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Best Practices for Managing a School District Health Crisis

By Amber Graham Fitzgerald on October 09, 2018 hst Print

One afternoon in the fall of 2016, Joan McIntyre, RN, BSN, health services director for the Enid (Oklahoma) Public Schools (EPS), received a jarring phone call about a critical community health issue.

A county health department official informed her that there had been a mumps outbreak in the community, and that several EPS students were infected.

“Since we had prepared for situations like this, fortunately, we were able to coordinate quickly,” McIntyre said.

While it was a community matter, McIntyre said EPS found itself at the epicenter of the health crisis and emerged as a leader for handling such issues as a result. McIntyre credits the district’s health crisis planning for its success in addressing the situation in a way that benefited the health of students and developed trust between the district and the public.

Preparation

According to McIntyre, a district’s ability to handle a health crisis begins long before an incident occurs, whether it is an uncommon epidemic or even a bad flu season. An effective response, she said, begins by developing strong relationships with local health professionals.

“Collaboration with medical professionals is key, especially public health officials,” McIntyre said. “Lines of communication must be open so that you can exchange appropriate information. We all work for different organizations, but we have a common mission – to ensure our fellow residents are healthy and safe. We have a better chance of accomplishing this goal when we work together.”

While EPS is fortunate to have a health services department, McIntyre said the lack of a medical professional on staff should not discourage districts from planning for an epidemic or outbreak. They can lean on local medical and public health professionals for support.

Prevention

As the adage says, “An ounce of prevention is worth a pound of cure.” School districts should encourage healthy best practices throughout the year, but they are especially important during flu season or other outbreaks.

The year of the mumps epidemic, EPS had embarked on an aggressive campaign to ensure all students complied with Oklahoma vaccination laws. School officials sent numerous letters and phone calls to those who needed immunizations (and had not filed a waiver form) with a deadline of when they would no longer be admitted to class without them. The district offered immunization clinics and provided any assistance necessary to help families comply with the law.

“We never want students to be denied the opportunity to attend class, but this came down to the importance of their health,” McIntyre said. “Fortunately, in a very short period of time, all EPS students were in compliance. We were confident this was one of the most important rules we could enforce to protect their health.”

The district also arranged on-site immunization clinics for school employees. Since EPS offers annual influenza vaccinations for staff, it was easy for the district to implement a similar event for this situation.

“The health department reported that 66 percent of those who contracted mumps had actually received the mumps vaccine earlier in life,” McIntyre said. “This made other prevention efforts even more important.”

Education is a vital component in the prevention of communicable illness. From creating posters for the hallway to demonstrating good handwashing for students, McIntyre recommends sharing the following information:

  • Wash your hands often with soap and water.
  • Avoid touching your face with unwashed hands.
  • Avoid close contact with people who are sick.
  • Do not share electronic devices with others, including cell phones.
  • Cover your coughs and sneezes with a tissue or your upper shirtsleeve.
  • Stay home when you are sick.
  • Ensure children are fever-free and diarrhea-free for 24 hours (without fever-reducing medication) before returning to school.

Communication

While medical professionals are understandably most concerned about health-related matters, McIntyre said communication during a health crisis is critical to minimize the spread of illness and to reduce public panic. She said the district knew it had to communicate immediately with parents and the community about the mumps outbreak.

“We didn’t have much notice before the State Health Department was scheduled to make an announcement,” McIntyre said. “Within minutes, we put together a letter that was emailed and texted to parents so that they would hear the news first from the school district. It is important for parents to know that they can trust us to be proactive and to do everything possible to keep their children safe.”

As a matter of best practice, parent and community communication should include several components in order to be effective. First, it should assure the reader that school and health officials are working together and that the safety of students and staff is their greatest priority.

Second, communication should include information about the illness, including symptoms and what to do if they appear. The Centers for Disease Control and Prevention is an excellent resource for finding and downloading handouts for this purpose.

Third, it must explain the district’s plan of action. Finally, it should encourage families to contact their personal physician or the public health department for more information about the illness.

Schools can employ all of their communication tools to share information about outbreaks and prevention, including email, phone and text systems, social media, local media and parent meetings.

Intervention

According to McIntyre, it was the day-to-day routine developed by community health and school officials that helped minimize the number of people who contracted mumps.

School officials tallied absences and diagnosis numbers every day in an attempt to identify illness trends, and they also provided guidance to families by referring them to the health department and local medical professionals for evaluation and care.

“The most important aspect of the plan was to require that students with symptoms were not in the school setting for at least five days to ensure that they were no longer contagious,” McIntyre said. “It took a great deal of coordination to ensure they were released by a medical professional before they returned to school.”

McIntyre said the school also took precautions to limit exposure in the school buildings, such as eliminating the use of water fountains without cups and comprehensively disinfecting the school sites each evening. It took the involvement of many school departments to respond to the outbreak with the energy and speed it required.

“When there is a medical emergency, everyone has to be on board to do what is necessary to protect students,” McIntyre said. “It takes the entire team. A daily meeting or frequent electronic communication is critical to make sure all parties are on the same page.”

Recovery

At the end of the Enid mumps outbreak, medical professionals documented about 50 cases; however, hundreds more exhibited symptoms of the illness. Without a comprehensive community response, however, the mumps outbreak would have lasted much longer and infected many more people.

At the end of the ordeal, McIntyre advised her colleagues to debrief about the situation to determine how they could improve their response for future health-related crises. This evaluation process is vital, she said.

“When it comes to the health of our students, it’s not enough to be good. We have to keep getting better,” McIntyre said. “Health and emergency planning must be ongoing, and we must always determine how we can improve our efforts. Our students deserve the very best.”