Emergency Intervention, Neurological
Discussion: Just in Time Learning
Pursuant to 167.625. Will’s law — definitions — epilepsy or seizure disorder, individualized emergency health care plan, requirements — immunity from liability, when. — 1. This section shall be known and may be cited as “Will’s Law”.
2. As used in this section, the following terms mean:
(1) “Individualized emergency health care plan”, a document developed by a school nurse, in consultation with a student’s parent and other appropriate medical professionals, that is consistent with the recommendations of the student’s health care providers, that describes procedural guidelines that provide specific directions about what to do in a particular emergency situation, and that is signed by the parent and the school nurse or the school administrator or the administrator’s designee in the absence of the school nurse;
(2) “Individualized health care plan”, a document developed by a school nurse, in consultation with a student’s parent and other appropriate medical professionals who may be providing epilepsy or seizure disorder care to the student, that is consistent with the recommendations of the student’s health care providers, that describes the health services needed by the student at school, and that is signed by the parent and the school nurse or the school administrator or the administrator’s designee in the absence of the school nurse;
(3) “Parent”, a parent, guardian, or other person having charge, control, or custody of a student;
(4) “School”, any public elementary or secondary school or charter school;
(5) “School employee”, a person employed by a school;
(6) “Student”, a student who has epilepsy or a seizure disorder and who attends a school.
3. (1) The parent of a student who seeks epilepsy or seizure disorder care while at school shall inform the school nurse or the school administrator or the administrator’s designee in the absence of the school nurse. The school nurse shall develop an individualized health care plan and an individualized emergency health care plan for the student. The parent of the student shall annually provide to the school written authorization for the provision of epilepsy or seizure disorder care as described in the individualized plans.
(2) The individualized plans developed under subdivision (1) of this subsection shall be updated by the school nurse before the beginning of each school year and as necessary if there is a change in the health status of the student.
(3) Each individualized health care plan shall, and each individualized emergency health care plan may, include but not be limited to the following information:
(a) A notice about the student’s condition for all school employees who interact with the student;
(b) Written orders from the student’s physician or advanced practice nurse describing the epilepsy or seizure disorder care;
(c) The symptoms of the epilepsy or seizure disorder for that particular student and recommended care;
(d) Whether the student may fully participate in exercise and sports, and any contraindications to exercise or accommodations that shall be made for that particular student;
(e) Accommodations for school trips, after-school activities, class parties, and other school-related activities;
(f) Information for such school employees about how to recognize and provide care for epilepsy and seizure disorders, epilepsy and seizure disorder first aid training, when to call for assistance, emergency contact information, and parent contact information;
(g) Medical and treatment issues that may affect the educational process of the student;
(h) The student’s ability to manage, and the student’s level of understanding of, the student’s epilepsy or seizure disorder; and
(i) How to maintain communication with the student, the student’s parent and health care team, the school nurse or the school administrator or the administrator’s designee in the absence of the school nurse, and the school employees.
4. (1) The school nurse assigned to a particular school or the school administrator or the administrator’s designee in the absence of the school nurse shall coordinate the provision of epilepsy and seizure disorder care at that school and ensure that all school employees are trained every two years in the care of students with epilepsy and seizure disorders including, but not limited to, school employees working with school-sponsored programs outside of the regular school day, as provided in the student’s individualized plans.
(2) The training required under subdivision (1) of this subsection shall include an online or in-person course of instruction approved by the department of health and senior services that is provided by a reputable, local, Missouri-based health care or nonprofit organization that supports the welfare of individuals with epilepsy and seizure disorders.
5. The school nurse or the school administrator, or the administrator’s designee in the absence of the school nurse, shall obtain a release from a student’s parent to authorize the sharing of medical information between the student’s physician or advanced practice nurse and other health care providers. The release shall also authorize the school nurse or the school administrator, or the administrator’s designee in the absence of the school nurse, to share medical information with other school employees in the school district as necessary. No sharing of information under this subsection shall be construed to be a violation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Pub. L. 104-191), as amended, if a student’s parent has provided a release under this subsection.
6. No school employee including, but not limited to, a school nurse, a school bus driver, a school bus aide, or any other officer or agent of a school shall be held liable for any good faith act or omission consistent with the provisions of this section, nor shall an action before the state board of nursing lie against a school nurse for any such action taken by a school employee trained in good faith by the school nurse under this section. “Good faith” shall not be construed to include willful misconduct, gross negligence, or recklessness.
Considerations:
- Given that when a student is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s Seizure Action Plan beforehand.
- NOTE: The student’s Seizure Action Plan should indicate when 911 should be called (i.e. on immediate onset of a seizure, after the student has been having a seizure for 5 minutes, student hasn’t responded to the rescue medication, etc.).
- Store the Seizure Action Plan in a location that is easily accessible during a seizure.
- Store Seizure Observation Recording Form with the seizure medication.
- Secured, but accessible storage of the medication should be considered in the student’s medication administration plan.
- The correct dose of rectal diazepam ordered by the health care provider should be locked into place on the device by the dispensing pharmacist.
- This is evident when the green READY is visible.
- Verify that the green READY band is present on the medication when the student first brings medication to school and prior to storing for future use.
- The school nurse should develop a plan to systematically check the expiration date on the medication to ensure the medication has not expired.
- Be sure to ensure the student’s privacy and confidentiality when calling for assistance. Do not say the student’s name over the PA system or walkie-talkie.
- If possible, have someone assist with removing onlookers and other students to provide the student with privacy.
Supplies:
- Rectal diazepam medication kit
- Seizure Action Plan/Health care provider’s order and student’s Individualized Health Care Plan (IHCP) and student’s Individualized Emergency Health Care Plan
- Parent/Guardian authorization form
- Seizure Observation Recording Form
- Gloves
- Lubricant
- Blanket or pillow case as barrier
First aid for a seizure:
- If someone is available, have them call for assistance.
a. To assist with removing other students/staff from the classroom/area and to assist in obtaining the student’s emergency medication - Ease the student onto a flat surface, such as the floor, being sure not to move the student any more than is necessary
- Turn the student onto their side to allow vomit or phlegm to be expelled rather than inhaled
- Place something soft under the student’s head to protect them from injury
- Ensure the student’s airway is not obstructed
- Loosen tight clothing around the student’s neck
- Do not restrict the student’s arms or legs
- Ensure there is no furniture or objects close to the student that could injure the student
- Review the child’s Seizure Action Plan/IHCP/health care provider’s orders
- Gather the emergency medication and needed supplies in case the seizure lasts longer than the designated time frame
Procedure:
- Identify that symptoms of a prolonged seizure are present and that based on the student’s Seizure Action Plan, emergency medication needs to be given
- Call for assistance, if you have not already done so
a. Ask that another school staff person call 911 or emergency medical services if indicated in student’s Seizure Action Plan
b. NOTE: The student’s Seizure Action Plan should indicate when 911 should be called (i.e. on immediate onset of seizure, after the student has been having seizure for 5 minutes, student hasn’t responded to rescue medication, etc.). - Note time of seizure onset on the Seizure Observation Recording Form
- If the student is not already in a side lying position, move them to a side lying position, if possible
- If possible, wash your hands
- Assemble supplies and place on a clean surface
- Review the six rights of medication administration to be sure it is:
a. The right student
b. The right medication
c. The right dose
d. Being given at the right time
e. Being given by the right route
f. Being given for the right reason - Be sure to check the medication to ensure it has not expired
a. If medication has expired do not administer it, call 911 - Review the student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer medication
- Follow the student’s Seizure Action Plan/ IHCP and ensure the appropriate amount of time has passed prior to administering the student’s seizure medication
- Put on gloves, if available
- Review the six rights again to be sure that it is:
a. The right student
b. The right medication
c. The right dose
d. Being given at the right time
e. Being given by the right route
f. Being given for the right reason - Make sure the delivery device is in the “Ready” mode
- While providing the student with as much privacy as possible, remove clothing from buttocks and drape the buttocks with a blanket, pillow case or other barrier
- Push up on the cap with your thumb and pull to remove the cap from the syringe
- Open the package of lubricant
- Lubricate the tip by inserting it in the lubricating jelly
- Move the student to a side-lying position if not already in position, with the top leg forward so the rectum is exposed
- Using non-dominant hand, separate the buttocks to expose the rectum
- Using dominant hand, gently insert the syringe into the rectum until the rim is snug against the rectal opening
- Push the plunger in slowly counting to three until the plunger stops
- Hold the syringe in place after inserting the medication and count to three
- Remove the syringe from rectum
- Immediately hold the buttocks together and count to three again
a. This helps keep the medication from leaking out - Keep the student on their side
- Keep blanket, pillow case, or other barrier in place to provide privacy for the student
- Note time of medication administration and document on Seizure Observation Recording Form
- If alone and you have not already done so, call 911 or emergency medical services now if indicated in student’s Seizure Action Plan
- Monitor seizure activity and respiratory effort
- If breathing stops, begin rescue breaths
- Instruct someone to bring an AED, if available
- If breathing and heartbeat stop, begin CPR
- Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
- Remember to dispose of all used equipment and medicine safely out of the reach of students
- Remove gloves
- Wash hands
- Document the date, time, and dose of medication given in addition to what was observed during the seizure and recorded on the Seizure Observation Recording Form
- Follow up with the parent or guardian and health care provider, as needed
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References:
Bausch Health US, LLC. (2023). DIASTAT- diazepam gel. Retrieved June 9, 2023, from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=88e0f275-dd7b-447d-b9d3-316a06da934f&type=display
Butler, S.M., Boucher, E.A., Tobison, J., & Phan, H. (2020). Medication use in schools: current trends, challenges, and best practices. J Pediatric Pharmacology Ther., 25(1), 7–24. doi: 10.5863/1551-6776-25.1.7
Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Retrieved June 6, 2023, from https://www.cdc.gov/epilepsy/about/first-aid.htm
Dean, P., O’Hara, K., Brooks, L., Shinnar, R., Bougher, G., & Santilli, N. (2021). Managing acute seizures: New rescue delivery option and resources to assist school nurses. NASN school nurse (Print), 36(6), 346–354. https://doi.org/10.1177/1942602X211026333
Epilepsy Foundation of America. (2020). Seizure training for school nurses: Caring for students. [On-demand course]. Retrieved June 23, 2023, from https://learn.epilepsy.com/courses/take/school-nurse-OD-v2a/lessons/45652454-course-introduction
Hartman, A.L., Devore, C.D.L, American Academy of Pediatrics and the Section on Neurology, et al. (2016, January 1). Rescue medicine for epilepsy in education settings. Pediatrics, 137(1):e20153876. Retrieved April 8, 2020, from https://pediatrics.aappublications.org/content/137/1/e20153876
Hoerth, M. & Osborne Shafer, P. (2020, April 17). Rectal rescue medications. Retrieved June 9, 2023, from https://www.epilepsy.com/treatment/seizure-rescue-therapies/rectal-rescue-medicines
National Association of School Nurses. (2018). School nursing evidence-based clinical practice guideline: Students with seizures and epilepsy. Retrieved June 9, 2023, from https://www.pathlms.com/nasn/courses/8992
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Acknowledgment of Reviewers:
Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services
Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last updated: February 20, 2024
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