All drivers and Vehicle Passenger Assistants (VPAs) on the HTST contracts have to complete the Epilepsy Training using the Learning Gateway. After three years the Refresher Training has to be completed. Council VPAs do the training face to face every year and have additional training where necessary.
The training module we have distributed is taken directly from materials provided by our specialist nurse for epilepsy working at Seaside View. The module has been checked and approved by the Children's Epilepsy Nurse Specialist.
Epilepsy Care Plans are written by nursing staff. An additional section with instructions for drivers and VPAs has been added to these plans and shared with the HTST team. Once permission has been provided by parents/carers these plans are shared with HTST operators for their use on HTST journeys.
Epilepsy Care Plan copies will be kept in a clear wallet in the bag of the young person whom it belongs to. Transport Operators also hold a copy of the individual Care Plans, which must be accessible for crews, whilst not kept in the vehicles overnight, copies stored digitally in the amin premises of the Transport Operator.
Not all children and young people who have had some form of epilepsy in the past may need an Epilepsy Care Plan. Children and young people may have a diagnosis of epilepsy but not have significant or severe seizures. Others may not have had a seizure for several years. As a result, the risk of another seizure may be considered very low. In these cases, there may not be a need for an Epilepsy Care Plan.
Those over 18 may not have an Epilepsy Care Plan as these are not routinely provided for adults by adult health care services.
If there is no Epilepsy Care Plan but a child or young person has a seizure on HTST transport, staff should follow the generic advice in the HTST epilepsy training which is summarized below.
Some Epilepsy Care Plans are still being written or produced. Other children have only recently been diagnosed with epilepsy and it will take some time to produce an Epilepsy Care Plan.
If the child or young person has an Epilepsy Care Plan and has a seizure during a HTST journey, then drivers/VPAs should follow the instructions for transport staff contained within the Epilepsy Care Plan (this is detailed in the HTST Epilepsy Training).
If there is no Epilepsy Care Plan, then drivers/VPAs should follow the instructions for a (general) medical emergency detailed in the HTST Introductory Training module.
The driver should stop the vehicle in a safe location, call an ambulance dialing 999 and await their arrival. This should be done without delay. It is very important that a note is made of the time the incident started. After calling the ambulance, the parents/carers, the HTST Team office and your “Transport Provider” office should be informed of the situation and kept updated. If the incident occurs on the route to school, they should also be notified.
The only exceptions to this guidance will be where the vehicle is within two minutes clear driving of the child or young person’s home address, or two minutes driving of a hospital with an Accident and Emergency Department.
The advice contained in the HTST Epilepsy Training module covers any eventuality where a child may have a seizure. In summary, and additional to the Emergency Procedure below also, this is:
Unless otherwise specified, during a seizure do not:
You can read more on our emergency procedure guidance in the driver and VPA handbook.
Following a seizure, the child or young person is likely to feel tired and unwell. They may go into a deep sleep. It is important that at this point the child or young person is made as comfortable as possible.
Some Epilepsy Care Plans will include a recommendation to lie a child down or place them in the recovery position after a seizure has finished. This recommendation is related to the circumstances in which the seizure has happened, the location in which the HTST vehicle has stopped, contact with the emergency services and the arrival of emergency services/ambulance/paramedic on site. It will be important to make the child or young person as comfortable as possible.
Advice from Children's Epilepsy Nurse Specialist is that drivers/VPAs will have contacted the emergency services and should follow the advice (regarding lying a child down or use of the recovery position) of the ambulance service or paramedic/ambulance staff, either over the 'phone or on their arrival on site.
In the vast majority of cases the ambulance crew and/or paramedic will have arrived and will determine the best position for a child or young person to be placed in when they arrive at the scene.
If operators have concerns about the instructions for transport staff in an Epilepsy Care Plan, they should raise them with the HTST Team as soon as possible and they will be checked and clarified with Children's Epilepsy Nurse Specialist staff.
The HTST team seek to ensure that routes are planned so that children and young people (CYP) with a diagnosis of epilepsy are accompanied by a VPA. If this has not happened and/or if HTST operators have concerns about route arrangements for children and young people with a diagnosis of epilepsy, they should raise them with the HTST Team as soon as possible. Risk assessments will be checked and, if necessary, clarified further with Children's Epilepsy Nurse Specialist.
There is, in principle, no reason why a number of CYP, each with a diagnosis of epilepsy, cannot travel together on a single HTST route. In addition to the risk assessment of individual pupils, a risk assessment of individual HTST routes will also be undertaken to determine the safety of multiple CYP with a diagnosis of epilepsy travelling together. This risk assessment will be supported by information provided above for individual CYPs.
HTST transport for some CYP involve longer journeys, sometimes outside the city of Brighton & Hove where the response times from emergency services could be, or are likely to be, lengthy.
The driver or VPA responsibility is to follow the instructions in the child or young person’s Epilepsy Care Plan (if there is one in place) or follow the instructions for a medical emergency.
Seizures could happen on similar journeys undertaken by parent/carers, or, for example, when a child or young person is on a school journey. Such situations will naturally raise anxiety levels for drivers and VPAs, but we would reassure drivers and VPAs that (if this were to happen) they are taking the correct and recommended action.
The HTST Team will communicate the increased risk inherent in longer journeys and those outside of the city of Brighton & Hove to parents/carers as part of the application process for HTST.
The HTST Team collects information about children and young people from parents on Pupil Travel Information Sheets and from the SEN Team within the council.
We check this information in our risk assessments and add the details to a list of children and young people that we know to have a diagnosis of epilepsy.
Diagnosis is of course on-going and there may be a time lag between a diagnosis and the point at which the HTST Team receive this information. We rely on parents and other services to inform us of children and young people who have a recent diagnosis.
We would ask that HTST operators raise any queries they about a diagnosis of epilepsy as soon as they arise and as a matter of urgency.
The HTST Team provide operators with copies of individual Pupil Travel Information Sheets which will contain details of a child or young person’s epilepsy.
If we receive an Epilepsy Care Plan from Children's Epilepsy Nurse Specialist, and have the parent’s permission to share this information, we will pass the Epilepsy Care Plan to the HTST operator.