Responding to School Health Crises: Students with Chronic Health Conditions May Need Monitoring on a Daily Basis and Assistance with Health Emergencies

By Gomes, Patricia; Smith, Mary | Leadership, March-April 2007 | Go to article overview

Responding to School Health Crises: Students with Chronic Health Conditions May Need Monitoring on a Daily Basis and Assistance with Health Emergencies


Gomes, Patricia, Smith, Mary, Leadership


Today's school administrators face an increasing array of duties. One of the potentially most serious responsibilities is student health services. It is estimated that 20 percent to 30 percent of all school-aged children in the United States have a health condition that may require monitoring.

One out of five students could have an asthma emergency; an increased number of diabetic students need assistance with blood sugar monitoring, carbohydrate counting and possible insulin administration at school; and students with severe allergies may need assistance with emergency epinephrine injections if exposed to shellfish, peanuts or other allergens.

Students with chronic health conditions may need specialized treatments during the school day, special diets at lunch, have activity limitations or need to be monitored for special behavioral or health emergencies. The speed and accuracy with which teachers, office staff and ultimately the site administrator respond to a student health crisis has far-reaching implications.

Monitoring students with chronic health conditions is the traditional role of the school health nurse, but due to high student/school nurse ratios, school nurses are often not available to monitor chronically ill students on a daily basis or to assist with normal health emergencies.

According to a survey by the California School Nurse Association, untrained and unsupervised staff administer first aid and medications to students in 83 percent of California schools. School districts face legal, financial and administrative issues when staff members perform medical procedures without proper training.

The courts have repeatedly found school districts responsible for training staff about asthma recognition, use of asthma medications, and procedures when an asthma emergency occurs. Other conditions with life-threatening potential include seizures, diabetic coma caused by low blood sugar, and severe allergic reactions to things such as bees and peanuts. All of these conditions may necessitate the administration of emergency injections or medications by school personnel before calling 911.

Most CPR/first aid programs do not provide information on monitoring students with chronic health conditions. In California, few administrative programs provide any health-related information. Educators who work in the classroom may not know current first aid practices unless site administrators have incorporated them into the school's staff development programs.

Survey says teachers unprepared

A survey of 60 new teachers in a medium-sized school district in California found that 71 percent of beginning teachers had students with chronic health conditions in their classrooms, with asthma the No. 1 condition identified. In addition, 20 percent of teachers said they had experienced a medical emergency in the classroom, but only 35 percent felt prepared to monitor students with the potential for health emergencies.

The teachers overwhelmingly said they needed information on health-related issues beyond what was covered in their teacher education programs. To address the problem, the district instituted a unique, three-pronged approach to health emergency training. Components included developing an Emergency Protocols Handbook to serve as a resource and training guide, instituting a new hire orientation in health areas for all new district staff, and establishing a no-cost CPR and first aid certification program for all school site staff as part of professional development.

The Emergency Protocols Manual

The first step was to determine what health information the district felt all school personnel needed to know. After reviewing the types of health conditions commonly seen in the school setting, district nurses wrote an Emergency Protocols Handbook that would become the basis for professional development at individual schools and the foundation for the new hire orientation. …

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