To the RESCUE: program fidelity and experiences of an Illinois stock inhaler program

The Resources for Schools Encountering Unexpected Asthma Emergencies-Illinois (RESCUE-IL) program-which provides stock inhalers, materials, and training-expanded to all Illinois public schools in its second year. A survey evaluated fidelity to emergency protocols and implementation experiences over the 2024-2025 school year as part of a larger program evaluation.

The 69-item survey was available to school staff (e.g. nurses, administrators, others) registered in the RESCUE-IL portal over February-March 2025. Questions were either respondent-specific (33 questions) or school-specific for up to three schools (12 questions per school).

A total of 327 respondents representing 483 schools completed the survey (response rate = 20.6%). Nearly all (96.3%) reported satisfaction with RESCUE-IL over the second implementation year. While 93.9% felt the emergency protocol was effective, fewer were comfortable with the protocol-directed four puffs for mild-moderate distress (61.2%) or with eight puffs for severe distress (49.2%). Most (96.0%) preferred to start with two puffs and give more if necessary. Additionally, 76.2% of respondents preferred to follow a student's Asthma Action Plan (AAP) when available over the provided emergency protocol, contrary to RESCUE rules. Furthermore, 40.9% of schools who had used a stock inhaler and 23.7% of schools who had not (p = 0.05) expressed concerns about student overreliance on stock inhalers.

Respondents were satisfied with the program overall but had low comfort with dosages over two puffs outlined in the RESCUE-IL protocol, likely due to discrepancies with student AAPs, requiring further individual and group training. Increasing uptake of current AAP recommendations is a priority.