Asthma death in Philly school

[Stitchy's mom]

I was just wondering what everyone thought about the little girl who died from an asthma attack in Philly. The parents are saying that the reason she died was because there wasn't a nurse at her school that day. I guess I'm wondering why the school didn't call 911 if she was having trouble breathing. I've got about 20 -30 kids with asthma at my school and I feel that if there's any doubt (inhaler/neb isn't working, meds aren't at school) I'm just calling 911. I would hope that if I'm not there (sometimes I leave a bit early to get to a class) that our staff would just call 911. The surgeons say "When in doubt, cut it out." I say "When in doubt, ship them out." I would much rather have a parent chew me out because I just cost them X dollars at the ER than to have a child die on me!

[Flare, ASN, BSN]

I think it would really be great if every school had full time certified school nurse. But let's get realistic here. Large cities have bottom line budgets. If they have well defined laws regarding how many school nurses per building (which I don't know PA law off hand nor do i have the energy to search for it right now) they're going to strech those laws to the fullest, expecially in the most (ahem) cash strapped areas in favor of other services.

Is it right? No.. Is it the only medical professional that some of these children have the potential of seeing? You bet your sweet stethoscope. But We all know that the service if offered at all in some schools often gets shared and one person can only be stretched so thin.

That being said. If the student had two complaints during the day of not feeling well, well, obviously the right call was made in calling the parent. The parent did make the choice in not responding to the school to deliver the medication. Would a school nurse have made a different call? Would a school nurse have sent the child via ems? I don't know - i suppose it's a HTBT type thing.

The sticking point -the thing that i can't get over is the 2 hour window after school before any action was taken by the parent AND the blame is still placed on the school. I would place the blame squarely on the school if the child was taken to the ER as soon as the parent made contact. I might even consider a lengthier time if it were a more rural area, but this is Philly. Hospitals are easilly accessable, the EMS system is a phone call away. The parent must have made some sort of determination that the child did not need immediate intervention upon returning home from school, or it would have been sought out immediately. Not 2 hours later.

[Spidey's mom, ADN, BSN, RN]

"Believing the girl too ill to walk home, a school staffer gave her a ride."

This is where the school district may get in trouble. Assuming she was having symptoms (wheezing/cough), if they felt she could not get home safely then IMHO they should have called 911.

Putting a kid in a car is not a good practice. If she was having no symptoms but still not well enough to get home, they needed to insist the parent get her or make an arrangement.

BUT that does not negate the parents responsibility to:

1) notify the school of her condition/diagnosis

2) provide her with a rescue inhaler-along with a parental medication form with the doctors order

3) pick her up

or

4) ask that 911 be called

What a sad day that his first course of action is legal......

I've taken a child to the ER in my car before with an asthma attack and no rescue inhaler (mom refuses to bring one). It was quicker than waiting for an ambulance as they were all out. Yeah, probably a risk but . . .

Last week a child had a seizure which at first went unrecognized as a seizure by teacher. New onset - the teacher thought the student fell asleep. Only outward sign was limp extremities and nystagmus. I happened to be in the building (I'm the nurse for the entire district which has 11 campuses). and was called and Grandmother was called (mom a drug addict). I assessed and took vitals (he was breathing fine) and told grandma he was having a seizure. She refused an ambulance and drove him to the ER but I followed to give an assessment.

I'm in full agreement with Jolie that this is the parent's fault. I won't reiterate all her great points.

Yes, it would be peachy if we could have a nurse in every building but school districts out here on the West Coast just don't have the money. I only work part-time.

Very tragic case.