EpiPen Emergencies on School Buses

Have you investigated how a school bus emergency would be handled with respect to an allergic reaction? 

Is your child allowed to carry an Epi-Pen on the bus?  If so, is the bus driver trained and authorized to administer it?  If not, do the local ambulances carry Epi-Pens?  What is their average response time?  What is the method of communication between the first responder or ambulance and the school personnel?  I.e.  How will the first responder be made aware that your child has food allergies if the child is not able to communicate this effectively? 

I asked these questions of the school, bus company and local fire department.  The fire chief took it upon herself to work out a plan with the others to handle school bus emergencies especially with respect to health issues such as food allergies and asthma.  It took from September through November to arrive at the plan and even a bit longer for all aspects of the plan to be put into place.  It is important to be respectful and patient when working with these authorities.  It may take several months to work out a plan.  Here is a summary of the plan that was worked out in our town. 

Summary:  Over the past three months an effort was made to review and put into place a process for handling an emergency on a school bus.  A special consideration was made to discuss how children with health issues would be identified and treated in such an emergency.  These health issues might include food allergies, asthma or diabetes.

Purpose:  This emergency plan addresses the issue of if there is a bus accident or other emergency, how would the emergency responders identify which children have special health considerations or needs?

Plan:  It was decided to establish a password so that the Officer-in-Charge (“OIC”) can provide the password when communicating with the school personnel at the time of an accident.  Once the password is communicated, the school personnel will access the database on the computer system at the school.  This database contains the health information of students as provided by the parents via the health information forms. (If parents do not fill out or submit the forms, then their children's health information will not be in the database.  Parents can ask for a form to resubmit or update their children's health information at any time.)  This database can sort the students according to which bus route they are on.  So if a bus has an accident, then all students on that bus along with the health information can be pulled up and provided to the OIC at the scene of the accident.  (It was decided not to store this information on the bus because bus routes may change at the last minute due to breakdowns or change in personnel.)

The current method of communication will be cell phones.  Regular radios will not be used because they are not private and would therefore violate HIPPA laws.  Funding is being sought for purchase the private channel over which the radio can be used to communicate the health information.  This solution will provide more reliable communications than cell phones and will be in compliance with HIPPA since it will be over the private channel. The cost is about $3,000.  This cost has been submitted as a budget item and will need to go through the process of getting placed into the budget.  In the meantime, the cell phones will be used so that information can be obtained if needed.  A dispatching policy is now in place to notify the proper individuals at all schools when a bus accident is reported. 

A first responder is the police, fire department or ambulance.  The only medication that the police or fire department can administer is oxygen. Our town’s ambulance has EMTs, not fully trained paramedics, but the EMTs are trained on the use of Epi-Pens and medication for diabetics and they carry these medications in the ambulance.  If this higher level of medical care or medication is required, then the R5 ambulance out of the neighboring city is dispatched, which takes about 12 to 15 minutes on average to arrive at the scene.  This ambulance has fully trained paramedics. 

Time can be critical if the emergency on the bus involves certain health issues.  For instance, if a child has an allergic reaction and is going into anaphylactic shock, they need to receive a shot of epinephrine from an Epi-Pen within 20 minutes.  Because the number of children with food allergies is rising at a rate of 20% per year, parents are bringing this health issue to the attention of the officials so that an increased awareness can be had.  Currently 4%-8% (or between 1 in 13 or  1 in 25) of children have severe food allergies—or three million nationwide.   Other health issues that have critical timeframes are asthma and diabetes. 

Open Issues:  The above plan was discussed and agreed upon, but two outstanding issue remain open.  (1) One is a budgetary item for a private radio channel—in the meantime there is a work-around.  (2)  The other is the reliance upon parents to provide the health information form to their schools so that the school’s database system has up-to-date health information on the child.  In other words, no matter how good the plan is, if the parents have not provided the information, then the children’s health issues will not be known to the emergency responders.  For this reason, a health information form will be resubmitted to each of the parents in the region’s four schools, along with this summary and the request for the information to be completed and sent back to the school. 

Your opinion:  What do you think?  Does your town have a plan?  Has the school communicated it to you?  Please share your ideas and experiences.