Should Have Called 911

nursekoll, BSN, RN · Jun 1, 2021

It is easy to second-guess our decisions, especially when there's no other medical professional to consult with in the building/immediately. I sent an allergic reaction to the ER after benadryl with mom by private car and to this day I think I probably should have used stock epi/albuterol per protocol and sent by ambulance. Kid ended up fine, but I still doubt my decision.

NutmeggeRN, BSN · Jun 1, 2021

Was there a negative outcome? Sometimes we blow it, not often I suspect. I am willing to be that we call more often vs less often, when it is needed. What is the situation? Can you learn from this? (I'm sure you can).

lifelearningrn, BSN, RN · Jun 1, 2021

What happened? It's a mistake we could all make.

pineappleupsidedowncake, BSN, RN · Jun 2, 2021

This happened to me today ?

It was a faculty member experiencing nausea/vomiting. They asked me to take their BP, which was high (PMH of HTN). It wasn’t high enough to be considered a “hypertensive crisis” but my mind automatically went to cardiac. So they didn’t want me to call EMS, and of course we can’t force an adult to go to the ER... but I’m more so upset with myself because I feel like I’m almost too calm in these situations. Maybe I should have been a little more insistent that they call their doctor or go to urgent care??? If it truly was a medical crisis that needed immediate intervention, that person may have needed a little bit more of a stern push to go checked out.

maybe I’m over reacting. It certainly didn’t help that all the other teachers were freaking out ?

NutmeggeRN, BSN · Jun 3, 2021

On 6/2/2021 at 4:41 PM, pineappleupsidedowncake said:

This happened to me today ?

It was a faculty member experiencing nausea/vomiting. They asked me to take their BP, which was high (PMH of HTN). It wasn’t high enough to be considered a “hypertensive crisis” but my mind automatically went to cardiac. So they didn’t want me to call EMS, and of course we can’t force an adult to go to the ER... but I’m more so upset with myself because I feel like I’m almost too calm in these situations. Maybe I should have been a little more insistent that they call their doctor or go to urgent care??? If it truly was a medical crisis that needed immediate intervention, that person may have needed a little bit more of a stern push to go checked out.

maybe I’m over reacting. It certainly didn’t help that all the other teachers were freaking out ?

I will call EMS if, in my professional opinion, they need to go. They can fight and sign off AMA if they choose not to. I always try and picture answering to the BON or a judge as to why, if I felt they needed it, didn't I call?

JenTheSchoolRN, BSN, RN · Jun 4, 2021

23 hours ago, NutmeggeRN said:

I will call EMS if, in my professional opinion, they need to go. They can fight and sign off AMA if they choose not to. I always try and picture answering tot the BON or a judge as to why, if I felt they needed it, didn't I call?

Same.

OP, I once had a female faculty member present with pretty severe chest pain. Given her age and history, my brain went to cardiac immediately. But I was still a new school nurse, and she was SO insistent I did not call 911 as she would send them away. She wanted to instead drive herself home. I would NOT let that happen and got her husband on phone, expressed my concerns to him and he was not able to convince her to let me call EMS, but did convince her to let him get her. Luckily, he was close by and took her straight to the ED, where it was later determined she was having a mild (thankfully) heart attack.

I should have 100% called EMS immediately and I would today, but I was green and not used to standing up to staff as much as I am today. (Not an excuse, of course, but what I saw later when I could re-examine the situation with a more experience under my belt.)

Staff stuff is harder here - they are adults and can say no. Let them send EMS away - but as I learned this year at work that my school will let me have the authority to not have a staff member return to work if I perceive their health issue will endanger students/staff and request they submit a doctor's note to me or HR. (Do I want this authority? That is a different thread, LOL...)

Mavnurse17, BSN, RN · Jun 7, 2021

Can I sort of branch off here and ask a question r/t?

I feel like I think in black and white when it comes to EMS calls. I know a sore throat doesn't need EMS and I know that cardiac arrest does needs EMS. But there are some gray areas where I think "hmm yeah they need to see a doctor but do I need an ambulance??"

For instance, a staff member with what is considered a hypertensive crisis by numbers but they have only a mild headache and show no neurological deficits and are otherwise asymptomatic. I mean, yeah 180's/100's is nasty and I want them to be evaluated but in a situation where they aren't in distress... should I call an ambulance?

I've called EMS probably 10 times in my 3 years of school nursing and only 2 of those have been true medical emergencies that paramedics intervened for. The other times, EMS shows up, takes vitals and says to the parent (for student) or staff, "it's your choice if you want to go to the hospital or not." So that furthers my questions of what really needs EMS and what doesn't.

I feel dumb for asking this ☹️

BrisketRN, BSN, RN · Jun 9, 2021

On 6/7/2021 at 2:05 PM, Mavnurse17 said:

Can I sort of branch off here and ask a question r/t?

I feel like I think in black and white when it comes to EMS calls. I know a sore throat doesn't need EMS and I know that cardiac arrest does needs EMS. But there are some gray areas where I think "hmm yeah they need to see a doctor but do I need an ambulance??"

For instance, a staff member with what is considered a hypertensive crisis by numbers but they have only a mild headache and show no neurological deficits and are otherwise asymptomatic. I mean, yeah 180's/100's is nasty and I want them to be evaluated but in a situation where they aren't in distress... should I call an ambulance?

I've called EMS probably 10 times in my 3 years of school nursing and only 2 of those have been true medical emergencies that paramedics intervened for. The other times, EMS shows up, takes vitals and says to the parent (for student) or staff, "it's your choice if you want to go to the hospital or not." So that furthers my questions of what really needs EMS and what doesn't.

I feel dumb for asking this ☹️

I think in those instances you trust your gut. I ask myself could this person decompensate quickly? How much longer would it take to seek medical attention if they were driven to the hospital vs. if EMS is called? I know at my school our EMS time is 8 minutes, and it takes about 15 minutes to drive to the nearest emergency room. We rarely call EMS for staff. They've typically jumped into someone else's car before EMS would even get here. No point in me calling if the person won't be here anymore.

AutumnDraidean · Nov 9, 2021

So I’m a sub, one of the schools I go to is a SPED environment. I was called to the gym, a kid had run, headlong into an electric box on the wall, when I got there he was still experiencing an altered LOC so when the principal asked if I wanted 911 called I said yes. That school was great, they had all the stuff needed for the ambulance and a member of admin called the family. When the dust settled it dawned on me that this kid had a shunt. I opted for 911 because of his LOC, but he would have needed the ER for imaging anyhow…right call, wrong reason.

I actually don’t know if they dealt with the hazard, fire inspector didn’t want the box covered in padding and I honestly don’t know which side won that fight.

Flare, ASN, BSN · Nov 15, 2021

Just as an aside, there are cover boxes that can be installed over fire pull stations. This may be an option, as they still allow the pull station to be readily accessed, but don't expose little ones who are head height to the sharp edges on a pull station. The fire inspector should allow that - they're fairly common, especially in schools.

NutmeggeRN, BSN · Dec 16, 2021

On 6/4/2021 at 7:15 AM, JenTheSchoolRN said:

I should have 100% called EMS immediately and I would today, but I was green and not used to standing up to staff as much as I am today. (Not an excuse, of course, but what I saw later when I could re-examine the situation with a more experience under my belt.)

When we know better, we do better...