Emergencies occur in childcare settings quickly and frighteningly. As we look at some of these predictable emergencies involving both illness and injuries, three factors should be considered: prevention, preparedness, and performance.

Consider injuries. Professionals generally prefer to use the term "injury" rather than "accident." "Accident" seems somehow to assume "unavoidable," thus skipping over what could have been done to prevent it. Most injuries are preventable, and that should be our continuing concern. A prime example is injury due to a fall upon a hard surface from playground equipment. Falls are going to happen; it's predictable. "Accident" is not a good term here because the injury might be prevented or lessened by having an appropriate soft surface.

Another example is Sudden Infant Death Syndrome (SIDS). Medical research shows that many SIDS deaths can be prevented by placing infants on their backs when they sleep rather than face down.

Awareness of and proper reaction to a serious illness or injury is crucial in the childcare setting. Most injuries are falls, particularly on the playground, and these should be anticipated and preventive measures taken. Other injuries, however, such as burns or especially poisoning, should not occur because they are so easily prevented. Unfortunately, these things do occur, and it is important to recognize the seriousness of the injury or illness and respond properly.

There are standard lists of conditions that require immediate medical help. In some cases, staff should call 911 or EMS immediately. In other instances, call the parents and ask them to come right away, or, if not immediately available, call the medical consultant for your center or EMS/911 for immediate help or advice.

This list is derived from the American Red Cross, and it is reproduced in the Caring for Our Children; National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. (See resources) A few of these conditions include:

• An infant less than four months of age who has an axillary (underarm) temperature of 100° F or more. Fever in a young baby is more ominous than in an older child.
• A child four months of age or more with an axillary temperature of 104° F or more. In this and in all things, use discretion. It is far better to overreach and seek medical attention, than not to react enough.
• An infant less than four months of age who forcefully vomits more than once after eating (or forcefully vomits once if not after eating.)
• A child who looks or acts very ill or seems to be worsening quickly. Illness in children often moves fast.
• A child who has pain when the neck is moved or touched. This is one of the symptoms of meningitis.
• A child who has a stiff neck or headache and looks sick. This, too, can be evidence of meningitis.
• A child who has a seizure. (Unless the child is known to be subject to seizures, in which case follow the procedures as directed by parents and physician.)
• A child who is unusually confused or disoriented.
• A child with unequal pupils (the dark part of the eyes). This is quite uncommon, except with serious head injury. If you shine a light near the eyes to check pupils, don't have it close to the eyes and be certain that it shines equally on both eyes.
• A child with red or purple rash consisting of pinhead-sized spots; or who has areas looking like bruises, but without injury. This can mean a significant problem with the blood.
• A child who has a rash like hives or welts (sort of like huge mosquito bites). This is a signal of an allergic rash.
• A child who appears unduly short of breath. This may become so severe that it interferes with talking, playing, or crying. This can mean several things, such as asthma, fever, or airway obstruction.
• A child with a severe stomach ache, particularly if it makes the child double over or cry out.
• A child who, following a blow to the abdomen or a fall, has a stomach ache. This can be a sign of injury to the internal organs.
• A child whose stools (bowel movements) are coal-black, or have blood mixed with them. This can be a sign of bleeding into the intestine. (Some medicines, such as iron and Pepto Bismol, can also turn the stools black and some foods such as beets can cause red stools.)
• A child who has not urinated in eight hours or more, or who has signs of dehydration such as dry tongue, decreased saliva and tears, and sunken eyes.
• A child who has continuous clear drainage from the nose after a hard blow to the head or a fall. This is an ominous sign of head injury.

Other Medical Situations

Head injuries are frequent and usually minor, but sometimes worrisome. Any significant fall, particularly if it is not followed immediately by the child's acting normally, is cause for concern. The most dangerous head injuries are, of course, falls from heights.

Cuts may require direct pressure, using a gauze square or clean cloth. This will stop virtually any bleeding. Spurting bleeding means an artery has been cut. Any arterial bleeding or other serious bleeding means get help fast!

Broken bones are often difficult to distinguish from sprains. The best treatment is to not move the child, apply cold compresses, and get help.

Burns are preventable and should not occur, but, if they do, cool the burn immediately in cool (not icy) water For minor burns, wrap with a sterile dressing. For more serious burns, or burns over large areas of the body, get medical help.

Eye injuries always require medical help. Cover both eyes (because as one eye moves to look around, so does the other one), but don't press on the eye! Don't attempt to remove foreign objects; leave that for medical professionals.

Nosebleeds, unless associated with head injury, are usually not emergencies. Having the child sit down (not lie down) and pinching the nostrils shut for about 10 minutes will almost always stop a nosebleed. If it doesn't work, try it again. If it still doesn't work, get medical help.

Choking, or other breathing problems are very serious. Any child who appears to be choking, or who cannot cough or talk, particularly after eating, is an emergency. Know how to check breathing and perform the Heimlich maneuver. Call for emergency medical help immediately.

Emergencies Do Happen

Emergencies do occur in the childcare setting and knowing how to act when they happen is essential. Prevention. Preparedness. Performance. These three P's are the keys to dealing with an emergency in a childcare center.

Resources

"Caring for Our Children; National Health and Safety Performance Standards, Guidelines for Out-of-Home Child Care Programs" can be obtained from the American Academy of Pediatricians, 800-433-9016.

The text can be found on the National Resource Center for Health and Safety in Child Care web site: nrc.uchsc.edu