Oxygen in School Programs

Oxygen administration in school requires the parents to provide consent and information related to this healthcare intervention. Parents also provide the supplies necessary for managing the learner’s health needs. Learners needing oxygen may use one of several oxygen-supplying units, including high-pressure gas cylinders or tanks, liquid oxygen, or oxygen concentrators. 

The use of oxygen in school must be done safely because it can support combustion even though it is nonflammable.

Safety Requirements

Please consider environmental safety measures for a learner who utilizes oxygen:

• An ABC fire extinguisher must be located on the bus or wherever the oxygen is stored in a school building.
• The portable oxygen unit should be less than 15 pounds in total weight.
• All valves and regulators must be protected against breakage by following the manufacturer’s precautions as printed on the oxygen unit.

Applicable Safety Tips For All Varieties of Oxygen Supplying Equipment:

• Do not use within 5 feet of electrical appliances, including stoves or heaters.
• Keep away from heat or open flames.
• Do not use near combustible materials, such as oils, grease, aerosol sprays, lotions, or solvents, as they may increase the potential for fire hazard or injury.
• The oxygen container/pack must be safely positioned during the school program.
• Staff should be aware of the training component regarding tripping hazards from carts and tubing.
• The school nurse will communicate with parents to determine supplies needed for the learner's daily oxygen use and confirm with parents the maintenance of supply inventory by the family.

Oxygen is considered a medication:

School nurses may choose to delegate and maintain accountability with this service to others in the management of the learner’s needs during their education program, depending on delegation factors, within nursing practice, and the complexity of care. 

Oxygen is considered a “medication” and should have medical authorization forms completed and on file at the school in accordance with policy. 

The delegatee will be required to follow all training requirements for medication administration in addition to training on the learner’s specific needs, medical supplies, and use alignment with the IHP and emergency plan(s).

Parents give the school the healthcare provider’s specific oxygen order requirements, including: 

• Student Information
• Amount – expressed as a liter flow rate or percentage.
• Duration and frequency – continuous, number of hours per day, or as needed (PRN)
• Delivery device/modality – nasal cannula, oxygen masks, ventilator, or continuous positive airway pressure mask, commonly known as CPAP
• Target saturation
• Date of expiration or duration for the treatment

If the necessary information is not all provided, the school nurse, as a healthcare provider, may clarify the order with the child’s healthcare provider to ensure safe healthcare delivery.

If a learner is ordered oxygen with a variable rate on an “as-needed” basis, the decision to delegate the task is the responsibility of the school nurse as it will require an assessment that cannot be delegated to unlicensed personnel

If a learner is ordered oxygen with a fixed rate on an “as-needed” basis utilizing a fixed parameter for pulse oximetry, the application of oxygen may be delegated by the school nurse who maintains accountability. The nurse who delegates must be notified by the delegatee when an as-needed oxygen application is initiated. 

School transportation and oxygen

Learners may utilize school transportation to access their education program.

The oxygen container transported should be secured either to the bus seat, sidewall, or wheelchair, in the upright position, using a rack or mounting bracket capable of sustaining five times the weight of the tank and contents.

Oxygen tanks or other medical support equipment are never to be stored or secured in the head impact zone of the bus or transportation vehicle.

Before busing a student who utilizes oxygen, the school transportation department must inspect and approve the methods of securing the oxygen container on the bus or to the wheelchair (if applicable).

Notify the school’s transportation department when a learner who utilizes oxygen. This will allow for an appropriate time to address the learner’s needs for all transportation needs in accessing their education program, to include school field trips or before and after-school sponsored programs.

School bus drivers, bus attendants, and substitute drivers should receive the following training before transporting students traveling with oxygen: 

• Tank inspection, handling, and securement procedures.
• Emergency evacuation procedures.
• How to secure oxygen and handle it in case of a bus evacuation.
• Emergency Bus Procedures
• Bus drivers, bus attendants, and substitutes should be familiar with the emergency evacuation plan developed in conjunction with the individual health plan transportation for each learner who is oxygen dependent.

Evacuation procedures for a student who utilizes oxygen:

• Evacuation procedures should be well-known and rehearsed by all personnel delegated to manage the student’s health needs.
• The daily seating plan on the bus should always consider evacuation procedures.
• Students who utilize oxygen should practice evacuation procedures to the same extent as their peers.
• The manufacturer's guidelines should be followed for the use and evacuation of oxygen on the school bus.
• A description of the tank should be included in the emergency evacuation plan. 

Oxygen signage requirements:

Appropriate signs must be posted where oxygen is used and stored in a school.

Tips:

• While it is not mandatory to place placards or signs on the bus, a decal indicating medical support equipment is in use would be helpful as a protective factor for the emergency personnel responding in the event of an emergency and all individuals involved.
• The school may communicate with the community fire department and apply signage of where a learner’s oxygen is stored in the school building as a protective factor for the fire department and emergency personnel responding in the event of an emergency, and all individuals involved.