Bioterrorism Knowledge and Emergency Preparedness among School Nurses
Evers, Sara, Puzniak, Laura, Journal of School Health
Bioterrorism is no longer a threat but a reality that presents new challenges to public health. To protect the health of our communities, public health agencies need to utilize all available resources and coordinate the planning and training necessary to mount an effective response. In a biological or a chemical attack, school nurses could be among the first health care professionals to recognize the event and respond.
Approximately 119,235 elementary and secondary educational institutions exist in the United States. (1) These facilities house more than 20% of the US population on any given day: more than 60 million people including students, faculty, and staff. (1,2) History demonstrates that schools are a target of terrorism. In 1998, just the thought that a letter claimed to contain anthrax was enough to force an evacuation of nearly 500 students and teachers from a school in Indiana. A similar occurrence in Wisconsin in 2000 caused a middle school to shut down and evacuate. (3) Schools contain a large gathering of people who are on a similar schedule every day, prepare large amounts of food with limited security, and transport large numbers of children by vehicles that could be tampered. In addition, there are physical and emotional differences in children that place them at an increased risk to the effects of a biological or a chemical event. Children have a smaller volume of blood and surface-to-mass ratio that can increase the concentration of an agent in the body. In addition, they react differently to stressful events? Most importantly, we need to protect children from harm, whether natural or intentional.
The 47,000 nurses in US schools provide the resources that begin to bridge the gap between schools, students, families, and the health care community. (5) Contrary to hospitals and other facilities with medical professionals in abundance, schools have a small number of people present with medical training, usually just 1 school nurse. The school nurse could be responsible for the children and staff trapped or sheltered in a facility. (6) Yet, in a study of rural public schools in New Mexico, only 44% of school nurses participated in school disaster preparation and planning, and only 11% were involved in community emergency preparedness planning. (7) When partnering with local public health agencies and the medical community, school nurses can play an invaluable role in emergency preparedness due to their knowledge of school processes and policies and the education they provide to the children and families. (8)
The burden of being prepared is increased when school nurses have to serve more than 1 facility. School staff may be required to deal with emergencies when the school nurse is not at a particular facility; however, 35% of the teachers studied in New Mexico had not received emergency training. (7) Similarly in a study of teachers in Missouri, Arkansas, and Kansas, approximately one-third had not received specific training in first aid, and 40% had not received training in cardiopulmonary resuscitation. (9) The data indicated that public school teachers "lack the adequate emergency care knowledge and skills" mainly due to the lack of formal training, low retention, and no incentives or requirements for training. (9)
A National Association of School Nurses position statement announced school nurses should be "trained in protection, detection, and treatment of victims of such events and in the command and control management techniques of the logistics of such a situation." (10) The strategic position of well-prepared nurses in the school environment has significant potential for minimizing the effects of a terrorist attack in school settings and, subsequently, in the community at large. This study assessed the knowledge present in the school nurse community of 3 large cities in Missouri, the educational needs, and the preferred format to address those needs.
Researchers surveyed school nurses attending school meetings and a conference on Bioterrorism/Emergency Preparedness for School Nurses held by the Heartland Center for Public Health Preparedness. …