Seizure Emergency Care Plan printable pdf download

SEIZURE EMERGENCY CARE PLAN

Date of Plan: __________. This plan is valid for the current school year: ____________________

The student’s primary care provider/health care team, including the parents/guardian, should complete this

plan. It will be reviewed with the relevant school staff and copies will be kept in a place that can be accessed

easily by the school nurse, trained personnel, and other authorized personnel.

Student Name: ________________________________Grade: ________

Current Medications: _______________________________

Type of Seizures: _____________________ How often do they occur? ___________________

Describe Seizure Activity (include symptoms before, during and after seizure):

School Restrictions: ___________________

Other: _________________________________

Protocol for seizure:

Keep calm and remain with student. Ease student to the floor. If needed, loosen any clothing

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around the neck area and protect him/her from any sharp or hard objects in the area.

Do not force anything into his or her mouth.

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Roll student on his/her side to drain secretions and insure that the student is able to breathe.

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Observe and record the nature and length of the seizure. After the seizure has subsided,

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continue to monitor airway and breathing. Allow the student to rest. (Documentation chart

located on back of this form).

Call parents to notify them of seizure after it has ceased and the student is aroused.

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If seizure last longer than 5 minutes:

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Call 911.

Page first responder team or call the school nurse at Ext. 105 for assistance.

Call parents.

Administer rescue medication: __________________________________ for seizures lasting

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longer than 5 minutes as prescribed by the physician. Monitor breathing rate and color of

student. (Persons administering medication MUST have training and clearance prior to

administering medication).

When 911 are called, remain with student until paramedics or other appropriate assistance arrives.

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If student is to go to the hospital with paramedics, a school staff member is to accompany the

student to the hospital with a copy of the health enrollment card and remain with the student until

the parents arrive.

SIGNATURES

Parent/Guardian: _________________________________________________ Date: _______

Physician/Health Care Provider: _____________________________________ Date: _______

Seizure Emergency Care Plan