SUMMARY
It is the position of the National Association of School Nurses that school nurses be included in all phases of disaster preparedness in schools. Further, school nurses need to advocate for their role in disaster planning. "Nurses, by virtue of their professional education, are experts in the nursing process (assess, plan, implement, and evaluate), steps that closely parallel the phases of disaster management (mitigation, planning, response, and recovery)" (Doyle & Loyacono, 2002, p. 3). Finally, the strategic position of the nurse within the school environment represents a vital resource to those planning for comprehensive crisis management for schools.
HISTORY
For years, disaster planning in schools encompassed primarily fire and severe weather drills. In the more recent past, the concept of school emergency, crisis, or disaster has taken on an expanded meaning. Maloney, Fitzgerald, Elam, and Doyle (2000) define a disaster as "any incident that results in multiple human casualties or disruption of essential public health services or any incident that requires an increased level of response beyond the routine operating procedures, including increased personnel, equipment, or supply requirements."
On any given day, schools take in a significant proportion of a community’s population, and accordingly have an obligation to be able to care for students, staff, and sometimes community members in the event of an emergency. School nurses provide a unique and necessary perspective relative to the successful creation and implementation of disaster preparedness plans for schools.
DESCRIPTION OF ISSUE
Disasters can occur within the school walls or beyond. Both types of disasters can impact the schools. Natural disasters include earthquakes, hurricanes, tornadoes, tsunamis, flooding, volcanic eruptions, severe storms, and serious communicable diseases such as pandemic influenza. Man-made disasters include acts of terrorism, radiation exposure, hazardous materials spills, transportation accidents, fires, and civil disobedience. Disasters may cause damage ranging from loss of power to major structural damage and/or physical injuries, including loss of life. In the event of an emergency, school officials, media, community members, fire, police, health officials, volunteer agencies, and government representatives may converge. Local, state, or community legislation specific to disaster preparedness in schools should be considered when developing plans. Continuous integration, coordination, and training of all school and community members are the keys to the reduction of injury and death in any school/community disaster.
Occasionally, an event may necessitate the school providing for the physical and emotional needs of a given population over an extended period of time. Although school administrators are responsible for implementing all four phases of disaster preparedness, the school nurse can play a crucial role. Examples of school nurse participation in the four phases of disaster management as defined by the Federal Emergency Management Agency (FEMA) can be highlighted as follows:
Mitigation: Before a disaster occurs, the school nurse can assist in preventing the occurrence of the disaster or in identifying actions that will help reduce the effects of the disaster. Examples include establishing and conducting school safety programs; encouraging structural and nonstructural hazard reductions; identifying and promoting security measures; and establishing backup power and communication systems (Doyle & Loyacono, 2002).
Planning: During the planning phase, the school nurse can serve on community-wide teams helping to develop the response capabilities of a school, including creating and revising disaster response plans and participating in exercises, reviews, and drills of these plans (e.g., evacuation, shelter-in-place, universal codes). Specifically, the school nurse can be instrumental in identifying unique emergency preparedness needs for children with special needs.
Response: During the disaster, it is critical the school nurse be knowledgeable about his or her role in the emergency plan. This may include triage, coordination of the first aid response team, and direct hands-on care to victims of the emergency. In addition to counseling students, families, and staff, the school nurse may serve as a key source of information to the school and broader community
Recovery: After the disaster, the school nurse assists with students, parents, and school personnel, providing direct support and being the liaison between community resources and those in need. The school nurse can provide a unique perspective when involved in the evaluation and revision of school emergency plans. The school nurse must also be aware of the effects of the disaster on her or his own personal and professional life. Awareness and actions to address personal effects of the aftermath are critical to the ability to resume the demanding role of school nurse.
RATIONALE
School nurses, strategically placed within school environments, are able to identify potential risks and assess the effectiveness of emergency trainings and practice activities. In particular, school nurses have pertinent knowledge regarding children with special health care needs. Further, school nurses are uniquely situated to recognize patterns indicative of an impending or actual disaster (e.g., food poisoning). As licensed health care professionals, they respond to all serious adverse events that threaten the health, safety, or well-being of a school population.
School nurses, as advocates for school safety, must address new challenges in disaster management and emergency response (Grant, 2002). The school nurse has an important role before, during, and after an emergency.
References/Resources
American Academy of Child and Adolescent Psychiatry. (2004, July). Helping children after a disaster. Retrieved April 1, 2006, from http://www.aacap.org/publications/factsfam/disaster.htm.
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. (1999, October). Emergency preparedness for children with special health care needs. Pediatrics, 104(4), e53. Retrieved April 1, 2006, from www.pediatrics.org/cgi/content/full/104/4/e53.
American Academy of Pediatrics, Committee on School Health. (2001). Guidelines for emergency medical care in school. Pediatrics, 107(2). 435-436.
American Heart Association (AHA). (2004). Scientific Statement. Response to cardiac arrest and selected life-threatening medical emergencies, the medical emergency response plan for school, a statement for healthcare providers, policymakers, school administrators and community leaders. Available online at http://www.nasn.org/Portals/0/statements/jointstatementcardiac.pdf.
American Red Cross. (2002). Homeland security advisory system recommendations. Retrieved April 1, 2006, from http://redcross.org/services/disaster/beprepared/hsas/schools.pdf.
Barrett, J. C. (2001). Teaching teachers about school health emergencies. Journal of School Nursing, 17(6), 316–322.
Doyle, J., & Loyacono, T. (2002). Disaster preparedness guidelines for school nurses. Scarborough, ME: National Association of School Nurses.
Federal Emergency Management Agency. Training course for educators. Retrieved April 1, 2006, from http://www.fema.gov/kids/fematce.htm
Federal Emergency Management Agency. (2005, October). Helping children cope with disaster. Release No. 1603-081. Retrieved April 1, 2006, from http://www.fema.gov/news/newsrelease.fema?id=19698.
Grant, T. W. (2002). Bring your first aid kit: An unannounced mock drill. Journal of School Nursing,18(3), 174–178.
Maloney, P., Fitzgerald, S., Elam, K., & Doyle, J. (2000). Managing school emergencies III. Scarborough, ME: National Association of School Nurses.
National Association of Attorneys General and the National School Boards Association. (2001). Keep schools safe: A collection of resources to help make schools safer. Retrieved April 1, 2006, from http://www.keepschoolssafe.org.
National Association of School Nurses (NASN). (2003). Position statement: Preparing for school emergencies. Available online at http://www.nasn.org/Default.aspx?tabid=238.
National Association of School Nurses (NASN). (2005). Position statement: Role of the school nurse in violence prevention. Available online at http://www.nasn.org/Default.aspx?tabid=254.
National Association of School Nurses (NASN). (2005). Position statement: School nurse role in bioterrorism emergency preparedness and response. Available online at http://www.nasn.org/Default.aspx?tabid=205.
National Association of School Nurses (NASN). (2005). Position statement: School nurse role in emergency preparedness and response to chemical and radiologic threats. Available online at http://www.nasn.org/Default.aspx?tabid=259.
Romig, L. (1995). The JumpSTART rapid pediatric triage system. Available e-mail: LouRomig@aol.com.
U.S. Department of Education, Office of Safe and Drug Free Schools. (2003, May). Practical information on crisis planning: A guide for schools and communities. Washington, DC: Author. Also available on line at http://www.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf.
The School Nurse Role in Emergency Preparedness:
Adopted: June 2001
Revised: June 2006