CardiologyResponse 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☆
Section snippets
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
References (62)
- et al.
Use of emergency medical services by children with special health care needs
Prehosp Emerg Care
(2000) - et al.
Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes
J Am Coll Cardiol.
(1998) - et al.
Catastrophic pediatric sports injuries
Pediatr Clin North Am.
(2002) - et al.
CPR and the single rescuer; at what age should you ‘call first’ rather than ‘call fast’?
Ann Emerg Med.
(1995) - et al.
Specificity and sensitivity of automated external defibrillator rhythm analysis in infants and children
Ann Emerg Med.
(2003) - et al.
Sudden coronary death in women
Am Heart J.
(1998) - et al.
Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival
J Am Coll Cardiol.
(1997) - et al.
High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics
Annals of Emerg Med.
(1996) - et al.
Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system
Resuscitation
(1998) - et al.
Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest
Resuscitation
(2001)
Cardiopulmonary resuscitation training in Washington state public high schools
Resuscitation
Pediatric patients requiring CPR in the prehospital setting
Ann Emerg Med.
A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest
Ann Emerg Med.
Guidelines for emergency medical care in school
Pediatrics
Use of automated defibrillators in children: an update
An advisory statement from the Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation. Circulation
The use of automated external defibrillators in children
Prehosp Emerg Care
National Athletic Trainers' Association position statement: emergency planning in athletics
J Athl Train
Emergencies in the school setting: are public school teachers adequately trained to respond?
Prehospital Disaster Med.
Emergency preparation in schools: a snapshot of a rural state
Pediatr Emerg Care
Deaths: Preliminary Data for 2000
1999 Injury Facts
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care; a consensus on science: new guidelines for first aid
Circulation
Part 9: pediatric basic life support. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation
Circulation
Prehospital emergency care for children at school and nonschool locations
Pediatrics
An epidemiologic profile of children with special health care needs
Pediatrics
A new definition of children with special health care needs
Pediatrics
Emergency preparedness for children with special health care needs
Pediatrics
Advance directives and do not resuscitate orders: nurses' knowledge and the level of practice in school settings
J Sch Nurs.
Cited by (25)
Empowering seizure management skills: Knowledge, attitudes, and experiences of school staff trained in administering rescue drugs in Northern Italy
2021, Epilepsy and BehaviorCitation Excerpt :Most seizures occur outside the home environment. Hazinski et al. reported that each year, about 67% of schools activate the emergency medical system, and 16% of these emergency calls are for children who have had a seizure crisis [1]. In this case, the first rescuer is necessarily represented by the school staff, who should be properly trained, because prolonged seizures can cause severe harm, cognitive deficits, and even death [2].
Identifying and minimizing abuse of emergency call center services through technology
2020, American Journal of Emergency MedicineCitation Excerpt :These special cases require intervention by social services or community resources. Another important area of concern relates to calls easily assumed to be harassment calls (heavy breathing or unclear speech), which are later revealed to be true emergencies, placed by individuals who are very young or hard to understand [12]. Mitigating the dangerous phenomena of phone abuse has proven difficult.
Cardiac arrests in schools: Assessing use of automated external defibrillators (AED) on school campuses
2013, ResuscitationCitation Excerpt :This subset of cardiac arrests has spawned a great deal of legislative activity and prompted educational foundations to support the deployment of public access defibrillation (PAD), programs that deploy automated external defibrillators (AEDs) and responders in schools. While a recent estimate identifies that 23 states mandate the placement of AEDs in high school1 and 36 states have established varying levels of CPR training to the student population, national organizations are still calling for a more widespread and standardized approach to CPR training with AEDs to be deployed as part of an integrated approach to school emergency preparedness plans.2 Besides the concern for sudden cardiac death in student athletes (with ventricular tachycardia and fibrillation as the first presentation)3, cardiac arrests in schools have gained attention due in part to SCA statistics demonstrating that the population at risk in schools is not just the K-12 age group.4
Novelities in resuscitation training methods
2011, Medicina IntensivaObstacles to teaching basic life support in secondary education: teachers' beliefs and knowledge
2024, Revista Electronica Interuniversitaria de Formacion del Profesorado
- ☆
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.