Background Since the early 2000’s, there have been local, state, and federal efforts to provide a framework for developing school health programs that meet a minimum recommendation for emergency preparedness. New York State has instituted multiple educational and public health laws offering guidance to school health officials on program infrastructure, school health communicable disease, emergency medical care, and school safety plans. These laws allow for, but do not require, schools to stock and maintain epinephrine auto-injectors, narcotic overdose kits, tourniquet kits, and allow for the development of school safety plans in response to a school crisis. However, compliance with these recommendations and statutes in schools has not been investigated. The objective of this study is to systematically identify the policies and procedures that schools have implemented to address community and individual emergencies.

Methods Cross-sectional study conducted between March 2024 and May 2024. An electronic survey based on a priori policies, federal regulations and NYS laws was sent to 6,600 eligible schools from a publicly available registry of NYS schools. Each respondent reported the school's demographics, as well as questions pertaining to various elements of emergency preparedness policies. There was no incentive provided by the research team for respondents to complete the survey. Descriptive analysis of the survey results was performed.

Results 185 total survey responses were received. The policies with the greatest implementation included presence of an emergency crisis plan (68.11%), emergency communication plan (67.57%), onsite CPR equipment (67.57%), onsite AED (63.78%), emergency contact information for all students and staff (63.24%), and staff trained in CPR onsite (61.62%). The presence of Narcan (28.65%), tourniquets (25.41%), glucagon (21.08%), and stress dose steroids (7.03%) onsite was notably low. Overall implementation of the recommended policies was found to be approximately the same (44-46%) among all school types, except for religious nonpublic schools, which noted substantially less (29.2%) overall adherence to the policy recommendations.

Conclusion We found that many of the policies recommended by state and federal authorities were not implemented by the majority of schools that responded. This creates a potential gap in care that is especially relevant given the recent increase in school violence. Further studies should focus on identifying trends in noncompliance and barriers to implementation of these policies, with the ultimate goal of providing students with the proper resources when school emergencies do occur.