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November 01, 2005  |   Comments (0)   |   Post a comment

Q&A: Invasive Procedures May Be Beyond Drivers' Scope

Navigating a school bus full of students is challenging enough as it is. Are drivers being subjected to undue stress when they are required to also perform some types of invasive actions on medically complex passengers? Should some procedures be left to a nurse or the IEP team?

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At the Transporting Students with Disabilities & Preschoolers conference this past March in Phoenix, Jean Zimmerman, supervisor of occupational/physical therapy at the School District of Palm Beach County (Fla.), spoke on complex medical procedures that school bus drivers are being asked to perform on special-needs students.

Zimmerman raised this question: In life-threatening situations, should bus personnel be required to tend to medically complex passengers, or should this be reserved for qualified medical professionals such as nurses?

SBF Associate Editor Albert Neal spoke with Zimmerman about the complexities involved in tending to these passengers.

SBF: What constitutes an invasive procedure?
JEAN ZIMMERMAN: It is a medical or surgical procedure that requires the skin to be cut open and/or an object is inserted into the body. A medication is injected or inserted into the body.

When would a person have to execute such a procedure?
All of these procedures depend on the child. In some cases, they are performed on a routine basis. Other times, the procedures are needed on an emergency basis.

What are drivers being asked to perform?
More and more students are requiring the use of an EpiPen when they are having an allergic reaction. For students with uncontrolled seizure activity, one procedure is the Vagus Nerve Stimulator and the administration of the medication Diastat. Also, students with a tracheostomy may need suctioning.

Would you say that some of these procedures are outside drivers’ scope?
I think it’s beyond the driver to be expected to drive the bus plus look at the medical reactions and conditions of children. The driver’s scope is to drive the bus. If there’s a need for a medical procedure, that’s where the IEP team comes in.

The IEP should include members of the transportation staff, medical professionals, the occupational and physical therapist, school staff and parents. These people should be familiar with the environment of the bus that the child would be riding. The IEP team should determine if a nurse is necessary on the bus or if someone else can be taught and safely do the medical procedure.

Is the interior of a bus conducive to executing these procedures?
Sometimes you have to put a child who is having a seizure down on the floor to be able to give them Diastat, which is a rectal suppository. If you only have a 12-inch aisle in a school bus, then you really can’t do that. There’s not enough space. Plus, you have the hard floors and the anchor points of the bus seats, on which children could hit and injure their heads. Then there’s the whole privacy issue.

The IEP team should consult the child’s physical about the possibility of another medication being given until the paramedics arrive. If this is not at all possible, the bus environment will need to be modified, including removal of seats, placing a mat on the floor and planning for privacy.

Can drivers be properly trained to perform invasive procedures?
It’s different with each procedure. Intense training is not always enough, because sometimes you need to have additional medical knowledge. It’s not only knowing how to do the procedure — it’s knowing when to do it and what, if any, side effects to expect. Some procedures include the use of medications that could slow down respiration. Therefore, the driver would also need CPR training.

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