Should Bus Drivers Be Trained to Administer Epinephrine?

Yesterday, I was interviewed live on FoxNews CT regarding this topic.  For years,  I, and several other parents including Erin Spaulding and Robin Comey, have been advocating for better, more consistent policies regarding food allergies in our school district.  Last year, Erin, the VP of FAEN,  pulled the issue of bus driver training to the forefront after a dangerous situation had occurred on the bus her children were riding on.   This received media attention and led to this public debate.

So, here is the question: Should bus drivers be trained to administer epinephrine?  If not, who should be responsible for the safety of children with food allergies and other medical conditions while they ride the bus?

According to Timothy Stokes, a spokesperson for First Student, Inc., the policy for First Student is the following: “In the event of an emergency, bus drivers are trained to pull the bus over in a secure location and radio dispatch for assistance.”

This policy should be worrisome to every parent.  What if a child were to choke on the bus?  Would the bus driver simply stand by and watch while waiting for EMS to arrive?  Erin states in her interview that her “daughter’s throats closes within 5 minutes of ingestion.”   Which means that by the time EMS arrives, it may be too late.   In the case of my daughter, her past reactions have occurred so quickly that she would have even less time.    We find this current policy to be unacceptable.

I received this tweet last night: “Just as everyone should know First Aid and CPR everyone should know how to use Epipen especially anyone involved in childcare, ”  and I agree.  As any teacher, parent, or bus driver can attest, accidents can happen at any time.  I think that we, as adults, owe it to our children to be prepared at all times to respond.  Frankly, if I were a teacher, a bus driver, or a paraprofessional, I would want to have that training provided for me.  No one wants to witness the death of a child and know they could have done something to prevent it…no one. In the case of anaphylaxis, most deaths are preventable if epinephrine is administered immediately.

Please, let you voice be heard.  Leave a comment here and on the pages below.

View Erin’s story HERE:

View my live interview HERE.

Leave comments here and on this blog page.

Thank you,

Gina

Gina Mennett Lee, M.Ed.

President, Food Allergy Education Network

9 responses

  1. Absolutely, yes! Our school has an amazing allergy awareness policy however this is the only issue that really troubles me. I drive my kids to school and pick them up every day. They should have access to the buses. I know there is food and am not comfortable with the risk if something happens. Thanks for bringing awareness to this issue. I will definitely share it.

  2. My son has food allergies. He knows not to accept food unless it has been approved by us (his parents) however my fear is that a child may have peanut butter for breakfast. If he/she doesn’t wash their hands and leaves the residue on the handrail or on a seat and my son touchs it and then touches his face, he will have a reaction. If bus drivers could be trained to administer epi-pens, I would be so grateful. It would put me a little be at ease knowing that his life could be saved if he was ever in that situation.

  3. Yes, the Epipen and Auvi-Q are easy to use. But identifying an anaphylactic kid is tricky. You mentioned choking – well, how does the bus driver know if the kid struggling for breath is choking on food or going ANA?

  4. I do think school bus drivers should be trained on how to administer an epinephrine injector. Waiting for an ambulance takes too long and every minute counts.

  5. Imagine for a moment that your child had an anaphylactic reaction while you were driving the family minivan on a busy street or highway. You would have to pull out of traffic safely, administer epi, call 911 and carefully observe your child. Is there a parent who would not feel a sense of panic in that situation? Now imagine that you’re a school bus driver in charge of 70 students, driving cautiously on a timed route in rush hour traffic with children entering and exiting the bus at busy intersections. It is up to you to make sure that they make it across the street safely, behave nicely toward one another and make it to school on time. You sit with your back to your students, eyes on the road, watching for the unexpected swerve of a child on a bike or a dog in the street. You make sure that the little ones get off at the right stops. You are all alone. What are the chances that you would notice a child in the back of the bus who was having difficulty breathing…for any reason? If you did notice, how would you feel if it were up to you alone to safely pull out of heavy traffic, calm and supervise 70 students and manage an anaphylactic reaction? Is that a reasonable expectation for your child’s bus driver? Is that scenario reasonable or safe for your child? What are the chances that everything would go smoothly? Have you been around a group of 70 students lately? If you want to assure your child’s safety but cannot drive or carpool, you might want to consider a 504 plan that would allow your child to ride a special bus with a trained monitor who could observe for and respond to emergencies in transit. Thank you for considering the question from a different perspective.

  6. Mare, thank you for your thoughtful response. You make excellent points. I do feel that the job of bus driver is extremely difficult and I admire the work that they do. (You stated in your scenario that the child may be in the back of the bus and therefore difficult to monitor. Many schools have opted to have children with food allergies sit at the front of the bus where they can be more easily monitored.) Personally, I would love to see a trained bus monitor on every bus (for many reasons), but we both know that that will not happen due to budgetary issues. So where does that leave us?

    That leaves us with literally millions of children riding the bus daily with no one there to respond should they have an allergic reaction. Based on statistics, I would estimate there are 2-4 children on every bus with food allergies (and remember, any allergy has the potential to be life-threatening). As I stated in the blog post, by the time EMS arrives, the child could die. Epinephrine is designed to buy you time until emergency medical treatment can be found. Therefore, I think anyone that is responsible for children should be given the information and training they need to keep the those children safe. Currently, bus drivers have all the responsibility but no training to accompany it. If I were a bus driver, I would demand to be given this training. This would include CPR, First Aid and Epinephrine Training.

    There are additional concerns such as: the fact that bus drivers may not even know which children have food allergies (identification), many parents do not know that they have the right to have a 504 plan for their child (education), etc… But, at the very least, we can give the bus drivers the tools they need to respond appropriately should they be placed in the position of sitting on the side of the road watching a child gasp for air surrounded by 70 children watching in horror as a classmate struggles to breathe hoping EMS gets there in time. It is truly frightening if you really think about it….and it’s only a matter of time before a tragedy happens on a bus. Proper training would prevent this.

  7. It’s not whether or not the bus driver him or herself should be responsible for administering the epinephrine, it’s about the school district delivering FAPE including transportation. Providing a bus aide as a necessary individual accommodation in a 504 plan would satisfy the obligation of FAPE without over extending the obligation of the SD.

  8. It should also be noted that there are no federal standards allowing all level of EMS professionals including EMT Basic to administer pediatric epinephrine. In some states only a full paramedic may administer pediatric epinephrine, and not every crew may have a paramedic responding. Therefore, without that federalized consistency there is a faulty assumption that the arrival of EMS means the arrival of a professional that could legally administer epinephrine to a pediatric patient is guaranteed.

    When in doubt always check where routes for kids will go cross-referenced with laws in your state and county, city regulations for how EMS will be manned. This includes field trips ranging further away from the school.

    I can certainly sympathize with the desire to petition the bus service to train drivers to administer epinephrine but when you look at the enforceability with regard to ADA and 504, FAPE and 504 really stand out as the greater protections which coincide with the prohibition of discrimination based on disability where greater protections shall always prevail.

    The bus company is responsible for a service and as a private entity would only be subject to Title III of the ADA as a public accommodation. The SD must perform its Child Find duties to seek out students with disabilities and eliminate discrimination where they exist in order to deliver FAPE. That squarely puts public schools under Title II at a minimum, and further when a qualifying individual is found eligible for 504 accommodations which are tailored to the individual.

    Why is that important? It comes down to whose jurisdiction this will fall under, in this case it is under the greater protection FAPE, 504 and Title II offer under federal regulations (school district’s responsibility) enforced by the US DOE OCR and not limited to Title III (public accommodation bus service) through US DOJ because the latter is a lesser protection therefore the former should prevail.

  9. To clarify my earlier comment, in concrete terms it is the LEA’s (local educational agency, i.e., School District) responsibility to take initiate necessary and effective accommodations on transportation as part of FAPE equal to non-disabled peers regardless of the qualifying disability, and clearly the ADAA in 2008 widened the definition to include students with food induced anaphylaxis as it represents a substantial limitation to at least one major life activity even when the condition is hidden and episodic.

    Invoking a lesser standard of protection in Title III is counter to the foundations of disability law, particularly students entitled to Title II, FAPE and 504 accommodations. A fine differentiation but one that exists on the books, especially in cases where it would move forward through a complaint with OCR.

    I offer that for consideration.

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