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March 01, 1999  |   Comments (0)   |   Post a comment

Opinions Vary on Driver's Role in Medical Emergencies

School districts are often hesitant to expand first aid training because of liability and confidentiality concerns.

by Andria Segedy

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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."

Facts & Figures

  • There are about 16 million people in the United States who have diabetes, but only 10 million have been diagnosed. About 123,000 children have been diagnosed with diabetes. - Centers for Disease Control and Prevention.
  • About 2 million Americans have been diagnosed with epilepsy, of which 300,000 are children aged 14 years and younger. - Epilepsy Foundation.
  • More than 5.6 million children were served under the Individuals with Disabilities Education Act during the 1995-96 school year in the 50 states, Washington, D.C., and Puerto Rico. - 19th Annual Report to Congress on the Implementation of the IDEA, published by the U.S. Department of Education.
  • Asthma affects about 15 million Americans, including almost 5 million children. The death rate for children 19 years and younger increased by 78 percent between 1980 and 1993. - Centers for Disease Control and Prevention.


    Andria Segedy is a free-lance writer in Lima, Ohio.

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