Jimmy B, a 4th grader in a rural Arizona school, experienced an episode of respiratory distress while playing at morning recess. He was struggling to breathe, unable to speak a complete sentence and his lips were turning blue. The school staff immediately called 911. Jimmy was assessed and treated by EMS personnel with a quick acting medication called Albuterol. He was then transported by ambulance to a nearby hospital emergency department (ED) for follow-up evaluation. After 6 hours in the ED, Jimmy was sent home with his parents who were instructed to follow-up with their physician. Not only was this a traumatic experience for Jimmy, but his family was left with an expensive hospital bill due to lack of health care insurance coverage.
One of the leading causes of school absenteeism is asthma, a common chronic disease among children and teens. Exposure to environmental triggers such as pollens and other allergens can prompt an asthma episode, making it difficult to breathe. In a classroom of 30 children, about 3 are likely to have asthma, and many may not be diagnosed.
In 2019, Arizona reported over 10,400 ED visits for children with asthma, according to the most recent analysis. Forty-one percent of all ED visits were for people under age 20. In rare instances, asthma episodes can be fatal.
Because asthma can be controlled by avoiding triggers and taking medications, many of these emergencies can be prevented. Children who have access to health insurance can get care and medicine to control their symptoms. They are allowed to have their quick-relief medication at school, but fewer than 14% have reliable access at school to this life-saving drug.
A 2023 Arizona School Health Assessment reports that the number of school medical emergencies is unknown, that they can have potentially severe consequences, and there is an opportunity to quantify and prevent them with stock medication programs.
Arizona schools now have access to an evidence-based program, the Stock Inhaler for Schools Program. Prior to the introduction of the program, stories like Jimmy’s were all too frequent. They resulted in significant loss of classroom instructional time, added burden on our emergency response system leading to unnecessary ED visits and their associated expenses. In 2017, Arizona passed H.B. 2208, “Stock Inhalers for Schools.” The law allows schools to procure, stock, and administer albuterol sulfate to any student experiencing respiratory distress by a trained person. The law releases participating personnel, schools, and medical professionals from civil liability and works with the Nurse Practice Act, thus protecting licensed school nurses.
A two-year pilot program designed by the University of Arizona Asthma & Airway Disease Research Center was implemented in a large public school district in Tucson. It resulted in a 20% reduction in asthma-related 9-1-1 calls and a 40% reduction in asthma-related EMS transports.
In 2017-18, the program was expanded to 229-plus schools located in Pima County. Schools reported 1,038 episodes of respiratory distress where medication was administered to a student. Eighty-four percent of events resulted in the student returning to class instead of being sent home or to the ED.
Because numerous schools in Arizona lack full-time, licensed nurses, and many are located far from a medical facility, this program offers an opportunity to train any school staff to respond quickly and efficiently to a respiratory emergency.
The cost is about <$100 per year per school for the medication and supplies. Funding so far has been provided by grants, local civic donations, county health departments and school budgets. Local sponsors include county health departments, hospitals, community health clinics and Chambers of Commerce.
The program is streamlined and easy to implement. Once school administration approves the program, schools are eligible to enroll online, designate at least 2 staff members to complete the free web-based training, and follow the protocol for using medication. Emergency episodes are logged into a statewide database and parents are notified when their child has an incident.
Arizona is a pioneer in launching the Stock Inhaler for Schools Program, with more than 570 schools participating in 9 counties. While 18 states have laws allowing schools to implement a school-based stock inhaler program, only a handful of schools across these states have a current Stock Inhaler for Schools Program at their school. Most states look to Arizona for guidance on program implementation.
The program is a grassroots effort, sponsored by the University of Arizona, the Arizona Asthma Coalition and Maricopa County Department of Public Health. A statewide stakeholder group includes many public health departments, education leaders and the American Lung Association. Mercy CARES is supporting the program with a grant in the current school year.
This innovative school-based stock medication program is part of a Safe and Healthy Schools Initiative that offers many benefits. Students can receive evidenced-based care on site. Parents are thankful that their child received immediate life-saving care. Most students will avoid a stressful ED visit or hospitalization and its associated cost. Because a high proportion can return to class, there is less absenteeism and more time for classroom instruction.
For communities that would like to learn more about the program and assistance with starting a stock inhaler program, please contact Dr. Ashley A. Lowe at stockinhaler@arizona.edu
