Medical emergencies can happen in any school at any time. They can be the result of pre-existing health problems, accidents, violence, unintentional actions, natural disasters and toxins. Premature deaths in schools from sudden cardiac arrest, blunt trauma to the chest, gunshot wounds, asthma, head injuries, drug overdose, allergic reactions and heat stroke have been reported.
School leaders and staff deal with these emergencies frequently, but in an often inconsistent manner. Consistency in response can be enhanced by developing an emergency plan to deal with life-threatening medical emergencies and training staff.
The American Association of Pediatrics (AAP) found that 18 percent of all teachers surveyed in elementary and high schools in the Midwest had provided some aspect of emergency care to more than 20 students each academic year. Seventeen percent reported that they had responded to one or more life-threatening student emergencies during their teaching career.
A survey of school nurses in New Mexico revealed that, each year, 67 percent of schools activated the EMS system for a student, and 37 percent of the schools activated the EMS system for an adult.
AAP published a heavily endorsed policy statement on this issue (Pediatrics, Vol. 113 No. 1 January 2004, pp.155-168). The AAP policy statement summarizes essential information about life-threatening emergencies, including details about sudden cardiac arrest, the components of an emergency response plan, the training of school personnel and students to respond to life-threatening emergencies, and the equipment required for the emergency response.
If your planning team is unfamiliar with the document, take a look, and use it to build or audit your medical emergency response plan. Visit AAP for more information and resources at http://pediatrics.aappublications.org.
Recommended elements of a plan:
- Ensure the school officials can communicate effectively with each other and with local EMS personnel
- Develop and practice a coordinated response plan.
- Reduce risk by identifying students with medical conditions and training staff members to prevent and respond to those conditions.
- Make sure staff is trained in CPR and the use of up-to-date first aid equipment.
- Train staff to use automatic external defibrillators for cardiac emergencies.
Medical care program considerations
When developing the guidelines and procedures for providing medical care at your school, be sure to consider the following elements:
- The procedures for responding to burns, cuts, fractures, choking, sudden illness and other incidents should conform to the applicable state medical practice requirements.
- Collect health history and emergency medical information for each student upon enrollment. Parents should be required to sign a consent form authorizing the school to administer first aid and get emergency services for their child. Both the medical history and consent form should be updated annually.
- Nurses and others providing medical care should possess current state credentials. In addition, staff members, such as physical education teachers, who oversee activities where injuries are more likely to occur should be trained in first aid.
- Have sufficient medical equipment and supplies to address urgent care situations. The equipment and supplies should be under the care of the school nurse or other primary health care practitioner.
- Have procedures in place for handling life-threatening situations. This should include arrangements for consultation with emergency care personnel and transportation to higher level care facilities.
- The parents or emergency contacts should be notified of the emergency, and where the child is being taken for treatment. Provisions should be made for the caregiver to accompany the child to the emergency care facility until the parent or legal guardian assumes responsibility for the child.
Finally, all medical incidents should be fully documented. The documentation should include detailed information about the incident, such as where and when it occurred, and those involved, as well as the names of any and all witnesses, and when the parents or legal guardians were notified.
In our increasingly litigious society, doing anything less is irresponsible.
Daniel Mahoney is vice president of risk control for Glatfelter Public Practice, a public entity specialist providing risk management services and insurance products to schools, municipalities, sewer/water authorities and emergency service organizations.