Concerned about Adminstering Diastat

[Lifeguards For Life]

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?

if it is a known re occuring condition, as i am guessing it is if your student has been prescribed diastat

 

[MMiz]

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.

If I were to believe everything I read from an advocacy group, we'd have the kids in plastic bubbles. I have students that have accommodations and plans will remove the carpet from our classrooms, require me to wear unscented deodorant, use unscented dryer sheets, and not use white board markers. All of these are deemed life threatening by some advocacy group and expert.

I guess I long for the good 'ole days.

 

[VentMedic]

If I were to believe everything I read from an advocacy group, we'd have the kids in plastic bubbles. I have students that have accommodations and plans will remove the carpet from our classrooms, require me to wear unscented deodorant, use unscented dryer sheets, and not use white board markers. All of these are deemed life threatening by some advocacy group and expert.

I guess I long for the good 'ole days.

In the old days these kids could not participate in phys ed and often had to be home schooled. Most of these children that are now attending school with medical needs would also have died at birth or had a very limited life expectancy. We couldn't save the 23 weekers that grew up to have multiple medical issues. Organ transplant was unheard of and cancer was a death sentence shortly after diagnosis. Let's not put us back to the 60s.

Medications have improved to where diseases are better controlled. However, for those with a break through, it is nice to know someone is there to help.

I guess you have never seen a child die from asthma or a seizure. It is truly not a nice thing for either the provider or the family and definitely not for the child as they struggle for their last breath.

I can't remember the last time I wore scented deodorant or perfume. I also don't have carpet in my house even though no one has asthma. The more I learned the more I applied in my own life and believe it or not a healthier lifestyle did emerge be it diet or decreased chemical exposure.

If you do advance your medical education, you will see where prevention can go much further than relying on EMS for everything.

May I suggest a field trip for yourself to a large children's hospital?

 

[VentMedic]

I also forgot to mention that children with HIV didn't attend school in the good 'ole days. Children with trachs were unheard of in the classroom and a ventilator was never a thought.

If a child did have a medical condition and allowed to attend school it was by way of the "short bus" regardless of their intelligence level.

So please let us not long for the good 'ole days and be advocates instead when it comes to education opportunities for children

 

[Shishkabob]

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?

Yes, a seizure can get to the point that it can cause life threatening threatening situations or anoxic brain injury, albeit it's rather rare looking at the big picture.


If someone goes in to sustained seizure, or has recurring seizures, they can go lengths of time without taking adequate / any breaths which as you know can cause hypoxia / hypoxemia which causes damage.




As for my advice on the drug? You're an EMT. You know how to study up on drug indications, contraindications and such. Read up on the drug, and get stuff signed by the kid's parents and your school board authorizing your use of the drug. Cover your butt, but don't be afraid to use the drug in a situation that requires it.

 

[JPINFV]

Another thing to think about in terms of liability is that this is a special case. You can't compare what you can do for everyone (whether operating as an EMT-B or as a lay responder) to situations where you have a patient specific protocol. I don't remember where, but I've heard of a handful of EMS systems (and yes... classroom!=EMS) that have started to produce special protocols for patients in their area that have special needs. I could see a problem if they gave you a medication and said, "Anyone that looks like they're having a seizure should get this medication," and "This student has a known seizure disorder. Here is a rescue medication that has been prescribed by his PMD and you should administer it if he starts seizing. Call 911 regardless of if the rescue medication works."

 

[VentMedic]

The child who will get this medication in the school system will have their own prescription.

The severity of the seizure will depend on the disease processs that is the reason for the seizures and the duration. Unfortunately in EMS education, only "seizure" discussed as if they are a disease by itself and rarely discusses the etiology or basic physiological process that has initiated the disorder. Thus, different seizure disorders and their orgins will have different maintenance and expectations as to risks if a seizure does occur. This medication will be prescribed for those who may be more at risk to where immediate treatment should be initiated.

 

[medicdan]

I understand what you are saying-- being held to a different standard because you are an EMT as well.
Would you feel better about the protocol or procedure if you have specific orders from an MD authorizing you to give the med? Almost like creating a patient-specific protocol for just your's and the patient's use?

 

[VentMedic]

Forget the EMT thing. He is not working for an ambulance when in the school system. He has a much bigger responsibility in the situation he is in as a teacher. He has to function under the guidelines of his job as a teacher and the responsibilities of it. If he wants to use "I'm just an EMT" excuse and throw away 6 years of college education as an educator then no one benefits least of all the child.

The child has a prescription from a doctor which just about any lay person can assist in giving with a little instruction.

Unfortunately it is those in EMS that do not always get the training.

Too many limit themselves because of that 110 hour first aid certification. Some even refuse to apply for certain hospital jobs because "phlebotomy" is not in their EMT scope but fail to realize the are working under a different title and medical director.

Believe it or not but in a school system, a teacher with an RN license but not working as a school nurse would have to function under the guidelines of the school system as any other teacher would. Their assessment skills would be just a little better. Even in the colleges where there are Paramedics and RNs in the classrooms, they are limited by what they have access to and are not working under a medical director for administering medical care. They are educators and follow the same guidelines in their system as the other teachers.

 

[rescue99]

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.

There is some active interest in training (volunteers) school staff here in Michigan right now. The second group if MFR candidates just began class last week in fact. The first group was trained during the summer of 2008 and reported a positive outcome after the first school year already. I think the program will be a great addition to our school districts in the years ahead.

Note: None are trained to administer anything beyond their scope as far as I am aware.

 

[VentMedic]

There is some active interest in training (volunteers) school staff here in Michigan right now. The second group if MFR candidates just began class last week in fact. The first group was trained during the summer of 2008 and reported a positive outcome after the first school year already. I think the program will be a great addition to our school districts in the years ahead.

Note: None are trained to administer anything beyond their scope as far as I am aware.

Again, that should NOT be meant to limit what teachers can do in a state. We have fought too long to get these kids into the school system and to give teachers the ability to given prescribed medications. It would be a shame to have a few MFRs and EMTs upset because a teacher can do more than they can. First aid training is great but generally there are teachers in a school system that have much greater knowledge about first aid than a MFR. As well, the school systems that do have several medical needs children offer educational programs for their teachers that definitely exceeds the knowledge of an EMT and probably most Paramedics (U.S.). They are taught about many medications that the EMT may never even hear about in their training.

Maybe because EMS is 40 years behind in its education about medications, diseases and pediatrics that it seems so unbelievable that teachers could be trusted with the care of children.

 

[rescue99]

Again, that should NOT be meant to limit what teachers can do in a state. We have fought too long to get these kids into the school system and to give teachers the ability to given prescribed medications. It would be a shame to have a few MFRs and EMTs upset because a teacher can do more than they can. First aid training is great but generally there are teachers in a school system that have much greater knowledge about first aid than a MFR.

In the impaired class room settings it is true, there is a fairly high level of training compared to the average school building. The MFR's in the particular district I know about have proven their worth from the reports I'm hearing thus far. I thought it interesting that most of the first group were either special ED or Para-pros. Their MFR training included PAT and Start/JumpStart with additional focus on MCI. The new (and group 1) candidates will have PEPP. It'll be interesting to keep following this study to see how well it develops over time.

 

[VentMedic]

In the impaired class room settings it is true, there is a fairly high level of training compared to the average school building. The MFR's in the particular district I know about have proven their worth from the reports I'm hearing thus far. I thought it interesting that most of the first group were either special ED or Para-pros. Their MFR training included PAT and Start/JumpStart with additional focus on MCI. The new (and group 1) candidates will have PEPP. It'll be interesting to keep following this study to see how well it develops over time.

But again, they should NOT limit what a teacher can do just becaue they are an EMT or MFR. The ARC classes might even be more appropriate since the "cert" would not be such of an issue. The chances of having a child with epilepsy, asthma or some allergies are greater than a MCI. To restrict teachers is just doing the chidren a disservice and limiting the educational opportunities of the student by putting them back on the short bus or having a parent remain with limited employment opportunities to stay "on call" with the child's medication either for emergent or routine administration. Thus, more hardship for the family.

 

[rescue99]

But again, they should NOT limit what a teacher can do just becaue they are an EMT or MFR. The ARC classes might even be more appropriate since the "cert" would not be such of an issue. The chances of having a child with epilepsy, asthma or some allergies are greater than a MCI. To restrict teachers is just doing the chidren a disservice and limiting the educational opportunities of the student by putting them back on the short bus or having a parent remain with limited employment opportunities to stay "on call" with the child's medication either for emergent or routine administration. Thus, more hardship for the family.

The MFR's are an adjunct aid to staff and the low, low numbers of nurses available in today's public schools. Districts make the rules and until there is incentive to change that, things will remain as they are. Programs like the one I am familiar with may be just the conduit needed.

 

[Ditchmedic]

concern about Diastat

Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

 

[rescue99]

Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

As a medic and mom, I have adminstered rectal valium a lot. Parents are quickly trained all the time to give meds per rectal. Staff can be as well.

One of our daughters went to a school for multiply impaired children. The "short bus" children, if anyone doesn't know what multiply impaired means <_< The staff there is well familiarized with the needs of the children attending and nursing is available all of the time. FD was right next door too, so we were all set Not a single issue cropped up for us however, there are quite a few emergencies in general. 10 a year maybe...dunno exactly.

The public school knew exactly what they were taught by me and our oldest's cardiologist. There was but 2 issues with her during school thank goodness. One scared the willies out of them but, they only became more dedicated to helping keep her in school. To the present day, we volunteer time to keeping the staff up to date on at least CPR/AED/FA. I would love to do more if only the district would allow....

When our son had his hip rebuilt twice, Tylenol 3's and IB were on hand in case he needed it. Those were prescribed by his surgeon and directions written exactly as I suggested. In every case with our oldest and youngest we had to meet with school nursing and get approval for the kids to return to school. It worked out well. Guess that's why we love the Plymouth/Canton area schools

 

[MrBrown]

What Mike might have to deal with would be "status epilepticus" rather than a "seizure" as in my education, the two are differentiated just like "asthma" and "status asthmaticus".

Diastat is PR diaz, it's a benzo like midaz which our ALS Paramedics use for stat ep, it's frickin great stuff and works wonders.

I am no expert on your FUBAR legal system but the dose in there is probably very low and not going to do any harm. Our system allows us to administer midazolam to a known seizure patient and provided they meet certain criteria to leave them at home so that should say something about risk right there.

Interestingly kids at school here are being loaded with auto injector adrenaline (epi-pen) in some sort of media fuel'd hype about nut allergies; I know one school where like 1/10th of the students have them! The common regurg line is "oh but Timmy only has five minutes to get adrenaline or he dies!" .... um, has Timmy HAD life threatening anaphylaxis before? Cue the blank stare and "whats that?".

 

[VentMedic]

Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

Did youi not read the list of "laws" for teachers in the different states I posted earlier? Post the "law" which states teachers can not give prescribed medications. This is absolutely not a "new thing". It just happens to be the first time MMiz has seen a child on the medication that he is responsible for during class time.

Forget the EMT cert if you have a higher responsibililty to students.

 

[MMiz]

I appreciate everyone's feedback on the issue, and I continue to work through it with my administration and available medical resources.

Vent, you keep saying that I need to forget that I'm an EMT while I'm at school. The truth is, I'm not part of the school's Emergency Response Team, and it's safe to say that few of my colleagues know of my background and involvement in EMS. Unfortunately it is quite clear, at least in my state, that I don't qualify as a lay person. I am held to a higher standard.

Unfortunately I've seen many of my teaching colleagues partake in the legal system due to their actions and acts of what I see as goodwill. It's essential for both my career and my well being that I ensure the safety of not only my students, but also myself.

 

[VentMedic]

Vent, you keep saying that I need to forget that I'm an EMT while I'm at school. The truth is, I'm not part of the school's Emergency Response Team, and it's safe to say that few of my colleagues know of my background and involvement in EMS. Unfortunately it is quite clear, at least in my state, that I don't qualify as a lay person. I am held to a higher standard.


Unfortunately I've seen many of my teaching colleagues partake in the legal system due to their actions and acts of what I see as goodwill. It's essential for both my career and my well being that I ensure the safety of not only my students, but also myself.

Knowing first aid and actually working under a medical director as an EMT are two very different things. Do you know how many people got an EMT cert just for general knowledge or because an ARC course was not available in their area? If you are not working directly under a medical director you are no more than a lay person or in this case a teacher in a school system which is a much higher standard as you have been trusted by the school system and the parents to do things a first aider aka EMT can not.

However, if your Medical Director is covering you while at school and you are receiving some compensation or it is specifically written into your school's job description that includes the word EMT and lists the responsible doctor for you, you are NOT an EMT at school unless you were hired as one. The other teachers may look to you for guidiance in some situations but that is the extent your EMT training should be. All the Paramedics serving burgers an McDonalds while waiting for a job at the FD are not held to a higher standard if someone chokes on a fry. When I moonlight as a bartender with both a Paramedic cert and an RRT license, I am still basically a lay person if someone falls off a bar stool injuring themselves.

Now, has this discussed amongst your fellow teachers and addressed at the state level? It is of little use to discuss it on an anonymous forum with the majority of the members not being at all in your situation and who only know the "EMT" scope of practice. Your responsibility as a teacher is much different and times are changing since the good 'ole days as kids are living longer with diseases they should have died from. For the past 20 years they have been entering the school systems and I have been very happy with the way I have personally seen the teacheres in my area accept them. They have been more than receptive to their changing roles. I seriously believe you are letting the very limited training the EMT has provided you blind you from seeing your changing role as an educator and caregiver for these students in your care. Educators are changing even if EMS never does. It is also very sad that the textbooks for EMS have not changed to reflect the needs of a changing community and patient population.