called 911

[basketball13]

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?

[kidzcare]

It is infinitely better to call 911 and not need them then to not call and wish you had.

I think you made the right call. You do not have oxygen on hand. I'm surprised that the other staff did not call 911 while this student struggled to breathe for 20 minutes. A nurse is not magic and anyone can call EMS.

[WineRN]

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...

Perfectly stated.

[Ben_Dover]

If places, for instance a SNF, can call 911, you should be able too, if the need arises!

If you happen not to be in the school premises, it might be a great idea to educate the principal and the rest of the staff as to when it's appropriate to call for an immediate assistance, such as 911.

You did the right thing! If I was the parent of that child, I'd be really appreciative of your action and forever grateful:up:

[ruby_jane, BSN, RN]

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.

Giving epi for an exacerbation of asthma *may* be ok...depending on the variables and the doctor's orders. But that wouldn't be my go-to first. I would want to see the kiddo first - is s/he hunched over, positioning for comfort, lips blue, unable to make 10-word sentences? If yes, I'd call EMS and hope I didn't need Epi along the way but alive student trumps making a decision the BON could judge as "practicing medicine without a license" so I can't say fully what would happen.

Would I delegate Epi in that situation? Nope.

You are doing a great job of preparing yourself and your staff for the next time something like this happens, though.

[OldDude]

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.

No on the Epi... unless it's in your protocol already, that's a MD call for asthma treatment...plus Epi administration is a mandatory trip to the ER.

[JenTheSchoolRN, BSN, RN]

No on the Epi... unless it's in your protocol already, that's a MD call for asthma treatment...plus Epi administration is a mandatory trip to the ER.

Also, read your standing orders for Epi. Most standing orders are for allergic reaction only, not asthma flare-up. Mine are. Now, several of my students with severe allergies also have asthma as there is a connection. But none of them have Epi listed in asthma action plan. Can it help? Sure. I can't say I wouldn't grab it if were a severe asthma kiddo who also has a severe peanut allergy and therefore an Epi-pen. But I think ruby_jane said it best above.

But I'm lucky, EMS response time is fast in the city. I did a 911 call this year for a student with asthma. They had just gotten back from an overnight field trip where inhaler was used more than usual. Student had used inhaler on bus, and again in my office. Wheeze in both lungs easy to auscultate. 02 was 96%, but again compensation at the time. HR in the 120s. I don't have standing orders for a neb or 02. I called 911, called Mom to meet us at the hospital. EMS gave student neb after assessing lungs in my office. Poor kid needed triple back to back nebs in the ED.

[bsyrn, ASN, RN]

I agree with everyone else, you absolutely did the right thing.

[Kooky Korky, BSN, RN]

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.

You did right, but I think you should have told the staff to call 911 immediately to cover yourself and all the bases because you weren't able to see her yourself. Lay people are pretty much not trained to make the decisions nurses make or make them for the reasons nurses do. Being as it involved breathing, I think it would have been safer to just tell them to call 911 and not ask them to watch her until you could get there after a, presumably, hectic 15 minute drive.

This time it turned out OK that you didn't, but you didn't know before the good result that the result would be good and who needs the fear? Make it easy on yourself. No one would fault you for calling 911 if you weren't immediately available to care for the student.

Glad she's OK.

[aprilmoss]

As an ill-equipped RN in a school situation, you can not handle emergent conditions. Calling 911 would have been something I did before getting in my car and hauling ass over there. EMS (at least in our area) has ACLS equipment and training, O2, cardiac monitors, defibrillators, IV, Epi, etc.... None of which I have. They also have the way to transport the child quickly and under supervision to an appropriate care center.

This was pretty much drummed into us in our specialty training. If the condition appears life threatening, call 911, THEN spend your time intervening.

[KelRN215, BSN, RN]

It's always better to call 911 and not need it than to not call 911 when you really needed it.

I never had to call 911 when I worked per diem at the boarding school but did a couple times when I was a visiting nurse. Both times part of the reason I called was because of unreliable parents.

1st was a 6 year old child with neuroblastoma who I was seeing for a daily injection. When I arrived to his house, his Mom called for me to come to the bedroom and I found him severely tachypneic (50s-80s), tachycardic (150s), febrile and covered in hives. Mom had left him like this since the previous night because she knew I was coming in the morning. I had a history with this Mom and I knew she was unreliable so I called 911.

2nd situation was an infant with myelomeningocele and (as of then untreated) hydrocephalus. He had been slowly showing signs of worsening hydrocephalus and had sustained an accidental skull fracture the week prior to this. I went to visit him for a scheduled visit, found that Dad had left him with a neighbor. He had all the signs you would expect to see in an infant with increased intracranial pressure- high pitched cry, fixed downward gaze, bulging fontanelle, increased head circumference, vomiting with every feed. He had been crying for HOURS and the neighbor who was watching him hadn't called anyone. The child's father was not home and not a licensed driver. When I called Neurosurgery, they advised to send him to the ER and there was no one that I could count on to bring him. The neighbor said she couldn't go because of all the other children. The father was not home and not a licensed driver. There was also a complex social history with this family and CPS was involved. There was no way I was going to leave this child in this situation and hope that a reliable adult would at some point arrive to drive them to the hospital, so I called 911. The on-call Neurosurgeon suggested I overreacted. This child ended up admitted to the hospital, shortly thereafter he did require surgical treatment of his hydrocephalus AND the next time I went to visit him, he wasn't home because the state had taken custody of him.

If you ever think you should call 911, you should.

[ruby_jane, BSN, RN]

KelRN215, thank you for sharing that. Those stories are the stuff of my nightmares.

[basketball13]

Thank you all. I am glad I called 911. In the future if something like this happens again and I am far away, I will tell them to call 911. The way the secretary described her condition to me, I was not sure how serious it was. Plus, this school calls me all the time for minor things. One time they called me and said this little girl hurt her knee really bad and needed checked. I drove over to the school, and when I got there she wasn't in the office. They said she was sitting on the bleachers in the gym. I walked in the gym and she was doing jumping jacks and running. The secretary was like "she was crying a lot!" lol. Regardless, better safe than sorry!