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Why many schools have launched lifesaving sudden cardiac arrest program—and how yours can too.
“Schools touch lives,” says Debbie King, RN, school health services coordinator in Georgia’s Fayette County, on the outskirts of Atlanta. “We have more people moving through our buildings than any business in town.”
A school is the quintessential public place—teeming with students, staff, faculty, parents, grandparents and visitors arriving for plays and recitals, homecoming games and graduations, fairs and community meetings. And anywhere large numbers regularly congregate, there’s a chance someone will collapse from sudden cardiac arrest (SCA), as upwards of a quarter of a million Americans do each year. That person will likely die unless there is a rescue plan in effect—which is exactly what public health experts recommend for such venues as shopping malls, sports stadiums, and, yes, schools.
Of the many public places that employ such plans, schools may offer the best opportunity for a good outcome: Washington state researchers found that 79 percent of cardiac arrests at schools were witnessed, compared with just 62 percent at other public locations.
King embraced the concept of SCA programs in 2003. “I’d been a nurse for 20 years and always believed people at schools should know CPR,” she recalls. “As soon as AEDs came on the market, I wanted one.” King reached out to a local physicians’ organization and the county’s EMS system, which donated the first AED units to the schools. Together they developed AED guidelines and policies to present to her school board. And soon, a first-rate SCA program was born.
Today, all of the Fayette County Public Schools’ nurses and their back-ups undergo CPR/AED training, along with one faculty person per grade and all phys-ed and health teachers. Coaches attend a first aid program, which includes CPR/AED use; the 250 bus drivers and 250 after-school staffers take a CPR course as well. As teacher’s assistants are hired, they, too, complete CPR training, as do all ninth-graders through their health class. And King isn’t finished: “My personal goal is to have a CPR-trained person in every classroom,” she says.
One of a school board’s main responsibilities is to implement essential safety measures, such as installing fire extinguishers in school buildings. SCA preparedness should have the same high priority, according to Maureen O’Connor, an advocate of school-based programs and manager of the public access defibrillation program for San Diego Project Heart Beat, an organization dedicated to combating SCA.
“Death from sudden cardiac arrest is not age-, gender- or health-specific,”O’Connor explains. “Every year, approximately 7,000 U.S. children are stricken, most often at school, because that’s where kids spend the majority of their day—in class or in after-school care or playing sports.”
When it happens, child and teen victims are subject to the same scary statistics as their elders: Without immediate intervention, only 5 to 10 percent will survive. But if the “chain of survival” is implemented, survival rates can reach an astonishing 70 percent. “Ask any fire fighter,” says O’Connor. “They’ll tell you that AEDs are used more than fire extinguishers.” (For more information, visit http://www.sdprojectheartbeat.com.)
Convincing a school board of the need for an SCA program shouldn’t be difficult, but it does take preparation. In 2002, Jeannie Salvadori, RN, was the district nurse in Southern California’s Carlsbad unified School District when she was approached by parents who had lost their 7-year-old daughter to sudden cardiac arrest and wanted AEDs placed in the schools. Before Salvadori addressed the school board, she elicited support from her school superintendent. “We did a lot of preliminary work before we wrote the proposal for the board,” Salvadori says.
When organizers in eastern Carver County near Minneapolis made their successful pitch to the school board, they came armed with data. “We started by identifying the hazard,” says health services coordinator Kristi Juaire, RN, LSN, NCSN. They described the statistics on sudden cardiac arrest, outlined the chain of survival, and laid out their plan for managing the program.
Any school board worth its salt will ask about legal liability, and you’ll need to be ready with your state’s laws on AEDs The good news is that all 50 states and the District of Columbia provide AED Good Samaritan protection for laypeople and legal immunity for all rescuers. “There are so many levels of protection for schools,” says Paul Weinberg, JD, of the Weinberg & Garber law firm in Northampton, Mass.
“Schools are protected not only by state laws, but also by the federal Cardiac Arrest Survival Act, which pre-empts state laws, providing additional protection for users and acquirers of AEDs, unless there is gross negligence or reckless behavior.”
“I’m not aware of any lawsuits against schools or school districts that have implemented CPR/AED programs,” Weinberg adds. “Besides, kids are dying. It’s just the right thing to do.” (For more information, visit http://www.sca-aware.org/sca-resources/aed-laws and http://www.w-g-law.com.)
Board members might be inspired to know that CPR training is a valuable addition to the students’ health curriculum. “You’re not just teaching squish and blow,” explains Lt. Brad Dykens, a firefighter and paramedic in St. Petersburg, Fla., of the student and adult CPR courses he teaches in Pinellas County Schools. “The CPR course includes a wellness component; it’s a threshold to understanding other avenues of health.”
Once you’ve gotten your board’s OK, maintain its support by keeping members in the loop. “It took three years before each of our schools had at least one AED,” says Debbie King of Fayette County. “Each time another came on line, we made announcements at school board meetings, in the local newspaper and in PTO newsletters. I also make a report every year to board members to keep them abreast of our progress.”
An AED can cost $1,200 or more, and you’ll need to pay for CPR training and materials—but you may be surprised by how many resources are available to help cover these start-up costs. A recent survey of 118 high school principals in Washington state found that 60 percent of the AEDs in their schools were funded by donations, compared with just 27 percent funded by the school district and 11 by the school itself or its athletic department.
When Jeannie Salvadori’s program in Carlsbad was gearing up, a large community fair brought in $54,000. Other local donors might include churches and hospitals, businesses willing to trade financial donations for promotional opportunities, and service or fraternal groups, such as Lions Clubs, Rotary Clubs or the Elks.
In California’s beach community of Oceanside, the school district recently received 10 AEDs from the Oceanside Pacific Kiwanis Club. The was a good fit for the service club, notes Randi Gibson, director of student services for the Oceanside Unified School District. “Kiwanis’ vision is to help children,” she says. And in Minnesota’s Carver County, a local medical center’s foundation donated money for start-up costs.
Another potential donor base is parents, many of whom are eager to add an extra layer of protection for their children, say Maureen O’Connor of San Diego Project Heart Beat. “Once you explain that most parents of victims were unaware that their child had a heart defect until the child collapsed in cardiac arrest, it’s a no-brainer for them to contribute,” she adds.
Finding a grant from a foundation is another way to cover initial costs, though the process can be time-consuming. If you take that tack, do your research. “Look for a local foundation with a mission that includes health and fitness, “ advises Dave Bianco, program coordinator of Pittsburghers United for LifeSaving Emergencies (PULSE).
“Simply handing an AED to a school is a recipe for failure,” says Bianco of PULSE’s selection criteria. “Schools must also have the means to manage and maintain the AEDs, something PULSE supplies for the districts in its program.” PULSE requires that schools demonstrate their investment in their own program by purchasing a wall cabinet for each AED and ensuring that on-site personnel obtain training in CPR/AED use. (For more information, visit http://www.stmargaretfoundation.org.)
Joan Mellor, program manager for the Medtronic Foundation, the philanthropic arm of the Minneapolis-based Medtronic medical technology company, takes a similar approach when funding start-up programs in schools. “We give priority to schoolprograms that educate students and staff about preventing sudden cardiac arrest and preparing them to act in an emergency,” she says. “It’s not enough to have 10 teachers who know how to respond to a cardiac emergency. A student body that also knows what to do is an essential part of the safety net.” Mellor looks for proposals with “built-in sustainability, including train-the-trainers courses, so the school won’t be spending money each time they teach CPR to a new faculty member.” (For more information, visit http://www.medtronic.com/foundation.)
Your funding challenge may depend on whether your state mandates AED placement in schools—and if it does, whether the mandate is funded. “Your budget may also depend on how your state has written legislation that affects such programs,” says
Mellor. If, for example, it requires that students be trained in CPR before they graduate from high school, the student CPR training portion of your program may already be funded.
Seeking help from local government may be an option; county supervisors sometimes have discretionary funds available for school health and safety programs. The feds are a less likely source, though some rural schools may be eligible for AEDs through the Department of Health and Human Services’ Rural Access to Emergency Devices Grant Program. (For more information, visit http://ruralhealth.hrsa.gov/funding/aed.htm.)
Take the long view when you pencil out your budget—and don’t forget that AEDs, like fire extinguishers, require periodic parts and maintenance. “To keep AEDs operable, you need to change their batteries periodically and the pads every two years, even if the devices haven’t been used,” says Salvadori. In the Carlsbad district, these ongoing costs are financed in a variety of ways. The PTAs in some schools paid for the batteries, pads and CPR training, and a small amount of funding came from California’s Local Educational Agency Medi-Cal Billing option, which allows districts to bill for some services they provide and redirect funds into school health and wellness.
Finally, because your funding may arrive in stages, consider focusing first on the high schools, where teenage sports are played, next on the middle schools, and last on the elementary schools.
When funds are limited, the American Academy of Pediatrics recommends giving priority to large schools, those used for community gatherings and those with the longest EMS response times. Above all, be positive. “In our experience, when a school is really motivated to implement an SCA program, there’s almost always a way to get the resources to do it,” says Laura Friend, associate executive director of the nonprofit program Parent Heart Watch. For more information, visit Parent Heart Watch at www.parentheartwatch.org and read http://www.sca-aware.org/sca-resources/finding-funding and http://www.sca-aware.org/schools/sca-information/funding-sources
-Mary Ellen Strote