Emergency Calls- How long do we wait?

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Specializes in Cardiology, School Nursing, General.

We had this child with respiratory problems, and could not breathe. Under protocol, we call parents first and let them know what's going on. Mom didn't answer, so I called grandma. Grandma came, and she could see the kid could not breathe. We finally got a hold of mom, but she would not be here for more than 45 minutes. It was past 30 minutes since the child came to my clinic and I felt it was necessary to call 911, because she was still having difficulty breathing, I had her on the nebulizer and she could not speak to me. I kept urging the grandmother that we need to call 911, because she can't breathe, but she kept insisting to wait for mom and that it's just asthma and because she has this (And she smells like cigarettes) she knows what's up, and to wait.

The principal and I had enough after an hour of this child not able to breathe and we called 911, the grandmother was pissed, but I was so mad, I didn't hold back. I explained to the grandmother, in the most civilized way that her granddaughter is having difficulty breathing, her mother is not here. You are not her guardian, you have no custody of this child. As of right now, she's under my responsibility and I would rather call 911 to make sure she's okay than wait for her mother. I know it's insurance issues, but please cooperate with us. Right when 911 came, mom came. Grabbed daughter and left, didn't need 911 help. Which is fine because the parent was there, but I told my principal we need to make a protocol that if this happens again, and parent is far from child, we need to call 911 after x minutes, because this took too long.

The child is fine, she was diagnosed with asthma and needs an inhaler, so that's established, but I was worried, what if it was worse? And that time frame could of harmed her. My question, how long should we wait? I would say 15 minutes at least if it's an emergency.

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Specializes in IMC, school nursing.

Four minutes, that's what you have once a person goes into respiratory arrest. Ventilations and intubation are marginally effective for asthmatics in full bronchospasm, they can die in the ER. That being said, parents are going to be far more forgiving of a death in the ER than an unavoidable death outside the hospital. Inability to talk is 911 immediately.

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Specializes in school nursing.

If a child is not yet diagnosed with asthma or I have no Drs orders/inhaler, I'm calling 911 right away and then calling the parents. I'd much rather deal with an upset parent who wasn't called first than any of the other circumstances that could come from waiting too long to call. For a child that can't speak full sentences without being out of breath (which is what it sounds like from your story) they need help ASAP, and no matter where Mom or Dad is I'm sure an ambulance can get there sooner. I will not apologize for ensuring one of my students is breathing.

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Specializes in School nursing.

Heck, if I have a diagnosed asthma student with respiratory distress to the point where they cannot speak AND has had no response from their inhaler AND neb? AND mom is 30+ minutes away? Oh, I'm calling 911. Actually I would be calling 911 first, then I'm calling Mom to tell her to meet the ambulance at the hospital instead.

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If a child is not yet diagnosed with asthma or I have no Drs orders/inhaler, I'm calling 911 right away and then calling the parents. I'd much rather deal with an upset parent who wasn't called first than any of the other circumstances that could come from waiting too long to call. For a child that can't speak full sentences without being out of breath (which is what it sounds like from your story) they need help ASAP, and no matter where Mom or Dad is I'm sure an ambulance can get there sooner. I will not apologize for ensuring one of my students is breathing.

THIS!!!!

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Specializes in Cardiology, School Nursing, General.

I think the same way, but stupid grandmother was like "Insurance this, insurance that." And would keep calling some random person and talking bad about me in front of me and I'm like, really? What I say, goes. So I'm thinking that I'm going to say this to the next safety committee meeting that I don't care what family says, if the child is having an emergency, I will call 911 then call parents.

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Specializes in IMC, school nursing.
I think the same way, but stupid grandmother was like "Insurance this, insurance that." And would keep calling some random person and talking bad about me in front of me and I'm like, really? What I say, goes. So I'm thinking that I'm going to say this to the next safety committee meeting that I don't care what family says, if the child is having an emergency, I will call 911 then call parents.

If they want to go down the $ road, a funeral costs WAY more than an ER deductible.

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Specializes in School nursing.
If they want to go down the $ road, a funeral costs WAY more than an ER deductible.

Not to mention, this may, unfortunately, be the parent that will sue the school if something goes wrong because you did not call 911, despite the parent telling you not to...

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In the few years I have done school nursing I have called for an ambulance 4x now. That is 4x too many to me of course. However, I will not procrastinate. I think about what I would want if it was my child. I would want absolutely the best for my child. Respiratory issues especially is nothing to play with not at all. I have had issues where a couple times it was panic attacks and the parents was beyond upset with me but, I don't care. These kids look to be in respiratory distress, and I'm not taking any chances. I call immediately especially since I do not have a pulse ox despite my frequent requests for one.

I had 1 recent situation where an asthmatic child did not have her inhaler. I did not chance it. OOOH, was the mother upset but, maybe that mother will 1) Make sure she send an extra inhaler to school. I'm in a high school and students are allowed to self carry but unfortunately too many are not responsible enough to always make sure they have their inhaler on them at all times.

Even after this incident the mother still has not brought an extra inhaler. Frustrating very frustrating.

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Specializes in Telemetry, Gastroenterology, School Nrs.

If the child is in distress and I unable to contact parent/guardian, I'm calling 911 immediately, no question, no waiting. Having very limited resources in the school setting, I want help as soon as I can get it!

It's better to have EMS there and then the parent can refuse transport once they arrive at the school if they don't feel it is necessary.

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Specializes in school nursing, ortho, trauma.

I agree with all of my esteemed e-colleagues. If the child is not improving, can't speak with neb tx's and inhalers to beat the band, i really don't care about the insurance woes. I'm going to make the call to ems. If you as the student's "guardian" (if you will) decide to sign off on the AMA slip once EMS gets there then that is between you and them, but I can document that i've done my due diligence and have done everything within my power with the best interests of the student in mind.

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Specializes in Pediatrics Retired.

You did the right thing. You can set up a protocol with "signs" of respiratory distress and triggers to call 911 but don't attach a "time to wait" to it. Good job.

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