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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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What should transportation departments do when asked to perform an invasive procedure?
First of all, transportation departments should take this opportunity to be proactive. We are transporting more and more medically complex students on our school buses. Be proactive. Form a task force in your area. Familiarize yourself with your state’s Nurse Practice Act — your state may say that only a nurse can perform certain medical procedures. Have policies and procedures in place before you need them. Have your school board attorney review your policies and procedures.



Invasive Procedures

Many children and adults are allergic to certain medications, food, insect bites/stings and latex. The result of exposure to one of these irritants could be anaphylaxis. This is a sudden, severe and potentially fatal systemic allergic reaction.

The EpiPen auto injector is commonly prescribed for individuals who have had prior severe allergic reactions. The EpiPen is an emergency injection of the medication epinephrine. Epinephrine constricts blood vessels, relaxes smooth muscle in the lungs to improve breathing and stimulates the heartbeat. The effects of epinephrine usually last 10 to 20 minutes, so it is still necessary to call 911 or proceed to the hospital. The child may need additional medication, cardiac or respiratory care.

Vagus Nerve Stimulation
Vagus Nerve Stimulation is a relatively new treatment for uncontrolled seizure. It is a type of treatment in which short bursts of electrical energy are transmitted into the brain via the vagus nerve, which is a large nerve in the neck. The energy comes from a small generator, which is surgically implanted under the skin, usually on the chest. Leads are threaded under the skin and attached to the vagus nerve in this same procedure. The physician programs the device to deliver small electrical stimulation bursts every few minutes. This electrical stimulation travels via the vagus nerve to influence parts of the brain that control seizures.

The second way Vagus Nerve Stimulation is delivered is when a patient, a family member or a caregiver senses a seizure coming on and passes the magnet over the area in the chest where the generator is implanted to activate an extra, on-demand stimulation. In addition to preventing the seizures, the stimulation can also decrease the severity of the seizure and decrease the recovery time after the seizure. School bus drivers are often asked to use this magnet.

Many children experience seizure activity that can be controlled by oral medications. However, some children have seizure clusters, which are episodes of multiple seizures that are different from the child’s usual pattern. These seizures may progress to status epilepticus (a state of non-stop seizures), which carries an increased risk of brain damage or even death. Diastat (diazepam rectal gel) is an acute at-home treatment for patients two years and older who are on stable anti-epileptic medications and experience bouts of increased seizure activity. The literature states that both medical and non-medical care providers can easily administer Diastat in the school setting.

However, there is also a warning in the literature that reads that Diastat “should only be administered by caregivers which in the opinion of the prescribing physician, i) can distinguish between a cluster seizure and the patient’s ordinary seizure patterns ii) have been instructed on how to administer Diastat and judge competent to do so, iii) understand explicitly which seizures may or may not be treated and iv) are able to monitor clinical response and recognize when the response mandates professional medical evaluation.”

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