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First Aid classes | States should require cardiac emergency response plans in elementary

Comprehensive cardiac emergency response plans can help schools save more lives, and should be required by state law, according to an American Heart Association policy published in the September issue of School Nurse.

Intended for elementary through high school personnel, healthcare professionals, boards of education and school safety advocates, the policy statement provides guidance for developing, implementing and improving the response to cardiac arrest at schools and school-sponsored events.

“This policy is focused on the school itself and keeping the students and staff safe,” said Kathleen Rose, R.N., co-chair of the panel that wrote the policy and consulting school nurse to the National Association of School Nurses. During a 30-year career as a school nurse, she has responded to cardiac arrests in students and visitors.

Nearly 64 million students and staff are at schools every day, according to the U.S. Department of Education. An estimated 7,000 children have a cardiac arrest outside the hospital and only 7 percent survive.

A school response plan that allows responding within a few minutes of a cardiac arrest can greatly improve someone’s chance of surviving. According to the policy, immediate CPR can double or triple the chances of survival, and a shock from a defibrillator within three to five minutes may increase survival as much as 50 percent to 70 percent.

Because vigorous physical activity can trigger cardiac arrests, “A lot of states have cardiac emergency response plans in athletics,” Rose said. However, cardiac arrests do occur in students who aren’t being active, and in adults at schools, so cardiac response plans give everyone “the opportunity for a rescue,” she said.

Although some students have known heart conditions and school nurses develop individual school plans to keep them safe, other students have conditions like long QT syndrome that may go undiagnosed until they have a cardiac arrest, Rose said. Long QT is an inherited heart rhythm disorder that could lead to cardiac arrest.

The policy recommends every cardiac emergency response plan include these minimums:

  • establishing a cardiac emergency response team;

  • placing and maintaining automated external defibrillators;

  • training response team and staff in CPR and the use of AEDs;

  • practicing the response through regular drills;

  • establishing a method to activate the team during an actual emergency;

  • disseminating the plan throughout the campus;

  • integrating the plan with local emergency medical services; and

  • reviewing and evaluating the plan to make ongoing improvements.

A federal or state requirement for schools to develop a cardiac emergency response plan “will have a huge impact on the survival rate, because everyone will be working off the same game plan,” Rose said.

However, it is also important that states give schools the flexibility to develop response plans based on their particular requirements, she said.

For example, larger schools may have more than one building, so to get an AED to a cardiac arrest victim’s side within the recommended three minutes might require the school to have multiple AEDs and response teams, she said. An AED is a medical device that analyzes the heart and shocks the heart to try to reset it during cardiac arrest. Multiple response teams may be necessary for schools with extended before or after-school care, she said.

CPR and AED training and regular drills are also recommended in the policy. “When [a cardiac emergency] actually happens, it’s not unusual for someone to freeze until they’ve done it enough times that it becomes second nature,” Rose said.

The policy statement calls for state laws, regulations and related educational standards to mandate the minimum plan requirements. It also urges state appropriations to help schools pay for the plans. Connecticut, Indiana, Michigan and New Jersey are currently the only states that require a cardiac emergency response plan in K-12 schools, according to the statement.

There are 34 states that require CPR training for all students as a high school graduation requirement

Only six states require all teachers to be CPR-trained, according to the policy statement. “Making the assumption that all teachers are already trained is incorrect and gives a false sense of security.”

“It takes the district being willing to take action” to make the programs happen without state funding, Rose said. She suggests rallying support from parents, the PTA, community groups and private foundations.



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