Emergency Calls- How long do we wait?

Specialties School

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We had this child with respiratory problems, and could not breathe. Under protocol, we call parents first and let them know what's going on. Mom didn't answer, so I called grandma. Grandma came, and she could see the kid could not breathe. We finally got a hold of mom, but she would not be here for more than 45 minutes. It was past 30 minutes since the child came to my clinic and I felt it was necessary to call 911, because she was still having difficulty breathing, I had her on the nebulizer and she could not speak to me. I kept urging the grandmother that we need to call 911, because she can't breathe, but she kept insisting to wait for mom and that it's just asthma and because she has this (And she smells like cigarettes) she knows what's up, and to wait.

The principal and I had enough after an hour of this child not able to breathe and we called 911, the grandmother was pissed, but I was so mad, I didn't hold back. I explained to the grandmother, in the most civilized way that her granddaughter is having difficulty breathing, her mother is not here. You are not her guardian, you have no custody of this child. As of right now, she's under my responsibility and I would rather call 911 to make sure she's okay than wait for her mother. I know it's insurance issues, but please cooperate with us. Right when 911 came, mom came. Grabbed daughter and left, didn't need 911 help. Which is fine because the parent was there, but I told my principal we need to make a protocol that if this happens again, and parent is far from child, we need to call 911 after x minutes, because this took too long.

The child is fine, she was diagnosed with asthma and needs an inhaler, so that's established, but I was worried, what if it was worse? And that time frame could of harmed her. My question, how long should we wait? I would say 15 minutes at least if it's an emergency.

Absolutely you did right by calling 911. In fact, if it had been me I would have called first, then dealt with fallout from granny, parents, etc. Our district has a call 911 first policy, THEN contact parent. I've had parents really mad a me for calling an ambulance, but my license is too important to worry about a parental hissy fit.

Specializes in PICU.

OP, your gut instinct was right. Just call 911.

I will share my horror stories. I'm in PICU. 100% of the kids I've had come in that were "found down" asthmatics did not survive. Once that airway shuts its hard to get them back in the field. All of them had CPR in the field. One coded in the back of her parents car as they drove around looking for a fire station. Every single family said "I didn't think they could die from asthma." They were all very haunting situations. í ½í¸ž

Specializes in ICU; Telephone Triage Nurse.

Oh, dear Lord. God bless you and all school nurses. I would think your judgement trumps family members who may be thinking in terms of dollars & cents, and not what may be best for their little one based upon their own limited medical knowledge. The internet makes everyone a doctor these days.

You did the right thing, and I totally agree there should be a protocol in place in case something like this happens in the future. Ultimately it is your decision as the only employed healthcare professional there - not the principal, not the parent, etc. You do not want a child rapidly deteriorate or, god forbid, die on your watch, under your care.

I would not give two craps if the parent or grandmother was angry - when the guardian is not present, you're in charge. I wonder if something could be stated and acknowledged when the parent signs their kid up for school that it is your discretion whether or not their kid needs to be transferred to the ER, and if the situation arises you will do that and then notify the parent. The parent can insist the kid doesn't need the ER but again, I think that's your call ultimately, not theirs.

You have excellent judgment and they hired you for a reason. :)

she kept insisting to wait for mom and that it's just asthma and because she has this (And she smells like cigarettes) she knows what's up, and to wait.

An adult's airway is NOT the same as a child's airway - a child's airway is VERY reactive and can close up so quickly and so tightly. A blue kid has got to be one of the scariest things I have ever seen as a nurse.

Specializes in School Nursing.

I had 1 recent situation where an asthmatic child did not have her inhaler. I did not chance it. OOOH, was the mother upset but, maybe that mother will 1) Make sure she send an extra inhaler to school. I'm in a high school and students are allowed to self carry but unfortunately too many are not responsible enough to always make sure they have their inhaler on them at all times.

Even after this incident the mother still has not brought an extra inhaler. Frustrating very frustrating.

I ended up calling child services after waiting 4 months for a second inhaler. The mom was mad, but she was also warned it could happen. Today, she came in and took our inhaler. If it's not returned Monday, I will have to call Child Services again. This child has an asthma attack at least once a week.

Specializes in IMC, school nursing.
I ended up calling child services after waiting 4 months for a second inhaler. The mom was mad, but she was also warned it could happen. Today, she came in and took our inhaler. If it's not returned Monday, I will have to call Child Services again. This child has an asthma attack at least once a week.

:banghead::no:

Specializes in Pediatrics Retired.
If it's not returned Monday, I will have to call Child Services again. This child has an asthma attack at least once a week.

And...if she is having this much trouble, you might add, she either doesn't have an asthma control plan, there isn't compliance with the asthma control plan, or the plan needs to be revised. I suspect, in this case there isn't compliance with the control plan.

As U.S. Army Children, Youth, and School Services (CYSS) nurse our policy is to always call 911 before calling the parent for just this reason.

Specializes in Cardiology, School Nursing, General.

As of now, I still haven't received a medical form to have the inhaler here, and I already explained that to mother and child. Hopefully it's only PRN, but I wasn't told anything yet. I'm going to call mother to ask her about it, because I am concerned.

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