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.