May 23 — 6:26 pm, 2014

Why do schoolchildren suddenly die?

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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