Preparedness. It’s no longer just a word that affects only emergency professionals. It is a comprehensive concept that those of us involved in school bus transportation must embrace.
Day to day, we are transporting students diagnosed with increasingly complex medical conditions. We must be prepared for an emergency with all students; however, students with special needs and complex medical considerations require greater preparation. As lead judges for national level roadeos, we have learned some valuable lessons about preparation for emergencies that involve students who have conditions that are medically complex. We would like to share some of those lessons with you.
Lesson #1: Extra preparation is needed to compensate for staff physical limitations.
Transportation managers have a critical job in assessing the driver and attendant for physical and emotional limitations. The drivers and attendants have an equally critical task of being completely honest about their abilities as they relate to evacuation skills.
Some of the considerations in evacuation preparation are height, upper-body strength, possible back weaknesses and respiratory conditions, such as asthma. Among the many decisions must be the following: “Are there enough staff members on this bus to safely evacuate this particular group of children?”
At one special-needs roadeo, we judged a team whose primary physical challenge was height. The scenario called for the evacuation of a child with cerebral palsy who was in a body cast. The methods this team chose to evacuate were potentially dangerous, based on the fact that they were not physically able to carry this simulated child. The team needs to evaluate its capacity to use each specific method chosen to evacuate the children on their bus.
The following question must be considered well before an actual evacuation is necessary: Have I looked at the physical ability of my staff and compared it to the physical and medical needs of the students?
Because runs are often bid by seniority, this situation can create difficulties for transportation directors. However, the safety of the students hangs in the balance. Directors will need to communicate such concerns to the labor organizations.
Lesson #2: Educate yourself about medical conditions.
Well before the actual competition, roadeo contestants are provided with student profiles, including age, medical diagnosis and a brief medical history.
Our goal is to have the roadeo teams seek out information about this medical condition ahead of time. Some teams have searched the Internet or contacted other experts about the medical diagnosis of those students on the bus.
Very often, however, the teams have not attempted to obtain any further insight into the needs of the student. In the real world, we would like to think that a driver or attendant would not be searching the Internet for information about a student’s condition — but are we providing it?
As transportation directors, we should be contacting the special-education department and requesting the information needed to safely transport and evacuate the student from the school bus. Ideally, every bus carrying students with special needs would have emergency medical information cards (with identification photos) for each passenger.
Should the emergency require professional medical assistance, the EMTs will need specific information, such as overall medical diagnosis, medications, allergies or any seizure activity. Consideration must be given to a scenario in which the adults on the bus are rendered unconscious, leaving non-verbal students in the care of emergency responders. The emergency cards will help the EMTs identify the students and understand their medical backgrounds.
At a recent roadeo, we had a simulated student who started to have a seizure that was uncontrolled and very different from her previous seizures. The parents had also signed a Do Not Resuscitate (DNR) order for the child. All teams recognized that the seizures were different and immediately called for emergency medical assistance. In turn, most of the teams were extremely sensitive to the other students on the bus as they shared this DNR order with a paramedic. A few teams, though, forgot the DNR order and did not even mention it to the paramedic. If there had been an emergency information card, this would not have become a significant issue in the incident.
Lesson #3: The role of the nurse on the bus is to attend to the assigned student.
Let us set another roadeo scene for you. A student with a high-level spinal cord injury had a tracheostomy and needed a ventilator to breathe for him. Normally, this child had a nurse on the bus with him; however, on the day of the simulated accident, his regular nurse was absent due to sickness. So the nursing agency sent a nurse who had never been on a school bus!
It was amazing how many roadeo teams asked the nurse to undo the tiedowns on the student’s wheelchair. The nurse kept announcing she knew nothing about the bus, but teams kept insisting she start releasing the wheelchair tiedowns. Should the nursing agency have sent this nurse? Possibly not, but maybe she was the only nurse available that day. What we need to impress on our drivers and attendants is that the nurse is there to attend to her assigned student’s medical needs.
In this scenario, the expected response would be that the transportation team would handle the bus equipment, while the nurse would be responsible for the medical needs of her assigned student.
We had hoped to see the bus driver or attendant take the lead and explain to this nurse what they would be doing and what they needed her to do prior to transporting students. The nurse was critical in assisting the student with breathing once he had to be taken off his ventilator for the evacuation. Releasing the securement straps on the wheelchair should not have been the nurse’s focus.
Communication is key between the transportation department, the nursing agency and the bus staff as to the specific role each will play in an evacuation emergency. Frequent emergency evacuation drills will help our drivers and attendants to make educated decisions when the unexpected happens. Remember to include nurses and the nursing agencies in all pre-planning stages and drill exercise content.
The best solution would be to have the nurses present for every drill planning session and subsequent drill exercise — expanding the team to three!
Lesson #4: It is vitally important to know the student’s equipment.
Time and again, we see drivers and attendants make poor decisions about evacuating students who are transported with specialized equipment.
In one of our roadeo experiences, a simulated student was in a heavy, motorized wheelchair controlled by a sip-and-puff device. In addition to the weight of the wheelchair, there was the weight of the simulated student himself. The combined weight was at least 600 pounds. There is no question that the school bus driver and attendant would do whatever needed to save the life of a child under their care. The reality is, however, that there is no way to safely roll a 600-pound wheelchair system out the rear emergency door of a school bus.
To evacuate this student, the team would need to lift him out of his wheelchair and lower him to an “emergency evac aid” and then drag him out of the bus. The nurse would have to breathe for the student via the “ambu” bag (manual resuscitation bag). A student with this condition would not be physically taken out of the bus during a drill, but you would definitely need to “walk” through the process, explaining to the student, nurse and transportation team what you would actually do in the case of an actual emergency evacuation.
Lesson #5: It is important to store equipment.
Wheelchair securement straps should be properly stowed when not in use. The importance of emphasizing this practice became evident during a recent roadeo in Orlando, Fla. The interior of the bus being used for the “emergency event” was extremely hot, and the windows were open. One of the judges tripped over a securement strap left on the floor and smashed her head into the top of the window. Our “emergency event” soon looked like a true emergency scene with two fire trucks and an ambulance rushing to the scene. It is dangerous to leave unused securement straps on the floor. Place them in appropriate storage on the bus.
Lesson #6: Be cautious when deciding to use bystanders.
In a roadeo, we heard a bystander entice a child with the following invitation: “Do you want to come with me and see my puppies?” What child wouldn’t want to see puppies? Choosing to use a bystander in an emergency can be the one decision a driver or attendant will make that will save a child’s life — or cost it.
When we plan for emergency evacuations, we generally hope that we will have bystanders who will help us. It is sad to think about this, but we must be aware that not everyone who stops to help a school bus has the right intentions. The bystander may well be a child predator who will prey on a confused and scared child in an emergency situation.
During the evacuation scenario at the 2006 roadeo, we “tested” the contestants’ detection skills. We had simulated bystanders who were instructed to approach one of the students with the puppy lure. Some teams were immediately aware that a child was being led away from the bus by an ill-intentioned bystander. Some teams did not, which could have resulted in another tragedy.
We recommend using bystanders who stop to offer their assistance. Best practice says that you never let bystanders on the bus — rather, use them as assistance outside the bus. Transportation professionals must make instant judgments about bystanders who are offering their assistance. Drivers and attendants are responsible for every student on their bus. As a team, keep your eyes on the students at all times.
Learning is the goal
We all hope that we will never be in a position to evacuate our school bus. It is critical that we not only pre-plan evacuations on paper, but that we actually practice the drills with the students themselves and make adjustments as we learn critical lessons. Roadeos are practice drills that simulate critical situations and create wonderful environments to learn vital lessons.
These lessons are invaluable. We urge you to discuss our six lessons with your staff. No one can ever foresee every detail of an emergency evacuation. However, with training, our drivers and attendants will be able to make good decisions quickly, safely and efficiently. The lives of their students ride with the team.
Jean Zimmerman is supervisor of occupational/physical therapy at the School District of Palm Beach County (Fla.). Kathy Furneaux is the executive director of the Pupil Transportation Safety Institute in Syracuse, N.Y.