Since the beginning of the school year, two Madison County students have been administered medication through an EpiPen, used to auto-inject a measured dose of epinephrine to treat a severe allergic reaction or anaphylactic shock, the school board learned at Thursday’s meeting.

In one instance, “the physician told the mom, if it (EpiPen) had not been there, she would not have made it,” said Michelle Malicote, the district’s school health clinic services manager.

Superintendent Elmer Thomas said he received a call the day after the incident, “basically saying … the child more than likely would have died at school had we not had a stockpile of Epipens and a nurse on staff. Nobody knows that, because everything turned out good, and it’s because of (the nurses).”

Last year, a new state law allowed school districts to keep a stockpile of EpiPens, said District Health Coordinator Becky Carr, who with Malicote presented a school health program summary to the board.

While EpiPens are kept for students with known allergies, a stockpile allows access to the potentially life-saving treatment for others whose allergies may be undiagnosed, Carr said.

Madison County is one of two districts in Kentucky to start building a stockpile this year, and “it takes some effort,” she said.

Not only must the health team of registered nurses train school employees on how to use the EpiPens, the effort must be carried out under a doctor’s orders, Carr said.

Dr. Richard Blum and Dr. Scott Hazelwood, pediatricians who both practice in Richmond, agreed to act as district medical directors, which allows school nurses to carry out more procedures than if they were “not under the umbrella of a doctor’s orders,” she said.

“When you have a medical director and physician over your program, that instantly raises the standards of care for your clinic,” she added.

Another example is the treatment of head lice, she said. “Because we’re under a doctor’s umbrella, our nurses are able to call prescriptions in.”

Carr reminded the board that because of its decision to hire its own staff of 11 nurses last summer, the team helps MCS stay in compliance with state law that requires districts to make “necessary arrangements for the provision of the health service” if school employees have not been trained and delegated responsibility to perform a health service.

“On day one of every year, no matter what walks through those doors, we’re ready,” Carr said.

Over the summer, more than 300 school employees were trained to perform health services so “arrangements” are not required, she added.

Some of the procedures employees are trained to perform include: tracheal suctioning, gastrostomy feedings, tracheostomy tube changes and others.

Carr said she received a call three weeks ago from the state department of education informing her that the Madison County district has the highest immunization compliance rates in the state.

The national average of immunization compliance is 88 percent, said Malicote, but Madison County averaged above 95 percent.

Gov. Steve Beshear and Lt. Gov. Jerry Abramson is creating a task force to try to get more children vaccinated and “they wanted to know what our secret is and how we’re doing it,” Carr said.

Nurses work closely with school principals and staff to keep students in compliance by sending letters home to parents and sending messages through the district’s automated call service, she said.

Principal Ken Bicknell has made a new policy at B. Michael Caudill Middle School, for example, to not allow students to attend school dances unless their immunization records are updated, Malicote said.

School staff and nurses also take an extra step than required to enter all dates of individual immunizations and not just the last date of immunization compliance. This allows nurses to see which vaccines are needed and to work with parents to get it done, Carr said.

Under the doctor’s orders, the district’s nurses may access a Centers for Disease Control portal to print immunization certificates. Nurses also work closely with the local health department and health providers to obtain current immunization dates, Malicote said.

Carr said the school health program seems to have improved attendance. Children who complain of an illness must be checked by the nurse before being permitted to leave school. Nurses decide whether the absence is excused or unexcused.

“In many cases, this makes a big difference for the parents,” Carr said.

Malicote pointed to year-to-date attendance statistics, which shows student attendance is up nearly 1 percent from the same time last year.

“We’re trying to take a little bit of credit for that,” she said.

From August to the end of April, nurses received nearly 21,000 student visits; just over 1,000 staff visits; 789 emergency action plans were written for children with health conditions; and nearly 3,000 calls were made to parents. 

Of the 21,000 student visits, more than 17,000 of those visits resulted in a student being treated and sent back to class. The district’s inventory includes 462 different medications that may be administered to students.

Nurses also write emergency action plans for conditions like diabetes, seizures, asthma, allergic reactions and other conditions such as cystic fibrosis and transplants. These plans are documented in Infinite Campus, the district’s student information system.

“We have 460 children with medical flags that have a life-threatening condition where they could actually die at school,” Malicote said.

A report of these students and their medical conditions is sent to the county’s Emergency Operations Center so first responders are aware of the zones in which these students attend school, she added.

After their report, board chair Mona Isaacs noted that it was Nurse Appreciation Week.

“We just want to thank you for everything you do. You do save lives every single day. You make us feel comfortable to send our children to school,” she said.

Board member Beth Brock, who also is a nurse, said she was proud the state was looking to Madison County Schools as a model.

“It was a big step for the board last year to decide to have our own health program,” she said. “I think we see the results of that.”

Crystal Wylie can be reached at or 623-1669, Ext. 6696.

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