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Nursing Health Services

Mission Statement

The mission of the Nursing Services Department is to promote, protect, advocate and improve the health status of all students, thus enabling each student to develop intellectually, physically, socially, and emotionally.

Beliefs

In support of our mission, we are committed to the following beliefs:

  • Optimizing the health of the Braintree Public School Community is our primary objective.
  • All students will be encouraged and assisted to reach their maximum health potential so that he/she may attain high standards of achievement to learn and grow.
  • Parents, in partnership with school health services, are an integral part of their child’s health including the identification of health concerns, the development of individual health care plans, and the coordination of services between home, school and community.
  • Students and staff should maintain optimal health and wellness through the provision of direct nursing care, preventative health education and counseling/referral services.
  • All students should acquire the knowledge, skill and motivation necessary to achieve and maintain lifelong optimal health and wellness.

Nursing Services

Braintree Public School nurses are essential members of the educational team responsible for promoting, protecting and improving the health status of all students. The unique role of the school nurse is to provide professional health care by coordinating services between home, school and community. The school nurse assists in maximizing each child’s potential to learn and grow by providing the best possible health care. Health care provided includes: identifying health problems; preventative health measures; maintaining and promoting health and learning; promoting healthy lifestyles in students, families and staff; acute and emergency care; health counseling; mandated screenings; immunization monitoring and adherence to state regulations; medication administration and evaluation; comprehensive and appropriate health education to students, parents and staff; skilled nursing care and management of children with special health care needs; individual health care planning; school nurse and parent conferences; health input to special education meetings; review and interpretation of medical and health records. Braintree Public School nurses have the professional education and expertise to function successfully in the complex system of education and health.

FYI

  • If your child becomes ill while at school, every attempt will be made to contact a parent to make arrangements to take the child home.
  • Injuries at school, if severe, will be handled as an emergency situation and local EMS will be called to take your child to the most appropriate receiving hospital. Parents will be notified immediately if an ambulance is called.
  • If your child needs to be excused from physical education class, notification in writing is mandatory from both parent and physician. Written documentation is required for return to physical education class as well.
  • Parents are expected to keep emergency contact numbers up to date. If the information for yourself or other emergency contacts changes, please notify the school nurse immediately.

Massachusetts offers free or low cost health and dental insurance to all children and teens through age 18. Call your school nurse or Health Care for All at 1-800-272-4232 for more information or www.hcfama.org.


 

State Mandated Physical Exams

Physical examinations by the student’s own physician are required upon entering Preschool, Kindergarten, and grades 4, 7 and 10.

MIAA Sports Physicals

MIAA rules clearly state that any student who wishes to try out, practice or play a sport is required to have a current (within twelve months) physical exam on file in the nurses office before being allowed to try out or practice. If the physical exam expires during a sports season, the student must have a new physical on file prior to the expiration date of the previous physical or will be unable to play. Please plan ahead.

Mandated Screenings

  • Hearing - Preschool, K-3, grade 7 & 10
  • Vision - Preschool, K-5, grade 7 & 10
  • Height, Weight, BMI - Grades 1, 4, 7, 10
  • Postural (scoliosis) - Grades 5-9
  • SBIRT – Grade 7-9

All screenings are preformed in accordance with the Commonwealth of Massachusetts regulations. Students may also be screened at any time during the year at a teacher or parent’s request. If screening results indicate the need for follow-up care by a physician, parents/guardian will be notified in writing.

Immunizations

All students must present evidence of immunizations in compliance with the requirements of Massachusetts General Laws, Chapter 76, Section 15, which specifically prohibits admitting a student to school without a physician verifying that, unless religious or medical exemptions apply, the child has been immunized against Diphtheria/Pertussis/Tetanus, Measles/Mumps/ Rubella, Polio, Hepatitis B, Varicella and Haemophilus Influenzae type B (HIB-Preschool requirement only). Children who are not fully immunized against these preventable illnesses are not allowed to attend school.

Medication Policy


Braintree Public Schools policy requires that a parent/guardian and a licensed provider (either a physician or nurse practitioner) sign consent for medications (including inhalers) to be given by the nurse during school hours.

  • All medications must be brought to school by a parent/guardian or designated adult in the original labeled container from the pharmacy.
  • An individual medication plan will be developed and must be signed by both parent/guardian and nurse. Only a 30-day supply of medication may be kept at school. No child is permitted to bring medications to school or carry medication in school with the exception of an inhaler, Epinephrine auto injector or if wearing an insulin delivery system (pump). Students may carry their own inhaler &/or Epinephrine auto injector and/or insulin delivery system only after contacting the school nurse and providing a physician medication order form and parental permission form. Call your school nurse for more information.
  • For short-term medications (less than 10 days), such as antibiotics, parental consent is required. However, the prescription on the bottle is sufficient for physician consent.

Medication Administration Plan and Parent/Guardian Consent Form

Medication Order

Permission Forms:

When to Keep Your Child Home From School

  • If your child has a fever of 100.4ºF or above.
  • If your child has a contagious illness such as chicken pox, strep throat, or flu.
  • If your child has a skin rash or condition not yet diagnosed by a physician.
  • If your child is vomiting or has diarrhea.
  • If your child’s eye is pink or red, itchy and/or drainage from the eye is present.
  • If your child has an active case of head lice.

Communicable Disease Control

In order to insure adherence to Massachusetts immunization requirements, monitoring of infections and other diseases are important functions of the school nurse. The nurse works with parents, administrators, school staff, primary care providers, local and regional Boards of Health, school physician and others to maintain a healthy school environment. Upon recommendation to administration, students may be excluded from school if immunizations are not up to date or if a student has a communicable disease such as chicken pox, pertussis, scabies or conjunctivitis.

Student Health Records


An individual health record is kept on file for each student throughout his or her school career. This record includes a health history, immunizations, and physical exams, screening results, health office visits and medication administration logs. Parents are asked to communicate directly with the school nurse about student health concerns, medical reports and/or issues. Student health records are strictly confidential and information will only be shared with other staff members with the expressed permission of the parents.

Individual Health Care Plans (IHCP)


When a student has a specialized medical need or diagnosis which must be assessed, managed, and monitored during school, such as asthma, a life threatening allergy, or diabetes, the nurse in collaboration with the parent will make an IHCP. This plan is based on the student’s individual need, medical history, and physician’s order. The IHCP is then reviewed, signed by the nurse, parent and physician (when necessary) and then shared with appropriate staff to ensure optimal integration of the student’s health needs into the school setting. In some instances, an emergency medical plan is also developed to expedite identification and treatment of a student with a life-threatening diagnosis.

Nurse as Educator

The school nurse teaches individual students, parents and staff about health and wellness issues and strives to promote an understanding of student health needs. At the elementary level, school nurses do formal classroom teaching on hand washing, dental health, hygiene and growth and development to name a few. At the secondary level, the school nurse works in collaboration with the health teacher to provide information and assist in presentations based on the needs of the student population.

 


 

Contact Your Child's School Nurse

For questions or concerns please contact your child’s school nurse

Nurses

Jean Afzali

District

Jane Bagley

Hollis Elementary School

Diane Bulman

Braintree High School

Cheryl Campbell

Morrison Elementary School

Margaret Ciulla

Integrated Perschool, PreK Center

Brenna Coughlin

Braintree High School
School: 4031

Sara Crowley

Monatiquot Kindergarten Center

Heather Driscoll

South Middle School, District

Karen Hubbard

Highlands Elementary School

Joanne Kelly

Liberty Elementary School

Heidi Morris

Braintree High School

Heidi Olson

Ross Elementary School

MaryAnn O'Rourke

East Middle School

Judith Sellon

Flaherty Elementary School

Ellen Wright

South Middle School, East Middle School

School Nursing

School Nursing is a specialty field within the practice of Nursing. (From National Association of School Nurses)

As the health services expert, the school nurse serves as the health professional for the school community. Some of the services provided include: illness and injury assessments and interventions; health assessments and participation in development of Individualized Education Plan for students with special needs; pediatric nursing procedures such as gastrostomy tube feedings, tracheostomy care, and catheterization; screening for health factors impacting student learning; activities to promote health and prevent teen pregnancy, sexually transmitted diseases, tobacco, alcohol and substance use and abuse; chronic disease management and education, administering medications; crisis team participation; recommending health curricula and guidelines for school district health policies; and serving as a health care provider liaison between the school and community. Read More https://www.nursesource.org/school.html

*If you are a registered nurse in MA and would like to see if school nursing is for you, consider applying for a per diem position in a district near you. For Braintree, please contact Jean Afzali, Director of School Nursing Services, at jean.afzali@braintreeschools.org or 781-848-4000 X 7840.

Massachusetts general requirements:

  • Achieve a passing score on the Communication and Literacy Skills test
  • Possession of a bachelor's degree
  • Completion of an orientation program based on the requirements for delivery of school health services as defined by the Department of Public Health
  • Possession of a bachelor's or master's degree in nursing
  • A minimum of two full years of employment as a Registered Nurse in
  • a child health, community health, or other relevant clinical nursing setting
  • Valid license to practice as a Registered Nurse in Massachusetts

 

Helpful Links:

School Health Forms

Asthma

What is Asthma?

Asthma is a chronic disease that affects your ability to breathe. Your airways, the tubes that carry air in and out of your lungs, become tight, swollen and produce mucus. The airways are also sensitive, and may react strongly to things that you are allergic to or find irritating. Symptoms of asthma are wheezing, coughing, chest tightness and trouble breathing. Asthma can cause symptoms ranging from minor wheezing to life-threatening asthma attacks. - MA Department of Public Health

School Nurses help students with Asthma stay in control and in school. If your child has Asthma please contact your child’s school nurse for assistance. Keeping students with chronic health conditions in school is a health partnership between the parents/guardians, the medical home and school health services.

Helpful Links:

Backpack Safety Tips

Backpack Safety Tips

  1. Choose Right - choosing the right size backpack is the most important step to safe backpack use.
  2. Pack Right - the maximum weight of the loaded backpack should not exceed 15% of your body weight, so pack only what is needed. Tip: if the backpack forces the wearer to move forward to carry, it’s overloaded.
  3. Lift Right - Face the pack, bend at the knees, use both hands and check the weight of the pack. Lift with the legs; apply one shoulder strap, and then the other. Tip: Don’t sling the backpack onto one shoulder.
  4. Wear Right - Use both shoulder straps, snug but not too tight. Tip: When the backpack has a waist strap use it.

Concussion

What is a Concussion?

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. READ MORE

Concussion VideoSigns and Symptoms of a Concussion

Children and teens who show or report one or more of the signs and symptoms listed below, or simply say they just “don't feel right” after a bump, blow, or jolt to the head or body, may have a concussion or more serious brain injury.


Concussion Signs Observed

  • Can't recall events prior to or after a hit or fall
  • Appears dazed or stunned
  • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes

*https://www.cdc.gov

Concussion Symptoms Reported

  • Headache or "pressure" in head
  • Nausea or vomiting
  • Balance problems or dizziness, or double or blurry vision
  • Bothered by light or noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Confusion, or concentration or memory problems
  • Just not "feeling right" or "feeling down"

Concussion Policy

Approved by School

Committee 3/12/2012

BRAINTREE PUBLIC SCHOOLS

CONCUSSION POLICY

GRADES 6 – 12

Purpose:

This policy provides for the implementation of MA 105 CMR 201.000, Head Injuries and Concussions in Extracurricular Athletic Activities. The purpose of this policy is to provide information and standardized procedures for persons involved in the prevention, training management and return to activity decisions regarding students who incur head injuries while involved in extracurricular athletic activities[1] including but not limited to, interscholastic sports, in order to protect their health and safety as required by Massachusetts law and regulations. The requirements of the law apply to all public middle and high schools, however configured, serving grades six through high school graduation. In addition to any training required by law, the following persons shall complete one of the head injury safety training programs approved by the Massachusetts Department of Public Health (DPH) as found on its website: coaches; certified athletic trainers; trainers; volunteers; school and team physicians; school nurses; athletic directors; directors responsible for a school marching band; employees or volunteers; and students who participate in an extracurricular activity and their parents. This policy provides the procedures and protocols for the Braintree Public Schools (BPS) in the management of and prevention of sports-related head injuries within the district or school.

Upon the adoption of this policy by the School Committee, the Superintendent shall ensure that the Department of Public Health receives and affirmation on school district letterhead that the district has developed policies and the School Committee has adopted a final policy in accordance with law. This affirmation shall be updated by September 30, 2013 and every two years thereafter upon review or revision of its policies.

Record Maintenance

The BPS Athletic Director or designee shall maintain the following record for three years or, at a minimum, until the student graduates, unless state or federal law requires a longer retention period:

    • Verifications of completion of annual trainings;
    • All Registration/Permission/Medical Forms and Pre-participation Head Injury/Concussion reporting forms;
    • Annual physical exams;
    • Report of Head Injury During a Sports Season forms;
    • Post Sports Related Head Injury Clearance and Return to Play Protocols.
    • Physician Head Injury Notification and Academic Accommodations Forms

These records will be made available to the Department of Public Health and DESE upon request or in connection with any inspection or program review.

This policy also applies to volunteers who assist with extracurricular athletic activities. Such volunteers shall not be liable for civil damages arising out of any act or omission relating to the requirements of law, unless such volunteer is willfully or intentionally negligent in his act or omission.

Most student athletes who sustain a concussion can fully recover as long as their brain has time to heal before sustaining another hit; however, relying only on an athlete’s self-report of symptoms to determine injury recovery is inadequate as many high school athletes are not aware of the signs and symptoms or the severity concussive injuries pose, or they may feel pressure from coaches, parents and/or teammates to return to play as quickly as possible. One or more of these factors will likely result in under diagnosing the injury and a premature return to play. Massachusetts General Laws and Department of Public Health regulations make it imperative to accurately assess and treat student athletes when concussions are suspected.

Student athletes who receive concussions may appear to be “fine” on the outside, when in actuality they have a brain injury and are not able to return to play. Incurring a second concussion can prove to be devastating to a student athlete. Research has shown that young concussed athletes who return to play before their brain has healed are highly vulnerable to more prolonged post-concussion syndrome or, in rare cases, a catastrophic neurological injury known as Second Impact Syndrome.

The following protocol will discuss and outline what a concussion is, the mechanism of injury, signs and symptoms, management and return to play requirements, as well as information on Second Impact Syndrome and past concussion syndrome. Lastly, this policy will discuss the importance of education for our athletes, coaches and parents and other persons required by law.

This protocol should be reviewed on a yearly basis with all staff to discuss the procedures to be followed to manage sports-related concussions. This protocol will also be reviewed on a yearly basis by the athletic department as well as by nursing staff. Any changes in this document will be approved by the School Committee and given to athletic staff, including coaches and other school personnel in writing. An accurate synopsis of this policy shall be placed in the student and faculty handbooks.

ATHLETIC CONCUSSION REGULATIONS

Section I. What is a concussion?

A concussion is defined as a transient alteration in brain function without structural damage, but with other potentially serious long-term ramifications. In the event of a concussion, the brain sustains damage at a microscopic level in which cells and cell membranes are torn and stretched. The damage to these cells also disrupts the brain at a chemical level, as well as causing restricted blood flow to the damaged areas of the brain, thereby disrupting brain function. A concussion, therefore, is a disruption in how the brain works; it is not a structural injury. Concussions are difficult to diagnose because the damage cannot be seen. A MRI or CT scan cannot diagnose a concussion, but they can help rule out a more serious brain injury to a student athlete. Because concussions are difficult to detect, student athletes must obtain medical approval before returning to athletics following a concussion.

Section II. Mechanism of Injury:

A concussion is caused by a bump, blow or jolt to the head or body. Any force that causes the brain to bounce around or twist within the skull can cause a concussion. A bump, blow or jolt to the head or body can be caused by either indirect or direct trauma. The two direct mechanisms of injury are coup-type and contrecoup-type. Coup-type injury is when the head is stationary and struck by a moving object such as another player’s helmet, a ball, or sport implement, causing brain injury at the location of impact. Contrecoup-type injury occurs when the head is moving and makes contact with an immovable or slowing moving object as a result of deceleration, causing brain injury away from the sign of impact. Indirect forces are transmitted through the spine and jaw or blows to the thorax that whip the head while the neck muscles are relaxed. Understanding the way in which an injury occurred is vital in understanding and having a watchful eye for athletes who may exhibit symptoms of a concussion so these student athletes can receive the appropriate care.

Section III. Signs and Symptoms:

Signs (what you can see):

    • Confusion
    • Forgets plays
    • Unsure about game, score, opponent
    • Altered coordination
    • Balance problems
    • Personality change
    • Slow response to questions
    • Forgets events prior to injury (retrograde amnesia)
    • Forgets events after injury (anterograde amnesia)
    • Loss of consciousness (any duration)

Symptoms (reported by athlete):

    • Headache
    • Fatigue
    • Nausea or vomiting
    • Double vision/blurry vision
    • Sensitivity to light (photophobia)
    • Sensitivity to noise (tinnitus)
    • Feels sluggish
    • Feels foggy
    • Problems concentrating
    • Problems remembering
    • Trouble with sleeping/excel sleep
    • Dizziness
    • Sadness
    • Seeing stars
    • Vacant stare/glassy eyed
    • Nervousness
    • Irritability
    • Inappropriate emotions

If any of the above signs or symptoms are observed after a suspected blow to the head, jaw, spine or body, they may be indicative of a concussion and the student athlete must be removed from play immediately and not allowed to return until cleared by an appropriate allied health professional.

Protocol:

Section IV. Pre-participation Requirements and Training

Concussion training is a pre-participation requirement and must be completed prior to practice or competition. The following persons annually shall complete one of the head injury safety training programs approved by Braintree Public Schools (BPS):

    • Coaches;
    • Assistant Coaches;
    • Certified Athletic Trainer;
    • School Physician;
    • School Nurses;
    • Guidance Counselors;
    • Middle and High School classroom teachers and specialists;
    • Athletic Director;
    • Person responsible for a school marching band, whether employed by a school or school district or serving in such capacity as a volunteer;
    • Employees or Volunteers assisting with athletics;
    • Students participating in extracurricular athletic activity;
    • Parents/Guardians of a student who participates in an extracurricular athletic activity.

This requirement may be met by:

    • Completing an approved free online program. The on-line courses can be found at:
      http://www.cdc.gov/concussion/HeadsUp/online_training.html
      http://www.nfhslearn.com/electiveDetail.00aspx?courseID=15000
    • The training must be repeated every subsequent year.
    • Students and parents must complete the Pre-participation Head Injury/Concussion Reporting Form, as well as sign that they have completed one of the above on-line courses and attach a copy of the certificate and return to the Athletic Director.
    • Coaches/Assistant Coaches must provide a certificate of completion of one of the on-line courses to the athletic director.
    • The athletic director will maintain all certificates of annual training or and training session rosters, Interscholastic Registration/Permission/Medical Forms and Pre-participation Head Injury/Concussion reporting forms for three years or, at a minimum, until the student graduates, unless state or federal law requires a longer retention period. The school nurse shall maintain all Physical Exams, Report of Head Injury forms, Medical Clearance forms and any other pertinent medical information in the individual student health record for a minimum of three years or until the student graduates unless state or federal law requires a longer retention period.
    • Game officials must also complete an approved training annually and provide BPS with verification of completion upon request.

Additionally, students who plan to participate in extracurricular athletic activities, as well as their parents, must complete and sign the pre-participation Interscholastic Registration/Permission/Medical Form prior to each season of participation. The questionnaire will be distributed through the athletic department. The questionnaire will be reviewed by the athletic trainer and school nurse prior to athletic participation. The school nurse will provide appropriate follow-up when necessary. Annually, students are also required to provide a physical exam to the school nurses’ office and the school nurse will report clearance to the athletic director. Additionally, no student shall be medically cleared for extracurricular athletic activities until the athletic trainer and school nurse have reviewed the Pre-participation Head Injury/Concussion Reporting Form, the Interscholastic Registration/Permission/Medical Form and Physical Exam form and reported clearance to the athletic director.

Braintree Public Schools may use a student’s history of head injury or concussion as a factor to determine whether to allow the student to participate in an extracurricular athletic activity or whether to allow such participation under specific conditions or modifications.

Additional parental requirement:

If a student sustains a head injury or concussion during the season, but not while participating in an extracurricular athletic activity, the parent shall complete the Report of Head Injury During a Sports Season form and submit it to the athletic trainer who will review it with the school nurse.

Section V. Exclusion from Play

    • Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition until medically cleared by a duly licensed physician, a duly licensed certified athletic trainer in consultation with a licensed physician, a duly licensed nurse practitioner on consultation with a licensed physician, or a duly licensed neuropsychologist in coordination with the physician managing the student’s recovery.
    • If an EMT is covering a sporting event, and an athlete sustains a head injury or suspected concussion they shall be removed from practice or competition immediately and may not return to practice or competition until medically cleared by a duly licensed physician, a duly licensed certified athletic trainer in consultation with a licensed physician, a duly licensed nurse practitioner on consultation with a licensed physician, or a duly licensed neuropsychologist in coordination with the physician managing the student’s recovery.
    • The coach/assistant coach shall communicate the nature of the injury directly to the parent in person or by phone immediately during or after the practice or competition in which a student has been removed from play due to a head injury, suspected concussion signs and symptoms of a concussion, or loss of consciousness. The coach/assistant coach must also provide parents/guardians with the following forms:

1. Head Injury Notification and Home Instruction Form

2. Physician Head Injury Notification and Request for Academic Accommodations Form

3. Post Sports Related Head Injury Medical Clearance and Return to Play Authorization Form

    • The coach/assistant coach or his or her designee shall communicate, by the end of the next business day, with the Athletic Director and the Athletic Trainer that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. The coach/assistant coach must also complete the Report of Head Injury During a Sports Season Form and give it to the Athletic Trainer by the end of the next business day. The Athletic Trainer will then communicate this information to the School Nurse who will make contact with the student’s guidance counselor.
    • The student shall not return to practice or competition unless and until the student provides medical clearance. The coach/assistant coach or athletic trainer shall provide the necessary forms for the student to take to their medical provider. This includes a letter explaining the need for the medical clearance from the primary healthcare provider, academic accommodations, and gradual return to play protocol.

Section VI. Return to Play

A BPS multidisciplinary team will develop a plan for the student’s academics and return to play. This team may consist of athletic trainer, school nurse, teaching staff, guidance counselor, primary care physician or physician managing the student’s recovery, and parent.

The plan shall include the academic recovery plan recommendations from the physician and multidisciplinary team and the return to play protocol of the athletic trainer.

Students must be symptom free and medically cleared in order to return to play. The following individuals may authorize a return to play:

    • A duly licensed physician,
    • A duly licensed certified athletic trainer in consultation with a licensed physician;
    • A duly licensed nurse practitioner in consultation with a licensed physician, or
    • A duly licensed neuropsychologist in coordination with the physician managing the student’s recovery.

Gradual Return-to-Play Protocol

Stage 1: No activity

Stage 2: Light aerobic exercise (walking, swimming, or stationary cycling) keeping intensity to 70% of maximum predicted heart rate; no resistance training

Stage 3: Sport-specific exercise (skating drills in ice hockey, running drills in soccer); no head impact activities

Stage 4: Non-contact training drills, progression to more complex training drills, eg, Passing drills in football and ice hockey; may start progressive resistance

Stage 5: Full-contact practice following medical clearance, participate in normal training activities

Stage 6: Return to play

Final return to play in the Braintree Public Schools requires the approval of the athletic trainer.

Section VII. Athletic Director Responsibilities

The Athletic Director completes an annual Concussion training.

The Athletic Director participates in the biannual review and revision of the policy.

The Athletic Director shall:

    • Ensure the annual training of coaches, staff, parents/guardians, volunteers and students;
    • Maintain records of annual trainings, certificates, affidavits, and/or attendance rosters for three years;
    • Ensure that all Interscholastic Registration/Permission/Medical Forms and Pre-participation Head Injury/Concussion reporting forms are completed and submitted prior to participation in any extracurricular athletic activity;
    • Review all pre-participation forms and forward to the athletic trainer and school nurse those forms indicating a history of head injury.
    • Ensure that all students meet the physical exam requirements consistent with 105 CMR 2000.000 prior to participation in any extracurricular athletic activity;
    • Ensure that the medically cleared list is provided to all coaches, assistants, and volunteers and that no student participates without this clearance;
    • Ensure that Report of Head Injury During a Sports Season forms are completed by parents/guardians or coaches and reviewed by the athletic trainer and school nurse;
    • Ensure that athletes are prohibited from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon;
    • Ensure that Braintree Public School issued athletic equipment is properly maintained, reconditioned and certified in accordance with National Operating Committee for Standards for Athletic Equipment (NOCSAE);
    • Maintain all Interscholastic Registration/Permission/Medical Forms and Pre-participation Head Injury/Concussion reporting forms for three years;
    • Inform parent/guardian that, if all necessary forms are not completed, their child will not participate in extracurricular athletic activities;
    • Include concussion information in student athletic handbook;
    • Develop a plan to communicate and provide language-appropriate educational materials to parents with limited English proficiency;
    • Report annual statistics to the Department of Public Health:
        • The total number of Head Injury Reports received from both coaches and parents;
        • The total number of students who incur head injuries and suspected concussions when engaged in any extracurricular athletic activities.

Section VIII. Athletic Trainer Responsibilities

The athletic trainer shall complete the annual Concussion training.

The athletic trainer shall participate in the biannual review and revision of the policy.

The athletic trainer shall:

    • Review in collaboration with the school nurse the Pre-participation Questionnaire and Report of Head Injury Report forms;
    • In the case of multiple concussion reported on the pre-participation form, collaborate with the school nurse to contact the parents/guardians and the students primary care provider regarding the decision to allow a player with repeat concussions to participate in a sports season;
    • Identify students with a suspected head injury or concussion that occur in practice or competition and complete a side line evaluation consisting of the Standardized Assessment of Concussion (SAC) test and Signs and Symptoms check list;
    • Refer students with a report of a head injury to their physician for further evaluation;
    • Monitor the symptoms of students with head injuries and maintain written documentation of such monitoring;
    • Will administer the ImPACT Test within 24-72 hours following the suspected head injury;
    • Determine Gradual Return- to- Play schedule based on receiving a physician signed Post Sports Head Injury Clearance and Authorization Form and completed Physician Head Injury Notification and Academic Accommodations Form and ImPACT Test scores are back to baseline score;
    • Implement the Gradual Return-to-Play Protocol;
    • Collaborate with coaches to ensure that the Concussion Return-to-Play protocol is being followed;
    • Notify the athletic director and school nurse of any student athlete diagnosed with a concussion or head injury;
    • All Concussion Return-to-Play protocols for students with head injury or concussion will be sent to the School Nurse for placement in the student’s health record folder.

Section IX. Coach/Assistant Coach and Band Instructor Responsibilities

The coach/assistant coach and band instructor completes the annual Concussion training and provides the athletic director with a certificate of completion.

The coach/assistant coach reviews the pre-participation information provided by the school nurse regarding a student’s history and/or risk of head injury.

The coach/assistant coach shall:

    • Ensure that all student athletes have completed ImPACT baseline testing prior to participation;
    • Ensure that all student athletes are on the medically cleared list prior to participation;
    • Identify athletes with head injuries or suspected concussions that occur in practice or competition and remove them from play;
    • Communicate the nature of the injury directly to the parent/guardian in person or by phone immediately during or after the practice or competition in which a student has been removed from play due to a head injury, suspected concussion signs and symptoms of a concussion, or loss of consciousness;
    • Provide parents/guardians with the following forms:

1. Head Injury Notification and Home Instruction Form

2. Physician Head Injury Notification and Academic Accommodations Form

3. Post Sports Related Head Injury Medical Clearance and Return to Play Authorization Form

    • Promptly notify the Athletic Director and Athletic Trainer of any student removed from practice or competition;
    • Complete the Report of Head Injury Form for any student with a head injury or suspected concussion that occurs during practice or competition and give to the Athletic Trainer;
    • Ensure that no student athlete returns to play until cleared by a physician and the athletic trainer and you have received this notification in writing from the athletic trainer;
    • Teach techniques aimed at minimizing sports-related head injury;
    • Discourage and prohibit athletes from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a musical instrument, helmet or any other sports equipment as a weapon;
    • Ensure that Braintree Public School issued athletic equipment is properly maintained, reconditioned and certified in accordance with NOCSAE.

Section X. School Nurse Responsibilities

The School Nurse completes the annual Concussion training and provides the athletic director with a certificate of completion.

The School Nurse shall participate in the biannual review and revision of the policy.

The School Nurse shall:

    • Review all Registration/Permission/Medical Forms and Pre-participation Head Injury/Concussion Reporting forms;
    • In the case of multiple concussion reported on the pre-participation form, collaborate with the athletic trainer to contact the parents/guardians and the students primary care provider regarding the decision to allow a player with repeat concussions to participate in a sports season;
    • Review all annual physical exams and record in computerized health record program;
    • Review all Report of Head Injury forms in conjunction with the Athletic Trainer;
    • Maintain all physical exams, Report of Head Injury forms, Medical Clearance forms and any other pertinent medical information in the individual student health record;
    • Share on a need to know basis any head injury information regarding a student that may impact their ability to participate in extracurricular athletic activities or places a student at greater risk for repeated head injuries;
    • Complete symptom assessment when student athlete enters Health Office with questionable concussion during school hours. Repeat in 15 minutes;
    • Observe students with a concussion for a minimum of 30 minutes;
    • If symptoms are present, notify parent(s)/guardian(s) and instruct parent(s)/guardian(s) that student must be evaluated by an MD:

(a) If symptoms are not present, the student may return to class;
(b) If symptoms appear after a negative assessment, MD referral is necessary;

    • School nurse will notify teaches and guidance counselors of any students or student athletes who have academic accommodations or modifications related to their concussion;
    • Participate in the reentry planning for students to discuss any necessary accommodations or modifications with respect to academics, course requirements, homework, testing scheduling and other aspects of school activities consistent with a graduated reentry plan for return to full academic and extracurricular athletic activities after a head injury and revising the health care plan as needed;
    • Monitor recuperating students with head injuries and collaborate with teachers to ensure that the graduated reentry plan is being followed;
    • Allow students who are in recovery to rest in Health Office when needed;
    • Develop plan for students regarding pain management;
    • Yearly provide educational materials on head injury and concussion to teachers and support staff.

Section XI. Guidance Counselor Responsibilities

Guidance Counselors will complete the annual Concussion training and provides the athletic director with a certificate of completion.

One Guidance Counselor will be appointed to participate in the biannual review and revision of the policy.

The Guidance Counselor shall:

    • Be designated as the contact or “point person” once informed by the school nurse that a student has been diagnosed with a concussion;
    • Will work with the student on organizing work assignments, making up work and giving extra time for assignments, tests/quizzes and plans in terms of MCAS participation;
    • Assist teachers in following the recovery stage and academic accommodations for student;
    • Convene meeting and develop rehabilitative plan as needed;
    • Notify teachers to decrease workload if symptoms reappear;
    • Recognize and educate teachers that the student’s ability to perform complex math equations may be different from the ability to write a composition depending on the location of the concussion in the brain;
    • Educate staff on the educational impact concussions may have on students;
    • Communicate with school nurse and athletic trainer any concerns or report of students progress and give any medical reports to school nurse.

Section XII. Classroom Teacher/Specialist Responsibilities

Every classroom teacher/specialist grade six through twelve will complete the annual Concussion training and provide the athletic director with a certificate of completion.

The Classroom Teacher/Specialist shall:

    • Follow the academic guidelines set forth in the Braintree Public Schools “Academic Expectations During Post Concussion Recovery Plan”;
    • Work in conjunction with the guidance counselor to implement the recommendations and accommodations set forth for the individual student;
    • Communicate with the guidance counselor and/or school nurse regarding the student’s progress, academic needs, and/or any additional issues or concerns.

Section XIII. Parent/Guardian Responsibilities

Parent/Guardian will complete the annual Concussion training and provides the athletic director with a certificate of completion.

The Parent/Guardian shall:

    • Complete and return to athletic director the Registration/Permission/Medical Forms,

Pre-participation Head Injury/Concussion Reporting forms and annual physical form;

    • Inform the Athletic Director if your child sustains a concussion outside of school hours and complete the Report of Head Injury During a Sports Season form and give to athletic director;
    • Watch for changes in your child that may indicate that your child does have a concussion or that your child’s concussion may be worsening. Report to a physician:

a. Loss of consciousness
b. Headache
c. Dizziness
d. Lethargy
e. Difficulty concentrating
f. Balance problems
g. Answering questions slowly
h. Difficulty recalling events
i. Repeating questions
j. Irritability
k. Sadness
l. Emotionality
m. Nervousness
n. Difficulty with sleeping

    • Encourage your child to follow concussion protocol;
    • Enforce restrictions on rest, electronics and screen time;
    • Reinforce academic accommodations and gradual return to play plan;
    • Communicate about your child’s progress, academic needs or concerns with guidance counselor;
    • Observe and monitor your child for any physical or emotional changes;
    • Recognize that you child will be excluded from participation in any extracurricular athletic event if all forms are not completed and on file with the athletic department.

Section XIV. Student and Student Athlete Responsibilities:

Student Athletes or students participating in the Marching Band will complete the annual Concussion training and provide the athletic director or band director with a certificate of completion.

Student Athlete shall:

    • Return to athletic director the Registration/Permission/Medical Forms, Pre-participation Head Injury/Concussion Reporting forms and annual physical form prior to participation in athletics;
    • Complete Baseline ImPACT Test prior to participation in athletics;
    • Report all symptoms to athletic trainer and/or school nurse;
    • Follow academic accommodations and return to play recovery plan;
    • Rest;
    • No athletics;
    • Be Honest;
    • Keep strict limits on screen time and electronics;
    • Don’t carry books or backpacks that are too heavy;
    • Tell your teachers and guidance counselor if you are having difficulty with your class work;
    • See the school nurse for pain management;
    • Return medical clearance form to athletic trainer prior to beginning gradual return to play protocol;
    • Return to sports only when cleared by physician and the athletic trainer;
    • Report any symptoms to the athletic trainer and/or school nurse and parent(s)/guardian(s) if any occur after return to play;
    • Students who do not complete and return all required trainings, testing and forms will not be allowed to participate in sports.

Section XV. Post Concussion Syndrome:

Post Concussion Syndrome is a poorly understood condition that occurs after a student athlete receives a concussion. Student athletes who receive concussions can have symptoms that last a few days to a few months, and even up to a full year, until their neurocognitive function returns to normal. Therefore, all school personnel must pay attention to and closely observe all student athletes for post concussion syndrome and its symptoms. Student athletes who are still suffering from concussion symptoms are not ready to return to play. The signs and symptoms of post concussion syndrome are:

    • Dizziness
    • Headache with exertion
    • Tinnitus (ringing in the ears)
    • Fatigue
    • Irritability
    • Frustration
    • Difficulty in coping with daily stress
    • Impaired memory or concentration
    • Eating and sleeping disorders
    • Behavioral changes
    • Alcohol intolerance
    • Decreases in academic performance
    • Depression
    • Visual disturbances

Section XVI. Second Impact Syndrome:

Second impact syndrome is a serious medical emergency and a result of an athlete returning to play and competition too soon following a concussion. Second impact syndrome occurs because of rapid brain swelling and herniation of the brain after a second head injury that occurs before the symptoms of a previous head injury have been resolved. The second impact that a student athlete may receive may only be a minor blow to the head or it may not even involve a hit to the head. A blow to the chest or back may create enough force to snap the athlete’s head and send acceleration/deceleration forces to an already compromised brain. The resulting symptoms occur because of a disruption of the brain’s blood autoregulatory system which leads to swelling of the brain, increasing intracranial pressure and herniation.

After a second impact a student athlete usually does not become unconscious, but appears to be dazed. The student athlete may remain standing and be able to leave the field under his/her own power. Within fifteen seconds to several minutes, the athlete’s condition worsens rapidly, with dilated pupils, loss of eye movement, loss of consciousness leading to coma and respiratory failure. The best way to handle second impact syndrome is to prevent it from occurring altogether. All student athletes who incur a concussion must not return to play until they are asymptomatic and cleared by an appropriate health care professional.

Section XVII. Concussion Education:

It is extremely important to educate coaches, athletes and the community about concussions. On a yearly basis, all coaches must complete the online course called “Concussion In Sports: What you Need to Know”. This course is offered by the National Federation of State High School Associations (NFHS). Student athletes also need to understand the importance of reporting a concussion to their coaches, parents, athletic trainer and other school personnel. Every year student athletes and parents/guardians will participate in educational training on concussions and complete a certificate of completion. This training may include:

The school district may also offer seminars, speakers, and discussion panels on the topic of concussions. Seminars offer an opportunity for the certified athletic trainer, athletic director and nurse leader to speak about concussions on the field at practices and games and to discuss the protocol and policy that the district has enacted. Providing education within the community will offer the residents and parents of athletes an opportunity to ask questions and voice their concerns on the topic of brain injury and concussions. When it comes to concussions, everyone needs to be aware of the potential dangers and remember that a concussion is a brain injury. Whenever anyone has a doubt about a student athlete with a concussion, sit them out and have them see the appropriate healthcare professional.

The Braintree Public School system takes the safety of student athletes seriously. All members of the school staff are expected to follow these policies and protocols to support the health and safety of student athletes. Failure to comply with the letter or spirit of this policy could result in progressive discipline for staff and or forfeiture of games. If students or parents have concern that the policy is being violated, they should contact the athletic director.

December 2011



[1] Extracurricular Athletic Activity means an organized school sponsored athletic activity generally occurring outside of school instructional hours under the direction of a coach, athletic director, or marching band leader including, but not limited to, Alpine and Nordic skiing and snowboarding, baseball, basketball, cheer leading, cross country track, fencing, field hockey, football, golf, gymnastics, horseback riding, ice hockey, marching band, rifle, rugby, soccer, skating, softball, squash, swimming and diving, tennis, track (indoor and outdoor), ultimate frisbee, volleyball, water polo, and wrestling. All interscholastic athletics are deemed to be extracurricular athletic activities. LEGAL REFS: M.G.L. 111:222; 105 CMR 201.000

Printable Version of the Concussion Policy Available Here

Helpful Links:

Diabetes

Health Services Newsletters

June 2018 - Volume 8, Issue 3

Medication Safety

Medication

June is National Safety Month.  

Medication safety is important for all.

This article focuses on young children.

In 2014, Safe Kids Worldwide released a new research report identifying new insights into why kids are getting into medicine nearly 500,000 times per year. Every minute of every day, a poison control center receives a call about a potential medicine poisoning for a child age five and under. And 64,000 times each year, or every eight minutes, a young child goes to the emergency room for medicine poisoning. In three out of four (77 percent) of those visits, a child got into medicine belonging to a parent or grandparent.

Families take medications and vitamins to feel and stay well. However, any medication, includ- ing those bought without a prescription, can cause harm if taken in the wrong way or by the wrong person. Practicing safe medication storage while at home and when on-the-go can help keep children safe.

Protect your children. Here’s how:

  • Teach your children about medication safety.  A Medication safety program will be presented to the Braintree Public School’s second grade students in the month of May. The program will emphasize teaching your child what medi- cine is and why you or a trusted adult must be the one to give it to them.
     
  • Never tell children medicine is candy to get them to take it, even if they don’t like to take their medicine.
     
  • Put all medication up and away and out of children’s reach and sight.   Children are curious and put all sorts of things in their mouths. Even if you turn your back for less than a minute, they can quickly get into things that could hurt them.  Pick a storage place in your home that children cannot reach or see. Walk around your house and decide on the safest place to keep your medicines and vitamins.
     
  • Put medicines away every time. This includes medicines and vitamins you use every day. Never leave medicine out on a kitchen counter or at a sick child’s bedside, even if you have to give it again in a few hours.  In 2 out of 3 emergency room visits for medicine poisoning, the medicine was left within reach of a child.
     
  • Make sure the safety cap is locked. Always relock the cap on a medicine bottle. If the bottle has a locking cap that turns, twist it until you hear the click or cannot twist anymore. Remem- ber, even though many medicines have safety caps, children may be able to open them. Every medicine must be stored up and away and out of a child’s reach and sight.
     
  • Only use the dosing device that comes with the medicine. Kitchen spoons aren’t all the same, and a teaspoon or tablespoon used for cooking won’t measure the same amount of medicine as a dosing device.
     
  • Tell your guests about medicine safety. Ask family members, houseguests, and other visi- tors to keep purses, bags, or coats that have medicine in them up and away and out of sight when they are in your home.
     
  • Write clear instructions for caregivers about your child’s medicine. When other care- givers are giving your child medicine, they need to know what medicine to give, how much to give and when to give it. Using a medicine schedule can help with communica- tion between caregivers.

  • Be prepared in case of an emergency!

    Call your poison control center at 800.222.1222 right away if you think your child may have gotten into a medicine or vitamin, even if you are not completely sure.

    Program the Poison Help number into your home and cell phones so you will have it when you need it.  You should also keep the number on your refrigerator or another place in your home where babysitters and caregivers can see it. And remember, the Poison Help Line is not just for emergencies, you can call with questions about how to take or give medicine.
     
  • Take Action: Visit the Up and Away Campaign’s website to learn more about storing medica- tions safely while at home and when traveling with young children. Share these safe storage tips with family and friends.

Sources: Safe Kids Worldwide(www.safekids.org ) & Center for Disease Control and Prevention (https:/ /www.cdc.gov/Features/Med ication Storage/ )         

10 tips for helmet safety

Boy Riding Bike Wearing Helmet

Each year approximately 600,000 people suffer from bicycle-related injuries that require hospital emergency room treatment — 250 of these children will die from bicycle-related injuries.

A helmet is the single most effective way to help reduce head injury and death from bicycle crashes. Helmets have been shown to reduce the risk of head injury by as much as 85 percent and the risk of brain injury by as much as 88 percent. Approximately 75 percent of bicycle-related fatalities could have been prevented by wearing a properly fitted helmet.

Helmet safety tips

  1. Adopt the simple saying, “Use your head, wear a helmet.” Children should always wear a helmet for all wheeled-sports activities.
  2. When skateboarding or long boarding, your child should wear a skateboarding helmet.
  3. Parents also should wear a helmet for every ride. Children learn from watching you so mod- el proper behavior.
  4. When it is time to purchase a new helmet, let your child pick out his/her own; he or she will be more likely to wear it for every ride.
  5. Helmets should sit comfortably on the head all the way around; sitting level and stable enough to stay in place during violent shakes or hard blows.
  6. Rest the helmet level on the head, not tilted.
  7. Make sure the straps of the helmet form a “V” under the ears when buckled.
  8. Have the strap underneath the chin fit comfortably snug.
  9. Secure the helmet to the point that twisting and tugging cannot remove it.
  10. Always replace a helmet after a crash. Damages may not be visible, but the foam can lose its integrity.

Source: Mackensey Stang, Injury Prevention Specialist CentraCare

HealthFacts and Figures are provided by the Brain Injury Association of Minnesota and the Bicycle Helmet Safety Institute.         

“Protect the Skin You’re In”

Child wearing Hat and Sunglasses

The sun’s ultraviolet (UV) rays can damage your skin in as little as 15 minutes. Follow these recommendations to help protect yourself and your family.

Shade 

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun. Your best bet to protect your skin is to use sunscreen or wear protective clothing when you’re outside—even when you’re in the shade.

Clothing 

When possible, long-sleeved shirts and long pants and skirts can provide protection from UV rays. Clothes made from tightly woven fabric offer the best protection. A wet T-shirt offers much less UV protection than a dry one, and darker colors may offer more protection than lighter colors. Some clothing certified under international standards comes with information on its ultraviolet protection factor.

If wearing this type of clothing isn’t practical, at least try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hat

For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck. A tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection. If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using a broad spectrum sunscreen with SPF 30, or by staying in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Sunscreen

Put on broad spectrum sunscreen with SPF 30 before you go outside, even on slightly cloudy or cool days. Don’t forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back. And remember, sunscreen works best when combined with other options to prevent UV damage.

How sunscreen works. Most sunscreen products work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays. All products do not have the same ingredients; if your skin reacts badly to one product, try another one or call a doctor.

SPF. Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking UV rays. Higher numbers indicate more protection. You should use a broad spectrum sun- screen with SPF 30.

Reapplication. Sunscreen wears off. Put it on again if you stay out in the sun for more than two hours and after swimming, sweating, or toweling off.

Expiration date. Check the sunscreen’s expiration date. Sunscreen without an expiration date has a shelf life of no more than three years, but its shelf life is shorter if it has been exposed to high temperatures.

Cosmetics. Some makeup and lip balms contain some of the same chemicals used in sunscreens. If they do not have SPF 30, don't use them by themselves.

CDC Centers for Disease Control and Prevention     
http s://www.cd c.go v/n iosh /d o cs/2 0 10 -116/

Seat Belt Safety for School Age Children, New Drivers, and Young Adults

The following is a helpful guideline of Massachusetts Laws pertaining to seatbelt safety. It is supported by the American Academy of Pediatrics.

Booster Seat:

Boy Belted into Car Booster Seat

A child should remain in a booster seat until they have reached 4 feet 9 inches (57 inches) tall, and are between the ages of 8-12. The height requirement is extremely important. This is so the shoulder strap rests across the shoulder and not across their neck.

For more information, and to find out where to go if you need a free or discounted booster seat contact the CAR SAFETY LINE at 1-800-227-7233 or visit Mass.gov/childsafetyseats.

When a child meets both height and age requirements, and the seat belt rests across their shoulder correctly, a booster seat is no longer needed.

When is it safe for your child to ride in the front passenger seat of any vehicle?

The safest place for a child to sit in any vehicle is the back seat.  In Massachusetts, if a child is at least 13 years old, and meets the height requirement, it is not against the law for them to sit in the front passenger seat. Never let any child ride with the shoulder strap behind their back.  In an accident this could result in a more severe injury to their abdomen. If the strap bothers him/her it is usually a good indication that he/she should still be in a booster seat.

New Drivers and Young Adults

Does your new driver or child know these facts regarding seat belt use?

In the State of Massachusetts any driver can be pulled over if a minor child or sibling is not properly restrained in a child safety seat and fined $25.  The driver can be cited an additional $25 for each person under the age of 16 that is also not restrained.

What is Vaping?

Vaping is a dangerous trend that is becoming more popular, but what is it?  Vaping is done via an electronic cigarette or E-Cig. The small, pen like devices are battery powered and heat a liquid into an aerosol which is then inhaled.   It may be odorless or it may be flavored.

These flavorings are often sweet enticing flavors to teens.  Vaping is inhaling an aerosol, meaning there are particles in the inhalant not just water vapor.  Many of the liquids that are used can contain nicotine, which is an addictive drug, the same drug contained in traditional cigarettes. Even though a vaping liquid may say it does not contain nicotine, they often do have a small percentage of nicotine.  Other ingredients found in the inhalants include heavy metals (nickel, tin, and lead), volatile organic compounds, and other chemical which can be harmful.

Some other popular names used for an E-Cigarette are E-Hookahs, Vape Pens, Mods, Juuls, and Tank Systems. Below is an example of  an E-Cigarette.

parts of an electronic cigarette

It is important to talk with your children about the dangers of vaping.  It is more prevalent in high schools than traditional cigarettes, and it is being used by middle school aged children as well.  Tips on how to talk to your child can be found on the CDC.org website.

Check out the Braintreeschools.org website, go under student life/BASHY and/or the townofbraintreegov.org website under departments/partnerships for events on substance use awareness.

Information adapted from the SurgeonGeneral.Gov

February 2018, Volume 8, Issue 2

Hand Washing

Good hand washing is important for everyone’s health!

Hand-washingGerms and illness can be easily and quickly spread. One of the simplest and best ways to avoid the spread of germs and help prevent illness is with good hand-washing.

 

Proper hand washing consists of 5 basic steps:

  1. Wet hands
  2. Apply soap
  3. Lather/scrub hands well for at least 20 seconds
  4. Rinse soap off
  5. Dry hands using a clean towel or paper towel

According to the CDC: “Hand washing is like a "do-it-yourself" vaccine—it involves five simple and effective steps (Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy. Regular hand washing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. It's quick, it's simple, and it can keep us all from getting sick. Hand washing is a win for everyone, except the germs”

For more information about proper hand washing and a video from the CDC please follow these links:

  • https://www.cdc.gov/cdctv/healthyliving/hygiene/fight-germs-wash-hands.html
  • https://www.cdc.gov/handwashing/pdf/handwashing-poster.pdf
  • https://www.cdc.gov/handwashing/pdf/wash-your-hands-fact-sheet.pdf

Para obtener más información sobre el lavado de manos adecuado y un video del CDC, siga este enlace:

  • https://www.cdc.gov/cdctv/spanish/healthyliving/acabe-con-los-microbios.html
  • https://www.cdc.gov/handwashing/pdf/handwashing-poster-es.pdf
  • https://www.cdc.gov/handwashing/pdf/stop-germs-spanish.pdf

Flu Facts

Flu SeasonWhile seasonal flu viruses can be detected year round in the United States, flu viruses are most common during the fall and winter. The timing and duration of flu season can vary, but influenza activity often begins to increase in October. Most of the time flu activity peaks between December and February, although activity can last as late as May.

Flu Symptoms

  • Fever or feeling chills (not everyone with the flu will have a fever)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue
  • Some people may have vomiting and diarrhea, although this is more common in children than adults

Flu TreatmentIf you get the flu, antiviral drugs may be a treatment option. When used for treatment, antiviral medication can lessen symptoms and shorten the time you are sick by one or two days. They can also prevent serious flu complications like pneumonia. Most people who are otherwise healthy and get the flu do not need to be treated with antiviral drugs. Treatments for mild cases include staying at home and resting, avoiding close contact with others, and drinking plenty of wa-ter and clear liquids to prevent dehydration. Most people who get the flu will recover in less than two weeks, usually in a few days. (www.cdc.gov).
Tips to Avoid the Flu

  • To protect against the flu get a yearly flu vaccine
  • Stay away from people who are sick
  • Cover coughs and sneezes with a tissue. Throw the tissue in the trash after use
  • Avoid touching your eyes, nose, and mouth
  • Wash hands often with soap and water or use hand-sanitizer if soap and water is not available
  • Drink fluids (water, juice, soup) to keep hydrated
  • Get plenty of rest
  • If your child has a fever keep him/her home until he/she has been fever-free for 24 hours without the use of fever reducing medication
  • Clean and disinfect surfaces and objects that may be contaminated with germs

More information is available at:

  • www.mass.gov/flu
  • www.cdc.gov/flu
  • www.immunize.org

Frostbite

Frostbite is a potential winter weather health hazard. According to the National Weather Service, each year there are dozens of people in the U.S. who suffer severe compromise to their health from exposure to the cold. Frostbite is an injury caused by freezing of the skin and underlying tissues. At first the skin becomes very cold and red, then numb, then hard and pale. Frostbite is most common on the fingers, toes, ears, cheeks and nose. Exposed skin in very cold, windy weather is the most vulnerable, but frostbite can also occur on skin covered by clothing. Frostbite can occur in a matter of minutes.

Frostnip is the first stage of frostbite. It can be treated with first aid and does not cause permanent damage. Mild frostbite can be treated with first aid. All other forms require medical attention due to the damage it can cause to skin, tissues, muscles and bones.

Possible complications of severe frostbite include infection and nerve damage.

The diagnosis of frostbite is usually made based on your signs and symptoms, the appearance of your skin, and a review of recent activities in which you were exposed to the cold.

Signs and Symptoms of Frostbite:

  • Cold skin, prickling feeling
  • Numbness
  • Red, white bluish-white or gray skin
  • Hard or waxy looking skin
  • Clumsiness due to joint and muscle stiffness
  • Blistering of skin after rewarming, in severe cases

Stages of frostbite:

  • Frostnip is the first stage of frostbite. With this mild form, your skin is pale or turns red and feels very cold. As your skin warms you may feel pain and/or tingling to the area. Frostnip does not cause per-manent damage.
  • Superficial Frostbite is the second stage. It appears as reddened skin that turns pale or white. The skin may remain soft. Your skin may begin to feel warm – a sign of serious skin involvement. If you re-warm the skin at this stage, it may appear mottled blue or purple. You may notice a stinging or burn-ing sensation. The skin may swell. A fluid filled blister may form 24 – 36 hours after rewarming. Do not break the blister. Allow blisters to break on their own.
  • Severe Frostbite: As frostbite progresses, it affects all layers of the skin, which includes all the tissues that lie below the exposed area. You may experience numbness, pain or discomfort. Joints and mus-cles may no longer work. Blisters usually form 24 – 48 hours after rewarming the area. Afterwards the area turns black and hard as the tissue dies.
  • Always seek medical attention for signs and symptoms of Superficial or Severe Frostbite

Tips to keep you safe:

  • Try to avoid being outside for long periods of time during very cold weather
  • Dress warmly in light layers. Wear a hat or headband that fully covers your ears. Cover your mouth to protect your lungs, and wear mittens instead of gloves. Wear socks and sock liners.
  • Recognize frostbite symptoms: a loss of feeling, or white or pale-looking toes, fingers, ear lobes or the tip of the nose.
  • If you are outside, warm frostbitten hands under your armpits.
  • Get inside to a warm area and remove wet clothing.
  • Gently rewarm frostbitten areas by soaking hands or feet in warm water for 15 – 30 minutes. Water should be warm but not hot. Do Not use direct heat such as a stove, fireplace or heating pad, since these can cause burns to your skin.
  • Don’t walk on frostbitten feet or toes. This further damages the tissue.
  • If the skin turns red and you feel tingling and burning as it warms, normal blood flow is returning.
  • Seek medical attention if the numbness or pain remains during warming or if blisters develop. Do not break blisters that may develop. Allow blisters to break on their own.
  • Protect the affected area (s) of skin from further cold exposure.
  • When traveling during the cold weather, carry emergency supplies and warm clothing in case you become stranded.
  • Keep moving – exercise can get the blood flowing and help you stay warm.

February is Heart Healthy Month

Healthy Heart Healthy You CartoonHeart disease is also known as cardiovascular disease. A heart attack happens when arteries become blocked and prevents oxygen and nutrients from getting to the heart.

It is never too early to start taking care of your heart. Young people can start doing small things every day that can keep your body and heart healthy and live a long happy healthy life.

The American heart association has out lined “Life's Simple 7” to help people of all ages keep their heart healthy.

  1. Avoid smoking and using tobacco products
    If your friends ask you to try smoking, smokeless tobacco or electronic cigarettes, say no! Using any tobacco can cause dam-age to your heart.
  2. Be physically active every day
    Making physical activity a part of your everyday life is also a good way to help achieve and maintain a healthy heart and life style.
  3. Eat a heart-healthy diet
    Eating healthy foods is one of the most important ways to keep your heart working at its best.
  4. Keep a healthy weight
    Being overweight is dangerous for your health. It can lead to serious health problems like, heart disease.
  5. Keep your blood pressure healthy
    Blood pressure is a measure of how easy or difficult it is for blood to be pumped by your heart through your body. Having a high blood pressure can cause damage to your heart.
  6. Keep your total cholesterol healthy
    Too much cholesterol in your blood is not good for your heart.
  7. Keep your blood sugar healthy If your blood sugar goes high too often, it can overwork the body’s ability to keep your blood sugar in healthy ranges.

It all begins with making the decision to follow Life’s Simple 7 steps!

Making small changes in our everyday life can make a difference. Heart disease is the number one killer and women, causing 1 in 3 deaths each year. Heart disease is not prejudice though, Men as well as children can also be affected. Incorporating “Life Simple 7” can help your everyday life the begin to prevent heart dis-ease. Always remember to visit your doctor yearly for your full checkup.

Visit These Great Websites for Fun and Helpful Health Information

  • Heart.org/Healthier Kids The American Heart Association is working to help kids and families live heart-healthy lives. Visit our website for great resources and to learn how you can help your child develop healthy habits early
  • KidsHealth.org KidsHealth is the largest and most-visited site on the Web that provides doctor-approved health information from before birth through adolescence. Created by The Nemours Foundation’s Center for Children’s Health Media, KidsHealth provides families with accurate, up-to-date and jargon-free health information. The site includes games and activities for kids as well as advice for teens.
  • http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids

Carbon Monoxide Poisoning

Silence isn’t always golden, especially when it comes to carbon monoxide (CO) poisoning. CO is an odorless, colorless gas that can cause sudden illness and death. When power outages occur after severe weather, such as winter storms, using alternative sources of power can cause CO to build-up in a home and poison the people and animals inside. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. High levels of CO inhalation can cause loss of consciousness and death.

There are steps you can take to help protect yourself and your household from CO poisoning. Have a CO detector in your home. Change the batteries in your CO detector every six months. If you don’t have a battery-powered or battery back-up CO detector, buy one soon.

CO is found in fumes produced by portable generators, stoves, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO.

Key Facts

  • Every year, at least 430 people die in the U.S. from accidental CO poisoning.
  • Approximately 50,000 people in the U.S. visit the emergency department each year due to accidental CO poisoning.
  • Red blood cells pick up CO quicker than they pick up oxygen.
  • When you inhale CO, your body replaces the oxygen in blood with CO.
  • People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms.

CO Poisoning Prevention Tips

  • Never use a gas range or oven to heat a home.
  • Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.
  • Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed struc-ture, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.
  • Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine less than 20 feet from an open window, door, or vent where exhaust can vent into an enclosed area.
  • Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.
  • If conditions are too hot or too cold, seek shelter with friends or at a community shelter.

Information from cdc.gov - https://www.cdc.gov/dotw/carbonmonoxide/index.html

Good Old Playtime

Remember going out to play as a child, fresh air, playing with friends, having adventures, riding bicycles, and just enjoying play time? As a child, play was the norm. We had no idea that there was really any benefit to play except to enjoy ourselves. As parents of children, we send our children out for exercise, fresh air, and to “go play”. I found a wonderful article called, “The Benefits of Play”, by Marie Hartwell-Walker, Ed.D. that I thought was extremely beneficial in a world where time spent “playing” on IPhones, IPads, and electronic devices has in some cases taken the place of time spent just playing. As Marie Hartwell-Walker, Ed.D states, “Finding time to play with kids can be a challenge if you are working, managing a household and meeting the many day-to-day challenges of getting things done but, play isn’t optional. It’s essential.”

Play is considered so important to child development that it has been recognized by the United Nations High Commission for Human Rights as a right of every child. Play — or free, unstructured time in the case of older children and adolescents — is essential to the cognitive, physical, social, and emotional well-being of children and youth. Play as a family weaves the ties of love and connection that bind family members together.

  • Play is needed for healthy brain development. 75 percent of the brain develops after a baby is born, in the years between birth and the early 20s. Childhood play stimulates the brain to make connections between nerve cells. This is what helps a child develop both gross motor skills (walking, running, jumping, and coordi-nation) and fine motor skills (writing, manipulating small tools, detailed hand work). Play during the teen years and into adulthood helps the brain develop even more connectivity, especially in the frontal lobe which is the center for planning and making good decisions.
  • Pretend play stimulates your child’s imagination and creativity. Studies have shown that children who are encouraged to use their imagination are more creative in their adult life. It’s the ability to “make believe” that can take people’s minds to places where no one has gone before.
  • Play develops the brain’s executive function. Executive function refers to the mental skills that allow us to manage time and attention, to plan and organize, to remember details, and to decide what is and isn’t ap-propriate to say and do in a given situation. It’s also what helps growing children learn to master their emo-tions and to use past experiences to understand what to do in the present. These are the skills that are cen-tral to self-control and self-discipline. Children who have a well-developed executive function do well in school, get along well with others, and make good decisions. Make believe play gives the frontal lobe of the brain, the center of executive function, a workout.
  • Play develops a child’s “theory of mind.”“ Theory of mind” is the ability to walk in another’s shoes. Chil-dren who play lots of “let’s pretend” learn to figure out what their various characters would think about and do. Engaging in pretend games with others requires understanding playmates’ thoughts and feelings. A well-developed theory of mind increases a child’s tolerance and compassion for other people and increases their ability to play and work well with others.
    Physical skills, emotional regulation, flexible thinking, the ability for children to get along with others and the confidence to try new things and think outside the box are all important to being successful in life. So what can parents do to ensure their children develop these important skills?
  • Encourage free play. Yes, it’s important to provide children with experiences that teach them new skills and how to work and play in a team. Whether a child participates in soccer, the orchestra, a dance team or any other organized activity; he/she will learn how to cooperate with a group goal and will develop physically and mentally.

It’s equally important not to get so caught up in providing so many structured activities that our children don’t have time to just hang out with other children and figure out for themselves what to do with their time. Children who are too involved in organized sports, classes and activities can end up not knowing how to entertain themselves. Children who are kept occupied every minute don’t have the time to flex their imagination muscles.

Further, when the adults provide all the ideas for leisure time and set all the rules, children are deprived of learning important social skills. Free play gives children the chance to learn to work with others and to make compromises. After all, a child can’t pretend to be a superhero without people to save. He/she can’t learn to take turns if there isn’t another child who wants to be the hero too. If he/she wants other people to play with, he/she has to learn how to go along with others’ ideas and to get along with the group.

  • Think before you buy. Free play comes for free. Resist the temptation to buy the latest video game, con-struction toy or costumes. Children who don’t have ready-made props for their play learn to improvise. Boxes and sofa cushions can become a fort. A superhero cape can be made out of a pillowcase. Dollhouse furniture can be created out of bottle caps and odds and ends from around the house.
  • Play with your kids. Play helps connect family members. When everyone in the family is occupied with their own personal screen for entertainment, they don’t form the bonds with each other that come from en-joying time together. When everyone in the family spends some playtime laughing, giggling, and enjoying some spontaneous play, everyone feels good about themselves and everyone else.

Parents who let their children direct the playtime learn much about their world. They can also provide some gentle guidance about positive behavior and problem-solving, if necessary, as the pretend game un-folds. Board games help older children learn how to take turns, follow rules and be both polite winners and gracious losers. Time around the game board promotes conversation and cooperation — and maybe some friendly competition. Best of all, when families play together, they tend to be more supportive of each other and more interested in each other’s lives.

Therefore, limit the screen time use for an hour or two after dinner and a few times a week. Find that “Chutes and Ladders” game or that deck of cards that’s at the bottom of the toy box. Throw a sheet over the table to make a cozy tent. Hand out paper plates and challenge everyone to make an outrageous hat. Play hide and seek and charades and most of all have fun!

Influenza

The Centers for Disease Control (CDC) is recommending that schools again offer Seasonal Influenza (flu) vaccinations to school aged children for the 2018-2019 school year.


During the 2017-2018 influenza season, the United States had record breaking levels of influenza illness.  Hospitalizations were of high severity in all age groups and geographically widespread for an extended period.  The flu vaccine helps your body to protect itself against the flu. Getting flu vaccine will not give you the flu or any other type of illness. Getting vaccine is the best way to protect against flu. https://www.mass.gov/service-details/flu-information-for-the-general-public

The Braintree Health Department will be offering students in middle and high school an opportunity to obtain the Flu vaccine in school on Nov 7, 2018 at both middle schools and Nov 14, 2018 at the high school.

Students need to have a completed vaccine consent/insurance form and screening form completed and returned to the school nurse by Friday November 2 in order to participate in the clinic.  

Forms can be found online or obtained at your child’s school health office.

If you have health insurance be sure to complete that information on the consent/insurance form.  Everyone with a form will receive the vaccine regardless of insurance. 

Students will be given a form stating they received the vaccine at the clinic.  Be sure to check in with your child for the form on Nov 7, 2018 or Nov 14, 2018.

We will only be able to vaccinate students who have returned the consent/insurance form.

Action Needed

  • No Vaccine: no Action Needed
     
  • Yes Vaccine:
  1. Read Vaccine Information Sheet
  2. Fill out consent/insurance and screening forms
  3. Return both forms to student’s school nurse no later than Friday November 2, 2018
  4. Ask student for form documenting vaccine was given November 7 or 14 after school.

If you have questions please feel free to contact your student’s school nurse.

Thank you
Jean Afzali MEd, BSN, RN, NCSN
Director of Nursing Services


2018-2019 Flu Vaccine Consent/Insurance Form

Influenza (Flu) Vaccine Information Statement

Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination

Massachusetts Immunization Information System Fact Sheet

Lice

 Surprised Smiley Face with Magnifying GlassHow to Avoid A "Hair Raising Experience"
Head lice often occurs in school aged children. While inconvenient, head lice do not cause medical harm and can be effectively treated.

Some things to know about head lice:

  • Head lice are not a sign of uncleanliness! They love clean hair.
  • Lice do not hop, jump, or fly. They crawl quickly, and the only way they can get from one person to another is through direct head to head contact.
  • Lice are not passed on pets. They need human blood to survive.
  • Schools are not the most common place where head lice are spread. Sleepovers are thought to be the most common way lice are passed from home to home.
  • School-wide head checks are not recommended by the American Academy of Pediatrics. The most effective screening occurs when parents frequently check their own children at home! (If help is needed to identify what you are seeing, please contact your school nurse).

The lifecycle of head lice:

Once a pregnant female or a male and female louse take residence in a head of hair, the reproduction process begins. A female lays about 6-10 eggs per day. The eggs can hatch anywhere from 3-10 days later. Once the egg hatches, the louse enters the nymph stage and cannot reproduce. It takes another 7-21 days for the nymph to grow into a mature adult that can reproduce.

Children usually have had head lice for about six weeks prior to initial diagnosis. It takes that amount of time for the child to develop sensitivity to the saliva of the louse that results in characteristic itchiness.

What do head lice look like?

Live lice are tiny black/brown insects that are similar in size to a sesame seed. Nits, which are eggs of the lice, are whitish, grey and stick to the hair shaft. They are not easily removed, like dandruff.

Signs of head lice:

Frequent head scratching, particularly at the top of the head and nape of the neck, and skin irritation or red bite marks around the ears and the nape of the neck.

What parents can do:

Check your child’s head weekly all year long. Call the school nurse if you suspect your child has lice. Call your physician to see what product he/she recommends for treatment.

Follow treatment directions exactly according to manufacturer’s instructions. For all over the counter treatment products, retreatment must be carried out again in 7-10 days. Use a lice comb to detect and remove lice and nits daily until all nits are removed. To kill lice on bedding, clothes, etc., wash and dry them as you would ordinarily. NEVER add any pesticide. Vacuum materials that cannot be washed. If you are concerned about head lice on carpets or furniture, vacuum them thoroughly or wipe smooth surfaces with a damp cloth. Place items that cannot be washed or dried, such as stuffed animals, in a tightly sealed plastic trash bag for 10 days. To kill lice on brushes, combs, or hair accessories, wash them with hot, soapy water.

For additional Information:

Life Threatening Food Allergies

MRSA

Questions and Answers About Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA is sometimes said as a single word, “mersa,” or by saying all four letters, “M-R-S-A”

What is MRSA?MRSA is a kind of bacteria that is resistant to some kinds of antibiotics. To understand MRSA it is helpful to learn about Staphylococcus aureus bacteria, often called “staph,” because MRSA is a kind of staph.

What are staph?Staph are bacteria commonly carried on the skin or in the nose of healthy people. About 25-30% of the U.S. population carry staph on their bodies at any time.

Do staph always make people sick?No. Many people carry staph in their nose or on their skin for a period of time and do not know they are carrying them. They do not have skin infections. They do not have any other signs or symptoms of illness. This is called “colonization.”

Sometimes, though, staph can cause an infection, especially pimples, boils and other problems with the skin. These infections often contain pus, and may feel itchy and warm. Occasionally, staph cause more serious infections.

How are staph spread?Staph are spread by direct skin-to-skin contact, such as shaking hands, wrestling, or other direct contact with the skin of another person. Staph are also spread by contact with items that have been touched by people with staph, like towels shared after bathing and drying off, or shared athletic equipment in the gym or on the field.

Staph infections start when staph get into a cut, scrape or other break in the skin. People who have skin infections—painful, swollen pimples, boils, and rashes, for example—should be very careful to avoid spreading their infection to others.

Is MRSA different from other staph?Yes. MRSA is different from other staph because it cannot be treated with some antibiotics. When antibiotics are needed to treat a MRSA infection, the right antibiotic must be used. If the right antibiotic is not used, the treatment may not work.

MRSA is just like other staph in almost every other way:

  • MRSA can be carried on the skin or in the nose of healthy people, and usually not cause an infection or make them sick.
  • It can cause minor skin infections that go away without any special medical treatment.
  • It is spread the same way as other staph.
  • The symptoms are the same as other staph infections.

What are the symptoms of an infection caused by staph?Pimples, rashes, pus-filled boils, especially when warm, painful, red or swollen, can mean that you have a staph or MRSA skin infection.

Occasionally, staph can also cause more serious problems such as surgical wound infections, bloodstream infections and pneumonia. The symptoms could include high fever, swelling, heat and pain around a wound, headache, fatigue and others.

What should I do if I think I have a staph skin infection?Keep the area clean and dry. See your doctor, especially if the infection is large, painful, warm to the touch, or does not heal by itself.

How will my doctor know if I have a MRSA infection?The only way to tell the difference between MRSA and other staph infections is with lab tests. Lab tests will also help your doctor decide which antibiotic should be used for treatment, if antibiotic treatment is necessary.

Your doctor will usually take a sample on a swab (like a Q-tip) from the infected area. The
sample will be sent to a laboratory to see if the infection is caused by staph. Blood and other
body fluids can also be tested for staph.

How are MRSA infections treated?Most MRSA skin infections are treated by good wound and skin care: keeping the area clean and dry, washing your hands after caring for the area, carefully disposing of any bandages, and allowing your body to heal.

Sometimes treatment requires the use of antibiotics. Lab tests help your doctor decide which antibiotic should be used for treatment, if antibiotic treatment is necessary. If antibiotics are prescribed, it is important to use the medication as directed unless your doctor tells you to stop. If the infection has not improved within a few days after seeing your doctor, contact your doctor again.

How can I prevent a staph infection?

  • Regular handwashing is the best way to prevent getting and spreading staph, including MRSA. Keep your hands clean by washing them frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after direct contact with another person’s skin.
  • Keep cuts and scrapes clean and covered with a bandage until they have healed.
  • Avoid contact with other people’s wounds or bandages.
  • Avoid sharing personal items such as towels, washcloths, toothbrushes and razors. Sharing these items may transfer staph from one person to another.
  • Keep your skin healthy, and avoid getting dry, cracked skin, especially during the winter. Healthy skin helps to keep the staph on the surface of your skin from causing an infection underneath your skin.
  • Contact your doctor if you have a skin infection that does not improve.

For more information about MRSA, visit the MDPH website at www.mass.gov/dph

Source: MA Department of Public Health PDF

Health Concerns

EEE

What is Eastern Equine Encephalitis?Eastern equine encephalitis (EEE) is a rare but serious disease caused by a virus.
How is the EEE virus spread?The virus that causes EEE is spread through the bite of an infected mosquito. In Massachusetts, the virus is most often identified in mosquitoes found in and around freshwater, hardwood swamps. More information about different types of mosquitoes that can spread the virus can be found on the MDPH website at www.mass.gov/dph/.

EEE virus particularly infects birds, often with no evidence of illness in the bird. Mosquitoes become infected when they bite infected birds. Although humans and several other types of mammals, particularly horses and llamas, can become infected, they do not spread disease.

How common is EEE in Massachusetts?EEE is a very rare disease. Since the virus was first identified in Massachusetts in 1938, fewer than 100 cases have occurred. Over 60% of those cases have been from Plymouth and Norfolk counties.

Outbreaks of EEE usually occur in Massachusetts every 10-20 years. These outbreaks will typically last two to three years. The most recent outbreak of EEE in Massachusetts began in 2004 and included 13 cases with six fatalities through 2006.

What are the symptoms of EEE?The first symptoms of EEE are fever (often 103º to106ºF), stiff neck, headache, and lack of energy. These symptoms show up three to ten days after a bite from an infected mosquito. Inflammation and swelling of the brain, called encephalitis, is the most dangerous and frequent serious complication. The disease gets worse quickly and some patients may go into coma within a week.

What is the treatment for EEE?There is no treatment for EEE. In Massachusetts, about half of the people identified with EEE died from the infection. People who survive this disease will often be permanently disabled. Few people recover completely.

What can you do to protect yourself from EEE?Since the virus that causes EEE is spread by mosquitoes, here are some things you can do to reduce your chances of being bitten:

  • Schedule outdoor events to avoid the hours between dusk and dawn, when mosquitoes are most active.
  • When you are outdoors, wear long pants, a long-sleeved shirt and socks. This may be difficult to do when the weather is hot, but it will help keep mosquitoes away from your skin.
  • Use a repellent with DEET (N, N-diethyl-m-toluamide), permethrin, picaridin (KBR 3023), or oil of lemon eucalyptus [p-methane 3, 8-diol (PMD)] according to the instructions given on the product label. DEET products should not be used on infants under two months of age and should be used in concentrations of 30% or less on older children. Oil of lemon eucalyptus should not be used on children under three years of age. Permethrin products are intended for use on items such as clothing, shoes, bed nets and camping gear and should not be applied to skin. 
  • Keep mosquitoes out of your house by repairing any holes in your screens and making sure they are tightly attached to all your doors and windows.
  • Remove areas of standing water around your home. Here are some suggestions:
    • Look around outside your house for containers and other things that might collect water and turn them over, regularly empty them, or dispose of them.
    • Drill holes in the bottom of recycling containers that are left outdoors so that water can drain out. 
    • Clean clogged roof gutters; remove leaves and debris that may prevent drainage of rainwater.
    • Turn over plastic wading pools and wheelbarrows when not in use.
    • Change the water in birdbaths every few days; aerate ornamental ponds or stock them with fish.
    • Keep swimming pools clean and properly chlorinated; remove standing water from pool covers.
    • Use landscaping to eliminate standing water that collects on your property.

Did you know?

Mosquitoes can begin to multiply in any puddle or standing water that lasts for more than four days!  Mosquito breeding sites can be anywhere. Take action to reduce the number of mosquitoes around your home and neighborhood. Organize a neighborhood clean up day to pick up containers from vacant lots and parks and to encourage people to keep their yards free of standing water. Mosquitoes don't care about fences, so it's important to remove areas of standing water throughout the neighborhood.

Need more information?

  • EEE and personal protection: MDPH, Division of Epidemiology and Immunization at 617-983-6800 or online at www.mass.gov/dph. You may also contact your local board of health (listed in the telephone directory under “government”).
  • Mosquito control in your city or town: Mosquito control in Massachusetts is conducted through nine mosquito control districts. The State Reclamation and Mosquito Control Board (SRMCB) oversees all nine districts. Contact information for each district can be found online at www.mass.gov/agr/mosquito/districts.htm. You may also contact the SRMCB within the Massachusetts Department of Agricultural Resources at 617-626-1777 or your local board of health. 
  • Health effects of pesticides: MDPH, Center for Environmental Health at 617-624-5757

Source: Eastern Equine Encephalitis Public Health Fact Sheet, April 2007 PDF

West Nile Virus

What is West Nile Virus (WNV)?West Nile virus (WNV) is a mosquito-carried virus that can cause illness ranging from a mild fever to more serious disease like encephalitis or meningitis. It was first identified in the United States in 1999.

How is WNV spread?WNV is most commonly spread to people through the bite of an infected mosquito. 

WNV may also be spread through blood transfusion or organ transplant. In addition, there are rare reports of WNV being passed from pregnant or breastfeeding women, who are infected with WNV, to their babies. Since these reports are rare, the health effects on an unborn or breastfeeding baby are unclear and still being studied.

People do not become infected by having direct contact with other infected people, birds or animals.

Why does my health department want me to report dead birds?When WNV infects birds, it can cause high mortality (death) in certain species, including crows, blue jays and robins. Collecting information about the location of these types of dead birds can help identify areas where WNV may be active in Massachusetts. If you would like to report a dead bird in your area, call the MDPH Public Health Information Line at 866-MASS-WNV (866-627-7968). MDPH generally collects this information from May through September.

What are the symptoms of WNV?The majority of people who are infected with WNV (approximately 80%) will have no symptoms.

A smaller number of people who become infected (~ 20%) will have symptoms such as fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands. They may also develop a skin rash on the chest, stomach and back.

Less than 1% of people infected with WNV will develop severe illness, including encephalitis or meningitis. The symptoms of severe illness can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. Persons older than 50 years of age have a higher risk of developing severe illness.

How common is WNV in Massachusetts?Because most people who are exposed to WNV have no symptoms, it is difficult to know exactly how many people have been infected. People who develop severe illness with WNV are most often reported. Between 2000 and 2006, 54 people were reported with WNV infection in Massachusetts. Six of these people died. Cases have been identified from around the state.

Is there any treatment for WNV?There is no specific treatment for WNV infections. People with mild WNV infections usually recover on their own.

People with severe WNV infections almost always require hospitalization. Their symptoms may last several weeks and neurological effects may be permanent. Approximately 10% of people who develop severe illness will die from the infection.

What can you do to protect yourself from WNV?Since WNV is most commonly spread by mosquitoes, here are some things you can do to reduce your chances of being bitten:

  • Schedule outdoor events to avoid the hours between dusk and dawn, when mosquitoes are most active.
  • When you are outdoors, wear long pants, a long-sleeved shirt and socks. This may be difficult to do when the weather is hot, but it will help keep mosquitoes away from your skin.
  • Use a repellent with DEET (N, N-diethyl-m-toluamide), permethrin, picaridin (KBR 3023), or oil of lemon eucalyptus [p-methane 3, 8-diol (PMD)] according to the instructions on the product label. DEET products should not be used on infants under two months of age and should be used in concentrations of 30% or less on older children. Oil of lemon eucalyptus should not be used on children under three years of age. Permethrin products are intended for use on items such as clothing, shoes, bed nets and camping gear and should not be applied to skin. More information on choosing and using repellents safely is included in the MDPH Fact Sheet on Mosquito Repellents which can be viewed online at www.mass.gov/dph/cdc/factsheets/factsheets.htm. If you can’t go online, contact the MDPH at (617) 983-6800 for a hard copy.
  • Keep mosquitoes out of your house by repairing any holes in your screens and making sure they are tightly attached to all your doors and windows.
  • Remove areas of standing water around your home. Here are some suggestions:
    • Look around outside your house for containers and other things that might collect water and turn them over, regularly empty them, or dispose of them.
    • Drill holes in the bottom of recycling containers that are left outdoors so that water can drain out.
    • Clean clogged roof gutters; remove leaves and debris that may prevent drainage of rainwater.
    • Turn over plastic wading pools and wheelbarrows when not in use.
    • Change the water in birdbaths every few days; aerate ornamental ponds or stock them with fish.
    • Keep swimming pools clean and properly chlorinated; remove standing water from pool covers.
    • Use landscaping to eliminate standing water that collects on your property.

Did you know?Mosquitoes can begin to multiply in any puddle or standing water that lasts for more than four days! Mosquito breeding sites can be anywhere. Take action to reduce the number of mosquitoes around your home and neighborhood. Organize a neighborhood clean up day to pick up containers from vacant lots and parks and to encourage people to keep their yards free of standing water. Mosquitoes don't care about fences, so it's important to remove areas of standing water throughout the neighborhood.

Need more information?

  • WNV and personal protection: MDPH, Division of Epidemiology and Immunization at 617-983-6800 or online at www.mass.gov/dph/wnv/wnv1.htm. You may also contact your local board of health (listed in the telephone directory under “government”).
  • Mosquito control in your city or town: Mosquito control in Massachusetts is conducted through nine mosquito control districts. The State Reclamation and Mosquito Control Board (SRMCB) oversees all nine districts. Contact information for each district can be found online at www.mass.gov/agr/mosquito/districts.htm. You may also contact the SRMCB within the Massachusetts Department of Agricultural Resources at 617-626-1777 or your local board of health.
  • Health effects of pesticides: MDPH, Center for Environmental Health at 617-624-5757

Source: West Nile Virus Public Health Fact Sheet, May 2007 PDF

Helpful Links