Jean M. Zimmerman is supervisor of occupational and physical therapy for the School District of Palm Beach County (Fla.).
When transporting students with complex medical conditions and special equipment, pre-planning is critical. In addition, it is important to note that children with the same medical diagnosis may present a very different picture. Each child is unique, and we can’t generalize how they will react. Thus, two students should never be compared, and assumptions should never be made based on what another student can do.
The transportation needs of students with medical conditions must be discussed at their individualized education program (IEP) meeting. A representative from the transportation department must be an active participant in the IEP process. The IEP meeting is where decisions regarding the need for a nurse to accompany the student on the bus should be made.
Other factors to consider when transporting these students include emergency evacuation planning and the involvement of local emergency response teams.
The following is a best practice evacuation guideline for students with various medical conditions, some of which require use of special equipment.
Keep emergency cards handy
All special-needs students riding a school bus should have an emergency card that describes their pertinent medical information.
This card should be stored in a universally accepted location that is known to all local emergency personnel. Photo identification should be on the card in the event of the driver becoming incapacitated.
Students who have seizures
Many students with medical conditions have seizure activities. A seizure is a sudden attack of altered behavior, consciousness, sensation or autonomic function that is produced by a self-limited description of brain activity. Seizures can range from a momentary blank stare to a temporary loss of consciousness. Although frightening to all, a seizure is usually not life threatening.
What do you do if your student has a seizure during an evacuation? You need to start to time the seizure. As you drag the student on the evacuation aide or as you carry the student, be sure his or her head is well protected. Also, have the student on his or her side so they do not aspirate on saliva, and loosen the student’s shirt collar to help with breathing.
Students with a tracheostomy
A tracheostomy is a surgically created opening in the neck into the windpipe that allows the student to breathe if he or she is unable to breathe well through the nose or mouth. The opening may have a metal or plastic tracheostomy tube inside to keep it open and allow air to pass in and out of the windpipe and lungs.
Speed is important during an evacuation, but with students who have a tracheostomy, one must be very careful when unfastening the occupant shoulder strap to avoid dislodging the tracheostomy tube. If the tracheostomy tube becomes displaced, in many cases it can be replaced. However, with some students who have a narrowing of their trachea, if the tube is displaced, it could be life threatening.