It is the position of the National Association of School Nurses (NASN) that school nurses provide leadership in all phases of emergency preparedness and management and are a vital part of the school team that develops emergency response procedures for the school setting, using an all-hazards approach.
Until recent years, disaster planning in schools encompassed primarily fire and severe weather drills. The concept of school emergency, or crisis, eventually took on an expanded meaning to include all dangerous events that normally can be managed at a local level (Doyle and Loyacono, 2007). Incidents or crises cannot always be controlled and vary in scope, intensity, impact, and location. Furthermore, it has been recognized that a crisis could occur before, during or after school, and each school is unique with its own needs, resources, and assets (Cole, Tyson, Fitzgerald, Hopkins, 2007).
Recognizing that nearly 49.4 million students attend public elementary and secondary schools and an additional 5.8 million students attend private schools on a daily basis (National Council for Education Statistics [NCES], 2010), NASN developed Continuing Nurse Education disaster preparedness training programs and carries the Disaster Preparedness Guidelines for School Nurses in its bookstore. In addition, NASN was instrumental in the delivery of a U.S. Department of Education Webinar on disaster preparedness. On any given day, schools accommodate a significant proportion of a community’s population and have an obligation to be able to care for students and staff, as well as community members, in the event of an emergency. The U.S Department of Homeland Security developed the National Incident Management System/Incident Command System (NIMS/ICS) to provide an operational framework that enables responders from various organizational levels and agencies to work together consistently and comprehensively to plan for, respond to, and recover from incidents (Cole, Tyson, Fitzgerald, Hopkins, 2007).
DESCRIPTION OF ISSUE
School nurses are the link to local public health departments (Fitzpatrick, 2006) and emergency services, and it is imperative that school nurses be familiar with this standardized common language provided through the federal government agencies. They serve as conduits for dissemination of public health information to students and families and liaison with emergency medical services to plan for a potential mass casualty event and provide care for students in the event of emergency illness or injury.
Children spend a large part of their day in schools; therefore, the school district plays an important role during a large-scale crisis. Schools are generally considered safe havens for children, but various types of emergencies can occur within the school walls or beyond, impacting the school and/or surrounding community. Natural disasters and pandemic illness, as well as physical plant or technological hazards, may cause damage in the school ranging from loss of power to major structural damage and result in physical injuries, including loss of life.
Doyle and Loyacono (2007) state that nurses, by virtue of their professional education, are experts in the nursing process (assess, plan, implement, and evaluate), and the steps taken during emergency situations closely parallel the phases of emergency management (prevention/mitigation, preparedness, response, and recovery). The school nurse is in a leadership position to provide continuous integration, coordination, and training of all school and community members as a part of the school’s emergency management plan. The role of the school nurse within the four identified phases of emergency management planning includes the following:
Prevention/ Mitigation: School nurse assistance is appropriate in an on-going assessment to identify hazards from all possible sources and to reduce the potential for an emergency to occur. Examples include establishing and conducting school safety programs, participating in school committees, implementing vaccination programs and educating students and staff about recognizing and reporting suspicious events (Doyle and Loyacono, 2007).
Preparedness: School nurse service on community-wide planning groups is helpful in the facilitation of a rapid, coordinated, effective emergency response within the framework of the Incident Command System. This includes establishing standard emergency response plans and participating in skills, drills and exercises to evaluate the response capabilities of a school, as well as the effectiveness of the plan (e.g., evacuation, shelter-in-place, lock down, intruder). Specifically, the school nurse can be instrumental in identifying unique emergency preparedness needs for children with special needs.
Response: It is critical that the school nurse be knowledgeable about his or her role in the emergency plan. This includes triage, coordination of the first aid response team, and direct hands-on care to victims of the emergency. In addition to providing mental health support to students, the school nurse is an important link to the medical/public health community and to parents (Fitzpatrick, 2006).
Recovery: After a 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 provides a unique perspective when involved in the evaluation and revision of school emergency plans. Schools may be identified as an emergency shelter resource for the community at large and/or a primary location for the community either to gather to volunteer services or to reunite families.
School nurses are strategically placed within school environments and can identify potential emergencies and assist in planning a comprehensive and coordinated response. 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 emergency management and response (American Academy of Pediatrics [AAP], 2008) and establish their vital role before, during, and after an emergency, addressing the needs of all members of the school community, including children with special health care needs.
Schools must address emergencies that can vary from a single student injured on a playground, possibly sustaining a fall from a height with a suspected head or spinal cord injury, to the mass illness situations seen with the H1N1 pandemic flu. School nurses deal with weather-related emergencies, and the nature of these emergencies often depends on geographic location. They can range from hurricanes, tornadoes, tsunamis and flooding to snow and ice storms. If students are required to be sheltered in school for long periods of time, this creates issues for students with chronic health conditions, including diabetes, asthma, and allergies/anaphylaxis. Dramatic large scale emergencies occur in the school as well as many well publicized violent events, such as school shootings that create serious safety and injury issues. Schools can also be vulnerable to explosions and fires. In addition, schools located near nuclear power plants have their own concerns about potential accidents and emergencies.
The school nurse is a vital school professional who is knowledgeable of the physical and emotional needs of the students served by the school (Fitzpatrick, 2006). It is important for the school team to include a school nurse on its crisis team to optimize positive outcomes in all phases of emergency management. School administrators should ensure that the school nurse pursue professional development, as needed, to address skills related to emergencies with an emphasis on planning, performing triage, providing emergency care and promoting a positive recovery phase for the school and community.
American Academy of Pediatrics (AAP). (2008) Disaster planning for schools. Pediatrics, 122 (4) pp. 895-901. doi:10.1542/peds.2008-2170
Cole, V., Henry, B., Tyson, D., Fitzgerald, R., Hopkins, R. (2007). In the face of danger: Comprehensive emergency preparedness and response for schools. Penn GSE Perspectives on Urban Education, Retrieved from http://urbanedjournal.org/archive/Vol.%205%20Iss.%202%20Order%20in%20Schools/Articles/Article_2_In%20the%20Face%20of%20Danger.html
Doyle, J., & Loyacono, T. (2007). Disaster preparedness guidelines for school nurses. Silver Spring, MD: National Association of School Nurses.
Fitzpatrick, B. (2006). Emergency management, crisis response and the school nurse’s role. In J. Selekman (Ed.) School nursing: A comprehensive text. (pp. 205- 233). Philadelphia: F.A. Davis Company.
National Council for Education Statistics (NCES), US Department of Education, Institute of Education Sciences (2010) Fast facts. Retrieved from http://nces.ed.gov/fastfacts/display.asp?id=372.
Acknowledgement of Authors:
Joan B. Cagginello, MS, BSN, RN
Sandra Clark, ADN, RN
Linda Compton, MS, RN
Catherine Davis, BSN, RN, NCSN
Marilyn Healy, BSN, PNP, RN, NCSN
Susan Hoffmann, MSN, BSN, RN, NCSN
Christine M. Tuck, MS, BSN, RN, NCSN
This document combines and replaces the following Position Statements:
Disaster Preparedness the Role of the School Nurse (Adopted: June 2001; Revised: June 2006)
Bioterrorism Emergency Preparedness and Response, School Nurse Role (Adopted: June 2002;
Revised: June 2005)
Chemical and Radiological Threats, Role of the School Nurse in Emergency Preparedness (Adopted: June 2002; Revised: June 2005)