The one time I take off ... 911 gets called!

  1. I have been at school every day since I started my job the end of August, to the point where my designated office staff trained to function in my absence joked about how I never needed them. Then the week before Spring Break my 3 year old gets strep and practicing what I preach, I can't send her to preschool until she is fever free for 24 hours. I work mornings and leave when I'm finished with lunch meds, and spouse works afternoons. Staff has my cell and knows they can call me for any questions and there is an RN next door at the middle school.

    So of course it being Murphy's Law, 5 minutes before dismissal on the last day of school before Spring Break a student with no known health history goes into anaphylaxis immediately after eating a snack in the classroom that contains tree nuts! Student vomits, leaves for the bathroom, comes back and is developing angioedema, complained that he felt there was something in his throat, student also develops wheezing. Teachers recognized it as an allergic reaction, brought student to office where the secretary and attendance clerk are designated personnel in my absence. One called 911 while the other looked to see if student has an EpiPen. They didn't see an EpiPen for this student, just the stock Epi (I only have one kiddo prescribed an EpiPen with an action plan who is much younger. The staff have been trained about this but I think they forgot and just knew where to go to find Epi). At some point after calling 911 they called the nurse next door who arrived about 2 minutes before EMS arrived (we are in an urban area so quick emergency response). As it was dismissal at this time, Mom was also located and confirmed kiddo has no known allergy issues. They called me on my cell phone right after the ambulance arrived.

    Next door nurse apparently didn't choose to give the stock EpiPen (I keep mine in a bright yellow unlocked box labelled "EPI PEN" that is right around eye level behind my desk), and the ambulance apparently didn't do Epi either. I was on the cell phone with the other nurse at this point and she said EMS had asked if we had benadryl in the clinic -ugh, that is not how you treat anaphylaxis but whatever - and she already knew the answer as we don't stock any OTCs in our district. They had O2 on the kid and I was told they were quite calm and not super hurried but did make the decision to transport within 5-10 minutes of arriving. They ended up admitting the student at the local children's hospital for at least one night, I haven't gotten a full update as it was Spring Break this past week and unfortunately there is a language barrier so I had to get an update from one of the bilingual teachers who visited that evening. Student was doing well but still having some wheezing issues.

    I felt ABSOLUTELY HORRIBLE that I wasn't there but I reiterated to the staff that I was super proud of how they handled it. After the ambulance left and the other nurse returned to her school, they second guessed if they did the right thing. I reminded them that they didn't hesitate to call 911 which was absolutely critical, that they got a nurse in the clinic and with the patient before the ambulance arrived and they got the parent there before the ambulance. I told them that only thing thing that would have happened differently were I there is I would have given the stock Epi Pen while they called 911. They seemed to feel badly that they didn't think to use the stock Epi Pen, but honestly I think with non-medical folks it is hard to jump to that. I reminded them that even the other nurse didn't choose to use the EpiPen when she arrived, so they shouldn't feel badly at their hesitation. Sidenote: I'm kindof surprised the other nurse didn't do so but it seems like there is a lot of hesitation with using Epi. I've talked to nurses who have hesitated even with diagnosed students on an action plan, so I guess when it's an unknown thing - it makes the tendency to hesitate even stronger???? Either way, I still made sure they knew how proud I was of their actions.

    So next week, I have plans to have a refresher on Epi Pen with my designated staff - including training on signs of anaphylaxis and when to use the stock EpiPen on a student. Then training for all of the teaching team who works with this student (with kudos to them for realizing what it was!) and lots of paperwork to get into place.
    Last edit by River Song, RN on Mar 17
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    About River Song, RN

    Joined: Jul '17; Posts: 84; Likes: 216

    18 Comments

  3. by   rbytsdy
    Eek! I was out one day when a staff member needed an EpiPen. Luckily my sub was a retired school nurse so she gave the EpiPen.

    I will say that I have given an EpiPen 3 times (all after that incident). Each time it's a struggle to make the decision to inject. Reading your story makes me think "Why didn't they give the EpiPen!?" But if it was a student with no known allergies, it's such a tough call in the moment (even if it seems obvious later). But remind them that they can't hurt someone with an EpiPen. They already called 911 so they weren't saving the student from a trip to the hospital.

    Kudos to you for having a well trained staff who too charge of the situation and recognized the need for emergency medical care!
  4. by   OldDude
    I can understand your frustration...all around. You had laid the ground work, done the training, and even another nurse and EMS didn't come through at the time of need. I think your reaction was quite professional by turning the event into a learning experience and using it to springboard others into the next level. Great job nurse.
  5. by   River Song, RN
    Quote from OldDude
    I think your reaction was quite professional by turning the event into a learning experience and using it to springboard others into the next level. Great job nurse.
    Getting praise from OldDude, RN at the virtual nurse's station should be what all new school nurses aspire to!
  6. by   River Song, RN
    I would love to see some research on *why* the hesitation to use epi? It is so very prevalent, I've had colleagues wait for parents to arrive as they would rather the parent make the decision. As an allergy mom myself, I know there are still so many doctors out there who tell families to use Benadryl first and make it sound like their autoinjector should be the last thing despite this going against anaphylaxis treatment protocols. My oldest child has a severe peanut allergy and we have carried epi for 7 years now. Both of our allergists have stressed Epi first and only epi!

    When I was recounting this story to my husband and got to the part about no one using the stock EpiPen, he made the comment that, "well they were afraid of making the kids heart explode!"
    No- just no! It can't explode hearts??! Why do you even think that??
    (I love my husband and he is not medical but has always taken the task of keeping our epi with our son so seriously- I had no idea that even he thought this??)

    Giving a shot of epinephrine, even if you don't *really* need it won't hurt anything. I told him unless you inject it totally wrong- like into the tip of your finger- there is just no downside.

    I think we need to get folks over the hurdle of thinking that an EpiPen is dangerous. I would rather err on the side of it looked like possible anaphylaxis so I used it vs. well I hesitated and like the middle school girl in Georgia last week- she got it too late and died
    Georgia Girl, 12, Died of Severe Peanut-Allergic Reaction, Despite Efforts to Save Her
    Lee student dies of allergic reaction - The Newnan Times-Herald

    I think it's the whole needle thing- that makes it seem so scary??
    Last edit by River Song, RN on Mar 18 : Reason: Added links to sad news stories
  7. by   smartnurse1982
    I know the answer is obvious but some nurses are reluctant to give anything without an order.

    That includes epipens and oxygen,even though it is needed.
  8. by   JenTheSchoolRN
    I think everyone hesitates to give Epi the first time.

    I know I did. I paused to think if this was the right thing, despite my plan because it can seem like an extreme thing to do. I didn't hesitate for very long and gave it and was glad I did so. The next time I didn't hesitate at all.

    Now I'm a medical professional. I totally believe my non-medical staff would hesitate, despite my teaching that Epi has no real side effects. I've never to let them try.

    Side note: I did take 2 days off earlier this school year and had a RN sub in. Allergic reaction happened to a student I had previously given Epi to earlier in the year. Sub was not a new nurse, but she hesitated and didn't give it (she had never used an Epi pen before). She did call 911 though and they also didn't give Epi but did transport and student was observed in ER for 8 hours or so.
  9. by   ohiobobcat
    Quote from smartnurse1982
    I know the answer is obvious but some nurses are reluctant to give anything without an order.

    That includes epipens and oxygen,even though it is needed.
    If my students have known allergies, I have an allergy action plan in place for them, which includes the orders for Benadryl and Epi (usually) and is signed by the student's medical provider.

    If my student has an unknown allergy, I have a school physician order through our anaphylaxis protocol and stock Epi-pens to administer to students/staff if needed.

    So not having orders for an Epi-pen is not my concern in the decision-making process as to whether to give it or not.

    As far as O2, in the school setting, I do not have any way to administer O2, nor do I have orders to do so.
  10. by   ruby_jane
    Quote from River Song, RN
    I would love to see some research on *why* the hesitation to use epi? It is so very prevalent, I've had colleagues wait for parents to arrive as they would rather the parent make the decision. As an allergy mom myself, I know there are still so many doctors out there who tell families to use Benadryl first and make it sound like their autoinjector should be the last thing despite this going against anaphylaxis treatment protocols. My oldest child has a severe peanut allergy and we have carried epi for 7 years now. Both of our allergists have stressed Epi first and only epi!
    First off - everything worked PERFECTLY. You did a great job training everyone. Laypeople do not have nursing judgment and we can't delegate that either.

    As to your question....I found EMS guys on the rig don't like to use "my" stuff, just theirs - and I don't fault them for wanting to stick to protocol. With the other nurse....maybe she saw something that made her gun-shy? You're right- that 0.3 dose Epi won't hurt a kid.
  11. by   BeckyESRN
    My Brownie Girl Scouts just did their First Aid badge work this Friday. We have 5 girls with life-threatening food allergies in our troop, so my first aid talk included Epi-Pen use. I brought in the trainers and had each girl test them out. My allergic kiddos talked about what it felt like to have a reaction (I was so proud of them for volunteering this info all on their own!) I did a demo with an expired epi on an orange. Training the next generation!

    I think the lay person's hang-up on Epi is that it's an injection. I bet if it were a less "scary" delivery method, there would be less resistance to give it.
  12. by   JenTheSchoolRN
    I realized I didn't write this in my post above, but wanted to add it.

    I actually can't delegate Epi for an undiagnosed allergy to a non-medical person in my state. I can delegate Epi that is prescribed. (A sub RN can give Epi in both situations.) Therefore I would never expect a non-licensed person to give it to a student without a diagnosed allergy and doing so could get my school in a lot of trouble.
    Last edit by JenTheSchoolRN on Mar 19
  13. by   ruby_jane
    Also I forgot to add that (since everything worked out, we all learned something, and nobody expired) there is nothing better than for the administration to see what can happen without you there.
  14. by   Leader25
    Be in trouble having a student survive?

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