The American Academy of Pediatrics (AAP) and the American Heart Association published guidelines stressing the need for school leaders to establish emergency-response plans to deal with life-threatening medical emergencies in children. 

Goals of these plans include:  developing an efficient and effective campus-wide communication system for each school with local emergency medical services (EMS); establishing and practicing a medical emergency-response plan involving school nurses, physicians, athletic trainers, and the EMS system; identifying students at risk for life-threatening emergencies and ensuring the presence of individual emergency care plans; training staff and students in first aid and cardiopulmonary resuscitation; equipping the school for potential life-threatening emergencies; and perhaps even implementing lay rescuer automated external defibrillator (AED) programs.  A brief, comprehensive, and frequently updated summary of the medical condition for children with special health care needs is recommended by the AAP to be a document that is rapidly accessible at home, school, during transportation, and for the closest emergency department. 

Disaster preparedness has also been made a priority, in recent years.  The AAP recommends that pediatricians take an active role in establishing disaster plans in their communities, including schools, and in training first responders (including school nurses, administrative staff, and teachers).
To determine whether school nurses have been able to comply with these guidelines, a questionnaire was mailed to 1000 randomly selected members of the National Association of School Nurses.  Of the 675 questionnaires returned, 573 were eligible for analysis. A majority of responses were from registered nurses who had been practicing for >5 years.

The most common reported school emergencies were extremity sprains and shortness of breath.   Most (68%) of school nurses have managed a life-threatening emergency requiring EMS activation during the past school year and 86% percent have a medical emergency response plan.   One third of schools do not practice the plan and 13% do not identify authorized personnel to make emergency medical decisions.
School nurses reported the availability in their school of: a bronchodilator meter-dosed inhaler (78%), an AED (32%), and epinephrine autoinjector (76%).  Responses were similar for nurses in inner-city and rural/suburban school settings.
School-nurses self-reported more confidence in managing respiratory distress, airway obstruction, profuse bleeding, extremity fracture, anaphylaxis, and insulin shock in a diabetic child.  They were comparatively less confident with managing cardiac arrest, overdose, seizure, heat illness, and head injury.  In schools with at least one child with special care needs, 90% have a medical emergency response plan, 64% have a nurse available during all school hours, and 32% have an efficient and effective campus-wide communication system in a rural or suburban setting.   

(Olympia RP, et al. Pediatrics 2005; 116:e738–e745.)  – H.T.