Cardiology
Response to cardiac arrest and selected life-threatening medical emergencies: The medical emergency response plan for schools—a statement for healthcare providers, policymakers, school administrators, and community leaders

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Introduction and purpose

This document introduces a public health initiative, the Medical Emergency Response Plan for Schools. This initiative will help schools prepare to respond to life-threatening medical emergencies in the first minutes before the arrival of emergency medical services (EMS) personnel.

This statement is for healthcare providers, policymakers, school personnel, and community leaders. It summarizes essential information about life-threatening emergencies, including details about sudden cardiac arrest.

Magnitude of the problem

School nurses, athletic trainers, and teachers are often required to provide emergency care during the school day and for extracurricular activities, including sports. In a survey of elementary and high school teachers in the Midwest, 18% of all teachers surveyed indicated that they personally provided some aspect of emergency care to more than 20 students each academic year, and 17% indicated that they had responded to ≥1 life-threatening student emergency during their teaching career.7 A

Current level of school preparation for medical emergencies

School nurses, teachers, athletic trainers, coaches, and staff are responsible for the physical well-being of a large portion of the nation's children for many hours each day. Schools now employ fewer nurses than ever before, and school nurses often rotate between schools, so some schools are without professional medical coverage for hours or days every week.7 Much of the responsibility for the physical care of students during a typical school day now rests with teachers, athletic trainers,

School medical emergency response plan: recommended elements

The goal of the Medical Emergency Response Plan for Schools initiative is to encourage every school to develop a program that reduces the incidence of life-threatening emergencies and maximizes the chances of intact survival from an emergency. Such a program will have the potential to save the greatest number of lives with the most efficient use of school equipment and personnel.

The authors and endorsing organizations of this statement recommend the following core elements of a school medical

Potential costs of proposed school emergency response plans

The goal of a school emergency response plan is to ensure an organized, efficient, and effective response to life-threatening emergencies. Although the response plan is designed for all life-threatening emergencies, an estimation of program cost per life saved can be made by using the example of the cost per survival of a high school victim of sudden cardiac arrest in a school with a medical emergency response plan that includes a lay rescuer AED program. This example will enable calculation

School data collection

More information is needed about the frequency of life-threatening emergencies, including sudden cardiac arrest in schools. Schools must collect or provide reports of emergencies. These reports will have maximum impact if collected and verified using the model of Maron and colleagues.25, 26 Only through the gathering of reliable data can we begin to accurately determine the frequency of life-threatening emergencies and plan the best interventions to save lives.

Legislative mandates and funding for school medical emergency response plan

Legislative efforts to save the lives of children who develop life-threatening emergencies at schools should support an approach that is most likely to save the greatest number of lives. A planned program should be required, as should appropriate training and equipment.

Unfunded legislative mandates, particularly those that address the purchase of equipment rather than programs of planned response, will limit effectiveness and place a substantial burden on school budgets. Many school budgets are

Conclusions

On any given day as much as 20% of the combined US adult and child population can be found in schools. Life-threatening emergencies in schools are relatively uncommon, but when they do occur, they require a planned, practiced, and efficient response with provision of first aid and possible CPR and use of an AED. To maximize survival from a life-threatening emergency, schools must develop a medical emergency response plan designed to provide appropriate therapy within the first minutes of the

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    Endorsed by the American Heart Association; the American Academy of Pediatrics; the American College of Emergency Physicians; the American National Red Cross; the National Association of School Nurses; the National Association of State EMS Directors; the National Association of EMS Physicians; the National Association of Emergency Medical Technicians; and the Program for School Preparedness and Planning, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health.

    Published simultaneously in Pediatrics and Circulation.

    This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on November 4, 2003. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596. Ask for reprint No. 70-0273. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1,000 or more copies, call 410-528-4426, fax 410-528-4264, or e-mail [email protected]. To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400.

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