Heart association recommends medical emergency plan for schools

American Heart Association
Tuesday, 6 January 2004

The American Heart Association introduced a public health initiative today to help schools prepare to handle life-threatening medical emergencies such as cardiac arrest.

"As part of the Medical Emergency Response Plan for Schools, the school nurse and physician, the athletic trainer, and several faculty members should be trained and equipped to provide first aid and cardiopulmonary resuscitation (CPR)," write the statement authors. "Ideally, the school should establish a goal to train every teacher in first aid and CPR and to train all students in CPR." Response to sudden cardiac arrest is a major focus of the statement.

The statement, published online in today's rapid access issue of Circulation: Journal of the American Heart Association, is endorsed by many national organizations. It encourages schools to develop a plan to reduce the incidence of life-threatening emergencies and maximize the chances of survival during an emergency.

On many days, as much as 20 percent of the combined U.S. adult and child population can be found in schools, said the authors. Citing a survey of elementary and high school teachers in the Midwest, the statement said 18 percent of the teachers indicated that they have provided some level of emergency care to more than 20 students each academic year. In addition, 17 percent of those teachers said they have responded to one or more life-threatening student emergencies during their teaching career.

Such incidents have sparked a grassroots effort to improve emergency response at schools, said Mary Fran Hazinski, R.N., co-author of the statement and a senior volunteer for the American Heart Association. "Many parents and friends of children who have died in schools have done a tremendous job increasing public awareness of the need for a response plan. Their efforts provided the impetus for the statement, designed to provide a blueprint for action.

"Schools should develop and practice a plan before it is needed," said Hazinski, a critical care nurse at Vanderbilt University Medical Center in Nashville, Tenn. "When a life-threatening emergency occurs, the quality of the response in the first few minutes, before emergency medical service (EMS) personnel arrive, can make the difference between life and death. During the emergency, teachers, staff and students should know what to do and should be prepared to act quickly.

"Schools plan and rehearse responses for emergencies such as tornadoes and fires. We feel they also should practice response to medical emergencies," she added.

While the statement focuses on cardiac arrest, members of the writing committee recognized that other types of emergencies, such as falls and other injury, asthma attacks and seizures occur more often at schools. As a result, the statement offers suggestions that can be applied to a wide variety of emergency situations.

Five key elements are recommended for school medical emergency response plans:

1. Effective and efficient communication throughout the school campus. The statement recommends establishing a rapid communication system that links all parts of a school campus, including outdoor facilities and practice fields, to the local EMS system.
2. Coordinated and practiced response plan. Schools are encouraged to develop a response plan applicable to a variety of common medical emergencies. Potential resources for developing a plan include the school nurse, athletic team physicians and trainers, and the local EMS agency. The emergency response plan should be practiced at the beginning of each school year and periodically during the year.
3. Risk reduction. The statement emphasizes injury prevention with appropriate precautions in classrooms and on playgrounds. It suggests identifying students, faculty, and staff members who have medical conditions that might increase their risk of life-threatening emergencies. School personnel should be trained and equipped to respond to the emergency conditions.
4. Training and equipment for first aid and CPR. The statement encourages schools to train as many teachers and school personnel as possible in first aid and CPR and provide the equipment necessary to respond appropriately to emergencies. It also encourages schools to train all high school students in CPR.
5. Implementation of a lay-rescuer automated external defibrillator (AED) program in schools with an established need. AEDs can deliver shocks to eliminate abnormal heart rhythms that cause cardiac arrest. AED programs have been shown to improve survival in adults who have cardiac arrest outside of a hospital.

Vinay Nadkarni, M.D., immediate past chair of the American Heart Association's emergency cardiovascular care committee, said, "This statement represents an important benchmark in cooperative effort among many national organizations to strengthen the chain of survival in every community, especially the community that cares for and educates our children."

Organizations endorsing the American Heart Association statement are: the American Academy of Pediatrics, American College of Emergency Physicians, the American National Red Cross, the National Association of School Nurses, National Association of State EMS Directors, National Association of EMS Physicians, 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 and The Centers for Disease Control Division of School and Adolescent Health.

For more information, or to contact American Heart Association, see their website at: www.americanheart.org