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    • Recognize minor injuries, serious injuries, and life-threatening injuries.
    • Identify signs and symptoms that indicate EMS (emergency medical services) should be contacted.
    • Assess how to respond to an injury.



    It is very important that you take a course in first-aid and cardiopulmonary resuscitation (CPR). This lesson does not replace that course. This lesson only provides a brief introduction to keeping children safe when they are injured.


    Children are natural explorers. Have you ever thought, “That child has no fear!”? You were probably right: Children do not always recognize the danger in situations. They challenge their developing bodies and minds. In school-age programs, we have to be prepared to respond to a range of injuries.  Some injuries will only require cleaning and bandaging. Other injuries require immediate medical attention. You must be able to tell the difference between the two. You must be prepared to respond during any situation. Consider these examples:

    1. As Simone climbs the ladder on the slide, she twists her ankle and falls backward onto the ground. Her left foot is turned at an awkward angle.
    2. Dante and Claire are chasing one another on the paved path through their play area. Dante trips and skins his knee.
    3. Madison and Tristan are playing basketball. Madison stops quickly. Tristan can’t stop in time and runs into Madison. Both children fall. Madison hits his mouth on the gound and loses a tooth.
    4. Luke drops his soccer ball on the way to his dad’s car. It rolls into the parking lot and he dashes to get it.  An oncoming vehicle cannot stop in time to miss him.
    5. Luis brings unidentified pills to your program and shares them with his friends.
    6. Millie is giggling with her friends during lunch. Suddenly she begins to choke. She cannot cough or make any sounds.

    Your program space is designed to minimize risks when accidents occur. For example, properly inspected playground equipment and cushioned fall zones make it unlikely Simone would be seriously injured in a fall from the slide. The safety rules you teach make it less likely children will collide with one another at high speeds. Even in the best situations, though, accidents happen. You must be prepared to act on injuries big and small. Some injuries are small and only require minor first-aid. For example, when Dante skins his knee, the staff member will likely respond by cleaning the wound, applying a bandage, and completing an incident report. Dante is able to continue playing.

    Other injuries are serious but not life threatening. For example, Madison and Simone may need medical treatment for their injuries, but they are not likely to face permanent disability or death.

    Some injuries are life threatening and require immediate medical attention. For example, Luke’s accident with a moving vehicle, ingestion of unknown pills, and Millie’s choking could all result in serious injury or death. As a school-age staff member, you must be able to recognize these situations and respond appropriately.

    You must know what resources are available for helping an injured child. Depending on the severity of the injury, you can:

    • Perform, or find someone who is trained to perform, first-aid or CPR. Training on first-aid and CPR is offered by your employer and community agencies, such as the Red Cross.
    • Call emergency medical services (EMS) or its equivalent in international locations. EMS refers to any emergency responders in your area. These may be firefighters, ambulance companies, or the police. EMS services are reached when you dial 911 in the United States. Outside of the United States, talk to your supervisor, trainer, or coach about how to obtain emergency medical services.


    You must know what to look for when you are deciding how to respond to an injury.

    After you have called EMS, remember to contact the child’s legal guardian.

    If a child has any of the following symptoms, call EMS right away:

    • You believe the child’s life is at risk or there is a risk of permanent injury.
    • The child has difficulty breathing, is having an asthma exacerbation, or is unable to speak.
    • The child’s skin or lips look blue, purple, or gray.
    • The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure).
    • The child is unconscious.
    • The child is less and less responsive.
    • The child has any of the following after a head injury: decrease in level of alertness, confusion, headache, vomiting, irritability, or difficulty walking.
    • The child has increasing or severe pain anywhere.
    • The child has a cut or burn that is large, deep, or won’t stop bleeding.
    • The child is vomiting blood.
    • The child has a severely stiff neck, headache and fever.
    • The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating.
    • Multiple children are affected by injury or serious illness at the same time.
    • When in doubt, call EMS.

    Follow your program’s policies if a child has any of the following symptoms or get medical attention within one hour: 

    • Fever in any age child who looks more than mildly ill
    • A quickly spreading purple or red rash
    • A large volume of blood in the stool
    • A cut that may require stitches
    • Any medical condition specifically outlined in a child’s care plan requiring parental notification


    Prevent injuries: Follow procedures outlined in other lessons in this course. Make sure dangerous and toxic items are out of children's reach.

    Be prepared: Have a well-stocked first-aid kit. Make sure your first-aid and CPR training are always current.

    Respond quickly: Use what you learned in your first-aid courses.

    • Stay calm.
    • Survey the scene. Look around and find out what is wrong. Decide whether it is safe for you to approach. Tell the child you are there to help. Ask questions and examine the child head-to-toe for injuries.
    • Take action. Decide whether injuries are life threatening: Is the child conscious? Is the child breathing? If the child is not breathing, perform CPR as needed. Use what you learned in your first-aid and CPR training to do the procedure correctly. If the injury is not life threatening, check the child head-to-toe. Look for all injuries. Ask the child questions and continue to check breathing and heart rate. Perform any basic first-aid that is needed. Do not move the child unless his or her life is at risk.
    • Make the calls. Decide whether you need to call EMS. Call the child's family.
    • Ride along. Be prepared to ride with the child in the ambulance. Know what documents and contact information you need to bring with you.
    • Document. Report the injury using the forms provided by your workplace.




    It is important to think about what you would do during stressful situations. Print the Responding to Injuries Activity. Read the questions and write your responses. Talk about your answers with a supervisor, coach, or trainer. Then compare your answers to the suggested responses.



    Make sure you are prepared for injuries and other emergencies. Print this form and use it to make sure your first-aid kit is well stocked. This activity acts as a guideline, be sure to check with your program for their specific first-aid kit requirements.




    Which of the following is not a life- threatening situation?


    Which of these situations does not require a call to 911 (or the local emergency number)?


    Which of these statements is true?

    References & Resources

    American Academy Of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education (2011). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at

    American Red Cross.

    Council of Accreditation's After School Program Standards (2010).