaritan
Provisions
School personnel who voluntarily assist persons suffering from anaphylaxis are immune from liability for ordinary negligence in accordance with R.I. Gen Laws §§ 9-1-27.1 and 16-21-22(d).
4.21.6
Food Allergy
Management
A. Schools that have
students with peanut/tree nut allergies are required to post a notice in
accordance with R.I. Gen Laws §
16-21-31.
B. In all public and non-public elementary,
middle or junior high schools, the school authority shall develop a policy
designed to provide a safe environment for students with peanut/tree nut
allergies pursuant to R.I. Gen Laws §
16-21-32.
C. Students with peanut/tree nut allergies,
must have an IHCP and EHCP developed in accordance with R.I. Gen Laws §
16-21-32 prior to entry into school or immediately thereafter for students diagnosed
with an allergy.
D. In addition to
the requirements of R.I. Gen Laws §
16-21-32,
the IHCP and EHCP must be part of the student's permanent record, include both
preventative measures to help avoid accidental exposure to allergens, and
emergency measures in case of exposure. Additional measures shall include:
1. Educating school personnel, students, and
families about food allergies; and,
2. Implementing protocols around cleaning
surfaces touched by food products, washing of hands after eating,
etc.
E. The EHCP must be consistent with applicable provisions contained in this Part, including, but not limited to, training, communication, plan review, Good Samaritan protections in accordance with R.I. Gen Laws § 9-1-27.1, and followup and documentation.
F. All school personnel who may be involved in the care of a student who has been diagnosed with a peanut/tree nut allergy must be informed of the IHCP and the EHCP, as appropriate.
4.21.7
Follow-up
&& Documentation Requirements
A. Following a traumatic injury, an episode
of anaphylaxis, or other emergency, a written report must be completed and
filed in the student health record and verbal notification made to the
student's parents as soon as possible by the school principal or
designee.
B. Following a minor
injury, the school nurse, or other appropriate school authority, must make a
notation of the minor injury in a log book maintained by the school
specifically for this purpose. At a minimum, the following items must be noted:
1. Date and time of injury;
2. Location where injury occurred;
3. Chief complaint;
4. Treatment administered;
5. Disposition (e.g., back to
class);
6. Signature of
responder.
C. For each
student, emergency information must be documented and updated on an annual
basis. Such emergency information must include no less than the following:
1. Name and telephone number of the student's
parent and additional contact person(s) in the event of an emergency;
2. Name and telephone number of the student's
primary care provider;
3. Health
insurance (optional);
4. Known
allergies (including drug, food, insect bite and chemical allergies);
5. Medical conditions that may need
attention, such as, past surgeries, heart problems, seizure disorders,
nosebleeds, or diabetes;
6.
Current, routine prescription medications and authorized OTC
medications.
D.
Protocols or procedures shall be developed to require an individualized
emergency care plan for a student at risk for anaphylaxis, asthmatic conditions
and/or any other medical emergencies, as defined in §
4.3 of this Part.
4.21.8
Concussions/Head
Injuries in Recreational and/or Athletic Competition
A. A youth athlete who is suspected of
sustaining a concussion or head injury in a practice or game related to
recreational and/or athletic competition must be removed from that practice or
competition at that time.
B. A
youth athlete who has been removed from play may not return to play until the
athlete is evaluated by a licensed physician and until the athlete receives
written clearance to return to play from that licensed physician.
C. A report of a concussion or head injury
and written clearance to return to play should be logged in the student's
health record.
D. All coaches,
trainers and volunteers involved in youth recreational and/or athletic
competition must complete a training course, and a refresher course annually
thereafter, in concussions and traumatic brain injuries.
E. All school nurses must complete a training
course and an annual refresher course in concussions and traumatic brain
injuries.
F. School districts and
schools are required to use training materials of the US Center for Disease
Control and Prevention entitled "Heads Up: Concussion in High School
Sports/Concussion in Youth Sports" or materials substantially
equivalent.
4.21.9
Opioid-related Drug Overdose in School Settings
A. All public and private elementary, middle,
junior, and high schools must develop policies and procedures for the provision
and maintenance of a supply of opioid antagonists (Naloxone) in the school
setting to treat suspected opioid overdose in accordance with R.I. Gen. Laws.
§
16-21-35.
1. School nurses and other school personnel
are immune from liability for ordinary negligence for acts or omissions
relating to the use of the opioid antagonist in accordance with R.I. Gen. Laws
§
16-21-35.
Disclaimer: These regulations may not be the most recent version. Rhode Island may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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