Tabletop Exercise 10: Student Goes Into Anaphylactic Shock

This medical emergency scenario emphasizes the importance of first aid training and radio communications, among other things.
Published: March 15, 2021

Medical emergencies are unpredictable and can happen in any place at any time. When a medical emergency occurs within a school, it is unlikely that a first responder or medical professional will be the first to respond. Therefore, that responsibility is passed on to school staff when students are under their supervision.

An effective way to test a campus’ readiness to respond to medical emergencies is through scenario-based training exercises, sometimes referred to as tabletop exercises. These exercises bring together a wide variety of stakeholders to test a school or campus’ emergency plans without having to conduct a full-scale exercise.

In the real-life tabletop scenario discussed below, which involves a student medical emergency, you’ll see that many campus employees played a role in the response, emphasizing the need to involve an array of employees in these exercises.

Since October, Guy Bliesner, an analyst for the Idaho Office of School Safety and Security (IOSSS), has provided Campus Safety with incidents that happened at Idaho schools in the last five years, how administrators and staff responded, and what changes were implemented as a result.

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Each scenario sets the scene for the day and describes the event in detail, along with the actual outcome of the scenario and findings from an after-action review. They are designed to be completed in 10-15 minutes as part of an administrative meeting.

The next scenario is detailed below.

Scenario #10

  • Season: Late spring
  • Day: Tuesday
  • Time: 11:46 A.M.
  • Weather: Warm and sunny
  • Temperature: 73 degrees
  • School type: Elementary (K-5)
  • Event: This is a 2-part event:
    • Part 1: You are involved in lunch supervision in and near the cafeteria; 4th and 5th graders are on the playground having finished eating, 3rd graders are finishing eating, and 2nd graders are entering the lunchroom to begin their lunch. A frantic 5th grader approaches you and is incoherent about an incident in progress on the playground. What steps should you take?
    • Part 2: Arriving at the playground, with difficulty, you are able to identify all three of the playground duty staff in a huddle on the far end of the grass area of your playground. As you approach, you notice that a 5th grader is on the ground and observe a swollen face and hands, blotchy red coloring and respiratory distress. What steps should you take?

How the School Handled the Situation

The 5th grader tells the principal there is no one in the office and the duty aide needs help on the playground. The student is not clear as to the specific issue. The principal asks a passing teacher to watch the lunchroom and leaves for the playground.

Once he reaches the playground, it takes some time to locate the duty personnel on the grounds as they are not easily identifiable among the students. Once located, the principal joins the group approximately 150 yards from the building. The duty staff indicates they have just called 911 and that the student has been down and in increasing distress for approximately 7 minutes. The younger sibling of the affected student approaches the group and says the child is allergic to bee stings and should have a “pen thing.”

Two more minutes pass and the principal sends a staff member to the office to retrieve the EpiPen. Approximately 5 minutes elapse before the staff member returns with the EpiPen. However, no one is trained to administer the EpiPen and another minute passes.

EMS arrives on the scene and a paramedic administers the EpiPen. The student is then transported to the hospital. The principal calls to notify the parents but cannot get ahold of them. They then notify the emergency contact in the Student Information System (SIS).

The parents contact the school the following day and are deeply concerned about the time taken to respond to the incident. The total time from the incident to the use of the EpiPen was approximately 15 minutes.

After-Action Review Findings

An after-action review (AAR) of a campus’ response should always be completed following an incident. See Part 1 for questions that IOSSS says should be used to review a response.

In this case, the AAR determined all of the following factors contributed to unsatisfactory performance in the incident:

  • An unacceptable amount of time elapsed between incident onset and response by someone in the school. Contributing factors included:
    • Inadequate communications
    • Cell phones were used and an answering system picked up in the office when called repeatedly
    • There was a lack of office staff available when the student tried to report the incident
  • First aid training was lacking
  • No access to an EpiPen on the playground
  • Student supervision staff lacked visibility
  • No notification was given to student supervision staff of an at-risk student

As a result, the following changes were made:

  • Policy is changed to provide for consistent office staffing
  • A one-to-many radio communications plan is developed and implemented to assure communication between the office and the playground
  • First aid training is both required for the initial hire of student supervision staff and provided as ongoing professional development
  • Students with special health needs are identified and access from the playground to appropriate medical equipment is provided
  • All staff engaged in student supervision are required by policy to wear easily identifiable, high visibility clothing for ease of identification

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