Seizure Emergency Action Plan Student Name:* VALID FOR THE CURRENT SCHOOL YEAR*2020 -20212021 – 2022Grade:* Date of Birth:* MM slash DD slash YYYY Parent/ Guardian Name:* Parent/ Guardian Email:* Parent/ Guardian Contact Number:* Medical History:*Date plan written:_SEIZURE Information : THIS STUDENT IS BEING TREATED FOR A SEIZURE DISORDER. THE INFORMATION BELOW SHOULD ASSIST YOU IF A SEIZURE OCCURS DURING SCHOOL HOURS.Seizure Type Length: Frequency: Description:Seizure triggers or warning signs:Student response after seizure: Standard First Aid EMERGENCY FIRST AID Stay calm Contact School Nurse at ext.711 Protect student from injury but do not restrain movements Help the student lie down and turn on one side if possible Loosen all tight clothing Do not put anything in the mouth Do not give medicines or fluids until the child is completely awake Stay with the student until he or she is fully alert and oriented Provide reassurance and support after the seizure episode CPR should not be given during a seizure Record the duration and describe the seizure on the epilepsy log Report the seizure to the appropriate person: parents, school nurse, and/or administrator Emergency Medical Care if: Seizure lasts more than 5 minutes Another seizure begins soon after the first Student is injured or has diabetes The student stops breathing or has difficulty breathing after the seizure Student cannot be awakened after the seizure There are specific orders from the physician Start CPR for absent breathing or pulse The need for assistance is uncertain Student has a seizure in water TREATMENT PROTOCOL DURING SCHOOL HOURS :(include daily and emergency medications)Is Medication needed to control seizure? Yes No List medication needed at school:ListDaily medicationDosage/Route/Time of Day GivenCommon Side Effects and Special Instructions Emergency/ Rescue Medication: Dosage and Route: Common Side Effects and Special InstructionsSpecial Considerations and Precautions(regarding school activities, sports, trips, etc.)Describe any special considerations or precautions:SignatureDate MM slash DD slash YYYY