Emergent Situation Gone Wrong. Ideas?

Gizmo44 · Apr 22, 2017

I think schools need to practice medical emergencies like they do fire drills and tornado drills. and now often active shooter drills. At least for the adults to know how operate. Sounds like you had utter chaos and your instincts kicked in meaning your focus was on the patient. This was more than skinning your knee on the playground and needing to go to the nurses office.

Ellie G · Apr 22, 2017

I would make sure to have a post event evaluation looking at what would have improved the response. It is a scary thing for health care professionals, but especially so for those who have other jobs in the school. It sounds like there wasn't any set role designation in an emergency and that needs to happen so that everyone is responding appropriately. We all know that even in the hospital, emergency situations can get chaotic and that is with trained people. Sounds like you did a great job with what you had available.

CRGRN · Apr 22, 2017

Regardless of how teachers or administrators respond, the nurse is always in charge of the patient.

You saved the day in this instance, but you had unnessesary interference. Carve out what is your domain, per your State School Nursing Certificate or Nurse Practice Act, whatever applies where you practice. Educate staff about your role and how it's implemented in your school. Consult other School Nurses to get ideas and create a comprehensive safety, best practice emergency response plan. But don't settle for the back seat of the bus. You really need to have control over the care of the precious children entrusted to you, and you seem to be competent.

Best wishes.

Hedgehog2325 · Apr 23, 2017

Great Job.

But it just like with any new urgent situation that involves adults in multiple disciplines and multiple children, Chaos Is highly possible. I'm an RN and a police officer who has worked as an SRO for years so I see your senecio from a unique position .

First establishing your role as the "primary " in this and similar medical emergencies is vital. "Even if feeling get touched". Patient comes first. Now trust me my police side does tend to take led but medical emergencies need health care first .

Second, all of these other disciplines should instinctively go to their training. (I.E.; teachers and assistants should be assisting in removing children to area away from scene to avoid the panic they experience with fear. Security should be preparing to receive EMS. Admin should be on phone with EMS. Coordinating their arrival and relaying the nurses assessment to medic dispatch in order to insure the proper unit is dispatched. Social workers and counselor need to be with remaining removed students providing care and also with the coordination with admin. , calling parents of the patient child (don't want everyone providing parents with different versions or update intel.)

Third, radio transmissions need to be limited to Nurse - Admin. Tell everyone to "shut up" . In a nicer but firm way. You can apologize later. Patient comes first. Radio clearance is so vital in an emergency Even police habitually talk over one another and need leadership to advise them to "clear the air unless you have an emergency '

yes put together a plan but this needs regular drills like a fire drill.

Great job with deciding to create a action plan for this and similar situations. You are a credit to the profession.

let me know if you need further assistance, if this response helps!

Sergeant Nurse

3ringnursing, BSN · Apr 23, 2017

It sounds like a post event meeting was in order to discuss what went right, and what could have been handled better. I bet that's the very first thing you did when the dust finally settled.

It sounds like everyone wanted to be helpful but didn't know exactly what to do, and in trying to be available to assist got in the way. Human nature, yet not particularly useful to the situation.

Perhaps a drill so everyone knows what is expected of them (i.e., you stand back and stop shouting, you keep the curious children away, you be ready to run and get my emergency bag of X, you take notes with the time, you call EMS, etc.).

Even with what you perceived as "tunnel vision", it sounds like you did very well. All that commotion and noise would get anyone but someone with ability to be a champion concentrator riled up and anxious, but maybe the tunnel vision helped you to pare down all the essentials in this situation. Whatever it was, you rose to the occasion wonderfully. Good job nurse! :nurse:

I think that assigning everyone a job in future will be a comfort too for all the non-medical folks.

I'm glad your student turned out okay when all was said and done.

3ringnursing, BSN · Apr 23, 2017

Great Job.
But it just like with any new urgent situation that involves adults in multiple disciplines and multiple children, Chaos Is highly possible. I'm an RN and a police officer who has worked as an SRO for years so I see your senecio from a unique position .
First establishing your role as the "primary " in this and similar medical emergencies is vital. "Even if feeling get touched". Patient comes first. Now trust me my police side does tend to take led but medical emergencies need health care first .
Second, all of these other disciplines should instinctively go to their training. (I.E.; teachers and assistants should be assisting in removing children to area away from scene to avoid the panic they experience with fear. Security should be preparing to receive EMS. Admin should be on phone with EMS. Coordinating their arrival and relaying the nurses assessment to medic dispatch in order to insure the proper unit is dispatched. Social workers and counselor need to be with remaining removed students providing care and also with the coordination with admin. , calling parents of the patient child (don't want everyone providing parents with different versions or update intel.)
Third, radio transmissions need to be limited to Nurse - Admin. Tell everyone to "shut up" . In a nicer but firm way. You can apologize later. Patient comes first. Radio clearance is so vital in an emergency Even police habitually talk over one another and need leadership to advise them to "clear the air unless you have an emergency '
yes put together a plan but this needs regular drills like a fire drill.
Great job with deciding to create a action plan for this and similar situations. You are a credit to the profession.
let me know if you need further assistance, if this response helps!
Sergeant Nurse

LOVE this!

What a wonderful combination: Sergeant + Nurse = Unique.

3ringnursing, BSN · Apr 23, 2017

"LOL"
Yea. Ummm...No.
We don't do that in this Forum. We are one of the most welcoming and helpful and supportive Forums on AN.
Put the spoon away, please. This pot doesn't need stirring.

Hugs! :cat:

RNGummy40 · Apr 24, 2017

"Hello all! I have been a nurse for 11 years, 8 of which I've spent in Hospice care... 3rd year as a school nurse..emergent situation in which a student...seizures outside at lunchtime...It was absolute chaos...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...all talking on it at once...couldn't talk to the main office who had 911 on the phone...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...turned blue...stopped breathing...thready pulse...flipped student onto his back...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."
From your brief description of the events, I believe you should give yourself a pat on the back for the amazing work you performed. You help saved this kids life and under very stressful and chaotic circumstances. Tunnel vision will happen when you are just focusing on our patients and you know that. Our ability to tune out what is happening around us to do what needs to be done for patient is necessary and you can only help one thing at a time. Great job becoming, "She-Hulk," for your patient!
"So I'm wondering, do printed protocols work to help avoid this situation in the future?"
Yes!!! You need protocols! Protocols protect nurses from litigation and provide concrete directions for medical care. Any school has protocols for CODE RED's. Fire drills have to happen so faculty and students can know how to respond to a fire. The same is for Hospitals as you know, and there should most definitely be a protocol for medical emergencies. I have worked in an acute psychiatric facility and hospital med-surg and the protocols protect staff from making errors and provide education to minimize fear and confusion during acute situations.
"School district does not have them but I figure I could put some together.
How do I handle Admin?"
Prepare a proposal, schedule a meeting with the Principle and other administrators (head of Security, Maintenance etc.)
"Would a team of adults to be called out for an emergency be helpful?
Any other thoughts?"
You need to have immediate access to administrators to communicate the situation. Is possible that your department have a separate walkee talkee system for communications? If not, could your use a code, "LIFE SAVER, LIFE SAVER, LIFE SAVER on seen." Your energy should be on taking care of your patient, and your team of colleges should be helping you clear the seen, and making sure you are safe.
Do you have a specific uniform or badge to allow others to identify who you are? EMT's have a uniform and in most hospitals, nurses have badges that clearly show their title. Your policy should identify who is the lead on seen, and if your medical assistant is first then they would be charge till you got on seen.
Yes, a team is always better. On the floor all staff is trained on how to perform BLS, where to get the needed equipment, who brings what to the scene (crash cart, ambu-bage, code bage etc). People are assigned positions, (note taking, airway, chest compressions, help with transferring patient, calling 911, etc).
Know that your school is lucky to have you! Hope your kid is doing better!

JenTheSchoolRN, BSN, RN · Apr 24, 2017

Ugh...too many chiefs, not enough Indians. Pre printed stuff is great until no one can find it.
I would have a conference with admin and then share with teachers WHAT TO DO, using the information from this situation, as an example.
Sometimes you need to just yell "Stop! Let me tacke care of this!"
Do what you need to stabilize the child first, while pointing to people and say:
You- call 911 (keeping them near you so you can get on speaker phone if necessary)
You- Get the AED
You- send someone to meet the ambulance (admin already knows their role here)
You- clear the area (of "lookie loos", or other students/teachers) (teachers know their role here)
You- get their biographical info ready for trhe ambulance (admin assistant knows her role here)
Admin will then call the parent if I am not able to and will also call for a stay in place as well as notifying any siblings who may be in the building.

I want to love this post x 10.

OP, awesome job, first off. The first time is scary, scary! Everyone wants to "help" in their own way, often not realizing that the best help is to just step aside and wait for instructions.

I've learned to put on my "boss voice," as I call it, but that took time to develop. Now, I do exactly what Nutmegge outlined. I'm accessing the kiddo/situation while pointing to key adults (or even a student messenger if needed) and giving pointed orders like "You, call 911, tell them the exact location in the building we are in and wait to direct ambulance/etc in" and "You, go to my office and grab the student's emergency health form from the x folder" and "You, talk to the office and get the parent on the phone and/or get me parent's phone number."

I have emergency plans that hang in each classroom for emergencies like allergic reaction and seizures (they are very basic and easy to read need-to-know stuff). Last emergency I handled with a seizure, and you know what? The staff had actually read the instructions! Kid was in perfect recovery position when I arrived. So some things do get through .

michaelg510 · Apr 25, 2017

We can always do better in hindsight but it sounds like you did great

KalipsoRed21, BSN, RN · May 3, 2017

Kudos. You did take control of the situation with the patient...but it is unlikely you would have been able to get control over the other adults in the situation. I worked ER as a travel nurse and the best ERs had a protocol for events with a named person responsible for certain activities. Ex: Trauma comes in there are two nurses and a tech in the pod. Nurse assigned to the room will be the one charting all activities. 2nd nurse preforming procedures. Tech helps strip patient and place on monitor and then is your runner for supplies, etc. I think your idea of a 'code team' dedicated to assigning who should respond and what you need them to do will save some of your drama the next time. You really can't expect a bunch of non medical people to do that on their own during a crisis. Practice and good protocol is the only thing that can do that.

icepak · May 3, 2017

At the beginning of the school year, ask for 30 minutes to do a staff presentation that covers emergencies. Also, a medical drill twice a year. Teachers on the medical team(if you have one) need to have a plan in place for their class to be covered if they are called to assist in an emergency. Then, assign everyone a job. A post meeting is a great idea to see "what we could have done better". This also validates you as the medical person in the building and shows admin why you are there!