Seizure Monitoring Chart (Page 2 of 2) in pdf

Seizure Monitoring Chart

Page 2 of 2

In the even of generalized seizure activity, the following observations and monitoring

procedures will be followed by school staff:

• Ease student to the floor (unless harnessed securely in wheelchair and breathing is

not restricted).

• Remove hazards in the area, such as, sharp or hard objects, to prevent further

injury.

• Loosen tight clothing at the neck.

• Turn student onto his/her side to allow saliva to drain and t keep airway open.

• Cushion the student’s head with something soft.

• Monitor student while seizure runs its course and speak to him/her in calming

tones.

• Following the seizure, allow the student to rest as needed in a quiet supervised

area.

• Following each occurrence, report activity to parent/guardian in writing and by

telephone.

Signals of an emergency situation:

• If any seizure last longer than five minutes, or

• If there is any continued, progressive respiratory distress, or

• If another seizure starts right after the first, then do the following:

Emergency action:

• Call 911.

• If breathing stops, CPR certified school personnel should initiate rescue breathing

(and CPR started if needed) while awaiting medical assistance.

• Notify parent/guardian

Primary Care Provider’ comments (i.e. medication, other measure-attach additional

sheet if necessary: ________________________________________________________

________________________________________________________________________

_________________________________

_____________________________

Physician’s Printed Name

Office Phone Number

_________________________________

_____________________________

Physician’s Signature

Date

*Note to parent/guardian: Signing this form shall release the Jackson County

Public Schools and staff from liability of any nature that might result from this plan

of action. I hereby give permission for the above information to be verified with the

above health care provider.

________________________________

______________________________

Signature of Parent/Guardian

Date

Seizure Monitoring Chart Page 2

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