Concerned about Adminstering Diastat

Discussion in 'ALS Discussion' started by MMiz, Dec 7, 2009.

  1. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    For the record, I'm trained, certified, and licensed as an EMT-Basic. My level of training goes beyond the EMT-Basic to include limited medications and advanced airways, but that's it.

    I've been asked to administer Diastat to a student in the school setting, and I don't feel comfortable doing it. I know far too little about the drug, and am concerned about my lack of tools needed to monitor the student's condition after administering the medication. I'm most concerned about potential liability as an EMT-Basic carrying out a skill beyond my normal scope of practice.

    I've been trained in the administration of insulin, Glucagon, Epi (auto-injector), and a few others, but I just don't feel comfortable admistering diazepam without medication direction or tools.

    Am I making a big deal out of nothing?
  2. isn't Diastat administered only per rectal?
  3. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    Sure is.
  4. what is your roll in the school setting? how old is the kid and are his seizures often, particularly violent, long in duration, idiopathic?
  5. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

    I feel as though I need to know his medical history, current medications, etc.
  6. firecoins

    firecoins IFT Puppet

    Location:
    Nyack, NY
    why are teachers administering meds?
  7. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    I haven't seen a school nurse in ages. Neither in wealthy Michigan districts with strong unions, nor in rural North Carolina. Most districts have teachers or teacher assistants administering medications, though that doesn't make it right.
  8. my best advice to you would be to decline, if at all possible. It is not fair to you or your patient/student to have you more or less blindly administer a drug to him. Diastat typically has few untoward effects, the ones that would most likely effect your situation would be diahrea, aggravation of asthma, head ache, nausea, abdominal pain.

    And I don't know of many school age kids that would wan't their teacher(are you his teacher) administering a drug in such a "personal manner." at about 12 kids start developing that "extreme sense of privacy". Also, it would not be desirable for any other students to discover what medication you are giving him, let alone how.

    But bottom line, I see it unethical to ask you to administer any drug, or treatment without knowing the essentials of why you are giving it, and what may potentially go wrong. you are absolutely correct in saying you need to know the pertinent medical hx and medications. While Diastat is relatively safe(especially in the pre measured syringe), once you give a drug. rarely can you "take it back".
  9. If you are responsible for administering a drug, then you ARE entitled to know the medical hx and current meds. especially if there is no one else on scene with more medical training
  10. Mountain Res-Q

    Mountain Res-Q New Member

    If I was you, the answer would be "Nope... ain't gonna do that under these circumstances."

    Here is the reason for my answer:

    I worked for a short while as the OnSite Medic at a Youth Correctional Facility. The medical staff was comprised of EMTs and CNAs. Part of the job was to administer a wide variety of medications that EMTs are not typically allowed to administer. The State provided an exemption waiver that allowed us to administer a limted number of OTC Meds (IBU, Pepto, Decongestants, etc.) and any medication that was perscribed by the Doctor that made a visit to the facility twice a week (Antibiotics, Narcotics, Sleep Aids, etc...). In this case the law allowed me (someone hired to work in a medical capacity) to adminster these meds (all oral). While I agree that knowing what you are giving, why you aer giving it, and the contraindications for giving it is a MUST, in this case all that was needed was an order given specifically to us from the kids primary doctor.

    However, in this case you are not working in a medical capacity. Even if you were, the law would prevent you (unless there were exeptions provided) from giving the medicaion. You are a teacher who is being asked to RECTALLY administer a medication to a student and not because you are medically trained (although not to give this med) but because you are an adult? Sorry, but I would see trouble coming. Concerns like this need to be mulled over by you with the local EMSA, the school officials, and the parents... and things need to be legal and on paper to protect your butt. But, in the end, you are not under any obligation that I am aware of to comply and if you feel inky about this... don't. In fact, from my perspective (and I mean no offense by this, just a liability concern) I would be very uncomfortable about being a school teacher whose duties include sticking things (although they may be medications) up a students butt. Sorry for being blunt, but in this day and age and with all those sickos out there, I think you could be opening yourself up for trouble. You are not the school nurse or even an EMT when you are working as a school teacher. Teach them... don't treat them... IMHO.
    Last edited by a moderator: Dec 7, 2009
  11. atropine

    atropine Member

    Location:
    Southern Cali
    EMS Training:
    Student
    Why don't you just call 911 and let the medics handle it?
  12. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    Calling 911 is part of the protocol. Though there is an EMS station about a mile from the school, the school says that EMS could be up to ten minutes away. Is a seizure really an emergency that requires Diastat? Is it a medical necessity?
  13. it's important but it's not that urgent.
  14. VentMedic

    VentMedic New Member

    Have you checked out this link?

    http://www.diastat.com/6-Resources/8-Back_to_School.html

    Many associations have continued their effort to see that kids with special needs can be placed in the school systems. Teachers often know their children better than sometimes even the parents who have come to trust their educators. We have had too many deaths in the school systems from waiting for EMS. Even then EMS is sometimes not familiar with the childhood conditions as pediatricss is a very, very weak section in an EMT(P)s education. However, you as an educator should have the resources available to you to do what the parent would do. We have even taught teachers who have no prior health care training except for CPR to work with children who have ventilators in their classroom.

    If you are serious about providing equal opportunities in eduation for all children, check what your state education system recommends for education and their stance for liability. You as an educator should have prior knowledge of your students's special medical conditions and your responsibilities should NOT be confused with your EMT cert.

    While you may have a very short response for EMS, other schools may not. Denying a child access to an education in a school system because of a medical condition should not happen. Yes, it is sad that cutbacks in schools to where the School Nurse is a rare commodity is a sad statement for the U.S.
  15. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    Vent,

    Thanks, I've read the information. As a teacher I'm committed to meeting the needs of all of my students. I am required by law to meet the medical needs of my students in the least restrictive environment possible. In injected students with insulin and Epi in the past, and we have students with some of the most bizarre medical disorders. I've sometimes changed decade-long habits to meet those medical needs.

    I'm just concerned about the medical necessity and liability for the administration of Diastat to a student. With my limited medical knowledge I don't believe that a seizure is a must-stop abnormality. How will waiting for EMS negatively impact the patient's condition or outcome?

    I'm not about passing the buck or saying pulling the "That's not my job" deal. This is about ensuring one of my students is provided the best care possible.
  16. VentMedic

    VentMedic New Member

    You might also find these articles interesting. The California Nursing Association is now even drawing fire from nurses who have children in the school system that have seizure disorders.

    http://www.ocregister.com/articles/school-214516-diastat-administer.html

    http://www.epilepsyfoundation.org/epilepsylegal/upload/diastatschool.pdf

    http://www.womeningovernment.org/files/file/a-z/DiastatinSchoolsChartCurrent2.pdf

    http://www.epilepsyfoundation.org/epilepsylegal/upload/lancasteramicus.pdf

    We've gone through this before with albuterol, epipens and AEDs.
    Last edited by a moderator: Dec 7, 2009
  17. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    I've read all of those, thanks.

    Unfortunately my state, like many, does not provide immunity for the administration of medications in times of emergency. Neither my EMT insurance or my professional liability insurance (for teaching) will cover the ministration of medication.
  18. VentMedic

    VentMedic New Member

    Again forget the EMT cert. It does not prepare you for most medical conditions which are now common. You are functioning as a caregiver with the assumption you have little to no medical training except for this medication.

    No one is ever protected fully from liability but if you can save a child's life who is in your care for several hours per week, some things will be taken into consideration when it comes to assigning liability.

    Diastat is not new in the schools and there so far have been very few liability issues cited in any of the arguments from even the CNA in California. However they have also expressed concern that the California Paramedics are not trained any better than the teachers to give the meds or deal with medical emergencies with children.


    Follow the events in California which is in this link.
    http://www.ocregister.com/articles/school-214516-diastat-administer.html
  19. MMiz

    MMiz I put the M in EMTLife Community Leader

    EMS Training:
    EMT-Basic
    Thanks, I appreciate the feedback.

    I always assumed that a seizure was generally not life threatening. My research on the internet seems to back that up. Am I generally correct?
  20. VentMedic

    VentMedic New Member

    Heard the same argument when it came to albuterol and epipens. Unfortunately it took 5 children dying in one year from asthma whle in a school system that they had limited access to their medications for some to realize how deadly asthma could be.

    Read the information provided by the epilepsy foundation and see just how serious a seizure is for a child. Adults may have more reserve but it doesn't take long for a child to suffer dire consequences. It is a medical emergency that requires immediate attention.
    Last edited by a moderator: Dec 7, 2009

Share This Page