If a client calls to report an absence because their child has Adenovirus, ask them when they were last at the swim school. If the infected child was in the swim school within 2-3 days of infection:

1. Notify the front desk of that location to let them know there has been a possible exposure. 
2. Site supervisors and booking center should work together to keep an eye/ ear out for any further cases reported. 
3. If more than one case is reported within the same week, notify General Manager. 

If a client calls and claims that their child contracted Adenovirus from our swim school, we can reply with the followingresponse as appropriate:

“Thank you for alerting us. We are aware that Adenovirus is a common childhood illness and can be found in places where there is a high volume of children such as child care centers, grocery stores, schools, museums, playgrounds and possibly Hubbard. While we do perform daily cleaning to our facilities, we will ALERT our staff to take EXTRA care toclean common surfaces, play areas, and changing areas throughout the day. Please keep us updated with any concerns please contact your pediatrician with any further questions. We hope your child feels better soon!”

In regards to a possible water transmission, the CDC states that while some forms of the Adenovirus can be spread through water, such as swimming pools, it is not as common. In regards to our pool water at HFSS, we are proud to saythat we exceed the requirements for Maricopa County Environmental Health Code. For example, in our small pool, we have a minimum water turnover rate every 110 minutes where as the Maricopa County Health Code only requires it to be within 8 hours. We also exceed recommendations on standard chemical maintenance by using high tech measures and UV light to neutralize microorganisms quickly and keep our water clean and safe for our clients and employees. 

Further questions regarding the care of our water, direct to a certified HFSS pool operator. 

Source: https://www.cdc.gov/adenovirus/index.html

Adenoviruses are common viruses that cause a range of illnesses. You can get an adenovirus infection at any age. People with weakened immune systems or existing respiratory or cardiac disease are more likely than others to get very sick from an adenovirus infection. 

SIGNS AND SYMPTOMS

• Cold-like symptoms
• Sore throat
• Bronchitis
• Pneumonia
• Diarrhea
• Pink eye (conjunctivitis)

HOW IT SPREADS

Adenovirus can spread from an infected person to an uninfected person through:

• Close personal contact such as touching or shaking hands
• The air by coughing and sneezing
• Touching objects or surfaces with adenoviruses on them then touching your mouth, nose, or eyes

PREVENTION

You can protect yourself and others from adenoviruses and other respiratory illnesses by following a few simple steps:

• Wash your hands often with soap and water 
• Avoid touching your eyes, nose, or mouth with unwashed hands
• Avoid close contact with people who are sick

TREATMENT

No treatment available other than to treat the symptoms. 

Anaphylaxis is a sudden, life threatening severe allergic reaction that involves the whole body and is usually caused by areaction to: food, insect stings, medication, and latex. A person may or may not have a history or diagnosis of an allergy or anaphylaxis. When a person exhibits symptoms of anaphylaxis, enact the Anaphylaxis EAP and CALL 911Immediately.

HUBBARD SPORTS CAMP: Note all allergies in your group, have a custom plan ready for each allergy (pre and post)

SIGNS AND SYMPTOMS

Symptoms can progress quickly and can be fatal without prompt treatment. Asthmatic reactions present many of the same symptoms as anaphylaxis. If you are unsure, always use Epinephrine (EpiPen) if one is prescribed for that individual.

1. Swelling of lips, eyelids, throat and tongue
2. Extreme difficulty breathing
3. Coughing/wheezing
4. Altered mental status
5. Anxiety
6. Hives/itching
7. Nausea/vomiting
8. Abdominal pain/ cramping
9. Diarrhea

FIRST AID 

1. Stay with patron.
2. If the patron has an EpiPen prescription with him or her or on site, the patron, guardian or rescuer may administer Epinephrine as directed. 
3. If EMS does not arrive within 5-10 minutes of first administration, prepare to administer 2nd dose. Epi or asthma medication should NOT be relied on to solve the problem.
4. Sit them up or put in recovery position. 
5. Notify the parents if not already done.
6. Meet EMT.
7. Accompany child to emergency care facility (family member/ staff member).

EpiPen Dosage:

How to administer EpiPen: (Call 911 if administering an EpiPen)

1. Form a fist around the center of the unit.
2. Pull off/Flip up activation cap.
3. Hold tip near outer thigh.
4. Swing and jab into outer thigh.
5. Hold in place and count to 10.
6. Pull the injector straight out. Rub injected area for 15 seconds.
7. Carefully place the used auto-injector, needle end first, into the storage tube of the carrying case. Ask EMS providers for help in proper disposal.

FIRST AID 

1. Put on Personal Protective Equipment
2. Remove jewelry and constricting clothing from affected area
3. Remove the stinger if visible. Do not pinch, this can release more venom.
4. Wash the area with soap and clean tap water.
5. Control the swelling with ice, and elevate the area. 
6. Watch for signs of an allergic reaction or anaphylaxis. 
   • If anaphylaxis occurs, see EAP Anaphylaxis. 
7. Contact parent or EMS if symptoms persist, worsen or do not subside.

Important issues to consider with any open wound are control of bleeding and infection. 

1. The first responder should stay with the patron.
2. Notify other responders to access first aid kit, equipment or emergency medical help if necessary.
3. PPE- Wear gloves (gown/ mask if appropriate) at all times when dealing with blood or other bodily fluids.
4. Provide appropriate care based on the patient, injury and training.
5. When treatment is complete, immediately fill out a detailed incident report. 

MINOR WOUNDS

Minor wounds include abrasions, lacerations, punctures, and incisions.

First Aid:

1. Put on PPE
2. Clean the wound with clean water if appropriate
3. Stop the bleeding with a clean, absorbent material. 
4. Apply pressure if needed.
5. Bandage as appropriate

MAJOR WOUNDS

A major wound requires immediate medical attention and may be a sign of serious injury to deeper tissues and organs.CALL 911

Goal: control bleeding, reduce pain, prevent infection and observe for signs of shock. 

First Aid:

1. Put on PPE
2. If bleeding is severe, do not attempt to wash the wound -this will remove clotting agents
3. If something is embedded in the wound, do not remove.
4. Stop the bleeding with a clean, absorbent material.
5. Keep pressure on the wound until help arrives
6. If blood soaks through gauze or dressing, do not remove; add more gauze and maintain firm pressure
7. If person becomes pale, cold or dizzy, SHOCK may be occurring- see SHOCK EAP
8. If something is embedded in the wound, do not remove.
9. Communicate with parents as appropriate.

Follow Clean up Procedure for Blood or Bodily Fluids

These chemicals are used for fecal accidents, urine, vomit, blood, etc. and cannot be used on skin.

CAVICIDE

1. Block off area of the incident from patrons until clean-up and disinfection is complete.
2. Put on disposable gloves (gown, mask if needed).
3. Gently spray Cavicide solution onto surface to be cleaned and immediately wipe up the spill with a paper towel. This ensures a clean surface to start disinfection process. 
4. Gently spray Cavicide solution on all contaminated surface areas again.
5. Let Cavicide sit on area for 3 minutes. Do not wipe, blow on or disturb area for 3 min. 
6. After 3 min., wipe area w/ disposable towels & throw the towels away in a garbage bag. 
7. If any other non-disposable cleaning tools such as mop, buckets, and brushes were used to clean the spill,use floor sink and rinse with water to remove debris then spray with the Cavicide solution and let air dry.
8. Remove gloves and place in garbage bag with all soiled cleaning materials.
9. Securely tie-up garbage bag and discard.
10. Thoroughly wash hands with soap and water.
11. Fill out incident report if necessary.

SUPER-SORB POWDER

If the spill is voluminous and/or hard to contain or soak up with a paper towel

1. Sprinkle Super-Sorb powder over fluid spill (blood, urine, vomit). 
2. Let Super-Sorb sit for 30 seconds; this will turn any liquid into an easy to dispose of gel.
3. Using disposable scoop or paper towel, clean up Super-Sorb gel and dispose of in a garbage bag. 
4. Disinfect the area using the clean up procedure steps for fecal, blood, or bodily fluids as listed above.

WHAT TO DO IF YOU (EMPLOYEE) ARE EXPOSED TO BLOOD ORBODILY FLUIDS 

1. Ensure the victim’s needs are taken care of
2. Wash the area on your body that has been exposed with soap and water for at least 10 seconds. Only use soap- do not use bleach or other types of cleaning agents. Soap is a cleaning agent
3. Notify your site supervisor or executive team member immediately if you feel blood or bodily fluid has come into contact with a wound on your body, or your mouth, eyes, or nose. 
4. Seek medical care as necessary
5. Fill out incident report

This can be life threatening; it is common in people with asthma but can also be a symptom of a serious medical emergency. 

Asthma is a disease in which the air passages in the lungs become narrower from swelling and extra mucous thus limiting airflow

SIGNS AND SYMPTOMS

1. Sudden onset of wheezing
2. Shortness of breath 
3. Constant coughing
4. Chest tightness
5. Stooped body posture
6. Extreme difficulty breathing with the chest and neck pulled in
7. Anxiety
8. Sweating

FIRST AID

1. Allow person to find most comfortable position 
2. Loosen any tight clothing
3. If patron has prescribed medicine for asthma, provide assistance
4. Alert EMS if patron does not improve within 5 minutes after initial treatment with medication. 
5. If the patron does not have asthmatic medication available alert EMS. Symptoms rarely resolve on their own. 

FIRST AID

1. Call for emergency help if the injury is severe.
2. Put on Personal Protective Equipment
3. Stop any bleeding by holding a clean, absorbent material over the injury and apply gentle, direct pressure. Add moregauze if bleeding saturates through. Do not remove bloodied gauze. 
4. Immobilize the injured area by placing hands gently above and below the injury. Do not move it from its original position.
5. If bone is protruding, do not attempt to straighten or push back under the skin
6. Do not allow the victim to bear weight on the affected limb
7. Ice the injured area to slow swelling while waiting for emergency help.

Burns can be caused by sun, fire, chemicals, hot liquids, hot objects and hot gases. Rescuer needs to prioritize personalsafety. If a patron is on fire, instruct him/her to STOP, DROP, and ROLL. If the patron is in contact with electricity, shutoff electrical power source.

MAJOR BURNS EVERE BLOCKAGE - FIRST AID 

Burns on the hands, feet, face, and genitals are considered to be very serious. Burns can also involve smoke inhalation,fractures, and other injuries. 

Signs and Symptoms:

• Dry/ leathery, white, blackened, and/or charred skin

First Aid:

• Assess, alert and attend to life-threatening problems.
• Expose burn.
• Cut and lift away any clothing covering burn area. If clothing is stuck to burn, do not remove.
• Remove jewelry if possible.
• Separate fingers and toes with dry, sterile, non-adhesive dressings.
• Lightly cover burn area with dry sterile bandages or a clean sheet if area is large.
• For a chemical burn, immediately flush chemical off with large amounts of water.

MINOR BURNS

Burns that involve but do not destroy skin tissue. Rapid treatment can provide patron with comfort and prevent longterm damage.

Signs and Symptoms:

• Pain
• Redness
• Swelling
• Blistering

First Aid:

1. Expose the burn
2. Heat burns: cool with cold water until pain is diminished or gone
3. After cooling, cover burn with a dry, sterile bandage or clean dressing
4. Protect burn from pressure or rubbing
5. Do not pop burn blisters or apply ointment, sprays, or anything else to burn site

What is child abuse and neglect?

When a parent, guardian or custodian inflicts or allows the infliction of physical, sexual or emotional abuse, neglect,exploitation or abandonment.

Who Must Report Child Abuse?

Any person who reasonably believes that a minor is or has been the victim of physical injury, abuse, child abuse, areportable offense or neglect that appears to have been inflicted on the minor by other than accidental means orthat is not explained by the available medical history as being accidental in nature, or who reasonably believes thatthere has been a denial or deprivation of necessary medical treatment or surgical care or nourishment with theintent to cause or allow the death of an infant who is protected under A.R.S. § 36-2281, shall immediately report orcause reports to be made of this information to a peace officer or to Department of Child Safety, except if the reportconcerns a person who does not have care, custody or control of the minor, the report shall be made to a peaceofficer only.

Where can a report be made?

A report can be made to the DCS Statewide Toll-Free Child Abuse Hotline at 1-888-767-2445, (1-888-SOS-CHILD) orlaw enforcement office. When reporting, the following information if known will be requested:

• name, age, and gender of child and other family members
• address, phone numbers, and/or directions to child's home
• parents' place of employment
• description of suspected abuse or neglect
• current condition of the child

IF A CLIENT/PATRON/EMPLOYEE SUSPECTS ABUSE

Arizona Child Abuse Hotline 1-888-SOS-CHILD (1-888-767-2445)

A report of suspected child abuse, neglect, exploitation or abandonment is a responsible attempt to protect a child.Arizona law requires certain persons who suspect that a child has received non-accidental injury or has been neglected to report their concerns to DCS or local law enforcement (ARS §13-3620.A). YOU may be a child’s only advocate at the time you report the possibility of abuse or neglect. Children often tell a person with whom they feel safe about abuse or neglect. If a child tells you of such experiences, act to protect that child by calling the toll Arizona Child Abuse Hotline at 1-888-SOS-CHILD (1-888-767-2445). 

If a client/patron approaches a HFSS staff member and asks the staff member to report an abuse, the HFSS staff member will provide that patron with the phone number 1-888-SOS-CHILD (1-888-767-2445) and that patron should report it themselves. 

HFSS staff is not responsible for reporting on behalf of the concerned patron. If the staff member feels inclined orhas personal suspicions/concerns, that staff member can report. 

HFSS staff may not give out the personal information of another client. The staff member should make a tracking note in the account of both people and the patron giving the report may list you as a person to contact if the DCS agency needs more information. If DCS contacts HFSS, we can give the information as requested.

References: https://dcs.az.gov

FIRST AID

1. Assess infant; look at face. If infant is silent, unable to cry, has blue lips, nails or skin, or face is bright red. ACTQUICKLY
2. If alone, provide two minutes of care before activating EMS. If bystander available, activate EMS
3. Give 5 back slaps
   1. Place infant face down over your forearm, with head lower than chest. 
   2. Support head by holding jaw
   3. Use heel of other hand to give back slaps between the shoulder blades
4. Give 5 Chest Thrusts
   1. Switch infant to other forearm, face up
   2. Cradle head with hand
   3. Place two fingers on breastbone, just below nipple line
   4. Give 5 chest thrusts
5. Repeat Back Slaps/ Chest Thrust sequence until infant becomes unresponsive or until object is expelled
6. If infant becomes unresponsive, lower him/ her to the ground
7. Begin CPR, starting with compressions; utilize AED if available
8. Check mouth prior to giving breaths, if you see object, attempt to safely remove
9. Continue CPR cycle, rechecking pulse every two minutes; 

MILD BLOCKAGE

Victim can speak, cough, gag. Encourage patron to cough forcibly.

SEVERE BLOCKAGE - FIRST AID 

1. Assess person: Are you choking? Nods yes. Activate EMS, get AED
2. Position yourself; stand behind victim with one of your legs between the patron’s for support if the patron should go unconscious. For a child, you may need to kneel behind them. 
3. Make a fist with one hand and place thumb side against abdomen, just above navel and below ribs; grasp fist with the other hand. 
4. Give thrust; INWARD and UPWARD
5. Continue until the object is expelled or victim becomes unresponsive.
6. If victim becomes Unresponsive, lower him/ her to the ground.
7. Begin CPR starting with compressions; Utilize AED if available. 
8. Check mouth for object prior to giving breaths; If you see object, attempt to safely remove.
9. Continue CPR cycle, rechecking pulse every two minutes.

A significant blow or force to the head can result in internal injury to the brain. Most concussions are temporary and resolve naturally but it is possible for one to progress to a life-threatening injury.

SIGNS AND SYMPTOMS

• Patron unable to remember what happened just before or after incident
• Stunned or dazed
• Headache
• Nausea
• Dizziness
• Problems with balance or vision
• Confusion

FIRST AID

1. Activate EMS or contact Parent depending on signs and symptom severity
2. Activate EMS immediately if there is a change or alteration in mental status
3. Do not allow patron to do anything that could pose a risk for additional injury and until assessed and cleared by ahealthcare provider. 

If a client calls to report an absence because their child has conjunctivitis, ask them when they were last at the swim school. If the infected child was in the swim school within 2-3 days of infection:

1. Notify the front desk of that location to let them know there has been a possible exposure.

2. Site supervisors and booking centers should work together to keep an eye/ ear out for any further cases reported.

3. If more than one case is reported within the same week, notify General Manager.

If a client calls and claims that their child contracted conjunctivitis from our swim school, we can reply with the followingresponse as appropriate:

“Thank you for alerting us. We are aware that conjunctivitis (Pink Eye) is a common childhood illness and can result from a variety of causes such as bacteria, viruses, allergens, or irritants. We recognize that it can be found in places where there is a high volume of children such as grocery stores, schools, museums, playgrounds and possibly Hubbard.It can be difficult to determine the exact cause of pink eye because some signs and symptoms may be the same no matter the cause. While we do perform daily cleaning to our facilities, we will ALERT our staff to take extra care to clean common surfaces, play areas, and changing areas throughout the day. Please keep us updated with any concerns and please contact your pediatrician with any further questions. We hope your child feels better soon!”

In regards to a possible water transmission, the CDC states that while some forms of Conjunctivitis can be spread through water, such as swimming pools, it is not as common. In regards to our pool water at HFSS, we are proud to say that we exceed the requirements for Maricopa County Environmental Health Code. For example, in our small pool, we have a minimum water turnover rate every 110 minutes where as the Maricopa County Health Code only requires it to be within 8 hours. We also exceed recommendations on standard chemical maintenance by using high tech measures and UV light to neutralize microorganisms quickly and keep our water clean and safe for our clients and employees.

Further questions regarding the care of our water, direct to a HFSS certified pool operator.

Source: https://www.cdc.gov/Features/Conjunctivitis/

Pink eye, also known as conjunctivitis, is one of the most common and treatable eye conditions in the world in both children and adults. It is an inflammation of the conjunctiva, the thin, clear tissue that lines the inside of the eyelid and the white part of the eyeball. This inflammation makes blood vessels more visible and gives the eye a pink or reddish color.

FOUR MAIN CAUSES OF PINK EYE

• Viruses
• Bacteria
• Allergens (like pet dander or dust mites)
• Irritants (like smog or swimming pool chlorine)

It can be difficult to determine the exact cause of pink eye because some signs and symptoms may be the same no matter the cause.

SIGNS AND SYMPTOMS

The symptoms of pink eye may vary depending on the cause but usually include:

• Redness or swelling of the white of the eye or inside the eyelids
• Increased amount of tears
• Eye discharge which may be clear, yellow, white or green
• Itchy, irritated, and/or burning eyes
• Gritty feeling in the eye
• Crusting of the eyelids or lashes
• Contact lenses that feel uncomfortable and/or do not stay in place on the eye

STOP PINK EYE FROM SPREADING

Pink eye caused by a virus or bacteria is very contagious and spreads easily and quickly from person to person. Pink eye that is caused by allergens or irritants is not contagious, but it is possible to develop a secondary infection caused by a virus or bacteria that is contagious. You can reduce the risk of getting or spreading pink eye by following some simple self-care steps:

• Wash your hands
• Avoid touching or rubbing your eyes
• Avoid sharing makeup, contact lenses and containers, and eyeglasses

CPR for the Unresponsive / Pulseless Patron 

Child (1 year- Adolescence/7 years old) / Infant (birth- 1 year)

FIRST AID

1. Complete primary assessment- normal breathing absent; pulse absent.
2. Activate EAP, Get AED- utilize AED as soon as possible. When alone, for an infant or a child, provide 2 minutes of care first.
3. Give chest compressions and rescue breaths
   • 30 chest compressions (SINGLE Rescuer) 15 chest compressions (2 Rescuers)
     • Infant: 1.5 inch depth
     • Child: 2 inch depth
     • Hard and fast
     • Allow full recoil
     • 100-120x/ minute
     • Hand position: tips of two fingers on the breastbone, just below the nipple line
     • Can use one or two hands or the encircling thumbs technique
   • Give 2 Rescue Breaths
     • Tilt head or jaw thrust (suspected spinal injury)
     • Give each breath over 1 second- puff for infants
     • Visible chest rise
4. Perform compressions for 2 minutes
5. Recheck pulse, taking no more than ten seconds.
6. If there is no pulse, continue CPR and AED until help arrives; (30 compressions to two breaths)
7. If there is more than one rescuer, rotate positions every two minutes.

CPR for the Unresponsive/ Pulseless Victim 

Adult (adolescence/8 years old and older)

FIRST AID

1 and 2 Rescuers (Ratio stays the same with 1 or 2 rescuers).

1. Complete primary assessment- normal breathing absent; pulse absent. 
2. Activate EMS, Get AED- utilize AED as soon as possible. 
3. AED: utilize if available; turn on and follow prompts; use adult pads
4. 30 chest compressions
   • 2-2.4 inch depth
   • Hard and fast
   • Allow full recoil
   • 100-120x/ minute
   • Hand position: tips of two fingers on the breastbone, just below the nipple line
   • Two hands 
5. Give 2 Rescue Breaths- use a CPR mask or BVM (requires 2 operators)
   • Tilt head or jaw thrust (suspected spinal injury)
   • Give each breath over 1 second
   • Visible chest rise
6. Perform compressions for 2 minutes
7. Recheck pulse, taking no more than ten seconds.
8. If there is no pulse, continue CPR and AED until help arrives; 
   • (30 compressions to two breaths).
9. If there is more than one rescuer, rotate positions every two minutes

Teeth can be dislocated, broken, or knocked out. A permanent tooth that is knocked out can be put back in.

DISLOCATED OR BROKEN TOOTH

First Aid:

1. If lips, teeth or gums are bleeding, apply direct pressure with clean cloth
2. Arrange for victim to see a dentist immediately

KNOCKED OUT TOOTH

First Aid:

1. If lips, teeth or gums are bleeding, apply direct pressure with clean cloth
2. Handle the tooth only by the chewing surface (Crown)
3. Place knocked out tooth in: 
   • Fresh Whole Milk (preserves cells for 6 hours)
   • Cold low-fat milk (preserves cells for 1 hour) 
   • Gatorade (preserves cells for 1 hour) 
   • Contact lens solutions (preserves cells for 1 hour) 
   • Do NOT put in tap water (this can damage the root cells, reducing the chance for tooth survival after replantation)
   • Water has been shown to damage the delicate tooth root cells, reducing the chance for tooth survival after replantation.
4. Get to your dentist as quickly as possible
5. Do not wrap knocked-out tooth in tissues, cloth or gauze

Follow Clean up Procedure for Blood or Bodily Fluids

Chronic disease that leads to an imbalance of blood sugar and insulin. Blood sugar can become very high or very low. If you are uncertain of whether blood sugar is high or low, it is best to give sugar. The effects of low blood sugar are more harmful to the body than high blood sugar. If low blood sugar is the issue, improvement in symptoms can occur within 10-15 minutes. If no improvement is noted, high blood sugar may be the problem. Regardless, prompt medical treatment is required.

SIGNS AND SYMPTOMS

• Altered mental status
• Anxiety/trembling
• patron may appear drunk
• Drowsiness/difficulty waking up
• Seizures
• Unresponsiveness
• A strong, fruity breath odor
• Pounding heart
• Weak
• Fainting
• Pale/sweaty

TREATMENT FOR HYPOGLYCEMIA

• If victim is a known diabetic and is responsive: give glucose tablets or dietary sugars (candy, fruit snacks, orangejuice, skittles). 
• Activate EMS if victim does not improve within 10-15 minutes.
• If victim is unresponsive or unable to swallow, do not give anything to eat; ACTIVATE EMS immediately.

Can range from mild (irritation) to very severe (object in eye). Severe eye injuries can be caused by objects in the eye, burns, or blunt injuries, all of which can potentially cause permanent loss of vision.

MINOR IRRITATED EYE

Signs and Symptoms:

• Pain/redness/stinging/burning/itching
• Bleeding/ bruising/ black eye
• Double vision
• Decreased vision
• Sensitivity to light

First Aid:

1. Rinse affected eye with a saline solution (tap water may be used if saline is unavailable)
2. If patron continues to complain of pain or feels as though something is still in the eye, cover the eye lightly with a gauze pad and seek medical attention

OBJECT STUCK IN EYE

First Aid:

1. Tape the bottom half of a foam or paper cup over the patrons eye to keep both the eye and the object from moving
2. Lightly cover the uninjured eye with gauze- both eyes move together and this will help keep the injured eye from moving, thus preventing further injury
3. Protect the patron from further harm as patrons vision is compromised
4. Provide safety and reassurance
5. Seek immediate medical care
6. Do not remove object
7. Do not allow patron to rub or apply pressure to the injured eye

CHEMICAL BURN IN EYE

1. Immediately flood the eye with large amounts of water (Drinking fountain, hose, faucet)
2. Seek immediate medical care after washing the eye
3. Do not cover or bandage/ leave as is

Follow Clean up Procedure for Blood or Bodily Fluids.

Swim school locations are supplied with gloves, first aid kits, biohazard bags, bodily fluid cleanup kits, disinfectants, CPRmasks, and an AED. These can be found in the lobby and/or the pool deck; care should be kept within the scope of responders certifications and ability.

In the event of an emergency, the following roles will need to be assigned:

• Main Rescuer/ Responder #1
• Second Rescuer/ Responder #2
• Responsible Person(s)
  • Crowd Control 
  • Safety of Other Patrons
  • Water Watcher

MEDICAL EMERGENCY

1. A qualified staff person should assume authority, and provide or delegate first aid responsibilities to the most qualified staff person available. Do not hesitate to call 911 if necessary. 
    
2. Assess the scene for safety. Assess the nature of the injury; begin providing care according to certification standards.
    
3. For an injury requiring more advanced care, such as cardiac arrest, stroke, severe bone breaks, spinal injury, head injury, electrical shock, physical shock, or death, respiratory distress, bleeding wounds, activate the 911 system,retrieve AED if available.
    
4. If you suspect death has occurred, do not move the body. Do not pronounce death or drowning. Only the coroner, ormedical personnel, can legally ascertain that death has occurred.
    
5. Activities in the room, or where the incident or illness happened, must cease unless you can safely evacuate, shield, the person to provide treatment and privacy. Ensure the pool is being monitored by assigning a waterwatcher.
    
6. Volunteers may assist, if needed, under the direction of the staff person who has assumed authority.
7. Stabilize the situation: provide structure for the group and on-going care for the patron. Assign support tasks to others.
    
8. If a patron requires transport and the parent or guardian is not present, a staff member should accompany the patron. 
    
9. Notify the General Manager as soon as possible. GM will notify Exec Team.
    
10.  The Executive team member, GM or Site Supervisor will notify the patron’s family asap.
     
11.  Complete a HFSS Report of Occurrence with accurate details of the incident.
     
12.  No statement shall be made to the media or public by staff about the occurrence. This is the responsibility of the Owner or Exec Team.
     
13.  Follow Clean up Procedure for Blood or Bodily Fluids.

If a client calls to report an absence because their child has HFMD, ask them when they were last at the swim school. If the infected child was in the swim school within 2-3 days of infection:

1. Notify the front desk of that location to let them know there has been a possible exposure. 
2. Site supervisors and booking centers should work together to keep an eye/ ear out for any further cases reported. 
3. If more than one case is reported within the same week, notify General Manager. 

If a client calls and claims that their child contracted HFMD from our swim school, we can reply with the following response as appropriate: 

“Thank you for alerting us. We are aware that hand foot mouth disease is a common childhood illness and can be found in places where there is a high volume of children such as grocery stores, schools, museums, playgrounds and possiblyHubbard. While we do perform daily cleaning to our facilities, we will ALERT our staff to take extra care to cleancommon surfaces, play areas, and changing areas throughout the day. Please keep us updated with any concerns andplease contact your pediatrician with any further questions. We hope your child feels better soon!”

Please see next page for information regarding HFMD

Source: https://www.cdc.gov/features/handfootmouthdisease/index.html

Hand, Foot, and Mouth Disease, or HFMD, is a contagious illness caused by different viruses. It is common in infants and children younger than 5 years old, because they do not yet have immunity (protection) to the viruses that cause HFMD. However, older children and adults can also get HFMD. In the United States it is more common for people to get HFMD during spring, summer, and fall. 

SIGNS AND SYMPTOMS

These symptoms usually appear in stages, not all at once. Not everyone will have all of these symptoms. Somepeople may show no symptoms at all, but they can still pass the virus to others.

• Fever
• Reduced appetite
• Sore throat
• Feeling unwell
• Painful mouth sores that usually begin as flat red spots
• Rash of flat red spots that may blister on the palms of the hands, soles of the feet, and sometimes the knees, elbows, buttocks, and/or genital area

HOW IT SPREADS

Adenovirus can spread from an infected person to an uninfected person through:

• Close contact, such as kissing, hugging, or sharing cups and eating utensils
• Coughing and sneezing
• Contact with poop, for example when changing a diaper
• Contact with blister fluid
• Touching objects or surfaces that have the virus on them

PREVENTION

You can reduce the risk of getting infected with the viruses that cause HFMD by following a few simple steps:

• Wash your hands often with soap and water for 20 seconds.
• Avoid touching your eyes, nose, or mouth with unwashed hands
• Avoid close contact with people who are sick

TREATMENT

No treatment available other than to treat the symptoms. 

A term used to address a number of symptoms that occur when the heart does not get enough oxygenated blood.

SIGNS AND SYMPTOMS

• Chest pain or dull discomfort behind chest wall; may or may not extend down arm
• Shortness of breath
• Weakness, nausea, dizziness
• Heavy sweating
• Anxiety, fear of impending doom
• Denial 

FIRST AID

1. Assess, alert & attend to life-threatening problems.
2. Have patron sit down or rest quietly.
3. Loosen any tight clothing.
4. If patron has a known heart condition, and they have nitroglycerin with them, help him/her take medication (typically nitroglycerin that is placed or sprayed under tongue). If chest discomfort/ pain is unimproved or worsens after medication is given, call 9-1-1 immediately.
5. Comfort, calm, reassure until EMS arrives.
6. Have AED present and ready.
7. If patron becomes unresponsive and is not breathing or not breathing normally, check for pulse and start CPR/utilize AED as appropriate.

HEAT EXHAUSTION

Exposure to hot and humid conditions can overwhelm the body's ability to cool itself down. Early recognition of heat exhaustion is essential to preventing heat stroke.

Develops when the body encounters high temperatures it is not accustomed to. 

SIGNS AND SYMPTOMS

• Early signs:
  • Heavy sweating
  • Thirst
  • Minor muscle twitches that progress to painful cramping
• Late signs:
  • Pale, cool, moist skin
  • Headache
  • Nausea / vomiting
  • Weakness/ dizziness
  • Feels faint/ collapses

FIRST AID

1. Assess, alert and attend to life-threatening problems
2. Immediately get out of the heat and rest, preferably in an air-conditioned room. If you can't get inside, try to find thenearest cool and shady place.
3. Remove any tight or unnecessary clothing.
4. Take a cool shower, bath, or sponge bath.
5. Apply other cooling measures such as fans or ice towels.
6. Place a cool compress on patron’s neck, groin, and/or armpits.
7. If such measures fail to provide relief or symptoms worsen within 15-30 minutes, contact a parent or EMS because untreated heat exhaustion can progress to heat stroke.

HEART STROKE

Heat stroke occurs when the body temperature is in excess of 105 degrees F and is a life-threatening medical emergency. High body temperature can cause permanent damage to the organs, specifically the brain. This is an emergency situation. 

SIGNS AND SYMPTOMS

• Confusion, hallucinations, bizarre behavior
• Altered mental status
• Warm, hot skin/ heavy sweating
• Seizure
• Unconsciousness

FIRST AID

1. Assess, alert and attend to life-threatening problems.
2. Begin aggressively cooling the patron.
   • Immerse in cold water up to the neck.
   • Spray or pour water on the patron or fan them.
   • Apply ice packs to patron’s neck, groin, and/or armpits.
3. If unresponsive:
   • Place patron on side in recovery position to protect airway.
   • Provide continuous cooling until EMS arrives.
   • Do not give patron anything by mouth if vomiting or unconscious.

1. Do a head-to-toe check of the victim for injuries. 
2. Ask victim (if conscious) for any medical history and to describe signs and symptoms using S.A.M.P.L.E.
   • S: Signs/symptoms
   • A: Allergies to medications, food, environment
   • M: Medications the person is taking
   • P: Pertinent medical history
   • L: Last oral intake of water/ food
   • E: Events that may have lead to illness or injury
3. Check
   • Head
   • Neck
   • Chest
   • Abdomen
   • Pelvis
   • All Four Limbs
4. Check for D.O.T.S.
   • D: Deformities
   • O: Open injuries
   • T: Tenderness
   • S: Swelling

PROCEDURE

1. Restrict all access to the scene of the incident if blood or bodily fluids are present.
2. Ensure all staff members trained in clean-up have proper attire prior to clean-up efforts.
3. Clean all areas with an approved disinfectant. Only staff members trained in clean-up should be helping with this.
4. Make sure all staff members involved immediately wash their hands with soap and water.
5. Make sure any exposed linens and first aid supplies are disposed of in the red biohazard bags.
6. Direct all staff members involved to a quiet place and write down their account of exactly what happened, who waspresent, what was done, etc.
7. The designated staff member should complete an Incident Report, gather all information documents from other staff, help collect witness signatures, and provide those to the site supervisor.
8. Site Supervisor should notify the family or Emergency Contact for the individual.
9. Site Supervisor contact the hospital to check on the condition of the victim if family or hospital allows.
10. Take inventory on the first aid kit and record any supplies that need to be restocked.
11. Debrief with Staff.

Nose Bleed

Recovery Position

FIRST AID

1. Assess the scene
2. Assess patron - has a pulse, is not breathing
3. Activate EMS, get AED; if you are alone and patron is an infant or child, provide 2 minutes of care before leaving the patron to get help
4. Open airway
5. Give rescue breaths - use a CPR mask or BVM (requires 2 operators)
   • Infant: 1 breath every 2-3 seconds
   • Child: 1 breath every 2-3 seconds
   • Adult: 1 breath every 5-6 seconds
6. Reassess for pulse every 2 minutes 

Keep doing rescue breaths until patron starts breathing on own or until patron loses pulse. If patron loses pulse, begin CPR

Seizures are a sudden attack, usually related to excessive electrical activity in the brain. Seizures can be caused by many medical issues, including epilepsy, head injury, stroke, low blood sugar, drug use, high fever, etc. 

Most seizures happen without warning, last only a short time, and stop without any special treatment. People who have frequent seizures do not usually need to go to the hospital; If the patron’s airway is compromised or you are unsure of the situation, call 911.

SIMPLE SEIZURE - NO LOSS OF CONSCIOUSNESS

Can present as a staring spell, confusion, wandering aimlessly, strange behavior

• Do not restrain the person
• Guide the person away from any dangerous situations
• Comfort, calm and stay with the person until the seizure is over

COMPLEX SEIZURE - LOSS OF CONSCIOUSNESS

Can present as: person suddenly becomes stiff and falls to ground; twitching or shaking of the body (convulsions); person recovers quickly but may be confused

1. Stay calm and note the time
2. To avoid injury, move objects away from the person that he or she may strike
3. Do not restrain the person
4. Allow the seizure to run its course
5. Do not put anything in the person’s mouth- there is no danger of swallowing tongue
6. When the seizure is over, place the person in a recovery position
7. Provide privacy to minimize embarrassment

SEIZURES IN THE WATER

• Extract patron from the water as safely and quickly as possible if able
• In unable to extract, keep face and airway above water
• Perform an initial assessment
• Assess specifically for any drowning related injuries- i.e. pulse, lack of oxygen, compromised breathing, water swallowed, aspiration, etc. 
• Follow seizure protocol unless CPR is indicated. If so, move to CPR EAP

SDS Sheets

Develops when poor blood flow creates a shortage of oxygen to body tissue; can be life threatening. Any serious illness or injury has potential to cause shock.

SIGNS AND SYMPTOMS

• Uneasy
• Restless
• Worries
• Confused
• Diminished responsiveness
• Skin: pale, cool and sweaty

FIRST AID

1. Activate EMS.
2. Lay patron flat on ground.
3. Maintain a normal body temperature.
4. Give nothing to eat or drink, even if the person asks for it.
5. Control bleeding if present
6. Ensure an open airway and adequate breathing
7. Prevent chilling or overheating
8. Keep person as comfortable and calm as possible until EMS arrives.

Suspect spinal injury when the patron has been exposed to significant physical force, such as a car accident, diving head first into the shallow end of the pool or a fall from greater than the person's height.

Primary Goal: keep person still in order to prevent further injury

Do not move patron if he or she is in a safe place.

SIGNS AND SYMPTOMS

• Altered mental status
• Obvious injury to head, neck or back
• Numbness, tingling, burning or loss of sensation in hands, fingers or toes
• Spinal pain, pressure, tenderness
• Multiple injuries such as open or closed fractures
• Weakness or paralysis in any part of the body
• Loss of bladder or bowel control

FIRST AID

1. Assess, Alert, and Attend to life-threatening injuries
2. If patron is responsive, tell him/ her not to move
3. Manually stabilize by putting hands on both sides of the patrons head
4. Comfort, calm and reassure the patron
5. Do not move or ask the the patron to move in order to “See what hurts”
6. Do not bend, manipulate, twist, or lift patron’s head or body
7. Do not remove a helmet if spinal injury is suspected

If the patron is unresponsive, is lying flat on his/ her back, and has debris/ blood/ secretions in his or her mouth or you must leave the patron to go get help, put the patient in recovery position.

Stroke is an interruption to the blood supply to a part of the brain, resulting in damaged brain tissue. Can occur due to a blockage caused by a blood clot caught in a narrowed spot in a blood vessel or when a weak spot in the wall of blood vessel bursts open and bleeds.

SIGNS AND SYMPTOMS

• Numbness or weakness of face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking or understanding
• Trouble seeing out of one or both eyes
• Trouble walking, dizziness, loss of balance, or coordination
• Severe headache
• May appear intoxicated

FIRST AID

1. Assess, alert and attend to life-threatening problems
2. Activate EMS
3. If patron is breathing and unconscious, put in the recovery position
4. If patron is conscious, provide comfort and calmness 
5. Attempt to establish time of onset of symptoms.

TESTING FOR STROKE - F.A.S.T.

(F) Face: Is the person experiencing numbness or paralysis on one side of the face?

(A) Arms: Can he or she raise both arms to an equal height?

(S) Speech: Can you understand the person's speech?

(T) Time: Call 911 as soon as you notice slurred speech or weakness/numbness on one side of the body.

Medical emergencies may also be caused by a sudden onset of illness that can be immediately life-threatening or exhibit symptoms that may become life threatening.

If patron is awake and able to talk to you, ask if it’s okay to help then proceed with assessment. If patron has serious warning signs, immediately alert EMS and activate the associated Emergency Action Plan.

SIGNS OF SERIOUS ILLNESS

• Altered mental state - confusion, drowsiness, change in behavior, inability to communicate
• Abnormal skin color- skin turns pale, blue, purple, or gray
• Breathing difficulty
• Seizure in a person who has no history of seizures
• Pain, severe pressure or discomfort in chest
• Temperature of 105 degrees or higher
• Appearing very weak, sick or in severe pain
• Sudden onset of blood-red or purple rash (in children)
• Fever in a child less than 2 months/ 8 weeks in age (infant)
• Fever in a child of any age who looks more than mildly ill (children)
• Large volume of blood in stool (children)

SUDDEN ILLNESS- THINK ABOUT

• Suspected Stroke; use FAST method, activate EMS, monitor
• Suspected Heart Attack; activates EMS, allow person to find a comfortable position, encourages chewing aspirin if person has it on hand or if EMS advises to do so, assists in administering person’s nitroglycerine if available
• Suspected hypoglycemia: gives glucose tablets or dietary sugar, activates EMS if no improvement within 10-15minutes
• Suspected heat exhaustion or heat stroke: have person lie down in cooler place and raise legs 6-12 inches, loosensclothing and cool body, gives sports drink or water; if no improvement in a few minutes or symptoms worsen,activate EMS and aggressively cool 

RESPONDING GUARD

1. Signal rescue to others by calling out: 
   • I NEED HELP NOW! 
   • Be clear and loud
   • Blow whistle (3 whistle blasts) 
2. Make rescue
3. Extract victim from water
4. Get SealRite mask or Call out for someone to bring mask to you
5. Give 2 initial rescue breaths (give 2 initial breaths in the water if there is a delay in getting victim out)
6. Check for responsiveness and normal breathing
7. Signal for backup and EMS activation if needed
8. Perform CPR and utilize AED if applicable until EMS arrives
9. Ensure proper handoff to EMS personnel 
10. Clean up site and clean/ replace equipment
11. Prepare incident reports
12. Debrief

ADMINISTRATIVE STAFF

1. Contact family if has not been done already
2. Follow Medical Emergency Follow Up

SEE NEXT PAGE IF ADDITIONAL STAFF AVAILABLE

ADDITIONAL CERTIFIED STAFF IF AVAILABLE

1. Cover zones and clear swimmers from the water
2. Assist responding guard in getting victim to surface/exit if necessary
3. Get backboard if necessary and be ready to help extricate patron
4. Remove patron from the water
5. Ensure emergency bag and AED has been brought to scene
6. Ready BVM 
7. Perform CPR and utilize AED if applicable until EMS arrives
8. Ensure proper handoff to EMS personnel
9. Clean up site and clean/ replace equipment.
10. Prepare incident reports
11. Debrief

ADDITIONAL STAFF 

1. Ensure the safety of the other swimmers.
2. Safely evacuate the pool and pool deck of swimmers and clients
3. Ensure that EMS has been called
4. Meet EMS personnel and direct towards scene
5. Listen for directions from the responding guard or Deck Supervisor on how to be of assistance; for example: getting any needed emergency equipment, crowd control, assisting in the care of the patron
6. Control Crowds and Ensure Safety for bystanders
7. Identify patron and notify director/family if necessary
8. Comfort and assist family members/ students if present
9. Obtain witness statements
10.  Prepare incident reports
11.  Conduct post-incident debriefing