Back to School: The Ultimate Pediatric Call

EMS calls involving pediatric patients are emotionally charged and can generate a high level of stress for the personnel who respond. Apprehension, uneasiness and anxiety are common in calls that involve one or two seriously injured pediatric patients. Can you imagine responding to a scene that may involve ten times as many pediatric patients? This article will discuss problems EMS agencies and school districts face in providing a strong and confident emergency response in the school setting and provide solutions.

Types of EMS Calls in the School Setting

EMS agencies respond to a wide range of calls in the school setting.

The so-called “routine” or “small-scale” calls may involve playground injuries or those sustained in phys. ed., technology or science classes. Medical emergencies may include asthma attacks or other allergic reactions. Trauma may result from physical altercations between students. On a less-common but larger scale, EMS providers may respond to a fire, bomb threat, hazardous-material incident in a chemistry lab, or a biohazard released in the building (such as anthrax or smallpox). Other calls may include shootings, stabbings, gang-related confrontations or physical encounters with disgruntled parents.

Multi-casualty incidents may involve a school bus accident on or off school grounds. This type of call is challenging. Issues regarding jurisdiction, consent, treatment and transport of patients must be addressed. Roles and responsibilities for EMS and the school must be well-defined. Plans must be developed and rehearsed in order to be effective.

Sporting events such as football, basketball, soccer and field or ice hockey can attract numerous spectators. Concerts and dances can also pose a danger when many enthusiastic participants become overzealous in displaying their “fan loyalty.” Bleacher collapse, “mosh pits” or “rushing the stage” can result in people being trampled or crushed. “Crowd surfing” and “stage diving” are also common, yet potentially dangerous practices at concerts that can result in blunt or penetrating trauma.

Accidents can and will occur. Our best defense is to be proactive rather than reactive. EMS agencies and school districts should strive to have a viable plan in place to deal with these situations.

Problems to Address

School districts and EMS agencies do not know what to expect from each other. Fortunately, this problem can be minimized by better communication between the agency and the district. This communication takes work. Some school districts encompass several square miles, which may fall into more than one agency’s jurisdiction. In this case, it may be helpful to have each of the agencies cover athletic events on a rotating basis. In this way, all agencies become familiar with the school setting, faculty and staff; which will help foster cooperation and communication. Other districts may have all their school buildings in a single physical setting and in one agency’s jurisdiction.

The key to establishing and maintaining a line of communication is to have at least one designated liaison between EMS agencies and the school or school district. This responsibility may fall to the principal, school nurse, fire chief or first aid captain. At times, these people are already overloaded with numerous duties. Sometimes they change jobs or leave their positions. The essential continuity in communication can break down. You need to work at keeping it current.

There has to be a district-wide plan to offer a coordinated response in the event of an emergency. The plan must be flexible and adaptive across differing structures, grounds and populations in the school district. The EMS agency should take the initiative in developing this plan with the schools. The lines of communication must be open and dynamic to respond to changing needs. Ongoing assessments have to be made and administrative, faculty and parental concerns need to be addressed. EMS has its own concerns and should also consider what it wants from the school. Are there things school personnel can do while waiting for EMS units to arrive on scene? This part of the plan should be clearly defined.

The School Response

In this “post-Columbine High School” era, school districts are in an ongoing process of developing prudent security measures for providing safe school environments. There are already some basic plans for emergency medical responses in schools. Many of these involve the small-scale types of calls mentioned earlier. In some cases the schools themselves have developed their own in-house “medical response teams” to handle these. This is a good idea, but I wish to raise a word of caution. The team coordinator—usually the school nurse or district medical officer—needs to set some criteria that will be used to place staff members on this team. Usually it is a faculty or staff member who has some background in first aid. There are coaches and physical education teachers with CPR and lifesaving backgrounds. There may be other staff members with fire and/or EMS backgrounds.

This team can be a valuable asset to the school, but preparation and planning are essential for success. It is important to know what training the members have as a starting point, making sure real skills are matched to potential calls. It is advisable to have periodic meetings with the team to evaluate their readiness and plan ways to increase their effectiveness. It is also vital that EMS agency representation and input be present at these meetings; our participation is paramount in setting up simulation drills and critiques of the schools’ response teams.

Faculty and staff who are not members of the team must also be informed as to what is expected of them from the school response team and EMS agency alike. Again, communication, planning and preparation will help the entire school community deal with these situations as they arise.

A Typical Plan

Plans must be made with input from police, fire and EMS to help schools deal with a potential large-scale incident such as “shots fired” or “intruder in the building.” Some schools have developed a planned response that begins and ends with lockdown. First, an announcement by the principal places the school in a lockdown mode. Students then go to a pre-designated “safe area” of the classroom. This presents a challenge when dealing with the library, cafeteria or a gym class. The doors are locked, kids are kept quiet, attendance is retaken, lights are switched off and the shades pulled down. Students in the hallways or restrooms are ushered into the nearest classroom. Everyone in the school stays put until an announcement by the principal clears the school from the lockdown. Meanwhile, key administrators, faculty and security staff have assigned duties along a chain of command for communicating with higher-ups, law enforcement and EMS, while securing student and staff safety.

Developing Relationships

There are many mutual benefits of cooperation and communication between EMS and schools.

In the area of training, certified EMS instructors from the fire or ambulance units in the school’s jurisdiction can teach school personnel various first aid courses such as CPR and the use of an AED. The school’s athletic department can help with in-service training by showing EMS personnel what type of equipment is being used in football practice and at games. It can help rescuers to see real people in real equipment when learning helmet removal and spinal immobilization techniques.

In the area of education, EMS and fire agencies can be used as a resource for classroom teachers. Career Day speakers might influence students to explore opportunities in EMS. Staging an automobile crash scenario with several teenagers injured, as the result of drinking, is an effective demonstration during Prom Week. Some high schools have developed a ride-along program that enables students to observe EMS agencies in action by spending a shift with an ambulance crew. Students get an idea what EMS personnel have to face in their jobs, while EMS personnel gain the perspective they need to relate to the kids. This can be a great help in dealing with this age group on a call.

Summary

EMS agencies will continue to respond to calls that have varying levels of seriousness in the school setting. Although most calls will be routine, the potential for a large-scale incident is ever-present. School districts and EMS agencies have to be proactive in developing a plan for responding to these situations. This proactive attitude is essential in fostering cooperation and communication between the school and EMS. It enables us to achieve the goal of making our schools safer. The process in reaching this goal is ongoing and evolving.

As an EMS provider, I am aware of the high anxiety that accompanies a call involving a seriously injured child. If the call involves five, 10 or more severely injured kids, the stress can be unbelievable. A plan of action that has been carefully developed, practiced and critiqued will lessen the anxiety and stress. As a teacher, I want my workplace and my students to be safe. If a situation arises, knowing that a planned response is in place, and knowing what I’m supposed to do, gives me the confidence to deal with the event so I can help my students. Finally, as a parent, it is important that my children are in a safe environment in which to learn. If an emergency response is needed, I want to know a good plan will go into effect. That would assure me that the people responsible for the health and safety of my children have done all they can to make school a safer place.