Should School Nurses be trained to deal with serious wounds?

I had to cover a public meeting for Journalism class. I chose my local high school's Board of Education Meeting. One item on the agenda was security. Clearly as a response to Sandy Hook, High Schools are being grilled for how they plan to protect kids.

School security can't be armed. That's whatever, armed security is expensive. School shootings are terrible, but mass-shooting aren't a thing that happens daily. I get that. Despite being licensed, teachers can't have a concealed carry. There are good arguments for and against that. That still isn't what I'm concerned about.

I've seen the effects guns have on people. I've seen people die and get seriously hurt at the result of firearms. I myself was shot last year. Thankfully, due to quick medical treatment my wound was taken care of and my body acts as if it never happened.

I posed the question to the board on security. I brought up the point they clearly can't fight back an intruder. I tried to make my point serious so they understood the gravity of that situation. If some crazy dickhead broke through your only defense (a locked door), there is literally nothing protecting you other than several minutes of police response time. Most the carnage at Sandy Hook occurred in a 2 minute time span. Even some of it continued while police were on property and they hesitated to take action.

With lack of security, I asked that the minimum they can do is provide a basic medical response on-scene. 90% of troop death in The Stan is due to bleeding to death. Thankfully all Infantry and Cavalry platoons have a medic and most MEDEVACS have a 5-10 minute response time and can get you in a Emergency room with a maximum of 12 minutes. At least where I was at in the country.

They could not answer if the nurses knew how to control bleeding. It doesn't take crazy intense training to learn how to stop/control bleeding and shock. That training is like half a page in my Basic Soldier Skills Book. I'm not expecting nurses to dodge fire and treat amputations. But they should at least know the basics for identifying casualties and how to use a tourniquet. I could seriously train a school nurse how to do this in 20 minutes.

Videogame forums clearly isn't the best avenue to explore this issue. But is the best means for me to gather a large opinion. I don't know if I'm allowing my personal experience cloud my judgement on the severity of this problem. Am I being insane? The school did promise that the dude in charge of health and wellness for the school district will call me.

Sure, absolutely. I am curious though; My school was never big enough to have a nurse or medical office or whatever, but I always thought the people working in them were fully qualified nurses. Apparently that's not the case?

As a teacher, sure, that's something I wouldn't mind seeing happen. As with all things, the more over arching question is just where is the money for the training going to come from, since budgets are always stretched, but the ramifications for that training would only leads to good things.

Joke Answer: Quik-Clot for everyone!

Real Answer: Yes, they should be.

I have a feeling that's against procedure. There are certain schools or unions (such as this one, and this one) that have such strict rules which prevent even the most basic care being given to students. A lot of the nurses and unions seem more intent on protecting their own than on protecting their charges.

/gross generalization

They could not answer if the nurses knew how to control bleeding. It doesn't take crazy intense training to learn how to stop/control bleeding and shock. That training is like half a page in my Basic Soldier Skills Book. I'm not expecting nurses to dodge fire and treat amputations. But they should at least know the basics for identifying casualties and how to use a tourniquet. I could seriously train a school nurse how to do this in 20 minutes.

Videogame forums clearly isn't the best avenue to explore this issue. But is the best means for me to gather a large opinion. I don't know if I'm allowing my personal experience cloud my judgement on the severity of this problem. Am I being insane? The school did promise that the dude in charge of health and wellness for the school district will call me.

I don't think you're being insane, but imagine the fallout if one of the treated kids died from an infection or blood loss. By taking action they are shouldering at least some responsibility, and it's their job if they screw up.

Yes. Not just for bullet wounds, but for any serious injury that could occur on school property.

Why are you making America's big war sound like a crappy local syndicate that airs nothing but Big Bang Theory reruns? (That's as far as my joke goes, because I don't know a lot about the situation in Afghanistan.)

Sounds like a recipe for a tasty lawsuit stew.

Yeah all Nurses should play the medic school section of America's Army.

Seriously though, when I played that back in the day it was incredibly awesome that they gave you real and useful information on how to stop bleeding and even apply tourniquets in the most extreme of dismemberment scenarios. Though for all practicality's sake, the most useful lessons in that game was on how to deal with someone going into shock.

Fun fact: The tourniquet standard has changed. The Army used to teach the soldier to place the tourniquet 2 inches above the wound or 2 inches above the joint if the wound is close to a knee or something. Now we're told to place it at the top of the limb regardless of where the wound is.

Unless the America's Army tutorial is so great it changes with Army doctrine. That would be impressive as fuck.

I think the better question is "Should schools have nurses?". Most schools don't have on-site nurses to begin with and when they do, it is because that was their day to have the nurse and the next day the nurse will be at a different school.

@tycobb: Realy? I thought that was a standard. All the schools in my district has a nurse unless it has changed. I've been out of public school for 4 years.

@tycobb: It's definitely true that in a lot of schools, the nurse's office is less for the sake of student health, and more for student counseling, if you view the training some of the staff that, er, staffs it have.

its a bit alarmist i think. school shootings are still ridiculously rare. besides the nurses wouldn't probably even be in a position to give medical care to anyone in the event of a shooting. they'd be evacuated out of the school with everyone else, by the time the nurse would get to the injured students proper medical emergency teams would already be on the scene and standing by.

even in the weird super specific scenario where, say, the nurses office was shot up but the nurse wasn't shot, i doubt think the nurse would be in any condition to preform medical care.

why not put gas masks in the hallways in case of a nerve gas attack. come on guys, think.

@epicsteve: It may have changed (Been 10 years since I was in school). I did find this article from a couple of years ago talking about half the schools not having full-time nurses. I can't remember seeing a nurse once during all of high school. I remember there was a nurse in elementary school, but she may not have even been a nurse since all she did was take a temperature.

Nurses should be trained to be able to take care of serious wounds, but the problem is that they are just nurses, not doctors. They aren't trained the same way and may not have the knowledge. If it is required to do so then they end up having to pay for certifications and can then start demanding even more money from school districts that just don't have the cash. This can possibly lead to even fewer nurses.

Yea-in the case of a mass disaster, the school nurse isn't really in a situation to do anything. Hell a doctor outside of a hospital is kind of useless except for triage.

That's interesting, I thought the tourniquet did a lot of damage to the tissue so choking off a whole limb seems crazy to me, but I'll trust the experts. I do distinctly remember learning it the old way though in the game. Then again I haven't played since like 2004 or so, the game has probably changed completely like three times by now, so it's possible they updated the medical lessons. I stopped playing after I earned my fake airborne wings. I couldn't get into the advanced marksmanship course. I don't think I ever played a proper round of AA. The game was fascinating enough as a simulation of military training.

@epicsteve: I think Epic Steve, that you have made a great suggestion to them that the Board was probably 100% unprepared to answer. Sounds like a practical and common sense standard to me. Perhaps however one that will do nothing to calm parents though (who undoubtedly just want to hear from the Board that their kids are 100% safe , true or not). That may be more of the issue, is that it doesn't make for a compelling pitch to concerned parents. Politics man, they are a thing at every level of gov't in this country.

I seriously doubt they ever thought about it until you brought it up.

Even it not such an extreme case as that I think that info would still be useful. Back in high school I was involved in a 4-car pileup and the nurses were there trying to help before even the police showed up. Luckily no one was seriously injured (the guy who started it was unconscious but he turned out fine) but in the case were something went south she was there to help.

Edit: Should mention that the accident was down the street from the school, which itself is surrounded cornfields for a good stretch.

Absolutely. If school nurses aren't medical nurses, equipped with all of that inherent knowledge and training, then what the hell are they called nurses for? May as well call them school doctors, since the leeway between the two isn't as large as it used to be by a long shot.

/rant

But yes, the saddest thing to me is that throughout your entire post and the ensuing responses, the words which rang through my head the whole time were "gun control, gun control, gun control". I'm sorry, it's difficult for me to put myself in the shoes of an American highschooler since over here in Australia stuff like the tragedies which pop up every couple of years over there is almost unheard of : /

That said, there are still some fucked up things happening here and other places with gun control (eg there's weird and disgusting surge of rape recently on the news : / ), but at least from my perspective, I prefer our problems to yours.

I just wish the whole anti-guns thing were part of the equation rather than something brought up every couple of years and quickly quashed - or at least that seems to be how it goes over there, from my (again, outsider) perspective.

Then again, there are other arguments - trying to reduce gang activity by increasing jobs and education, cracking down on criminal groups who distribute unlicensed firearms to minors, etc. These all have weight, but still.

To me the answer will always be "just stop proliferating deadly weapons throughout your populous". Heck, in New South Wales, where I live, we can't even own crossbows or sword canes - but uno what? I make that trade happily every day.

ED: And it's not like we discount the validity of guns as a sport over here either. Some of the best olympic shooters have come from Australia and there are plenty of rifle shooting or gun clubs in Sydney alone - so I simply do not see this as an argument.

Yes, that would be great. I've been shot at twice, once was on purpose and I would never want to go through that. So, I'm sorry to hear about your wound, glad you came out okay! However, it would be comforting knowing someone nearby has a chance to save my life.

That's an odd question considering that the more people who know how to treat wounds in general, the better. So yes, of course.

That's like asking if people in the military who aren't on the front lines should learn to use guns.

I think they should be train especially now with all those school shootings and the like. It is better to be prepared for those kinds of scenarios.

I would say 'yes' if only it were feasible. That training would take a lot of time and money. If it could be boiled down to a short, economically minimal course so that all nurses, including the new ones who come on after the older and trained nurses leave, then I would be all for it.

I have to agree on that. Training does take a lot of time and money and many of the schools don't have much of those two.

I thought nurses know these things by default.. Is it possible that it's just the Board of Education that doesn't know if they do? I guess they should have known if their school employees are qualified or not, but I don't want to jump to conclusions about the school nurses just yet.

I'm actually surprised they let you in on the meeting. Maybe they didn't think highly of you as a journalist and thought that you weren't going to ask any questions. Boy, they sounded like they were completely caught off-guard by such a simple question. When you're performing life-saving medical treatment there's no such thing as being over-qualified. Call you back? That's like a politician calling off an interview with the excuse that his secretary will "answer any questions you may have". Total cop-out. Those fuckers are the same people responsible for the welfare of the Nation's future. The least they can do is try.

to look at it at a comical angle, i think they should have armed nurses (which thats essentially medics?) that way you get the best of both worlds.

but in seriousness though, yea, better trained nurses would be great if its cost-effective,

There should be a basic level of knowledge attributed to someone with the title of "nurse". If your afraid that the nurse will do badly at their job and you will be liable for legal action then you have hired the wrong person for the job.

Though, more importantly if your main fear in a medical emergency is that there might be legal action and not simply giving the person the greatest chance to live then you are doing it wrong.

I say this as someone who lives in a safe place who rarely see's violence, I have never seen a gun in real life, but everyone called a nurse should be trained to a basic level of medical expertise to at least hold someone till the ambulance arrives. I dont know what that level is but its more than what it seems like most schools are willing to allow in case of legal action.

I have never seen a school that had an actual dedicated nurse and wasn't just something like the Gym teacher that had taken CPR training. Though at my school a lot of the teachers were also volunteer fire fighters so I'm sure they got some extra health training. Maybe they play a different role in other parts of the world, but if someone at school needs serious attention then the paramedics should already be on their way to help. It makes sense for teachers to get basic triage training to do what they can to help until the paramedics arrive to do the actual helping. There's not a whole lot you can do unless you have access to the proper medical supplies.

@pazy: @audiobusting: @selfconfessedcynic:@epicsteve:

The issue is that a school nurse has a different license and different skill set then what must of us apply to a person with the label 'nurse'. Here's a summary that describes what this license entails Link. Basically a 'public health nurse' has a focus that emphasizes health education more then health application. Here's a brief summary from the link;

"In presentations at schools, community groups, senior centers, and other local groups, public health nurses explain proper nutrition, demonstrate effective safety practices, promote early detection of common diseases, tell people how to care for disabled or ill family members, and inform people about other important health issues. Their goal is to make health information easy to understand, so people can take greater control over their well being."

So it's not out of the question that they would learn more specific skills to help treat more dramatic problems but it would probably require a change to what their license allows for and what these nurses learn in school prior to receiving their licenses.

@jasonr86: Kudos for doing the research.

Odd - I'm not familiar with a distinction at the university level over here, though granted, I was never very interested in the medical profession.

I wonder if there is actually an entirely separate stream for "public health nurse" of if it's just position for a normal nurse but one who chose to go for a different career path.

It's probably just a different discipline represented by a split in training while in college. For example I'm officially called a Licensed Mental Health Counselor which is a different discipline from a school counselor. So I'm not trained in what a school counselor does and that school counselor isn't trained in what I do. I imagine the same could be said between a school nurse versus a nurse you'd find in a hospital.

Besides, as JasonR86 pointed out, the limitations that school nurses have there are also legal implications that I can see too. Believe it or not some parents won't want their children being treated no matter the circumstances for religious, political, or other reasons. Then there's the whole thing about the child being a minor and how far do you go with the treatment, do you have to get prior written consent, how verbose does that consent actually have to be. It's a much more complicated issue than nurse heal kid, kid live. If a doctor or nurse goes above and beyond what a parent will allow then they could legally be sued. If a doctor or nurse heals a kid but that kid develops an infection and dies then they legally could be sued. Typically no matter what they do if it isn't to the satisfaction of the parents they'll be sued.

It's hardly black and white. No matter how much I morally agree with you that it would be a good idea I understand why school districts might not ever do it. It's easier to have an armed guard in school then to deal with malpractice suits that are unsubstantiated or not. And if they don't want an armed guard there then they're less likely to get the walking lawsuit.

That would mean America would have to actually spend money on public schools, Politicians ain't got time for that!

Nurses in schools should be alot better paid and alot more qualified than they are, in fact every school should have a qualified doctor as well.

The school I taught at had a set up like this where the district would share nurses between each other on a schedule. I had one student pass out in class and the nurse wasn't available so we had to call an ambulance. In any case I would certainly like to see schools have more universal standards of medical care for the kids.

The problem with this is the legal ramifications for the school and the lawsuits that they understandably don't want to risk.

From what I've observed the education system has more problems wasting money and properly allocating funds rather than not having enough money. There are schools that aren't properly funded, and more money couldn't possibly hurt, but the bigger problem is how the money is spent. You wouldn't believe the ridiculous shit some schools throw money at, not to mention how much they spend on sports.

A Tenured Professor in a University makes about 90k, a Football Coach makes over 1 million.

A good football program can bring in over 100 million dollars a year to the school. That 1 million is a drop in the bucket.

That's also at universities that make a lot of money and get millions and in some cases billions in endowment. Not at a public high school.

So do school nurses have no medical training at all or something? I mean I've had that kind of training too just for working at a swim school during the summers. Seems someone who makes it his/her full time profession should be required to have that kind of knowledge already. I'm gonna go out on a limb and guess that school nurses have that kind of training because otherwise I'm fucking terrified.

Like I said, the board just kind of looked at one another and basically said, "Shit, uhhhhhh.....". One guy even said, "That's a good question". But the agenda WAS security and part of security is being able to deal with a current threat and the aftermath of it. Either Nurses don't have training or the people in charge of the school don't even know their capabilities. To me, that's as terrible as not knowing how to lock the door. I'm expecting a call today from a representative of the nurses. If that doesn't happen, I'm probably just going to go to two schools near my house and pop in the nurses office and just ask. Cause...Journalism.

All the semi-serious injuries I saw in high school were either sports related or the one time a buddy of mine cut off his thumb with a paper cutter(don't come to art class stoned, kids). I don't think a slightly faster response time to a few random injuries justifies the cost.

@_chad:

The public school system is a huge mess. Just last year the town where I live passed a millage to rebuild a seven year old football field, and at the same time cut the teachers pay. People in the education field have it rough these days (except superintendents, those guys are assholes).

This so much! You'd be appalled at just how much funding goes into administration, it's fucking criminal.

Yep. Where I went to high school we had 4 vice principals all making 100k+ a year. Same at the high school across town, they were paying 8 vice principals over one million dollars a year combined plus full benefits. That's not even including the two actual principals. Also the superintendent got a lot grief because his two kids both went to private school.

Got an update from the guy in charge of Health of my school district. He said nurses are trained to use AEDs and CPR. They do not have formal training to deal with blood wounds but assures that they would "know what to do. Which is a bullshit answer. So, no, no one on the school grounds in my district has training to deal with any shooting.

@_chad: That's pretty much what was happening at the school I taught at. My pay was roughly 30,000 a year (It's not as bad as it sounds) while the administrators were making salaries equivalent to aerospace engineers. But yeah the cost of administration in the public school system is astronomical.

Geez, when I was teaching we didn't even have a school nurse. You would think that first responder techniques (tourniquets, direct pressure) would be an annually reviewed "infrequently used skill" given the patient demographics (i.e., children who literally leap before they look), but as far as I know, that isn't the case. If a district had money to employ a nurse, he/she would probably be rotating through multiple schools each week; I doubt there would be money for RN education. That is the fiscal state of public education in California, at least. Also, depending on specialization, nursing focuses on pharmacology more than trauma medicine, so if a nurse didn't get that training in the RN program, chances are he/she will not receive it from a budget-strapped district. The tyranny of the urgent often trumps common sense in education.