September 2009 Dear Parents/Carers Welcome back to the start of another school year. We thought we would give you some reassurance over swine flu. As you are aware, the numbers of cases of swine flu dropped considerably over the summer but with the start of the new academic year cases may start increasing again. NHS advice is that the best way to prevent the spread of infection is to remember the “Catch it, Bin it, Kill it”. To sneeze into a tissue, to dispose of the tissue as soon as possible and then to clean your hands. We shall be emphasising this message in schools and hope that you will be able to reinforce it at home. If you think your child or anyone else at home has swine flu, please remember that for most people swine flu will be a mild illness that can be managed by resting, drinking plenty of fluids and taking paracetamol. If you have another health problem or are concerned, ring the national pandemic flu helpline on 0800 1513 513 for information or 0800 1513 100 for treatment. You can also go online at:Helpline staff, or the pandemic flu website, will take you through a series of questions to check that you are suffering from flu and that there are no medical reasons why you should not take the antiviral medication. They will then give you an authorisation code and advise you where to get your antiviral medication as close to possible to where you live. If you need to get Tamiflu do not go yourself if you have symptoms – send a friend or relative who is well. You do not need to contact your GP unless your child is under 1 year old or has an underlying condition or you are concerned. Unlike at the start of the pandemic in the spring, if a student becomes unwell with swine flu schools will not be closed unless there is a shortage of staff. Our current advice is that only pupils with swine flu symptoms (or have other illnesses) need to stay home from school. Those who have been in contact with a sibling with symptoms can still go to school unless they themselves are unwell, but please keep checking the NHS South Gloucestershire website onfor updates on swine flu. For national guidance go to the HPA websitYou can check the South Gloucestershire Council website for updates on individual schools and their policies on Children in clinical “at risk” groups, who normally receive the seasonal flu vaccine, should expect to be offered the new swine flu vaccine in due course. Please keep an eye out for further information about vaccinations. While we appreciate that swine flu is of concern to parents, we want to reassure you that the health authorities are working with South Gloucestershire Council to provide the most effective care and protection for your child. We would like to thank you for supporting the message and the practice of good hand hygiene - this being one of the best methods of protecting yourself and your family. As the leading health organisation in the area we are monitoring the situation closely and should numbers start to rise we will take appropriate steps to protect our communities. To ensure that you have the latest advice and guidance please refer to the websites above in the first instance. Finally, we wish you all the best for the coming term and school year. Dr Chris Payne Therese Gillespie Director of Public Health Director of Children & Young People NHS South Gloucestershire Department South Gloucestershire Council Mark Evans Covering Director Avon, Gloucestershire and Wiltshire Health Protection Unit Health Protection Agency


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One of the primary roles of Emergency Medical Ser-vices is to provide emergency care for life-threatening medical events. This section reviews clinical and system considerations in the EMS care of these time-critical conditions. Altered Mental Status/Altered Level of Consciousness INTRODUCTION patient as possible from the scene. Because the patient often cannot provide an adequate history, fi

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