Emergencies always have one thing in common: They are unplanned.
Nobody plans on having tornadoes gallop through their town. Nobody plans on having a mudslide careen down a mountain toward a school. Nobody plans on having a deranged gunman hold an entire building hostage.
Though they are not planned on, emergencies must always be planned for.
"In recent years, we have witnessed the tornados that destroyed schools in Joplin and the wildfires that occurred in the Sacramento Valley. Not to mention the handful of violent crimes that have taken place within the walls of various schools," said Linda Davis-Alldritt, MA, RN, president of the National Association of School Nurses (NASN).
Davis-Alldritt serves as a fellow for NASN and the American School Health Association. As president of NASN, she encourages school districts to utilize the unique skill set of nurses in forming an emergency preparedness program.
"Quite often, the school nurse is the only healthcare professional in the entire building. [Therefore], it is crucial that a school nurse is brought in on any emergency preparedness plan," said Davis-Alldritt.
Although some school districts have decided to cut funding for a school nurse, there are a cornucopia of reasons why the school nurse should be the cornerstone of a school's emergency preparedness plan.
The Wide Skill Set of Nurses
School nurses, as their dual title implies, are members of two unique communities; although they are nurses, these trained healthcare professionals are also members of the school community. This makes school nurses the ideal bridge between school and emergency responders.
"In order for an emergency to be handled smoothly, the school must be able to speak the language common to other emergency responders. School nurses are the ideal person for that task," said Davis-Alldritt.
In a bedside care setting, nurses are expected to effectively communicate to both patient and physician. This requires nurses to translate a message into both the common vernacular as well as the precisely technical. In a disaster, school nurses have a similar responsibility to both school and healthcare professionals.
"In an emergency, school nurses can be the ones who speak both languages. A school nurse can quickly and effectively explain to healthcare professionals the needs of the school community. Then, we can convey to the school community what healthcare professionals are doing. We are a bridge responsible for translating a vital message to two different communities," said Davis-Alldritt.
More than just skilled medical translators, nurses also have the ability to act and react. Rather than providing one-size-fits-all care, nurses can provide personalized care specific to the situation. The nimble nursing mind lends itself well to the highly unpredictable world of disasters.
"Nurses are trained to continually assess, plan and respond to changing situations. Furthermore, nurses have been trained to constantly evaluate the effects of their intervention on the situation and adjust their care accordingly. This skill set fits in perfectly with any emergency preparedness program," said Davis-Alldritt.
As the bridge between school and healthcare community, school nurses are responsible for all phases of emergency preparedness, which include prevention, preparedness, response and recovery.
Prevention & Preparedness
"One of the first things that a school nurse does automatically is assess where an accident might happen," said Davis-Alldritt.
Whether it is looking for gaps in the sidewalk that may be a tripping hazard or assessing the broader environment for hazards, school nurses are always looking to mitigate potential accidents."
For instance, this assessment of the broader environment might include knowing where floodplains are located in proximity to the school and when they are at risk of being filled with water. This information would allow the school nurse to adjust accordingly and mitigate any potential emergencies that could occur.
Stopping emergencies before they start is a crucial first step. While this is an effective and vital first step, unplanned emergencies will still occur. Therefore, the second phase of planning for an emergency is preparedness.
"If an emergency were to happen, the individual needs of students must be planned for ahead of time," said Davis-Aldritt.
"In a lockdown situation, a school nurse would need to know which students had special healthcare needs and what those needs are. If a child has diabetes, she cannot wait 72 hours for insulin."
This phase entails planning for what would need to happen were an emergency to occur. School nurses, with their broad medical knowledge, can predict student's medical needs in a wide range of situations.
Response & Recovery
Even diligent prevention and planning cannot stop every emergency. When an emergency does arise, school nurses are called on to respond.
"As far as responding to an emergency, nurses are highly trained in triage and first aid. Nurses know what needs to happen and when it needs to happen whether it is an individual injury or a mass causality event," said Davis-Alldritt.
Assessment is a hallmark of all nursing, especially the school nurse in a disaster situation. After executing the plan, the school nurse should also be the one to ask rigorous follow-up questions to improve for the future.
"When it comes to recovering from an emergency situation, school nurses can be the ones to ask 'How did we do?' Or, if a death occurred in the emergency, school nurses can assist in facilitating grief counseling and a variety of other post-emergency activities," said Davis-Alldritt.
All too often, school districts think of the school nurse's office as merely a holding chamber for sick children. In reality, the school nurse is a healthcare professional strategically placed in a leadership position. An unplanned tragedy makes it clear how vital it can be to have a nurse in the school.
"I strongly believe that any school's emergency response plan will be lacking without a nurse's involvement. School nurses can provide on-the-spot assessment, intervention and triage that will not be available if she is not on staff," said Davis-Alldritt.
Keeping Nurses in School
Despite the importance of having a school nurse, many school districts choose to direct their funds toward classroom support rather than funding a school nurse. Davis-Alldritt and the NASN are looking to other entities to help keep nurses in school.
"Since school nurses are providing healthcare and managing chronic and acute illnesses, health insurance companies are receiving a substantial cost savings. Health insurance companies should really be offering support to help school districts bear the financial burden of school nurses," said Davis-Alldritt.
If school districts and private health insurers refuse to see the benefit of having nurses in schools, perhaps the broader community will. In emergency situations, a school nurse can quickly become the community's nurse.
"Many schools have multipurpose rooms and kitchens that can feed many people. In community-wide emergencies, school nurses have been instrumental in organizing medical shelters and accommodating people's medications needs," said Davis-Alldritt.
Schools and communities never plan on having an emergency. School nurses, though, are uniquely able to help schools and communities plan for any unplanned emergencies.
A. Trevor Sutton is a frequent contributor to ADVANCE.