Responding to School Emergencies

Children of all ages and with varying degrees of special healthcare needs spend a substantial portion of each day in schools or on school-related outings. Often, schools also serve as centers of community activity, making them a likely place for medical emergencies.

In 2003, the federal Emergency Medical Services for Children (EMSC) program recognized the need for greater preparedness for school emergencies and contracted with the National Association of Emergency Medical Technicians (NAEMT) to develop guidelines for prehospital response to medical emergencies at schools. This article summarizes these guidelines and the development and testing process that led to them.

Our Nation's Children

There are 72.3 million children under the age of 18 living in the United States, according to the 2000 census. The federal Maternal and Child Health Bureau estimates that of this group, 18 million have special healthcare needs. These children account for 25% of pediatric patients seen in hospital emergency departments each year. The prevalence of children with special healthcare needs in schools means that schools represent a source of pediatric patients with a broad range of medical conditions that may require special equipment, preparation and/or transport destinations.

Leaders from various EMS groups, as well as other stakeholders, met in Washington, DC, in January 2004 to address these children and their emergency medical needs. The groups that were represented included the meeting host, NAEMT, as well as HRSA's Maternal and Child Health Bureau, the EMSC National Resource Center, Family Voices, Fire and EMS Exploring, the International Association of Emergency Managers, the International Association of Fire Chiefs, the National Association of School Nurses, the National Association of State EMS Directors, the National Highway Traffic Safety Administration and the Rural EMS and Trauma Technical Assistance Center. Other prehospital care professionals, school administrators, school nurses, law enforcement officers and mental health professionals also participated.

Based upon the input of all of these stakeholders, in April 2004, NAEMT posted draft guidelines for public comment on its website, as well as on the websites of the EMSC National Resource Center and the National Association of School Nurses. The guidelines were revised based upon public comment, and then were disseminated to three test sites. The final guidelines were approved in July 2004 and are available online at http://naemt.org/emsc.

Get Everyone Involved Before an Emergency Occurs

The primary recommendation in the guidelines is that the emergency response community and the local school system come together to discuss how to respond to emergencies at schools before an emergency occurs.

Of major importance is ensuring that everyone with a stake in the emergency response is at the table. Sometimes this is easier said than done, especially when school district boundaries do not coincide with public safety jurisdictions and service areas, school districts cross local government boundaries and/or multiple school districts lie within jurisdictions. The issue is further complicated by the need to plan for off-campus emergencies (e.g., on field trips and sporting events) and emergencies involving school buses. Stakeholders will vary from one community to another, and may include:

• public safety agencies (police, fire, EMS and emergency communications)
• other response organizations (ambulance services, private security forces, public works)
• school administrations (including school nurses, principals and a district-wide representative)
• emergency management
• legal advisors and policymakers for communities and school systems
• parent/family organizations
• student body representatives
• mental health professionals
• local news media.