Washington requires the health and public instruction departments to develop uniform policies for asthma management in schools.  It requires schools to provide case management, care coordination and mental health counseling, if needed, for students with chronic conditions.  The state has been very proactive with its programs to retrofit school buses.  Washington was one of less than a dozen states to place hybrid powered school buses into service in 2006.  Washington meets 15 of 18 core policy standards and nine of 15 extra credit indicators.

Medication & Treatment

Medication Policies

Under Substitute Senate Bill 5841 students are ensured the right to carry and self-administer asthma medications and auto-injectable epinephrine, provided that:

a health care practitioner (HCP) has prescribed the medication and instructed the student in correct and response use; the student has demonstrated adequate skill level to the school nurse as well as the HCP or designee; the HCP formulates a written treatment plan for managing asthma or anaphylaxis episodes of the student and for medication use by the student during school hours; and the student’s parent or guardian has completed and submitted to the school the written documentation required, including the treatment plan above and a statement releasing the school from liability.

School districts are also required to keep backup medicine for the student’s use, if provided by the parent or guardian.

In Washington, all levels of emergency medical technicians are allowed to carry and trained to use epinephrine auto-injectors.

Identification and Reporting

School nurses are mandated to identify children with life-threatening conditions before the school year begins and to develop individual and emergency care plans in coordination with the health care providers, parents, school personnel and students.  This applies to both asthma and allergy.  Written incident reports are required for asthma or anaphylaxis episodes, and schools are required to report incidents to parents, teachers and the state health authorities. 

Asthma and Allergy Management Policies

In 2005, Washington passed legislation requiring the superintendent of public instruction to develop a uniform policy for all school districts providing for: In-service training for school staff on the symptoms, treatment, and monitoring of students with asthma, including the standards and skills for training; adoption of policies regarding asthma rescue procedures; authorization for students to carry and self-administer medication to treat their asthma or anaphylaxis; maintenance of backup medications at school; maintenance of easily accessible, individual files containing information about dealing with an asthma or anaphylaxis emergency.

The Washington State Asthma Plan, developed in 2005, provides detailed guidelines and information to help schools implement their asthma policies. 

As a prerequisite for attending public school, all children in the state of Washington must present a medication or treatment order from their health care provider addressing any life-threatening health condition that may need to be treated at school, according to RCW 28A.210-.320. 

Health Services Capacity

Schools are required to provide case management, coordination of care and mental health counseling if needed for students with chronic conditions. 

Washington schools do not currently require or recommend a nurse-to-student ratio of 1:750, as is recommended by the National Association of School Nurses as well as Healthy People 2010. 

Washington currently recommends a school district nurse-to-student ratio of 1:1500, but according to the Washington State Asthma Plan, “Washington State falls far short of these goals.  In rural districts, many schools have access to a nurse only half a day or less per week, and nurses may be driving hundreds of miles each week to service these schools.  In large districts, a nurse may service multiple schools, spending one day per week at each site.”

Washington has 10 school-based health centers, a ratio of about 1 for every 220 public schools.  These facilities, which provide a full range of outpatient physical and mental health services to students, help where available but are not numerous enough to fill the service gap. 

Schools have access to a State Health Services Coordinator.

Awareness

Washington also provides for the appointment of a coordinator for staff training in asthma/allergy awareness. School nurses must also educate staff about the special needs of these children, negotiate classroom accommodations, and provide and/or monitor and supervise provision of services such as medication administration, peak flow monitoring, nebulizer treatments and counseling.    

RCW 43.20.145, “Food service rules,” mandates schools to follow the U.S. Department of Agriculture’s guidelines for food service personnel, under which students with food allergy must be served special meals if they provide a written statement from their physician.  Foodservice staff is required to receive training in serving students with special dietary needs as well as procedures for dealing with allergic reactions to food.  Additionally, staff training in food allergies is provided to all teachers and other school staff. 

Staff development requirements for school nurses include continuing education training in administration of medications; case management for students with chronic health conditions; identifying and tracking students with chronic health conditions; accessing benefits for students with disabilities; teaching self-management to students with chronic health conditions; tobacco use prevention; and tobacco use cessation.  Asthma awareness training covering the schools’ asthma program, policy and procedures is required for all school staff. 

Washington’s Health and Fitness Essential Academic Learning Requirements (2002) require students to receive instruction on non-communicable diseases such as asthma, and environmentally related health concerns, including asthma.

School Environment

Indoor Air Quality

Washington does not have a mandatory indoor air quality (IAQ) policy for schools.  However, RCW 43.20.050 and WAC 246-366-080 require schools to control environmental conditions including pesticides, molds, excessive heat and ventilation. 

The state board of health has the authority and a procedure for oversight of IAQ in schools.  Washington Rev Code 43.20.050 and Washington Admin Code 246-366 require local health departments to conduct periodic inspections of schools for compliance with state environmental health standards.

RCW 70.162.050 allows the superintendent of instruction to implement a model program in a district that evaluates the current indoor air quality in the district and establishes procedures to ensure the maintenance and operation of any ventilation and filtration system.

The state also provides funding or staff development to schools/districts on how to implement an IAQ policy.

Washington does not require, but does recommend that schools follow an integrated pest management (IPM) program and provides funding for staff development on IPM implementation.  RCS 17.21.415 requires that schools notify parents of upcoming pesticide applications and post warnings and/or otherwise notify the community of pesticide applications.

Outdoor Air Quality

Washington has been very proactive with its School Bus Retrofit Program.  Among its recent successes are:

1. 213 school buses have been retrofitted with diesel oxidation catalysts (DOCs) under the Diesel Solutions Program of the Puget Sound Clean Air Agency, and 600 more DOCs are on order.  Some school districts are using ultra-low sulfur diesel.
2. The Washington Department of Ecology has provided a revenue source for retrofitting school buses state-wide, with an initial goal of 1,000 school buses.  Three school districts in the Olympia area together operate 49 dedicated or bio-fuel natural gas-powered buses.
3. Biodiesel fuel will soon be used by school districts in Puget Sound and Spokane.  In school year 2006-2007, Washington was one of 11 states to put hybrid school buses into service.   
4. The Puget Sound Clean Air Agency received an EPA Grant for the “Western Washington Clean Buses, Healthy Kids Retrofit Project,” which will begin school bus retrofits in small, economically stressed rural public school districts in Western Washington.
5. Anti-idling efforts are voluntary.  One program, conducted as a cooperative effort of the Washington Department of Ecology, the Oregon Department of Environmental Quality and Washington and Oregon’s local air agencies, is entitled the “No Idle Zone - Dare to Care About the Air.”  This program is designed to motivate bus drivers, parents and others to turn off their engines rather than idling vehicles at schools.  In 2004, it was piloted at three local schools and showed a 56% reduction in idling in school pick-up/drop-off areas when compared to the non-pilot schools.

Tobacco Policies

Smoking is prohibited for all persons in all school sites, including school buildings and grounds, school buses and at off-campus school functions under to RCW 28A.210.310 (1997).

Tobacco use prevention is required in the health curriculum for all students, and tobacco use prevention training is required for health education teachers.  The state has provided funding or staff development to schools/districts on how to implement a tobacco use prevention program. 

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