SERT Activation

The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the school or program needs.

School Personnel Role: All school personnel must be trained to report the RIGHT information when calling in to the office to activate the SERT team using a “code word” locally determined. School personnel should stay with the individual and provide reassurance until the SERT members arrive. If back or neck injuries are suspected, it is important to not move the individual and provide the following information:

1. Who is having an emergency? (staff, student or visitor)
2. What is their first and last name (if known)
3. Where is the emergency located
4. What is the emergency (if known)
5. Are they conscious or not conscious?
6. Do you see an emergency ID necklace or wrist ID on the individual?
7. If you did not witness, what did bystanders see?

Scene Safety

The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the school or program needs.

SERT Members Role

1. Report to the location reported by the office, to include:
   1. observing for hazards: substances, situational danger, environmental danger
      1. if school personnel are unable to control the hazards: contact 911
2. Provide crowd control
3. Provide emergency care as delegated or within licensed practice
4. Turn over responsibility to local community emergency response and school leadership only when both are on scene.

Building Office Personnel Role

1. Handle incoming calls from the SERT response
2. Handle communication between SERT, school nurse(s), family, dispatch, and community emergency response personnel

Across the Room Assessment

The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the school or program needs.

The SERT team uses sight, hearing and smell when completing an across the room assessment to see if it is safe to approach or if backup assistance is necessary. The team is always preparing for the unexpected. The SERT team is alert to what they see, what they hear, smell, and for the presence of any environmental hazard that would mandate immediate evacuation of an area before completing a primary assessment.  

When an emergency or disaster situation occurs or is imminent, school leadership determines in unison with the SERT if this will require an in-building response or an evacuation and/or transport to another site. Some situations allow time to take shelter while in other situations, there may be no warning and immediate action is needed. 

Examples that would indicate evacuation, not limited to: fire, noxious fumes, potential explosion, active shooter, imminent environmental event, unstable structure, electrical hazard, or other potential mechanisms of injury.

Response Assessment

The SERT team member will assign 1 of 4 response assessment types to each injured individual:

A (Alert): means alert & responsive 

V (Verbal): means responds to verbal stimuli

P (Pain): means responds to painful stimuli

U (Unresponsive): means unresponsive to any stimuli 

Primary Assessment (C-ABCDE)

Considerations for the delegating school nurse and authorized or qualified SERT team members:

Catasrophic Hemmorage

Any obvious hemorrhaging should be controlled by direct pressure if possible and, if needed and trained, implement “Stop the Bleed” training

Airway

Ask the individual a question. If the individual can speak coherently, the individual is responsive, and the airway is open. Look at position, listen for sounds, see if there is a visible obstruction.

Breathing

Inspect the individual’s chest for rate, depth/pattern, symmetry, sounds, work of breathing, odors, injuries

Circulation

Check the individual’s heart rate and quality of pulses, capillary refill time, skin color, temperature and/or pupil response. Is the skin moist? Is the student or individual bleeding?

Disability

What is the individual’s level of consciousness or response assessment listed above (A, V, P, U)

Exposure

Exposure with environmental control to prevent heat loss.  Observe/inspect for more emergent problems.  Treat wounds or other findings as appropriate.

Secondary Assessment (FGHI) 

Full Set of Vitals

Licensed, authorized or qualified SERT team members may complete a full set of vital signs – heart rate, respiratory rates, blood pressure (temp if possible, height & weight if known) baseline and as needed for comparison later or as delegated.  Neurological checks include orientation to person, place and time.

Give Comfort Measures and Pain Assessment

Give comfort 

History Head to Toe Assessment/Focused Physical Examination (Completed by Licensed School Personnel)

Head to toe assessment 

Injuries and Additional Information

If necessary, isolate, address injuries or perform interventions as necessary. 

The school nurse completing an evaluation can provide the additional information to EMS:

AMPLET Mnemonic

The school nurse can use the pneumonic ‘AMPLET” when providing additional information in their evaluation to Emergency Medical Services (EMS):

A: Does the student have allergies?

M: Does the student take any medications?

P: Does the student have past medical history?

L: Does the school nurse know the last oral intake of the student?

E: What are the events leading up to the injury?

T: Does the school nurse know if the child has had a tetanus or can the school nurse provide the childhood immunization status to EMS?

JumpSTART Pediatric Triage 

Triage principles allow those most in need to be treated first. The instructional steps assist the registered nurse working under the auspices of the school or program in professional judgement and accountability of delegation. Additional steps may be required depending on the school or program needs. The bolded four levels of triage include: 

1. Spend less than 1 minute on each individual.
2. The responding SERT team will put on appropriate personal protective equipment.
3. Immediate/Emergent – Level I – Red: victims have life-threatening injuries but with quick response, can survive. Victims will need to be transported for a higher level of care as soon as possible.
4. Delayed/Urgent – Level 2 – Yellow: injuries are not immediately life-threatening but need care beyond first aid within a couple of hours. Delaying transport to a higher level of care jeopardizes these victims.
5. Non-emergent/Non-urgent – Level 3 – Green: injuries not urgent and victim does not need immediate or urgent transport for higher level of care. Victims may be able to assist in their own care.
6. Dead or Mortally Injured – Level 4 – Black: victims are dead or sustained injuries non-compatible with survival – no transport or survival interventions are delivered. A child who remains apneic after positioning the airway is triaged based on the presence of a pulse and their response to 5 rescue breaths. If the child does not have a pulse or if they have a pulse but remain apneic after 5 rescue breaths, they are triaged as BLACK (Deceased). If the child has a pulse and begins breathing spontaneously after 5 rescue breaths, then they are triaged as RED (Immediate)

When Calling 911

When calling 911 do not hang up until the dispatcher gives you permission to end the call and follow the dispatcher’s instructions. 

Provide the following information:

• School name and address: Be specific about the building. location, or  room where the emergency is happening.
• Type of emergency: Clearly state what is happening, like a medical emergency, active shooter situation, fire, etc.
• Number of people involved: If there are injuries, specify how many people are affected.
• Contact phone number: Provide your name and a phone number where the dispatcher can reach you back if needed.