Emergent Situation Gone Wrong. Ideas?

  1. Hello all! I have been a nurse for 11 years, 8 of which I've spent in Hospice care. This is my 3rd year as a school nurse. Recently my school had my first truly emergent situation in which a student with unremarkable medical history was having seizures outside at lunchtime. It was absolute chaos. I knew what to do for the student. But the other adults around me were panicked and all trying to take control at the same time (Administration was on scene too and was also panicking). Everyone had a radio and they were all talking on it at once so I couldn't talk to the main office who had 911 on the phone. A security guard was standing over me yelling at the student to 'calm down' as student tried to stand (big kid) post seizure and promptly went into another seizure. Student turned blue and stopped breathing. He had a thready pulse. I flipped student onto his back from his left side and opened his airway, ready to begin CPR if necessary, and the act of flipping him rather roughly (adrenaline is an interesting thing....) got him breathing again. Thank heavens for my health assistant, who was marvelous at getting just what I needed such as the AED on standby and a face sheet for EMS. Long story short, student was dehydrated and did not have lunch so blood sugars were in the toilet (not a known diabetic).

    Deconstructing the event I see that I needed to take control and failed to do so as I got 'tunnel vision' about the student's immediate needs.

    So I'm wondering, do printed protocols work to help avoid this situation in the future? School district does not have them but I figure I could put some together. How do I handle Admin? Would a team of adults to be called out for an emergency be helpful? Any other thoughts?

    Thanks!
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  2. 47 Comments

  3. by   Nurse_JackieVA
    Reminds me of a similar situation in a psych facility, we had a psych pt with the same issues but it was a known SZ D/O and we had to call 911 but it was complete chaos because it was a bunch of psych nurses not knowing how to handle a medical emergency.

    I do like your idea of having a "code" team to handle emergent situations and to keep the environment calm/secure as much as possible though in that situation - outside with everyone all hyped up would have been hard.

    I'd go to the Admin and tell them your concerns and a team needs to be formed so situations like this can be handled quickly and safely. When medical emergencies happen there needs to be a black out on the radios or limited chatter so you have direct access to the main office until EMS arrives.

    Just a few ideas being thrown out. Good luck with your new team!
  4. by   bluebonnetrn
    Yikes!
    Sorry that happened but we all know that is exactly the big WHAT IF and the main reason we are all here. (Even though we all really know it's about mounds of paperwork )
    I think you having tunnel vision on the student is EXACTLY HOW IT SHOULD BE. Good job school nurse!
    I am so glad you have a strong clinic assistant. I do too and it is such a blessing.
    I definitely think a written plan as well as a meeting with all the other adults about how it should happen versus how it actually happened would be perfect.
    I have had the same issue with admin and other adults acting in the most unhelpful ways during an emergency. I have tried to go over the fact that in an emergency they should each have a defined role and that I DO NOT HAVE TIME to give them step by step directions or answer each and every one of their questions. Why would hypoglycemia lead to seizures is a fantastic question but let's cover it later shall we?
    So far, my instructions have fallen on deaf ears. I get that they aren't medical people and don't know how to stay calm, cool and collected through a really scary situation but still....
    Good luck. I hope you can make some progress.
  5. by   NutmeggeRN
    Ugh...too many chiefs, not enough Indians. Pre printed stuff is great until no one can find it.

    I would have a conference with admin and then share with teachers WHAT TO DO, using the information from this situation, as an example.

    Sometimes you need to just yell "Stop! Let me tacke care of this!"

    Do what you need to stabilize the child first, while pointing to people and say:

    You- call 911 (keeping them near you so you can get on speaker phone if necessary)
    You- Get the AED
    You- send someone to meet the ambulance (admin already knows their role here)
    You- clear the area (of "lookie loos", or other students/teachers) (teachers know their role here)
    You- get their biographical info ready for trhe ambulance (admin assistant knows her role here)

    Admin will then call the parent if I am not able to and will also call for a stay in place as well as notifying any siblings who may be in the building.
  6. by   NutmeggeRN
    Quote from bluebonnetrn
    Yikes!
    Sorry that happened but we all know that is exactly the big WHAT IF and the main reason we are all here. (Even though we all really know it's about mounds of paperwork )
    I think you having tunnel vision on the student is EXACTLY HOW IT SHOULD BE. Good job school nurse!

    I get that they aren't medical people and don't know how to stay calm, cool and collected through a really scary situation but still....
    Good luck. I hope you can make some progress.
    That's why they have us !!!
  7. by   KidsRNstill
    We have a First Responder Team at our school--a group of interested staff members who are CPR certified and are the only ones to respond if an emergency is called. We rehearse an emergency response at least once or twice a year, varying the location and the type of emergency (we even do a rehearsal on the playground). They all know the steps as first on the scene, second on the scene, etc, and one of the jobs of the last ones there is crowd control.

    It worked like a charm recently when we had a similar incident.
  8. by   bluebonnetrn
    Quote from KidsRNstill
    We have a First Responder Team at our school--a group of interested staff members who are CPR certified and are the only ones to respond if an emergency is called.
    I tried to get that going at my school and nobody was interested....
  9. by   Farawyn
    Quote from KidsRNstill
    We have a First Responder Team at our school--a group of interested staff members who are CPR certified and are the only ones to respond if an emergency is called. We rehearse an emergency response at least once or twice a year, varying the location and the type of emergency (we even do a rehearsal on the playground). They all know the steps as first on the scene, second on the scene, etc, and one of the jobs of the last ones there is crowd control.

    It worked like a charm recently when we had a similar incident.
    STEALING!!!

    This is a great idea.
  10. by   KidsRNstill
    Quote from bluebonnetrn
    I tried to get that going at my school and nobody was interested....
    I think that bringing in some CPR instructors who teach for free might have helped some folks volunteer ( I even became an AHA instructor in order to help train people). It also helps that our area has a large children's teaching hospital that has a Heart Saver program that offers to come into schools and train them to be Heart Safe--all at no cost.

    But I work with a wonderful staff and Admin Team (all of whom are on the First Responder Team)!
  11. by   kidzcare
    Quote from NutmeggeRN
    Sometimes you need to just yell "Stop! Let me tacke care of this!"

    Do what you need to stabilize the child first, while pointing to people and say:

    You- call 911 (keeping them near you so you can get on speaker phone if necessary)
    You- Get the AED
    You- send someone to meet the ambulance (admin already knows their role here)
    You- clear the area (of "lookie loos", or other students/teachers) (teachers know their role here)
    You- get their biographical info ready for trhe ambulance (admin assistant knows her role here)

    Admin will then call the parent if I am not able to and will also call for a stay in place as well as notifying any siblings who may be in the building.
    This. Exactly this. Take charge and take care of the patient.

    You did what you needed to do to get this student safe and to the right place. Once others see that you have taken charge and are now the leader, they will fall in line. If they do not, I would say it's fine (in the hectic moment) to tell them to back off and sort out hurt feelings later.
  12. by   GdBSN
    If you go to www.heart.org/cerp, you will find information about developing an Cardiac Emergency Response Team. I took this information and developed a plan for my school, assigning certain individuals specific jobs (calls 911, assists with care, crowd control, print face sheet, contact parents, etc).
  13. by   MrNurse(x2)
    It may help to do a post incident follow up with those there, today if possible. Acknowledge everyone's feelings and position and thank them for their contribution. Acknowledge the good outcome, but let them know things weren't as smooth as they could have been and then lay it out that you are in charge in those instances. During the debriefing, point out that you would not be involved in a discipline issue or a grading situation, so it is OK that they aren't competent in that situation. Point out that radio silence should be maintained during this time unless directed by you. Hope you are able to make a great outcome for the future.
  14. by   ruby_jane
    You did as well as you could with what you had!

    Yes to all the above. Meet with your principal to discuss the chatter on the walkies. If the nurse is on scene, any extra bodies on scene should be silent nurse helpers. Also..if it's an intruder or any other kind of emergency....that kind of chatter on the walkies will directly affect the safety of the students and inhibit the response from the outside.

    Our district policy requires me to have a medical team - I have a list of coaches who are CPR trained but like others have said, I can't get regular teachers trained during school hours (and they choose not to do so during the summer). But I have designees. Our police officer always calls EMS. My aide always prints up the health form. "Any available AP to the clinic" on the walkie gets them all here and then I have a plethora of folk to call the parent, go stand at the door for EMS, etc.

    On the plus side - you are now valuable to them in a way they've not perceived!

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