Safe School Plan - William S. Hart Union High School District

Signs/Symptoms to Watch For:
1. Altered level of consciousness, faintness, or personality changes.
2. Pale appearance with dazed look and glassy eyes. The skin will be pale, cool and moist.
3. Blurred or double vision.
4. Disoriented and confused with poor coordination.
5. Restless, irritable, and combative. Student may present as shaky, nervous, and/or unable to
concentrate.
Intervention:
1. ***CALL 911***
2. Place student in a side-lying position to ensure drainage of secretions or vomitus.
ONLY ADMINISTER GLUCAGON INJECTION IF PHYSICIAN’S ORDERS ARE IN PLACE.
Steps for administration: 1. Remove saline filled syringe from box. 2. Remove vial of Glucagon
powder from box and flip top off of vial. 3. Uncap needle of syringe and inject all fluid into the
vial. 4. Place cap back onto needle of syringe. 5. Roll vial between hands until powder is all
dissolved. 6. Uncap needle of syringe and poke it back into the vial. 7. Holding vial upside
down pull back on the plunger allowing medication to fill up syringe. 8. Holding syringe with
needle up, push medication up to the top with the plunger until it barely squirts out of the
needle. 9. If an alcohol swab is available, clean injection site (front mid-thigh area) and inject
medication. 10. Document time of administration.
3. Remain with student and monitor vital signs and symptoms.
4. Notify Parent.
5. Notify District Nurse.
The health clerk or administrative personnel will notify paramedics and parent of the situation. The
parent will meet the student at the hospital. Parents give permission to transport student to an emergency
facility per paramedic unit (911) and will assume all financial responsibility if necessary.
FIELD TRIPS: Parents are responsible for making arrangements to meet the special needs of their student,
including providing extra drinks and snacks, blood glucose testing, insulin administration, and emergency
administration of Glucagon, for all field trips. In the absence of a parent, legal guardian or an adult trained in
the administration of Glucagon, Emergency Medical Response (911) would be called in the event of a severe
hypoglycemic episode.
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Please sign and return to the health office.
This care plan will continue to stay in effect pending any written communication from parent/guardian to
District Nurse. Therefore any updates of medical condition changes are parent/guardian responsibility.
Date: ____________ Student’s Name: _________________ School: ________________________
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