Richer Education is committed to caring for, and protecting, the health, safety and welfare of its children, staff, and parents.

We always confirm our adherence to the following standards:

• To ensure that trained First Aid staff renew, update or extend their HSE approved qualifications at least every three years
• To have a minimum of one trained paediatric First Aider on each site at any one time
• To record accidents and illnesses appropriately, reporting to parents and the Health & Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (2013)
• To provide accessible first aid kits at various locations throughout the premises
• To record and plan for children and staff with specific medical conditions
• To deal with the disposal of bodily fluids and other medical waste accordingly, providing facilities for the hygienic and safe practice of first aid
• To contact the medical emergency services if they are needed, informing next of kin immediately in such a situation
• To communicate clearly to children and staff where they can find medical assistance if a person is ill or an accident has occurred
• To communicate clearly in writing to parents or guardians if a child has sustained a bump to the head, however minor, and to communicate in writing

Responsibilities of the Trained First Aiders

• Provide appropriate care for children or staff who are ill or sustain and injury
  Record all accidents centrally in the Accident Book (to be found with the supervisor on duty)

• In the event of any injury to the head, however minor, ensure that the event is recorded in the First Aid book in the Medical Room and the supervisor informed immediately. An email will be sent to parents as well as a phone call to the parent or carer

• Make arrangements with parents/guardians to collect children and take them home if they are deemed too unwell to continue the day

• Inform the supervisor all incidents where first aid has been administered

Responsibilities of the Supervisor

• Ensure that all staff and children are familiar with the first aid procedures
• Ensure that all staff are familiar with measure to provide appropriate care for children with particular medical needs (eg. Diabetic needs, Epi-pens, inhalers)
• Ensure that a list is maintained and available to staff of all children with particular medical needs and appropriate measures needed to care for them
• Monitor and re-stock supplies and ensure that first aid kits are replenished
• Ensure that the company has an adequate number of appropriately trained First Aiders
• Co-ordinate First Aiders and arrange for training to be renewed as necessary
• Maintain adequate facilities
• Ensure that correct provision is made for children with special medical requirements both in company
• On a monthly basis, review First Aid records to identify any trends or patterns and report to the Health and Safety committee
• Report to RIDDOR, as described below
• Contact emergency medical services as required.
• Maintain an up-to-date knowledge and understanding of guidance and advice from appropriate

Personal Protective Equipment (PPE)

The company provides PPE to all staff. This includes disposable gloves, face masks and hand sanitiser. Surfaces are regularly cleaned with anti-bacterial disinfectant by the cleaning department. Staff should wear disposable gloves if physical contact is likely to be made with potentially contaminated areas or items. It is recommended that staff should wear a face mask when there is an anticipated risk of contamination with splashes, droplets of blood or body fluids. Staff should clean their hands thoroughly with soap and water or alcohol sanitiser before putting on and after taking off PPE.

What to do in the case of an accident, injury or illness

A member of staff or child witnessing an accident, injury or illness should immediately contact a named trained first aider.
Any child or member of staff sustaining an injury whilst at class or camp should be seen by a first aider who will provide immediate first aid and summon additional help as needed.

The child or member of staff should not be left unattended.
Parents should be informed as necessary by telephone by the first aider or supervisor.
This will be followed up in writing and a record kept. A record of all accidents, injuries and the administration of first aid is maintained in the accident log.
In relation to a head injury, please refer to Appendix.

Contacting parents

• Parents should be informed by telephone as soon as possible after an emergency or following a serious/significant injury including:
• Head injury. The parent is informed immediately by a call from the supervisor and a follow up email sent.
• Suspected sprain or fracture
• Following a fall from height
• Dental injury
• Anaphylaxis & following the administration of an Epi-pen
• Epileptic seizure
• Severe hypoglycaemia for children, staff or visitors with diabetes
• Severe asthma attack
• Difficulty breathing
• Bleeding injury
• Loss of consciousness
• If the child is generally unwell
• If non-emergency transportation is required, an authorised taxi service will be used if parents are delayed. A member of staff will accompany the child until a parent arrives.
• Parents can be informed of smaller incidents at the end of the day by the form supervisor on duty.
  
  

Contacting the Emergency Services

An ambulance should be called for any condition listed above or for any injury that requires emergency treatment. Any child taken to hospital by ambulance must be accompanied by a member of staff until a parent arrives. All cases of a child becoming unconscious (not including a faint) or following the administration of an Epi-pen, must be taken to hospital.

Accident reporting

The accident log must be completed for any accident or injury occurring with Richer Education,. This includes any accident involving staff or visitors. The accident log will be monitored by the Lead First Aider as certain injuries require reporting (RIDDOR requirements). Care should be taken that the accident log, whether hard copy or electronic, is stored securely so that it can be seen only by those who have authority to read it.

Children who are unwell during the day

If a child becomes unwell, a parent should be contacted as soon as possible by the supervisor. In the event a parent is unavailable the company should attempt to contact the secondary contact. Anyone not well enough to be in the classes or camps should be collected as soon as possible by a parent.

First Aid equipment and materials

The supervisor is responsible for stocking and checking the first aid kits. Staff are asked to notify the supervisor when supplies have been used in order that they can be restocked. The first aid boxes contain (based on HSE guidance):

• A first aid book
• First aid report book
  At least 20 adhesive hypoallergenic plasters
• 4 triangular bandages (slings)
  Safety pins
• Cleaning wipes
• Adhesive tape
• 2 sterile eye pads
• 6 medium sized unmedicated dressings
• 2 large sized unmedicated dressings
• Disposable gloves
• Yellow clinical waste bag

Emergency care and/or medication plans and treatment boxes

The supervisor ensures that staff are made aware of any child with an emergency care plan. These care plans are heled with the supervisor. Emergency treatment boxes will be held with the supervisor on duty.

Children using crutches or having limited mobility – Parents must inform Richer Education of the nature of injury and the anticipated duration of immobility. Arrangements will be made for the child to arrive/leave early to allow for a safe transfer around the building. Parents must inform Richer Education of any particular difficulties.

If a child has either temporary or ongoing limited mobility, the company will consider whether the child requires a personal evacuation plan, for implementation in fire drills and similar occasions.

Dealing with bodily fluids

In order to maintain protection from disease, all bodily fluids should be considered infected.

To prevent contact with bodily fluids the following guidelines should be followed.

• When dealing with any bodily fluids wear disposable gloves.
• Wash hands thoroughly with soap and warm water after the incident.

• Keep any abrasions covered with a plaster.
• Spills of the following bodily fluids must be cleaned up immediately.
• Bodily fluids include:

• Blood, Faeces, Urine, Nasal and eye discharges, Saliva, Vomit

Process

• Disposable towels should be used to soak up the excess, and then the area should be treated with a disinfectant solution
• Never use a mop for cleaning up blood and bodily fluid spillages
• All contaminated material should be disposed of in a yellow clinical waste bag (available in all first aid boxes) then placed in the waste bin
• Avoid getting any bodily fluids in your eyes, nose, mouth or on any open sores.
• If a splash occurs, wash the area well with soap and water or irrigate with copious amounts of saline.

Infectious diseases

If a child is suspected of having an infectious disease advice should be sought from the supervisor who will follow the Public Health England guidelines below to reduce the transmission of infectious diseases to other children and staff.

Administration of Medication

• No child should be given any medication without their parent’s written consent.
• No Aspirin products are to be given to any child.
• Parents must be given written confirmation of any medication administered, a copy of which will be kept on the child’s file.
• Children will need to take medication during the day e.g. antibiotics. However, wherever possible the timing and dosage should be arranged so that the medication can be administered at home.

(i) Non-Prescription Medication

Non-prescription medication will not be administered to children.

(ii) Prescription-Only Medication

Prescribed medicines may be given to a child by the supervisor if they have been appropriately trained. Written consent must be obtained from the parent or guardian, clearly stating the name of the medication, dose, frequency and length of course. The company will accept medication from parents only if it is in its original container, with the original dosage instructions. Prescription medicines will not be administered unless they have been prescribed for the child by a doctor, dentist, nurse or pharmacist. Medicines containing aspirin will be given only if prescribed by a doctor.

All medication administered must be witnessed by another adult, documented, signed for and parents informed in writing.

(iii) Administration of Medication

Any member of staff administering medication should be trained to an appropriate level, this includes specific training e.g. use of Epi-pens

• The medication must be checked before administration by the member of staff confirming the medication name, child’s name, dose, time to be administered and the expiry date.
• It is advisable that a second adult is present when administering medicine.
• Wash hands.
• Confirm that the child’s name matches the name on the medication.
• Explain to the child that his or her parents have requested the administration of the medication.
• Document any refusal of a child to take medication.
• Document, date and sign for what has been administered.
• Complete the form which goes back to parents.
• Ensure that the medication is correctly stored in a locked drawer or cupboard, out of the reach of children.
• Antibiotics and any other medication which requires refrigeration should be stored in the fridge in the kitchen. All medication should be clearly labelled with the child’s name and dosage.
• Parents should be asked to dispose of any out-of-date medication.

Major injuries from schedule 1 of the regulations:

1. 
   Any fracture, other than to the fingers, thumbs or toes.
   2. Any amputation.
   3. Dislocation of the shoulder, hip, knee or spine.
   4. Loss of sight (whether temporary or permanent)
   5. A chemical or hot metal burn to the eye or any penetrating injury to the eye.
   6. Any injury resulting from an electric shock or electrical burn (including any electrical burn caused by arcing or arcing products, leading to unconsciousness or requiring resuscitation or admittance to hospital for more than 24 hours.
   7. Any other injury leading to hypothermia, heat induced illness or to unconsciousness requiring resuscitation or admittance to hospital for more than 24 hours
   8. Any other injury lasting over 3 days
   9. Loss of consciousness caused by asphyxia or by exposure to a harmful substance or biological agent. 10. Either of the following conditions which result from the absorption of any substance by inhalation, ingestion or through the skin:
   11. Acute illness requiring medical treatment; or
   12. Loss of consciousness
   13. Acute illness which requires medical treatment where there is reason to believe that this resulted from exposure to a biological agent or its toxins or infected material.
2. Death
3. A specified dangerous occurrence, where something happened which did not result in an injury, but could have done.

Further information on RIDDOR reporting requirements can be found on the RIDDOR website; http://www.hse.gov.uk/riddor/

APPENDIX 1: Guidance to staff on particular medical conditions

(i) Allergic reactions

Symptoms and treatment of a mild allergic reaction:

• Rash
• Flushing of the skin
• Itching or irritation
  
  

If the child has a care plan, follow the guidance provided and agreed by parents. Administer the prescribed dose of antihistamine to a child who displays these mild symptoms only. Make a note of the type of medication, dose given, date, and time the medication was administered. Complete and sign the appropriate medication forms, as detailed in the policy. Observe the child closely for 30 minutes to ensure symptoms subside.

(ii) Anaphylaxis

Symptoms and treatment of Anaphylaxis:
• Swollen lips, tongue, throat or face
• Nettle type rash
• Difficulty swallowing and/or a feeling of a lump in the throat • Abdominal cramps, nausea and vomiting

• Generalised flushing of the skin
  • Difficulty in breathing
  • Difficulty speaking
  • Sudden feeling of weakness caused by a fall in blood pressure • Collapse and unconsciousness

When someone develops an anaphylactic reaction the onset is usually sudden, with the following signs and symptoms of the reaction progressing rapidly, usually within a few minutes.

Action to be taken

1. Send someone to call for a paramedic ambulance and inform parents. Arrange to meet parents at the hospital.
2. Send for the named emergency box.
3. Reassure the child help is on the way.
4. Remove the Epi-pen from the carton and pull off the grey safety cap.
5. Place the black tip on the child’s thigh at right angles to the leg (there is no need to remove clothing).
6. Press hard into the thigh until the auto injector mechanism functions and hold in place for 10 seconds.
7. Remove the Epi-pen from the thigh and note the time.
8. Massage the injection area for several seconds.
9. If the child has collapsed, lay him/her on the side in the recovery position.
10. Ensure the paramedic ambulance has been called.
11. Stay with the child.
12. Steps 4-8 may be repeated if no improvement in 5 minutes with a second Epi-pen if you have been instructed to do so by a doctor.

REMEMBER Epi-pens are not a substitute for medical attention, if an anaphylactic reaction occurs and you administer the Epi-pen the child must be taken to hospital for further checks. Epi-pen treatment must only be undertaken by staff who have received specific training.

(iii) Asthma management

Trigger factors

• Change in weather conditions
• Animal fur
  • Having a cold or chest infection
• Exercise
• Pollen
  • Chemicals
  • Air pollutants
  • Emotional situations
• Excitement

General considerations

Children with asthma need immediate access to their reliever inhaler. Younger children will require assistance to administer their inhaler. It is the parents’ responsibility to ensure that the company is provided with a named, in-date reliever inhaler, which is kept in the classroom, not locked away and always accessible to the child. Staff should be aware of a child’s trigger factors and try to avoid any situation that may cause a child to have an asthma attack. It is the parents’ responsibility to provide a new inhaler when out of date. Children must be made aware of where their inhaler is kept and this medication must be taken on any out of the activities.

Recognising an asthma attack

• Child unable to continue an activity
• Difficulty in breathing
  • Chest may feel tight
  • Possible wheeze
• Difficulty speaking
  • Increased anxiety
  • Coughing, sometimes persistently

Action to be taken
1. Ensure that prescribed reliever medication (usually blue) is taken promptly.
2. Reassure the child.
3. Encourage the child to adopt a position which is best for them-usually sitting upright.
4. Wait five minutes. If symptoms disappear the child can resume normal activities.
5. If symptoms have improved but not completely disappeared, inform parents and give another dose of their inhaler and call the Lead First Aider or a first aider if she is not available.
6. Loosen any tight clothing.
7. If there is no improvement in 5-10 minutes continue to make sure the child takes one puff of their reliever inhaler every minute for five minutes or until symptoms improve.
8. Call an ambulance.
9. Accompany child to hospital and await the arrival of a parent.

(iv) Diabetes management

Staff must be made aware of any child with diabetes attending the classes and camps.
Signs and symptoms of low blood sugar (hypoglycaemic attack)

• Pale
• Glazed eyes
• Blurred vision
• Confusion/incoherent
• Shaking
• Headache
• Change in normal behaviour-weepy/aggressive/quiet
• Agitated/drowsy/anxious
• Tingling lips
• Sweating
• Hunger
• Dizzy

Action to be taken

1. Follow the guidance provided in the care plan agreed by parents.
   2. Give fast acting glucose-either 50ml glass of Lucozade or 3 glucose tablets. (Children should always

have their glucose supplies with them. Extra supplies will be kept in emergency boxes. This will raise the blood sugar level quickly.
3. This must be followed after 5-10 minutes by 2 biscuits, a sandwich or a glass of milk.

4. Do not send the child out of your care for treatment alone.
   5. Allow the child to have access to regular snacks.
   6. Inform parents.

Action to take if the child becomes unconscious:

1. Place child in the recovery position and seek the help of a first aider.
2. Do not attempt to give glucose via mouth as child may choke.
   3. Telephone 999.
   4. Inform parents.
3. Accompany child to hospital and await the arrival of a parent.

Signs and symptoms of high blood sugar (hyperglycaemic attack)

Hyperglycaemia – develops much more slowly than hypoglycaemia but can be more serious if left untreated. It can be caused by too little insulin, eating more carbohydrate, infection, stress and less exercise than normal.

• Feeling tired and weak
  • Thirst
  • Passing urine more often
• Nausea and vomiting
  • Drowsy
  • Breath smelling of acetone
• Blurred vision
  • Unconsciousness

Action to be taken

1. Inform the supervisor
2. Inform parents
   3. Child to test blood or urine
   4. Call 999

(v) Epilepsy management

How to recognise a seizure

There are several types of epilepsy, but seizures are usually recognisable by the following symptoms:

• Child may appear confused and fall to the ground.
• Slow noisy breathing.

• Possible blue colouring around the mouth returning to normal as breathing returns to normal.
• Rigid muscle spasms.
• Twitching of one or more limbs or face
• Possible incontinence.

A child diagnosed with epilepsy will have an emergency care plan

Action to be taken

1. Send for an ambulance;
   2. if this is a child’s first seizure,
   3. if a child known to have epilepsy has a seizure lasting for more than five minutes or
   4. if an injury occurs.
   5. Seek the help of the Lead First Aider or a first aider.
   6. Help the child to the floor.
   5. Do not try to stop seizure.
   6. Do not put anything into the mouth of the child.
   7. Move any other children away and maintain child’s dignity.
   8. Protect the child from any danger.
   9. As the seizure subsides, gently place them in the recovery position to maintain the airway.
2. Allow patient to rest as necessary.
   11. Inform parents.
   12. Call 999 if you are concerned.
   13. Describe the event and its duration to the paramedic team on arrival.
   14. Reassure other children and staff.
   15. Accompany child to hospital and await the arrival of a parent.

Appendix 2: HEAD INJURY POLICY

1. Background

A head injury is defined as any trauma to the head excluding superficial injuries to the face. Fortunately, the majority of head injuries within the premises are minor and can be managed at the premises or at home. However, some can be more severe and it is important that a child is assessed and treated accordingly. The risk of brain injury can depend on the force and speed of the impact and complications such as swelling, bruising or bleeding can occur within the brain itself or the skull.

Concussion is defined as a traumatic brain injury resulting in the disturbance of brain function. There are many symptoms but the most common ones are dizziness, headache, memory disturbance or balance problems. Concussion is caused by either a direct blow to the head or blows to other parts of the body resulting in a rapid movement of the head e.g. whiplash.

It is also important to note that a repeat injury to the head after a recent previous concussion can have serious implications.

2. Process for managing a suspected head injury

All head injuries that occur on the premises must be recorded immediately in the First Aid book by the person who witnessed the accident. The same person will inform the supervisor of the child; this is to ensure that the child is monitored throughout the day if they remain at the premises following the injury.

A member of the supervisor is informed immediately, a First Aider assesses the injury and a call is made by the member of the supervisor to the parent(s) regardless of the severity of the injury and an email is sent to the parent or carer.

The supervisor is informed. The exception for this is if the child needs urgent medical attention, at which point the Emergency Services should be called by the witness and/or supervisor with no delay. The child must be assessed and monitored for at least one hour by a qualified First Aider and referred for medical review as per the guidelines in this document. If in doubt, the First Aider should call NHS 111 for advice or 999.

If after one hour the child is symptom free, he/she can return to the sessions but must be kept under observation for the remainder of that day. This applies even if the child feels it is unnecessary. As concussion typically presents in the first 24-48 hours following a head injury, it is important that the child is monitored and assessed until they go home.

4. Recognising Concussion

One or more of the following signs clearly indicate a concussion:

Seizures
Loss of consciousness – suspected or confirmed
Unsteady on feet or balance problems or falling over or poor co-ordination

Confused
Disorientated – not aware of where they are or who they are or the time of day Dazed, blank or vacant look
Behavioural changes e.g. more emotional or more irritable
more of the following may suggest a concussion:
Lying motionless on the ground
Slow to get up off the ground
Grabbing or clutching their head

5. Emergency Management

The following signs may indicate a medical emergency and an ambulance should be called immediately:

• Rapid deterioration of neurological function
  ● Decreasing level of consciousness
  ● Decrease or irregularity of breathing
• Any signs or symptoms of neck, spine or skull fracture or bleeding for example bleeding from one or both ears, clear fluid running from ears or nose, black eye with no obvious cause, new deafness in one or more ear, bruising behind one or more ear, visible trauma to skull or scalp, penetrating injury signs
• Seizure activity
  ● Any child with a witnessed prolonged loss of consciousness and who is not stable (i.e. condition is

worsening)

6. Referral to Hospital

The supervisor, or in their absence, a qualified First Aider, should refer any child who has sustained a head injury to a hospital emergency department, using the Ambulance Service if deemed necessary, if any of the following are present (a member of the SLT must be informed):

• Glasgow Coma Scale (GCS) score of less than 15 on initial assessment.
  ● Any loss of consciousness as a result of the injury.
  ● Any focal neurological deficit – problems restricted to a particular part of the body or a particular

activity, for example, difficulties with understanding, speaking, reading or writing; decreased sensation; loss of balance; general weakness; visual changes; abnormal reflexes; and problems walking since the injury.

• Amnesia for events before or after the injury (assessment of amnesia will not be possible in preverbal children and unlikely to be possible in children aged under 5).
• Persistent headache since the injury.
  ● Any vomiting episodes since the injury.
  ● Any seizure since the injury.
  ● Any previous brain surgery.
  ● A high-energy head injury. For example, pedestrian struck by motor vehicle, occupant ejected from

motor vehicle, fall from a height of greater than 1 metre or more than 5 stairs, diving accident, high- speed motor vehicle collision, rollover motor accident, accident involving motorised recreational vehicles, bicycle collision, or any other potentially high-energy mechanism.

• Any history of bleeding or clotting disorders.
  ● Current anticoagulant therapy such as warfarin.
  ● Current drug or alcohol intoxication.
  ● There are any safeguarding concerns (for example, possible non-accidental injury or a vulnerable person is affected).

● Continuing concern by the professional about the diagnosis.

In the absence of any of the risk factors above, consider referral to an emergency department if any of the following factors are present, depending on judgement of severity:

• Irritability or altered behaviour, particularly in infants and children aged under 5 years.
  ● Visible trauma to the head not covered above but still of concern to the healthcare professional.
• No one is able to observe the injured person at home.
  ● Continuing concern by the injured person or their family/guardian about the diagnosis.

It is the responsibility of the parent/guardian to take the child to the nearest Emergency Department if it is recommended by the supervisor.

7. Questions to ask the child to determine issues with memory.

If they fail to answer correctly any of these questions, there is a strong suspicion of concussion “Where are we now?”
“Is it before or after lunch?”
“What was your last activity?”

8. DO’s and DON’Ts

• If he/she is vomiting or at risk of vomiting DO NOT give him/her anything to eat or drink until completely recovered
• Unless there are injuries elsewhere, monitor the child in a semi upright position so that the head is at least at a 30-degree angle if lying down.
• DO apply a covered instant cold pack to the injured area for 15-20 minutes UNLESS the area has an open wound.

9. Head Injury Notifications

The person supervising the child at the time is responsible for contacting:

• The supervisor
• The supervisor contacts the child’s parents/carers

If the head injury is minor and the child stays at the premises, the parent/carers should be informed by the supervisor. A Head Injury email is sent home and the child monitored for potential deterioration of symptoms.