Key Concepts
Emergency Policies
Managing Injuries: Physical and PsychologicalFirst Aid
Documenting, Debriefing, and Following Up Incidents
Questions for Discussion/Reflection
Resources
     Publications
     Videos
     Information Memorandums
     Organizations

Key Concepts

• Emergencies and severe injuries are rare, but they can have a significant impact on the health and well-being of staff, children, and families.
• Head Start staff can minimize the harmful consequences of emergencies by preparing in advance with emergency policies, provisions, and education for staff, children, and parents.
• Managing injuries effectively involves:
  • surveying the scene
  • assessing the injured child
  • providing immediate care for the child, including first aid
  • notifying parents
  • obtaining emergency medical care, if needed
  • documenting and reporting the incident and actions taken
    
• During and after injuries, staff should communicate sensitively with the injured child and other children, staff, and parents to address their fears and concerns.
• Debriefing after emergencies and periodic review of injury reports can help identify strategies to prevent and manage injuries more effectively.

Background Information

A. Emergency Policies

Although emergencies and severe injuries are rare, they do happen. The best way for Head Start programs to handle emergencies effectively and minimize the harmful consequences is to prepare thoroughly in advance.

Head Start programs need emergency policies, procedures, provisions, and training that comply with the Head Start Program Performance Standards and state child care licensing regulations. In some cases, state Nurse Practice Acts may apply. According to Head Start Program Performance Standards and best practice standards, every program should have emergency policies and procedures covering the following:

• supervision
• safety surveillance
• medication administration
• medical emergencies
• dental emergencies
• first aid
• blood-borne pathogens precautions
• emergency contacts (e.g., police, fire, ambulance, poison control, child protective services)
• notifying parents
• transporting children (e.g., daily transport to and from program, field trips, to hospital)
• exclusion guidelines
• evacuation of the site and emergency shelter (e.g., for fire, storm, earthquake, bomb threat, power failure)
• inflicted injuries (e.g., biting, hitting)
• child abuse and neglect
• dangerous parent situations (e.g., non-custodial parent, intoxication, threat of violence, unauthorized person)

Most of the policies and procedures can follow general recommendations outlined in current health and safety resources. (See Resources at end of document. ) However, programs may need to individualize certain emergency procedures for children with disabilities and special medical needs. For example, special evacuation procedures may be needed for children in wheelchairs, and special emergency provisions may be needed for children who take daily medications.

The policies and procedures should address who is responsible and what needs to be done. They must be in writing and communicated to new staff in orientation training with periodic updates for all staff. They should be readily accessible with key information posted, such as emergency telephone numbers and exit routes.

Emergency supplies (e.g., first aid kit and three-day supply of food or formula, water, clothes, diapers, blankets, flashlight, batteries, medications, etc.) should be prepared and restocked as needed. The first aid kit and children's emergency individual information must be accessible to indoor and outdoor areas in the program as well as transportation and on field trips.

Staff, parents, and children should have periodic opportunities to practice emergency procedures. This helps everyone follow the basic rules of emergency response: stay calm, follow emergency procedures, and act quickly. Fire drills should be scheduled monthly, at different times of the day to allow practice evacuating the site from different activities. Dramatic play games, such as "What if..." can help children understand what an emergency is and role-play what they should do.

B. Managing Injuries: Physical and Psychological First Aid

In managing emergencies, it is crucial to remember that the impact of emergencies and injuries is both physical and psychological. Any injury, whether a fall or child abuse, leaves physical and emotional bruises. Also, every incident affects not only those with physical injuries but also other children and adults who observed the incident or have a relationship with the injured person. Other children and adults often experience concern and fear for the injured person as well as for themselves.

For these reasons, attention should be paid to both physical and psychological first aid, treatment and follow-up for children, staff, and parents during and after an incident. During and after injuries, staff should take care to communicate sensitively with the injured child and other children, staff, and parents to address their fears and concerns. Head Start programs should rely on both their emergency medical services as well as mental health professionals for consultation and help with emergencies.

C. Documenting, Debriefing, and Following Up Incidents

After any incident or injury, it is important to document what happened and what actions were taken. Injury or incident report forms can help to ensure thorough documentation of the incident. This documentation helps inform parents and health care providers so that they can give the child the best possible care. Documentation also may be needed for reporting serious incidents to the licensing agency or for other legal review. Programs should periodically review incident reports and injury logs to determine how emergencies could be handled more effectively.

After any serious incident, Head Start staff, parents, and children should "debrief." Mental health professionals can give guidance and help facilitate discussions of what happened and how everyone is feeling. Debriefing allows children and adults to tell their story and regain a sense of control that can minimize the negative long-term effects of frightening, traumatic incidents.

Follow-up discussion of incidents can also help to identify what still needs to be done and what could have been done to prevent or manage the incident more effectively. With good follow-up, an unfortunate incident can be turned into an opportunity for learning and growth like the "new trees growing after the forest fire."

Questions for Discussion/Reflection

Think about an emergency situation that your program has faced in the past year.

• What was the overall impact of this emergency on staff, children and parents?
• What aspects of the emergency situation were handled well?
• What aspects could have been handled better?
• Were staff, children, and parents adequately prepared in advance with emergency policies, procedures, and provisions? If not, have policies and procedures been revised to address this need?
• Was there adequate debriefing and follow-up after the emergency?

Resources

Publications

American Academy of Pediatrics. Injury Control for Children and Youth. Elk Grove, IL: American Academy of Pediatrics, 1987 (under revision).

This book summarizes of the major causes of injury to children, from infants through teens. It is organized into separate chapters on the different causes of injury, such as motor vehicles, falls, drowning, burns, and choking. The book also reviews the history of injury prevention and recommendations for injury prevention counseling for parents and other caregivers.

American Academy of Pediatrics. The Injury Prevention Program (TIPP): A Guide to Safety Counseling in Office Practice. Elk Grove, Ill.: American Academy of Pediatrics, 1994 revision.

This is an easy-to-use injury prevention program for health care providers to incorporate into clinical pediatric practice. It is organized by the child's age, corresponding to the periodic well-child visit schedule, and contains parent surveys about safety, guidelines for counseling, and safety handouts.

American Academy of Pediatrics. "Childhood Injury: It's No Accident" (speaker's kit with slides). All Kids Safe Campaign. Elk Grove, Ill.: American Academy of Pediatrics, 1997.

This is a speaker's kit on childhood injury prevention for presentations to parents, teachers and community groups. It contains a script and slide set reviewing the causes and key prevention measures for childhood injury. It also includes a home safety checklist.

American Academy of Pediatrics Work Group on Disasters. "Psycho-social Issues for Children and Families in Disasters: A Guide for the Primary Care Physician." Washington, D.C.: U.S. Department of Health and Human Services, Center for Mental Health Services. May 1995.

This manual helps health care providers assist children and families respond to disasters. It reviews the common responses of children according to their age and development, and interventions and resources to help children and families recover. It also provides guidelines for when additional mental health services may be necessary.

American Red Cross. Child Care Course: Health and Safety Units. Unit A (Preventing Childhood Injuries) and Unit B (Infant and Child First Aid). Washington, D.C.: American National Red Cross, 1990.

This is a training curriculum for child care providers on preventing and managing children's injuries. It contains training outlines, activities, videos, worksheets, handouts, and checklists.

American Public Health Association and American Academy of Pediatrics. Caring For Our Children: National Health and Safety Performance Standards—Guidelines for Out-of-Home Childcare Programs. Washington, D.C.: American Public Health Association, 1992.

This is a comprehensive set of health and safety guidelines for child care that were developed by key child health and child care organizations. Injury prevention is addressed in many chapters including staffing, activities, health protection and promotion, nutrition, facilities, children with special needs, and administration. The document includes rationales and comments relating to standards, references, and detailed appendices.

Aronson, S. and H. Smith. Model Child Care Health Policies. Bryn Mawr, PA: Pennsylvania Chapter of American Academy of Pediatrics, 1993.

This manual provides a sample health policy for early childhood programs. It addresses injury prevention and management in sections on supervision, discipline, safety, and emergencies. It has a comprehensive safety checklist and forms, and is available on disk to help programs develop their own health policies.

Centers for Disease Control. Flood, Hurricane, Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety (pamphlets). Atlanta, GA: Centers for Disease Control, USDHHS.

These pamphlets contain clear health and safety guidelines for preparing for and responding to natural disasters such as flood, hurricane, and extreme heat.

Jambor T., Palmer S.D. Playground Safety Manual. Birmingham, Ala.: University of Alabama, 1991.

This is an easy-to-read manual on playground safety for school administrators and teachers. It contains general safety recommendations as well as specific guidelines and checklists for different kinds of playground equipment.

Kendrick, A.S., R. Kaufmann and K.P. Messenger, eds. Healthy Young Children: A Manual for Programs. Washington, D.C.: National Association for the Education of Young Children, 1995.

This is a comprehensive book on health and safety in early childhood programs. It addresses injury prevention and management in chapters on Safety and First Aid, and Special Health Issues including Child Abuse and Neglect, and Lead Poisoning. It also contains safety checklists and emergency forms.

Slaby, Roedell, Arezzo, and Hendrix. Early Violence Prevention: Tools for Teachers of Young Children. Washington, D.C.: National Association for Education of Young Children, 1995.

This is a book on violence prevention for early childhood teachers. It includes chapters addressing violence at home, in the community, and in media; as well as practical suggestions for structuring the classroom to promote nonviolence through the environment, activities, materials, problem-solving skills, and handling aggressive behavior.

U.S. Consumer Products Safety Commission. Handbook for Public Playground Safety. Washington, D.C.: U.S. Consumer Products Safety Commission.

This comprehensive manual details safety recommendations for different kinds of playground equipment and surfacing. It contains helpful illustrations and charts.

U.S. Department of Health and Human Services, Head Start Bureau: Head Start Facilities Manual, 1995.

This is a detailed manual for Head Start facilities, including safety features. The site safety checklist is less comprehensive than checklists in other resources listed above.

-Us in a Bus: A Transportation Manual for Head Start Programs, 1984.

This manual outlines guidelines for transportation safety in Head Start. It includes safety procedures, planning a transportation system, and training activities for drivers and bus monitors.

Videos

American Red Cross. Child Care Course: Health and Safety Units. Unit A (Preventing Childhood Injuries) and Unit B (Infant and Child First Aid). Washington, D.C.: American National Red Cross, 1990.

These videos on injury prevention and first aid accompany the written curriculum described above.

American Public Health Association and American Academy of Pediatrics. Caring For Our Children: National Health and Safety Guidelines. Elk Grove Village, Ill.: American Academy of Pediatrics, 1995.

This set of six videos accompanies the written manual described above.

Video Active Productions (Huber, D., Producer) Safe Active Play. Delaware, 1997.

This video demonstrates strategies for ensuring safe active play in early childhood programs. It follows the guidelines listed in Caring for Our Children.

Information Memorandums

• Drug and Alcohol Testing Requirements for Head Start Drivers.
  Originating Office: Head Start Bureau, Issuance Date: 12/12/95.
• Notice of Proposed Rulemaking on Head Start Transportation Safety.
  Originating Office: Head Start Bureau, Issuance Date: 6/19/95
• Occupational Health Standards for Bloodborne Pathogens.
  Originating Office: Head Start Bureau, Issuance Date: 8/27/93
• Transportation Safety. Originating Office: Head Start Bureau,
  Issuance Date: 3/18/93

Organizations

• American Academy of Pediatrics
  141 Northwest Point Blvd., Box 927
  Elk Grove Village, IL 60009
  (800) 433-9016
  Web Site: http://www.aap.org
• American Public Health Association
  1015 15th Street, NW, Suite 300
  Washington, DC 20005
  (202) 789-5600
  Web Site: http://www.apha.org
• American Red Cross National Headquarters
  Jefferson Park
  8111 Gatehouse Road
  Falls Church, VA 22042-1203
  (202) 737-8300 General Information
  Web Site: http://www.redcross.org
• Centers for Disease Control and Prevention
  Center for Injury Prevention and Control
  1600 Clifton Road, N.E.
  Atlanta, GA 30329
  (404) 639-3311
  Web Site: http://www.cdc.gov
• Head Start Facility Referral and Information Service (FRIS)
  Aspen Systems Corp.
  1600 Research Blvd., 5F
  Rockville, MD 20850
  (800) 303-0705 or (301) 251-5164
  E-mail: mcunningham@smtpinet.aspensys.com
• National Center for Education in Maternal and Child Health
  Maternal and Child Health Bureau
  2000 15th Street, North, Suite 701
  Arlington, VA 22201
  (703) 524-7802
  Web Site: http://www.ncemch.org
• Emergency Medical Services for Children (EMSC)
  National Resource Center
  111 Michigan Avenue, NW
  Washington, DC 20010
  (202) 884-4927
• National Highway Traffic Safety Administration
  400 7th St., SW
  Washington, DC 20590
  (202) 366-4000
  Web Site: http://www.nhtsa.gov ADD HYPERLINK HERE
• National Program for Playground Safety
  University of Northern Iowa, School of HPELS
  Cedar Falls, Iowa 50614-0461
  (800) 554-PLAY
• National SAFE KIDS Campaign
  1301 Pennsylvania Ave., Suite 1000
  Washington, DC 20004
  (202) 662-0600
  E-mail: info@safekids.org
• National Safety Council
  444 N. Michigan Ave.
  Chicago, IL 60611
  (630) 285-1121
  Web Site: http://www.nsc.org
• National Domestic Violence Hotline (24 hours/day)
  Texas Council on Family Violence
  3616 Far West Blvd., Suite 101
  Austin, TX 78731
  (800) 799-SAFE
  TDD: (800) 787-3224
  Web Site: http://www.ndvh.org
• U.S. Consumer Product Safety Commission
  Washington, DC 20207
  (800) 638-CPSC
  Web Site: http://www.cpsc.gov