Caring for Our Childen (CFOC)

Chapter 9: Administration

9.2 Policies

9.2.4 Emergency/Security Policies and Plans

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


The facility should have a written plan for reporting and managing what they assess to be an incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. The facility should also include procedures of staff training on this plan.

The management, documentation, and reporting of the following types of incidents, at a minimum, that occur at the child care facility should be addressed in the plan:

  1. Lost or missing child;
  2. Suspected maltreatment of a child (also see state’s mandates for reporting);
  3. Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the child care facility;
  4. Injuries to children requiring medical or dental care;
  5. Illness or injuries requiring hospitalization or emergency treatment;
  6. Mental health emergencies;
  7. Health and safety emergencies involving parents/guardians and visitors to the program;
  8. Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the child care facility, even if the death occurred outside of child care hours;
  9. The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility.

The following procedures, at a minimum, should be addressed in the plan for urgent care:

  1. Provision for a caregiver/teacher to accompany a child to a source of urgent care and remain with the child until the parent/guardian assumes responsibility for the child;
  2. Provision for the caregiver/teacher to provide the medical care personnel with an authorization form signed by the parent/guardian for emergency medical care and a written informed consent form signed by the parent/guardian allowing the facility to share the child’s health records with other service providers;
  3. Provision for a backup caregiver/teacher or substitute for large and small family child care homes to make the arrangement for urgent care feasible (child:staff ratios must be maintained at the facility during the emergency);
  4. Notification of parent/guardian(s);
  5. Pre-planning for the source of urgent medical and dental care (such as a hospital emergency room, medical or dental clinic, or other constantly staffed facility known to caregivers/teachers and acceptable to parents/guardians);
  6. Completion of a written incident/injury report and the program’s response;
  7. Assurance that the first aid kits are resupplied following each first aid incident, and that required contents are maintained in a serviceable condition, by a monthly review of the contents;
  8. Policy for scheduled reviews of staff members’ ability to perform first aid for averting the need for emergency medical services;
  9. Policy for staff supervision following an incident when a child is lost, missing, or seriously injured.
RATIONALE
Emergency situations are not conducive to calm and composed thinking. A written plan provides the opportunity to prepare and to prevent poor judgments made under the stress of an emergency.

Unannounced mock situations used as drills can help ease tension and build confidence in the staff’s ability to respond calmly in the event of a real incident. Discussion regarding performance and opportunities for improvement should follow the drill.

An organized, comprehensive approach to injury prevention and control is necessary to ensure that a safe environment is provided to children in child care. Such an approach requires written plans, policies, procedures, and record-keeping so that there is consistency over time and across staff and an understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

Routine restocking of first aid kits is necessary to ensure supplies are available at the time of an emergency. Staff should be trained in the use of standard precautions during the response to any situation in which exposure to bodily fluids could occur. Management within the first hour or so following a dental injury may save a tooth.

Intrusions by threatening individuals to child care facilities have occurred, some involved violence resulting in injury and death. These threats have come from strangers who gained access to the playground or an unsecured building, or impaired family members who had easy access to a secured building. Facilities must have a plan for what to do in such situations (1-3).

COMMENTS
The American Academy of Pediatrics’ policy statement, “Medical Emergencies Occurring at School” contains information including a comprehensive list of resources that is relevant to child care facilities. The Emergency Medical Services for Children National Resource Center (http://www.childrensnational.org/emsc/) has downloadable print information for emergency medical training, particularly the brochure entitled “Emergency Guidelines for School” at http://ems.ohio.gov/EMSC web site_11_04/pdf_doc files/EMSCGuide.pdf. This site also lists internet links to emergency plans for specific health needs such as diabetes, asthma, seizures, and allergic reactions. Resources for emergency response to non-medical incidents can be found at http://www.chtc.org/dl/handouts/20061114/20061114-2.pdf and http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/EmergencyResponse.pdf.

It is recommended that parents/guardians inform caregivers/teachers their preferred sources for medical and dental care in case of emergency. Parents/guardians should be notified, if at all possible, before dental services are rendered, but emergency care should not be delayed because the child’s own dentist is not immediately available.

Facilities should develop and institute measures to control access of a threatening individual to the facility and the means of alerting others in the facility as well as summoning the police if such an event occurs.

TYPE OF FACILITY
Center, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
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
9.2.4.2 Review of Written Plan for Urgent Care
9.2.4.3 Disaster Planning, Training, and Communication
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. AFP. 2009. Belgian charged over daycare killings. Nine News, Jan 24. http://news.ninemsn.com.au/world/.
  2. Haggerty, R. 2010. Man kills self after firing shots at day care. Journal Sentinel, Feb 17. http://www.jsonline.com/news/crime/.
  3. Guerra, C. 2010. Child care providers get lessons in Lee County on being prepared. News-Press, Apr 19. http://beta.news
    -press.com.