9.2.4.1: Written Plan and Training for Handling Urgent Medical or Threatening Incidents

Early care and education programs should have a written plan for urgent incidents that threaten the health or safety of children, staff, or volunteers. The plan should include policies and procedures for training staff to manage, document, and report these incidents.  

Developing a Written Plan

A written plan will cover these types of incidents:¹

• Lost or missing child
• Suspected sexual, physical or emotional abuse or neglect of a child
• Staff members not reporting their suspicion, although they are mandated reporters
• Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members that takes place on site
• Illness or injury needing urgent or emergency medical care or dental care
• Mental health emergencies
• Health and safety emergencies involving parents/guardians and visitors
• Death of a child or staff member-including death from a serious illness or injury that happened on site, even if the person died outside of regular program hours
• An unauthorized, threatening, or violent person who tries to enter-or who does enter-the program
• Violence in the community

The written plan should include a policy for debriefing staff after an incident has occurred.

A written plan for illness or injuries that need urgent or emergency care should clearly state:

• Where the closest urgent care is
  • Hospital emergency department
  • Medical or dental clinic that is open during the program’s operating hours and is acceptable to families
• Which supplies and equipment to have on site. For example:
  • First aid kit
  • Car and car seat to accompany a child to a health care facility
• Standard safety precautions if exposed to body fluids
• How staff must stay with the child until the family arrives and takes responsibility for them
• Emergency information for medical personnel including:
  • A signed emergency medical care authorization form
  • A signed informed consent form that allows the program to share medical information with medical staff
  • Additional information for children with special health care needs or disabilities
• How backup staff members will step in to help maintain child-to-staff ratios
• How to alert others in the building about a medical urgency
• Communication procedures for promptly notifying parent/guardian, or family emergency contact
• A procedure to regularly update and verify emergency contact and health information²
• How to complete an incident/injury report and the program’s response to the emergency
• Using and restocking first aid kits, which includes checking their content, condition, and expiration dates every month.
• The policy for regular reviews of staff’s ability to perform first aid

A written plan for threatening incidents should include:

• How to control access to buildings and outdoor play areas
• How to report a lost child or child abuse
• How to alert others in the building that a threatening person is on site
• How to alert police/emergency services³
• How to alert a parent, guardian, or family emergency contact if an unauthorized or threatening person tries to make contact with or remove a child, staff member, or volunteer
• What to document (e.g., all possible descriptions of a person; a car’s color or license plate number)²
• How to complete an incident/injury report and the program’s response to the emergency

Staff Training on Drills

Policies and procedures for staff training on emergency drills should include:

• Frequency, timing, and documentation of drills²
• A system for notifying families, staff, and children about planned drills
• Preparing children to participate in drills by letting them know:
  • When the drill will happen
  • What to wear
  • What they will practice
• When to exclude children from drills
  • They should not practice some drills until they are developmentally ready.
  • They should only practice drills that will help, not harm, them.
• A policy for debriefing staff and children after a drill

RATIONALE

Medical urgencies are common in early care and education settings. Also, threatening intrusions can happen and sometimes involve violence, injury, and death. Having written plans, staff training, and regular drills help programs prepare for emergencies. They are a guide for making responsible decisions while under stress. Drills can help ease tension and build confidence in the staff’s ability to respond calmly during a real incident.

Careful planning means having written plans, policies, and procedures, and keeping accurate records. All this is needed to keep the program safe and to handle medical emergencies or threatening incidents consistently, even if the staff is different. For example, checking first aid kits regularly will make sure supplies are always available. Careful planning also helps families understand what the staff will do to keep their children safe.

Having children practice drills that are very intense (e.g., drills that use fake gunfire to simulate an attack by a shooter) is inappropriate. The intensity may distress and psychologically harm children who are not developmentally ready.⁴  

However, programs can still prepare for violent or threatening incidences, with advice from health care providers, mental health consultants, child care health consultants, and first responders.⁵ These experts can:

• Help programs prepare for and reduce potential harm
• Help programs prepare children, staff and families
• Make sure that emergency response and recovery plans consider children’s developmental needs.⁵  

ADDITIONAL RESOURCES

The National Center on Early Childhood Health and Wellness, U.S. Department of Health and Human Services Administration for Children and Families Office of Head Start’s Emergency Preparedness Manual for Early Childhood Programs has detailed explanations and examples of procedures for emergency situations.

https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf

The Emergency Medical Services for Children Innovation & Improvement Center has educational materials and disaster planning resources.

https://emscimprovement.center/domains/planning

 

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.4.3.1 First Aid and Cardiopulmonary Resuscitation Training for Staff
1.4.3.2 Topics Covered in Pediatric First Aid Training
1.4.5.3 Training on Occupational Risk Related to Handling Body Fluids
1.5.0.1 Employment of Substitutes
1.5.0.2 Orientation of Substitutes
3.2.3.4 Prevention of Exposure to Blood and Body Fluids
3.6.4.5 Death
5.6.0.1 First Aid and Emergency Supplies
9.2.4.2 Review of Written Plan for Urgent Care and Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.5 Emergency and Evacuation Drills Policy
9.2.4.8 Authorized Persons to Pick Up Child
9.4.1.9 Records of Injury
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
9.4.1.11 Review and Accessibility of Injury and Illness Reports
9.4.2.1 Contents of Child’s Records

REFERENCES

1. Illinois Department of Public Health, Illinois Emergency Medical Services for Children. Emergency Preparedness Planning Guide for Child Care Centers & Child Care Homes. Published January 2016. LurieChildrens.org Web site. https://www.luriechildrens.org/en/emergency-medical-services-for-children/disaster/child-care-centers/. Accessed February 15, 2021.

2. Pennsylvania chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014.

3. Schonfeld DJ, Rossen E, Woodard D. Deception in schools — when crisis preparedness efforts go too far. JAMA Pediatr. 2017;171(11):1033–1034.
   

4. Schonfeld DJ, Hashikawa AN, Melzer-Lange M, Gorski PA; AAP Council on Children and Disasters; Council on Injury, Violence, and Poison Prevention; Council on School Health. Participation of children and adolescents in live crisis drills and exercises. Pediatrics. 2020;146(3):e2020015503
   

5. Needle S, Wright J, Disaster Preparedness Advisory Council, Committee on Pediatric Emergency Medicine. Ensuring the health of children in disasters. Pediatrics. 2015;136(5). https://publications.aap.org/pediatrics/article/136/5/e1407/33847/Ensuring-the-Health-of-Children-in-Disasters

NOTES

Content in the standard was modified on 03/22/22.