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SUMMARY
It is the position of the National Association of School Nurses that school nurses should be designated and recognized as, and given authority to act as, first responders to mass casualty emergencies, including those resulting from bioterrorist events. School nurses should be trained in protection, detection, and treatment of victims in such events and in the command and control management techniques of the logistics of such a situation. In addition, training in the coordination of the response with other community providers is essential to maximize effectiveness of these other trainings. Local Emergency Planning Committees should include school nurses in developing plans for the distribution of the National Pharmaceutical Stockpile at the local level. The strategic position of well-prepared nurses within the school environment has significant potential for minimizing the effects of a biological attack in school settings and, subsequently, in the community at large.
HISTORY
With heightened awareness of potential vulnerabilities to bioterrorism after the attacks of September 11, 2001, the subsequent attacks with anthrax, and the relative ease of disseminating bioterrorist agents with high morbidity and mortality (CDC, 2001), school nurses have a responsibility to participate in planning and implementing a response to such threats to the school community. There are an estimated 57,954 school nurses in the nation’s public and private elementary and secondary schools (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000, p. 59). In addition, school nurses are the only professional health care providers in many schools. School nurses represent a unique and vital resource relative to the successful creation and implementation of bioterrorism preparedness plans for schools.
DESCRIPTION OF ISSUE
There is an increasing threat that chemical and biological weapons will be used on a civilian population in an act of domestic terrorism. Children would be disproportionately affected in such an event. (AAP, 2000). Many biologic agents are inexpensive, easy to obtain, and easy to disseminate and create high morbidity and mortality in a large population. Biologic agents include bacteria, viruses, toxins, and other pathogens (CDC, 2005). Attacks using these agents could occur at or near schools. School nurses must be prepared to respond.
RATIONALE
School nurses are the only professional health care providers in many schools. Some children spend up to 10 hours in school each day. Students, teachers, and staff work in close proximity to other people, increasing the easy spread of airborne and droplet diseases.
School nurses have easier access to large populations of people than most health professionals and are, therefore, in positions to monitor unusual signs, recognize patterns of symptom presentation, act to protect against the spread of communicable diseases, and provide immediate treatment and decontamination for members of the school community.
Additionally, school nurses frequently assess students and staff before students and staff consider themselves ill enough to seek other professional health assistance. School nurses are, therefore, potentially in a position to provide earlier detection of a significant event, thus improving patient outcomes and decreasing the spread of disease.
In addition, children are particularly vulnerable to aerosolized biological attacks and may show signs and symptoms sooner than the general population (AAP, 2002). Proactive and comprehensive training of school nurses in disease surveillance and in emergency preparedness, response, and coordination with broader community resources would provide for early detection, reporting, and response to a bioterrorism event. A well-executed response could dramatically minimize the number of victims and possibly slow the spread of a biological agent in a bioterrorist attack.
Role of the School Nurse
School nurses are strategically placed to plan and implement responses to bioterrorist events within school environments. There are many skills and roles that school nurses bring to emergency preparedness:
Surveillance and disease pattern recognition
Knowledge of exposure patterns related to school attendance and activities.
Ability to assess potential emergency risks
Ability to assess the need for and to institute isolation procedures per state public health law and/ or CDC guidelines
Ability to assess the adequacy of emergency trainings and practice activities
Position on the front line when an emergency occurs and involvement in the response to all serious adverse events that threaten the health, safety, or well-being of a school and its community
Possession of detailed knowledge of the needs of children with special health care needs and the ability to plan for these students’ needs in emergency situations
Ability to assist in the short-term and long-term recovery phase after a traumatic event has occurred
Moreover, when a child becomes sick or arrives at school sick, a school nurse is often first and perhaps the only health care professional to assess, treat, and possibly refer the child to other health care facilities.
In the event of a biological or chemical attack on the United States, school nurses could be among the first health care professionals to recognize the event and respond. School nurses, thus, serve as public health sentinels in such events.
Additionally, schools are usually spread in a geographically even pattern across communities. Most individuals in a community know where the local school is located and live close enough to get to a school building. This makes schools a natural choice for mass distribution of the National Pharmaceutical Stockpile to the public. School nurses with appropriate training/ support are a natural choice to augment public health staff in these mass distribution clinics in response to a bioterrorist event or natural outbreak. Therefore, schools that employ adequate school nurse coverage and medical disaster planning principles are a potential critical resource in both small scale events and widespread community disasters.
References/ Resources
American Academy of Pediatrics (AAP), Committee on Environmental Health and Committee on Infectious Diseases. (2000). Chemical-biological terrorism and its impact on children: A subject review (RE9959). Pediatrics, 105-(3), 662-670.
American Academy of Pediatrics (AAP), (2002, February). The youngest victims: Disaster preparedness to meet children’s needs. Retrieved 3/7/2005, from http://www.aap.org/advocacy/releases/disaster_preparedness.htm.
Centers for Disease Control & Prevention (CDC).(2001). Recognition of illness associated with the intentional release of a biologic agent. Morbidity and Mortality Weekly Report, 50(41).893-7.
Centers for Disease Control & Prevention (CDC). (2005). Emergency preparedness & response/ bioterrorism agent/s-diseases. Retrieved 3/7/2005 from http://www.bt.cdc.gov/agentlist-category.asp
Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2000). The registered nurse population: Findings from the National Sample Survey of Registered Nurses. Washington, DC: U.S. Department of Health and Human Services, Health Resources and Service Administration, Bureau of Health Professions, Division of Nursing.
School Nurse Role in Bioterrorism Emergency Preparedness:
Adopted: June 2002
Revised: June 2005 |