By Shadlie Kensrue, MSN, RN, CSN, PHN and Christopher Riccardi, CHSP, CHEP
“Within minutes of a school shooting, the first ambulance leaves campus. Parents race to the school and local hospitals while buses transport classmates to a reunification site. Hospital staff struggle to identify injured children. School officials can’t confirm which students were transported to which receiving facility. Families receive conflicting information from multiple agencies. Although everyone is working hard, no one is working from the same playbook. While responders focus on saving lives, another crisis is unfolding. Parents simply want to know where their children are.”
Every school emergency plan includes some version of reunification. Most districts have identified a reunification site, developed student release procedures, and practiced moving students from one location to another. Yet after nearly every major school emergency in the United States, after-action reports tell us the same thing: reunification remains one of the most difficult parts of the entire response.
The problem isn’t that schools aren’t planning. The problem is that most plans stop at the school campus.
What happens when injured students are transported to multiple hospitals? What happens when parents bypass the reunification site and head directly to emergency departments? Who helps hospitals identify children arriving without identification? Who confirms custody when families arrive looking for answers? How do schools communicate clear information amidst the chaos of a large-scale emergency?
Those questions became the foundation for the School and Hospital Alliance for Response in Emergencies (SHARE).
Looking beyond the school campus
For over a decade, the Emergency Preparedness Interagency Collaborative (EPIC), founded by the Irvine Unified School District, has brought together education, public safety, health care, emergency management, and community partners to improve regional preparedness. Through that collaboration, one vulnerability surfaced repeatedly. What happens after injured students leave campus?
Schools had excellent plans for accounting for students and releasing them to parents. Hospitals had excellent plans for treating injured children. But almost no one had developed a coordinated process connecting the two.
Both systems were doing exactly what they were designed to do, but neither had planned for the space between them. Neither system was failing, they simply weren’t designed to operate together during pediatric disasters.
After-action reports from Hurricane Katrina, the Sandy Hook Elementary School shooting, California wildfires, and numerous transportation accidents consistently identified fragmented communication, delayed identification of children, and confusion over reunification as recurring operational failures.
Rather than waiting for another tragedy to expose the same gaps, the SHARE partners asked a different question: “How can schools and hospitals work as one system before the next emergency?” The answer became SHARE, a simple but powerful model for extending reunification beyond the school campus.
Imagine a school bus crash involving multiple critically injured students. EMS transports children to three different hospitals. Within minutes, pre-designated school nurses report to participating hospitals where they assist with student identification using school records, verify emergency contacts, support family communication, and coordinate information back to district leadership teams. Instead of operating independently, schools and hospitals function as one integrated system. This isn’t a hypothetical vision of the future. It’s exactly the kind of coordinated response SHARE was created to support.
The birth of SHARE
SHARE was never intended to replace existing school reunification plans. Instead, it extends them beyond the school campus, connecting schools, hospitals and emergency responders into one coordinated reunification system. It was developed under the leadership of Shadlie Kensrue, Director of Health Services for the Irvine Unified School District and Christopher Riccardi, Manager of Emergency Management and Business Continuity for Rady Children’s Hospital Orange County as a collaborative partnership between school districts, hospitals, emergency management agencies, and health care coalitions throughout Orange County.
Unlike many emergency preparedness initiatives that begin with grant funding or regulatory requirements, SHARE began with a simple question: “What happens after the ambulance leaves?”
The answer wasn’t reassuring.
Schools possess critical information hospitals desperately need during emergencies including student photographs, emergency contacts, custody information, medical histories, and trusted relationships with families. Hospitals possess critical information schools need including patient location, medical status, family assistance resources, and emergency coordination. Yet historically, those two systems rarely trained together.
SHARE was created to change that by bringing schools, hospitals and emergency responders together before, not during, the next emergency.
Today, SHARE connects 28 school districts, 26 hospitals, including Orange County’s Level I Pediatric Trauma Center, higher education institutions, emergency management agencies, and public safety partners into one of the nation’s most comprehensive school-hospital preparedness collaborations, working together to improve pediatric disaster response and family reunification before disasters occur. The alliance has also created a practical toolkit of templates, planning guides and implementation resources to help communities adapt and replicate this model. SHARE succeeds because it wasn’t built by one organization. It was built through relationships established long before the next disaster.
Every minute hospital staff spend trying to identify an injured child is time diverted from patient care. Every minute school officials spend trying to locate transported students delays reunification. Every minute parents receive conflicting information erodes public confidence and compounds psychological distress. Effective reunification isn’t simply about communication; it directly supports clinical care, emergency operations, and community trust.
School nurses: The missing link
One of the earliest discoveries made by the SHARE partners was that school nurses naturally occupy the intersection between health care and education. They already understand medical terminology. They already know students’ health needs. They already have established relationships with families. Most importantly, they understand both educational privacy requirements under FERPA and health care privacy requirements under HIPAA.
Instead of creating an entirely new role, SHARE recognized that school nurses were already positioned to become one of the most valuable resources during pediatric disasters. School nurses do not become hospital employees during an incident. They remain educational professionals serving as trusted liaisons between the two systems that rarely train together. By integrating school nurses into hospital reunification planning before an incident occurs, hospitals gain access to knowledgeable professionals who can assist with student identification, family communication, and coordination with school districts.
Just as importantly, families often recognize and trust their school nurses. During highly emotional incidents, that familiar face can help reduce anxiety and improve communication.
Lessons from after-action reports
The SHARE model wasn’t built from theory; it was built from lessons repeatedly documented in after-action reports. Across multiple disasters, investigators consistently identified similar problems:
- Parents arriving at hospitals before schools could communicate student locations.
- Hospitals receive unidentified pediatric patients with no access to school records.
- Multiple reunification sites operating independently with conflicting information.
- Delays caused by uncertainty surrounding HIPAA and FERPA.
- Staff are forced to improvise family assistance processes under intense emotional pressure.
These issues were documented after Hurricane Katrina, the Sandy Hook Elementary School shooting, California wildfire evacuations, and numerous transportation incidents involving children.
Different disasters.
Different states.
The same operational problems.
SHARE was intentionally designed to address those recurring themes rather than waiting for another incident to produce another report.
Practical lessons for school leaders
One of the strengths of the SHARE model is that it doesn’t require expensive technology or major organizational changes. Most improvements involve relationships, planning, and practice.
Six questions every superintendent should ask:
1. Do we know which hospitals will likely receive our students?
- Which trauma centers?
- Which pediatric hospitals?
- Which local acute care hospitals?
2. Have we met those emergency managers?
- A simple introduction before an emergency creates opportunities for joint planning, exercises, and understanding each organization’s capabilities.
3. Do those hospitals know us?
- School nurses bring expertise that hospitals often lack during pediatric emergencies.
- Relationships work both ways. Hospitals should know who to call at your district before an incident occurs, not during one.
4. Can our school nurses and designated support staff assist hospital reunification efforts?
- In-person or virtually?
- Support staff with access to the student information system?
5. Have we exercised together?
- Inviting school nurses to participate in health care exercises benefits both organizations and builds relationships long before they’re needed.
6. Do staff understand emergency privacy provisions?
- Both FERPA and HIPAA include provisions allowing disclosure during emergencies to protect health and safety. Training staff on these provisions before an incident helps reduce confusion when every minute counts.
Building relationships before they’re needed
Perhaps the greatest lesson learned through SHARE is that successful reunification depends less on written plans than on established relationships.
Emergency managers often say disasters don’t create new relationships; they test existing ones.
Schools that have exercised with hospitals, met emergency managers, discussed privacy concerns, and established communication pathways before an incident consistently perform better during real events.
Likewise, hospitals that understand school operations and include educational partners in preparedness activities are better equipped to support families during pediatric emergencies.
Preparedness is ultimately about reducing uncertainty. When responders already know each other, trust each other, and understand each other’s systems, they spend less time figuring out who should do what and more time helping children and families.
Call to action: Five things you can do this month
- Meet your hospital emergency manager.
- Review your reunification annex.
- Include hospitals in your next exercise.
- Invite school nurses into the planning meetings.
- Discuss HIPAA and FERPA before the disaster.
Looking ahead
Disasters involving children will always be emotionally challenging. No plan can eliminate the chaos or heartbreak that accompanies a school emergency. Planning can reduce confusion, shorten reunification times, improve communications, and reassure families that schools and hospitals are working together.
More than a regional coalition, SHARE demonstrates that effective reunification begins long before an emergency occurs. It begins with partnerships, shared training, and recognizing that schools and hospitals are not separate systems, they are partners serving the same children.
The ambulance should never become the point where one emergency plan ends and another begins. It should become the connection point between two systems working from the same playbook. That’s what SHARE was built to do.
Learn more: Additional SHARE resources, templates and tools are available at: https://epicirvine.org/share
Shadlie Kensrue, MSN, RN, CSN, PHN, and Christopher Riccardi, CHSP, CHEP, co-chair the School and Hospital Alliance for Response in Emergencies (SHARE), a regional collaboration of 28 school districts, 26 hospitals, emergency management agencies, and public safety partners to strengthen pediatric disaster preparedness and family reunification.
References
California Department of Education. (2020). Emergency Planning Guidance for Schools.
Centers for Disease Control and Prevention. (2024). Reunification with Children After a Disaster or Emergency.
Connecticut State Police. (2014). Sandy Hook Elementary School Shooting Final Report.
Federal Emergency Management Agency. (2023). Reunification Support.
National Commission on Children and Disasters. (2010). Report to the President and Congress.
National Transportation Safety Board. (2018). Highway Accident Reports Involving School Transportation.
SchoolSafety.gov. (2023). Emergency Planning Strategies and Resources.
U.S. Department of Education, Readiness and Emergency Management for Schools (REMS) Technical Assistance Center. Family Reunification Annex (recommended through SchoolSafety.gov)
U.S. Department of Education. (2019). FERPA and the Disclosure of Student Information During Emergencies.
U.S. Department of Health and Human Services. (2020). HIPAA Privacy Rule and Emergency Situations.
