Prepared for anything

In the early 1970s, an Eastern Air Lines flight crashed into the Florida Everglades, killing 99 people on board. It was later discovered that the crash happened because the flight crew was overly fixated on a burnt-out indicator light—they were so focused on trying to fix the malfunctioning light that they failed to notice the plane’s autopilot was disengaging. With time the plane slowly lost altitude and eventually crashed.

Like the nurses around me, I listen in stunned silence as Boston Children’s Tara Kelly, BSN, RN, CNRN tells this story at a Community Education Initiative (CEI) lecture for school nurses. As Kelly described the scenario, all in attendance wondered the same thing—how could a simple lapse in teamwork cause such chaos?

Of course, this is exactly the point—or at least one of the points—Kelly and her colleagues hope to impress upon their audience.

Hopefully most school nurses will never find themselves in a situation as dire the one faced by the Eastern Air Lines flight crew, but the story’s underlying theme of placing importance on communication and teamwork still rings very true, and is at the heart of the Crisis Resource Management (CRM) course CEI Program Coordinator Stephanie Porter, MSN, RN offers to school nurses across the state.

Michael Ellsessar's parents John and Luann, 2nd and 3rd from left, spoke at the event. Since Michael's passing, the Ellsessars have become school safety advocates

CRM is one of the newest additions to educational programs for school nurses offered by CEI, which provides training to over 1,300 school nurses annually. Last year, Porter, along with Louise Quigley, DNP, RN-BC, Maureen Pursley, BSN, RN, Jayne Rogers, MSN, RN, NEA-BC, Kate Donovan, BS, PhDc, and Judi Naar, set out to create a simulation-based training program for emergency response teams. The group presented a curriculum to the School Nurse Leaders of Greater Boston in May 2012—the same month Governor Deval Patrick passed “Michael’s Law.”

Michael’s Law requires all Massachusetts public schools to prepare a Medical Emergency Response Plan to help prevent tragedies similar to the one involving Michael Ellsessar, for whom the law is named. Michael, a high school sophomore and son of John and Luann Ellsessar, passed away in November 2010 when he suffered a deadly heart disruption after a blow to the chest during a football game.  “Michael’s law puts accountability and credibility into play with the schools and the cities,” explained John, who was a guest speaker at the most recent CEI lecture.

Boston Children's Hospital's Crisis Management Resource training program

That accountability falls largely on the shoulders of school nurses who can be somewhat isolated in their roles, especially because they work in nonmedical settings. The growing range of skills school nurses are expected to master mean that increasingly they are turning to Boston Children’s for the training and practice they need, including the simulation-based CRM course. The courses are designed to match a school’s current level of readiness and meet individual school needs.

Rather than preparing school nurses for specific emergencies like heart attacks or seizures, the CRM course focuses on the communication and teamwork skills needed to handle any type of medical emergency until help can arrive. As Porter puts it, “the lessons from the course cover anything from a child having a seizure to a janitor experiencing cardiac arrest.”