Are you prepared if a passenger falls ill?
By George Spencer
Your motorcoach is ferrying middle-schoolers. A teacher yells, “She’s choking!” What is your driver’s next step?
Your coach is carrying senior citizens. An elderly man turns pale, grimaces, and complains of severe chest pains. What does your driver do?
A medical crisis on board any operator’s vehicle is a matter of serious concern. “Emergency Preparation for Drivers: Passenger Incidents” was the topic of remarks by Michael Faulkner, president of Cape Fear Coach Lines in Wilmington, N.C., at the recent annual meeting of the North Carolina, Virginia, and South Carolina Motorcoach Associations (NCMA, VMA, and SCMA) in Roanoke, Va.
Policies toward handling medical emergencies vary from operator to operator. Cape Fear has a proactive attitude; its drivers are trained for medical emergencies. Other companies’ policies only require drivers to call 911. Meanwhile, operators who do business with public school districts can be required to have drivers receive special training.
Neither the federal government nor any state have regulations requiring a motorcoach to have special emergency medical equipment on board, such as EpiPens or defibrillators, according to Brandon Buchanan, ABA’s director of operations.
An EpiPen is an epinephrine auto-injector used to treat sudden, often deadly, shock due to allergic reactions. Portable defibrillators are known as AEDs (automated external defibrillators). Although manufacturers advise users to watch training videos, these devices “speak” to users and walk them through the steps necessary to try to revive someone in cardiac arrest.
Many public school districts require AEDs to be at sports events and practices, according to Carylann Assante, president of the Student Youth Travel Association (SYTA). Indeed, more than 20 states have passed laws requiring AEDs to be at some school and athletic facilities, according to the Sudden Cardiac Arrest Association.
Education group leaders are starting to ask bus companies if they carry this equipment, Assante said.
Any operator who does business with schools knows that there are always special concerns when transporting children.
Doing business with public school districts has required ABA member H&L Charters of Rancho Cucamonga, Calif., to train its drivers for CPR (cardio-pulmonary resuscitation) and first aid, said H&L President Jodi Merritt. All her vehicles carry small first-aid kits as well as masks and gloves that drivers can use if they have to perform CPR.
Wisconsin has its own policies. “School bus requirements can be higher depending on the contract,” said Badger Coaches President John Meier, ABA’s outgoing chairman of the board. “We need first aid and epinephrine training for one of our contracts. Special education training can be more extensive, depending on the students the driver is transporting.”
For work not involving school children, some operators have policies that limit a driver’s involvement in a medical incident.
“We respond to each event separately when it comes into our operations center,” said Reginald Addy, director of development at Hoosier Ride, a subsidiary of ABA member Miller Transportation in Louisville, Ky. “If it’s a serious emergency, we always call medical authorities and remove the passenger. If [the medical problem is on] a school bus and the driver is trained in CPR, we allow them to administer the necessary measures.”
Medical problems aboard his company’s buses are “very rare,” said Addy, happening perhaps only once every few years.
At ABA member Greyhound, the nation’s largest motorcoach carrier, “All of our drivers are trained to identify medical emergencies, and if a medical emergency occurs, the driver will pull the bus over safely and contact 911,” said Al Smith, Greyhound’s director of safety and security. “Our drivers are not required to be CPR-trained, but some of them are. If a driver is trained and certified, he or she can administer CPR while waiting for the paramedics to arrive.”
Meanwhile, Cape Fear Coach Lines has a more active policy. “I don’t think a driver needs to know how to perform a tracheotomy, but I do think there are things that can be done with little risk to a company,” said Faulkner, a former firefighter and EMT.
Every year, he takes his staff and drivers to a local fire department station for training in CPR, first aid, and the proper use of fire extinguishers.
“We advertise on our website that our drivers are trained in CPR and first aid and how to use fire extinguishers,” Faulkner said. “We think that gives us a competitive advantage. Every time we train with the fire department, we always contact the news, and it does an article. This is extremely good PR for our company and our industry.”
His company also stores inexpensive CPR masks onboard its vehicles in case a driver or passenger has to perform CPR. (These prevent the transmission of bodily fluids.) His vehicles also carry individual-use packets of aspirin and Benadryl in case 911 or medical personnel ask if they are available. His drivers are not allowed to administer the drugs. Benadryl is sometimes given to those with allergic reactions, and aspirin is sometimes administered to those with cardiac issues.
Any operator who is creating or reviewing his or her company’s policy concerning onboard medical events should consider consulting with the company’s legal advisers or insurance company.
“It is important to recognize that the main responsibility of any driver is to provide a smooth, safe, comfortable ride,” said Bob Crescenzo, vice president of Lancer Insurance, which provides coverage to motorcoach operators. “If a medical emergency occurs on a bus, the driver should pull over to a safe place, call 911, and provide first aid up to the level of their formal training. They may also ask if there are any other passengers who are trained to provide aid. Medical emergencies are best managed by trained professionals.”
George Spencer is a Chapel Hill, N.C.-based freelance writer and frequent contributor to ABA media.