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HISTORY:
Ensuring that the school environment is responsive to the health and emergency needs of students is essential to creating a safe setting for learning in schools (CDC, 2001; Marx & Wooley, 1998; National Governors’ Association, 2000). The school environment is where children spend a significant portion of each day (DiScala, Gallagher, & Schneps, 1997). This sets the stage for schools being second only to home as the location where injuries occur in children (Junkins, Knight, Lightfoot, Cazier, Dean & Cornelli, 1999; Miller & Spicer, 1998). Nearly 100 percent of schools provide on-site first aid to students. However, the actual emergency equipment present in schools varies widely.
DESCRIPTION OF ISSUE:
Schools cannot accomplish their academic mission without addressing the health and safety of the students, including emergency response. Yet the definition of emergency in the school setting, where teaching and learning is the focus, differs greatly from an emergency in the acute health care setting. School staff often sees any health issue that interferes with academics as an emergency. There are also a myriad of issues affecting recommendations on how to best prepare schools to safely and effectively respond to potential health emergencies.
Many argue that prevention is the key and that having prevention programs in place at school would diminish the frequency and intensity of emergency treatment interventions needed at school. While this is true, one cannot ignore the fact that injuries can, and do, happen despite our most vigilant attempts to prevent them.
Furthermore, an estimated 15-30 percent of children under the age of 18 in the United States are affected by some chronic illness (e.g., asthma, diabetes, epilepsy). These children are at higher risk for medical emergencies while in school (Broome, Knafle, Feethma & Pridhan, 1998; Lowe & Miller, 1998).
Complicating all of this is the reality that not every school has a school nurse. Realizing that school personnel responsible for responding to the emergency health needs of students may have varied skill and licensure levels impacts any recommendation on emergency equipment and resources for schools.
Reviewing the literature provides limited guidance for recommending minimal essential medical equipment and resources for schools. Relatively few studies in the United States examine the incidence and etiology of injuries, due in part to the lack of a systematic way to collect this information (DiScala et al., 1997; Junkins et al., 1999). Therefore, a national group of experts was convened by the National Association of School Nurses to provide national recommendation. The resulting recommendations addressed emergency supplies and equipment for schools without a nurse present (Table 1) and a second list for schools with a nurse present (Table 2) (Bobo, Hallenbeck, & Robinson, 2003).
RATIONALE:
Due to the varied skill and licensure levels of school personnel responsible for administering first line care and treatment of student emergencies, more than one list of recommendations was warranted: one list of minimal equipment and resources required in schools where a nurse may not be present and one with additional equipment and resources for schools with a nurse on the premises.
One in four children in all settings experience nonfatal injuries serious enough to require medical attention or restrict activity (Children’s Safety Network, 1997; DiScala et al., 1997). Because school is a place where children spend significant portions of each day, it is not only prudent but also an obligation of the school to have the equipment necessary to minimally stabilize a sick or injured student.
Equipment is, of course, merely one aspect of ensuring that the emergency health needs of students are addressed appropriately. Having personnel who are trained to respond to medical emergencies is also necessary.
CONCLUSION:
The National Association of School Nurses supports an established minimal standard to ensure that every student has the same opportunity for effective management and stabilization of likely emergencies at school. Each school nurse has a responsibility to analyze and anticipate the types of equipment and services that should be available to best meet the school’s needs, building on the national recommendations for schools without a school nurse present and those with a school nurse (Bobo et al., 2003). This vital information also will become part of the school-wide emergency plan.
Table 1
Minimal Essential Emergency Equipment and Resources
FOR SCHOOLS WITHOUT A SCHOOL NURSE PRESENT
| Accessible keys to locked supplies |
| Accessible list of phone resources |
| Biohazard waste bags |
| Blunt scissors |
| Clock with a second hand |
| CPR staff on-site when students are on the premises |
| Disposable blankets |
| Emergency cards on all staff |
| Emergency cards on all student |
| Established relationship with local EMS personnel |
| Ice (not cold packs) |
| Individual care plans for students with specialized needs |
| First aid tapes |
| Non-latex gloves |
| One-way resuscitation mask |
| Phone |
| Posters with CPR/Heimleich instructions |
| Refrigerator or cooler |
| Re-sealable plastic bags |
| School-wide plan for emergencies |
| Soap |
| Source of oral glucose (i.e., frosting) |
| Splints |
| Staff that have received basic first aid training |
| Variety of bandages and dressings |
| Water source/normal saline |
From "Recommended minimal emergency equipment and resources for schools: National consensus group report" by N. Bobo,
P. Hallenbeck, & J. Robinson. 2003. Journal of School Nursing, 19(3), 150-154.
Table 2
Additional Minimal Essential Emergency Equipment
and Resources for Schools With a School Nurse Present
| C-spine immobilizer |
Glucose monitoring device*
*Committee acknowledges challenges with maintenance and expense of test strips. Monitoring of machine must also be in compliance with CLIA (Clinical Laboratory Improvement Amendments) |
Medications *
Albuterol
Epinephrine pen
Oxygen
*All medications should be in accordance with state laws, pharmacy, and nurse practice acts |
| Nebulizer |
| Penlight |
| Self-inflating resuscitation device in two sizes (500 ml and 1 liter) with appropriate sized masks to meet needs of population being served |
| Sharps container |
| Stethoscope |
| Suction equipment (minimal source, does not have to be electric, i.e., turkey baster) |
From: "Recommended minimal emergency equipment and resources for schools: National consensus group report" by N.Bobo,
P. Hallenbeck, & J. Robinson, 2003. Journal of School Nursing, 19(3), 150-154.
References/Resources:
Bobo, N., Hallenbeck, P., & Robinson, J. (2003). Recommended minimal emergency equipment and resources for schools: National consensus group report. Journal of School Nursing, 19(3), 150-156.
Broome, M., Knafle, K., Feethma, S., & Pridhan, K. (Eds.). (1998). Children and families in health and illness. Thousand Oaks, CA: Sage.
Centers for Disease Control and Prevention (CDC) (2001). School health guidelines to prevent unintentional injuries and violence. Morbidity and Mortality Weekly Report (MMWR), 50(RR22), 1-46.
Children’s Safety Network (1997). Injuries in the school environment: A resource guide (2nd ed.). Newton, MA: Education Development Center.
DiScala, C., Gallagher, S.S., & Schneps, S.E. (1997). Causes and outcomes of pediatric injuries occurring at school. Journal of School Health, 67, 384-389.
Junkins, E.P., Knight, S., Lightfood, S.C., Cazier, C.F., Deank J.M., & Corneli, H.H. (1999). Epidemiology of school injuries in Utah: A population-based study. Journal of School Health, 69, 409-412.
Lowe, J., & Miller, W. (1998). Students with chronic health problems. Journal of School Nursing, 14(5), 4-16.
Marx. E., & Wooley, S.E. (Eds.) (1998). Health is academic: A guide to coordinated school health programs. New York, NY: Teachers College Press.
Miller , T.R., & Spicer, R.S. (1998). How safe are our schools? American Journal of Public Health, 88, 413-418.
National Governors’ Association (2000). Improving academic performance by meeting student health needs. Washington, DC: Author.
Adopted: November 2003 |