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.
