providing emergency medical assistance to pupils with diabetes suffering from the State Department of Health Services’ Diabetes Prevention and Control …
Glucagon Training Standards for School Personnel:
Providing Emergency Medical Assistance to Pupils with Diabetes
Performance Standards for the Training and Supervision of School Personnel in Providing Emergency Medical Assistance to Pupils with Diabetes Experiencing Severe Hypoglycemia
May 2006
Table of Contents
Introduction Performance Standard 1: Understanding Diabetes Performance Standard 2: Understanding Hypoglycemia, Its Causes, Signs Symptoms Symptoms of Hypoglycemia Copy and Post Flyer Performance Standard 3: Blood Glucose Monitoring Performance Standard 4: Caring for the Student with Mild to Moderate Hypoglycemia Performance Standard 5: Understanding Glucagon and How it Should be Stored Performance Standard 6: Understanding When and How to Administer Glucagon Performance Standard 7: Understanding the Follow-Up Procedures When Glucagon is Used Resource Section Sample Diabetes Medical Management Plan Quick Reference Emergency Plan Glucagon Administration Training Documentation Check-List Education Code 494145b4A Page 3 4 5
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Information contained in this guide has been adapted from the National Diabetes Education Programs Helping the Student with
Diabetes Succeed: A Guide for School Personnel and the American Diabetes Association
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Introduction
In October 2003, Assembly Bill 942 Leno was approved by the Legislature and Governor and was chaptered as Education Code Section 494145 This legislation encouraged the American Diabetes Association to develop performance standards for the training and supervision of school personnel in providing emergency medical assistance to pupils with diabetes suffering from severe hypoglycemia These performance standards were to be developed in cooperation with Department of Education, the California School Nurses Organization, the California Medical Association, and the American Academy of Pediatrics The performance standards were to be approved for distribution by the State Department of Health Services Diabetes Prevention and Control Program California Diabetes Program and made available by that agency upon request According to Section 494145 of the California Education Code, school districts may train school personnel who volunteer to provide emergency medical assistance including the administration of glucagon, in accordance with a health care providers written statement and the standards
established pursuant to this statute, to students with diabetes experiencing severe hypoglycemia in the absence of a credentialed school nurse or other licensed nurse The school nurse, when available, is the most appropriate person in the school setting to provide care for a student with diabetes However, many schools do not have full-time nurses Even for schools that do, the nurse may not always be available during the school day, during extracurricular activities, or on field trips or other school sponsored events to assist with emergency care, so pursuant to Education Code Section 494145, trained non-medical school staff members may be trained to provide care to pupils in the event of severe hypoglycemia School personnel who do not volunteer or who have not been trained to administer emergency medical assistance may not be required to provide emergency medical assistance Training of school personnel for this purpose must be given by a physician, credentialed school nurse, registered nurse or certified public health nurse The trainer shall document the training and provide periodic review or retraining a minimum of one time per year See Training Documentation Check-List for
School Personnel The students parent must provide all materials necessary to administer glucagon
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Performance Standard 1: Understanding Diabetes
Diabetes Overview Diabetes is a chronic disease in which the body does not make or properly use insulin, a hormone needed to convert sugar, starches, and other food into energy People with diabetes have increased blood glucose sugar levels because they lack insulin, have insufficient insulin, or are resistant to insulins effects High levels of glucose build up in the blood and spill into the urine; as a result, the body loses its main source of fuel When insulin is no longer made, it must be obtained from another source–insulin shots or an insulin pump When the body does not use insulin properly, oral medications may be taken instead of, or in addition to, insulin Neither insulin nor other medications, however, are cures for diabetes: they only help control the disease Taking care of diabetes is important If not treated appropriately, diabetes can lead to serious health problems The disease can affect the blood vessels, eyes, kidneys, nerves, gums, and teeth, and it is the leading cause of adult blindness, lower limb amputations, and
kidney failure People with diabetes also have a higher risk of heart disease and stroke Some of these problems can occur in teens and young adults who develop diabetes during childhood The good news is that research shows that these problems can be greatly reduced or delayed by keeping blood glucose levels near normal There are two main types of diabetes: type 1 and type 2 Type 1 diabetes is sometimes referred to as juvenile onset diabetes Type 1 diabetes results from the bodys failure to produce insulin Type 2 diabetes is sometimes referred to as adult onset diabetes Type 2 diabetes is a caused by insulin resistance a condition in which the body fails to properly use insulin it makes, combined with relative insulin deficiency Although type 2 diabetes generally occurs in adults an increasing number of children and adolescents are being diagnosed with type 2 diabetes Maintaining good blood glucose control is important to the health of a person with diabetes There are many factors involved in the day-to-day management of diabetes including eating nutritious food in appropriate quantities, getting regular physical activity, monitoring blood glucose levels, and taking medications when
necessary
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Performance Standard 2: Understanding Hypoglycemia, Its Causes, Signs Symptoms
Hypoglycemia Overview Hypoglycemia, also called low blood glucose or low blood sugar, is one of the most frequent complications of diabetes and can happen very suddenly Hypoglycemia occurs when a students blood glucose level falls below the students target blood glucose range Hypoglycemia usually can be treated easily and effectively If it is not treated promptly, however, hypoglycemia can lead to unconsciousness and convulsions and can be life threatening Early recognition of its symptoms and prompt treatment, in accordance with the physicians written orders for the student, are necessary for preventing severe symptoms that may place the student in danger This information, contained in the Quick Reference Emergency Plan, should be provided to all school personnel who have responsibility for the student with diabetes see sample in the resource section Causes of Hypoglycemia Hypoglycemia usually occurs as a result of administering too much insulin, skipping or delaying meals or snacks, exercising too long or too intensely, or a combination of two or more of these factors It is more likely
to occur before lunch, at the end of the school day, or during or after physical education classes Signs and Symptoms of Hypoglycemia Hypoglycemia is not always completely preventable, and not all students, especially young children, will recognize its symptoms with every episode Therefore, school personnel should be familiar with the symptoms and treatment so that an urgent problem can be handled appropriately Hypoglycemia can impair thinking abilities and sometimes can be mistaken for misbehavior If a student with diabetes has a sudden change in behavior, becomes lethargic, combative, or unconscious, or is having a seizure or convulsion, presume that the student has hypoglycemia
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–Copy and Post as Appropriate–
Symptoms of Hypoglycemia
Mild/Moderate Symptoms shaky sweaty hungry pale headache blurry vision sleepy dizzy confused disoriented uncoordinated irritable or nervous changed personality/behavior inability to concentrate weak lethargic Severe Symptoms inability to swallow having a seizure or convulsions unconscious
Adapted from the National Diabetes Education Programs Helping the Student with Diabetes Succeed: A Guide for School
Personnel
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Performance Standard 3: Blood Glucose Monitoring
Blood Glucose Monitoring Overview Blood glucose monitoring is critical to diabetes management Blood glucose levels fluctuate throughout the day Regular blood glucose monitoring provides information for management decisions It is also critical for the identification, treatment, and prevention of high and low blood glucose levels The frequency and timing of regular blood glucose tests should be outlined in the physicians written orders for the student Additional blood glucose testing may be required when there is a change in physical activity level, food intake, and medication or when the student is not feeling well Many students are able to perform blood glucose monitoring themselves in nonemergency situations Other students, because of their age, maturity level, or other factors, may require an adult to check their blood glucose or assist them with this task All students may need an adults assistance to check blood glucose when experiencing severe hypoglycemia In order to check blood glucose the following tools are needed parent/guardian will provide: Blood glucose meter Testing strip specific to each meter Lancet a
sharp, pin-like tool Sharps container to dispose of lancets Preparation Begin by having the student wash and dry hands thoroughly if possible If assisting or performing the blood glucose check for the student, put on disposable gloves and when finished, wash hands thoroughly after removing gloves Performing the Blood Glucose Test Turn the blood glucose meter on if it does not turn on automatically when a test strip is inserted Using the test strips supplied by the parent/guardian, insert a test strip into the meter Blood samples for use with the meter are often obtained from the side of the finger but some meters allow blood samples from other parts of the body such as the forearm Follow the instructions specific to the meter provided by the parent/guardian on how and where to obtain blood for the meter The results from the blood glucose test will be displayed on the meter Processing times vary Most meters will display results with one minute Dispose of the lancet in a sharps container Test strips may be discarded in a
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regular trash can Record the blood glucose result and as needed, take action according to the physicians written orders for the student Meters do not only
display numbers Some display Lo or Hi for results outside of the meters parameters Some display error messages Consult with the meter manual to determine the meaning of messages A copy of the meter manual should be supplied by the parent/guardian and kept in the health office
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Performance Standard 4: Caring for the Student with Mild to Moderate Hypoglycemia
When a student with diabetes has symptoms of hypoglycemia, its important to treat it right away Begin by checking the students blood glucose level, and if appropriate treat for hypoglycemia If a meter is not accessible, and the student has symptoms, go ahead and treat for hypoglycemia Step 1 Have the student eat or drink something with 15 grams of carbohydrate Suggestions include: Glucose tablets equaling 15 grams of carbohydrate can regular non-diet soda 6-7 lifesavers 1 c non-fat milk 1 tbs sugar, honey, or corn syrup 2 tbs raisins The physicians written orders for the student may provide more specific direction on what carbohydrate source should be used Step 2 Wait 15 minutes, check the blood glucose level If the blood glucose is still below his or her target range give the student another 15 grams of carbohydrate
and check again after 15 minutes If the students blood glucose remains too low even after treatment, contact the school nurse if possible and the parent/guardian The student may need to be seen by his or her health care provider
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Performance Standard 5: Understanding Glucagon and How it should be Stored
Glucagon Overview Glucagon is a hormone that raises blood glucose levels by causing the release of glycogen a form of stored carbohydrate from the liver It is administered when the students blood glucose level gets so low that the student passes out, is unresponsive, experiences seizures, or cannot safely eat, drink or swallow Although it may cause nausea and vomiting when the student regains consciousness, glucagon can be a life-saving treatment and cannot harm a student, even if the students blood sugar is already high The students parents/guardian should supply the school with a glucagon emergency kit and be responsible for replacing the kit when it has expired This glucagon kit contains a bottle vial of glucagon in powder form and a pre-filled syringe with special liquid; the two are mixed just before a glucagon injection is given Storing Glucagon Glucagon may be stored at
room temperature according to the manufacturers directions The school nurse and trained designated personnel must have ready access to the glucagon emergency kit at all times, including on field trips and during a disaster
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Performance Standard 6: Understanding When and How to Administer Glucagon
When Glucagon Should Be Used Glucagon is used to treat severe hypoglycemia Severe hypoglycemia is rare at school and generally can be prevented with prompt treatment when the early signs of low blood glucose are recognized See Signs and Symptoms of Hypoglycemia and Performance Standard 4 Begin by checking the students blood glucose level If a blood glucose meter is not readily available and the student is exhibiting the signs and symptoms of severe hypoglycemia, treat the student with glucagon if it has been prescribed by the students physician and a trained person is available If there is no prescription for glucagon treat as per the students DMMP, and call 911 and the students parent/guardian When hypoglycemia is severe, the school nurse or trained designated personnel must respond immediately Glucagon should be given according to the physicians written statement when a student with
diabetes is unresponsive or unconscious, if the student is having a seizure or convulsions, or if the student cannot safely eat, drink, or swallow Severe hypoglycemia can cause brain damage or death Although it may cause nausea and vomiting when the student regains consciousness, glucagon is a life-saving treatment that will not harm the student
How Glucagon is Administered For this section, please refer to the American Diabetes Associations Diabetes Care Tasks at School, Glucagon Administration Module or the attached hard copies The ADAs Diabetes Care Tasks at School, Glucagon Training Module can be accessed at:
http://wwwdiabetesorg/advocacy-and-legalresources/discrimination/school/schooltrainingjsp
Steps for Administering Glucagon Never attempt to give a student suffering from severe hypoglycemia food or a drink or to put anything in the mouth because it could cause choking Position the student safely on their side for comfort, protection from injury and to prevent choking in the event of vomiting, a possible reaction to glucagon administration Have another school staff member call for emergency medical assistance 911 and the students parent/guardian while glucagon is being
administered Do not delay administering glucagon while these calls are made Remove the cap from the glass vial containing dry powder Remove cap from syringe and insert the needle into the vial through the rubber stopper
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Inject all the fluid in syringe into the bottle containing the dry powder Shake gently or roll to mix until all powder is dissolved and solution is clear Inspect the vial The solution should be clear and colorless Do not administer if discolored or does not dissolve well Hold the vial upside down in one hand Insert the syringe into the vial Draw the prescribed amount of solution into the syringe refer to physicians written orders for the student Clean the site, if possible The best sites for injection are buttocks, thighs, and upper arms Inject the glucagon at 90 angle into the tissue under cleansed area Push syringe plunger all the way down Count to five Remove needle from skin and dispose of syringe safely into a sharps container Dispose of any unused portion of the mixed glucagon Confirm that 911 has been called Stay with the student, keeping him/her on their side until they regain consciousness or emergency personnel have arrived
It may
take 15-20 minutes for the student to regain consciousness It is likely that emergency personnel will have arrived on the scene and will have taken responsibility for treatment If they have not: Check blood glucose Give sips of fruit juice or regular soda once the student is awake and able to eat or drink Follow the physicians written orders for the student Record the glucagon administration in the students health record and on the medication log
Do not be surprised if: The student does not remember being unconscious, is incoherent or has a headache Blood glucose becomes very high over 200 Nausea or vomiting occur
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Performance Standard 7: Understanding the Follow-Up Procedures When Glucagon is Used
Follow-Up Requirements According to Education Code Section 494145b4A, any school personnel who administer glucagon must notify the credentialed school nurse assigned to the school district If a credentialed school nurse is not assigned to the school district, the school personnel must notify the superintendent of the school district, or his or her designee
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Resource Section
Sample Materials Diabetes Medical Management Plan Quick Reference Emergency Plan School
Personnel Training Documentation Check-List
Authorizing Statute Education Code Section 494145b4A
Helpful Links American Diabetes Association http://wwwdiabetesorg California Department of Education http://wwwcdecagov/ls/he/hn/ California Diabetes Program, Diabetes Information Resource Center DIRC http://wwwcaldiabetesorg/ California School Nurses Organization http://wwwcsnoorg/ National Diabetes Education Program http://wwwndepnihgov/indexhtm
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Date of Plan: _______________
Diabetes Medical Management Plan
This plan should be completed by the students personal health care team and parents/guardian It should be reviewed with relevant school staff and copies should be kept in a place that is easily accessed by the school nurse, trained diabetes personnel, and other authorize 
d personnel Effective Dates: _______________________________________________________________ Students Name: _______________________________________________________________ Date of Birth: _______________________ Date of Diabetes Diagnosis: __________________ Grade: _____________________________ Homeroom Teacher: ________________________ Physical Condition: Diabetes type 1 Diabetes type 2
Contact Information
Mother/Guardian: _____________________________________________________________
Address: _________________________________________________________________
____________________________________________________________________________ Telephone: Home __________________ Work _________________ Cell_________________ Father/Guardian: ______________________________________________________________
Address: __________________________________________________________________
_____________________________________________________________________________ Telephone: Home _________________ Work __________________ Cell _________________ Students Doctor/Health Care Provider:
Name: __________________________________________________________________ Address: ___________________________________________________________________
Telephone: ________________________ Emergency Number: ___________________________ Other Emergency Contacts:
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Name: __________________________________________________________________
Relationship: __________________________________________________________________
Telephone: Home ______________ Work _______________ Cell ____________
Notify parents/guardian or emergency contact
in the following situations: __________________ _____________________________________________________________________________ _____________________________________________________________________________ Blood Glucose Monitoring Target range for blood glucose is
70-150
70-180
Other __________________
Usual times to check blood glucose _________________________________________________ Times to do extra blood glucose checks check all that apply before exercise after exercise when student exhibits symptoms of hyperglycemia when student exhibits symptoms of hypoglycemia other explain: ____________________________________________________________ Can student perform own blood glucose checks? Yes No Exceptions: __________________________________________________________________ ____________________________________________________________________________ Type of blood glucose meter student uses: __________________________________________ ____________________________________________________________________________ Insulin
Usual Lunchtime Dose
Base dose of Humalog/Novolog /Regular insulin at lunch circle type of rapid-/short-acting insulin used is _____ units or does flexible dosing
using _____ units/ _____ grams carbohydrate Use of other insulin at lunch: circle type of insulin used: intermediate/NPH/lente _____ units or basal/Lantus/Ultralente _____ units
Insulin Correction Doses
Parental authorization should be obtained before administering a correction dose for high blood glucose levels Yes No _____ units if blood glucose is _____ to _____ mg/dl _____ units if blood glucose is _____ to _____ mg/dl _____ units if blood glucose is _____ to _____ mg/dl
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_____ units if blood glucose is _____ to _____ mg/dl _____ units if blood glucose is _____ to _____ mg/dl Can student give own injections? Can student determine correct amount of insulin? Can student draw correct dose of insulin? Yes Yes Yes No No No
_______ Parents are authorized to adjust the insulin dosage under the following circumstances: _____________________________________________________________________________ _____________________________________________________________________________ For Students with Insulin Pumps Type of pump: _______________________ Basal rates: _____ 12 am to _____ _____ _____ to _____ _____ _____ to _____ Type of insulin in pump:
________________________________________________________ Type of infusion set: ____________________________________________________________ Insulin/carbohydrate ratio: ________________________ Correction factor: ________________ Student Pump Abilities/Skills: Count carbohydrates Bolus correct amount for carbohydrates consumed Calculate and administer corrective bolus Calculate and set basal profiles Calculate and set temporary basal rate Disconnect pump Reconnect pump at infusion set Prepare reservoir and tubing Insert infusion set Troubleshoot alarms and malfunctions Needs Assistance Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No
For Students Taking Oral Diabetes Medications Type of medication: ____________________________________ Timing: ________________ Other medications: ___________________________________ Timing: ________________
Meals and Snacks Eaten at School Is student independent in carbohydrate calculations and management?
Yes
No
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Meal/Snack Breakfast Mid-morning snack Lunch Dinner
Time ______________________ ______________________ ______________________
Food content/amount __________________________________
___________________________________ ___________________________________
Mid-afternoon snack ______________________ ___________________________________ ______________________ ___________________________________
Snack before exercise? Snack after exercise?
Yes Yes
No No
Other times to give snacks and content/amount: _____________________________________________________________________________ Preferred snack foods: _____________________________________________________________________________ Foods to avoid, if any: _____________________________________________________________________________ Instructions for when food is provided to the class eg, as part of a class party or food sampling event: _______________________________________________________________________ _____________________________________________________________________________ Exercise and Sports A fast-acting carbohydrate such as _________________________________________________ should be available at the site of exercise or sports Restrictions on activity, if any: _______________________________________ student should not exercise if blood glucose level is below ____________________ mg/dl or above
____________________ mg/dl or if moderate to large urine ketones are present Hypoglycemia Low Blood Sugar Usual symptoms of hypoglycemia: ________________________________________________ _____________________________________________________________________________ Treatment of hypoglycemia:______________________________________________________ _____________________________________________________________________________ Glucagon should be given if the student is unconscious, having a seizure convulsion, or unable to swallow Route _______, Dosage _______, site for glucagon injection: _______arm, _______thigh, _______other
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If glucagon is required, administer it promptly Then, call 911 or other emergency assistance and the parents/guardian Hyperglycemia High Blood Sugar Usual symptoms of hyperglycemia: ________________________________________________ _____________________________________________________________________________ Treatment of hyperglycemia: _____________________________________________________ _____________________________________________________________________________ Urine should be checked for ketones when blood glucose levels are above _________ mg/dl Treatment
for ketones: __________________________________________________________ _____________________________________________________________________________
Supplies to be Kept at School _______Blood glucose meter, blood glucose test strips, batteries for meter _______ Lancet device, lancets, gloves, etc _______Urine ketone strips _______Insulin pump and supplies _______Insulin pen, pen needles, insulin cartridges _______Fast-acting source of glucose _______Carbohydrate containing snack _______Glucagon emergency kit
Signatures
This Diabetes Medical Management Plan has been approved by: _________________________________________________ Students Physician/Health Care Provider _______________________ Date
I give permission to the school nurse, trained diabetes personnel, and other designated staff members of ______________________________ school to perform and carry out the diabetes care tasks as outlined by __________________________s Diabetes Medical Management Plan I also consent to the release of the information contained in this Diabetes Medical Management Plan to all staff members and other adults who have custodial care of my child and who may need to know this information to
maintain my childs health and safety
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Acknowledged and received by: _________________________________________________ Students Parent/Guardian _________________________________________________ Students Parent/Guardian ______________________ Date ______________________ Date
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Quick Reference Emergency Plan for a Student with Diabetes Hypoglycemia Low Blood Sugar Students Name Grade/Teacher Date of Plan
Emergency Contact Information:
Mother/Guardian Home phone Work phone Cell
Father/Guardian Home phone Work phone Cell
School Nurse/Trained Diabetes Personnel
Contact Numbers
Never send a child with suspected low blood sugar anywhere alone
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Causes of Hypoglycemia Too much insulin Missed food Delayed food Too much or too intense exercise Unscheduled exercise
Onset Sudden
Symptoms
Mild Hunger Sweating Shakiness Drowsiness Weakness Personality change Paleness Inability to concentrate Anxiety Irritability Dizziness
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Other: ___________
Circle students usual symptoms
Moderate Headache Blurry vision Behavior change Weakness Slurred Speech Poor coordination Confusion Other___________ Circle students usual symptoms
Severe Loss of
consciousness Seizure Inability to swallow Circle students usual symptoms
Actions Needed Notify School Nurse or Trained Diabetes Personnel If possible, check blood sugar, per Diabetes Medical Management Plan When in doubt, always TREAT FOR HYPOGLYCEMIA Mild
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Student may/may not treat self Provide quick-sugar source
3-4 glucose tablets or 4 oz juice or 6 oz regular soda or 3 teaspoons of glucose gel Wait 10 to 15 minutes Recheck blood glucose Repeat food if symptoms persist or blood glucose is less than______ Follow with a snack of carbohydrate and protein eg, cheese and crackers
Moderate Someone assists Give student quick-sugar source per MILD guidelines Wait 10 to 15 minutes Recheck blood glucose Repeat food if symptoms persist or blood glucose is less than______ Follow with a snack of carbohydrate and protein eg, cheese and crackers
Severe Dont attempt to give anything by mouth
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Position on side, if possible Contact school nurse or trained diabetes personnel Administer glucagon, as prescribed Call 911 Contact parents/guardian Stay with student
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Quick Reference Emergency Plan for a Student with Diabetes Hyperglycemia High Blood Sugar
Students
Name Grade/Teacher Date of Plan
Emergency Contact Information:
Mother/Guardian Home phone Father/Guardian Home phone Work phone Cell Contact Numbers Work phone Cell
School Nurse/Trained Diabetes Personnel
Causes of Hyperglycemia Too much food Illness Too little insulin Infection Decreased activity Stress
Onset Over time–several hours or days
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Symptoms
Mild Thirst Frequent urination Fatigue/sleepiness Increased hunger Blurred vision Weight loss Stomach pains Flushing of skin Lack of concentration Sweet, fruity breath Other: __________________ Circle students usual symptoms
Moderate Mild symptoms plus: Dry mouth Nausea Stomach cramps Vomiting Other:_______________
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Circle students usual symptoms
Severe Mild and moderate symptoms plus: Labored breathing Very weak Confused Unconscious
Circle students usual symptoms
Actions Needed Allow free use of the bathroom Encourage student to drink water or sugar-free drinks Contact the school nurse or trained diabetes personnel to check urine or administer insulin, per students Diabetes Medical Management Plan If student is nauseous, vomiting, or lethargic, ____ call the parents/guardian or ____
call for medical assistance if parent be reached
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Glucagon Administration Training Documentation Check-List for School Personnel Employee Name:_________________________________________Date:_______________ School:____________________________________________________________ As a school employee who has volunteered to provide emergency medical assistance to students with diabetes who are experiencing severe hypoglycemia, it is necessary that you receive adequate training and document that you have been trained to provide this assistance The person providing the training must be a school nurse, public health nurse, registered nurse, or physician In addition to the first training, you will receive periodic review and retraining annually If for any reason you feel that you are not adequately trained, need a review, and are unable to continue to provide this assistance, or have any questions, immediately contact your school nurse, trainer, and/or supervising site or district administrator If you hear from the students parent/guardian or physician that any of the written orders for care have changed, immediately contact your school nurse, other trainer or supervising site or district
administrator for clarification regarding your role in the changing needs for the student Skill Reads physicians written orders for the student Reads Performance Standards for the Training and Supervision of School Personnel Providing Emergency Medical Assistance to Pupils with Diabetes Experiencing Severe Hypoglycemia Watches video or power point presentation Understands diabetes basics States common symptoms of hypoglycemia Reviews procedures for blood glucose monitoring Reviews treatment for mild to moderate hypoglycemia States purpose of glucagon States when glucagon should be used Date Received Training
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I certify that the above employee has been trained to administer glucagon in accordance with the Performance Standards for the Training and Supervision of School Personnel in Providing Emergency Medical Assistance to Pupils with Diabetes Experiencing Severe Hypoglycemia and is competent to respond appropriately in the event such an emergency
__________________________________________________________________ Signature of School Nurse/Trainer Date
__________________________________________________________________ Printed Name of School Nurse/Trainer
I certify that I have
received the training above and feel that I am competent to provide emergency assistance to a student experiencing severe hypoglycemia I agree that if I have any questions or learn of any changes in the physicians written orders for the student, I will immediately contact the school nurse, other trainer or supervising site or district administrator
__________________________________________________________________ Signature of Designated Trained School Personnel Date
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Authorizing Statute: Section 494145 of the California Education Code 494145 a In the absence of a credentialed school nurse or other licensed nurse onsite at the school, each school district may provide school personnel with voluntary emergency medical training to provide emergency medical assistance to pupils with diabetes suffering from severe hypoglycemia, and volunteer personnel shall provide this emergency care, in accordance with standards established pursuant to subdivision b and the performance instructions set forth by the licensed health care provider of the pupil A school employee who does not volunteer or who has not been trained pursuant to subdivision b may not be required to provide emergency
medical assistance pursuant to this subdivision b 1 The Legislature encourages the American Diabetes Association to develop performance standards for the training and supervision of school personnel in providing emergency medical assistance to pupils with diabetes suffering from severe hypoglycemia The performance standards shall be developed in cooperation with the department, the California School Nurses Organization, the California Medical Association, and the American Academy of Pediatrics Upon the development of the performance standards pursuant to this paragraph, the State Department of Health Services Diabetes Prevention and Control Program shall approve the performance standards for distribution and make those standards available upon request 2 Training established pursuant to this subdivision shall include all of the following: A Recognition and treatment of hypoglycemia B Administration of glucagon C Basic emergency follow-up procedures, including, but not limited to, calling the emergency 911 telephone number and contacting, if possible, the pupils parent or guardian and licensed health care provider 3 Training by a physician, credentialed school nurse, registered
nurse, or certificated public health nurse according to the standards established pursuant to this section shall be deemed adequate training for the purposes of this section 4 A A school employee shall notify the credentialed school nurse assigned to the school district if he or she administers glucagon pursuant to this section B If a credentialed school nurse is not assigned to the school district, the school employee shall notify the superintendent of the school district, or his or her designee, if he or she administers glucagon pursuant to this section 5 All materials necessary to administer the glucagon shall be provided by the parent or guardian of the pupil c In the case of a pupil who is able to self-test and monitor his or her blood glucose level, upon written request of the parent or guardian, and with authorization of the licensed health care provider of the pupil, a pupil with diabetes shall be permitted to test his or her blood glucose level and to otherwise provide diabetes self-care in the classroom, in any area of the school or school grounds, during any school-related activity, and, upon specific request by a parent or guardian, in a private location
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d For the
purposes of this section, the following terms have the following meanings: 1 School personnel means any one or more employees of a school district who volunteers to be trained to administer emergency medical assistance to a pupil with diabetes 2 Emergency medical assistance means the administration of glucagon to a pupil who is suffering from severe hypoglycemia
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Source:alz.org
