Assessment and Immediate Actions for Everyday School Incidents

A Repeatable Assessment Sequence: “Stop, Look, Ask, Decide”

In a school setting, the most helpful skill is not memorizing every possible injury—it is using the same short assessment sequence every time. A repeatable sequence reduces missed details, keeps you calm, and produces clear information for the nurse or emergency responders. Use this order: (1) rapid check for responsiveness and breathing, (2) targeted child-appropriate questions, (3) visual checks, (4) safe comfort measures, (5) decision points, (6) objective communication scripts.

1) Rapid Check: Responsiveness and Breathing (First 10–15 Seconds)

Start with a quick scan before touching the student. Your goal is to identify immediate life threats and decide whether to activate emergency response right away.

• Scene check: Is it safe to approach (spilled chemicals, traffic in hallway, sports equipment, aggressive behavior)? If not safe, get help and make the area safe if possible.
• Responsiveness: From a close but safe distance, speak clearly: “Are you okay? Can you look at me?” If no response, gently tap the shoulder (if appropriate) while calling for help.
• Breathing: Look for normal breathing (chest rise, regular breaths). Listen for noisy breathing (wheezing, gurgling, high-pitched sounds). If the student is not breathing normally, treat as an emergency and activate emergency services per school procedure.
• Major bleeding: If you see heavy bleeding, prioritize controlling it while someone calls the nurse/office.

Practical tip: If you are alone, use a “two-task rule”: while you assess breathing, direct a nearby adult or responsible student: “Please go to the office now and tell them I need the nurse at the gym—student not responding/possible breathing problem.”

2) Targeted Questions for Children: Simple, Specific, and Calm

Once the student is responsive and breathing normally, move to short questions that children can answer. Ask one at a time and wait. Avoid leading questions that suggest an answer.

For very young students: Offer choices: “Does it hurt here or here?” and use observation: crying, guarding a limb, refusing to walk, unusual quietness.

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3) Visual Checks: What to Look For (Head-to-Toe in 20–30 Seconds)

After questions, do a quick visual check. You are looking for signs that change your decision (stay in class vs nurse vs emergency). Keep the student still if you suspect a significant injury, and avoid moving them unnecessarily.

• Bleeding: Is it oozing, steady, or spurting? Is blood soaking through cloth? Is bleeding from nose/ears after a head impact?
• Swelling and bruising: Rapid swelling can indicate significant injury. Compare both sides when possible.
• Deformity: Limb looks bent, rotated, or “not the same” as the other side; student cannot bear weight or use the limb.
• Rash/hives: Raised itchy welts, widespread redness, facial swelling—especially with breathing symptoms.
• Breathing effort: Fast breathing, retractions (skin pulling between ribs), wheezing, inability to speak full sentences, persistent coughing.
• Mental status changes: Confusion, unusual sleepiness, irritability, slurred speech, poor balance, “not acting like themselves,” or worsening headache.

Mini-check for head impact: Ask the student their name, where they are, and what class they are in. Note if answers are slow, confused, or inconsistent.

4) Safe Pain and Comfort Measures (Within Typical School Policy)

Comfort measures reduce distress and can prevent symptoms from worsening while you wait for the nurse or parent. Use measures that do not require diagnosis or medication administration unless your school policy explicitly allows it.

• Position of comfort: Let the student sit or lie in the position that eases pain, unless you suspect a serious injury that requires them to stay still.
• Rest and reassurance: Use calm voice, simple directions, and privacy when possible. “You’re safe. I’m going to help you and we’ll get the nurse.”
• Cold pack (if allowed): For bumps, minor sprains, and swelling. Use a barrier (cloth) and short intervals (e.g., 10–15 minutes) to avoid skin irritation.
• Direct pressure for minor bleeding: Use gloves if available; apply steady pressure with clean gauze or cloth. Elevate the area if it does not cause pain or suspected fracture.
• Support/immobilize: Encourage the student to keep an injured area still. Use simple support (e.g., resting arm on a folded sweatshirt) rather than forcing movement.
• Hydration check: If the student is alert and not nauseated, and school policy permits, small sips of water may help mild heat discomfort or dry throat. Do not give food/drink if there is vomiting, significant head injury concern, or altered mental status.
• Reduce stimulation: For headache, dizziness, or after a hit to the head, move to a quieter area with supervision.

Avoid: “Testing” an injury by making the student walk, bend, or “see if it still hurts.” Avoid heat on fresh injuries with swelling. Avoid making promises (“You’re fine”)—use observation-based reassurance instead.

5) Decision Points: Class vs Nurse vs Emergency Services

Use decision points to standardize actions. When in doubt, involve the nurse/office early with objective findings.

Decision A: Can the student safely remain in class with simple measures?

Consider staying in class (with monitoring) when all are true: student is alert, breathing normally, symptoms are mild and improving with comfort measures, no red flags, and the student can participate without worsening symptoms.

• Examples: small paper cut controlled with pressure; mild bump with minimal swelling and normal behavior; minor scrape cleaned and covered per school procedure; mild stomach discomfort without fever/vomiting and student wants to return.

Monitoring plan: Set a time check: “I’m going to check on you in 10 minutes.” Document what you saw and did per school process.

Decision B: Should the student be sent to the nurse/office now?

Send to the nurse/office (with supervision appropriate to age and condition) when symptoms require assessment, treatment supplies, or observation beyond the classroom.

• Common triggers: persistent pain; swelling that is increasing; limping or reduced use of a limb; nosebleed that does not stop with pressure; headache after a bump; nausea; fever; rash without breathing issues; asthma symptoms that improve but need evaluation; any injury needing wound care beyond a simple bandage.
• Supervision: Younger students or those who are dizzy, weak, or in significant pain should be escorted by an adult. Avoid sending an unsteady student alone.

Decision C: When to call emergency services (activate emergency response)

Call emergency services immediately (per school procedure) if you observe or strongly suspect any of the following. These are “act first” situations.

• Breathing problems: not breathing normally, severe trouble breathing, blue/gray lips, inability to speak, worsening wheeze with distress.
• Unresponsiveness or seizure: not waking, seizure activity, or seizure followed by prolonged confusion or breathing concerns.
• Severe allergic reaction: facial/tongue swelling, hives with breathing difficulty, repeated vomiting with other allergic signs, or rapid worsening after exposure.
• Major bleeding: bleeding that will not stop with firm pressure, blood soaking through materials quickly, or suspected amputation.
• Serious head/neck concern: confusion, repeated vomiting, worsening headache, unequal pupils, slurred speech, significant drowsiness, neck pain after a fall/collision, or any concerning change in behavior.
• Possible broken bone with deformity or circulation concern: obvious deformity, bone visible, or limb is cold/pale/numb.
• Severe pain or sudden collapse: especially with pale, sweaty skin, fainting, or altered mental status.

While waiting: Continue observation, keep the student as still and comfortable as possible, and be ready to report changes (breathing, color, responsiveness).

6) Objective Communication Scripts (Nurse/Office/Parents)

Clear, factual phrasing prevents confusion and speeds up appropriate care. Focus on what you saw, what the student said, and what you did—avoid diagnosing (“concussion,” “broken,” “panic attack”) unless directed by school protocol.

Script: Calling the nurse/office (non-emergency)

Hi, this is [Name] in [Room/Location]. I have a student, [Student first name/ID], who [brief event: “tripped and fell during recess”]. They are alert and breathing normally. They report pain at [location] rated [0–10]. I see [objective signs: “swelling about the size of a quarter,” “small cut with bleeding controlled,” “rash on both arms”]. I have done [actions: “applied a cold pack,” “held pressure for 5 minutes,” “had them sit and rest”]. They are [current status: “still limping,” “pain unchanged,” “dizzy when standing”]. Can you advise next steps or send someone to assess?

Script: Calling the office to activate emergency response

This is [Name] at [Location]. I need emergency response now for a student. The student is [unresponsive / having trouble breathing / having a seizure / heavy bleeding]. We are doing [basic action: “monitoring breathing,” “applying firm pressure to bleeding”]. Please call emergency services and send the nurse/administrator to [Location].

Script: Message for parent/guardian (objective and calm)

Hello, this is [Name] from [School]. I’m calling about [Student]. At approximately [time], [brief event]. [Student] is alert and breathing normally. They report [symptoms in their words] and point to [location]. I observed [objective signs]. We provided [comfort measures] and sent them to the nurse for assessment. The nurse/office will update you on next steps.

Helpful wording: “The student reports…” “I observed…” “At [time]…” “Symptoms are improving/worsening…”

Wording to avoid: “It’s definitely…” “I think it’s broken…” “They’re faking…” “It’s just anxiety…” Replace with observable facts and student statements.

Putting It Together: Two Quick Practice Scenarios

Scenario 1: Playground fall with wrist pain

• Rapid check: Student is responsive, breathing normal, no major bleeding.
• Questions: “What happened?” “Point to where it hurts.” “Any dizziness or nausea?”
• Visual check: Swelling at wrist, student avoids moving it, no open wound, no obvious deformity.
• Comfort: Support arm against body, cold pack with cloth barrier, keep student seated.
• Decision: Send to nurse with adult escort due to persistent pain and swelling; avoid having student “test” it.
• Report: Time, fall mechanism, pain score, swelling size, actions taken.

Scenario 2: Student feels faint during assembly

• Rapid check: Responsive, breathing normal, pale and sweaty.
• Questions: “Do you feel dizzy?” “Any nausea?” “Did you eat today?” “Any allergies/asthma?”
• Visual check: No rash, no injury, mental status intact but slow.
• Comfort: Sit or lie down in a safe area, loosen tight clothing if appropriate, quiet environment, monitor for worsening.
• Decision: Nurse evaluation now; emergency response if they become unresponsive, have breathing difficulty, or cannot be kept safely awake/alert.
• Report: Onset time, position when symptoms started, observed color/sweating, student statements, any improvement with rest.