called 911

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I am a relatively new school nurse. The other day I got a phone call from one of my elementary schools (while I was at one of the my other schools) that a student was short of breath and struggling to breathe. They stated that she had been running in gym class when it started. No PMH or allergies that we knew of. I asked a few questions and then drove over to that school as fast as I could (about 15 minutes). Her face was bright red, lung sounds were wheezing, very labored breathing, tachypneic, O2 in the low 80s. She'd been like this for about 20 minutes at this point. Principal said she hasdn't gotten any better. Attempted to call mom, but initially could not reach her, so I called 911. While I called 911, the secretary reached the mother and she was on her way as well. EMS got there and put 2L of O2 on her. Within a couple of minutes, the wheezing went away, her O2 went up to the mid 90s, and her breathing became less labored. Mom arrived after the student looked much better from the oxygen. Mom has asthma. We took the O2 off of her and she continued to do fine at this point. EMS talked to the mom and didn't feel that she needed to go to the ER, but encouraged her to follow up with her PCP and get tested for asthma (which I generally agreed with). Mom ended up taking the student home and said she was going to call her PCP.

Of course, since this has happened I've been questioning whether calling 911 was the right thing to do or if I should have held off. The nearest hospital is 45 minutes away. I had absolutely nothing at school that I could give her (we can only stock epi and narcan). What would you have done?

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You did fine. I would have done the same. The only thing I may have done differently was to tell the secretary to go ahead and call 911 since you were not on campus and 15 minutes away.

We now have stock albuterol along with stock epi in our district. Maybe you can check to see if that is a possibility. Having the albuterol on hand has cut down our calls to EMS in situations like this.

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Specializes in Pediatrics Retired.

What you should've done and what could've happened isn't relevant so don't go there. What is relevant is you got help for this girl and she left walking and talking. There is never a time when..."you should not have called 911." No one can predict the future or how conditions will unfold. Another kid snatched from the jaws of death!! Great job!

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You did the right thing! She improved with O2, you do not have O2. As nurses, we seem to think that it has to be something catastrophic to call EMS, but, please keep in mind, EMS gets calls from people that just want help off of the toilet...

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Specializes in ED, School Nurse.

You absolutely did the right thing. She could have decompensated quickly, as kids are prone to do, and I personally do not like to mess around with airway issues in school, as my resources are limited here.

It is never wrong to call EMS and end up not needing them, but boy oh boy, you sure can run into issues if you don't call when they are needed. I'd rather err on the side of caution every time.

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You did fine. I would have done the same. The only thing I may have done differently was to tell the secretary to go ahead and call 911 since you were not on campus and 15 minutes away.

We now have stock albuterol along with stock epi in our district. Maybe you can check to see if that is a possibility. Having the albuterol on hand has cut down our calls to EMS in situations like this.

I did at least tell the secretary that if she seems to be getting worse before I got there, not to hesitate to call 911, but I wasn't sure if I should have went ahead and told her to call 911 or not. The bad thing is is that I have no cell service between the two schools. Of course, I did not think of this until I was on the road.

I wish we could stock albuterol, but it's a state law we can only stock epi and narcan. Narcan was just added this year, but our schools don't stock that as of now. Just epi.

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We have O2 tanks at our school- I wish you did too.

Good job!

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Specializes in ICU/community health/school nursing.

You did great! As previously mentioned, you couldn't fix this, but EMS did.

Do you have a written policy when your lay staff would call EMS ahead of you? Because EMS can assess in your absence but a secretary cannot (formally, legally) assess.

Hang in there. Makes me happy to only have one campus.

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Specializes in school nursing, ortho, trauma.

so my rule of thumb is, if i am looking at a child and thinking "should i call EMS?" then I call EMS. I would much rather explain why I called than why i didn't.

You made the right call. The i've had many times that the parents have arrived while ems has been doing their assessment and has signed ama or been told the same as you. It's the right call even if they don't leave in the ambulance.

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I'm shocked with SPO2 in the low 80's that she was bright red and not blue. Yikes!!

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Thank you all! I definitely wish we had portable O2 tanks lol. Do you all think I should have considered giving her epi (and call 911 of course)? I just want to know better for next time.

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Specializes in School nursing.

I would have called 911. I don't have 02 or stock albuterol. And kids are fine until all of sudden they aren't.

I have never regretted a 911 call.

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