School Health Room: Installation, Operation, and Role

1. Installation and operation of a school health room ・The role of the school health center ・Illness and injury at schools in Myanmar ・General emergency care ・How to establish a school health room

2. Installation and operation of a school health room • ⅠThe need for management of school health rooms （The role of the school health center ） • (1) First aid point and a resting place for injured and sick children • (2) Health guidance and health counseling for children with physical and mental health problems • (3) The collection, application, and management of health information • (4) Instrument storage • (5) Implementation of infection and disease prevention • (6) Development of educational materials for the promotion of health education • (7) For gaining an understanding health problems in schools

3. Installation and operation of a school health room • ⅠThe need for management of school health rooms （The role of the school health center ） • (1) first aid point and a resting place for injured and sick children • (2) health guidance and health counseling for children with physical and mental health problems • (3) the collection, application, and management of health information • (4) instrument storage • (5) implementation of infection and disease prevention • (6) development of educational materials for the promotion of health education • (7) for gaining an understanding health problems in schools

4. ・It is difficult to have a health room. 設置 ・It is difficult to employ a teacher having special knowledge and skills regarding health for the health room. 雇用 ・It is difficult to maintain sufficient amounts of medicines and equipments for the health room. 薬品と物品維持 ・A necessary medicines in the health room are bought by the school fund or contributed.予算と寄付 ・The notice board for slogans and posters is insufficient. 掲示板不足 ・A public health center staff in the village executes treatment because there are no doctor, dentist, and pharmacist for a health room.保健所職員の支援 ・The teacher in charge can't be in the health room because he/she has to teach and work for other purpose.責任者の非常駐 Result of study for 9 schools in Yangon, Mandalay, Mawlamyaing （March, ２００８）

5. ⅡTeachers and staff concerned with management of school health rooms Principal Tawnship officer Persons having special knowledge and skills regarding health Improving school health team Nurse（experts from outside the schools） Public health center staff（experts from outside the schools ） Parents（experts from outside the schools） Doctor （experts from outside the schools）

6. ⅢEmergency care guidelines for the person in charge of children’s health in schools Food poisoning (1) Infectious food poisoning ①bacteria-related food poisoning ②virus-related food poisoning (2) Chemical substance food poisoning (3) Natural food poisoning Representative symptoms: diarrhea, stomach ache , nausea, vomiting, and fever It is necessary to seek medical advice immediately, particularly for symptoms such as numbness and bloody or matter excrement.

7. Food poisoning Diarrhea, vomiting Water and certain electrolytes (Na, K, and Cl) are lost Dehydration The indicators of dehydration: signs of skin dehydration “a decrease in skin turgor, sunken eyes,” loss of consciousness, sluggishness, convulsions, ill- temper, cold hands and feet, and cyanosis first aid：supplying sufficient water, electrolytes, and sugar (glucose)

8. Food poisoning （ORS：Oral Rehydration Salt）経口補水塩 ORS is formulated to allow the intestines to absorb maximum quantities of water, certain electrolytes, and glucose in balanced amounts. In children over 6 years of ages and adults, a single measure of ORS (200ml), 500 ml〜1000 ml/day may be sufficient for mild to moderate dehydration diarrhea or vomiting.

9. Food poisoning （ORS：Oral Rehydration Salt）経口補水塩 【Home-made ORS in emergencies 】 1 liter of clean water add a 1/2 level teaspoon of salt (3 g) 8 level teaspoons of sugar (40 g).

10. ⅢEmergency care guidelines for the person in charge of children’s health in schools Heat stroke (1) Heat cramp：This occurs because water and electrolytes are lost from the blood via perspiration and are not replenished. This can result in painful muscle convulsions. (2) Heat exhaustion：This results from a loss of electrolytes from the blood and subsequent circulatory disorder caused by excessive perspiration. Blue skin. Fever (mild-temperature of less than 37℃). (3) Heatstroke：This occurs when heat cannot be emanated from the body surface; consequently, body temperature rises. This may lead to a disruption of the central nervous system regulation of body temperature. Hot, dry skin that is flushed but not sweaty. Fever (temperature of over 39℃).

11. Heat stroke • (1)Prevention • ① Amounts of the activity should adjusted in proportion to the prevailing temperature and humidity. Consume adequate amounts of water. • Ｓupplying ORS：Oral Rehydration Salt • ② People should refrain from activity when their physical condition is poor owing to diarrhea, fever, etc. • ③ Suitable clothing should be worn.

12. Heat stroke • (2) Treatment • ① Observation：Confirm the state of consciousness. Ask the patient his/her name. Judge the state of consciousness by tapping the patient lightly on the shoulder and asking some questions. Confirm respiration, pulse, color of face, and body temperature. Capillary refilling time is used for the judgment of the severity of symptoms of dehydration. 朝日新聞より図を転用

13. Heat stroke • (2) Treatment • ② First aid： A. Rest：Place the patient in an environment where he/she can rest. Remove clothing. Substitute stretchers Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

14. Heat stroke • (2) Treatment • ② First aid： B. Cooling down： Inform the patient to rest in a cool and airy shaded area. • In situations where consciousness is lost, attempt to lower the temperature as soon as possible. When the patient regains consciousness, make him/her comfortable by gently applying cool water to the skin followed by fanning to stimulate sweating, and by placing ice packson the thick blood vessels of the neck, armpits, and groin. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate– medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

15. Heat stroke • (2) Treatment • ② First aid： • C. Water supply： ORS is preferable. Give water only in situations where the patient is clearly consciousness. • In cases of consciousness disorder or nausea, it is important to provide medical treatment as soon as possible. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate– medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

16. ⅢEmergency care guidelines for the person in charge of children’s health in schools First aid of Injury • Excoriation, (2) Incised wounds, (3) Stab wounds ① Observation：In the case of (2) incised wounds and (3) stab wounds, take precautionary measures to ensure that the injured part is immobilized so as to prevent possible damage to nerves or muscles. ② Irrigation： irrigate dirt and blood from the wound in cases of (1) excoriation or (2) incised wounds. Pull out the foreign body and extract blood in cases of (3) stab wounds

17. First aid of Injury • ③ Hemostat：compress and staunch bleeding from the wound with a sanitary gauze or handkerchief. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

18. First aid of Injury • ③ Hemostat：compress and staunch bleeding from the wound with a sanitary gauze or handkerchief. • ④ Disinfection：apply disinfectant and a sticking plaster or sanitary gauze and bind the wound with a bandage or a sling for protection. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

19. First aid of Injury • ③ Hemostat：compress and staunch bleeding from the wound with a sanitary gauze or handkerchief. • ④ Disinfection：apply disinfectant and a sticking plaster or sanitary gauze and bind the wound with a bandage or a sling for protection. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

20. How to fold up a sling Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

21. ⅢEmergency care guidelines for the person in charge of children’s health in schools • (4) First aid of fractures • Once the following signs and symptoms have disappeared, administer first aid for the fracture. • (1) Touching or moving causes severe pain • (2) Severe swelling or transformations • (3) Crooking of the limb in the opposite direction. • (4) The sound that the bone touches • (5) A pale complexion, cold sweat.

22. (4) First aid of fractures • ① Apply a hemostat. • ② If the bone is protruding from the wound, do not irrigate. Apply a thick sanitary gauze and bind the fractured area with a bandage, or a sling if a hemostat has been used. • ③ Splinting with a sling or a cloth for fixation in a non-painful position. • ④ Passive rewarming and administering medical treatment as soon as possible. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate– medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

23. Substitute splint • Cardboard • Cushion • Blanket • Newspaper • Magazine • Pencil • chopsticks • Board • Measure • Umbrella • Bamboo sword (cane) Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate– medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

24. Ⅳ Equipment (how to establish a school health room) • (1)General equipment：desk, chair, bed, washbowl, health education information, etc. • (2) For physical examination/health counseling：stature meter, scales, tape measure, eye chart (Landolt Chart), blood pressure gauge, etc.

25. Ⅳ Equipment • (3) For first aid/implementation of infection and disease prevention：clinical thermometer, scissors, forceps, nail clippers, cotton buds, bottles of water, disinfectant (80% ethanol and 10% povidone-iodine), sanitary gauze, medical tape, bandages, sticking plasters, sanitary napkins, plastic gloves, and penlight.

26. Ⅳ Equipment (4) For protection and transport：blanket, sling, splint, stretcher, etc. (5) Medicine： ORS or sugar and salt, bottles of water, eye lotion, anti-inflammatory analgesic plasters, digestive medicine, antibiotics, analgesics, antihistamines, antibiotic ointment, and adrenocorticotrophic hormone ointment, etc. Figure from：Editorial Supervisor Dr. OSAWA Seiji, “Sugunidekiru oukyuteate–medemirukyukyujiten–”, POPLAR Publishing Co.,Ltd., 1995

27. Ⅳ Equipment • (6) For environmental hygiene inspection: thermometer, hygrometer, illuminance meter, noise level meter, water quality test, etc. • (7) Necessary items for a first-aid carrying case： • Scissors, forceps, nail clippers, cotton buds, sling, bandages, plastic gloves, clinical thermometer, sanitary gauze, splint, sticking plasters, ORS or sugar and salt,(bottles of water), disinfectant, anti-inflammatory analgesic plasters, digestive medicine, analgesics, eye lotion, antihistamines, sanitary napkins, memo pad, ballpoint pen, penlight, and plastic bags.