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Planning for a Mass Casualty Incident in Arkansas Schools

Posted on: Thursday, 6 October 2005, 06:00 CDT

By Graham, James; Liggin, Rebecca; Shirm, Steve; Nation, Brian; Dick, Rhonda

School preparedness includes the possibility of a natural disaster,1,2 but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs).3-7 This survey examined the preparedness for the prevention and response for MCIs at public schools in Arkansas.

SURVEY METHODS

A mailed survey was sent to superintendents of all 307 public school districts in Arkansas in August 2003, using a list obtained from the Arkansas Department of Education. A second mailing was sent to nonresponders in September 2003. The survey assured superintendents that no individual school district response would be released and only aggregate data would be reported. An addressed, stamped envelope was included for survey return. The survey was reviewed and exempted by the University of Arkansas for Medical Sciences Institutional Review Board.

SURVEY RESULTS

Some 226 of 307 surveys were returned (74%). Most school districts (51.3%) reported they did not have a written plan for the prevention of a terrorist or mass casualty event. Very few districts reported using student (14.6%) or teacher (29.2%) identification badges. When asked about any kind of physical barrier or restricted vehicular access (such as fences or gates) to school grounds, only 27% reported having such barriers.

Most districts (78.8%) reported having a written plan for an MCI. Most (76.2%) reported having a plan for lock down of the facility in an emergency. Most districts (91.2%) reported having plans for evacuation by a variety of means (28.6% on foot, 27.2% by school bus, 18.4% by parental and/or teacher vehicles). Although most districts reported an evacuation plan, 55% reported never having conducted an evacuation drill.

Most school districts (57.5%) reported having made arrangements for an alternate building for shelter in case of evacuation as follows: houses of worship (69 districts), other school buildings (25 districts), and community centers or other public buildings (14 districts).

About one half (50.4%) of superintendents reported that parents in the district knew what buildings would be used as an alternate shelter; the other half said parents did not know. A few superintendents reported that they do not publicize the location for security reasons.

The majority (55.7%) reported having a written parental reunification plan for release of students to parents, guardians, or family members in a disaster or mass casualty situation. Most authorized a person to initiate lockdown or evacuation measures in the district as follows: superintendent only (59 districts); superintendent or principal (54 districts); principal only (49 districts); superintendent, principal, or local law enforcement personnel (28 districts); and school resource officer (1 district).

Virtually all school districts (98.9%) reported maintaining an updated master list of students, usually in individual school offices. Only 25% (57 districts) reported keeping a backup copy of the master list at central district offices.

A minority (30.1%) reported no plans for mental health counseling or referral in the event of mass casualty. Slightly more than one half (51.3%) reported special provisions for children with special health care needs in their emergency plans.

Superintendents reported meeting with local emergency medical services (EMS) officials to discuss emergency planning as follows: never met with EMS officials (114 districts), met 1 or 2 times with EMS officials (99 districts), and meet regularly with EMS officials (14 districts). Superintendents reported meeting with local law enforcement officials to discuss emergency plans as follows: never met with local law enforcement officials (75 districts), met 1 or 2 times with local law enforcement officials (130 districts), and meet regularly with local law enforcement officials (20 districts). Most school districts (61.6%) provided copies of floor plans for their buildings to local law enforcement officials.

SURVEY IMPLICATIONS

Approximately 53 million children in the United States attend public or private schools each day. In addition, approximately 6 million adult teachers and staff work in those facilities.8 Because large gatherings occur daily, schools represent a risk for an MCI from either natural or intentional causes. Therefore, school personnel must ensure the safety and security of schools, and schools also have a special responsibility because of their in loco parentis role.

In this survey, most school districts reported they did not have a written plan for prevention of an MCI. Schools have traditionally prepared for natural or unintentional disasters, such as fires, earthquakes, and tornadoes. Such disasters are unpredictable and unpreventable. With the advent of school shootings and terrorism, the need for prevention or mitigation has become apparent.

Proper identification of individuals who are appropriately on campus and the rapid identification of those not authorized to be on school property is important. Identification badges provide a simple, inexpensive means to mark those appropriately on campus but are used by few school districts in Arkansas. Other organizations, such as hospitals, routinely use identification badges for security purposes. Vehicle barriers may prevent a vehicular threat, such as a car or truck bomb, in close proximity to a school building. Only a few superintendents reported using such barriers. The expense of such structural modifications can be significant.

Most schools did not have a prevention plan, but most reported having a written plan for responding to a disaster on campus. Almost all districts reported having an evacuation plan, including movements by foot, school bus, and private vehicles. Although most schools had an evacuation plan, less than one half had ever conducted an evacuation drill to evaluate the effectiveness of such a plan. For example, Seattle schools conducted drills of emergency plans, including evacuation and shelter-in-place plans, and revised the plans after the drill.8

In an MCI, schools must be prepared to inform parents of the location of their children and how to reunite with their children. Such an event can occur at any time, and children may not be on school grounds when reunification occurs, so a master list of students and a plan for releasing students to parents or responsible relatives is important. Slightly more than one half of districts in this survey reported having a written parental reunification plan. Most districts kept a master list of students, but only about one fourth of them kept a copy of the master list off the school campus. If a disaster destroyed a school building, an offsite list would be important in accounting for everyone in the school.

Children with special health care needs present a special challenge in emergency plans.9-11 Mobility may be impaired, posing a challenge for evacuation. If sheltering-in-place is necessary, an adequate supply of items needed to care for these children must be provided.

Ensuring that plans are coordinated with local emergency agencies is important. During the Columbine school shootings, local law enforcement special weapons and tactics (SWAT) teams and ambulances initially were told that there was shooting in the library. Because they did not have a current floor plan, there were difficulties in the initial emergency response and getting personnel to the school library.3,4 A previous study demonstrated that EMS ambulances are frequently called to schools for emergencies, even outside the disaster or mass casualty situation.9 Although most school superintendents had met with local law enforcement personnel, most had never met with local EMS officials to discuss emergency planning. Few school districts reported holding regularly scheduled meetings with either EMS or law enforcement.

CONCLUSIONS

This survey demonstrated that most school districts in Arkansas have plans for responding to a mass casualty event, but less than one half have a plan for prevention or mitigation of such an event. Since this survey was conducted, Arkansas has passed a law requiring all school districts to develop such an emergency response plan. The findings highlight a need for continued planning and preparation. For example, most schools had not conducted a mass casualty drill. Most superintendents had not met with local EMS officials, and only a few have regularly scheduled meetings. Schools should continue to plan and prepare for the unwelcome prospect of a disaster at a school. School district administrators, nurses, physicians, local emergency response agencies, and the local medical community should all be involved in formulating a coordinated plan for their local community schools.

References

1. Allanson JF. School mass disaster policies. J Sch Health. 1967;37:285-288.

2. Van Horst J. An earthquake preparedness plan at Webster Elementary School. J Sch Health. 1989;59:367-368.

3. Heightman AJ. Assault on Columbine. J Etnerg Med Serv. 1999;24(9):32-46.

4. Nordberg M. When kids kill: Columbine High School shooting. Emerg Med Serv. 1999;28(10):39-45.

5. Merz K. The Columbine High School tragedy: one emergency dep\artment's experience. J Emerg Nurs. 1999;25(6):526-528.

6. Brener ND, Simon TR, Anderson M, et al. Effect of the incident at Columbine on students' violence- and suicide-related behaviors. Am J Prev Med. 2002;22(3):146-150.

7. Kostinsky S, Bixler EO, Kettl PA. Threats of school violence in Pennsylvania after media coverage of the Columbine High School massacre: examining the role of imitation. Arch Pediatr Adolesc Med. 2001;155(9):994-1001.

8. National Advisory Committee on Children and Terrorism. Schools and terrorism: a supplement to the report of the National Advisory Committee on Children and Terrorism. J Sch Health. 2004;74(2): 39- 51.

9. Sapien RE, Alien A. Emergency preparation in schools: a snapshot of a rural state. Pediatr Emerg Care. 2001;17(5):329-333.

10. Abrunzo T, Gerardi M, Dietrich A, et al. The role of emergency physicians in the care of the child in school. Ann Emerg Med. 2000;35(2):155-161.

11. Emergency Cardiovascular Care Committee. Response to cardiac arrest and selected life-threatening emergencies: the medical emergency response plan for schools. A statement for healthcare providers, policymakers, schools administrators, and community leaders. Pediatrics. 2004;113(1):155-168.

James Graham, MD, Professor, (grahamjames@uams.edu); Rebecca Liggin, MD, Assistant Professor, (ligginrebeccal@uams.edu); Steve Shirm, MD, Associate Professor, (shirmstevenw@uams.edu); and Rhonda Dick, MD, Associate Professor, (dickrhondam@uams.edu). Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, 800 Marshall St, Little Rock, AR 72202; and Brian Nation, MPA, Trauma System Coordinator, (bnation@ healthyarkansas.com), Arkansas Department of Health, Office of EMS and Trauma Systems, 4815 West Markham St, Little Rock, AR 72205. This study was supported by a grant from the Health Resources and Services Administration-Maternal and Child Health Bureau (MCH #1H33 MC 00088 01).

Copyright American School Health Association Oct 2005

Source: Journal of School Health, The

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