My very first squad call

[cjl_RN]

I’ve been reading a lot your guys first squad call... fearing when would mine be... welp that was today!

Teacher walkie in a calm voice need the nurse student fell and wheel chair outside. Responded to scene student is lying on the ground and I could see through his denim jeans that his left knee had poppped out and was external rotated. Ask students his pain level and if he’s moved it or has feeling. Student has no feeling in leg. Immediately yelled for our SRO to get a squad here ASAP. Continued to assess gently lift pants up to make sure there was no blood running down the leg. Jeans were pretty tight. Student was pale in color hollered for my emergency bag to take vitals. Soon as I got my bag the engine pulled up and he had moved his leg and popped back into place.

however the squad took him still to be evaluated to the closest hospital. Of course parents couldn’t be reached an admin had to ride with the child they finally got ahold of parents at the hospital.

I will follow up with the child’s condition tomorrow.

The student was outside there was some staff members wanting to move him inside due to cold weather temps, but I had a blankets on the way for him instructed we could not move him, got a pillow to support his head. Some were wanting me to splint it, but I didn’t see benefit of a split the knee cap was completely out of socket rest of the leg was straight, I didn’t feel comfortable moving him.

looking back I should have brought my emergency bag with me, (put scissors in my bag) should have cut to jeans to ensure there wasn’t an open fracture. (Squad didnt cut jeans either).

Anything else I should have done differently?

15 hours ago, EnoughWithTheIce said:

SPOT ON!!!!! I love it all of it but #1 speaks to my soul.

I see no sense in splinting if EMS has been called. As someone else, stated - they need to do their own assessment and have their own protocols (with appropriate equipment) in place.

I had a kid last year with 2 obviously deformed fractured arms laying stomach down on the tennis courts. As soon as I saw what an awkward position he was in with neck at a strange angle, I called 911. Just monitored ABC's and tried to keep him calm. PE coach kept wanting to flip him over and I stood my ground!

It took 5 EMT's and lots of imaginative maneuvering to get him onto the stretcher.

I cannot even imagine the pain that poor kid must have been feeling! Yikes!

[Seeing Myself Out]

It's a good chance that they are going to re-do the splint or make a cast at the ER, so splinting on scene while you are awaiting transport probably isn't a necessity. If EMS is concerned about the dislocation getting worse from the patient getting moved or getting bumped around riding the ambulance, then it's their job to splint the injury. Can't think of anything to splint a knee dislocation other than perhaps a vacuum splint, which I doubt you would have as a school nurse.

Here is a good article I found on the EMS side, but I think some of it applies to your setting too.

https://www.jems.com/articles/print/volume-41/issue-2/features/ems-evaluation-and-management-of-limb-threatening-knee-injuries.html