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

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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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Dale Mezzacappa

@dalemezz
Dale is a contributing editor at the Notebook. She has reported on education since 1986, most of that time with The Philadelphia Inquirer.