Camp Bravo DOJ Settlement Agreement administration of Diastat (includes mention of nurse and bus)

J.B. & T.B. v. Manalapan-Englishtown Regional Board of Education (SEA NJ 2007) required District to provide an adult trained delegate for daily transport, epinephrine specific

Heya.  Drive by posting.  Real quick this is hot from my inbox.

Georgia bus aide to administer emergency medication. Diastat--remember that US DOJ settlement agreement with camp regarding the refusal to administer Diastat, moreover without any remedy for an adult delegate to administer on bus rides.  Need that one?  Look in Main under camp DOJ.

Maybe I'll put in a Bluebook cite later.  Too busy right now.  It's no magic bullet and I have not read it in full.  However, with Manalapan-Englishtown (DP decision by IHO / ALJ), this shows a consistency with the need for an adult trained aide to deliver epinephrine and Diastat expeditiously rather than pull over and dial 911 as part of FAPE.

UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF GEORGIA ATHENS DIVISION·CASE NO. 3:14-CV-72 (CDL) (M.D. Ga. Jul 01, 2015)

No time to copy and paste section highlights. 

Quote from: joanna5 on September 11, 2014, 12:22:17 PM
My son is turning ten next month and in fourth grade.  He had a monitor for the ride home the last two years (I drove him to school- they couldn't find a monitor for the am) and is riding without one now.  He carries two Epi Pens and knows how to self administer- in theory, at least.  His bus driver can't legally be asked to administer, but said she would absolutely do so if he needed it.  It's a 1.6 mile bus ride from the school to our door and the route goes past the police/fire/EMS complex.  He also has two friends on the bus who have a parent or sibling with LTFA so there is some awareness, at least.  The bus is also not full at all- the kids sit one to a seat.  I went back and forth on a monitor this year, but my son really didn't want that any more.  I still go back and forth a little, but things have gone fairly well so far.  There was one incident of eating on the bus.  My son told me, I emailed the 504 Coordinator telling her and asking that he not be singled out when it was addressed.  The principal dealt with it very well and there haven't been issues since.

I should update that shortly after I wrote this, our district's head nurse (she's also the nurse for my son's school) contacted me to tell me that, thanks in large part to my advocacy, all regular and substitute bus drivers in the district are now trained on both Epi Pens and Auvi-Qs.  This will be done twice a year.  The policy change turned out to be a huge help when my son's driver suffered a severe health issue of her own and he had a substitute driver for several months.  The nurse was thrilled when she called- she said she'd been fighting for this for years, but had made very little headway until my son came to the district. 

Wow. A national company.

What's interesting about this case is that the allergist is also a mom of a child with FAs AND is social media savvy--specifically Twitter.

I wonder if she is willing to shake some trees.

Tweeted by @NoNutTraveler

"Western Springs parent wants food allergy training for bus drivers"
http://www.chicagotribune.com/suburbs/western-springs/news/ct-dws-food-allergies-tl-0716-20150709-story.html#page=1

QuoteWest would like bus drivers to be able to identify anaphylaxis and use epinephrine autoinjectors — commonly called EpiPens — if necessary. Dr. Sakina Bajowala, Audra's allergist, said the EpiPen ideally should be administered at the first sign of an anaphylactic reaction.

QuoteThe national bus company does not train its drivers to use epinephrine autoinjectors

in general, is it going to take a tragedy before school districts address this safety gap? 

Um-- as per my note in the other thread-- I realize this sounds incredibly bitter and cynical-- but--

even that will simply not be enough.



People are INCREDIBLY good at distancing themselves from tragedy with rationalizations.  This is why things like drunk driving, smoking, alcohol abuse, and yes, school security and health services are all battles that have been hard-hard-hard to win.

It takes WANTING to learn to do better, and opening one's heart and mind to the possibility that yeah, it really CAN happen to you.   I'm convinced that most people lack the ability to see that, or to contemplate disaster before it strikes them.

Tweeted by @AllergicLiving & @think_inclusive


"ALL Students Should Be Safe at School"
http://ollibean.com/2014/09/13/all-students-should-be-safe-at-school/

QuoteIn just 10 months in 2012, Isabella Herrera, Jenny Caballero, and Jessie Shillingford, three minority students with disabilities died under the district's care.

QuoteI'm very concerned about the reports from the transportation department last Spring and what occurred last Friday when 9 year old Tamya Johnson was left sleeping on her school bus.

QuoteWith any organization, the attitudes and the culture is established from the top down.

My son is turning ten next month and in fourth grade.  He had a monitor for the ride home the last two years (I drove him to school- they couldn't find a monitor for the am) and is riding without one now.  He carries two Epi Pens and knows how to self administer- in theory, at least.  His bus driver can't legally be asked to administer, but said she would absolutely do so if he needed it.  It's a 1.6 mile bus ride from the school to our door and the route goes past the police/fire/EMS complex.  He also has two friends on the bus who have a parent or sibling with LTFA so there is some awareness, at least.  The bus is also not full at all- the kids sit one to a seat.  I went back and forth on a monitor this year, but my son really didn't want that any more.  I still go back and forth a little, but things have gone fairly well so far.  There was one incident of eating on the bus.  My son told me, I emailed the 504 Coordinator telling her and asking that he not be singled out when it was addressed.  The principal dealt with it very well and there haven't been issues since. 

Quote from: ajasfolks2 on September 10, 2014, 12:49:23 PM
There seem to be so many unique situations as to school bus transport here in US . . . but I'm thinking that at the VERY LEAST there should always be 2 doses of epinephrine on the bus . . . either with child (self-carry) or in child's special med pack that is given by parents to bus driver who then hands over to school staff upon arrival at school . . . and then reverse set up for going home.

My personal belief is that the child is entitled to an adult-on-bus who would administer.  I cannot comprehend how anything else is defensible given the need for immediate use of epinephrine and the potential consequences for delay of epi.

But then who would admin if child cannot and bus drive cannot / will not?  If the EMT does not carry own epinephrine, would they be willing / allowed to use the child's prescribed epinephrine?  And what's to be done if EMT cannot get there?

If the bus-to-dispatch communication does not work, how does the driver contact 911?  Is there always a back up resource for contacting emergency personnel?

Based on my experience with the bus drivers in our county, I would recommend that the medication be on the child. I got a call a year later about a card with contact info, allergy info, and DD's picture on it being found in a bus (this was clearly while being prepped for the upcoming school year) that I had provided to DD's bus driver the year before (at the misbegotten suggestion of the transportation department staff). DD has also had substitute bus drivers.

I'm glad I didn't send DD on the bus when she was in elementary school.

Another consideration not discussed, over-crowded buses.  DD's bus had 3 kids to a seat when she was in 6 and 7 grade. This is contrary to what is stated on the transportation department's site, which says that at MS/HS level, it is only 2 to a seat.

We did lake swimmer. As did the letter from our allergist. It was clear they were going with precedent and catering to the loosest comfort zone.

What I do when I don't feel schools or etc understand my safety concerns is that I explain a possible scenario and the possible risks of that scenario.  A person who has ana should get the epi pen at the least with in 20-30 min of the start of a reaction.  Some say 10 minutes.  A child on a bus may go unnoticed by the bus driver until after that point.  The child could have even started the reaction before getting on the bus.  Once the child is in bad enough shape that other kids on the bus bring the situation to the attention of the driver there could be very little time left for the child to receive the epi.  Pulling over and calling 911 or continuing 5, 10, 15 min to home or school to get someone to get the epi (which will take time as well) will take much longer than having the driver administer the epi on the spot.  By then it could be too late.

There are kids who get stings from insects just before or while on a bus as well.  It is good that we are not seeing FA fatalities on buses.  That doesn't mean that riding a bus with no epi is a good idea or safe.  I would say it means odds are that it is unlikely a person is going to have fatal ana on a bus but I would also say that if a person is having a serious reaction on a bus (which certainly could happen--kids eat just before getting on buses all the time) then they are in a dangerous position if there is no epi trained adult who is allowed to give the epi.  Many bus companies forbid their drivers from giving it.

I would have told that special ed director something along those lines.  Easy to be flip about something that doesn't affect a person directly.

That was another thing we requested after the van was denied...a bus aid. That prompted the most condescending email I've ever had the pleasure of reading, from the sped director. He stated that there are many allergic children who ride the bus without an aid, every day and do just fine. Would I like to talk to one of those parents?

So I composed an email back to him that needed to be edited before I hit send so that my husband would be allowed to keep his job. I boiled it down to "we'll follow our physician's advice, not the advice of a random parent who clearly has a looser comfort zone than myself".

It all boiled down to precedent. They never did for anyone else. They certainly weren't willing to open that door for our child. I think being a teachers child actually hurt us. Politics be damned!

There seem to be so many unique situations as to school bus transport here in US . . . but I'm thinking that at the VERY LEAST there should always be 2 doses of epinephrine on the bus . . . either with child (self-carry) or in child's special med pack that is given by parents to bus driver who then hands over to school staff upon arrival at school . . . and then reverse set up for going home.

My personal belief is that the child is entitled to an adult-on-bus who would administer.  I cannot comprehend how anything else is defensible given the need for immediate use of epinephrine and the potential consequences for delay of epi.

But then who would admin if child cannot and bus drive cannot / will not?  If the EMT does not carry own epinephrine, would they be willing / allowed to use the child's prescribed epinephrine?  And what's to be done if EMT cannot get there?

If the bus-to-dispatch communication does not work, how does the driver contact 911?  Is there always a back up resource for contacting emergency personnel?

When DS was in elem., we had a plan in place, but it would not work for most.  Our school is 1.6 miles from home.  The bus takes a direct route (although there are stops in between).  But that means that the furthest the bus is from either school or home is .8 miles.  The plan was in case of emergency bus either turns around and heads back to school, radioing nurse on the way so she is waiting, or if close to our home, skip all stops in between and head straight to our house.  Which could have been a problem if I wasn't home, which sometimes I wasn't, but usually was.  Obviously, reverse that for morning.

The bus did, one time, pull out of the parking lot, turn around, and pull right back in.  DS was having a seizure (epilepsy was the other reason for this plan).  Of course, this was the day I was out in the yard waiting for the bus, with the phone inside.  So the bus was quite late, then DS wasn't on it.  But the bus driver stopped, told me what happened, and i headed over to the school.  When I got home I found several messages from the school on the answering machine.

Oy vey!

I called our state DOE Transportation Department about this.  Guess what they said?  Many districts choose to call 911 rather than administer the epi (during transportation) because they have calculated how far away the EMTs would be and determines that it would be safer for the child to receive the epi from trained medical personnel who could also monitor vital signs, etc.

What a load of crap.