EMS talking down to Nurse

[heynurse1996]

School Nurse Vent!!!

So, I see my nurse assist per IEP diabetic three times a day, he sticks himself but I carb count for him and help him draw up the insulin, supervise and make sure hes rotating sites,ect. Today he came in very panicked. Stating he was in DKA.

Now this kid is happy go lucky and never has a complaint...ever. So immediately I am worried. He has Large ketones in his urine, Blood glucose 390 (he usually runs low,never seen him above 180) And generally knows whats going on with his own body, He's vomiting, kussmaul respirations, fruity breathe, weakness, blurred vision, sleepiness the whole nine yards.

So I call 911, the EMS team thought I was an idiot, the paramedic informed me "390 is not even that high" I replied that he is a type one with dx hypoglycemia issues per MD and even printed out his CBG record and MD note stating this. Still the whole time they rolled my eyes made a big production and were dragging there feet on taking him. At one point when I handed them his dx list they stated that this was probably a "panic attack" because of his mental health dx. None being anxiety mind you.

I finally tell them they need to go with him to the hospital now. With some shuffling they go on. My RN supervisor (I'm an LPN) Seems to think its because I'm young and stated the same thing happened to her....I was wondering if anyone else has had the same experience.

It just frustrates me that people with mental health dx are being overlooked when its a WAY bigger issu because "Its just part of it" Anyways...very upset about the whole thing and kind of still seeing red...

Update: He's being transported to the "big city" Diabetic Peds unit...it was DKA

[OldDude]

Interesting posts all around...so heynurse, BAM! Another kid snatched from the jaws of death...school nurses, that's what we do. Awesome assessment and kudos to you for standing your ground as a patient advocate. Praise be to God you were there to facilitate this child and parent's ability to hug each other afterwards and have this become just a story to tell.

[moreoreo]

Still reading everyone's replies but completely agree with all that you did the right thing!

I called paramedics recently for an asthma flare up in a student who did not have medication in the health office (parent could not come right away and her symptoms worsened as she waited) and the paramedics in this situation also did not seem impressed with the student's presentation (but quickly decided to transport). I think they may not realize the position we are in. No, I do not think the student specifically required an ambulance. If she had an inhaler to take or a parent who could arrive right away to bring her medication or take her to use her medication, she may have been fine without urgent attention. My situation I think was less emergent than yours was but the point is, it's not our child, and our hands are tied due to lack of tools and inability to personally take the student to where they need to be.

I'm glad you stood up for your student and were confident in your assessment! I know he must have appreciated it.

[Farawyn]

Yeah, what else is new? That's how many of them roll. I ignore it. As long as we are both helping, let him/her have their moment.

[Amethya]

Thankfully our EMTs nearby are super nice (and hot...) and actually work with me when something happens. Good job on keeping your stance on the issue! I would of said, "Do you know this student? Is he your patient?? If you know so much about him, then please tell me what is his personal average BG?"

[NutmeggeRN, BSN]

You were right. End of story. But what can you take from this? Maybe approach your local EMS and forge relationships? I have been around long enough that I qualify for the COB society!! They don't ( and we don't) always know what we don't know. Maybe a collaborative inservice? Touching on common issues in the school health office and a coordinated approach?

I'm curious what did the ER say? Was it DKA? Sure sounds like it was. Plesae keep us posted.

[heynurse1996]

Update: It was DKA, dad left me a message this morning. They actually had to take him to a local Peds Hospital

because our "big hospital" was scared to keep him. So they stabilized him and shipped him out.

I had called to give report to the hospital as EMS was getting there yesterday (used to work acute care old habits

die hard) the nurse taking report said "Oh, him" In response to the paramedic. So apparently this was his MO. She also informed him (while I was on the phone, he would have to wait to give report, she had to speak to the nurse. Catty, but funny) Paramedic also apparently tried to not give the MD my CBG report and MD bit his head off and per nurse on phone informed him baselines are just as important as "textbook memorized values" (All while I was on the phone)

All I can say is Karma folks :)

[Forest2]

I have seen some really bad stuff by EMS. One thin elderly lady fell, her left leg shortened and externally rotated. Easily identifiable as a fractured hip, the EMS just had to manipulate the leg and move it out and in, up and down, mean while the lady screaming in pain. I had to get them to load her up and take her to ER, like we told them it was a probably fracture but they had to do their thing. Ridiculous and unnecessary, they even tell patients, "You don't have to go to the hospital, you know, you don't really want to go do you?". Of course what do you think they are going to say? They don't want to go, they need to. A nurse really has to take a stand against this. I had formally made a complaint a time or two and things got a little better with that group.

[NutmeggeRN, BSN]

Update: It was DKA, dad left me a message this morning. They actually had to take him to a local Peds Hospital

because our "big hospital" was scared to keep him. So they stabilized him and shipped him out.

I had called to give report to the hospital as EMS was getting there yesterday (used to work acute care old habits

die hard) the nurse taking report said "Oh, him" In response to the paramedic. So apparently this was his MO. She also informed him (while I was on the phone, he would have to wait to give report, she had to speak to the nurse. Catty, but funny) Paramedic also apparently tried to not give the MD my CBG report and MD bit his head off and per nurse on phone informed him baselines are just as important as "textbook memorized values" (All while I was on the phone)

All I can say is Karma folks :)

Nice!!

[aprilmoss]

As a mother of a diabetic child I can tell you that you did the right thing. The high glucose reading isn't itself telling but your other signs: vomitting (always a problem in a diabetic) and the ketones indicate a serious problem.

[Kittery]

I'm just here to say WAY TO GO! So glad you were this student's school nurse!

[Farawyn]

Update: It was DKA, dad left me a message this morning. They actually had to take him to a local Peds Hospital

because our "big hospital" was scared to keep him. So they stabilized him and shipped him out.

I had called to give report to the hospital as EMS was getting there yesterday (used to work acute care old habits

die hard) the nurse taking report said "Oh, him" In response to the paramedic. So apparently this was his MO. She also informed him (while I was on the phone, he would have to wait to give report, she had to speak to the nurse. Catty, but funny) Paramedic also apparently tried to not give the MD my CBG report and MD bit his head off and per nurse on phone informed him baselines are just as important as "textbook memorized values" (All while I was on the phone)

All I can say is Karma folks :)

Great job.

[Nurse SMS, MSN, RN]

You did great, listening to your patient, recognizing, intervening and advocating. Excellent nursing.