Published online March 1, 2007
PEDIATRICS
Vol. 119
No. 3
March 2007, pp.
651-652
(doi:10.1542/peds.2006-3335)
Preparing for Asthma-Related Emergencies in Schools
Robert E. Sapien, MD, FAAP
Department of Emergency Medicine
Division of Pediatric Emergency Medicine
University of New Mexico Health Sciences Center
University of New Mexico
Albuquerque, NM 87131
To the Editor.—
Hillemeier et al1 reported in Pediatrics that preparedness for an asthma-related emergency in Pennsylvania schools is suboptimal. Although not cited in the article, similar deficiencies have been identified in New Mexico schools, including the urban and rural school deficiencies.2,3 For example, only 20% of New Mexico school nurses reported having nebulizers on campus, and only 45% reported having peak flow meters. As for asthma management plans, 24% of students with asthma did not have a plan, and of those with a plan, only 51% of the nurses either had had input or were identified in the plans.2 In addition, the New Mexico study surveyed for 2 emergency, life-saving medications for severe asthma exacerbations: oxygen and autoinjectable epinephrine. Although 20% of New Mexico schools have oxygen, rural schools were 16 times more likely than urban schools to have it available. Rural schools were also twice as likely to have autoinjectable epinephrine available (life-saving for asthma exacerbations in extremis and food allergies). Both of these medications are well within the capability of school nurses to administer, are of relative low risk in severe situations, and offer additional benefits to β-agonist administration.
Generally, there are 3 major areas of emergency preparedness in schools: emergency response plans (including emergency medical services [EMS] interaction/involvement), equipment, and training. Emergency medical response plans for schools are of 3 distinct types: (1) all hazards (eg, disaster, acts of terrorism); (2) student-specific individual response plans (eg, asthma, seizure); and (3) response plan for general emergencies (eg, playground injury, principal with chest pain). There are components common to each type of plan, but the plans should indicate the unique aspects of response and roles for the school nurse and others. Hillemeier et al reported that 94% of Pennsylvania schools have an emergency response plan, but the extent or type of plan were not reported. Similarly, 86% of New Mexico school nurses reported an emergency plan, but the type and details varied greatly from simply "call 911" to elaborate, detailed plans. In addition, only 44% of school nurses participated in school disaster plans, and only 11% were involved in community disaster planning. Although EMS activation is an integral part of any school emergency plan and involving EMS during preparation efforts is prudent,4 there was great variation in EMS response time and provider training level in rural versus urban schools.3
Finally, training for school nurses and school staff in school emergency preparedness, including asthma management, is paramount. There are a limited number of emergency training opportunities specific to school nurses including the Emergency Medical Services for Children Programs from Connecticut, Illinois, and New Mexico and the National Association of School Nurses. The most recent is a Web-based, 14-hour video-scenario course entitled "Virtual School Nurse and EMS Training."4 This course contains modules on emergency planning, triage and assessment, respiratory equipment (asthma), and clinical scenarios including asthma.
Unfortunately, the school nurse may not be available on campus when an individual student with an asthma exacerbation presents. It has been reported that school staff may lack knowledge regarding asthma. A program to train nonmedical school staff to recognize signs of respiratory distress in children with asthma has been described and evaluated. Using video-footage examples of children with asthma in respiratory distress, school teachers were instructed on general asthma signs/symptoms and management, including when to activate EMS.5
Asthma is but one emergency situation/condition that may arise in the school setting. Preparedness for emergencies in schools is critical, and school nurse and school staff roles in preparedness are crucial.
REFERENCES
- Hillemeier HM, Gusic ME, Bai Y. Rural and urban children with asthma: are school health services meeting their needs?
Pediatrics. 2006;118
:1097
–1103[Abstract/Free Full Text]
- Sapien RE, Allen A. School preparation for the asthmatic student.
J Asthma. 2000;37
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- Sapien RE, Allen A. Emergency preparation in schools: a snapshot of a rural state.
Pediatr Emerg Care. 2001;17
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–333[CrossRef][ISI][Medline]
- Elgie R, Sapien RE, Fullerton-Gleason L. School nurse emergency training: performance evaluation with on-site mock emergency scenarios.
J Sch Nurs. 2005;21
:218
–223[CrossRef][Medline]
- Sapien RE, Fullerton-Gleason L, Allen N. Teaching school teachers to recognize respiratory distress in asthmatic children.
J Asthma. 2004;41
:739
–743[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
