How to Evacuate Students With SMA

Part 3 of this series focuses on spinal muscular atrophy (SMA), which is a group of inherited diseases that cause progressive muscle degeneration and weakness. Knowing how to carry passengers with this condition on an evacuation device and including a nurse in training drills will help to ensure their safety.

Published: November 6, 2011Author: CS Staff

<p>Katie, who has spinal muscular atrophy, received her first motorized wheelchair at the age of 2.</p>

<p>Zimmerman says students with spinal muscular atrophy are aware of bus evacuations, but physically they are unable to help themselves. Therefore, it is critical to be in constant verbal communication with the students to reassure them that they will be evacuated safely.</p> Implications for an emergency evacuation
The following must be taken into account when doing an emergency evacuation for a student with SMA:

These students are usually in a motorized mobility device at a very
young age.
These students will need to be either carried out of the bus or dragged out of the bus on an emergency evacuation device.
These students will have extreme weakness of their trunk muscles and often cannot sit by themselves. Be sure that during an evacuation you protect and support the student’s head and back.
As a student with SMA gets older, a tracheostomy and ventilator (i.e., a breathing machine) may become necessary to help the student breathe.

Plan well in advance to provide manual respirations for this student during an emergency. Also, practicing this drill will be critical to the student’s safety.

Often, a nurse will ride the bus with a student who has a tracheostomy and ventilator. During an evacuation, the student will need to be disconnected from the ventilator. Respiration will be performed manually by the nurse. However, the transportation staff will also need to know how to perform manual respirations in case the nurse is unconscious due to the accident.

For a student being dragged out of the bus who needs to breathe with an Ambubag, use this recommended procedure:

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During the dragging process, the bus staff members drag the student, then pause to allow the nurse to use the Ambubag to breathe for the student, then resume dragging, pause again to let the nurse use the Ambubag, etc.
Repeat this process until the student has been safely evacuated. The nurse will continue operating the Ambubag until medical help arrives. For this reason, it is critical that the nurse be involved with emergency evacuation drills.

Summary
It is important to recognize that students with SMA are aware of an evacuation, but physically they are unable to help themselves. During evacuations, it is critical to be in constant verbal communication with these students. They will need reassurance that we will be doing everything we can to get them out of the bus safely.

Jean M. Zimmerman is supervisor of occupational and physical therapy for the School District of Palm Beach County (Fla.). She is the author of Evacuating Students With Disabilities, a comprehensive manual and training course written in conjunction with the Pupil Transportation Safety Institute. The program can be purchased at www.ptsi.org or by calling (800) 836-2210.

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