Asthma Action Plan
Your patient has applied for participation in a Cape Eleuthera Island School/ Institute (CEIS) course. They indicated a history of asthma. We request your help in developing a decision sequence protocol in treating your patient.
To participate in the course the student needs:
1. A signed asthma plan
2. Appropriate medication to control an acute exacerbation should it occur
3. An understanding and how and when to use the medication
Most students will be in the mild intermittent and, occasionally, the mild persistent category. The remote location of our courses greatly limits the response time to definitive medical care. Therefore applicants who exhibit more severe symptoms are unlikely candidates for participation.
If nebulizers are required on a daily basis this generally makes a candidate unlikely for participation. If a nebulizer is only used occasionally and only under certain circumstances, participation may be acceptable. Please speak to your patient or their legal parents/ guardian for more information on programme specifics.
CEIS staff will carry epinephrine in their first aid kit, and through WFR or EMT training are certified to administer it. Participants should come with their daily medications and those medications necessary to control an acute exacerbation, but do not need to bring epinephrine. Your completion of this form is required for your patient’s participation in the course.
Please fill out the following information