One more round of "What Would You Do?"

Specialties School

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An Atlanta-area mother is very upset that a school nurse did not call 911 for her 6-year-old daughter's severed fingertip (linked story contains auto-play video). The way I see it, a severed fingertip is not a life-threatening emergency, so 911 is not needed. I would put the fingertip on ice, stabilize the patient, call the parent, and call 911 if requested.

What would you do? Does your school have a protocol for amputation injuries?

Specializes in kids.

911 then parent, if parent gets here before ambulance, they can have the conversation re transport.

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I think this is the bottom line, pun intended. and was this mom prepared to pay that transport cost?

Call parents,

There is nothing an EMT or Paramedic can do for this except give a very expensive ambulance ride to the closest facility.

But, I would make sure the parents know what would be the most appropriate facility to transport to.

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Our ER is less than a mile away - I might have driven the kiddo myself. :blink:

I've driven a child with the beginning of an asthma attack when parents were 70 miles away and the ambulances were all out on calls.

In our litigious society, I think I'd opt for 911 and then parents and if I needed to, I'd drive the child.

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Call parents There is nothing an EMT or Paramedic can do for this except give a very expensive ambulance ride to the closest facility. But, I would make sure the parents know what would be the most appropriate facility to transport to.[/quote']

Not sure if it's the same where you guys are, but if an ambulance leaves a public park, swimming pool, etc around here then the cost of the ambulance ride is not charged to the patient, it goes to the facility. Is leaving a public school possibly the same?

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Specializes in School Nursing, Public Health Nurse.
Not sure if it's the same where you guys are, but if an ambulance leaves a public park, swimming pool, etc around here then the cost of the ambulance ride is not charged to the patient, it goes to the facility. Is leaving a public school possibly the same?

Not where I live. I've had so many angry parents with ambulance bills. They think the school should pay because we called 911. Sometimes the ambulance bill will be covered by insurance if the person (student) is admitted to the hospital. Not to mention the parents that think we should cover medical expenses if a student gets hurt at school. Parents can get very testy when 911 is involved. The hospital is literally up the street from us and ambulances are real quick (small city). My office at one school is across the street and once during an emergency on the basketball courts the Firetruck made it to the side of the school before I did.

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Not sure if it's the same where you guys are, but ifrespondedlance leaves a public park, swimming pool, etc around here then the cost of the ambulance ride is not charged to the patient, it goes to the facility. Is leaving a public school possibly the same?

Wow where do you live?

You mean anyone who twists an ankle or bruises a finger tying their shoes can get a free ambulance ride? I bet some hobble across the street to a city park just for the free ride. Alot of our homeless patients come from the parks. The state or city have not offered to pay the ambulance bills excpt for whatever funding is provided for the EMS contract with the other funds coming from billing and insurance.

Even for school sponsored events like sports the school wants to know if the child is insured.

In some places you will get two bills. One from the fire department which responded with a Paramedic who then rides in with the child to the hospital in the private ambulance which also bills. Even if the Paramedic does nothing for the child it may still be a policy for them to ride and bill if it is a child.

Of course you will also make for a good discussion on the EMT forums about nurses who freak out over any little thing and call 911.

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I'm mostly speaking from experience working at a park district where we instructed to always call 911 and advised parents to let us call 911 even for minor injuries. The cost of the an ambulance ride is minuscule compared to amount some may sue for later if complications arose.

I had to call so many times for a scraped knee or vomiting or a bumped head. Might be goofy but just following the rules.

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Oh for heaven's sake... if it's my kid, don't call 911 unless we can't figure out another way to get them to the hospital.

Just because things need urgent attention from a skilled physician doesn't mean that they need an ambulance ride.

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The best part is the EMTs or Paramedics will wait at the school for the parent to ask mom or dad about 30 minutes of questions. These will be some of the same questions you will be asked in the ED. The Paramedic will probably drive while the EMT sits with the child in the back of the ambulance since there is not much to do except complete the paperwork for billing. And the parent will follow right behind the ambulance in their own car to the hospital.

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Specializes in school nursing, ortho, trauma.

the overall is that most of my parents have a minimum of a 20 to 30 minute response time to begin with (the average time being closer to an hour to an hour and a half). And that's after I call 7 numbers to find someone to pick up / call back or have a working number. Yes, I suppose if it were a child of a parent that I knew for sure that was in town and would be in school within a few minutes, I would maybe give the option of get here - do you want me to call 9-1-1 or are you just going to take to the ER yourself? but for everyone else - if the parent gets here and EMS hasn't transported yet, they can always refuse transport if they don't want the bill.

Now, don't think i'm quick to call 9-1-1 for everything. But in the case of a detached body part... well, after being an emt for about 6 years I can easily say that not only did we go on calls that were of much less emergence, but that our questioning and interview with patient and family certainly did not take 30 minutes.

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I would call 911 then the parents. If parents are able to get to the school in time they can then make the decision whether to transport. Just way too many lawsuit happy people out there and I do not want to take a chance with that.

In our city, EMS calls are not charged until you are in the truck and being transported - they make it clear to us in the schools we can call them anytime to come and assess a situation without anyone being charged - of course they are always going to recommend to seek treatment at the ER. The cost of EMS transports is on the parents in our district. The district does carry a supplemental insurance policy to help parents with "school accidents" but the responsibilty falls on the parents to file the claims and for payment of any bills.

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Specializes in School Nursing, Public Health, Home Care.

My school district works the same as AdobeRN. Our EMS people are VERY willing to come and assess a student or faculty member and the only charge is if they transport. One thought that hasn't been mentioned yet is this one: perception. I would call an amputation a serious injury. I can just hear the grapevine: and they didn't even call 911! Does this injury REQUIRE 911? maybe not. But the PERCEPTION would be that the school did everything possible. Right or wrong.

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