Located at the front of the neck, a tracheotomy (also called a stoma) is a surgical opening into the windpipe through which an artificial airway or tracheotomy tube (also called a trach tube) can be passed. The child then breathes, either partially or completely, through this tube. Students with trach tubes must always be transported with a personal attendant or nurse, who will suction the tube when necessary and provide other assistance as needed. Assign a seat or a wheelchair seating area to children with tracheotomies. Avoid placing them to the rear of the bus, as a rough ride may dislodge the trach tube. Avoid sharp turns, sudden stops and potholes. Pull over immediately if a personal attendant or nurse must suction a child. Signs that a student needs suctioning include: rattling mucus sounds from the trach tube, fast breathing, bubbles of mucus in the tube opening and dry, raspy breathing or whistling noises from the trach tube. Air conditioning on the bus is required, along with care to keep the air quality as high as possible during the ride. Exposure to smog, dust or wind should be avoided. Avoid horseplay on the bus and keep small objects such as food and toys away from trach tubes to prevent matter from becoming lodged in the tube. Source: “Transporting Medically Fragile or Technology-Assisted Students,” Ray Turner, Ed.D., www.whitebuffalopress.com.