NOTE: The board is NOT required to adopt a policy or regulation regarding the implementation of DNR orders or CPR directives. However, because of the increasing number of medically fragile students attending school, each district should consider the issues raised in this policy. We recommend that the board work with its own legal counsel, with medical personnel and with school nurses, special education directors, teachers and other appropriate staff members to develop a policy that fits the district's unique circumstances and meets the requirements of state law. Colorado law requires emergency medical service personnel, health care providers and health care facilities to honor CPR directives. It does not place an affirmative duty on non-medical school personnel to honor such directives. However, persons who comply with a CPR directive in good faith cannot be held criminally liable under state law.
(Implementation and Protocol for CPR Directives)
Determining whether implementation of a CPR directive is feasible
In determining whether it is feasible for the CPR directive to be implemented in the school, the CPR directive team shall:
Consider the impacts on the school, including the mental, emotional and physical health of all students and personnel in the school. If the team determines that the impact of the ill student's participation is too disruptive, the team shall initiate a request for homebound educational services, subject to laws pertaining to the education of students with disabilities.
Consider obtaining an independent medical opinion, which may include an evaluation by hospice personnel.
Involve legal counsel in review of the CPR directive to determine whether it is valid under state law, including whether the persons signing the form have legal authority to make medical decisions on behalf of the student.
Consult with the emergency response personnel responsible for responding to an emergency call at the school to determine whether school personnel who have contact with the student have the proper training and expertise to implement a proposed protocol for health-related emergency events involving the student, including the ability to assess whether the circumstances specifically described in the protocol are present and to provide or withhold the specific assistance or care.
Determine whether school personnel who have contact with the student have any moral or ethical issues related to complying with the protocol. If so, and only with parent/guardian permission, arrangements shall be made to transfer the student to a different classroom or school. If the parent/ guardian does not agree to the transfer, the CPR directive will not be implemented. The school district reserves the right to designate specific classrooms or schools to which students subject to a CPR directive will be assigned.
Provide counseling resources, which may include hospice, for students and school district personnel on issues of death and dying prior to and during the student's attendance at the school.
Obtain a written statement from the parents/guardians stating that any time the school nurse, principal or designee feels the student is too ill to be in class, the parents/guardians or designee will be immediately available to pick up the student from school and if they are not, that they consent to transportation of the student according to the instructions contained in the statement. The statement shall state the place to which the student shall be transported, who will provide transportation and who shall be responsible for any transportation charges.
Address confidentiality issues.
Designing an emergency protocol
In designing a protocol for handling health-related emergency events, the CPR directive team shall:
Describe the specific assistance or care, including comfort care, to be provided to the student, by whom and under which specifically described circumstances. This shall include a description of care to be provided when a treatable or curable intervening disease, medical condition or injury occurs.
Describe the specific assistance or care that is not to be provided to the student, by whom and under which specially described circumstances.
Specify the potential signs and symptoms of health deterioration. Every effort shall be made to transport the student from school at the first signs of deteriorating condition.
Upon the onset of signs or symptoms of health deterioration and while waiting for transportation by parents/guardians or emergency medical personnel, provide for removal of the student from the classroom to a private setting. If the affected student's removal is not possible, provide for removal of other students in the room.
Address how other students in the room at the time of the health-related emergency event will be cared for.
Describe how and by whom notification of emergency medical personnel and the county coroner will occur.
Describe how and by whom notification of the student's parents/guardians will occur.
Describe how and by whom communication with parents/guardians of other students in the school will occur.
Address transportation needs in the event the student dies while at school, including the mortuary to which the student is to be transported and by whom.
Provide for professional counseling to students and personnel in the school following a health-related emergency event.
At the discretion of the school principal or designee, involve legal counsel in review of the protocol.
All parents/guardians having authority to make medical decisions must sign the protocol developed by the CPR directive team before the protocol can be implemented.
A current photograph of the student shall be submitted with the CPR directive and shall be kept with all copies of the CPR directive. A copy of the CPR directive with the student's photograph shall be kept in a confidential location where it can be easily located at all times. The original CPR directive shall be kept in the nurse's office.
COLORADO SAMPLE REGULATION 2001