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Why do schoolchildren suddenly die?

By Eileen DiFranco on May 23, 2014 05:26 PM

In my twenty-four years as a school nurse, I’ve called quite a few parents about all sorts of problems. There was the boy who dislocated his shoulder while hanging from the doorjamb and the boy who fractured his jaw. There was the little girl with the 104-degree temperature and the girl with the nosebleed we simply could not stop. I’ve called about seizures, asthma attacks, and lacerations needing stitches. Each time I’ve called the parent- even if I’ve called 911- I try to reassure the parents by saying, “Your baby is OK, but I’ve called 911 because….”

I simply cannot imagine calling the parent of that little 1st-grader at Jackson Elementary School on May 21. What can one say to coat the awful truth that their child collapsed in school and stopped breathing?
In the scheme of things, little children should not suddenly die. They are the healthiest segment of our population.
Consequently, there is always a lot of conversation and controversy surrounding a child’s death at school.  The first level of conversation always seems to want to ascribe blame. Someone must be responsible for a child’s death.
Sometimes this is true. Rarely, a child has a deadly, undiagnosed condition or allergy that appears seemingly out of nowhere and leads to a death no one could have expected or prevented. This is apparently what happened to little Sebastian at Jackson Elementary School. Other times, there are parents who don’t follow through on medical appointments, medications, or doctor’s orders. Or, there are trained medical personnel who do not immediately recognize a potentially serious problem, even when the child is taken to the emergency room.

So what can schools really do to protect children given the variables that cannot all be possibly controlled in a school setting?

The presence of a certified school nurse is one thing that will go a long way to protect the safety and life of children in school. Nursing literature, which includes numerous, long term studies about patient safety, has proven without a shadow of a doubt that favorable patient outcomes depend upon having an adequate nursing staff. While having ancillary staff trained in CPR is certainly to be desired, nothing substitutes for the watchful eyes and skilled hands of a nurse. Those institutions with low nurse staffing have poor outcomes.

Perhaps if the one-day-a-week nurse had been present, it might not have made a difference in the child’s survival. We shall really never know since Sebastian’s death resulted from one of those deadly conditions that come from nowhere and carry off the innocent without warning. The fact that we’ll never know brings no comfort to his grieving family. It should bring no comfort to anyone.

In the end what can be said about the death of a little child? There can never be a worse scenario. Parents send a perfectly healthy child to school in the morning, fully expecting the child to be sitting around the family table at dinner that evening. Then something terrible happens in school that changes that picture forever. The unexpected death of a child is every parent’s worst nightmare. People of good will should grieve with and for the parents of the little child from Jackson Elementary who died yesterday.

Aside from the pain and unbearable suffering of the parents, the children and staff at the school are also traumatized by a student’s death. Years ago, a seventh grader from the school where I was working died from an unexplainable infection. I will never forget the look on the students’ faces when the principal, the counselor and I walked into the room to tell them that their friend and classmate was dead.

Regardless of the cause of Sebastian’s death, much can be said about the current level of nurse staffing in schools that are plagued, often, by overcrowding, illness, poverty, ignorance, and violence. There aren’t enough nurses in Philadelphia’s schools. Nurses provide a much needed layer of safety in our grossly understaffed buildings where too few hands are expected to do many things, including saving lives.

Two of our precious children have died this year from emergencies that began in school. This should make all citizens of Philadelphia pause. The nurses who protested outside of 440 for six months after a hundred nurses were laid off in December of 2011 warned anyone who would listen that this would happen. Our warnings have gone unheeded.

The fact that Sebastian died from a deadly, undiagnosed heart condition does nothing to absolve the governor, the mayor, and City Council  from failing to fully fund our schools with a budget that includes adequate nurse staffing. Sebastian’s death is one more terrible indication that all is not well in our schools.

Eileen M. DiFranco, R.N., is a certified school nurse who has proudly served the schoolchildren of Philadelphia for 23 years. She is a lifelong resident of Philadelphia.

The opinions expressed are solely those of the author.

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Comments (7)

Submitted by Lisa Haver on May 23, 2014 9:46 pm
Thank you, Eileen.
Submitted by Anonymous (not verified) on May 25, 2014 8:39 pm
It's all true, Eileen. And THIS is precisely why the School District of Philadelphia is the workplace of absolute LAST resort for teachers. Sign on for wages that are far less than any surrounding school district pays, with far more challenging student behaviors than any other school district encounters - and if the pitiful wages and perpetually violent school house atmosphere don't discourage you - then how about the fact that working in Philly (even for a short while) virtually guarantees that you'll never get work in a suburban district, that you'll never know until September or October or December whether you'll get laid off, or whether your already paltry salary will be cut another 13% or 20% or whatever seems like a good idea at the time to 440, that you'll be working without a vice-principal or a counselor or art and music teachers or adequate security and custodial staff, that special ed services will be cut to the bone and those out-of-control "emotional support" kids (and their massive IEP's) will now be "mainstreamed' into your class of 40+ pupils - and now, with the threat of additional nursing cuts, that all those 504 kids with asthma and epilepsy and life-threatening allergies will be YOUR responsibility. And at the end of it all, you can be a 34 year old teacher like myself who - after 11 years in the SDP - looks 54, suffers from high blood pressure, ulcers and chronic fatigue, and wonders whether the hell she'll live long enough to collect a pension that even the most optimistic economic forecasters predict won't exist beyond a few more years. And to think ... for this I gave up a promising career at Burger King!.
Submitted by Anne Tenaglia (not verified) on May 24, 2014 2:22 am
Eileen, you wrote a wonderfully understandable essay on the situation and I thank u for it. I hope our nurses and counselors find their rightful places soon. God bless you.
Submitted by gloriaendres (not verified) on May 24, 2014 5:23 pm
Thank you, Eileen. Those who complain that some are exploiting this tragedy to milk more money for themselves are obscenely wrong. What I would like to see happen is for not only every school to have a certified school nurse on duty but that teachers and staff be trained in CPR and the Heimlich maneuver. When I was a young teacher we received such training, maybe once or twice. One of our teachers saved the life of a child who was choking on a piece of candy because she knew HM. Last year, while volunteering in a school, I observed one of the children with her arm in a sling. Upon questioning, she told me she had fallen from her skateboard over the weekend, and her parents had gone to Rite Aid for a sling and some Tylenol. Of course, the arm was 3 places, but there was no nurse on duty to call the parents and insist that she go to the ER. Only persistent calls to the home by other staff members resulted in the child being treated. after enduring a broken arm for 3 days. They were simply masking the pain with the Tylenol. Such events should make us all cringe.
Submitted by Anonymous (not verified) on May 25, 2014 9:52 am
well, this summer my plan is to take the CPR course offered by the Red Cross....hope never to need it and that my school keeps its nurse Linda K.
Submitted by Maura McInerney (not verified) on May 29, 2014 3:55 pm
Thank you for this incredibly thoughtful, compassionate commentary and for urging us to act to increase needed funding.
Submitted by Anonymous (not verified) on June 9, 2014 5:27 pm
I am stunned that you were able to contact the parents of students. In our experience, as many as half the numbers are incorrect. Students are counseled by parents not to provide the school with updates. Attempts to keep the list current overtax the lone secretary. Gush all you want, but a sad fact is that too many PSD parents fail their children by not troubling to enroll in the CHIP program, or neglecting to fill prescriptions needed to learn. A battalion of additional school nurses would make little difference other than bandage deeper issues.

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