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Schools have emergency procedures; not all have defibrillators or staff trained in CPR

By Dale Mezzacappa on May 23, 2014 12:07 PM

Accounts of the collapse of a 7-year-old boy at Jackson Elementary School on Wednesday say that at least two first responders -- a library volunteer who was a retired nurse and an employee of a behavioral health organization trained in CPR -- were not regular staffers and just happened to be in the building.

That raises the question of whether Jackson had in place an emergency plan required by the state departments of Health and Education that identifies "specially trained" staff and specifies staff responsibilities. 

"In true emergency situations, the school should do all in its power to render emergency care," say the guidelines. "To prepare for emergencies that can be reasonably anticipated in the student population, the school should have written first aid policies and emergency management practices in place. These policies and procedures should reflect staff responsibilities and district expectations for staff action in an emergency situation, including identifying specially trained and designated individuals who, in addition to the nurse, will render first aid."

In its response to the incident, the District is emphasizing that there were trained personnel on site who were able to immediately rush to the student's aid and perform CPR. An ambulance arrived within five minutes, according to District spokesman Fernando Gallard. The child was taken to Children's Hospital, where he died.

News reports say the city medical examiner has attributed the death to a congenital heart defect, called an anomalous coronary artery, in which children may show no symptoms but can die suddenly at a young age.

"The emergency plan was in place, it was put into action," Gallard said. "The No. 1 part of the plan is to call 911 to get medical personnel in there to assist. That’s what they did."

Gallard said that it is the principal's responsibility to ensure a plan for medical emergencies in each building. The District has a first-aid policy with a flip chart of procedures, called the MEH-50, that the school nurse trains the staff to implement, he said.

While the state guidelines call for "specially trained and designated individuals." in addition to the nurse, who can render first aid, Gallard said the District's approach is for the nurse to train all school staff on first aid.

In an emergency situation, Gallard said, "we do not want to be searching for one specific individual."

He also said that the school nurse creates emergency plans for those students who have known special health needs or conditions and trains staff members who have been designated by the principal to provide support, "on a need to know basis. Such plans are written, placed in a binder that is accessible to the principal and referenced in the student's health record," he said.

Gallard said that it is the principal's job to ensure that the school nurse has trained all staff on the MEH-50 and first-aid procedures.

State guidelines do not require a full-time nurse in every building, and Jackson doesn't have one. Its nurse is there on Thursdays and every other Friday, although she was full time five years ago. The District has 179 nurses on staff, who must also service private and parochial schools, a number shrunk considerably by two years of budget cuts.

Gallard said about half the schools have full-time nurses. Those schools are determined based on their size and whether they have medically fragile students.

With the nurse cutbacks, nurses who cover several schools are now responsible to write more of these plans. 

As far as emergency response, Gallard said that the system worked as intended at Jackson.

"Jackson hasn’t had a full-time nurse for four or five years," Gallard said. "I am not trying to make excuses, but personnel were there -- trained CPR personnel -- the child had immediate assistance and was transported to one of the best hospitals in the nation. Those are the facts of what occurred." 

State guidelines do not require that there be people trained in CPR in every school, or that there be a defibrillator. Gallard said that all the District's high schools have defibrillators, as do some other schools with organized sports teams. Coaches and athletic directors, but not regular gym teachers, are required to be trained in CPR and in the use of the defibrillators.

This was the second death of a student this year who fell ill in a Philadelphia school without a nurse on duty, and the incident has stoked outrage over the District's decimated budget. 

Even Superintendent William Hite tied the District's financial plight to the child's death, which occurred while he was begging City Council for more funds. 

"During times of tragedy," Hite said, "our community should not have to question whether an extra staff member or program would have made a difference. We should all feel confident that our schools have everything they need." 

The tragedy, Hite said, "illustrates the serious needs and challenges that our students, teachers, staff and principals face every day."

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Comments (23)

Submitted by Helen Gym on May 23, 2014 2:12 pm

Wow. I would like to know how many school staff feel like they're adequately trained on first aid to tackle such situations and call themselves a qualified medical team who had signed up for this. I'd also like to challenge the District that Jackson was the perfect situation. Neither individuals who worked to save the boy's life were regular staffers. They were volunteers who happened to be in the building. If "crossing your fingers" is your best plan, this is the mentality that needs to be addressed immediately by parents and community members to refocus a priority on school safety - not school luck. 

Submitted by queensteach (not verified) on May 23, 2014 2:12 pm
I've been a teacher in the SDP since 1999 & I have never, ever been trained in First Aid or CPR by the School Nurse or anyone. That is a blatant lie. Such a policy has never existed. This is news to all the teachers and nurses of the SDP.
Submitted by Anonymous (not verified) on May 23, 2014 6:08 pm
All we got at my former school is what we get at my new school, a hall pass and a little packet of band aids...oh and lest I forget the little flip chart that we are to read while dealing with the emergency that is required to posted near the front of the classroom....heaven forbid if anything happens in the back of the classroom and you can't read the flip chart..... Linda K.
Submitted by Anonymous (not verified) on May 24, 2014 12:11 am
Same here. Been teaching since 1993 and never received any first aid or CPR training.
Submitted by Penny (not verified) on May 26, 2014 6:58 pm
You're right. SDP management has their heads up their backsides. They lie.
Submitted by Matt Mandel (not verified) on May 23, 2014 4:05 pm
Helen, Gallard's comments pale in comparison to those of Governor Corbett in a form response to those of us who wrote him yesterday. In it, Corbett: 1) attributes zero responsibility to his administration's budget cuts; 2) points out the Jackson's current nurse staffing situation predates his administration; 3) lays blame squarely at the feet of union leadership, who are "disconnected" from the city's teachers, for failing to negotiate in a way that puts children first. At least I respect Dr. Hite for acknowledging that schools are not properly staffed due to the underfunding of public education.
Submitted by Helen Gym on May 23, 2014 5:45 pm

Yup. I read that. Dr. Hite's statement is fine. My issue is Gallard's claim that ALL staff in school are trained to deliver emergency care in lieu of a medical professional in life or death situations - and that this is an IDEAL/perfect/non-troublesome situation - is a stretch to say the least - and in direct contradiction to Dr. Hite's comment yesterday.

Submitted by Anonymous (not verified) on May 23, 2014 6:09 pm
my pack of school issued band aids and the flip chart is NOT enough training thank you Linda K.
Submitted by Anonymous (not verified) on May 26, 2014 8:15 pm
You said it, Linda K. I am a teacher, not a Doctor, Nurse or EMT. Jeff P.
Submitted by Anonymous (not verified) on May 26, 2014 10:54 am
I never received CPR/AED/First Aid training while working in the district. I did it ON MY OWN because I knew I would be coaching a player with a heart problem. It was not until recently that all coaching staff is required to be certified in that. The only thing I was ever given was a box of band-aids and told not to give them directly to a student because that would be considered "administering first aid".
Submitted by Anonymous (not verified) on May 23, 2014 3:26 pm
Why wait for your district to train you in CPR - visit the red cross website and find a location near you..
Submitted by Anonymous (not verified) on May 23, 2014 5:36 pm
Are you serious! That's really not the issue. A certified nurse is in every school every day is.
Submitted by Anonymous (not verified) on May 24, 2014 11:46 am
As an administrator in the 90's and early 2000s I tried to have my staff trained. It was astronomically expensive. Our teachers pay for many supplies. Paper is rationed. Budgets are cut more every year. There are few if any nurses, counselors or school police. We had to depend on school volunteers! It's a travesty and must be addressed. As usual we wait for an emergency or 2 to occur before having a conversation and then it blows over.
Submitted by Lisa Haver on May 23, 2014 5:01 pm
"Jackson hasn’t had a full-time nurse for four or five years," Gallard said. "I am not trying to make excuses, but personnel were there -- trained CPR personnel -- the child had immediate assistance and was transported to one of the best hospitals in the nation. Those are the facts of what occurred." If they don't work for the school district, then they are not "personnel". How many children have been saved because there WERE nurses in the building? Isn't that the real question?
Submitted by Anonymous (not verified) on May 23, 2014 6:56 pm
they will NEVER answer that one because you make too much sense Linda K.
Submitted by Teachin' (not verified) on May 23, 2014 6:22 pm
There is no district policy mandating CPR for district personnel. It was a coincidence that they were there. And who knows that what the child needed was CPR?
Submitted by g (not verified) on May 23, 2014 8:30 pm
This comment is for Dale Mezzaccapa-PLEASE call the district out on these blatant lies.Please FORCE Gallard to admit that he has directly lied.The fact that such bold-faced lies have been told on such an important issue needs to be front page news.As a teacher-I hope to never be helplessly in a position to watch a child in my care suffer and die.Never in my 25 years teaching in Phila. have I been medically trained in anything. The only"plan" in place is to cross your fingers and hope you get through another day. Most days-nothing dramatic happens.However-chronically ill children receive haphazard care on a daily basis. For example-when there is no nurse to determine if a child is wheezing- the care is hit or miss. If the child has no inhaler at school(often) a secretary must determine if she must insist that a parent come get the child or if the child just goes back to the class and hope for the best. If a child (for any number of reasons)asks for his or her inhaler-and has one at school-the secretary must administer it-often leading to over-medication of a child-because a 5,6, or 7 year old is not always a good judge of his or her medical needs. All day long-school secretaries must make medical judgement calls. This is not fair to anyone.Dale-PLEASE do not allow LIES to stand.We are NOT medically trained and Gallard knows it.
Submitted by Teachin' (not verified) on May 24, 2014 8:28 pm
I agree. The district's comments need be examined with a more critical eye. There are no education reporters currently investigating the situation as is. Rather, they are throwing ia handful of facts in between some unverified quotes. Real investigative reporting would turn up so much more than the surface job every reporter in this city is doing.
Submitted by Poogie (not verified) on May 23, 2014 8:27 pm
There is box on the wall in my High School which says that a Defibrillator is inside moving said device from the basement to the 3rd or 4th floor would take hours the way we are organized. But let us assume that someone ran down three flights of stairs and ran back up with the defibrillator to assist a stricken student what happens then? 1. No one I mean No one has any idea how to use a defibrillator and the district offers no such training despite the flights of fantasy in Gallard's mind. Show me evidence of a training program in the past 10 years! 2. The thing is battery operated and battery powered. Since the Philadelphia Trial Lawyers donated the thing in the 1990s it has never been opened. You think the batteries are still Good? What does Gallard say about the district Defibrillator battery check policy? I am sure he claims there is one. Yet they missed my High School. Must be the fault of some teachers. Right?
Submitted by battlefront heroes hack (not verified) on May 28, 2014 1:22 pm
Hello colleagues, nice article and fastidious arguments commented here, I am actually enjoying by these.
Submitted by Angry Lady (not verified) on May 23, 2014 10:57 pm
Two years ago, my neighbor's daughter was a student at Constitution High and she accidentally bit the tip of her eraser off her pencil during class. The school nurse was not at the school that day and when the girl started choking because the eraser was lodged in her throat, they were lucky enough to have at the school a teacher who was also a registered nurse. He was able to dislodge the eraser from the girl's throat and get her breathing again. But I often wonder what would have happened to this child if CHS wasn't just lucky enough to have TWO registered nurses on staff. It's scary and we shouldn't count on dumb luck and coincidence to save children's lives.
Submitted by Anonymous (not verified) on May 24, 2014 1:32 pm
That teacher is no longer at Constitution High. Back to counting on dumb luck.
Submitted by Matt Mandel (not verified) on May 25, 2014 2:38 pm
Here' s an excerpt from Corbett's email reply to those of us who wrote him after this tragedy to implore him to increase funding: "Faculty and support staff across the Commonwealth are trained in First Aid/CPR to intervene in case of an emergency – as was done by the staff at Andrew Jackson Elementary School this week." Does this sound like he gets it? Like Gallard, Corbett seems to suggest that the school was adequately prepared and that this tragic outcome could not have been avoided. This is ridiculous in many respects, namely that most district employee do not feel "trained" (and the few who might certainly not by the SDP), and that those heroic individuals who labored to save the little boy just happened to be there,. Gallard (not his fault; he has his orders) and Corbett seem to confuse luck with preparation. I, for one, believe we will never know whether a full-time nurse at Jackson would have made a difference. But that's not the point. The point is should we be sitting around wondering if it might have? When it comes to health and safety, we should always err on the side of caution. Corbett concluded his email by saying, "The Commonwealth, the School District, the School Reform Commission and City Council are all working to contribute to the success of Philadelphia’s schools and students. I will continue to ask the union leadership to put the children of Philadelphia first and engage in a meaningful dialogue and a shared vision for the future of the children of Philadelphia." Again, it appears the implication is that Philly teachers remain the only adults in the state who don't have the best interests of children at heart.

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