YOUNGSTOWN, Ohio (AP) - Long associated with treating playground scrapes and tummy aches, school nurses nationwide say they need to be more prepared for emergencies such as terrorist attacks.
Many are trying to work around tight school budgets and a lack of respect as front-line responders to get the training needed to prepare for the worst.
"Because of 9/11, so many things have changed," said Kathy Steffey, a nurse at Lakeview High School in Cortland. "We have to be prepared for almost anything."
Nearly half the nurses who responded to a National Association of School Nurses survey listed emergency preparedness as their highest priority. But, disaster preparedness trainer Deborah Strouse noted that many schools don't even have a full-time nurse or health services.
Ohio is one of several states that does not require a nurse in every school.
"They're really on the front line before even the EMT person gets there," said Wanda Miller, executive director of the school nurses association. "They are the person that has to react, has to be prepared and must have some kind of plan in place to manage the situations that occur."
Schools were recognized as potential terrorist targets long before the seizure of a Russian school in September in which 330 hostages were killed.
Many developed disaster plans following the Columbine school shootings in 1999 or the Sept. 11, 2001, terror attacks. Yet, they do not have the funding to train administrators and teachers on how to carry out the plans, said Julie Underwood, general counsel for the National School Boards Association.
"There's a great unmet need for training and additional security," she said.
Columbus Public Schools is an exception. The district is using a $454,000 grant from the Homeland Security Department to train a team of school personnel in each of its 140 schools to respond in an emergency, spokesman Greg Viebranz said.
"We'd like to be considered a model for our efforts," Viebranz said.
Other states are trying to catch up. Acting New Jersey Gov. Richard Codey, in his State of the State address last month, made protecting schools from terrorists a top priority. He said security experts would tour every school before next fall and that security courses would be taught to educators, bus drivers and nurses.
"Educators aren't terrorism experts," Codey said. "They know about the SAT not the CIA, but they want to protect our schools and we must help them."
Federal officials acknowledge that it is difficult to give a nationwide assessment of schools' disaster preparedness.
Homeland Security funnels grants through state governments, but it does not have an estimate of how much has reached schools, spokesman Marc Short said.
"The answer to that would vary state by state," he said.
Bill Modzeleski, associate deputy undersecretary for the Education Department's office of Safe and Drug-Free Schools, said there's still more work to do.
"We've really encouraged schools to look at crisis planning from A to Z. We have to plan for everything," Modzeleski said. "I don't think we should ever be satisfied."
The National Association of School Nurses, which has about 12,500 members, has developed a disaster preparedness program to meet the demand for training - more than 2,000 school nurses have participated.
In Ohio, at a session this month in suburban Youngstown, many of the nurses in attendance responded with a collective sigh as Strouse displayed photos of a baby covered with smallpox.
Strouse told the nurses they don't need to know how to treat victims of biological weapons such as smallpox and anthrax, just how to identify early symptoms.
She warned that if there is a bioterrorist attack, school nurses would likely see a pattern of high fever and rashes before students or teachers are sick enough to go to the doctor.
"The school nurse is in a unique position to pick up on trends almost before anyone else does," Strouse said.