Safety beyond the playground an important consideration for students

According to the National Center for Education Statistics, 49.4 million students attended public elementary and secondary schools in fall 2010, and another 5.8 million students attended private schools. Although many consider schools to be safe havens for these children, there is a great need to ensure that children in school remain safe.

From safety while playing school sports to safety while riding a school bus to remaining safe during a natural disaster, maintaining student safety plays a major role in schools. According to the website preventinjury.org, students spend almost one-fourth of their total waking hours in school, and an estimated 2.2 million children aged 14 and younger sustain school-related injuries each year.

Sports injuries

According to data from the Children’s Hospital Boston, 30 million children and teens in the United States participate in some form of organized sports, and more than 3.5 million sports-related injuries occur each year.

Jon Divine, MD, clinical director of sports medicine at Cincinnati Children’s Hospital Medical Center and the head team physician at the University of Cincinnati, told Infectious Diseases in Children that ankle sprains are the most common injury, comprising 15% to 20% of sports injuries. The second most common injury is concussion, comprising at least 10% of sports injuries. He said for all age ranges, it is important to eliminate the risk of a second injury.

“Once someone has had one injury and continues to play sports before the injury has healed, the chances of having another injury are great,” Divine said. “Completely fixing the first injury is the best advice we give, since that is a common risk factor for future injuries.”

Using protective equipment that is properly fitted is important, especially for helmets. In players who have had concussions, Divine said physicians often discover that the air padding in helmets was under-inflated or deflated. Also important is learning how to fall and land correctly, which involves using the knees and feet and ankles more as a spring.

“For kids who typically play only one sport, we encourage them to participate in tumbling or gymnastics class for a few months so that they learn how to fall properly, which helps prevent fractures,” Divine said.

When it comes to concussions, the main symptom is headache. However, experiencing dizziness on the field after receiving a blow to the head is one of the most predictive signs that a child will have long-term recovery issues, Divine said. In addition, another symptom is amnesia, which is also predictive of a significant time to recovery after concussion.

In a 2001 statement issued by the AAP Committee on Sports Medicine and Fitness and Committee on School Health, pediatricians are encouraged to help assess the readiness of children and preadolescents to participate in organized sports. They are also encouraged to help educate coaches about health and safety issues and monitoring the health and safety of children involved in organized sports.

School bus safety

Of the 371,104 fatal motor vehicle crashes that occurred since 2000, 1,245 were classified as school transportation-related, according to the US Department of Transportation’s National Highway Traffic Safety Administration. Occupants of school transportation vehicles accounted for 8% of the fatalities.

In a 2006 study published in Pediatrics, researchers used data from the National Electronic Injury Surveillance System All-Injury Program to determine the epidemiology of nonfatal school bus-related injuries among children and teenagers aged 19 years and younger. They estimated that 51,100 school bus-related injuries occurred in the United States from 2001 to 2003, making a national estimate of 17,000 injuries per year. Most of these injuries (43%) occurred in children aged 10 to 14 years, and the leading mechanism of nonfatal school bus-related injury was motor vehicle crashes.

In 2007, the AAP issued a policy statement on school transportation safety in which it made recommendations to make school buses safer, including its recommendation that seat belts be installed on all new school buses. For preschool-aged children, the AAP recommends height- and weight-appropriate safety seats and restraint systems that meet federal motor vehicle safety standards. For school-aged children, the AAP recommends that children use age-appropriate, properly secured child-restraint systems.

Aside from proper restraint systems, the AAP also recommends that states adopt measures to protect children from exposure to toxic air contaminants that are released in bus exhaust. It also recommended additional adult supervision on school buses to ensure that children stay seated and use appropriate restraint systems.

Disaster planning

According to a 2007 report by the United States Government Accountability Office, most school districts have developed plans for emergency management, but would benefit from further federal guidance on preparing for emergencies. There is no federal law requiring emergency management plans, but 32 states have laws and policies requiring school districts to have such plans.

The AAP released a policy statement in 2008, which stated “community awareness of the school district’s disaster plan will optimize a community’s capacity to maintain the safety of its school-aged population in the event of a school-based or greater community crisis.”

The policy statement outlines four areas in disaster planning: mitigation and prevention, preparedness, response and recovery. According to Linda Grant, MD, MPH, associate professor of pediatrics at Boston University School of Medicine and the lead author of the AAP policy statement, many tend to think only of response when it comes to disaster planning.

“Most people don’t think about preparing for a disaster ahead of time,” Grant told Infectious Diseases in Children. “Considering this ahead of time and preparing a disaster plan might decrease the issues that occur when a disaster strikes. There are many children in schools, and it’s important to know ahead of time what to do for shelter-in-place or evacuation, especially for children with special health care needs.”

Grant said community pediatricians should be familiar with AAP resources on emergency and disaster planning, and should familiarize themselves with the disaster plans of their communities and school districts. Pediatricians should also talk to their patient’s families about disaster plans, especially about reconnecting children with their families after a school evacuation.

Some communities are predisposed to possible crises such as tornadoes, earthquakes and hurricanes, and it is important for pediatricians to have an office-based disaster plan to be prepared to treat medical issues resulting from the crisis. Grant said there are free online courses that pediatricians can take to be certified in disaster planning.

“Disasters have a good chance of happening while kids are in school, since that is where they spend a lot of time,” Grant said. “It is important to make sure that pediatricians are guiding families in alignment with how their schools are thinking about disasters.” – by Emily Shafer

For more information:

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Pediatrics. 2007;120:213-220.
American Academy of Pediatrics Committee on Sports Medicine and Fitness. Pediatrics. 2001;107:1459-1462.
American Academy of Pediatrics Council on School Health. Pediatrics. 2008;122:895-901.
McGeehan J. Pediatrics. 2006;118:1978-1984
National Center for Education Statistics. Fast facts. Available at: http://nces.ed.gov/fastfacts/display.asp?id=372. Accessed Aug. 11, 2011.
Preventinjury.org. School injury. Available at: http://www.preventinjury.org/PDFs/SCHOOL_INJURY.pdf. Accessed Aug. 11, 2011.
United States Department of Transportation. School transportation-related crashes. Available at: www-nrd.nhtsa.dot.gov/Pubs/811396.pdf. Accessed Aug. 15, 2011.
United States Government Accountability Office. Emergency management: Most school districts have developed emergency plans, but would benefit from additional federal guidance. Available at: www.gao.gov/new.items/d07609.pdf. Accessed Aug. 11, 2011.

Follow the PediatricSuperSite.com on Twitter.