School buses & allergy preparedness - Will it take a tragedy?

[LinksEtc]

I was talking to a school nurse that I know.  We got on the topic of FA.

She was telling me she's had kids arrive at the school in the morning having reactions ... probably from something they ate for breakfast or from contact ingestion as there is a "no eating" rule on the bus.  She tried to address the school bus safety gap with the district, but they decided not to act.

A confession - I may be a decent advocate for dd most of the time, but she rides the bus without an epi or trained driver.  It is the ONLY time that she is without an epi close by.  I educate her ... where she goes, the epi goes ... except the *#%$ bus.  I didn't start this thread to talk about my personal situation ... I know I could fight for it, I know how, I also feel that given dd's medical history that she is probably not at a huge risk of ana on the bus, & the school is close with an EMS station on the way.

My reason for starting this thread is to ask, in general, is it going to take a tragedy before school districts address this safety gap?  Why do so many individual parents have to fight so hard regarding this one issue?  Is it so hard ... the medical guidelines are clear ... FA kids in the school's care should have epi and trained adult with them at all times.

So many times it takes a tragedy & lawsuits before policies are changed.  Can't the FA community & schools skip this step with buses and just change the policies already?

[LinksEtc]

Oh, and another thing, my older dd has informed me that her bus driver breaks our school's "no eating on the bus" policy by sometimes giving the kids on the bus food treats!!!

I know that one of those kids has celiac.

Can you just say ... Huge Liability Issue!!!

Get these drivers trained!

[ajasfolks2]

I have to agree that one of the top issues right now for LTFA kids in schools is the school bus situation:  both t/from school and for activity bus and fieldtrips.

It's a huge concern.

It shouldn't take a tragedy to get this changed.

It's going to take a LTFA village . . . working in concert . . . and doing it politely, but firmly.

[MandCmama]

My husband and I fought this fight armed with a letter from our allergist stating it was medically necessary that our son (who has had contact ingestion reactions) take a van to school ( at the time he was 5, self carrying and would have to switch buses at another elementary school).

Our argument was the van was smaller, easier to monitor, and would be door to door. We also knew the driver of the regular bus in our neighborhood and brought up his cognitive ability to administer meds, let alone recognize the need ( no argument from school personnel there. Probably should have pushed that angle further).

We were denied the van. The superintendent stated that the school is not bound to follow the recommendation of our physician and that wiping down the hand rail and his seat would be sufficient. ( like this would EVER happen. Not to mention it would isolate him ).

The most frustrating part to me was that my husband teaches in the district and knows for a fact that one of his students is taken by van, by himself, everyday from the middle school to the high school for high level math. Ummm. I don't believe his safety and well being depend on this...


A friend was so upset by this decision he offered to hire legal counsel on our behalf. My husband ( the one who would suffer the consequences at work) was gung-ho. I felt for the small bit of safety we'd be gaining, it wouldn't be worth the emotional and mental toll. And the burning of bridges.

We were able to finagle our schedules to get him to/from school ourselves. We also had them state in our 504 that we and our physician felt the schools recommended accommodations were inadequate.

[ajasfolks2]

So, here are some of the problems with the whole school bus situation in this country so far as LTFA (in NO particular order and NOT aimed at anyone in particular):

1.  No epi-trained adult -- either the bus driver OR a separate adult aide on bus.
2.  Bus driver might be epi-trained but is NOT trained in basic assessment to even know if/when . . . the training is all over the map.
3.  A "false sense of security" (yes, good use of THAT phrase here) by the school district in their thinking that they can just rely on the "pull over, call EMS" response.
4.  Districts that don't allow the student to even self-carry the epinephrine such that it is even on the bus. 
5.  Assumption that because the child ate AT HOME that morning, then there cannot possibly BE a reaction on the bus.  "False sense of security" again.
6.  Refusal to acknowledge the potential for contact reaction on bus that goes to ingestion and ana reaction.
7.  "No food" rule on the bus that is Unenforced.  NObody is accountable and people ARE eating.
8.  Bus drivers foolishly giving out food "treats" on bus . . . and even parents giving out "food treats" at the bus stop before kids get on bus.  Hello?!


Will come back to expand on some, but anyone is free to add more and to expand on anything.

Yup.  Houston, we have a problem.

[ajasfolks2]

MandCmama, we were posting at same time.

Pretty amazing as to what was stated so far as you & physician's belief as to 504 accommodations . . .

Many schools seem to ONLY want to accommodate if it is FREE or virtually NO cost to them . . . and also not exactly accountable.

[ajasfolks2]

More things to consider:

Some school districts have bus drivers who are actual district employees.
However, many districts now have outsourced that to companies that just provide bus drivers.

Some rides are really long, but all city and near med care.
Some rides are really long and very rural, with med care far away -- both time and distance.

Any bus ride can get stuck in a traffic situation such that EMS cannot reach them.

Some drivers (regardless of who employs) are totally capable of being epi trained and anaphylaxis-recognition trained.  Some drivers are not.

Substitute drivers . . . what to do & how to handle?



Obviously, there can be no one-size-fits-all answer. 

But that doesn't mean there should be NO plan and NO meaningful strategy.

~ ~ ~

This blew me away -- when we lived in Fairfax County, I heard 1 LTFA mom say that she was relying on OTHER kids on the bus to give the epi if her son needed it.   Her argument was that the other kids were adults / almost adults and could handle it and that she shouldn't be expecting the school to do anything for her or her son.

THAT is what many are fighting -- the other LTFA parents who have always covered for the school or excused the school from its duty of care -- either intentionally or mistakenly.

So many facets to this issue.

[maeve]

Another facet: in Virginia a school district is not required to provide transportation to school.

[ajasfolks2]

maeve,

isn't that only if under 1 mile from school? 

(Some shorter distances in some school districts -- called "nontransportation zones" -- but can be reviewed for safety as need be?)

[lakeswimr]

Many bus companies forbid their drivers from administering the epi.  Our district used to have a company that did this and I tried to get that changed and was met with a brick wall.  Our superintendent was met with the same brick wall.  The bus company's lawyer advised them that they would have liability if they gave ANY medication so they have a rule against giving any at all.

Our district thankfully has a new bus company now and I think part of why may be because of this policy by the old company.

The old policy and that of many schools is that if a child has a reaction on a bus the driver is to pull over and call 911.  I pointed out to the school district that this is not safe and if it were safe then no one would need to carry epi pens.  People carry epi pens because sometimes the EMTs are not going to arrive in time (and not all EMTs even have epis anyway). 

My son's allergist felt that it was OK for bus drivers to not give the epi "because we don't see reactions happen on busses."  I know there was one boy in MA a few years back who had a serious reaction on a bus. 

[maeve]

maeve,

isn't that only if under 1 mile from school? 

(Some shorter distances in some school districts -- called "nontransportation zones" -- but can be reviewed for safety as need be?)

Nope. The is no legal obligation to provide any transportation. Now our county and Fairfax use 1 mile walk zones (actually I think Fairfax's are 1.5 miles for MS and HS kids); kids living in those walk zones are not provided transportation.

"A. School boards may provide for the transportation of pupils, but nothing herein contained shall be construed as requiring such transportation except as provided in § 22.1-221."

http://lis.virginia.gov/cgi-bin/legp604.exe?000+cod+22.1-176


Section 221 of the code (referenced at the end of the quote)
http://lis.virginia.gov/cgi-bin/legp604.exe?000+cod+22.1-221

[Janelle205]

Ajas, I think that it differs by state as well.  Here, school districts are required to provide transport for anyone who lives farther than two miles away.  The district that we live in now buses everyone though, which is nice, because there isn't really a walkable route that would be safe for anyone under maybe HS age.

[daisy madness]

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. 

[hedgehog]

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.

[ajasfolks2]

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?