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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 chemical and radiologic 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 mass casualty events, mass evacuations, basic field decontamination, and sheltering procedures and plans. The strategic position of well-prepared nurses within the school environment has significant potential for minimizing the effects of a chemical or radiologic event in school settings and, subsequently, in the community at large.
HISTORY
With heightened awareness of potential vulnerabilities to terrorism after the attacks of September 11, 2001, the threat of relatively accessible sources of radiologic materials (American Academy of Pediatrics, 2003), the ease of obtaining and disseminating chemical materials, and recent industrial accidents causing the release of these materials (Centers for Disease Control and Prevention, 2005), school nurses have a responsibility to participate in planning and implementing responses 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 disaster preparedness for chemical and radiologic events in and around 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 (American Academy of Pediatrics, 2000). Accidents and attacks involving these agents also could occur at or near schools. Approximately 800,000 shipments of hazardous substances travel daily throughout the United States by ground, rail, air, water, and pipeline. These materials frequently are transported over, through, and under areas that are densely populated or populated by schools, where the consequences of an acute release could result in severe injury or death (Centers for Disease Control and Prevention, 2005). Radionuclides can be stolen and used for the creation of radioactive dispersal devices. Those radioactive materials used in research, medical treatment, and other industry are less secure (American Academy of Pediatrics, 2003) than those in weapons systems and nuclear power plants. Events such as the unsuccessful release of a gas bomb at Disneyland (American Academy of Pediatrics, 2000) and the attack on the school at Belsan, Russia, indicate that terrorist acts may be directed specifically at children. School nurses must be prepared to respond.
RATIONALE
School nurses have easier access to large populations of people than most health professionals. They are, therefore, in positions to monitor unusual signs, recognize patterns of symptom presentation, act to protect against the immediate spread of chemical and radiologic contaminants, and with appropriate training and support, to 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 contamination of a wider population. School nurses are the only professional health care providers in many schools. Some children spend up to 10 hours in school each day.
In addition, children are particularly vulnerable to aerosolized attack or accident and may show signs and symptoms sooner than the general population (American Academy of Pediatrics, 2002). Children exposed to various chemicals, such as nerve agents and organophosphates, may not present with a clinical picture like that observed in adults (Rotenberg & Newmark, 2003). 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 chemical or radiologic event. A well-executed response could dramatically minimize the number of victims and significantly reduce mortality and morbidity in victims of a radiologic or chemical incident.
Role of the School Nurse
School nurses are strategically placed to plan and implement responses to chemical and radiologic events within school environments. There are many skills and roles that school nurses bring to emergency preparedness:
Surveillance and injury 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 and decontamination procedures
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 accident or 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 that employ adequate school nurse coverage and medical disaster planning principles a potential critical resource in a widespread community disaster.
References/ Resources
American Academy of Pediatrics. (2002). The youngest victims: Disaster preparedness to meet children’s needs. Retrieved 3/7/2005, from http://www.aap.org/advocacy/releases/disaster_preparedness.htm
American Academy of Pediatrics, Committee on Environmental Health (2003). Radiation Disasters in Children. Pediatrics, 111(6), 1455-1466.
American Academy of Pediatrics, 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.
Centers for Disease Control and Prevention. (2005). Public health consequences from Hazardous substances acutely released during rail transit - South Carolina, 2005; selected states, 1999-2004. Morbidity and Mortality Weekly Report, 54(03). 64-67.
Rotenberg, J. and Newmark, J. (2003). Nerve agent attacks on children: Diagnosis and management. Pediatrics, 112 (3). 648-658.
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, D.C.: 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 |