"Are you being silly?" a school counselor at South Philadelphia's Andrew Jackson Elementary asked 7-year old Sebastian Gerena on May 23.Philly.com reports that the first-grader, who had been en route to the bathroom with a school aid, was walking down the hall with the aid and a counselor when he sat down on the floor and began making bird call noises before passing out.  

Gerena did not respond, indicating to the counselor that the situation was far more grave than she initially presumed. Immediately, she called 911 and, within seven minutes, an ambulance was there to take Gerena, his 7th grade brother, a teacher, and the counselor to the hospital.  

It was 2:30 p.m. when the counselor dialed for help. By 4:30 p.m., Gerena was dead.  

In the aftermath of the tragedy, the school, parents, and 18 doctors at Children's Hospital of Philadelphia are attempting to grapple with what happened — especially since doctors were initially unsure of what led to the seemingly healthy child's death. While they later concluded the cause was a congenital heart defect, the momentarily mysterious death raised several other questions. Namely, the public began to question the implications of Gerena's death — since he initially fell ill at school — and whether or not a school nurse have been able to prevent the event.  

Andrew Jackson Elementary, a school within the fiscally strained Philadelphia School District, only has a school nurse on campus every Thursday and every other Friday.  The principal Lisa Ciaranca-Kaplan told the Philadelphia Daily News that a nurse would not have "changed the outcome” — but not every is convinced.  

This is not the first death the district has seen in the past year. In September, a 6th grade student died after having an asthma attack at school. No nurse was present there, either. 

Philadelphia schools, which have seen a 40% reduction in school nurses over the course of the past two years, are not alone when it comes to a lack of school nurses.Currently in the U.S., 45% of K-12 schools have full-time nurses, 30% have a part-time nurse like Jackson Elementary did, and 25% have no nurse at all.  

While demand for school nurses may be growing — especially with the rise of diabetes, anaphylactic food allergies, seizure disorders, asthma, obesity, and mental health issues — tight budgets typically result in nurses being some of the first to go.  

Running counter to monetary shortage claims is a recent study in the Journal of American Medicine Association Pediatrics that contends nurses actually cut schools' costs. According to the study, for every dollar spent on school nurses, $2.20 is saved in medical costs and lost productivity from teachers and parents.  

The study monitored 933 school nurses in the 2009-2010 school year and found that while the total cost of the nurses was $79 million, schools would have spent over $150 million without the nurses — including $129.1 million in teacher productivity losses.

This productivity loss is exactly what was seen at Jackson Elementary, where the entire school went on lockdown after Gerena lost consciousness. While the district's superintendent, William R. Hite Jr,. has commended the school for following protocol — dialing 911, placing the school on lockdown, and having a volunteer, who also happened to be a certified nurse, at the school giving Gerena CPR — others are skeptical. As one nurse in the district told the Philadelphia Inquirer, "That's no plan. That's just dumb luck."  

This story is part of our newly expanding K12 coverage.  If you would like to subscribe to the Education Dive: K12 newsletter, click here. You may also want to read Education Dive's look at 8 learning management system options for K-12 classrooms.