Opinions Vary on Driver's Role in Medical Emergencies

School bus drivers who are taught how best to respond to medical emergencies are more confident in their work, say transportation directors nationwide. However, not all state training requirements go beyond basic first aid. How much training drivers receive varies dramatically based on priorities of individual school districts. And while training material and courses are available, questions of liability and confidentiality remain concerns to some transportation directors, even though the level of training can impact students with disabilities. Certainly, drivers are better prepared to do their jobs when they know the medical needs of students, whether the student is medically fragile or just allergic to bee stings, according to some transportation directors.

Drivers left in dark?
Driver training for a student with special needs is unique for that specific child, notes Terry Voy, Iowa's director of pupil transportation. The child's Individualized Education Program (IEP) is the starting point for an exchange of information critical to the safe travel of that student. "To come up with a state training program is difficult," Voy says. "When it comes down to dealing with children who need feeding tubes or oxygen en route, that needs to be dealt with at the IEP staffing level." In many areas, drivers still do not receive the information and training they need for some of the children they have on board. "They may not even know a child is diabetic," Voy says. "There's the right to know and the need to know. Certainly drivers who transport these kids have a need to know."

Confidentiality is key
Understanding the rules of confidentiality is important. As long as the school bus driver is educated about confidentiality, there should be no problem, says attorney Peggy Burns, counsel for Adams Twelve Five-Star School District in Northglen, Colo. In 1996, the Family Educational Rights and Privacy Act was amended. Prior to the amendment, a school official was someone with a legitimate educational interest, she explains, and nobody thought of a bus driver as a school official. The amendment clarified that a school official includes support staff, and legitimate educational interest is defined as needing information to carry out job responsibilities, she explains. "Schools need to make a public statement on who is a school official, and they need to say it is a school bus driver, as long as certain training is given to the school bus drivers and they don't give the information to anyone else," Burns says. Specifically, trainers should explain to bus drivers that a student's confidential medical information "may not be disclosed to third parties, and they can use the information they are given only for the purpose for which it is given," Burns says. Liability is another concern, according to Ted Finlayson-Schueler, executive director of the Pupil Transportation Safety Institute in Syracuse, N.Y. "Operations say they aren't going to train in first aid because they'll be liable. That's a head-in-the-sand attitude. Given the fact that the federal government has identified that it's expected you would take care of your passengers until help arrives, we need to take care of people with a basic level of care," he says.

Knowledge is power
Information is critical, agrees Burns. However, she says that along with the training, it's important to give bus drivers the parameters as to how to use that information. "There is no question, if there are situations that you can predict that can come up on the school bus, for those situations absolutely there should be training to drivers," Burns says. Finlayson-Schueler says that drivers should focus on common injuries. "Running noses, bee sting allergies and asthma attacks; those are what all school bus drivers must deal with at one time or another," he says. "It's the minor stuff that they face, yet it's an asthma attack or bee sting that could be fatal if they aren't prepared."

Extra training saves a life
Joan Corwin is a registered nurse and an emergency medical technician. She also is president of Chappaqua Transportation Inc. in Chappaqua, N.Y., which contracts with school districts. Corwin teaches extensive first aid to her 126 drivers so they can respond comfortably to medical emergencies. In fact, during snow delays, her drivers are not out throwing snowballs, she says; they are inside watching training videos. "Your drivers are 90 percent of your safety program," she says. One of her drivers saved a girl's life by using the Heimlich maneuver when the girl started choking on candy. This alone justifies the cost of training, she says. "Look what I saved by teaching my drivers the Heimlich maneuver. How can you say it's expensive when you can save a child's life?" But it's the medical information provided to the driver that best helps them prepare for emergencies. In Ogden, Utah, Weber School District uses the medical information forms provided by parents, says Monty Hadley, transportation specialist. "Each child has a form that is filled out on their medical status so we know what to watch for," he says. "We put them in a location on our bus so we can get to them quickly." Driver and monitors on special-education buses receive additional emergency training, Hadley says. They're taught certain skills, such as how to replace or connect a trachea tube, how to respond to seizures and how to work with kids on oxygen. Hadley budgets one hour of extra pay per day to his drivers to compensate them for the time they take on their own to attend safety and medical training courses.

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Help at local college
Some directors point to Dean Transportation in Lansing, Mich., as a model company when it comes to training school bus drivers. For about a decade, Dean has required all new drivers to take a 10-week medical-training program at Lansing Community College. Dean employs 350 drivers, and it contracts with 40 school districts throughout central Michigan. About two-thirds of its business is in transporting special-education students. "Our staff is not out there dealing with health care every day," says Kellie Dean, company president. "So the drivers have had a significant increase in their knowledge base, increase in their self-esteem and an increase in their confidence to do their jobs, and it affects all our passengers." In a survey, Dean's drivers said they wanted additional training on respiratory concerns, so an advanced driver program was established, says Deborah Collin, a registered nurse who teaches the courses for LCC. Collin holds a two-hour respiratory training update that includes one hour of lecture and one hour of hands-on instruction. Drivers and monitors learn the basics of trachea suction and oxygen tank handling. They also learn to perform the Heimlich maneuver. In Los Angeles, the district's 1,100 drivers are required to take a written test from the California Highway Patrol or have a first aid card through the American Red Cross or another state-approved agency. Clarence Hutchinson, transportation services manager at Los Angeles Unified School District (LAUSD), says the Effective School Bus Driver class includes 42 hours of training over seven weeks. One evening class covers special-education issues, such as wheelchair tie-downs and seizures. LAUSD also offers cardiopulmonary resuscitation (CPR) training. "We don't require them to have it," Hutchinson says. "Our drivers are required to have 10 hours of in-service training annually. CPR could be part of that training." Nevada does not require first aid training, says Craig Falconer, assistant transportation director at Washoe County School District in Sparks, Nev. "We tend to train to the need," Falconer says. "We work closely with our special-education office in the district. If they are going to be placing a child with an unusual medical need, they'll let us know. The kid doesn't start on the bus until the driver gets trained." All of his 250 drivers and 29 substitutes receive CPR and limited first aid training. "We do have some DNR (do not resuscitate) students, but our district will ignore those orders," Falconer adds. "If a kid is in distress, we'll call paramedics. We're not qualified to determine if a kid is in a terminal state." In Florida, school bus drivers are required to have first aid training as part of a 40-hour pre-service training curriculum, says Charlie Hood, state director of pupil transportation.

Repeat instructions often
Maintaining strong communication lines between drivers, monitors and their special-needs passengers is essential, particularly in training youngsters to react properly in a variety of situations, including emergencies. Many special-education students may have difficulty when their routine is unexpectedly interrupted. Frequency of instruction is critical. For example, evacuation training drills are held three times a year in New York, but is that often enough to ensure that the children will remember what to do during an actual evacuation? You might want to make it part of a driver's weekly routine to coach her students on emergency evacuation procedures. That coaching can include showing the ambulatory students how to open the window or the emergency door. With the less able-bodied children, a driver can talk them through the process. For example, the driver might say, "If this were a real emergency, Johnny, I would take you out of your wheelchair and carry you through the rear emergency exit." This helps them to get accustomed to the driver's words and tone of voice, as well as her gestures and body language. If the driver regularly spends time communicating the process, the students will be more likely to respond appropriately in an emergency.

CPR can be vital
CPR and first aid are part of training received by Polk County school bus drivers, says David Milhorn, vehicle and safety services manager at Polk County Schools in Bartow, Fla. "We train them to deal with minor cuts and abrasions," Milhorn says. "Anything more serious than that, we have a radio system on our buses, and we dispatch paramedics to their vehicle." Polk County's American Red Cross-certified trainer for CPR and first aid is also a bus driver. Because of this, Cheryl Milam says she is able to tailor the course to fit the drivers' needs. She takes the standard Red Cross training and brings into it her six years of experience as a driver. "I can relate my experience to the textbook and give them a short anecdote to go along with it," Milam says. And in some instances, she knows that the textbook's guidelines differ from what the school system will allow. For example, the textbook suggests giving orange juice or sugar to a diabetic, "but the board says don't administer anything unless you have a doctor's prescribed form that says that," she says. Polk County covers 1,868 square miles, larger than the state of Rhode Island, Milhorn says. The school system transports about 38,000 children daily with about 460 buses, of which about 90 are specific to Exceptional Student Education (ESE) use. There are attendants on ESE buses, not nurses. "If they are that severe to need a nurse," Milhorn says, "we contract with the parent to transport them to school." As with many school districts, Polk County asks parents to complete an information form about the child if there is a medical concern. But ultimately, it's the bus driver who is on the front line, everyone agrees. "Each person will react in a situation differently," Milam says. "What's most important is that they can recognize an emergency and at least make the call to the dispatcher."

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