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Journal: Pediatricians Should Assist Schools on Resuscitation Requests

The May 1 issue of the medical journal Pediatrics renews its call for pediatricians to work with school nurses and personnel to help honor Do-Not-Attempt-Resuscitation requests for students.

Over the years, children who have complex chronic medical conditions have been increasingly able to attend schools, putting school personnel in the position of possibly having to carry out the wishes of a family to forgo life-sustaining medical treatment, including CPR. Some families make that difficult choice if such treatment would be ineffective or because the risks outweigh the benefits, Pediatrics says.

In 2000, the American Academy of Pediatrics first called for pediatricians to help parents work with schools to develop health plans for such students. But honoring those requests in the school environment is complex, the article says, because there is a limited availability of school nurses and oftentimes, a lack of supporting state legislation and regulations.

The issue has become more commonplace in schools. The percentage of schools in which health-services staff were reported to follow DNAR orders increased from 29.7 percent in 2000 to 46.2 percent in 2006, according to a Centers for Disease Control and Prevention survey cited by the article.

"Pediatricians have an important role in helping school nurses incorporate a specific action plan into the student's individualized health-care plan," the article says. "The action plan should include both communication and comfort-care plans. Pediatricians who work directly with schools can also help implement policies, and professional organizations can advocate for regulations and legislation that enable students and their families to effectuate their preferences."

Educators, has this situation ever come up in your school? What are your thoughts about it? Does your school have a clear policy about it? Does your state have regulations that address it?

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