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    Seizure Care Plan Epilepsy Foundation

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    heather579
    This document outlines a seizure action plan for a student. It provides information about the student's seizure type, triggers, reactions, and emergency response procedures. Basic first aid instructions are given which emphasize safety, comfort, and monitoring the student. Emergency protocols specify conditions that warrant contacting emergency services and potential emergency medications. Daily medications and special safety precautions are also addressed. The plan requires signatures from the physician, parent, and school nurse.

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    Seizure Care Plan Epilepsy Foundation

    Uploaded by

    heather579
    848 views2 pages
    This document outlines a seizure action plan for a student. It provides information about the student's seizure type, triggers, reactions, and emergency response procedures. Basic first aid instructions are given which emphasize safety, comfort, and monitoring the student. Emergency protocols specify conditions that warrant contacting emergency services and potential emergency medications. Daily medications and special safety precautions are also addressed. The plan requires signatures from the physician, parent, and school nurse.

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    This document outlines a seizure action plan for a student. It provides information about the student's seizure type, triggers, reactions, and emergency response procedures. Basic first aid instructions are given which emphasize safety, comfort, and monitoring the student. Emergency protocols specify conditions that warrant contacting emergency services and potential emergency medications. Daily medications and special safety precautions are also addressed. The plan requires signatures from the physician, parent, and school nurse.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    848 views2 pages

    Seizure Care Plan Epilepsy Foundation

    Uploaded by

    heather579
    This document outlines a seizure action plan for a student. It provides information about the student's seizure type, triggers, reactions, and emergency response procedures. Basic first aid instructions are given which emphasize safety, comfort, and monitoring the student. Emergency protocols specify conditions that warrant contacting emergency services and potential emergency medications. Daily medications and special safety precautions are also addressed. The plan requires signatures from the physician, parent, and school nurse.

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    SEIZURE ACTION PLAN Effective Date

    Name: DOB Parent email:


    Parent/Guardian: Phone
    Emergency Contact Phone
    Treating Physician: Phone

    SE IZ UR E IN FO RM ATIO N:
    Seizure Type Length Frequency Description

    Seizure triggers or warning signs:

    Student’s reaction to seizure:

    BASIC FIRST AID: CARE & COMFORT: (Please describe basic first aid procedures)
    Basic Seizure First Aid:
     Stay calm & track time
     Keep child safe
     Do not restrain
    Does student need to leave the classroom after a seizure? YES NO  Do not put anything in mouth
    If YES, describe process for returning student to classroom  Stay with child until fully conscious
     Record seizure in log
    For tonic-clonic (grand mal) seizure:
    EMERGENCY RESPONSE:  Protect head
    A “seizure emergency” for this student is defined as:  Keep airway open/watch breathing
     Turn child on side

    *********************************************

    A Seizure is generally considered an


    Seizure Emergency Protocol: (Check all that apply and clarify below) Emergency when:
    ___ Contact school nurse at ________________________  A convulsive (tonic-clonic) seizure lasts
    ___ Call 911 for transport to ______ longer than 5 minutes
    ___ Notify parent or emergency contact  Student has repeated seizures without
    ___ Notify doctor regaining consciousness
    ___ Administer emergency medications as indicated below  Student has a first time seizure
    ___ Other  Student is injured or has diabetes
     Student has breathing difficulties
     Student has a seizure in water
    TREATMENT PROTOCOL DURING SCHOOL HOURS: (include daily and
    emergency medications)
    Daily Medication Dosage & Time of Day Given Common Side Effects & Special Instructions

    Emergency/Rescue Medication ***_______________________________________________________________________


    Location of medication: _____Office _____ With teacher _____With student
    ***A completed Medication Authorization Form must be signed by both parent and physician and on file in the office
    before any medication can be given or carried at school.

    Does student have a Vagus Nerve Stimulator (VNS)? YES NO


    If YES, Describe magnet use
    SPECIAL CONSIDERATIONS & SAFETY PRECAUTIONS:  (regarding school activities, sports, trips, etc.)
     
                
                 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
       

    Physician Signature: Date:


    Parent Signature: Date:
    School Nurse Signature: Date

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