priority in education and training for safety and accident prevention, CPR, and first aid, and use of the community emergency medical system.
The following are initial questions that a community can ask to ensure that a system is in place to deal with potential crisis medical situations:
Does a school-based emergency system or plan exist? What are its provisions?
Are school personnel informed of access to the emergency medical care system of the community?
Are school personnel trained in first aid and CPR?
What school accident prevention and accident reporting systems are in place? Who reviews these reports? How is information from these reports used to modify existing risks for students?
How are community providers of emergency medical care services involved in education and training of school-based health personnel and other school staff?
Are school medical consultants available for establishing triage, guidelines for need or immediacy of referrals, or standing orders as deemed necessary?
Screening is the process of using a relatively simple test to identify those who may have a particular problem. Unfortunately, screening programs are ineffective unless procedures are in place for ensuring follow-up of identified problems. Certain mandates for screenings are old and outdated, and statutory requirements should be reviewed for scientific validity.9 In a climate where resources are scarce, a balance may have to be struck between population-based screenings and targeted interventions for high-risk groups, as mentioned earlier in this chapter (Starfield and Vivier, 1995).
Overviews of screening recommendations are found in such publications as School Health: Policy and Practice from the American Academy of Pediatrics (1993) and Principles and Practices of Student Health, Volume II (Wallace et al., 1992b). The value of any screening program must be based on criteria outlined in Box 4-2.
As mentioned previously, Medicaid reimbursement for school-based