Emergent Situation Gone Wrong. Ideas?

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Hello all! I have been a nurse for 11 years, 8 of which I've spent in Hospice care. This is my 3rd year as a school nurse. Recently my school had my first truly emergent situation in which a student with unremarkable medical history was having seizures outside at lunchtime. It was absolute chaos. I knew what to do for the student. But the other adults around me were panicked and all trying to take control at the same time (Administration was on scene too and was also panicking). Everyone had a radio and they were all talking on it at once so I couldn't talk to the main office who had 911 on the phone. A security guard was standing over me yelling at the student to 'calm down' as student tried to stand (big kid) post seizure and promptly went into another seizure. Student turned blue and stopped breathing. He had a thready pulse. I flipped student onto his back from his left side and opened his airway, ready to begin CPR if necessary, and the act of flipping him rather roughly (adrenaline is an interesting thing....) got him breathing again. Thank heavens for my health assistant, who was marvelous at getting just what I needed such as the AED on standby and a face sheet for EMS. Long story short, student was dehydrated and did not have lunch so blood sugars were in the toilet (not a known diabetic).

Deconstructing the event I see that I needed to take control and failed to do so as I got 'tunnel vision' about the student's immediate needs.

So I'm wondering, do printed protocols work to help avoid this situation in the future? School district does not have them but I figure I could put some together. How do I handle Admin? Would a team of adults to be called out for an emergency be helpful? Any other thoughts?

Thanks!

Specializes in ICU/community health/school nursing.

You did as well as you could with what you had!

Yes to all the above. Meet with your principal to discuss the chatter on the walkies. If the nurse is on scene, any extra bodies on scene should be silent nurse helpers. Also..if it's an intruder or any other kind of emergency....that kind of chatter on the walkies will directly affect the safety of the students and inhibit the response from the outside.

Our district policy requires me to have a medical team - I have a list of coaches who are CPR trained but like others have said, I can't get regular teachers trained during school hours (and they choose not to do so during the summer). But I have designees. Our police officer always calls EMS. My aide always prints up the health form. "Any available AP to the clinic" on the walkie gets them all here and then I have a plethora of folk to call the parent, go stand at the door for EMS, etc.

On the plus side - you are now valuable to them in a way they've not perceived!

Specializes in kids.
"Any available AP to the clinic" on the walkie gets them all here and then I have a plethora of folk to call the parent, go stand at the door for EMS, etc.

On the plus side - you are now valuable to them in a way they've not perceived!

Oh yes, when I say I need help and an adminstrator, they all come running, because they know I need a hand with something big!

Apparently I have two allnurses accounts....oops. Anyway Thanks for all your help! I did talk to security and let them know that screaming security officers are less than helpful during emergencies. :) I am emailing everyone involved to debrief them. We're in the throes of testing right now and there is no way we can all meet.

Thanks!

Specializes in School Nursing, Hospice,Med-Surg.

I've been attempting the First Responder team all 3 years that I've been here. Every August when I look for a first responder on each floor of the campus, faculty and staff suddenly develops this unique skill of blending into the walls.

Specializes in School Nursing.

Wow! Our school is not organized at ALL. I really try my best to keep everything in order in case of emergencies, but honestly it's the coaches/teachers who panic and call 911, before I have even had to chance to check anything out. 911 should only be used for life-threating emergencies, not because a kid has a "COUGH" or looks pale :sniff:. The RN has told me she is only paid to train glucose/Epi-pen to staff who volunteer and that's all she wants to do. Admin is new this year, and feels everything runs great.

Specializes in Psych, Addictions, SOL (Student of Life).
Reminds me of a similar situation in a psych facility, we had a psych pt with the same issues but it was a known SZ D/O and we had to call 911 but it was complete chaos because it was a bunch of psych nurses not knowing how to handle a medical emergency.

Why is it that everyone assumes Psych nurses don't know how to handle a medical emergency? The Nurses at our facility are pretty good at this stuff but we do drill on it and have code teams in place etc...

Just saying

Hppy

Specializes in ED.

Yep. When I was teaching EMS, we would routinely have local companies that have security guards--send their people to us for the 3 month EMT training.

What shocks me is that for some bizarre reason, the Boards of Nursing seem to think being a CNA is somehow more useful than being an EMT. I have pushed very hard to convince my unit that a requisite for working on any medical unit is that they have to take a three month EMT course.

Seriously. First responders know much more than just CPR. They know about scene safety (clearing the crowd), crowd control, emergency management, etc. I love my CNAs, but when I changed jobs to another ED and they told me that they got rid of all of their CNAs and replaced them with.....PARAMEDICS....I almost kissed the interviewing RN Mgr's feet. My medics can start my lines, give meds, cath, and do ACLS far better than 90% of RNs---and they aren't above transporting, changing over a room or cleaning up vomit. They're the bomb. The difference between having an NA and a medic as a team member is like night and day. Stuff gets done, and I feel safe knowing that if my pt crumps while I'm off doing something else, these guys aren't gonna stand around and wonder what to do.

Having a medic on staff at schools, in psych units, etc....FAR MORE USEFUL than having a CNA that can sit with a pt and do q2 checks. Imagine if OP had just ONE trained first responder to help instead of a panicked crowd. This could have ended very, very badly.

In the moment, I agree with the post about verbal commands and "taking charge"....but moving forward, could you possibly hold a staff meeting to discuss this situation and how you'd like it handled in the future if it (or something similar) occurs again?

Do you have a good relationship with your admin? If so, I'd suggest a sit-down with them where you thank them for the involvement, but explain how chaotic things were and how this could have compromised the patient outcome. As several other posters suggested, as the nurse you should be the "point of care" in a medical emergency. We get that, but other professionals do not. You could put together a presentation for the next staff meeting where you explain how you need space and calm for a student in an emergency. Other staff should wait to be assigned a task from you as they arrive on the scene. I recently had something similar happen at work, and the security stood over the person, gawking as others gathered. I had to tell him 3 times to BACK UP I need SPACE!

Why is it that everyone assumes Psych nurses don't know how to handle a medical emergency? The Nurses at our facility are pretty good at this stuff but we do drill on it and have code teams in place etc...

Just saying

Hppy

Assuming Psych knows nothing medical is just par for the course. Nurses eating their young, their old, their Psychs, and all that. LOL (sort of)

Having a trained first responder is a fabulous idea! Of course, the schools don't want to pay for it, however.....Yes, an EMT would have been GREAT to have around and I agree, this could have ended very badly.

Specializes in school nursing, ortho, trauma.

on spring break this week but peeked in this week and caught this post - yes - have definitely been there and it's hard to break from the student to delegate to say You - get the students out of here, you go wait for ems, you just get the hell out of my way - but I have also found that if I empower a fer people - admins or guidance or such - they get into my groove and we tend to run like a well oiled machine. If i have an ems worthy issue going on in my office, the GC stands outside my office like a bouncer to turn kids away.

I second the idea of having a debriefing. Having a written protocol may be helpful, but don't expect people to have it on them or remember it in the heat of the moment. The look to you to be the cool headed one. That's why we make the big bucks!! ha ha

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