Should Have Called 911

[Sxhoolnurse1991]

Do you guys have any instances where looking back, you realize you should have called 911? I am usually good about calling EMS when needed but today I think I made the wrong decision. ? Sometimes I feel like I’m not smart enough to be doing this 

[puxipillow]

If it makes you feel any better, as a paramedic, I'd say less than 10% of our calls really require a lights and sirens trip to the ER and of those, the outcome is still usually a nothing burger.  Also its not like you are the only point in time that 911 can be activated.  It's super rare that the timing of that call actually changes the outcome.  That being said, because so many 911 calls are "just in cases", you might as well call, its not like you'll be an outlier.  And for peds cases its almost always "just in cases".

[linda1959]

On 6/7/2021 at 3:05 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 have had to call EMS many times over my 10 years, for staff.  I let the staff member know BEFORE EMS arrives my reasoning for sending them to the ER. I also tell them that in my experience, certain squads will try to talk them out of going, and why I advise them to say they want to go.  And sometimes, I say it in front of the squad.  

Remember that each EMS member will have their basic training, and some many years of experience, but it does not mean they know more than you. If your judgement says they should go, then advocate for them. 

As for students, there is not an option. If I think they need to go, we tell the parent they are going, we are sending staff with them, and they need to meet them at the hospital.

Just once did I not call an ambulance for a staff member who asked me not to, and I agreed because we are friends.  She did OK and her husband came and took her, but it was the wrong call, and I told her I will never do that again. I have had to call 2 more times for her, and she knew there was no negotiation.

Trust your judgement and skills. Better to err on the side of caution.

And in the situation you described? I would ask them to call their doctor right there in my office and ask their advice. If they refused, that is what I would document. 

[bluebonnetrn, BSN, RN]

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

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 have had EMS give the parent a choice on a 2nd grader with retractions and sats in the 80s without oxygen! Bologna! (Turned out to be a post-flu pneumonia)
And another case with a 7th grader HR in the upper 190s to 200s for >30 min with a known previous cardiac history. They gave mom the choice and mom said no to EMS and THEY LEFT HER THERE WITH ME IN THE CLINIC.
I was furious
Needless to say... I don't trust a lot of what EMS does

[NutmeggeRN, BSN]

Can you have any follow up discussion with them?  I woulds pursue that to get their take on it. And, I would involve their supervisor...

[JenTheSchoolRN, BSN, RN]

I haven't been around much in the forum lately, but logged on today and just realized the nugget I shared with the last three school nurses I've trained (I'm now the school nurse leader for my small district) is this:

You will never regret calling 911. You may regret NOT calling 911. 

I'm in a city where traffic alone means it is super, super rare for a parent to beat EMS to the school. Usually, I'm sending a staff adult with the student to meet up with the parent at the hospital because no parent on site to tell EMS not to transport.

I'm hitting my 10 year school nurse anniversary (!!) and I realize now that I've never had a parent call me after angry I called 911 for their child. 

[nursekoll, BSN, RN]

JenTheSchoolRN said:

I'm hitting my 10 year school nurse anniversary (!!) and I realize now that I've never had a parent call me after angry I called 911 for their child. 

I'm also a 10- year school nurse. I HAVE had a parent angry about a 911 call on their child with epilepsy. They were very angry that their child went to the hospital by ambulance after a seizure. I was not in that building at the time, but I stand by my staff calling 911 due to the fact that the beginning of the seizure was unwitnessed and it was on the playground, likely after a fall or blow to the head as the student was found under the swings. It is written in the seizure plan to call if possible injury before or during the seizure and if the timing is unknown, as the beginning of the seizure was unwitnessed. 

[JenTheSchoolRN, BSN, RN]

nursekoll said:

I'm also a 10- year school nurse. I HAVE had a parent angry about a 911 call on their child with epilepsy. They were very angry that their child went to the hospital by ambulance after a seizure. I was not in that building at the time, but I stand by my staff calling 911 due to the fact that the beginning of the seizure was unwitnessed and it was on the playground, likely after a fall or blow to the head as the student was found under the swings. It is written in the seizure plan to call if possible injury before or during the seizure and if the timing is unknown, as the beginning of the seizure was unwitnessed. 

Was the student also unconscious for a period? And found under the swings? With no nurse there to even assess? I would 100% stand by calling 911 and applaud the staff for doing so. 

[nursekoll, BSN, RN]

@JenTheSchoolRN Yes, found under the swings. I assume the student either had a seizure and then fell off, or fell off and then started having a seizure. Either way, the call was appropriate and I did applaud the staff for calling even though the parent was angry. I think the parents were mostly mad that the ER "did nothing", just sent the kid home (according to the parent's report). We live in a rural area where volunteer EMT's take awhile to arrive, but still arrived before the parents.