Broken leg/Ambulance

[peaceful2100, BSN, RN]

A kid may have possibly broken his leg at school yesterday. I called the parents immediately to tell them my concerns and he needs to be taken to the ER for further evaluation.

The grandma came to get him as she was closer and parents was going to meet her at the ER.

This never happened to me before..of course it was during the absolute worse time of day...recess and my office is absolutely chaotic during that time, and plus dealing with all the sick kiddos right now...

I questioned myself and wondered if I should have had an ambulance come and transport him instead???

Do you call an ambulance for possible broken legs??

[Wuzzie]

What part of the leg and what kind of care did you provide?

[peaceful2100, BSN, RN]

Suspected lower leg by Ankle/or even possibly ankle.

Kid flat out refused for me to touch leg. Place ice pack on leg right by ankle where they pointed, did not want it on leg/ankle.

Assessed for pulse, and warmth.

Kid was in pain, but not to the point of yelling or screaming.

[Wuzzie]

I'm not a school nurse so there's that but having a family member transport wasn't unreasonable. In one of my side jobs I dealt with these kind of injuries fairly frequently. We would use cardboard splints to immobilize. Like this.

I would call the parents and give them the choice of how to transport. Private vehicle, bus or ambulance. It sounds like that's what you did and I think you did fine. Situations where I feel an ambulance is necessary include:

• open fractures
• long bone (humeral or femur)
• abnormal PMS
• severe pain
• dislocations
• MOI that is suspicious for internal injuries
• any loc

I'm sure I missed a few. Do you folks take any sort of first aid course? Nursing school really doesn't cover it.

[GdBSN, RN]

No, calling an ambulance was not necessary. If parents are able to transport to the hospital for a non-life threatening injury, then that is the way to go. This also saves the parents the cost of the ambulance ride. You made the right call.

[Flare, ASN, BSN]

When i call to explain the injury, i offer to call ems at the time for an injury such as that. if the parent wishes for an ems transport then yes, of course, i am more than happy to make that call. Often once the parent gets to my office, they realize that putting their child into their car is going to cause a huge issue and i again offer ems, especially in the case of a suspected leg injury as you described.

If a parent can't get to their child in a reasonable amount of time, i would also probably opt for ems.

[OldDude]

I would not have called EMS.

[jeckrn, BSN, RN]

Nothing wrong with grandparents transporting the patient. The EMS system is over worked because of patients that can be transported via POV instead of a ambulance.

[Csn2016, BSN]

I definitely would not have even thought of calling EMS for a possible break like that. An open fracture on the other hand absolutely

[lifelearningrn, BSN, RN]

Since parents pay for the ambulance ride, they get to choose!

[guest83140]

My protocol book says,

Call EMS, 911 if "1. the limb is deformed or bent in any unusual way 2. the skin is broken over the possible fracture site or 3. the bone is sticking through skin. (leave them in that position with it covered until help arrives." Otherwise, I would call the parent to have them get him to have it checked out.

[KelRN215, BSN, RN]

peaceful2100 said:

Suspected lower leg by Ankle/or even possibly ankle.

Kid flat out refused for me to touch leg. Place ice pack on leg right by ankle where they pointed, did not want it on leg/ankle.

Assessed for pulse, and warmth.

Kid was in pain, but not to the point of yelling or screaming.

If the kid was home, parents would presumably drive him to the ER or even the pediatrician's office for this kind of injury. Unless the bone is sticking out of the skin, I see no need for EMS. And, as someone else pointed out, ambulance rides are expensive so it may have actually been the parents' preference to transport the child in their private vehicle. Many insurances have high deductibles/coinsurances these days and they may appreciate saving the cost of an unnecessary ambulance.

I never called 911 when I worked in the school and only did it twice when I was a visiting nurse- once was a kid whose mother had let him spend the night tachypneic and breaking out in hives because she knew I was coming the next morning, the other time for a baby with untreated hydrocephalus who was starting to show signs of increased ICP (bulging fontanelle, no upgaze, high pitched cry, vomiting) who could have been transported in a car if there were any reliable adult to bring him. He was with a neighbor who let him vomit and cry all day and the Dad told me he didn't have a license when I called him and told him he needed to come home to bring the baby to the ER. The only reason I called 911 in that case was because of the social situation- I couldn't leave and hope that a licensed driver would show up and bring the baby to the ER when they'd left him in not good condition all day. He also had an open case with CPS and, though he didn't need emergency surgery that day, he soon did have surgery for his hydrocephalus and the next time I went to visit him he wasn't there because CPS had taken custody of him.

It sounds like this family had their act together and responded appropriately. I think you did the right thing.