TITLE XV
EDUCATION

Chapter 200
HEALTH AND SANITATION

Section 200:1 to 200:10

    200:1 to 200:10 Repealed by 1971, 499:3, I, eff. Sept. 4, 1971. –

Section 200:11

    200:11 Investigation of Sanitary Conditions. – The department of health and human services shall, upon complaint of any responsible person, investigate the sanitary conditions of any schoolhouse or building used for school purposes.

Source. 1915, 35:1. 1921, 85, VIII:14. PL 123:11. RL 142:11. RSA 200:11. 1983, 291:1, I. 1995, 310:181, eff. Nov. 1, 1995.

Section 200:11-a

    200:11-a Investigation of Air Quality. –
I. The school principal, or designee shall annually investigate the air quality of any schoolhouse or building used for school purposes using a checklist provided by the department of education. The checklist shall be established in rules adopted by the state board of education pursuant to RSA 541-A. The purpose of the review shall be to consider physical factors that can influence the air quality within the schoolhouse or building. The review shall require a physical assessment of the facilities, not a measurement of the air quality. The checklist shall allow an evaluation of the following physical conditions that can impact air quality: general cleanliness, ventilation, moisture control, and chemical use and storage. The completed checklist shall be filed after the annual inspection with the department of education, the local school board, and the local health officer. Checklists shall remain on file for 5 years. Checklists shall be reviewed during the 5 year school approval process and shall be a factor in the approval process for a public school.
II. The department of education shall ensure that every public school in New Hampshire possesses a copy of the United States Environmental Protection Agency Tools for Schools program and shall encourage public schools to implement the program to help provide and maintain good indoor air quality in public school buildings.
III. Any school principal or designee who has conducted a good faith report under RSA 200:11-a shall be immune from civil liability.

Source. 2010, 319:1, eff. Jan. 1, 2011; 295:12, eff. Jan. 1, 2011 at 12:01 a.m.

Section 200:12

    200:12 Requiring Changes; Condemnation. – If the department of health and human services shall find that such schoolhouse or building is in any respect a menace, or likely to become a menace, to the health or bodily welfare of the pupils or teachers, the department shall call the attention of the local board of health to the facts; and, if after a reasonable length of time the complaint has not been attended to in a satisfactory way, the department shall either order such changes as will in their judgment make the building safe and sanitary for school purposes or condemn the same and forbid its further use.

Source. 1915, 35:2. 1921, 85, VIII:15. PL 123:12. RL 142:12. RSA 200:12. 1995, 310:175, 181, eff. Nov. 1, 1995.

Section 200:13

    200:13 Cost of Changes. – It shall be the duty of the school board of the district forthwith to make the changes ordered, and the cost of the same shall be a charge upon the district.

Source. 1915, 35:3. 1921, 85, VIII:16. PL 123:13. RL 142:13.

Section 200:14

    200:14 Assessment of Cost. – The selectmen shall assess the cost upon the ratable estate of the district in addition to money voted by the district or required by law for the support of schools. In anticipation of such assessment the school board may borrow money on the credit of the district to meet the charges incurred.

Source. 1915, 35:3. 1921, 85, VIII:16. PL 123:14. RL 142:14.

Optional Provisions

Section 200:15 to 200:25

    200:15 to 200:25 Repealed by 1971, 499:3, II, eff. Sept. 4, 1971. –

School Health Services

Section 200:26

    200:26 Definition. – As used in this subdivision the word "child" shall mean any child who attends, or who should attend an elementary, junior high, or senior high school, and shall include any child who attends a public kindergarten or special class for disabled children which is an integral part of the local school district.

Source. 1971, 499:1. 1990, 140:2, X, eff. June 18, 1990.

Section 200:27

    200:27 School Health Services. – The local board in each school district may provide school health services to include school nurse services and school physician services to every child of school age in the district as hereinafter provided.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:28

    200:28 School Physician. – Each school board may appoint one or more school physicians, legally qualified to practice medicine and currently licensed to practice in New Hampshire or immediately adjacent states, and may assign one to the schools in the district and may provide them with all proper facilities for the performance of their duties as relate to the school health program.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:29

    200:29 School Nurse; Certification. –
I. A superintendent may nominate and school board appoint a school nurse to function in the school health program, and provide said nurse with proper facilities and equipment. A school nurse shall be a registered professional nurse currently licensed in New Hampshire and certified by the state board of education.
II. (a) An individual shall have the following entry level requirements to be certified as a school nurse:
(1) Have completed a board of nursing approved registered nursing program at the bachelor's degree level or higher under RSA 326-B; and
(2) Have 3 years current experience in pediatric nursing or other related nursing areas.
(b) An applicant for certification as a school nurse shall have the skills, competencies, and knowledge in the following areas:
(1) In the area of delivery of the school nursing services, the skills and abilities to:
(A) Assess student's health or situation through analysis of data collected and synthesize comprehensive data.
(B) Identify outcomes and develop plans for individual students or situations including strategies and alternatives.
(C) Implement interventions identified in the plan of care/action, coordinating care with school employees and evaluate outcome.
(D) Consult with administration to provide health education and employ strategies to promote health, wellness, and a safe environment.
(E) Systematically evaluate the progress for the quality of practice and effectiveness toward attainment of outcomes for promoting health and a safe environment.
(2) In the area of school nursing, the applicant shall demonstrate the knowledge and ability to:
(A) Provide quality nursing practice in a school setting.
(B) Evaluate his or her nursing practices and continue professional development as required by a school district's professional development master plan.
(C) Collaborate with students, families, school staff, and others in the conduct of school nursing practices.
(D) Integrate ethical provisions and research findings into practice as a school nurse.
(3) In the area of accountability, knowledge, skills, and application in:
(A) Planning and delivering school nursing services factoring in safety, effectiveness, cost, and impact on nursing practice.
(B) Providing leadership in the profession and professional nursing practice setting.
(C) Managing school health services.
(D) Complying with professional nursing practice standards, guidelines, relevant statutes, rules, and regulations.
III. The state board of education shall adopt rules, pursuant to RSA 541-A, relative to:
(a) The application process for certification under paragraph II.
(b) Form and content of any forms required under paragraph II.
(c) Application fees for certification under paragraph II.
(d) Further rulemaking necessary for the proper administration of certification under paragraph II.
IV. (a) All school nurses hired on or before the effective date of this paragraph and having applied for certification prior to the effective date of this paragraph shall not be subject to the certification requirements in paragraph II.
(b) All school nurses appointed after the effective date of this paragraph and before July 1, 2022 holding an associates' degree in nursing, and all nurses hired before the effective date of this paragraph who did not meet the application deadline in subparagraph (a), shall be enrolled in a registered nurse to bachelor of science in nursing program and shall complete such program within 6 years of the date of this paragraph.
(c) All school nurses appointed after the effective date of this paragraph holding a bachelor's degree or higher in nursing shall hold certification pursuant to rules adopted by the state board of education.
(d) All school nurses appointed on or after July 1, 2022, shall meet the certification requirements in paragraph II, pursuant to rules adopted by the state board of education.

Source. 1971, 499:1, eff. Sept. 4, 1971. 2016, 285:2, eff. Aug. 20, 2016. 2019, 144:1, 2, eff. Aug. 25, 2019.

Section 200:30

    200:30 School Dental Hygienist. – Any school board may employ for their district a dental hygienist who is a graduate of an accredited school of dental hygiene and is licensed by the state dental board. Said hygienist shall be under the supervision of a qualified dentist licensed to practice in New Hampshire.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:31

    200:31 School Health Personnel. – Any school board may employ or contract for its district a licensed practical nurse (LPN) or licensed nursing assistant (LNA) who shall hold an unencumbered current license in New Hampshire, to work under the supervision of the school registered nurse in accordance with rules adopted under RSA 541-A, by the board of nursing.

Source. 1971, 499:1. 1997, 326:1. 2007, 41:1, eff. July 20, 2007.

Section 200:32

    200:32 Physical Examination of Pupils. – There shall be a complete physical examination by a licensed physician, physician assistant, or advanced practice registered nurse of each child prior to or upon first entry into the public school system and thereafter as often as deemed necessary by the local school authority. The result of the child's physical examination shall be presented to the local school officials on a form provided by the local school authorities. No physical examination shall be required of a child whose parent or guardian objects thereto in writing on the grounds that such physical examination is contrary to the child's religious tenets and teachings.

Source. 1971, 499:1. 1996, 277:1, eff. Aug. 9, 1996. 2009, 54:5, eff. July 21, 2009.

Section 200:33

    200:33 Repealed by 1996, 277:5, eff. August 9, 1996. –

Section 200:34

    200:34 Special Examination. – Every child with a presenting problem and found to need further evaluation, after due consideration and evaluation by the appropriate school authority, shall be referred by the school physician or school administrator to the parents or guardian of said child for examination, and evaluation by an appropriate practitioner and if said parents fail or neglect to have said child so examined and fail to present the recommendations from said examiner within a reasonable period after the referral by the school to said parents, then said child may be examined by the school physician, or other qualified personnel.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:35

    200:35 Reporting of Defects or Disabilities. – The parent or guardian of the child shall be informed or counseled concerning any defects or disabilities discovered and identified through observation, screening procedures or physical examinations. The school nurse may make home visits, arrange parent conferences at school or send written notices as determined pursuant to local school policy.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:36

    200:36 Medical Examination of School Personnel. – All school personnel, to include but not limited to administrative, secretarial, maintenance, cafeteria and transportation personnel in each school district shall be required to have a pre-employment medical examination by a licensed physician qualified to practice medicine in at least one of the states of the United States of America. Any person who objects to all or part of any medical examination because of religious beliefs shall be exempt from said examination, except that no such exemption shall be granted if state or local authorities determine that such exemption would constitute a hazard to the health of persons exposed to the unexamined individual. The local school board shall further require additional medical examinations at specific intervals or upon the request of the local superintendent of schools during the period of employment. A written recommendation from the examining physician shall indicate that the employee is medically capable of performing his designated assignment.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:37

    200:37 Medical Examination of School Bus Operators. – Notwithstanding the provisions of RSA 200:36, before employing any person as a school bus operator, the town or city governing body which pays for such transportation shall require that such person submit a certificate signed by a licensed physician setting forth the physician's findings as a result of the examination to determine the physical condition of drivers in accordance with the requirements of 49 CFR 391.41-391.49. Such certificate shall be submitted to the local governing body prior to the commencement of such employment, which shall retain a copy of such certification. Every 2 years thereafter, either prior to the commencement of the school year or prior to the reemployment of such person as a school bus operator, such governing body shall require submission of a like certificate, except that school bus operators attaining the age of 70 shall be required to undergo an annual examination and to submit a certificate annually.

Source. 1971, 499:1. 1992, 69:1, eff. June 19, 1992.

Section 200:38

    200:38 Control and Prevention of Communicable Diseases; Duties of School Nurse. –
I. Each school nurse shall ensure that:
(a) All children shall be immunized prior to school entrance in accordance with RSA 141-C:20-a.
(b) [Repealed.]
(c) All children shall have a complete physical examination prior to school entrance in accordance with RSA 200:32.
II. If the provisions of paragraph I are not met, each school nurse shall be responsible for informing school administrators of the noncompliance and for assisting with meeting such requirements, unless the child is exempted under RSA 141-C:20-c.

Source. 1971, 499:1. 1987, 193:8. 1996, 277:2. 2001, 83:2, II, eff. Aug. 18, 2001.

Section 200:39

    200:39 Exclusion From School. – Whenever any student exhibits symptoms of contagion or is a hazard to himself or others, he shall be excluded from the classroom and his parents or guardians shall be notified as soon as possible.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:40

    200:40 Emergency Care. – Written policies shall be adopted by the local school board for the purpose of providing immediate and adequate emergency care for students and school personnel who sustain injury or illness during school hours, or during scheduled school activities.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Section 200:40-a

    200:40-a Administration of Oxygen by School Nurse. – A school nurse shall be permitted to administer oxygen to a pupil in a medical emergency without parental permission or a physician's order.

Source. 2001, 83:1, eff. Aug. 18, 2001.

Section 200:40-b

    200:40-b Glucagon Injections. –
I. (a) The state board of education, after consultation with the department of health and human services, shall adopt rules pursuant to RSA 541-A for addressing incidents of hypoglycemia resulting in unconsciousness, seizure, and/or the inability to swallow in order to provide for the health and safety of children who have been medically identified as having diabetes. The rules shall provide that:
(1) A parent or legal guardian of any child may authorize a school employee, or person employed on behalf of the school in cases where there is no school nurse immediately available, to administer glucagon to a child in case of an emergency, while at school or a school sponsored activity;
(2) The glucagon shall be kept in a conspicuous place, readily available; and
(3) Glucagon administration training may be provided by a licensed physician, physician assistant, advanced practiced registered nurse, or registered nurse, however in no case shall school nurses be required to provide training; and the school administration shall allow school employees to voluntarily assist with the emergency administration of glucagon when authorized by a parent or legal guardian.
(b) No school employee shall be subject to penalty or disciplinary action for refusing to be trained in glucagon administration.
(c) A parent or legal guardian shall provide a diabetes management plan or physician's order, signed by the student's health care provider, that prescribes the care and assistance needed by the student including glucagon administration.
II. The state board of education, in conjunction with the American Diabetes Association, and the New Hampshire chapter of American Academy of Pediatrics, shall develop standards and guidelines for the training and supervision of personnel, other than the school nurse, who provide emergency medical assistance to students under this section. Such personnel shall only be authorized to provide such assistance upon successful completion of glucagon administration training.
III. No school teacher, school administrator, school health care personnel, person employed on behalf of the school, any other school personnel, nor any local educational authority shall be liable for civil damages which may result from acts or omissions in use of glucagon which may constitute ordinary negligence. This immunity shall not apply to acts or omissions constituting gross negligence or willful or wanton conduct.
IV. Training on the administration of glucagon for school personnel, or those employed on behalf of the school, shall not be considered the delegation of nursing practice.
V. The administration of glucagon by school personnel, or those employed on behalf of the school, shall not be considered the practice of nursing.

Source. 2015, 20:1, eff. July 4, 2015.

Section 200:40-c


[RSA 200:40-c effective September 1, 2022.]
    200:40-c Emergency Plans for Sports Related Injuries. –
I. The local board of each school district or the governing body of each nonpublic school that includes any of the grades 4 through 12, shall establish an emergency action plan for responding to serious or potentially life-threatening sports related injuries. Each plan shall:
(a) Document the proper procedures to be followed when a student sustains a serious injury or illness while participating in school sponsored sports or other athletic activity.
(b) List the employees, team coaches, and licensed athletic trainers in each school who are trained in first aid or cardiopulmonary resuscitation.
(c) Identify the employees, team coaches, or licensed athletic trainers responsible for carrying out the emergency action plan.
(d) Identify the activity location, address, or venue for the purpose of directing emergency personnel.
(e) Identify the equipment and supplies and location thereof needed to respond to the emergency.
(f) Identify the location of any automated external defibrillators and personnel trained in the use of the automated external defibrillator.
(g) Document policies related to cooling for an exertional heat stroke victim consistent with guidelines established by the American College of Sports Medicine and the National Athletic Trainers' Association.
II. The plan shall be posted within each school and disseminated to, and coordinated with emergency medical services, fire department, and law enforcement. In addition, each school district shall adopt procedures for obtaining student-participant medical information relative to any injury or illness related to or involving any head, face, or cervical spine, cardiac injury or diagnosis, exertional heat stroke, sickle cell trait, asthma, allergies, or diabetes for each student athlete prior to engaging in activities; policies related to hydration, heat acclimatization and wet bulb globe temperature guidelines as established by the American College of Sports Medicine and the National Athletic Trainers' Association; and procedures for students to return to play after a sports or illness-related injury, which shall be kept on file by each school district and made available to the department of education and public upon request. Access, filing, and confidentiality of student-participant medical information shall be managed in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA). Each plan shall be added to the school's emergency response plan and adopted procedures shall be reviewed annually and updated as necessary.
III. The plans shall be implemented by the beginning of the first full school year after the effective date of this section.

Source. 2021, 210:2, Pt. III, Sec. 1, eff. Sept. 1, 2022.

Section 200:41

    200:41 Appropriation. – A district may raise money to carry the provisions of this subdivision into effect.

Source. 1971, 499:1, eff. Sept. 4, 1971.

Pupil Use of Epinephrine Auto-Injectors

Section 200:42

    200:42 Possession and Use of Epinephrine Auto-Injectors Permitted. –
A pupil with severe, potentially life-threatening allergies may possess and self-administer an epinephrine auto-injector if the following conditions are satisfied:
I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian. The school shall obtain the following information from the pupil's physician:
(a) The pupil's name.
(b) The name and signature of the licensed prescriber and business and emergency numbers.
(c) The name, route, and dosage of medication.
(d) The frequency and time of medication administration or assistance.
(e) The date of the order.
(f) A diagnosis and any other medical conditions requiring medications, if not a violation of confidentiality or if not contrary to the request of the parent or guardian to keep confidential.
(g) Specific recommendations for administration.
(h) Any special side effects, contraindications, and adverse reactions to be observed.
(i) The name of each required medication.
(j) Any severe adverse reactions that may occur to another pupil, for whom the epinephrine auto-injector is not prescribed, should such a pupil receive a dose of the medication.
II. The school principal or, if a school nurse is assigned to the pupil's school building, the school nurse shall receive copies of the written approvals required by paragraph I.
III. The pupil's parent or guardian shall submit written verification from the physician confirming that the pupil has the knowledge and skills to safely possess and use an epinephrine auto-injector in a school setting.
IV. If the conditions provided in this section are satisfied, the pupil may possess and use the epinephrine auto-injector at school or at any school-sponsored activity, event, or program.
V. In this section, "physician" includes any physician or health practitioner with the authority to write prescriptions.

Source. 2003, 50:1, eff. Aug. 15, 2003.

Section 200:43

    200:43 Use of Epinephrine Auto-Injector. – Immediately after using the epinephrine auto-injector during the school day, the pupil shall report to the nurse's office or principal's office to enable the nurse or another school employee to provide appropriate follow-up care.

Source. 2003, 50:1, eff. Aug. 15, 2003.

Section 200:44

    200:44 Availability of Epinephrine Auto-Injector. – The school nurse or, if a school nurse is not assigned to the school building, the school principal shall maintain for a pupil's use at least one epinephrine auto-injector, provided by the pupil, in the nurse's office or in a similarly accessible location.

Source. 2003, 50:1, eff. Aug. 15, 2003.

Section 200:44-a

    200:44-a Anaphylaxis Training Required. –
I. (a) Designated assistive personnel shall complete an anaphylaxis training program prior to providing or administering an epinephrine auto-injector at least every 2 years following completion of the initial anaphylaxis training program. Such training shall be conducted based on resources provided by the National Association of School Nurses, the Food and Allergy Anaphylaxis Network, or the New Hampshire School Nurses' Association. Training shall be conducted online or in person and, at a minimum, shall cover:
(1) Techniques on how to recognize symptoms of severe allergic reactions, including anaphylaxis.
(2) Standards and procedures for the storage and administration of an epinephrine auto-injector.
(3) Emergency follow-up procedures.
(b) The school nurse conducting the anaphylaxis training shall maintain a list of individuals who have successfully completed the anaphylaxis training program.
II. Not later than January 1, 2017, the department of education, in consultation with the New Hampshire School Nurses' Association, shall develop and make available to all schools guidelines for the management of students with life-threatening allergies. The guidelines shall include, but not be limited to implementation of the following by a school nurse: education and training for designated unlicensed assistive personnel on the management of students with life-threatening allergies, including training related to the administration of an epinephrine auto-injector; procedures for responding to life-threatening allergic reactions; the development of individualized health care plans and allergy action plans for every student with a known life-threatening allergy; and protocols to prevent exposure to allergens. Not later than September 1, 2017, each school district, under the direction of a school nurse, shall implement a plan based on the guidelines developed pursuant to this section for the management of students with life-threatening allergies enrolled in the schools under its jurisdiction, and make such plan available to the public.

Source. 2016, 39:2, eff. July 2, 2016.

Section 200:45

    200:45 Immunity. –
I. No school district, member of a school board, or school district employee shall be liable in a suit for damages as a result of any act or omission related to a pupil's use of an epinephrine auto-injector pursuant to RSA 200:43, if the provisions of RSA 200:42 have been met, unless the damages were caused by willful or wanton conduct or disregard of the criteria established in that section for the possession and self-administration of an epinephrine auto-injector by a pupil.
II. No school that possesses and makes available epinephrine auto-injectors, member of its school board, school nurse, school district employee, agents or volunteers, no health care practitioner that prescribes epinephrine auto-injectors to a school, and no person that conducts the training described in RSA 200:44-a shall be liable for damages as a result of the administration or self-administration of an epinephrine auto-injector, the failure to administer an epinephrine auto-injector, or any other act or omission related to the possession or use of an epinephrine auto-injector, unless the damages were caused by willful or wanton misconduct.
III. The administration of an epinephrine auto-injector by designated school personnel pursuant to the provisions of this subdivision shall not require licensure.
IV. This section shall not be construed to eliminate, limit, or reduce any other immunity or defense that may be available under state law.

Source. 2003, 50:1, eff. Aug. 15, 2003. 2016, 39:3, eff. July 2, 2016.

Use of Asthma Medications by Pupils

Section 200:46

    200:46 Possession and Self-Administration of Asthma Inhalers Permitted. –
A pupil may possess and use a metered dose inhaler or a dry powder inhaler to alleviate asthmatic symptoms, or before exercise to prevent the onset of asthmatic symptoms, if the following conditions are satisfied:
I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian. The school shall obtain the following information from the pupil's physician:
(a) The pupil's name.
(b) The name and signature of the licensed prescriber and business and emergency numbers.
(c) The name, route, and dosage of medication.
(d) The frequency and time of medication administration or assistance.
(e) The date of the order.
(f) A diagnosis and any other medical conditions requiring medications, if not a violation of confidentiality or if not contrary to the request of the parent or guardian to keep confidential.
(g) Specific recommendations for administration.
(h) Any special side effects, contraindications, and adverse reactions to be observed.
(i) At least one emergency telephone number for contacting the parent or guardian.
(j) The name of each required medication.
II. The school principal or, if a school nurse is assigned to the pupil's school building, the school nurse shall receive copies of the written approvals required by paragraph I.
III. The pupil's parent or guardian shall submit written verification from the physician confirming that the pupil has the knowledge and skills to safely possess and use an asthma inhaler in a school setting.
IV. If the conditions provided in this section are satisfied, the pupil may possess and use the inhaler at school or at any school sponsored activity, event, or program.
V. In this section, "physician" includes any physician or health practitioner with the authority to write prescriptions.

Source. 2003, 51:3, eff. Aug. 15, 2003.

Section 200:47

    200:47 Immunity. – No school district, member of a school board, or school district employee shall be liable in a suit for damages as a result of any act or omission related to a pupil's use of an inhaler if the provisions of RSA 200:46 have been met, unless the damages were caused by willful or wanton conduct or disregard of the criteria established in that section for the possession and self-administration of an asthma inhaler by a pupil.

Source. 2003, 51:3, eff. Aug. 15, 2003.

Air Quality in Schools

Section 200:48

    200:48 Air Quality in Schools. – The school board of each school district shall develop and implement a policy governing air quality issues in schools. The policy shall address methods of minimizing or eliminating emissions from buses, cars, delivery vehicles, maintenance vehicles, and other motorized vehicles used for transportation on school property taking into account the state anti-idling and clean air zone policies established by the department of environmental services.

Source. 2010, 100:1, eff. Jan. 1, 2011.

Head Injury Policies for Student Sports

Section 200:49

    200:49 Head Injury Policies for Student Sports. – Education is the key to identification and appropriate management of all concussions. The school board of each school district shall develop guidelines and other pertinent information and forms for student sports to inform and educate coaches, student-athletes, and student-athletes' parents or guardians of the nature and risk of concussion and head injury including continuing to play after concussion or head injury. On an annual basis, a school district or school shall distribute a concussion and head injury information sheet to all student-athletes. The Brain Injury Association of New Hampshire is available to educate and assist the public with implementing and/or updating concussion management protocols.

Source. 2012, 234:2, eff. Aug. 17, 2012. 2014, 42:1, eff. July 26, 2014.

Section 200:50

    200:50 Removal of Student-Athlete. –
I. A school employee coach, official, licensed athletic trainer, or health care provider who suspects that a student-athlete has sustained a concussion or head injury in a practice or game shall remove the student-athlete from play immediately.
II. A student-athlete who has been removed from play shall not return to play on the same day or until he or she is evaluated by a health care provider and receives medical clearance and written authorization from that health care provider to return to play. The student-athlete shall also present written permission from a parent or guardian to return to play.
III. No person who authorizes a student-athlete to return to play shall be liable for civil damages resulting from any act or omission in the rendering of such care, other than acts or omissions constituting gross negligence or willful or wanton misconduct.

Source. 2012, 234:2, eff. Aug. 17, 2012.

Section 200:51

    200:51 School Districts; Limitation of Liability. – An employee of a school administrative unit, school, or chartered public school, or a school volunteer, pupil, parent, legal guardian, or employee of a company under contract to a school, school district, school administrative unit, or chartered public school, shall be immune from civil liability for good faith conduct arising from or pertaining to the injury or death of a student-athlete provided the action or inaction was in compliance with this subdivision and local school board policies relative to the management of concussions and head injuries. This limitation of liability shall extend to school-sponsored athletic activities. A school district or school may provide concussion guidelines to other organizations sponsoring athletic activities on school property, however the school district or school shall not be required to enforce compliance with such guidelines.

Source. 2012, 234:2, eff. Aug. 17, 2012.

Section 200:52

    200:52 Definitions. –
As used in this subdivision:
I. "Health care provider" means a person who is licensed, certified, or otherwise statutorily authorized by the state to provide medical treatment and is trained in the evaluation and management of concussions.
II. "School property" means school property as defined in RSA 193-D:1, V.
III. "Student-athlete" means a student involved in any intramural sports program conducted outside the regular teaching day or competitive student sports program between schools in grades 4-12.
IV. "Student sports" means intramural sports programs conducted outside the regular teaching day for students in grades 4-12 or competitive athletic programs between schools for students in grades 4-12.
V. "Head injury" means injuries to the scalp, skull, or brain caused by trauma, and shall include a concussion which is the most common type of sports-related brain injury.

Source. 2012, 234:2, eff. Aug. 17, 2012. 2013, 19:1, eff. July 15, 2013. 2014, 42:2, eff. July 26, 2014.

Bronchodilators, Spacers, and Nebulizers in Schools

Section 200:53

    200:53 Definitions. –
In this subdivision:
I. "Administer" means the direct provision of a bronchodilator, spacer, or nebulizer to an individual.
II. "Asthma" means a chronic lung disease that inflames and narrows the airways. It causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. For the purpose of this subdivision, "asthma" also includes "reactive airway disease," commonly referred to as RAD.
III. "Bronchodilator" means any medication used for the quick relief of asthma symptoms that dilates the airways and is recommended by the National Heart, Lung, and Blood Institute's national asthma education and prevention program guidelines for the treatment of asthma, such bronchodilators may include an orally inhaled medication that contains a premeasured single dose of albuterol or albuterol sulfate delivered by a nebulizer (compressor device), or by a pressured metered dose inhaler used to treat respiratory distress, including, but not limited to, wheezing, shortness of breath, and difficulty breathing, or another dosage of a bronchodilator recommended in the guidelines for the treatment of asthma.
IV. "Designated unlicensed assistive personnel" means a school employee or agent of a school designated by the school nurse, who has completed the New Hampshire School Nurses' Association approved training required to provide or administer bronchodilators, spacers, or nebulizers. Designated unlicensed assistive personnel shall complete an asthma training program prior to providing or administering a bronchodilator, spacer, or nebulizer made available by the school nurse and at least annually following completion of the initial asthma training program. Such training shall be conducted by the school nurse based on resources provided by the New Hampshire School Nurses' Association, the National Association of School Nurses, and the American Lung Association. Training shall be conducted in person and at a minimum shall address techniques on how to recognize symptoms of severe respiratory distress or asthma, and standards and procedures for the storage and administration of a bronchodilator with a spacer or nebulizer. The school nurse shall maintain a current list of those individuals who have successfully completed the asthma training program.
V. "Health care practitioner" means a person who is licensed to prescribe, administer, or distribute controlled drugs.
VI. "Provide" means to supply a bronchodilator to an individual.
VII. "School" means any public or private elementary, middle, junior high, or senior high school.
VIII. "School nurse" means a registered nurse (RN) licensed by the New Hampshire board of nursing employed by a school district or a school.
IX. "Self-administration" means a student or other person's discretionary use of a bronchodilator, spacer, or nebulizer, whether provided by the student or by a school nurse or designated school personnel pursuant to this subdivision.

Source. 2016, 45:1, eff. July 2, 2016.

Section 200:54

    200:54 Supply of Bronchodilators, Spacers, or Nebulizers. –
I. A school board may authorize a school nurse who is employed by the school district and for whom the board is responsible to maintain a supply of asthma-related rescue medications at the school. The nurse shall determine the quantity of medication the school should maintain.
II. To obtain asthma rescue medications for a school district, a health care practitioner may prescribe bronchodilators, spacers, or nebulizers in the name of a school district for use in asthma emergency situations.
III. A pharmacist may dispense bronchodilators, spacers, or nebulizers pursuant to a prescription issued in the name of a school. A school, under the direction of the school nurse, may maintain a supply of bronchodilators, spacers, or nebulizers for use in accordance with this subdivision.
IV. A school may enter into an agreement with a manufacturer of bronchodilators, spacers, or nebulizers, third-party suppliers of bronchodilators, spacers, or nebulizers, or health care offices to obtain bronchodilators, spacers, or nebulizers at no charge or at fair-market prices or at reduced prices. A school district may accept gifts, grants or donations from foundations, organizations, or private parties to purchase bronchodilators, spacers, or nebulizers.
V. A school that possesses and makes available a supply of bronchodilators, spacers, or nebulizers pursuant to this subdivision shall maintain an annual report summarizing the use of the bronchodilators, spacers, or nebulizers.

Source. 2016, 45:1, eff. July 2, 2016.

Section 200:55

    200:55 Administration of Bronchodilator, Spacer, or Nebulizer. –
I. A school nurse and designated unlicensed assistive personnel may administer or make available to self-administer a bronchodilator, spacer, or nebulizer to a student who has been diagnosed with asthma for use in emergency or other situations as determined by the school nurse provided that:
(a) The school has on file an asthma action plan for the student which shall be filed annually and updated as necessary with the school and includes an order from the student's health care provider to provide the student with an asthma rescue inhaler, including dosage information and permission for the student to use the school's stock in the event of an emergency; and
(b) The student's parent/guardian has provided written permission to the school nurse to administer a bronchodilator, spacer, or nebulizer from the school's supply.
II. The school nurse shall notify the student's parent or legal guardian whenever a bronchodilator, spacer, or nebulizer from the emergency stockpile is administered to a student. The school nurse shall make the notification as soon as practicable in accordance with the contact information on file at the school.

Source. 2016, 45:1, eff. July 2, 2016.

Section 200:56

    200:56 Department of Education Guidance Provided to Schools. – No later than 90 days following the effective date of this section, the department of education, in consultation with the New Hampshire School Nurses' Association and the American Lung Association, shall provide guidelines to all schools for the management of students with asthma. The guidelines shall include, but not be limited to, implementation of education and training for designated unlicensed assistive personnel on the management of students with asthma, including training related to the administration of a bronchodilator with a spacer or nebulizer, and procedures for responding to life-threatening respiratory distress.

Source. 2016, 45:1, eff. July 2, 2016.

Section 200:57

    200:57 Immunity. –
I. No school district, school district employee, member of a school board, school nurse, designated unlicensed assistive personnel, or agent or volunteer of a school district shall be liable in a suit for damages as a result of any act or omission related to a student's use of a bronchodilator, spacer, or nebulizer pursuant to this subdivision, except for damages caused by willful or wanton conduct or disregard of the requirements established in this subdivision.
II. The administration of a bronchodilator, spacer, or nebulizer in accordance with this subdivision shall be considered to be the administration of emergency medication in school. If delegated the task of administering a bronchodilator, spacer, or nebulizer by a school nurse, the designated unlicensed assistive personnel shall not require licensure as a health care provider.
III. This section shall not be construed to eliminate, limit, or reduce any other immunity or defense that may be available under state law.

Source. 2016, 45:1, eff. July 2, 2016.

Screening and Intervention for Dyslexia and Related Disorders

Section 200:58

    200:58 Definitions. –
In this subdivision:
I. "Dyslexia" means a specific learning disability that is:
(a) Neurobiological in origin;
(b) Characterized by difficulties with accurate or fluent word recognition and by poor spelling and decoding abilities that typically result from a deficit in the phonological component of language; and
(c) Often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction, and may include secondary consequences such as reading comprehension problems and reduced reading experience that can impede growth of vocabulary and background knowledge.
II. "Potential indicators or risk factors of dyslexia and related disorders" means indicators that include, but shall not be limited to, difficulty in acquiring language skills, inability to comprehend oral or written language, difficulty in rhyming words, difficulty in naming letters, recognizing letters, matching letters to sounds, and blending sounds when speaking and reading words, difficulty recognizing and remembering sight words, consistent transposition of number sequences, letter reversals, inversions, and substitutions, and trouble in replication of content.
III. "Related disorders" include disorders similar to or related to dyslexia, such as a phonological processing disorder, reading fluency disorder, and dysphasia.

Source. 2016, 262:1, eff. Aug. 14, 2016.

Section 200:59

    200:59 Screening and Intervention for Dyslexia and Related Disorders. –
I. School districts shall screen all public school students, including English learners, using the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) or an equivalent cost effective screener for the identification of potential indicators or risk factors of dyslexia and related disorders upon enrollment in public school kindergarten or first grade, and at appropriate times thereafter, to monitor progress. Beginning in 2017, such screening shall be completed no later than November 30 of each school year.
II. The student's school district shall provide age-appropriate, evidence-based, intervention strategies for any student who is identified as having characteristics that are associated with potential indicators or risk factors of dyslexia and related disorders beginning no later than January 1, 2018.
III. The parent or legal guardian of any student who is identified by the public school as having characteristics that are associated with potential indicators or risk factors of dyslexia and related disorders shall be notified and provided with all screening information and findings, in addition to periodic formal screening results based on individual written intervention and support plans developed with the student's parents or legal guardian.
IV. A parent or legal guardian of any student who is identified as having characteristics that are associated with potential indicators or risk factors of dyslexia and related disorders has the right to submit the results of an independent evaluation from a licensed reading or intervention specialist highly trained in dyslexia and related disorders for consideration by the student's school district. A parent or legal guardian who submits an independent evaluation shall assume all fiscal responsibility for that independent evaluation.

Source. 2016, 262:1, eff. Aug. 14, 2016.

Section 200:60

    200:60 Reading Specialist. –
I. The commissioner of the department of education shall issue a request for proposals pursuant to RSA 21-G to secure the contract services of a reading specialist to enable the department to provide school districts with the support and resources necessary to assist students with dyslexia and related disorders and their families. The reading specialist shall be qualified by education and experience in accordance with paragraph II and shall provide technical assistance for dyslexia and related disorders to school districts.
II. The reading specialist shall:
(a) Be trained and certified in best practice interventions and treatment models for dyslexia, with expertise in related disorders, and dysgraphia.
(b) Have a minimum of 3 years of field experience in screening, identifying, and treating dyslexia and related disorders.
(c) Be responsible for the implementation of professional awareness.
(d) Serve as the primary source of information and support for school districts to address the needs of students with dyslexia and related disorders, and dysgraphia.
III. The commissioner shall submit a report assessing the effectiveness of the reading specialist in complying with the requirements of this section, to the speaker of the house of representatives, the senate president, the chairpersons of the house and senate education committees, and the governor no later than November 1, 2018, and annually thereafter.

Source. 2016, 262:1, eff. Aug. 14, 2016. 2017, 156:152, eff. July 1, 2017.

Section 200:61

    200:61 Teacher Professional Development and Training. –
I. No later than June 30, 2017, the reading specialist shall develop and make available a program to ensure all New Hampshire teachers and school administrators have access to materials to support professional awareness of best practices on:
(a) Recognition of the characteristics of dyslexia and related disorders, and dysgraphia.
(b) Evidence-based interventions and accommodations for dyslexia and related disorders, and dysgraphia.
II. The reading specialist and the council for teacher education established in RSA 190 shall collaborate to ensure that all teacher education programs offered at New Hampshire's public institutions of higher education provide explicit professional awareness of best practices on:
(a) Recognition of characteristics of dyslexia and related disorders, and dysgraphia.
(b) Evidence-based interventions and accommodations for dyslexia and related disorders, and dysgraphia.

Source. 2016, 262:1, eff. Aug. 14, 2016.

Section 200:62

    200:62 Dyslexia Resource Guide. – No later than June 30, 2017, the reading specialist shall develop and publish on the department of education's Internet website, a reading support resource guide to be used by school districts as a resource. The reading specialist shall solicit the advice of experts in the fields of dyslexia and related disorders, and dysgraphia in the development of the guide. The reading specialist shall update the guide as necessary.

Source. 2016, 262:1, eff. Aug. 14, 2016.

Head Injury Policies for Students

Section 200:63

    200:63 Head Injuries; Return to Learning Policy and Plan. –
I. The department of education shall collaborate with the Brain Injury Association of New Hampshire to develop a concussion and traumatic brain injury return to learning policy and plan for school districts. The plan shall include a recommendation on school-based concussion and brain injury in-service training.
II. The school board of each school district shall adopt a concussion and traumatic brain injury return to learning policy school education program.

Source. 2020, 38:16, eff. Sept. 27, 2020.