SmartTranscript of House Education - 2025-02-27 - 9:00 AM

[Technician]: And you are live. [Chair Peter Conlon]: Alright. Welcome everybody to House Education on February twenty seventh twenty twenty five. This discussion currently is going to be h two zero nine, an act relating to intranasal epinephrine in schools. This seems like a very simple, easy bill, but we just to confirm that everything's fine, we'll have a little bit of testimony, and we'll start off with Kathleen Goodell who joins us via Zoom. Welcome to the committee, and I'm looking forward to what you have to say about this, although it's probably not much. [Witness Kathleen Goodell]: Good morning. So I'm a nurse at an elementary school in Southern Vermont. And [Chair Peter Conlon]: Hang on one second, Kathleen. We gotta get turn up our volume. [Witness Kathleen Goodell]: Gotcha. [Technician]: Also, nice school nurse sweatshirt. I really like that. [Speaker 3 ]: Yeah. Wash your hands. [Chair Peter Conlon]: You little piggies. [Representative Kate McCann]: That's with my sweatshirt. [Witness Kathleen Goodell]: February sweatshirt. Are we ready? [Chair Peter Conlon]: Right. Hang hang on one second. Okay. [Speaker 3 ]: I think that I'm gonna have [Witness Kelly McGovern]: to submit an IT ticket, and I need a passcode to switch the speaker. [Chair Peter Conlon]: Okay. Well, let's all be super quiet and listen very carefully because I think we can hear you at least a little. We just have we went through a little technology change in here then still needs a few kinks to be worked out. But why don't you go ahead? We'll see how we do. [Witness Kathleen Goodell]: Alright. I can try to speak as loud as possible. So simple thing, every year, schools well, we have this law so that we can have epinephrine on hand in schools. [Speaker 3 ]: Sorry. [Witness Kathleen Goodell]: Recently, there was FDA approval for an intranasal epinephrine, which is called nephi. There is a shortage of the auto injectors. So this year, we could not get our EpiPens, our stock EpiPens. So we had to actually buy them, which costs us five hundred dollars out of our budget for each school, which is a lot for nursing budget. We don't have much. And so NEFE, the new intranasal, has a free program. [Chair Peter Conlon]: Oh, we just had we just had success. Now we can hear you very well. So I [Witness Kathleen Goodell]: don't have to speak loud anymore. [Speaker 3 ]: Okay. Okay. [Witness Kathleen Goodell]: So, NEFE has this new program. It's NEFE for schools, and it provides, I forget how much is it. Each public school k through twelve will get four single use doses for free. It's only approved currently for sixty six pounds and up. So that's roughly, like, second grade and up. But there's another one, a pediatric dose that's slated to be approved by the FDA. I think it's by, like, end of March, beginning of April. The studies so far have shown great success. It's actually faster acting than the auto injectors and less stress inducing because kids don't like needles. So our current law states only auto injectors, so I reached out to Leslie Goldman and asked her if she could work on this to get the intranasal put on there. So that's why I'm here. [Chair Peter Conlon]: Great. Any questions? Yeah. Go ahead, representative. [Representative Kate McCann]: So I I was when I was reading through this, at first, I I saw that it says maintain a stock of them, and it does sound like that is actually what does occur. So these don't have to be you don't have to have a prescription for a certain student for these? These are just something that the nurses office would have on hand? [Witness Kathleen Goodell]: Yeah. So we have a providing prescribing provider, a local one. Most schools do. And he wrote us a standing order with a protocol for when to administer epinephrine. [Representative Kate McCann]: Okay. Alright. Interesting. Thank you. [Chair Peter Conlon]: Yeah. Any other questions? I'll probably just make this happen. Thank you very much. And I see you're sticking around for our next topic, but we will hear from Kelly McGovern, president of the Vermont State School Nurses Association. Welcome, and have a seat right up front here. You. Thanks for joining us and making the trip here. [Witness Kelly McGovern]: Oh, I'm glad to be here. Thank you. [Chair Peter Conlon]: Just introduce yourself and [Witness Kelly McGovern]: Sure. So I'm Kelly McGovern. I'm the president of the Vermont State School Nurses Association. I'm also a school nurse at Middlebury Union High School and the nurse leader in Madison Central School District. Thank you again for having me here this morning. [Chair Peter Conlon]: Did you drive over this this morning? [Witness Kelly McGovern]: I did. I live in Bridgeport. Yeah. I should say I'm also a resident of Bridgeport. So, yeah. Brick Drive. Yeah. It wasn't too too bad, but, yeah, I left her alone. So I appreciate, Kat's input on this. I did wanna tailing off of what she just shared about having a provider order. As she said, most school districts do have a consulting provider who can write orders for epinephrine, for stop epinephrine for us for our schools, but the equity around that is not one hundred percent. There are certainly school districts that may not have access to a provider. And so that's just something you could maybe think about. I don't know. I think the solution would be having our health commissioner our health commissioner write a standing order for Allstate students. Just something to think about. So just tailing off of what Kat said. As far as my feedback on the bill, I'm very much in support of it, of course, and and really it makes sense to add the intranasal epinephrine to our current law that allows us to have the injectable epinephrine in schools. In consultation with some of the other leadership in Vermont State School Nurses Association, we just we have with some bullet points and feedback that we wanted to share. I shared this with Annie later last evening, so I'm sorry if you don't have this in front of you. But I'm just gonna start kind of from the top of the bill. We tried to identify, like, specific sections that we wanted to talk about. So first point of discussion is on page one, lines ten through fourteen, and then page two, lines one through four. We're concerned with the language around an administrator, a school administrator being able to determine who can administer epinephrine. It really is inter like, we interpret this as saying that this allows the school administrator to authorize a nonlicensing or nonlicensed personnel delegate to administer epinephrine or allow a student to self administer epinephrine. Only a licensed nurse, either an RN or an LPN, can delegate, patient care in a school. I know this language comes right from the, injectable epi bill in law, but in our opinion, that language is flawed. And I don't know if school nurses had input on that original language, but I think that's an important piece to clarify and that's supported by our Nurse Practice Act, which is law that determines, you know, who can and can't delegate. [Chair Peter Conlon]: So I [Witness Kelly McGovern]: think we have to be really careful around that because I don't I don't know if folks have questions about that. But as it really typically could be interpreted that a school principal could go to the administrative assistant or a paraprofessional who is maybe acting as the delegate of the nurse and say, this is something I need you to manage, and I need you to train staff and things like that. And that's that is not [Chair Peter Conlon]: good practice for Would you repeat the first part of what you said? Only nurses can delegate people to [Witness Kelly McGovern]: do this Exactly. With a licensed nurse. Yeah. So that would be an RN or an LPN. [Chair Peter Conlon]: So this would be like Advil. That would Correct. Administration can't or the administrator can't delegate the person [Witness Kelly McGovern]: to Yeah. Yep. And as you may know, you know, certainly, our smaller rural schools in Vermont, there's not a full time school nurse. So there's a lot of delegation that happens. You know, often there is a a staff at the school, and there's a nurse overseeing them and delegating care of students' medication administration, first aid, things like that, but that has to be overseen by a nurse. So in all circumstances so I think the the take home with school nurses are crucial in this piece and have to be the ones that are actually determining what you know. [Chair Peter Conlon]: I'm doing yeah. How old that language is [Witness Kelly McGovern]: or Yeah. Yeah. It's all Right. [Chair Peter Conlon]: Current statute. [Witness Kelly McGovern]: Yep. Any questions around that before I move on? Okay. And then the language around and this might just be standard for for bills of this nature, so forgive me if that's something that isn't relevant. But the language of health care professional when we're referring to someone who might be a prescriber, We just thought it might be more helpful to re refer to a prescriber as a health care provider because a health care professional could be an l and a licensed nursing assistant, a licensed practical nurse, and registered nurse, and those folks are not prescribers. So just a small piece of feedback on that. If if that's a possibility, it might clarify that that is a provider, local physician, or a nurse practitioner who's prescribing that medication. Yeah. [Chair Peter Conlon]: I just put down line seven [Witness Kelly McGovern]: number three. [Chair Peter Conlon]: It it depends on [Witness Kelly McGovern]: your threshold. And kind of along those lines, and jumping ahead on my bullet points, but page five, line thirteen, instead of saying physician, we just recommend using health care provider. Or if you're wanting to keep the language of health care professional in there just to be consistent and inclusive of all who may be prescribing that, and that might not be just physician. Again, it could be an advanced practice nurse, a physician assistant. Any questions on there? Alright. And then page two of line twenty one through page three lines one through twelve, it has language around the pres the prescriber writing protocols around the administration of the intranasal epinephrine, and it's really not practical that the provider will be writing those protocols solely on their own. They might be part of a team, say a school administrator, school nurses in consultation with the provider to actually be developing those protocols around the storage and procurement and administration and training of the app and app run. [Chair Peter Conlon]: Well, I always just doesn't matter whether it's auto inject or Internet results. Right. [Witness Kelly McGovern]: Yeah. Yeah. [Chair Peter Conlon]: Your confidence would be the same. [Witness Kelly McGovern]: Yeah. Yeah. I just don't want it to read that the provider would be the the sole person who's writing those protocols, but they certainly certainly may be consulted and part of a team doing so. And page five, line ten, we just recommended that instead of saying schools, that it maybe say school nurses. And then one of my colleagues, Clayton Wetzel, who's a school nurse at Waitsfield Elementary and our BSSNA treasurer, he added some additional feedback. He also supported, you know, the language around it in in administrator. Just put his yeah. Around so his was page two lines one through four. The designated personnel language previously stipulated that the school administrator authorized which personnel can administer the epinephrine. We need to make sure that the committee understands that the current language is likely to conflict with the Nurse Practice Act. The school administrator, unless licensed as a registered nurse or advanced practice nurse, cannot authorize the use of medication, also known as delegating, in accordance with fifteen seventy two. So just additional information about that language. And then his other feedback was just that the major change in this bill from the injectable epinephrine is adding the language for intranasal epinephrine. H two zero nine does not address the use of intranasal epinephrine prescribed for students with a life threatening allergy, possession and self administration of an emergency medication, and the current proposal only addresses undiagnosed anaphylaxis in schools. And schools certainly do, keep stock epinephrine TPUs for those students. We don't always especially in older age students, they might be self caring. So part of the use of our stock epinephrine might be using that on those students who have a diagnosed allergy in the event that we don't have quick access to their supplies. So [Chair Peter Conlon]: So this does allow that currently? That what you're saying is that what it what exists now is really about undiagnosed allergies, somebody having a Yeah. Bad reaction. Yep. But if it's somebody who knows that they have that, they carry their own. [Witness Kelly McGovern]: They do. Or, you know, sometimes if it's like, in younger kids, it is stored in the nurse's office if we get a dose from parents to from caregivers, which doesn't always happen. Sorry. So we just wanna make sure that this law allows us to use stock epinephrine on students who already have a unknown allergy and not just undiagnosed. Yeah. Let's see. And then just, some minor recommendation, like, page one lines eight through nine. The bill adds intranasal epinephrine to the existing authorization for auto injector epinephrine, and our proposed changes for the use of intranasal epinephrine in addition to epinephrine auto injectors in schools. So just adding, to the auto injectors as well just so that's also included in this bill. And, again, we already have our law in place around the autoinjectors, but having that in there may be helpful. And then eight one lines nine through ten, same idea, schools to maintain the stock supply of intranasal epinephrine in addition to epinephrine autoinjectors. And that's I mean, that and those are the major points that we wanted to share. [Chair Peter Conlon]: So Thank you. Not as simple as we had thought had I known that there would have been a number of I probably would have said this off for another [Speaker 3 ]: twenty minutes. I know. This is where we really dug in and kind of as we [Witness Kelly McGovern]: were reading that language, we said, oh gosh. This could be problematic. So especially around me who can delegate and authorize Yep. The administration. So [Representative Kate McCann]: Great. [Chair Peter Conlon]: Yeah. Thank you. Thank you. [Representative Kate McCann]: I don't are you do [Chair Peter Conlon]: you take a note of some of that? [Technician]: I've taken note. Katie McGlen, also, the council for the record. So some changes can be made. Some we should probably have a conversation about. For example, the word provider usually means, like, a group of providers, like a facility. So I don't think that would be the right term. Can make changes to the statement of purpose. So those lines seven through fourteen on page one are kind of static at this point. But the concept of not the not delegating to a designated person, I think that is something that [Witness Kelly McGovern]: could be tightened up. Mhmm. What was the other thing? The protocols, [Technician]: I think that's maybe a policy question. Mhmm. Identifying who is the lead person responsible and sort of standard practice in statute, but you could add language about you would want the person to consult with other people that would be important. So I think there is remember, some changes and maybe some of them Mhmm. [Witness Kelly McGovern]: We'd have to hold on. Great. Okay. [Chair Peter Conlon]: Thanks. Thanks. And if [Witness Kelly McGovern]: you need any help around wording at any point [Chair Peter Conlon]: I guess I would say if you if you could perhaps work with the the nurses association to incorporate what is possible and then bring a version back to us to discuss it sound like? Sure. [Technician]: There we are. [Chair Peter Conlon]: Thank you very much. [Speaker 3 ]: Thank you so much. [Witness Kelly McGovern]: Thank you. For party accuracy [Chair Peter Conlon]: response plans. Alright. You know? Things being simple, I'll be very happy. [Witness Kelly McGovern]: Is anything ever simple in this building? [Chair Peter Conlon]: The sunscreen bill works. [Representative Kate McCann]: It never said. [Witness Kelly McGovern]: That's true. I don't think so. Wasn't really It was. [Chair Peter Conlon]: Indeed. I wasn't sure I was gonna both Alright. Tony, why don't you come join us at the front and talk to us about h two forty seven? Morning, everyone. Morning. Good morning. [Likely Tony]: Actually, this one might be fairly simple. [Chair Peter Conlon]: Oh, you should say. [Likely Tony]: I have something I prepared. I I sent it over to the rest of you. [Chair Peter Conlon]: It's now up on our list. [Likely Tony]: Okay. Dear chair Conlon and members of the committee, thank you for the opportunity to speak today in support of h two forty seven, a bill that would require schools to develop cardiac emergency response plans. I come before you not just as a supporter of this legislation, but as someone who has seen the life saving impact of quick action during a cardiac emergency. On January third of this year, sixteen year old Dominic Barkham, a sophomore at Milton High School, collapsed during his JV basketball game at Spalding High School. In an instant, his heart stopped. Thanks to the immediate intervention of trained staff, quick application of CPR, and the use of automated external defibrillators, AEDs, Dominic's life was saved. Without these crucial actions, the story could have had a much sadder ending. Dominic's story is not unique. Sudden cardiac arrest is a silent threat that can strike anyone anywhere, especially young athletes. While the survival is a testament to the heroism of those present that night, it is also a stark reminder that cardiac emergencies can happen at any time in any school, and that preparedness makes a difference between life and death. H two forty seven takes an essential step in ensuring that schools are ready for such moments by requiring every school district and independent school to create a cardiac emergency response plan. The bill outlines necessary components, including the formulation of a response team trained in CPR and AED use, the placement and maintenance of AEDs in accessible locations, regular staff training and emergency drills, coordination with local emergency medical services. The effectiveness of this kind of planning is already well documented. When schools have clear procedures, trained personnel, and accessible life saving equipment, survival rates for sudden cardiac arrest increased dramatically. As Dominic himself has expressed, he's only here today because the right people knew what to do at the right time. This legislation will help ensure that every school in Vermont is prepared to respond as effectively should another student, teacher, visitor, or anyone else suffer a cardiac event. I urge this committee to support h two forty seven not just as a policy, but as a commitment to protecting the lives of Vermont students. No parent should have to wonder whether their child's child's school is ready for a medical emergency. Let's act now to make every school a safer place. And I've included on the back some cardiac facts that we'll provide made by the American Heart Association. Great. Thank you very much, Lazarus. [Chair Peter Conlon]: I think maybe we'll go right to a walk through, Bill with legislative counsel. I think I'll take a look. Over here. Thank you. So why don't you have a seat over here? If we have questions, we'll we'll, okay, on the way. Thank you. Thanks, John. [Speaker 3 ]: Good morning. That's AJM's office of the legislative council. Do you need me to share my screen? [Chair Peter Conlon]: No. We'll be all headed up. K. [Speaker 3 ]: So we're gonna walk through h two forty seven as introduced, which is an app relating to cardiac emergency response plans in schools, is supposed to add a new section to the health and safety chapter in federal sixteen called acute cardiac events in schools. It begins on it begins with a definition subsection. So I'm on the very bottom of page one, line eighteen. Automated external defibrillator or AED, has the same meaning. And here we're referring to the definition that is in title eighteen under the emergency medical services chapter, the automated external defibrillator section. So being consistent with state law there. Page two at the very top, subdivision two, cardiac emergency response plan is defined as a written document that establishes the specific steps to reduce death from cardiac arrest in any setting, including a school, community organization, workplace, or sports facility. And sudden cardiac arrest means the sudden loss of all heart activity due to an irregular heart rhythm, which if not treated within minutes, could quickly lead to death. Subsection b requires the establishment of a cardiac emergency response plan in for school districts and then independent schools. They're required both sets of educational settings are required to develop cardiac emergency response plans that address the appropriate use of school personnel to respond to incidents involving an individual experiencing sudden cardiac arrest or a similar life threatening emergency while on school grounds. Each school district and approved independent school with an athletic department or organized athletic program shall develop a cardiac emergency response plan that addresses the appropriate use of school personnel to respond to incidents involving an individual experiencing sudden cardiac arrest or similar life threatening emergency while attending or participating in an athletic practice or event while on school grounds. School officials are required to work directly with local EMS providers to integrate the cardiac emergency response plan into the community emergency medical service responder protocols. And each plan, is required to integrate evidence based core elements such as those recommended by the American Heart Association guidelines or other nationally recognized evidence based standards. I'm on page three, line three. Subsection d are the plan requirements. So the cardiac emergency response plans shall include at a minimum, establishment of a cardiac emergency response team, guidelines for when a team is activated in response to a sudden cardiac event, implementation of AED placement and routine maintenance within the school, dissemination of the plan throughout the school campus, maintaining ongoing staff training and CPR and AED use, practice drills, integrating local EMS with the plan, and ongoing and annual review of and evaluation of the plan. [Chair Peter Conlon]: Excuse me. [Speaker 3 ]: Subsection d, I'm on page three, line fifteen, requires appropriate AED placement to be dictated by the cardiac emergency response plan and in accordance with guidelines set by the American Heart Association. Training, subsection e. Appropriate school staff shall be trained in first aid, CPR, and AED use that follow evidence based guidelines that work by the American Heart Association. Staff trained shall be determined by the cardiac emergency response plan, including licensed coaches, school nurses, and athletic trainers. And then on page four, this is a piece of session law about implementation. So it requires school districts and independent schools to have a cardiac emergency response plan developed and ready for implementation beginning in the twenty twenty five, twenty twenty six school year, so next school year. And then the app to twelve will take effect on July one twenty twenty five. [Chair Peter Conlon]: Great. Thank you. Questions before we get a little bit more testimony here? If not, we'll move right on to I'm sorry. [Technician]: I was just gonna ask, will this cost schools anything? Do they need to budget for this? [Chair Peter Conlon]: I I think we'll probably get some comment on that Okay. Going forward. Yes. That that is the the big question. Yeah. And if you recall, we also had a a budget request Yeah. So we sort of said probably should be attached to it. [Speaker 3 ]: Okay. Right. Okay. [Chair Peter Conlon]: Yeah. Okay. Let's move on to Kathleen Goodell once again. Thanks for sticking around and providing some testimony on this. [Witness Kathleen Goodell]: Yeah. No problem. I just I looked at the agenda and saw this. Oh, sorry. [Chair Peter Conlon]: Yeah. Go ahead. You're right. [Witness Kathleen Goodell]: Okay. So last year, I actually took it upon myself, to create a cardiac emergency response plan and team in my building. I utilized project Adam to train myself and then train my team. We wrote a plan together. We did a drill together. We did, we went through our drill and what we failed at and what we did good at after, and it created a sense of security in my building. And I've been trying to push that out to the other schools in my district, but it's difficult. A lot of people don't have time. So if we had this bill, I think it would be fantastic. We have a huge sports program in our district, so having a team in the high school and the middle school would be very beneficial and could save a life. [Chair Peter Conlon]: Do, all your buildings have AEDs? Yes. Okay. [Witness Kathleen Goodell]: And I also sorry. I also reached out to the local emergency response team who would come to our building, and they came to the building, and I showed them where the AED was, and I showed them my plan. [Chair Peter Conlon]: And it does every building that has an AED have somebody who is trained in CPR and AED use? I know they're made pretty foolproof now. [Witness Kathleen Goodell]: Yeah. We actually our district is, really lucky. We have a full time school nurse in every building. [Chair Peter Conlon]: Okay. [Witness Kathleen Goodell]: So those individuals are trained. Yeah. [Chair Peter Conlon]: Representative McCann? [Witness Kelly McGovern]: I was just wondering if it made sense to task someone with, like, a model plan so that schools can then go there and take that and work it for their own building or whatever. I don't know who. [Chair Peter Conlon]: I think when we have time, we'll probably have the Art Association join us again to talk about their hundred fifty thousand dollar request Mhmm. Sort of see how that might integrate with a plan. Mhmm. [Representative Kate McCann]: Yes. You mentioned the Project Adam, and I I unfortunately, I haven't heard about that before. Is that something that actually walk you through writing the plans? [Witness Kathleen Goodell]: Yeah. They have templates and everything. It's very well it's oh, I can't the words are not with me. It's very well thought out, and it was so easy to implement. The training was short and sweet but thorough. And, yeah, like, without that, it would have taken me a lot longer to write my own plan and make sure that it was covering all my bases. [Representative Kate McCann]: So Is that is that a free free program that you can [Witness Kathleen Goodell]: Yes. It's free. [Chair Peter Conlon]: You know, the the objections that will come to this maybe is that it's just one more mandate, potentially an unfunded mandate from the state on a group of people who are already really busy. I mean, the the justification for it is obvious. But, yeah, just hearing that you're also sort of getting pushed back, not I I don't think anybody objects to the goals here, but just, like, I don't have the time or the staff to put this all into place. How do we sort of answer that? [Witness Kathleen Goodell]: If I could say, I think the pushback is because they don't understand how simple this is to implement. I think if they knew that the templates and everything were there, you just fill in the blanks. And as far as running a drill, we already run so many different types of drills with evacuation drills, change of location drills, fire drill. Like, we could just add this to that. And that's what I did in my school, and my principal was fully on board, and it was very simple. [Chair Peter Conlon]: And and, really, this is about training adults, not about kids going through drills. [Witness Kathleen Goodell]: Yeah. Yeah. It would basically be a clear the halls drill for the students, which they already do those, and then the cardiac emergency response team would go into action. [Chair Peter Conlon]: Does the ADaM protocols that doesn't get into training. That's just about sort of how the school responds, or is that also a CPR and AED? [Witness Kathleen Goodell]: No. They don't have CPR, AED training, but the benefit of being in a school is we already have the policy where all coaches, athletic directors, and nurses have to be CPR, AED certified. So you already have people on staff that are. [Chair Peter Conlon]: Yeah. I wonder how widespread that because if that's universal. I suspect it probably is. That's very interesting. Yeah. [Witness Kathleen Goodell]: I believe it's indicated by the Vermont Principles Association. [Chair Peter Conlon]: Great. We'll get some testimony on that. Terrific. That was very helpful. Thank you very much for both the testimony here with the with the epinephrine issue. I think we'll wrap here on these two topics, reset, and move on to our next topic. I adjusted the agenda a little bit based on availability. So we're gonna reset the live stream.

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SmartTranscript of House Education - 2025-02-27 - 9:00 AM

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