Health Care in the School

I think that the simplest solution would be to have a nurse available for the most basic medical care. In my K-6, this was the case. In middle school and high school, there was no nurse on the campus, but we did have basic medical care for cuts and other first aid needs. In addition, we had athletic trainers for any sports related injuries. I really don't believe that there is much to do beyond this point without over addressing the issue. Since the nurse was not in that day, I believe that the right course of action was taken. I don't really believe that every person working in the school setting should have a medical background other than basic CPR training. On the other hand, I do believe that each teacher should be aware of any medical conditions that their students have. In the event that the condition occurs during school, the teacher should be able recognize and direct the student to the appropriate care giver.

Like everyone has already said, there are several things to consider that could improve care.  First off, all staff should be trained with basic healthcare skills so when situations like this occur, then staff would know that basic precautions or steps to take to help improve the situation.  Secondly, the office administration should be oriented to know where all the inhalers are kept and the method that they are labeled.  When I went to elementary school, there was one nurse for four schools.  The way they dealt with inhalers was there was a cabinet that clearly labeled and every child who had to take medication on campus had their own little labeled box.  This was an easy, organized system. Third, what was it that this girl was doing that actually worsened her asthma.  Was she running? Was she just sitting outside?  This is important to consider because it may be able to identify a trend of when she might have another attack, allowing staff to be more prepared in the future. Third, maybe the school district should consider having the inhalers be kept in the students actual classroom, under the supervision of the teacher.  The inhaler would be more accessible and each student would know exactly where to find it. Lastly, there needs to be more school nurses.  

The need for regulation, education, and planning in school health care.

Regulations on medication usage in schools is important to protect our children. However, these regulations should be done on a case-by-base basis. An asthmatic child needs to have his inhaler at hand at all times, where as a hyperactive child should not be given the same treatment because ritalin is not a drug that is needed acutely, and there is a risk of children sharing this drug. 

Education is key. The school faculty and staff need to have basic training in how to handle medical emergencies. This should include treatment of common acute conditions, basic CPR, and the specifics of the school's security system. Additionally the child needs to be properly educated on the severity of their own medical conditions and what to do in the case of an emergency. 

Lastly, the schools need improved planning for all emergencies. In the case of this school there should have been a back up plan for how to get to a child's meds when the nurse is unavailable. Additionally, it would be valuable for school aids to have emergency inhalers readily available. 

I have seen the light...thanks to Andrew "I think I might be British" Kamrouz

Just in case you haven't read it yet, the following is this week's blog entry of a fellow classmate, an esteemed colleague and good friend of Sir William Shakespeare, Andrew T. Kamrouz:

"This scenario has the makings of a Shakespearean tragedy in that so many things must and do go wrong for there to be an unfortunate outcome. As a friend of a number of asthmatics, I can say that most people with a propensity for asthma attacks should (and often do) carry their own inhalers, even in elementary school. Second, the office seems like it could use some organizing, and it may have been a good idea for the nurse to leave some instructions with the office assistant for the days that there will be no nurse on duty. Or at least label the cabinets so that the asthma meds wouldn't be mixed up with the bandaids and lollipops.

More pertinently, our healthcare system could use an overhaul so that a career in nursing is a bit more appealing, and 3 schools wouldn't have to share a single nurse (afterall, the need for nurses is ubiquitous in nearly every branch of healthcare). This could include the government subsidizing nursing school programs, offering higher wages and better hours for nurses, more attractive insurance policies, and other incentives for nurses working full time or in schools, etc. Perhaps we could also instate a universal healthcare system so that the parents of our unfortunate 9 year old wouldn't have to worry about paying for expensive inhaler refills, and she could see a doctor more regularly to keep her medication current and appropriate. And while we're on the subject of overhauls, the education system could also use more funding (so that they can afford a nurse for more than 1.7 days per week, not to mention the raising the quality of education), and we could also clean up the Port of Los Angeles and develop a very comprehensive, super green public transport system to lower the pollution level in the city so that asthma rates wouldn't be so high in the first place. Also, I'm a big fan of the metric system."

------------------

Now I'd like to take some time to address the serious issues that were brought up in an otherwise sarcastic and comical piece full of satire. Without questioning why our classmate has several friends in elementary school, it is important to understand that in some school districts, all prescriptions and medications must be filed and kept with the nurse. This was the case even at my high school (I remember because I was afraid that when my biology class got searched by drug dogs they'd find my stash of three Tylenols in a ziploc bag and I'd get into trouble...no joke). So although a lot of the author's pre-pubescent friends are smuggling drug paraphernalia in their Hannah Montana backpacks and Transformers lunchboxes, there are other ways to go about solving this problem.

As Mr. Kamrouz mentions, organization is the first big step to eradicating unneccessary hospital (or maybe even emergency room, if uninsured) visits by children suffering mere asthma attacks. The efficiency of a system in which occurrences like this go on is questionable at best. Simple labeling of drawers, cabinets, and files can make finding medications easier than receiving a government bailout. And if it takes too much time, have the kids do it in arts and crafts or in spelling class. They'll get a kick out of trying to spell albuterol and pirbuterol and it'll serve as a jumpstart to their pre-med education. If people know where things are when the nurse is at one of the other two schools, or just enjoying a day away from the kids because her mom called in for her, there wouldn't be such a scramble to find the necessary inhaler or medication.

The easiest solution, though, would be to hire a nurse at each elementary school, but I can understand why that money may go elsewhere, like getting a new playground where kids can have fun and sometimes get hurt and then go get the wound disinfected and covered with a bandaid from the....oh wait, scratch that (No, no not the wound, silly! The idea that the nurse would come to the rescue, duh). The point is that a lot of the money received from funding that we all pay through taxes is being spent on little things (unless it's a huge playground that'll fit someone my size), when it should be spent on things and individuals who are more ubiquitous in society, such as nurses.

Although I will not go as far as to say that I am a fan or even a proponent of the metric system (because I like it when I have to think and make complicated conversions....sike), I will say that I do enjoy a good ol' futbol (please note spelling) game from time to time. I'm not talking about a rivalry like Chivas USA vs. LA Galaxy (which ended in a scoreless tie...booooooringgg), but more like today's Liverpool vs. Chelsea matchup that was more up and down than funding for SB1. Actually, that's just been down so that was a terrible attempt at an analogy.

Bottom line is this, everyone has suggested everything that can be done to help avoid this situation and I think if we take the information from the prompt and couple it with the data in the Children's Health Study currently being conducted by elite members of the faculty at USC, we will find that the areas in California most prone to pollution are schools close to freeways. Elementary schools. With kids. Asthmatic kids. Innocent kids. So remember, help control the asthmatically attacked population and have your nurses and staff spayed or neutered...errr I mean educated and ready to provide the proper inhalers.

L-l-l-l-l-l-like a lollipop.

Oh, and Aaron, I feel you on the whole pocket thing, but I liked your Play Station analogy better because it made less sense and was more confusing...this pocket one reminded me of the metric system, so easy a caveman (or ogre) can do it. Maybe Andrew's a caveman and that's why he likes it better. It's all starting to make sense. I think the "T" in Andrew T Kamrouz may stand for Tor, an infamous caveman after whom Andrew's parents named him.

TOR:



ANDREW TOR KAMROUZ:



I mean he's even carrying a club in his hand and wearing a t-shirt in icy winter conditions. No way he's human. (And Aaron's head is almost the equivalent of the monkey on the real Tor's shoulder).

OK, I've spent two hours on this, I should really stop now.

It is unfortunate that 911 has to be called to treat something as chronic and frequently occuring as asthma. Better organisation is key to this issue with fair ground but having a school nurse at all times for elementary school kids is imperative. There is definitely a shortfall of nurses and is felt at more than elementary schools. An overhaul of the system is imperative to making nursing an attractive field. Currently the demand is more than the supply and this wouldn't be a problem if it was vice versa. Every school could have their nurse without a tug of war. Its high time for the government to reorganise the nursing system along with our health care.

Children do need to be trained on self care in case of chronic diseases though dispensing their own medications is not a good idea for young elementary school kids. Having teachers trained in management of most commonly encountered ailments is a good idea and can be enforced. Teachers could be well versed with their students and what ailments they suffer from and how they could be timely managed with appropriate medication.

school health care

All school staff should know the basic protocol on what to do in emergency situations and training should be standard. Its unfortunate enough that there is only one nurse for 3 different schools (another issue on its own) but if the nurse is out, there should be another person in the admin office who is capable of running the nurses station. And schools should have a more organized system for how medications are organized so that the nurse and any other staff member can find the proper medication in a timely manner.

Better organization of the inhalers, for one. They should be able to pick out the right one with their eyes blindfolded. Better training of the office assistant would be crucial, because he/she seems to be the weakest link in this scenario. The teachers should also be aware of who in their classes have what medical problems, have some knowledge about those problems, and be on the alert during high physical exertion activities such as recess. All teachers should all be trained in basic CPR and first aid, as well. If the nurse is not present, she should at least be available via pager, so that in case of an emergency at a different school, she can better allocate her time to treating that case first, even if it is over the phone.


The parents of the little girl should also inform her better about asthma and the family should sit down and talk to the nurse together about how to manage the attacks, or what to expect in the case of an attack.


But of course, if the asthma attack, or the medical condition, was severe, then it is better to call 911.

A Modest Proposal...

The ideal situation of having a nurse on call at all times during school hours for elementary students may not be realistic, given the budget line of most schools. Therefore, I propose the following: training teachers and staff. With an educated administration - one that is able to attend to students during certain medical emergencies including asthma attacks, chocking, minor injuries, etc. - schools will be able to better ensure the safety and well-being of students during times of emergencies. Having a two to four week program where teachers are given the tools necessary to provide first aid and basic care by nurses and physicians would not only be cost-effective, but inject a breath of life and confidence to teachers and staff in being able to assist a vulnerable population (like elementary kids) during a time of need.

The answer is simple... if health was a priority...

Factors to consider to improve care for this girl?
(1) competent and organized staff
(2) on-site nurse every day
(3) protocol/policies on how to have youth understand their health
(4) protocol/policies on how to have staff deal with situations like these

which pocket do you keep your stuff in

It may seem like a simple concept, but do you know which pocket you keep your stuff in most of the time? I usually keep my phone in my right pocket, my wallet in my left pocket, keys in my left back pocket, and random papers/coins/whatever in my right back pocket. It may seem like a simple solution to have the nurse handy every day, but with our economy, that just seems like something that would be more difficult to attain than how it sounds. So there should be some sort of organizational system in this administration office, perhaps with different cubby boxes for each class, or organized by last name. Organization is key when youre trying to find your things. If I hear my phone ringing, I don't want to have to go through every pocket (especially if I'm wearing cargo pants) to find where my phone is. If there is a simple organizational system that the administration knows regarding where the medications are, then it should not be a daunting task to find the kid's medicine. Also, all these medications should be stored in a place where it is easily accessible by staff only, via a special key always on hand. They have keys to the classrooms, why not also carry around this other key? Imagine having to find someone to unlock your pocket in order to get your phone, and youre not even sure which pocket it's in? Ridiculous! Organize! Find it fast! Forreal!

School Nurses and Health Ed

Unfortunately, I believe scenarios like this happen all too often. Some are minor incidents while others can be life threatening. In this case, the child's inability to breathe properly could have been detrimental and have been a tragedy for all parties involved. By not having a nurse on call or on the premises, the school has the potential to be liable for incidents similar to this one. To remedy this problem, every school should have their own nurse or at least a health trained official during school hours. Educational health classes should be mandatory for all teachers, staff and aids. In addition, if the child has a legitimate health problem a note from the parent and/or the doctor should be on record in the school office allowing their child to have unrestricted access to their proper medications without having them be stored in an office where improper storage can cause confusion as was the case in this scenario. Furthermore, children at the age of nine, for the most part, are very aware of their health issues especially if they have chronic issues and should be granted the ability to carry with them their meds which can save their lives.

A simple measure

Ideally, there would be a school nurse always on campus....

I agree with those proposing an improvement on the way in which the medications are stored and managed. I also think that care could be improved by simply educating students on what measures to take when they experience or see a classmate having some sort of medical emergency. An "emergency plan" would, for instance, avoid wasting precious time trying to finding a teacher to take an ill student to obtain care.

more school nurses?

One day at school, a 9yr old child with asthma starts to have difficulty breathing during recess. The school has a policy that meds must be kept in the admin office. She finds a teacher to take her to the office, the office assistant struggles to find her inhaler among many, and the problem worsens. The teacher calls 911 because the school nurse is not on campus that day (the nurse is shared by 3 schools). What are some of things you might want to consider to improve care for this girl?

The best way to improve the situation is to provide school nurse in every school although it will take a lot of funding. If unable to provide school nurse in every school, then we should have regulation on medicine that school provide. Once a year, there will be an inspector coming to school and check if the medicine are appropriately categorized in different cabinets and if the medicine are not outdated or expired. I understand to provide each school with a school nurse is nearly impossible, therefore, I think maybe school officers could go into training to have basic knowledge about medication and any possible kind's illness symptom. I believe the training session that school district provide once a half year or once a year wouldn't be too difficult with budget.

There are a lot of things that could have been done differently to prevent this situation from happening.  However, aside from hiring a school nurse to be full time, the idea of an admin office storing all of the children's medications is absurd.  It sounds like this school is storing medicines for serious conditions in the same manner they store books and other school supplies.  One significant change could involve the children keeping track of their own medications, such as inhalers, so that it does not become a chaotic mess.  The problem here is obviously the age of elementary school children and the notion that they probably shouldn't be dispensing drugs themselves.  However, there may be a way around that.  If the child is taught by both the parents and the physician on how to take their medication, there is no reason for the situation described above.  

Of course, there are exceptions to each case and there would still be a need for a nurse's office and for some medications to be kept with them.  Yet no child should have to suffer, especially when the solution should have been so readily available.  Health care in the school systems are not going to be amazing based on school district funds and the number of students, however, they should be at least at the minimum standard of care and not endangering the lives of these students.

School Health Care

School nurses are good for a lot more than emergency situations and administering medicine. They can play a valuable role in the health of school children on a regular basis. When I was in elementary school our school nurse would visit classrooms once a month and talk about keeping healthy and active. Whether it was a topic on flu germs or hygiene we'd always get some sort of worksheet to fill out or play a game. She created a bond with the students at the school that made learning about hand sanitizer incredibly interesting to a third grader. A good school nurse is so valuable to the growth of young children. They spend the majority of their time in school so to neglect their health and safety during those times is an incredible disservice to their growth into healthy adulthood. 

As other said in regards to the scenario, it is obvious that stretching one nurse between three schools is irresponsible and that money needs to be allocated within the school system to ensure that nurses are available at each school in case of emergency situations. I can understand the logic in not allowing kids to keep their own medicine but if this is going to be a rule then there needs to be a very organized way of keeping these medicines so that any of the staff can respond quickly in case there is an emergency and the nurse is not in the vicinity. 

Training for administration staff

I agree with Hailin when he said the administration staff should be trained to handle medication storage. Since they cannot administer medication, it is necessary to have a trained health care professional on staff, even if not a nurse. If the child would have died, the school would have been responsible for the death because they did not have a trained professional on the premises or because they medication storage was inadequate. The policy where medications must be kept in the office seems like a sensible enough but would do much more good if the office was in a central location to the school premises and this is not always guaranteed. Some people may argue for medicine to be store in each classroom, but this would underestimate a student’s chicanery, even in elementary school, not all teachers are so careful, and it would be harder to keep track of expired medications, if there are so many classrooms.

Rules are Usually There for a Reason

I get the feeling that there's more indignation about the student not being able to carry her own meds than about larger systemic issues regarding the school-based healthcare system.

Since there is only one federal law regarding healthcare in schools (all schools must provide services for children with chronic conditions under the American Disability Act), the regulations for each school district can vary widely. However, it seems that every school has a rule that medications must be kept in the admin office.

This is probably for the students' own good, because apparently medical errors in schools are very high (according to a large survey of school nurses in 2000):

"Errors included giving an overdose or double dose (22.9%), giving medicines without authorization (20.6%), giving the wrong medicine (20%) or unspecified mistakes (29.8%)."

You might think that this is more an indication of short-staffing or lack of training on the staff's part than anything having to do with the students. However:

"A major factor in medication errors was the use of "unlicensed assistive personnel" such as school secretaries, health aides, teachers, parents, and even students, to administer medications. Only 25 percent of the nurses said they administered all the medication in their schools. The other 75 percent said that unlicensed personnel dispense medications to students."

So this suggests that schools started locking up students' meds because the students (or other unlicensed people) weren't doing a great job of administering it themselves, or were being irresponsible and sharing, trading, or selling their meds (which I wouldn't put past high school students), or there were threats of lawsuits or other pressure from parents for the school to keep a better eye on their kids' drugs. Whatever the reason may be, schools seem to have come to some unanimous agreement that meds should be regulated and placed out of students' reach.

This is probably legitamate for elementary school kids, who normally get their meds in monitored doses under their parents' watchful eyes, but I seriously doubt kids in middle school or high school have trouble taking care of themselves, especially if they have a chronic condition that they've probably been lectured and trained on since their diagnosis. But for that 9 year old, I honestly don't know which scenario is worse: one where an ambulance has to be called because her meds weren't readily available, or one where an ambulance has to be called because she accidentally misplaced her own inhaler.

In any case, the rules are there for a reason...and there's probably no changing it with all parents backing it up. A better solution may be to look at this at the systemic level, and ask why there aren't enough incentives for medical practitioners to work in schools.


Source: McCarthy, A.M., Kelly, M.W., Reed, D. (2000). "Medication administration practices of school nurses." Journal of School Health, 70, 371.

We can do it without nurse

The first question that came to my mind is: what's her parents doing?  If this girl has been diagnosed of asthma, her parents have the responsibility of educating her the basis and precautionary measure of asthma.  If the girl had the inhaler with her at that time, things would be a lot easier.

Next, when I went through the text, I found something else that could be improved in this scenario.  

1) Medication kits should be kept at where they could be obtained quickly at need, instead of so called "admin office".  What if the door of the office is locked?

2) The office assistant should be familiar with the meds kept there, instead of  'struggling to find her inhaler among many'.  Otherwise I cannot understand why this kind of admin office exists.  Maybe med appliances are part of school property so they should be kept carefully?

Of course short of nurse is a problem, and there's a lot of reason for us to solve it.  But I want to address that, if the system I mentioned above is functioning well, the girl's asthma problem could be solved more efficiently, even without school nurse.  We are facing health care worker shortage, so would it be possible for us to consider alternative approaches?

I think one of the most unfortunate things about this story is that it could easily have been prevented. We're talking about a misplaced inhaler here. Although the bigger problem seems to be that there is a shortage of school nurses (1 circulating between 3 schools), I think at the bare minimum schools should ensure that medicine and simple medical supplies are easily accessible and organized.

It really should not be too difficult to arrange a space to place inhalers, medications, and splints for minor injuries. Sure schools can make a valid point that they lack funding for nurses or that there is a shortage of nurses, but it is their responsibility to ensure that a child will be able to access his/her inhaler when needed. There is absolutely no reason why the school can not designate an organized system for filing medications and medical supplies for children. How hard is it to purchase a sterile bin or any storage container for an inhaler? Schools simply have no excuse for not ensuring a rudimentary system for basic health care needs for children. Plain and simple.

Lets just use robots instead!

 The tidbit about the poor asthmatic girl not receiving her inhaler illustrates the key problem of the nursing shortage going today.  I started pondering a viable solution to the dilemma and concluded: why not robots?  

They were already used in the LA county hospital (as we recently saw on our class hospital tour) and they seemed to be doing an adequate job of supplying patients with their necessary medications.  Why is it that this same approach can not be applied at school?  Sure, costs would skyrocket, we'd lose all human contact, interactions, and diagnostic skills but hey, all the children would at least be safe :)  I know this might seem a bit far fetched and I'm certainly being a bit tongue and cheek about this dire situation. But in reality,  might not be far from the truth.  

"Substitute Nurse"

I completely agree to what has been mentioned already. Having a nurse on duty during school hours and even during after school hours when kids are still present on school grounds is necessary. Young children at school are constantly getting sick, spreading germs, getting hurt, and are in need of basic health attention. Every child should have documented records of what their physical and chronic ailments are stored at their school’s adminstrative office and health office. Like any absentee teacher who is replaced by a substitute teacher, an absentee school nurse should also have a proxy. A child’s health and well being is equally equivalent to a child’s academic success. Local county or state level governments need to standardize protocol for the healthcare and nursing of kids at school. What happened to the asthmatic child at that one school is unacceptable. The government needs to intervene educational institutions to ensure their safety. Possibly, say for instance, the LA County Department of Health Services and Los Angeles Unified School District can colloborate to create both structural and process changes to the school nursing system. Another way to ensure child safety at school is to re-licensure nurses and provide continual training for them.

From Idea to Action

There are many good ideas being posted in the blog so far. Everything from ideas as simple as organizing drawers to having dedicated school nurses for each school are all valid solutions that address the issue raised by the hopefully hypothetical situation in the prompt. The difficulty in making such moves lies in the logistics and the resources available to school districts. Private schools are somewhat removed from this debate as they rely on their own funding and usually have adequate services for their students. Public schools however, have limited resources and even more limited control over changing their circumstances. Having a dedicated nurse would no doubt eliminate such a problem. Having office administration that is aware of each child’s medical condition would of course increase efficiency during times of emergency. With so many students and so little staff however, such ideas remain just that, ideas. I would agree with the other bloggers in their recommendation of having teachers responsible for each of their students’ medications. This responsibility is a little easier to take than the large scale project of making the administration responsible for the whole school.

school health care

In the case of this child, the school's policy of keeping medication locked up without anyone monitoring access is counterproductive. I can understand the safety measure of locking up medications but only if the school nurse or another informed staff member is available during all school hours. If children can't access the medication they need within the critical time, then the protocol in place is useless. If a full time nurse isn't affordable for the school, maybe the responsibility for student's health can be spread out amongst the teachers. For instance, each child that needs a particular medication can be assigned to their homeroom teacher and records can be kept so that if emergencies such as this occur, that particular teacher will already have knowledge about how to adminster and access the medication for that specific child. It would take more effort on the already strained role of teachers, however without an increased budget there are limited options when working within the system.

School Care

I think that one of the most important things to recognize is that there is only one nurse for three different schools. Had the nurse been at school that day, the girl's asthma would not have been so bad because she would've received access to her inhaler earlier. I think that schools only recognize how important it is to have a nurse at school everyday when problems other than "playground scrapes" arise. Another way to improve care is for the teacher's to be aware of the students who have more serious illness so that they can be better prepared when an emergency occurs. In addition, the office should organize the medications, either via grade level, last name, etc. so that if there isn't a nurse around, someone in the office could effectively handle the situation.

School Health Care

There are a couple of measures that could have been taken to prevent such a dilemma from happening. First, the school should consider revising its policy about meds to allow students to keep medication on them, or at the very least with the teacher in the classroom. An explanation of the child's situation and any special instructions could very easily be explained to the teacher by the parents or guardians. That way, the office assistant isn't burdened with the additional task of organizing ALL the students' meds on top of the many duties he/she already has. Second, there should be a school nurse at each school, as opposed to sharing one nurse for 3 different schools. It's understandable that this is perhaps the situation in many schools today, especially considering the budget cuts that many schools have faced. However, it is situations such as this with the 9 year old child that should send a wake up call to those who delineate where our tax dollars are allocated to. Although it may seem like they are saving money by only hiring one nurse for every 3 schools, in the long run this may be even more costly than it may appear. For instance, if something serious were to happen to the 9 year old child, the school then becomes vulnerable to lawsuits by the parents and subsequently can even damage the reputation of the school (thus costing them even more money).

Training

I think the most important thing to address is the fact that one nurse is being shared among 3 schools. I think there should always be a school nurse on duty in case there is an emergency. What do these schools do when a child gets sick and there is no nurse on duty? Do they just send the child home because there is no one to take care of them? I think that would lead to a lot of upset parents who have to pick their child up from school for something that could've been treated really easily by the nurse. Maybe what the school should do is have that one nurse as the head nurse and allow her to rotate through other schools, but have her train someone for when she isn't there. That way, there is always someone trained in the office. Or even, maybe the nurse should have one day where she shows everyone in the admin office where everything is stored so that they will be able to find things quickly. 

Some of things I would consider improving so the girl can get the adequate care she needs is organizing the drawer so the inhaler is easily located and making sure the person administering the medication is adequately trained. However, regardless if this is implemented there are many things wrong with this picture. First of all, why is there only one nurse shared by three schools? So let’s start by having a designated nurse per school. Next, making sure the nurse is up to date with her credentials and placing the nurse in a designated health care facility/bungalow on school grounds. The nurse would also be responsible for keeping track of all of the children’s medical records. I would think that if the nurse was on school grounds during an emergency crisis it would greatly reduce the number of dispatched calls to the emergency medical call centers which would perform a simple technique of administering a breathing medication which could have been done by the nurse if she/he was around. It’s very tragic that schools have to reduce their budget by designating one health provider for three schools. Especially since accidents are bound to happen often considering the amount of time children spend in school.

Things to improve in school health care

The biggest problem with this scenario is that the inhaler was hard to find. Therefore, the biggest improvement is naturally to make the inhaler easy to find. A simple filing system would do, where each child with medication has their own file in a cabinet. Then, when and if the need arises, all an "office assistant" or any other staff member would need to do is find the name of the student and pull out the appropriate medication, or in this case, inhaler. I understand the policy for not having kids carry around their own medication, but if that's going to be the policy, there has to be a better alternative.

Second, I would strongly advocate for a single school nurse to be assigned to full time duty at each school. However, I don't remember a time when that ever happened in my public school education in WA, so I doubt it will happen, especially when funding is already tight. In this inevitable case, I agree with several previous posters that some simple instructions need to be laid out so that an arguably unnecessary call to 911 can be avoided. There should be an accessible, widely known location where the key to the cabinet (in the improved filing system noted above) is kept, so that all staff members can have quick access to these meds that might be able to save a kid's life. Accompanying each child's medication should be easily understood instructions for administering the medication, in order to make the process as easy and quick as possible.

Lastly, I would encourage a general training day on how to use the most common medications, along with emphasizing the need for quick recognition of common symptoms like asthma attacks. This scenario is highly preventable, and with a bit more careful planning could be mostly avoided if there was a simple, streamlined process for administering the medications that are required to be stored.

School Health Care

I think that California budget takes money away from schools causing them to make cuts that may have adverse affects to the students. The sharing of nurses can present many problems to the children on a school campus. It is imperative that a nurse be available on campus at all times for situation that may arise. Another problem is that the medication of students should be well organized and easy to find. There is no excuse for the mad search to find her medication. I am not sure why children are not allowed to have their own medication. I feel that when they are responsible enough, such as a nine year-old, they would be the best person to know how to administer it and when to administer it. I also feel that teachers need to be aware of medical conditions their students may have to ensure a quick response if something did go wrong and so that they can keep an eye out on the children.

Policy Change and Organization

First off, I question why the school has a policy that medications must be kept in the administrative office. When I attended elementary school, the children had their inhalers in their bags or in their pockets. It was easily accessible and it did not get mixed up with other children's medications or inhalers. Furthermore, even if the nurse is shared by 3 schools, the very least this nurse and people in the administrative office should do is clearly label the medications and inhalers to whom it belongs to with specific instructions. The inhalers and medications should be extremely organized and in a room where extreme heat or cold will not detrimentally harm the medication's efficacy. Children's lives are at stake when medications are unorganized.

It is unacceptable that the school has the medications all mixed up and 911 has to be dialed. If this was my child in this situation... and my child is okay after dialing 911 and being care for by emergency treatment... at the very least I would demand that the school organize the medicine and consider changing its policy that medications must be kept in the administrative office. If no changes are made, I would go to the school district and state and file a lawsuit so changes are made.

School health care

There should be a school nurse working at every school instead of one being shared by three. But given the budget cuts, especially if this is in California, is it not uncommon to hear. Instead, maybe they can have an on-call nurse who they can contact if there is an emergency. And the school can also clearly label medications such as inhalers for each child and make the name and instructions very clear. If getting a nurse for each school is not an option, the school should get a nursing assistant or medical assistant, or any other health professional that would have more experience than an office assistant.

Fair is foul and foul is fair.

This scenario has the makings of a Shakespearean tragedy in that so many things must and do go wrong for there to be an unfortunate outcome. As a friend of a number of asthmatics, I can say that most people with a propensity for asthma attacks should (and often do) carry their own inhalers, even in elementary school. Second, the office seems like it could use some organizing, and it may have been a good idea for the nurse to leave some instructions with the office assistant for the days that there will be no nurse on duty. Or at least label the cabinets so that the asthma meds wouldn't be mixed up with the bandaids and lollipops.

More pertinently, our healthcare system could use an overhaul so that a career in nursing is a bit more appealing, and 3 schools wouldn't have to share a single nurse (afterall, the need for nurses is ubiquitous in nearly every branch of healthcare). This could include the government subsidizing nursing school programs, offering higher wages and better hours for nurses, more attractive insurance policies, and other incentives for nurses working full time or in schools, etc. Perhaps we could also instate a universal healthcare system so that the parents of our unfortunate 9 year old wouldn't have to worry about paying for expensive inhaler refills, and she could see a doctor more regularly to keep her medication current and appropriate. And while we're on the subject of overhauls, the education system could also use more funding (so that they can afford a nurse for more than 1.7 days per week, not to mention the raising the quality of education), and we could also clean up the Port of Los Angeles and develop a very comprehensive, super green public transport system to lower the pollution level in the city so that asthma rates wouldn't be so high in the first place. Also, I'm a big fan of the metric system.

School Based Health Care System

I think we could do a number of things to provide a better care to the girl in this scenario. Splitting the time between 3 schools by a school nurse, is not an effective way to provide better care to the girl in this case. The school needs to recruit more nurses or nurse aides.

First of all, we could provide better education to the parents of the girl and family, regarding proper asthma management. If the girl had known history of asthma, her parents should have provided her with the inhaler or similar toolkits all the time, especially if she had experienced similar episodic asthma before. But, if it is the first time, the school has responsibilities to provide better care of the girl. It’s unnecessary to call 911 just because the school nurse isn’t available to find the inhaler.

The School Based Health Care Centers or Clinics should be well in placed at school and at least one health care provider should be available. In this case, the problem is the inaccessibility of school nurse in time of need. There can be a number of ways to avoid similar problem like this in the future.

One way to address the issue, is to recruit volunteer nurses or nurse aides to work in part time or to be able to accessible on campus, to cover the school nurse absence; especially when something like this happen. They have to make sure that at least one health care profession is available during school hours.

There also should be health policy that would promote partnership between the school and nearby community health center. By establishing a formal link with nearby community health center, pediatric nurse can be readily available whenever needed or can help coordinate care when the school nurse is not available.

So, health policy makers should advocate the policy that gear towards the establishment of school-based health centers (SBHCs) and integration of SBHCs and community based systems of care, as a way to improve access to health care for all school children in the future.

organization and planning

In the depicted situation, organization is definitely very important. The medications the children need if they are put in the office should have been organized in an efficient manner so that they are easy to find. In addition, like a good emergency plan, the teacher, students, and any other involved personnel should have had a plan in place when any students needs help or medication. Just because the school nurse isn't around does not mean the rest of the staff at school should not know what to do. In addition, there should be a back up plan for the medication. Perhaps, the teacher of the child can store the medication in her classroom in a locked cabinet instead of everything at the office. Schools can be very large and sometimes the time lapse is the msot crucial part of saving a child's life. They could also hold mock emergency trainings with the children so they each have a role in case there is a child who needs medicaiton or any other emergency.