# Teachers Administer Glucagon, Why Can't You?



## MMiz (Aug 28, 2008)

This year I, along with many of our public school teaching staff, was trained on the administration of glucagon to our diabetic student population.

Our training, taking less than ten minutes, instructed us that when a diabetic patient went unconscious, we were to:
1.  Notify the office, who will notify EMS and parents.
2.  Retrieve glucagon from central storage location
3.  Put on gloves, while opening kit
4.  Take vial and swirl for 30 seconds, making sure "sugar cube" in bottom was dissolved
5.  Uncap needle, stick in vial, and invert vial
6.  Draw as much medication into the syringe as possible
7.  Remove air from syringe by pushing until no bubbles are visible
8.  Inject glucagon into fatty tissue around upper arm
9.  Place needle in sharps container.

I have significant concern about the procedure and the lack of detail.  Especially:

1.  Why weren't we checking for a patient's name, expiration date, and that we have the right meds?
2.  Shouldn't we rub the injection site with an alcohol swab?
3.  How far should we insert needle?  What if our student has no fatty tissue, what is a good backup site?
4.  What doctor's license are we operating under, and what are our liabilities?  North Carolina does not protect a Good Samaritan in the case of "gross negligence."  What if we really mess up?
5.  Our staff have absolutely no medical training, and we don't have an on-site nurse.  Isn't this asking a bit much?

Everyone, including the nurse, made it seem so routine.  What am I missing?


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## mycrofft (Aug 28, 2008)

*Is this a test?*

You pretty well sum it up. Why not oral glucose syrup followed by a PBJ or PBH sandwich? (Oh, and beverage...don't want an airway emabarassment).

This reminds me of the spineboard situation at my work. The mechanics are not difficult but the systemic ramifications may be. It can become a slippery slope. 

I know...let's create the EMT-T..."Emergency Medical Technicican-Teacher".


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## BossyCow (Aug 28, 2008)

mycrofft said:


> You pretty well sum it up. Why not oral glucose syrup followed by a PBJ or PBH sandwich? (Oh, and beverage...don't want an airway emabarassment).



Ummm maybe because it says 'when unconscious'?


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## mikie (Aug 28, 2008)

Whoa!  Teachers, who probably have no medical training (maybe CPR & AHA First aid), administering Glucagon?  A drug that majority of basics cannot administer (who have far more (not enough) training)?

I understand somewhat where they're coming from, but honestly, I think Glucagon is a step too far.  

Now maybe an Epi-Pen for the kids with the peanut allergies (as an AUTO INJECTOR)...but a needle and syringe?!  

Why wouldn't they just train the nurse and she can 'respond' to the location?


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## BossyCow (Aug 28, 2008)

mikie333 said:


> Whoa!  Teachers, who probably have no medical training (maybe CPR & AHA First aid), administering Glucagon?  A drug that majority of basics cannot administer (who have far more (not enough) training)?
> 
> I understand somewhat where they're coming from, but honestly, I think Glucagon is a step too far.
> 
> ...



First, I don't think that teachers should be administering the med, but in many schools the nurse is covering multiple schools and will probably not be on site when the event happens. 

More appropriate would be for the teachers to be trained on how to recognize the s & s of a diabetic emergency so that they get help on the way before the kid goes unconscious.


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## reaper (Aug 28, 2008)

How are they getting away with this? They are not licensed medical professionals, they are not under Medical Control. Has this been investigated with the state DOH? They could be setting themselves up for major legal and liability troubles!


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## firecoins (Aug 28, 2008)

Don't teachers sometimes have the power to recommend kids should be on ritalin?


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## mikie (Aug 28, 2008)

BossyCow said:


> but in many schools the nurse is covering multiple schools and will probably not be on site when the event happens.



Ah, didn't know that.  At my elementary schools each had their own nurse


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## mycrofft (Aug 28, 2008)

*I was unconscious! Sorry!*

du-oh!:blush:


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## zacdav89 (Aug 28, 2008)

Well they are also giving Narcan to drug users. Some states I know have good Samaritan law the include the use of an Epi-pen or the older kits that required the Epi to be drawn up then injected, as long as they had a formal training course. Maybe they should train the teachers to notice a diabetic emergency before it get to the point that the student goes unconscious so the use of Glucagon is not needed.


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## mikie (Aug 28, 2008)

Furthermore, an anxious teacher with no prior medical training or patient experience might be too 'jittery' to do it properly and somehow (maybe) 'botch' the administration or poke him/herself h34r:


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## Flight-LP (Aug 29, 2008)

mikie333 said:


> Whoa!  Teachers, who probably have no medical training (maybe CPR & AHA First aid), administering Glucagon?  A drug that majority of basics cannot administer (who have far more (not enough) training)?



While I do not completely agree with the idea (the RN scenerio would be more prudent), comparing a teacher to an EMT-B is unequivicable. An EMT also doesn't have much more medical training than first aid and absolutely no training in anatomy, physiology, chemistry, or microbiology. A teacher has all of them and then some, not to mention a minimum of a bachelors degree. No comparison in my mind.......................

If it came down to my child being unconscious secondary to acute hypoglycemia and I had to choose between her third grade teacher and an EMT-B, i'd take the teacher. And it really has nothing to do with medicine. 

Bottom line is Glucagon is a naturally occuring polypeptide hromone. It can be administered SQ, IM, or IV. Outside of known hypersensitivity, there is only one contraindication. The pharmacodynamics of the hormone only provides a minimal peak glucose release (usually around 130mg/dl) and the pharmacokinetics show a short half life averaging only 15 minutes. So bottom line, technical administration risk is low. Unless its given to a ketoacidotic patient or one in HHNK, the chance of side effects or a negative outcome is minimal. So either one could potentially give the drug safely. The difference being the security factor a child would have with their teacher or Principal vs. Joe EMT. Lets face it, one other area our EMS educators really fail at is interpersonal communication, especially with pediatric patients. I have seen very few EMT's, or Paramedics, that can effectively provide care for a pediatric patient at the emotional level. The child will be far more receptive to his / her safe environment in the school vs. with a strange looking EMT.

Lets not get upset for another profession being allowed to do something that a few of us want to do ourselves. We have this same argument over Nitroglycerin, Albuterol, and even Aspirin. Don't make a mountain over a molehill.............

Matt, you have valid concerns and I believe they should be addressed. Please share with us any updates you get............


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## Flight-LP (Aug 29, 2008)

zacdav89 said:


> Well they are also giving Narcan to drug users. Some states I know have good Samaritan law the include the use of an Epi-pen or the older kits that required the Epi to be drawn up then injected, as long as they had a formal training course. Maybe they should train the teachers to notice a diabetic emergency before it get to the point that the student goes unconscious so the use of Glucagon is not needed.



That's not always possible and you know that. There are too many factors involved. Instead of trying to work around the solution, work on properly initiating the solution. It is being done, teachers are giving it, that is that. Instead of acting like typical EMT's and griping about it, perhaps we could help and educate our educators to ensure a safe outcome. Its not about us, we have got to stop thinking that way!

Also, I am curious to see verifyable evidence showing that schools (or any medical professional for that matter) are handing out Narcan to drug users. Sounds a little peculiar to me...........................


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## mikie (Aug 29, 2008)

Flight-LP said:


> . An EMT also doesn't have much more medical training than first aid and absolutely no training in anatomy, physiology, chemistry, or microbiology. A teacher has all of them and then some, not to mention a minimum of a bachelors degree. No comparison in my mind.......................
> 
> If it came down to my child being unconscious secondary to acute hypoglycemia and I had to choose between her third grade teacher and an EMT-B, i'd take the teacher. And it really has nothing to do with medicine.



The educational background of the teacher is situational (though hopefully all teachers do/should have a minimum of a BA).  And you do make a good point about comparing the two.  Perhaps teacher probably does have more experience with children as does a NEW EMT.  But say you have a veteran EMT (or even a higher level provider) versus your everyday school-teacher, do you really think the teacher (assuming s/he has no medical background) is prepared for the emergency?  As EMTs of all levels, we at least have an idea (or supposed to) of what we are doing and how it is supposed to help.  It is sad when EMTs do not know why a med is administered.  "Hypoglycemic?  I guess Glucagon will do!"  -The EMT should know all of what you later stated in your post (to some extent), about it being a naturally produced hormone.  Indications/Contra/etc.  The teacher probably  only knows, "Unconscious and has hx of diabetes?  I guess Glucagon will do!"

Just my thoughts, always subject to being horribly wrong.


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## reaper (Aug 29, 2008)

I still want to know the legal aspect of this? Glucagon is a prescribed medication that needs a Dr's over-site. We as Paramedics are extender of the MD's license and have over-site by the MD.
A teacher has no state license to administer a medication. So, did the school system find a Medical control Dr.? Did the state issue some kind of special medical license to teachers? These are all legal questions that I would like to know, for my own knowledge.

BTW- My kids third grade teachers have no medical background or knowledge of medicine. Not all teachers take micro or A&P. If they are not a dedicated science teacher, most have never taken these classes.


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## Flight-LP (Aug 29, 2008)

reaper said:


> I still want to know the legal aspect of this? Glucagon is a prescribed medication that needs a Dr's over-site. We as Paramedics are extender of the MD's license and have over-site by the MD.
> A teacher has no state license to administer a medication. So, did the school system find a Medical control Dr.? Did the state issue some kind of special medical license to teachers? These are all legal questions that I would like to know, for my own knowledge.
> 
> BTW- My kids third grade teachers have no medical background or knowledge of medicine. Not all teachers take micro or A&P. If they are not a dedicated science teacher, most have never taken these classes.



Perhaps Matt can comment on the legal stuff, I couldn't tell you. I know my children's school district has a physician on staff that delegates all orders throught the nursing and professional staff.

Regardless of the degree or specialty, every Bachelor's level program I have ever seen requires a minimum of 8 hours of post-secondary science. Many do require Biology. The point being is that a teacher is an educated and degreed professional with a strong sociological, educational, and psychological background and a specific understanding pertaining to the growth and development of the child. An EMT-B and most EMT-P's do not. So in that respect, yes they are in my belief more qualified to administer this particular treatment as opposed to an EMT-B, new or veteran.


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## reaper (Aug 29, 2008)

I agree on that one. I do not think EMT-B's should be able to administer it either.


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## Buzz (Aug 29, 2008)

Flight-LP said:


> Perhaps Matt can comment on the legal stuff, I couldn't tell you. I know my children's school district has a physician on staff that delegates all orders throught the nursing and professional staff.
> 
> Regardless of the degree or specialty, every Bachelor's level program I have ever seen requires a minimum of 8 hours of post-secondary science. Many do require Biology. The point being is that a teacher is an educated and degreed professional with a strong sociological, educational, and psychological background and a specific understanding pertaining to the growth and development of the child. An EMT-B and most EMT-P's do not. So in that respect, yes they are in my belief more qualified to administer this particular treatment as opposed to an EMT-B, new or veteran.



Many require biology, but unless it particular pertains in some way to human physiology or disease processes, I don't see how it makes any difference. Botany is a type of biology--would you consider that useful in regards to this topic (especially considering than an introductory level course would likely meet the requirements)?


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## Clibby (Aug 29, 2008)

Flight-LP said:


> While I do not completely agree with the idea (the RN scenerio would be more prudent), comparing a teacher to an EMT-B is unequivicable. An EMT also doesn't have much more medical training than first aid and absolutely no training in anatomy, physiology, chemistry, or microbiology. A teacher has all of them and then some, not to mention a minimum of a bachelors degree. No comparison in my mind.......................
> 
> If it came down to my child being unconscious secondary to acute hypoglycemia and I had to choose between her third grade teacher and an EMT-B, i'd take the teacher. And it really has nothing to do with medicine.
> 
> ...



You are aware that elementary school teachers are only required to take one science course to be certified in most states? This course can be in biology, chemistry, intro to science, geology, astronomy etc. I wouldn't call that a background if I were you and I am going to have to completely disagree with your reasoning. I would trust any EMT who has worked for a month and has seen diabetic emergencies over a teacher of even 30 years. Very few teachers in elementary schools, where the students can't monitor themselves, have taken anything past biology 101 (same as high school bio with most of it being about plants and animals, very little human anatomy to be honest). 

I'm not saying that I am for or against teachers administering glucagon, especially with such a low risk, but if teachers are administering it, EMT-B's should be as well. As of now, if our diabetic goes unresponsive and we have a blood sugar of 11, we have to wait for ALS to intercept. With glucagon, we could have the opportunity of getting him alert enough in a few minutes for oral glucose.


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## VentMedic (Aug 29, 2008)

Learning the skill should not be an issue. Teachers are usually alerted to children in their classes that have special medical conditions. The teachers may also recognize any change in their students fairly quick. I see no more of an issue with this than allowing the child to administer their own albuterol inhaler. That, too, was forbidden for many years until the number of dead kids started to add up. 

With the proper medical information provided to the teacher along with how to perform a quick assessment and perform the skill, I see rapid intervention as a benefit. As previously stated, pediatrics is one of the weakest and most uncomfortable areas for EMTs and Paramedics. This is not so for teachers who have spent at least 4 years in college preparing to work with children. 

Egos should be put aside and who cares who has more sciences since very little education is required for entry into EMS. Don't throw stones when your own house is made of glass.


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## Flight-LP (Aug 29, 2008)

Clibby said:


> You are aware that elementary school teachers are only required to take one science course to be certified in most states? This course can be in biology, chemistry, intro to science, geology, astronomy etc. I wouldn't call that a background if I were you and I am going to have to completely disagree with your reasoning. I would trust any EMT who has worked for a month and has seen diabetic emergencies over a teacher of even 30 years. Very few teachers in elementary schools, where the students can't monitor themselves, have taken anything past biology 101 (same as high school bio with most of it being about plants and animals, very little human anatomy to be honest).
> 
> I'm not saying that I am for or against teachers administering glucagon, especially with such a low risk, but if teachers are administering it, EMT-B's should be as well. As of now, if our diabetic goes unresponsive and we have a blood sugar of 11, we have to wait for ALS to intercept. With glucagon, we could have the opportunity of getting him alert enough in a few minutes for oral glucose.





			
				buzz said:
			
		

> Many require biology, but unless it particular pertains in some way to human physiology or disease processes, I don't see how it makes any difference. Botany is a type of biology--would you consider that useful in regards to this topic (especially considering than an introductory level course would likely meet the requirements)?



Again, what post secondary sciences and education does the average EMT bring to the table???

You both are hitting on a point that is of minor consequence to my point. And my perception of your responses is one of self servance. You cannot actually tell me you believe that a stranger, one with minimal training and education, can be more beneficial in a specific treatment, than one who has an emotional, psychological, and sociological bond with the child. The treatment itself aside, do either of you really believe it serves a better purpose for the pt. if the EMT administers it? Other than a personal wanting to perform a medication administration. Do you believe the child will place more trust in you vs. his/her teacher? That is my point..........................


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## MMiz (Aug 29, 2008)

firecoins said:


> Don't teachers sometimes have the power to recommend kids should be on ritalin?


As a teacher in two states, I can tell you that I'm not even allowed to hint at medicating a condition.  I've attended countless parent meetings where I would have loved to make the suggestion, but it's not my place.


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## MMiz (Aug 29, 2008)

To address multiple issues:

In order to be "highly qualified" as a middle school or high school teacher, you must have a full degree in what you teach, many education classes, and then an assortment of general education credits.  I've taken a biology course and lab while in college, even though it has nothing to do with my subject.  I don't think that additional biology courses would assist me in this situation, though I found my EMT-Basic course gave me a good foundation of knowledge.

We have orange juice, juice boxes, and glucose tabs in our rooms if the student is conscious.  I'm not about to load an unconscious patient up with glucose tabs and pray I don't create an airway obstruction.

Prior to the training I spent a lot of time searching the internet, and found that teachers administer glucagon in almost every state, including those with strong unions.  There have been issues where a parent has sued, but it has always been covered under the Good Samaritan law.  Unfortunately there have been many general cases on LEXIS-NEXIS where the Good Samaritan law did not cover a person in cases of gross negligence.

The reasoning for allowing teachers and trained personnel to administer the glucagon is the consequences for not administering it promptly.  Possible brain damage is a heavy price to pay for having a diabetic emergency.


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## Flight-LP (Aug 29, 2008)

MMiz said:


> The reasoning for allowing teachers and trained personnel to administer the glucagon is the consequences for not administering it promptly.  Possible brain damage is a heavy price to pay for having a diabetic emergency.



Risk vs. benefit analysis, that seems like sound reasoning and justification to me. It is nice to see this type of offering available to our students, especially those with a known potential need................


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## firecoins (Aug 29, 2008)

Flight-LP said:


> If it came down to my child being unconscious secondary to acute hypoglycemia and I had to choose between her third grade teacher and an EMT-B, i'd take the teacher. And it really has nothing to do with medicine. .



Really? I have a B.A. in economics.  I took a microbiology class and a neuroscience class. With that education in mind, I would be as useless as a brick in an emergency situation. I would trust an experieced EMT over a master's level teacher any day.  It has nothing to do with medicine either.  Education by itself is meaningless if one panicks.  Experience in delaing with a emergency situations means alot.


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## firecoins (Aug 29, 2008)

MMiz said:


> As a teacher in two states, I can tell you that I'm not even allowed to hint at medicating a condition.  I've attended countless parent meetings where I would have loved to make the suggestion, but it's not my place.



Its why I asked instead of "informed".  I just "heard" things.


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## firecoins (Aug 29, 2008)

Flight-LP said:


> Again, what post secondary sciences and education does the average EMT bring to the table???


 I beleive Science classes should be required for EMTs. Science classes are pre-requisite classes for medical training.  They are not medical training though.



> You cannot actually tell me you believe that a stranger, one with minimal training and education, can be more beneficial in a specific treatment, than one who has an emotional, psychological, and sociological bond with the child.


How do emotional bonds qualify someone to give glucagon?  They don't.  It usually qualifies them to panick.   



> The treatment itself aside, do either of you really believe it serves a better purpose for the pt. if the EMT administers it? Other than a personal wanting to perform a medication administration.


If a patient is unconscious and is hypoglycemic, yes an EMT should be able to do it. Or EMT should call for a medic.  He shouldn't call for a teacher, even if that teacher has a master's degree compared to the medics A.A.S.



> Do you believe the child will place more trust in you vs. his/her teacher? That is my point..........................



We should let a teacher with no medical training administer a drug because the unconscious, hypoglycemic child possibly trusts tham over someone with minimal training and experience in dealing with emergencies whom the child has never met.  Right.


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## Clibby (Aug 29, 2008)

Flight-LP said:


> Again, what post secondary sciences and education does the average EMT bring to the table???
> 
> You both are hitting on a point that is of minor consequence to my point. And my perception of your responses is one of self servance. You cannot actually tell me you believe that a stranger, one with minimal training and education, can be more beneficial in a specific treatment, than one who has an emotional, psychological, and sociological bond with the child. The treatment itself aside, do either of you really believe it serves a better purpose for the pt. if the EMT administers it? Other than a personal wanting to perform a medication administration. Do you believe the child will place more trust in you vs. his/her teacher? That is my point..........................



Yes I do, and no it has nothing to do with my ego. I have no need to defend my basic position, I am just not comfortable about handing out any drug to someone who doesn't use it frequently enough to make them proficient. Yes I also believe that basics need more training, up to EMT-I, and there should only be two levels, but that is neither here nor there. This situation comes down to pt care.

As to your point, a teacher does not have experience in emergencies, they have no medical background, and they have that bond with the child. I count all those as negatives. Have you ever seen a teacher in an emergency? They tend to panic around their kids because they know them and their families. This is the same reason why doctors cannot treat family members. Knowing a pt causes you to second guess yourself and panic because you know what could happen. Without experience these emotions can often take over. Not to mention that a teacher may only need to do this once or twice in their career. If the child is unconscious then s/he isn't going to care who gives him/her anything. Its when they come to that they could be frightened and why would the teacher/nurse/school official leave the child alone? Do we say that a mother should treat a child over a paramedic because they know them? No, we say that the mother should be right there with the paramedic to make the child calm.

An EMT isn't going to freeze up, is going to administer the medication more often, and is going to know what the medication does. Just because a teacher may or may not have taken Bio 101 8 years ago doesn't mean that they know how the glucagon affects a child's metabolism, cells, etc. They know it raises blood sugar. A teacher could have a biology major and a chemistry major, but they both mean nothing. Classes mean nothing without the medical background to connect the dots, especially basic science classes. They can help, but the only one that really matters in EMS is A&P (cell bio can help too, but it isn't as useful as A&P). EMTs learn the basics of how their drugs affect a pt and con eds help reinforce that. They also will use the medication every week and know how to administer it properly recognizing the signs better.

I'm not saying it is a bad idea to let teachers give glucagon (I don't really like it), but you cannot tell me that a teacher is more qualified to administer a medication than a professional that deals with emergencies every day.


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## Ridryder911 (Aug 29, 2008)

I am shocked that states would allow a teacher to administer anything. My sister retired last year after 45 years as a teacher and this will not even allow them to administer a Tylenol. Unless it is a prescribed medication (pill form) usually then if the school has a school nurse to administer them. 

Here's my suggestion, teach the educators the s/s of hypoglycemia and enforce preventative measures before Glucagon has to administered. As well, teach them how and when to call 911. Allow the Paramedics to administer the medication, the same goes for the basics that just has above the advanced first aid training. 

R/r 911


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## VentMedic (Aug 29, 2008)

Clibby said:


> An EMT isn't going to freeze up, is going to administer the medication more often, and is going to know what the medication does. Just because a teacher may or may not have taken Bio 101 8 years ago doesn't mean that they know how the glucagon affects a child's metabolism, cells, etc. They know it raises blood sugar. A teacher could have a biology major and a chemistry major, but they both mean nothing. Classes mean nothing without the medical background to connect the dots, especially basic science classes. They can help, but the only one that really matters in EMS is A&P (cell bio can help too, but it isn't as useful as A&P). EMTs learn the basics of how their drugs affect a pt and con eds help reinforce that. They also will use the medication every week and know how to administer it properly recognizing the signs better.
> 
> I'm not saying it is a bad idea to let teachers give glucagon (I don't really like it), but you cannot tell me that a teacher is more qualified to administer a medication than a professional that deals with emergencies every day.


 
That depends on the EMT. As I stated before, this is the weakest area for EMT and it is barely covered in class. Even age appropriate behavior is not really stress but rather mentioned or skimmed. EMT is still only an entry level certificate which covers many of the same things one can get through a few ARC classes also. Not all EMTs run high volume emergencies either and especially those dealing with children. 

A call for a child down is an emotional one and quite possibly it will be the teacher who will be the calm one and a better assessor of the situation.

Do you know how many medical needs children there are now in the school systems that teachers deal with every day? Many EMTs or Paramedics will not even see this type of patient or if they do it will be very infrequently. I know RNs and RRTs have assisted school systems get better prepared to deal with children with asthma, trachs, colostomies, feeding tubes and diabetes. Yes, in some systems the teachers even assist suctioning the trachs. 

I personally would put more faith into a teacher who had the discipline to go through 4 years of college to work with children and who sees the children everyday as opposed to an EMT with 110 hours of training with little pediatric knowledge or experience. Some teachers in the athletic departments do have much more training and education than an EMT-B in first-aid as it is part of their curriculum. Other programs may have at least a class of safety and first-aid built into their programs. My degree (College of Education) in Exercise Physiology covered many more medical conditions and treatment than most paramedic schools. 

Attempts to justify why a highly educated person comfortable with children can not perform a skill on a student with a known medical condition are still ego based. EMT-Bs have even been taught advanced skills such as ETI with very little education or training to back them up.

Rid, 
We said the same thing for Albuterol inhalers. Look where that got us or should I say the unfortunate dead children that neither the students or their teachers had access to this med.


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## Flight-LP (Aug 29, 2008)

firecoins said:


> I beleive Science classes should be required for EMTs. Science classes are pre-requisite classes for medical training.  They are not medical training though.
> 
> How do emotional bonds qualify someone to give glucagon?  They don't.  It usually qualifies them to panick.
> 
> ...



O.k. look at it this way, you have two options, an EMT-B or a teacher. Option one is to call 911, wait who knows how long for an EMT to show up, just to realize that ohh, we can't give that medicine. Now you get to wait for ALS to show up to treat. Better yet, you have a vollie service that is insufficently staffed and takes 15 minutes to get en route. OR option B which is to have a teacher who is authorized to administer the medicine give it right away. Doesn't seem like a difficult decision. See the difference is they can, you can't. All other is immaterial. I still stand by my thought and belief, feel free to disagree with it, it wouldn't be the first. Heck it won't be the last. I do enjoy debating with you though, you put up a good fight!


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## Flight-LP (Aug 29, 2008)

I will also be as bold to say that in the several hundreds of times I have responded to a school, I have actually seen very little panicking on the part of the educational staff. Now ask me how many times I have seen an EMT wig out on scene (or a paramedic for that matter)....................................................


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## VentMedic (Aug 29, 2008)

The piece of legislation to give teachers access go glucagon was not just random or made up one day by a groups of teachers in a lunch room. It did have the support from professional organizations involving Physicians and Nurses. This also goes along with the support these groups have given to establishing access to AEDs and O2 in the school systems and public places. Health professionals have long supported community education for CPR and choking. Repiratory Therapists, RNs and MDs fought a battle that lasted over 10 years to allow children access to their inhalers and epi-pens in the schools. It is still being fought in a couple of states (Colorado is one) but at least the other 48 recognize the benefit. 

So, why is it that EMS seems to be the only group that is against public education or lifesaving procedures done by others? It is unfortunate, and embarrassing, that EMS did not have representation when some of these bills were being presented. Some of the Florida paramedics made the same statements that Rid did when Albuterol inhalers and epi-pens were being discussed. 


> As well, teach them how and when to call 911. Allow the Paramedics to administer the medication, the same goes for the basics that just has above the advanced first aid training.


 
If one can not breathe, 4 minutes is a long time. The same with diabetic emergencies. You can make statements about being proactive but kids will want to be active and not just sit there for you to watch their actions 100% of the time. We have long encouraged children not to look a their medical problems as a reason to avoid "life as a child". We have educated them to be as normal and possible and have enlisted the support of the teachers to make this happen. 

The difference from an EMT-B coming across an emergency and a teacher, is the teacher already knows what medical problems his/her student has. The teacher also knows a normal baseline for the child. Some of the disease processes/disorders the child has may not have ever been covered in EMT school. Thus that could be a distraction for the EMT. The teacher will probably have been informed about the student's medical condition and usually in detail. Parents are funny that way in knowing there is someone looking out for their kids when they are not around. 

We have also educated teachers about trachs, colostomies, ventilators and feeding tubes. Parents with no medical background, and at times little education, are trained to take home their babies with all of those gadgets for care 24/7. 

Some thought an AED was beyond the ability of the lay person or even an EMT-B at one time. 

As a carry over from the sexual assault thread, we (RNs, RRTs, and MDs) have lobbied for oxygen to be placed on dive boats, gyms, schools and other public places. We have encouraged employees in those areas to take a class in O2 administration and they can deliver O2 without many risks. There are also some myths that need to go away like "never give more than 2 L NC to a COPDer" no matter what the problem or how the patient presents. Some will still argue that with an SpO2 of 70% the hypoxic drive will shut down and will bring a very hypoxic pt to the ED on 2 L NC. Then they will try to justify their actions "by the protocol" that oxygen is harmful. 

EMS is also always complaining about how over burdened they are and they will admit that they may even be tied up with another call when something serious comes across the radio and the next available truck is several more minutes away. How many times do we here about a truck breaking down or getting into an accident enroute?  Why play Russian Roulette with a child's life if teachers can be trained to start the lifesaving? 

Give kids a chance to grow up to be adults. Put your egos aside and assist in the education and/or lobbying for faster access to lifesaving procedures. This is not to bypass EMS but rather to get some type of treatment started before the EMTs/Paramedics arrive.


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## Clibby (Aug 29, 2008)

VentMedic said:


> A call for a child down is an emotional one and quite possibly it will be the teacher who will be the calm one and a better assessor of the situation.
> 
> Do you know how many medical needs children there are now in the school systems that teachers deal with every day? Many EMTs or Paramedics will not even see this type of patient or if they do it will be very infrequently. I know RNs and RRTs have assisted school systems get better prepared to deal with children with asthma, trachs, colostomies, feeding tubes and diabetes. Yes, in some systems the teachers even assist suctioning the trachs.
> 
> ...



I am not advocating that EMT-B's should or should not be able to administer the drug without the proper education, I am saying that teachers are not qualified with the training they have or the legal problems behind it. Gulcagon is a lot like epi in that it is naturally occurring, minimal complications, and life saving, yet still requires an ALS intercept. I believe it should be in an auto-injector form for use by EMT-Bs just like oral glucose, but a lot of things need to be changed. (Yes I know they don't exist because glucagon cannot last long in water, but it shouldn't be hard too engineer one that activates the injector just before use. Idea, hmm...) Again I think the EMT training needs to be addressed at all levels, but that is a different subject.

If some teachers are trained higher than an EMT, test and certify them to protect the children and the teachers legally; don't give them meds because the have a college degree. A college degree really isn't much. Anyone can get them these days online or at a state university, it just take the money pay for it. Don't try and tell me that it makes someone more experienced in something other than what they majored in. You majored in physiology, so of course it will prepare you for a field relating to the body. Someone with a history degree or even a chemistry degree knows very little about how things interact with the body without specializing in it or using it in something medical that they do everyday. 

You are using your degree to justify your argument. How many elementary and middle school teachers have a degree in physiology? Most have a general education degree or a BA in their area of expertise; i.e. history, biology, etc. Some teachers are calm enough to *assist* a nurse with pediatric emergencies, but most are not. Furthermore, teachers with regular experience tend to be in urban environments; rural teachers see very little, especially when there is a school nurse. Which brings me to my biggest problem with the whole situation: where is the school nurse who is qualified during all this? Rather than give teachers meds, give them a refresher on how to recognize the signs and symptoms of hypoglycemia in order to alert the school nurse and/or 911. It comes down to training and if teachers are going to be allowed to do this, train them how, don't just hand it out. I'm all for getting other professionals involved in the EMS system, but train them in how it all works and the consequences of what they are doing. I don't want some Joe shmo teacher treating my child, I want one who is trained and knows what he is doing.


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## Flight-LP (Aug 29, 2008)

VentMedic said:


> So, why is it that EMS seems to be the only group that is against public education or lifesaving procedures done by others?



Because it impedes on the egocentric arena that EMS calls their own. Unfortunately, they can't control it and have yet to obtain professional status with it. So round and round we go...............It's really a sad situation if you think about it. The very same people who say they advocate for the patients and their community are the ones fighting it tooth and nail.

I am so glad that I live in a region where this self centered egoism does not factor into the delivery of health care.....................


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## RESQ_5_1 (Aug 29, 2008)

As near as I can tell, EMT-B's are esentially useless. I guess there should only be one level. That way, every ambulance has two EMT-Ps that can perform every EMS skill in the way it should be performed. We could require 4 year degrees of those EMT-Ps. Then, we could require them to do a minimum of 200+ hours of Con-Ed/ year to keep their certification. 

EMT-Bs could exist, I suppose. Someone has to drive the rig. 

I keep seeing repeated posts of how EMT-Bs are allowing their egos to override their common sense over this. But, it seems to me that the EMT-Ps are, in a way, almost bragging about their training and skill sets. Maybe it would be a good idea if those that had the training and education reined in their egos a bit and tried to assist the EMT-Bs to become more profficient at their job. 

Regardless of the amount of education you now possess, everyone starts at the same point. And, not everyone has access to the same resources to be able to continue their education.


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## VentMedic (Aug 29, 2008)

Clibby said:


> I am saying saying that teachers are not qualified with the training they have or the legal problems behind it.


 
Did you read anything I just wrote?

This just isn't pulled out of their arse one day and the teachers decide they are going to give glucagon.

There are physicians, nurses and lawyers on the state boards that determine the efficacy and legal implications for their teachers. 

How much education do you think an EMT-B has to give one this feeling of superiority when it comes to the life of a child? 

Maybe you should broaden your own education in pediatric emergencies or just school age children in general before you make such judgements against teachers.



> If some teachers are trained higher than an EMT, test and certify them to protect the children and the teachers legally; don't give them meds because the have a college degree. A college degree really isn't much.


 
I think this statement sums up your lack of understanding of the situation. Usually those without education are the first to criticize those with.

Many people have the same equivalent training of an EMT if not much more within their education or job requirement even if they are not "EMTs". Coal miners, factory workers, off shore fishermen and coaches are all examples of this. They have this training to treat a co-worker and not to stroke their ego with a "cert" or patch.


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## reaper (Aug 29, 2008)

Vent,

I asked earlier on how this is being done legally. I understand there are Dr's and nurses involved with the school boards and lawyers at the state level. My question was this: Glucagon is a prescribed med that must have over-site by an Md. The Nurses have a legal license to administer the drug, under a Dr's orders. How are they getting by the DOH regulations? Teachers have no medical license to administer meds. Even a Paramedic is licensed to administer meds, as an extender of the Md's license.

This is the one question I had. I would search it out, but have no clue which state or school system Matt is with. I've been waiting for Matt to come by an try to answer this.


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## VentMedic (Aug 29, 2008)

I know in Florida, for inhalers and epi-pens, this information is known by the teachers and the children have known scripts. Essentially the teachers are assisting the child in administering what they themselves or their parents would be giving in case of an emergency. I seriously doubt a teacher would be giving anything if the condition was not known. 

Teachers who do instruct technology dependent children do have special training and are able to do what is necessary to maintain the "normal" function of that child during the time they spend with them in class. 

Public access for emergency O2 and AEDs were taken through special legislation such as the FDA Fresh Air 2000 for O2.

Edit:
Good new thread just started:
*AED in Oklahoma Schools*


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## Clibby (Aug 29, 2008)

VentMedic said:


> Did you read anything I just wrote?
> 
> This just isn't pulled out of their arse one day and the teachers decide they are going to give glucagon.
> 
> ...



I don't know, maybe I've had bad experiences with teachers and their incompetency, but I still don't believe in allowing them to give meds without the proper training. They still need to be trained in CPR & AED, so why not certify them in Epi and Gucagon administration? This covers them legally and ensure that they not only can administer it properly, but that they are ready for the responsibility. Again though, where is the school nurse during this?

I also think you misunderstand my intentions. I am not advocating to rip this away from teachers or just give EMT-Bs glucagon. Glucagon won't hurt if administered properly. I believe EMT-B should be a 1 year program. They need more training because as of now they are essentially useless in MA. I also believe that EMT-I needs to go and basics should be trained to an EMT-I type level. I am just stating my objections to teachers being given tools without knowing how to use them. A quick response is necessary, but if screwed up, it can cause harm. I have delt with children quite a bit and I know how it can be difficult to notice a change in a child if you don't have a baseline, but treating that change without knowing how is just irresponsible and legally questionable.

I can see your lack of trust in EMT-Bs, but that doesn't mean our opinions are baseless. We deal with people everyday, just like paramedics, we just don't have the tools or training to treat them yet. Giving teachers glucagon without a cert is no different than giving an EMT-B glucagon. Glucagon won't hurt, but often neither of them fully understand how it works. 

As for the coal and factory workers, yes they know first aid, but they aren't using sharps. Commercial boats have MPICs. There is always someone who has some training in first aid. Knowing the people around me, I don't like the idea of Joe Schmo treating my friends and family.


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## firecoins (Aug 29, 2008)

Flight-LP said:


> O.k. look at it this way, you have two options, an EMT-B or a teacher. Option one is to call 911, wait who knows how long for an EMT to show up, just to realize that ohh, we can't give that medicine. Now you get to wait for ALS to show up to treat. Better yet, you have a vollie service that is insufficently staffed and takes 15 minutes to get en route. OR option B which is to have a teacher who is authorized to administer the medicine give it right away. Doesn't seem like a difficult decision. See the difference is they can, you can't. All other is immaterial. I still stand by my thought and belief, feel free to disagree with it, it wouldn't be the first. Heck it won't be the last. I do enjoy debating with you though, you put up a good fight!



If you justification is a matter of time, why not let the EMT do it also? Therefore he doesn't have to wait for a medic to arrive. The medic may be covering a larger area than the EMT's area and have a response time to prove it.


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## VentMedic (Aug 29, 2008)

It doesn't take much of an internet search to find out there is support for this.

http://www.diabetes.org/uedocuments/GlucagonLifeSaverStories02-06.pdf

http://www.doh.state.fl.us/family/dcp/school/glucagon.pdf

New York
http://www.emsc.nysed.gov/sss/HealthServices/fieldmemo-glucagon-JAK-JDP.htm

Virginia

http://www.doe.virginia.gov/VDOE/Instruction/Health/insulin-glucagon.pdf



Teachers must keep up their teaching credentials, stay current with updates in their profession and pay attention to the special or medical needs of their students. The majority have accepted these responsibilities knowing the children depend on them.

Many EMT-Bs will remain EMT-Bs with only 110 hours of training. Some shun the thought of going to college for even an A&P class or any other book learning. Even the required CPR and renewal CEUs are an annoyance to some. This is even with the knowledge that it could be helpful for patient care. 

by firecoins


> If you justification is a matter of time, why not let the EMT do it also? Therefore he doesn't have to wait for a medic to arrive.


 
EMTs would require more education and they would have situations which are unknowns whereas the teacher has access to the student informatiom.

by clibby


> Commercial boats have MPICs. There is always someone who has some training in first aid. Knowing the people around me, I don't like the idea of Joe Schmo treating my friends and family.


 
I'm not talking about big freighters but dive, tour and fishing boats, both for tourists and smaller scale commercial.

It is sad that you are not proactive for the community to learn CPR and other lifesaving procedures. You, the EMT, may not always be around to save the day.


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## BossyCow (Aug 29, 2008)

Whoa... who said that EMS in general is against training teachers in lifesaving treatments???? Are we jumping on a bandwagon here before we even know the key the band is playing in or where the horses are taking us???

I have repeatedly seen in here EMTs being bashed for even suggesting that someone without extensive training in A&P and Pharmacology even thinks about giving a shot or even for sticking someone with a sugar monitor. But apparently that all changes on a whim. 

Either a lifesaving med should be administered in an emergency situation, or it shouldn't. Whoever gives it should know what they are giving and why. They should be trained on the indications and contra-indications of the med. They should be aware of the risks and they should be covered liability-wise for when those risks are taken during the course of employment. 

I remember sitting in a school board meeting while a friend who had an 8yo with a severe allergy to beestings begged the school to reconsider their policy that epi-pens must be locked in the office. 

I helped another friend write a letter to the same school board informing them of the liability the school would incurr if they insisted on forbidding the teacher in the special needs class from calling 911 herself instead of calling the office and going through channels. This mother had a child with an immune deficiency that caused respiratory arrest. The teacher was told not to initiate CPR until after she called the office staffed by a high school student volunteer who would then find a staff member who would determine if 911 was to be called. 

Yes we've made progress since those days. But lets not go too far in the opposite direction. The key is not are teachers better suited to adminster meds than EMTs. But is the person administering the med trained and competent in the skill.

I personally find arrogant and offensive, the implication that the obtaining of a 4 yr degree in any field constitutes a higher level of intelligence than average. I've known some teachers that I wouldn't trust as far as I could throw them. and to assume that they are going to a, not panic. b, remember the skill and c. perform it adequately is a leap I'm not willing to risk a child's life on.  SOME teachers are idiots. SOME EMTs are the same. To blanket the entire profession with a license to give meds is ludicrous.


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## VentMedic (Aug 29, 2008)

BossyCow said:


> To blanket the entire profession with a license to give meds is ludicrous.


 
What profession are you talking about here? License?

Some here are mistaking "assisting" a student with a prescription or doing what a parent would do with practicing medicine. 

This is a common mistake some EMTs make when their statutes say "assist" patient with the administration of their medication.


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## Clibby (Aug 29, 2008)

VentMedic said:


> I'm not talking about big freighters but dive, tour and fishing boats, both for tourists and smaller scale commercial.
> 
> It is sad that you are not proactive for the community to learn CPR and other lifesaving procedures. You, the EMT, may not always be around to save the day.



Aren't those individuals just good samaritans? 

Anyway, yes I would like the community to be more certified. My agency sponsors multiple CPR classes each year, donates AEDs to local businesses, and constantly makes appearances at local schools, but you can't do anything if people just don't want to learn. Most classes have the same people show up and are usually around 5-8 people, for a free class! 

You can be as proactive as you want, but that won't force people to listen and learn. That is why if you are going to give a med to a teacher, you should be certain that they learn how to use it. That is all I have said this whole time. Most won't go out and learn themselves without some incentive. Its no different than giving the drug to a physical theripist, or a manager in the workplace, or even a babysitter unless there is some training and upkeep behind it, just like CPR. If you can allow teachers to give it, I see no reason why an EMT-B should not, especially if the training is built into their curriculum and CEUs. It is about assuring that the person giving the drug knows what they are doing.


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## reaper (Aug 29, 2008)

VentMedic said:


> What profession are you talking about here? License?
> 
> Some here are mistaking "assisting" a student with a prescription or doing what a parent would do with practicing medicine.
> 
> This is a common mistake some EMTs make when their statutes say "assist" patient with the administration of their medication.




But, We are not talking about assisting a student with their medication administration. We are talking about an unconscious pt. If they are conscious, then they can assist with oral glucose or food.

If they are unconscious, would this not be considered administering a medication on their judgment only?

P.S.- Guys lets keep this on a learning level, not bashing. I think this is a good subject to be discussed.


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## firecoins (Aug 29, 2008)

VentMedic said:


> EMTs would require more education and they would have situations which are unknowns whereas the teacher has access to the student informatiom.



This brings up 2 things.

1 Why can't emts receive this training?  Because they may be annoyed?  So what?  How do you justify not giving the EMTs the extra training? I fail see why EMTs can not get this extra training.  And you can not say A&P is necessary because teachers are not required to have A&P in this scenario either.  

2. How are teachers qualified to give injections of medications? NYS teachers have less medical training than EMTs get.  Having access to student info doesn't make them more qualified. Teachers may get a CPR class at best.   I think EMTs should be able to give glucagon if a teacher can.  Teachers may have a bachelor's and a master's in education but have way less than 110 hours of medical training and there is no medical experience gained by simply teaching.


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## VentMedic (Aug 29, 2008)

Continued:
FLorida
http://www.doh.state.fl.us/family/School/reports/DiabetesGuidelines2003.pdf

California
http://www.csno.org/docs/2007%20Glucagon%20for%20Emergency%20TX.pdf

Tennessee
http://www.tennessee.gov/sbe/Policies/4.205 Use of Health Care Professionals.pdf


http://www.cnn.com/2003/EDUCATION/06/08/diabetes.schools.ap/


> At least five states -- Virginia, North Carolina, Washington, Tennessee and Wisconsin -- have laws or executive orders to provide some coverage for diabetic youngsters where there are no school nurses. Most involve administration of glucagon, which poses no health risk. Only Virginia *allows non-medical personnel to be trained to administer insulin*.


 
Seems like this is nothing new as many of the policies date back 10 years. 




firecoins said:


> 2. How are teachers qualified to give injections of medications? NYS teachers have less medical training than EMTs get. Having access to student info doesn't make them more qualified. Teachers may get a CPR class at best. I think EMTs should be able to give glucagon if a teacher can. Teachers may have a bachelor's and a master's in education but have way less than 110 hours of medical training and there is no medical experience gained by simply teaching.


 
Teachers aren't going to be running around the streets looking for patients. They know their students. The reasons they are doing this is different. If the child was at home, the parents would do the same thing. They would not just wait around for EMS to show up to save the day.



reaper said:


> But, We are not talking about assisting a student with their medication administration. We are talking about an unconscious pt. If they are conscious, then they can assist with oral glucose or food.
> 
> If they are unconscious, would this not be considered administering a medication on their judgment only?


 
*It is still a known student with a known medical problem that the teachers have been instructed on.* I haven't read through all the states so the may be variations. Again, EMS is also called. This does not bypass the emergency system.


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## reaper (Aug 29, 2008)

Thanks for the info Vent. Sorry, work computers do not allow us to use search engines!


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## Buzz (Aug 29, 2008)

VentMedic said:


> Learning the skill should not be an issue. Teachers are usually alerted to children in their classes that have special medical conditions. The teachers may also recognize any change in their students fairly quick. I see no more of an issue with this than allowing the child to administer their own albuterol inhaler. That, too, was forbidden for many years until the number of dead kids started to add up.
> 
> With the proper medical information provided to the teacher along with how to perform a quick assessment and perform the skill, I see rapid intervention as a benefit. *As previously stated, pediatrics is one of the weakest and most uncomfortable areas for EMTs and Paramedics.* This is not so for teachers who have spent at least 4 years in college preparing to work with children.
> 
> Egos should be put aside and who cares who has more sciences since very little education is required for entry into EMS. Don't throw stones when your own house is made of glass.



That's very true. It's an uncomfortable area for most people to deal with unless they are used to it. Just out of curiosity, has anyone else here taken a pediatrics specific course? 

I've taken PEPP and thought it was neat. Our instructor asked us to bring in our kids if we had them so that we had children brought in to interact with. It helped a lot, actually. Are there any other courses like that out there?


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## Flight-LP (Aug 29, 2008)

Buzz said:


> That's very true. It's an uncomfortable area for most people to deal with unless they are used to it. Just out of curiosity, has anyone else here taken a pediatrics specific course?
> 
> I've taken PEPP and thought it was neat. Our instructor asked us to bring in our kids if we had them so that we had children brought in to interact with. It helped a lot, actually. Are there any other courses like that out there?



Yup! Lifespan Development and Intro to Sociology would offer a great insight! These two would be my top recommendations.

PEPP is decent. Having interaction with children during the course is a neat idea. I actually liked the PPPC (Pre-Hospital Pediatric Provider Course) course, but it is no longer offered. Unfortunately, PALS has become like the rest of the AHA offerings and is pretty much a joke these days.

NRP and NALS are nice to have though if you can get them.............................


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## Hastings (Aug 29, 2008)

In the end, EMS should not be so far away as to cause a situation where immediate injection of Glucagon is necessary. It's simply better for everyone if you wait the 5 minutes for professionals.


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## firecoins (Aug 29, 2008)

VentMedic said:


> Continued:
> Teachers aren't going to be running around the streets looking for patients. They know their students. The reasons they are doing this is different. If the child was at home, the parents would do the same thing. They would not just wait around for EMS to show up to save the day.



Lets assume teachers "know" their children's medical conditions and are authorized to now give med that parents would otherwise be in charge of. 
An unconscious child is an emergency in a school setting.  The teacher has other students. The teacher must now stop paying attention to the other students to administer glucagon to a child.  Do you think the school is not going to send the child to a hospital anyway? 



> *It is still a known student with a known medical problem that the teachers have been instructed on.* I haven't read through all the states so the may be variations. Again, EMS is also called. This does not bypass the emergency system.


So why not wait for EMS?  Why not wait for medics?  In this case the EMTs would arrive and be told this kid is a diabetic. They would know the same exact information the teacher knows.  

As an EMT-B I have been called to many situations where I knew that I was dealing with a diabetic due to a bystander providing the information.  


Teachers may be comfortable teaching children after years of training but they are not medical providers.  Just because EMS is "weak" in providing pediatric care does not make a teacher ready to provide medical care in any situation.


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## MMiz (Aug 29, 2008)

Just to add some more information from the teacher's perspective.

In order to apply for a teaching license I was required to take and pass a CPR/AED/First Aid Course taught by the AHA.  None of this taught me how to inject glucagon, but that's the extent of my training (beyond being an EMT-Basic).

As a teacher I am generally not allowed to provide a student medication, including Tylenol.  All medical must originate from the secure central storage location, and must be accompanied by a doctor's order, the district's approval, and the associated paperwork.

We were provided a sentence or two of training about the symptoms of Hypoglycemia.  We were told the student may be fidgety, lethargic, agitated, and a myriad of other symptoms.  We were instructed to provide the student a juice box first, a snack second, and use the glucose tabs as the last resort for a conscious student.  The glucagon is only for an unconscious student.

Five years ago, having come from a community with less than a four minute average response time, I would have agreed with you that a student could wait for EMS.  Since then I moved to a community with an average response time of 15 minutes.  Now I teach in a community with probably a five minute response time, but can the student afford to be unconscious for that long?  I really don't know.

The diabetes activists are clearly supporting the training of non-medical personnel in the administration of glucagon.  As a parent, I'd want my student's teachers to be trained in the administration of life-saving medication.  It certainly doesn't take a rocket scientist to adminster Epi or glucagon.

Lastly, I can't help but say that "Times have changed."  10% of our school's population is on an IEP (Individual Education Plan), which provides accomodations during classroom and testing situations.  Some I must read aloud to, while others get a copy of my lesson plan each day.  Some get free access to water and the restroom, while others must sit in a certain desk.  I even had one student who has a severe chemical allergy/sensitivity, meaning I can't wear scented deorderant, must use low odor white board markers, and can't use cleaning chemicals in my room.  It's my job as a teacher to meet the needs of all of my students, at whatever cost to myself and the school.  While sometimes I'm frustrated having to prepare multiple accomodations for a single lesson, as a teacher I want to provide my students a safe environment.

When I started this thread I just wondered why EMS in generally isn't as progressive as I would have hoped?  Many states still don't equip EMT-Basic units with Epi, something I was trained to administer as a camp counselor many years ago.  Heck, the school secretary gives injections, nebulizer breathing treatments, and quite a bit more.  Why cant EMS?


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## VentMedic (Aug 29, 2008)

> Lets assume teachers "know" their children's medical conditions and are authorized to now give med that parents would otherwise be in charge of.
> An unconscious child is an emergency in a school setting. The teacher has other students. The teacher must now stop paying attention to the other students to administer glucagon to a child. Do you think the school is not going to send the child to a hospital anyway?


 
The children are not little babies and even if they were, they'll get by okay while their teacher assists a child in need.

I emphasized that this is NOT to bypass EMS.



> So why not wait for EMS? Why not wait for medics? In this case the EMTs would arrive and be told this kid is a diabetic. They would know the same exact information the teacher knows.


 
And why watch a child's life slip away if there was something you could do? 
Why have bystander CPR? Why not take the inhalers and epi-pens away from the kids and teachers also? Ban AEDs and definitely that awful oxygen? 

Just keep the kids locked up in a basement at home. 

Do you know the number of children with medical problems in the school systems? Teachers are having to watch over them many hours a day, 5 day/week. 




> Teachers may be comfortable teaching children after years of training but they are not medical providers. Just because EMS is "weak" in providing pediatric care does not make a teacher ready to provide medical care in any situation.


 
The few hours that an EMT-B gets in their training for peds and they will probably see very few pedi patients during their career. 

If you read the state policies I posted, you will see that there will be a few keep people trained in emergencies. It didn't say all 2000 teachers in a school system would do this. 

Have you ever coded a child?

Have you ever thought a child died needlessly because help couldn't get there quick enough or the bystanders were not prepared for any type of emergency?

Have you ever known a family who had to terminate life support on their child? 

Have you ever ended a code or terminated life support on a child? And then handed the child's dying body to the parents? 

Have you ever visited a pediatric subacute and saw all the sad stories hooked up to technology? Many of which could have been prevented if someone had been more proactive. 

EMS also needs to expand its education to better understand what is happening in the medical community and what needs are out there. You would be surprised how many children there are with chronic needs. Luckily the families can be trained to run ventilators, feed pumps, give insulin and suction trachs without always calling EMS. The same for teachers that have these children with some of this technology in their classroom. Kids are also better trained to be aware of their diseases but sometimes things happen when they want to be like the others and fit in.


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## Hastings (Aug 29, 2008)

MMiz said:


> Now I teach in a community with probably a five minute response time, but can the student afford to be unconscious for that long?



Yes. Yes, they can. And in the end, you have a professional treating them properly, and everyone wins.

Instruct the teachers instead to monitor the ABC's and manage the other bystanders/students until EMS arrives. Not to administer medications. That way, once EMS DOES arrive, all is well that ends well. Supportive care is all that is really necessary during the short amount of time EMS is en route. And that's something the teachers can be taught to manage. Nothing invasive, all basic, all without any issues in the long run.


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## VentMedic (Aug 29, 2008)

Hastings said:


> Yes. Yes, they can. And in the end, you have a professional treating them properly, and everyone wins.


 
Are you really willing to gamble with a child's life?   Or risk having them with a trach, peg and vent for the rest of their life?  

What qualifies you to make such a statement?  Did you read any of the reports, references and policies I posted earlier?  Again, this is not just joe smo who wants to play with needles but doctors, nurses and law makers who have determined there is a need for this. 

110 hours of training in slightly advanced first-aid  does not make one an expert in pediatrics.  

If you go to any Pediatric ICU and pose these questions to anyone who has experience in pediatrics, I believe you find advocates for the children.  They are not going to stroke their own egos.  They also know what it is like to educate people who have minimal education to keep their child alive. Teachers have a big responsibility and they are now truly the first responders to preventing tragedy in a family.  Teachers do have a lot of expertise to recognize emergencies. Probably much more than than are given credit for or want to acknowledge themselves.


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## Hastings (Aug 29, 2008)

VentMedic said:


> Are you really willing to gamble with a child's life? Or risk having them with a trach, peg and vent for the rest of their life?



Yes, I am. Because I know that's simply not realistic. We're talking about a kid that suddenly falls unconscious due to hypoglycemia. We're talking about a 5 minutes ETA for EMS on average. Is a child that just went unconscious from hypoglycemia going to stop breathing and develop brain damage in those 5 minutes? No. They really aren't. Kids having seizures are the ones that sometimes stop breathing. But even then, the teachers call EMS, EMS arrives, EMS treats child, and how often do those children end up on one of the mentioned life-long treatments? I don't really know, but personal experience has shown me that in both cases, it can wait for EMS. Teach the teachers how to manage the ABC's, and EMS will be along soon to get the kid back on the playground.


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## VentMedic (Aug 29, 2008)

Is everyone guaranteed an ambulance in 5 minutes? Why are there so many articles about response times across the country? 

Why don't you take your arguments to the names on the reports and policies I posted earlier? The ones with MD behind their names.

How many years of experience do you have working in Pediatrics? What are your credentials? 



> and how often do those children end up on one of the mentioned life-long treatments?


Your posts have shown a very limited knowledge about children with special needs. There are many, many types of needs out there beside just a "seizure". Again, attend some continuing education classes at a children's hospital and learn what you will encounter in the community. Diabetes, as is asthma, is an increasing problem. There are also the many complications from being born a preemie or to the parents of drug and alcohol addictions. The children may be stuck with a life time of problems because of the actions of their parents. Some parts of the country have schools where 30% of the students have been diagnosed with RAD or asthma. We could also talk about children with cancer or who have had a crippling accident. How about cardiac annomalies in children? We can easily do 3 pedi heart surgeries a day in our pedi CVICU.  These kids live somewhere and will be in someone's classroom. 

Those of us who work with these children on a regular basis know what a difference a few minutes can make.


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## Hastings (Aug 29, 2008)

VentMedic said:


> Is everyone guaranteed an ambulance in 5 minutes? Why are there so many articles about response times across the country?
> 
> Why don't you take your arguments to the names on the reports and policies I posted earlier? The ones with MD behind their names.
> 
> ...



Asthma, for instance, IS an immediate threat, as it can affect the child's breathing quickly and severely. And as such, children with the condition have inhalers. 

However, tell me, how likely is it that a child who goes unconscious due to hypoglycemia suddenly will stop breathing and suffer brain damage and other complications within 5 minutes? If that's the case, it sounds like teachers need to instead learn how to recognize the signs of hypoglycemia and get on treatment A LOT faster. Because that's not an acute thing.


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## VentMedic (Aug 29, 2008)

Hastings said:


> However, tell me, how likely is it that a child who goes unconscious due to hypoglycemia suddenly *will stop breathing and suffer brain damage *and other complications within 5 minutes?


 
Here lies the problem with your general summary.  Research what happens with hypoglycemia in pediatric diabetes.  

Again, can you always guarantee the ambulance is just 5 minutes away?

Why are you willing to risk further injury to a child when it can be immediately treated?


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## VentMedic (Aug 29, 2008)

MMiz,

This might be a good article on training and monitoring school employees.

http://www.ndep.nih.gov/diabetes/pubs/SNN_September_2004.pdf

I also forgot to mention children that have insulin pumps in my list of technology.


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## Ridryder911 (Aug 29, 2008)

Obvious Vent there are those that do not understand insulin shock pathophysiology. Yes, hypoglycemia is an immediate and life threatening event. What do you think binds and carries oxygen based cells to the brain? ..  hint: learn pathophysiology. 


Hypoglycemia does and may cause seizures, and rapid loss of consciousness. Children unfortunately are not as symptomatic and informative as adults as well due to the higher metabolism altered LOC is more rapid and likely. 

Also.. the national average response time for EMS is >8 to 10 minutes. 

Personally, I don't see the big deal. I much rather have an teacher administer glucagon to a known diabetic than for a Basic to assume to know what the treatment for DM and be over zealous or wrong because they can treat. We teach patients (children) and family members all the time to administer Insulin as well as Glucagon. 


In regards pediatric courses, where have everyone been? PALS, PEPP, NRP, and now EPC from NAEMT and for those heavily involved in advanced neonate and pediatric critical care transport from UMBC, and if one can find a APLS course I highly recommend to attend. 


EPC course info: http://www.naemt.org/EPC/default.htm

CCEMT/P for neonates and pediatric :http://ehs.umbc.edu/ce/PNCCT/index.html


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## Hastings (Aug 29, 2008)

Ridryder911 said:


> We teach patients (children) and family members all the time to administer Insulin as well as Glucagon.



Because when the patient or family does it, there's no one to sue.


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## Ridryder911 (Aug 29, 2008)

Everyone will sue. Do it properly or not having available trained staff that interact appropriately in a timely manner.. The results will be determined on what would you have done? among peers. 

Like I said, I am surprised they allow anything. Most states won't even allow much more than a band-aid .

R/r 911


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## Outbac1 (Aug 30, 2008)

Injecting glucagon is not a hard thing to do or to be trained to do. I don't have a problem with a teacher being trained to do it. Most places do not have a < 5 min response time. Even here we run 3 ALS trucks 24/7 and a day truck 8hrs/day and cannot guarantee a less than 10 min response time to all schools. Even if everyone is not busy and available at their post. We all know that you can't predict when an emergency call will happen but often they happen at nearly the same time, which reduces the availability of trucks to handle the calls. From the time a call is placed to when a medic is at the patients side could easily be 10-15 minutes. 

  It would be better for a school nurse to administer but many schools don't have one or share one between several schools. A teacher could be trained to inject it just as well. If only an EMT-B shows up more time is lost waiting for an EMT-P to arrive or transporting to a hospital. 

  Until you can provide full ALS service 24/7 or at least a PCP level, I would want my childs teacher to be able to give it. 

  A full EMT-P, (ACP), level of service should be the minimum for everywhere. But since that's not going to happen anytime soon, you, (the USA), should at least be upgrading your minimum level to at least something akin to our PCP level. As Rid said medicine is medicine and it should progress ever upwards. 

  I find it hard to believe that the American public is satisfied and content with an EMT-B level of service. I'm sure if the public really knew what service they had they would be clamouring for the politicians to change it. If you bother the politicians enough they will find the money to make the changes if only to shut up the public. It doesn't matter what side of the border you are on politicians are still politicians. The squeaky wheel gets the grease.

  And lest anyone think that I think our health care system is perfect, it most assuredly is not. We have our share of problems. However our prehospital care has, for the most part, moved past you and other countries past us. 

  I think the USA can do better and would like to see you do so.


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## Ridryder911 (Aug 30, 2008)

Outbac1 said:


> I think the USA can do better and would like to see you do so.



It'd not that we can't; rather many prefer not to. Why do we allow someone to be able to maintain their EMT level > 5 years?...

R/r 911


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## rhan101277 (Sep 1, 2008)

I know this may be a little of topic but-

Every state needs to get on the bandwagon and figure out how much they want to train basics, paramedics.  I think more is better, after all if there were more protocols and interventions that could be done, more lives could be saved I am sure.  These are people's lives we are talking about.  I just don't understand what is so hard about adding more to the curriculum, not just about this (EMT-B's can't use a glucometer in MS.) but other things that more knowledgeable folk would know.  It is almost like the doctors want the patients to come in, in the worst possible condition, due to hands being tied etc.  Back to the glucometer, I think we can control that kind of bleeding.

I just think once I become a basic, if someone dies because I am not trained on a procedure I could have used, it would be very frustrating.


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## traumateam1 (Sep 1, 2008)

After reading all these posts I must say I am very surprised that there are professional health care providers out there that want to delay patient care!! If a child becomes unconscious and their teacher knows they are diabetic than by all means allow that teacher (or another _if_ that teacher is panicking) to give glucagon! Yes I DO think that the teachers should have more training, based on what I saw (less than 10 minutes; a few sentences describing s/s, etc) but if a teacher can recognize and treat that condition before EMS arrives than that is GOOD! It's our children out there, if a teacher is as capable as a paramedic in the physical doing of injecting a kid with glucagon, than please allow it. Instead of standing there and waiting for BLS to show up, and then call for ALS this  is a waste of time, IF the teachers had the option of delivering it. I am very surprised that so many EMT-B's are against it, why? I'm not entirely sure, but it is very shocking.

Lets think about it this way - *Teacher administering Glucagon*
00:00 Kid found unconscious in cafeteria
00:30 Page made for nearest/available teacher to go to location for a medical emergency
01:30 Teacher on site, assesses, calls 9-11, orders for Glucagon
02:30 Teacher administers Glucagon
03:45 Kid starts to come around
11:00 EMT-B's show up, assess kid, update ALS and monitor until ALS shows up.
*Teachers NOT allowed to administer Glucagon*
00:00 Kid found unconscious in cafeteria
00:30 Page made for nearest/available teacher to go to location for a medical emergency
01:30 Teach on site, assess, calls for 9-11, puts in recovery position
02:00-11:00 Teacher monitors _unconscious_ patient until EMT-B shows up, they assess, admin O2, take vitals and update ALS
13:00-17:00 EMT-B's monitors _still unconscious_ patient until ALS shows up, delivers Glucagon and kid comes around.
So you are taking off possibly 13-15 minutes of this kid being unconscious, if teachers are allowed to administer Glucagon as apposed to waiting the, lets say 17 minutes for ALS to show up. Come on, give me a break and do whats BEST for all the kids out there.

As far as my opinion about EMT-B's being allowed to administer Glucagon subq, I think that if they took a course on it.. or expanded their medications aspect of the course it would be a very good idea. Seeing as how it's usually an EMT-B that is first on scene... In MY opinion I think it's a good idea. (Let's not have any ALS guys saying essentially the same thing the BLS guys were saying about the teachers now.) Lets help each other learn and grown and provide better patient care, no matter what level. To have *paragod* syndrome is a very dangerous thing, and no paramedic, regardless of the level, or experience should ever have this horrible syndrome. No one is always right 100% of the time. People make mistakes and it's as simple as that.
My case in point:
Allow teachers to better student care;
Help EMT-B's become better at their level; 
and last but not least, if you are bettering patient care,  I don't see why it's such a big problem. (It's not like their giving any advanced medications that take a year in school to know how to administer them, when and where)


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## reaper (Sep 1, 2008)

traumateam1 said:


> Lets think about it this way - *Teacher administering Glucagon*
> 00:00 Kid found unconscious in cafeteria
> 00:30 Page made for nearest/available teacher to go to location for a medical emergency
> 01:30 Teacher on site, assesses, calls 9-11, orders for Glucagon
> ...



 You need to adjust your time line. Glucagon takes a while before you see results. It's not D50, where you would see instant results.


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## MMiz (Sep 1, 2008)

Even worse, glucagon takes a half a minute to prep prior to injection.  I can't see any of my teaching coworkers waiting that long.


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## traumateam1 (Sep 1, 2008)

Point being.. if a teacher is taught how to do, than it's still faster than awaiting for ALS to show up. Right?
And yes I did mess up that timeline. That is a my bad.


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## mikie (Sep 1, 2008)

What about a Glucagon auto-injector?  I don't think such things exsist...but would make it easier, like an epi-pen.....a glucy-pen?:blush:


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## firecoins (Sep 1, 2008)

traumateam1 said:


> Point being.. if a teacher is taught how to do, than it's still faster than awaiting for ALS to show up. Right?
> And yes I did mess up that timeline. That is a my bad.



hopefully it is faster. I doubt teachers will have glucagon instantly at their fingertips. It would probably be kept in a central office and they would have to call for it.  It has been mentioned that many school districts don't let teachers call 911 directly.  They have to call the office for that too.  So I guess the glucagon will theoretically be administered prior to the arrival of EMS but not necessarily.  

There is no reason this could not be taught to EMT-Bs either.

In my system medics are simultaneously dispatched to all calls.  It is quite common for medics via flycar to arrive first on scene or at least shortly thereafter the BLS ambulance.  

All schools in my area have an RN on staff. If anyone would administer drugs prior to the arrival of ALS, the RN is that person.


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## MMiz (Sep 1, 2008)

I have taught in one poor area, two extraordinarily rich areas, and a couple somewhere in the middle.  Unfortunately I haven't taught at a school with a full-time nurse.  The best I've had is one shared amongst several schools.  Back in Michigan I taught in a rich area that had parents with MDs or RNs come in and volunteer part-time as nurses, but that was the best I've seen.

I'd like to ask about the glucagon auto-injector idea.  Why wouldn't that work?


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## mikie (Sep 1, 2008)

MMiz said:


> I'd like to ask about the glucagon auto-injector idea.  Why wouldn't that work?



We should market it...make $$$


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## reaper (Sep 1, 2008)

It would have to be made to break and mix. Glucagon will not last long once mixed. It could be designed easy enough. Just like how Solumedrol is pakaged.


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## ffemt8978 (Sep 1, 2008)

MMiz said:


> Our training, taking less than ten minutes, instructed us that when a diabetic patient went unconscious, we were to:
> 1.  Notify the office, who will notify EMS and parents.
> 2.  Retrieve glucagon from central storage location
> 3.  Put on gloves, while opening kit
> ...



I've got a couple of questions about this procedure that may be slightly off topic.

1)  If you have this scenario, you have to leave the patient to go retrieve the drug from a central storage location?  How long will this take for you to do that and return to your patient?
2) Who's monitoring the patient while you are fetching the drug?
3) Who's monitoring the other two dozen or so kids in the class room while this is going on?


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## MMiz (Sep 1, 2008)

Yeah, there are actual laws about leaving kids these days, so that's not an option.  I'd have to call down to the office, and then they'd have to run it to me.

One time I was breaking up a fight in the hallway in between classes while another student in my room took the top off of my stool (seat) and threw it to the school board member's son... who can't catch, and got hit in the head.  I got in trouble for that one.  Can't win no matter what these days.


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## ffemt8978 (Sep 2, 2008)

Our local school district currently employs 3-4 of our EMTs and one FF.  The EMT's are not teachers, but support staff like guidance counselors, administration, and safety officers.  Part of their job duties are to respond to emergencies on the school campuses, and they have a fully stocked jump kit they bring with them.

They also administer prescription meds to the students that need them, and do have medical oversight.  It's worked out very well for us in several ways (as evidenced by one of our cardiac arrest saves).  They get there quick, start appropriate treatments, call for ALS if needed, get a good history (because they know the kids), and eliminate a lot of the BS calls for things liked scraped elbows and such.


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## traumateam1 (Sep 2, 2008)

ffemt8978 said:
			
		

> Our local school district currently employs 3-4 of our EMTs and one FF. The EMT's are not teachers, but support staff like guidance counselors, administration, and safety officers. Part of their job duties are to respond to emergencies on the school campuses, and they have a fully stocked jump kit they bring with them.
> 
> They also administer prescription meds to the students that need them, and do have medical oversight. It's worked out very well for us in several ways (as evidenced by one of our cardiac arrest saves). They get there quick, start appropriate treatments, call for ALS if needed, get a good history (because they know the kids)



This is what they should do here... Our school district only has first aid attendants at the schools. I'm not too sure about the elementary levels (grade 1-5) but I know middle (6-8) and high schools (9-12) have level 2 first aid attendants. If anything like the unconscious diabetic kid happens, they can only assess and O2 and call for 9-11. The only time nurses are on school property is when they are administering shots, and even then when kids pass out from the sight of the needle or blood, they don't do anything.. just sit there and continue calling numbers.
Hence why I am *for* teachers being able to admin glucagon.


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## BossyCow (Sep 2, 2008)

MMiz said:


> The diabetes activists are clearly supporting the training of non-medical personnel in the administration of glucagon. As a parent, I'd want my student's teachers to be trained in the administration of life-saving medication. It certainly doesn't take a rocket scientist to adminster Epi or glucagon.



But my issue with Vent's post is not that teachers shouldn't but the supposition that a teacher can be taught to do this adequately and to assess the need, but not an EMT B. If the skill can be taught adequately to someone with no medical experience at all beyond that CPR/FA class, it certainly can be taught to EMT Bs as an adjunct skill. 

To imply that by virtue of 4+ years spent learning something other than EMS means a teacher can learn the skill better than an EMS worker offered the same training is elitist.


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## VentMedic (Sep 2, 2008)

BossyCow said:


> But my issue with Vent's post is not that teachers shouldn't but the supposition that a teacher can be taught to do this adequately and to assess the need, but not an EMT B. If the skill can be taught adequately to someone with no medical experience at all beyond that CPR/FA class, it certainly can be taught to EMT Bs as an adjunct skill.
> 
> To imply that by virtue of 4+ years spent learning something other than EMS means a teacher can learn the skill better than an EMS worker offered the same training is elitist.


 
Again, not all of the 2000 teachers in our system were instructed on this "skill". 

But, since you mentioned it:

People with college education do have a better chance of picking up skills and KNOWLEDGE faster than those that have no formal education beyond high school. They have already demonstrated the discipline to go through 4 years of college. EMT-Bs do not always discipline themselves to advance by education but rather focus purely on another SKILL. States that continue to promote more certs for skills and not actual education are not helping the cause either. I believe Washington state falls into that category with their 6 - 7 certifications based on skills. 

There are reasons for why there should be college prerequisites prior to taking EMT-B or Paramedic. The student will be able to develop some discipline for studying. Without these, you can expect thread after thread on the many forums about how hard the EMT class is. 

It has already been shown on this thread that some who where opposed to teachers giving glucagon actually had little knowledge about pediatric diabetes even at a Paramedic level. I'm sure a few with EMT-B had even less knowledge but were still agruing it should only be their skill. So one might take that to be more of a "turf" thing in a place where egos should not come to play. 

I'm sure by now MMiz has done his own research as an educator about pediatric diabetes in addition to whatever his school system and the parent give him. 

Teachers in some areas are made aware the various disease processes and disabilities that the children have through inservices and continued training by RNs and RRTs involved in the education system. The teachers then may need to individualize access to different eduational activities the the children with medical needs. Parents are usually more than happy to give the teacher their own inservices and whatever information to see that their child is safe. 

Times are changing with different health habits and medical science being able to save 23 week gestation babies. We have had to teach parents with very little education and high levels of education to provide for these babies if they don't grow up perfectly healthy. The school systems have had to become more educated also to accomondate these children. 

EMS should be joining in to become more educated about this population and educating instead of fighting the educators, kids, parents, professional associations and other healthcare providers every step of the way because they think it is solely their turf. 

Yes, EMT-Bs can learn this "skill" but don't make the kids wait for their arrival. Kids want to be active and not restrained to just an area of easy access for EMS. 

As the links I posted earlier stated, many school systems have had this in place over 10 years. 

These kids are not going away. Attitudes need to change or maybe we should just stop saving the children that aren't born "perfect". Maybe the kids with medical needs should just be home schooled for the sake of not having this argument and having people get their feelings hurt.

EMS also needs to change its attitude about education and stop bashing those who have it just because they don't. You would be surprised how easy some things become once you start advancing your education.


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## firecoins (Sep 2, 2008)

VentMedic said:


> People with college education do have a better chance of picking up skills and KNOWLEDGE faster than those that have no formal education beyond high school.


I originally took this course during my sneior year of high school.  Passed with no problems.  Adults many years out of college had difficulty because they were no longer adept at being in school.  I had am advantage due to being a student.  It isn't the level of education but rather how active a student one is.   



> They have already demonstrated the discipline to go through 4 years of college.EMT-Bs do not always discipline themselves to advance by education but rather focus purely on another SKILL.


 Learning skills is a *part *of the educational process. Obviously there is more too it than just learning skills but it is still a part. 



> There are reasons for why there should be college prerequisites prior to taking EMT-B or Paramedic. The student will be able to develop some discipline for studying.


 I agree wuth being an active student. 



> It has already been shown on this thread that some who where opposed to teachers giving glucagon actually had little knowledge about pediatric diabetes even at a Paramedic level. I'm sure a few with EMT-B had even less knowledge but were still agruing it should only be their skill.


If pediatric diabetes is so serious that untrained people should be taught this, than we can eliminate egos and teahc it to EMT-Bs also.


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## VentMedic (Sep 2, 2008)

firecoins said:


> If pediatric diabetes is so serious that untrained people should be taught this, than we can eliminate egos and teahc it to EMT-Bs also.


 

I didn't say not to teach them.  My quote:



> Yes, EMT-Bs can learn this "skill" but don't make the kids wait for their arrival. Kids want to be active and not restrained to just an area of easy access for EMS.


 
My point was that people were jumping on the band wagon to say teachers shouldn't be doing this skill when they themselves did not know that much about the pathophysiology of pediatric diabetes.  Essentially they too would only be treating a recipe of symptoms just as the teachers would be except the teachers were close by and had prior knowledge of the child's medical problems.


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## zippyRN (Sep 15, 2008)

reaper said:


> How are they getting away with this? They are not licensed medical professionals, they are not under Medical Control. Has this been investigated with the state DOH? They could be setting themselves up for major legal and liability troubles!



 there is a however a patient specific direction  for each of the students they  may have to adminster  it to - becasue it's for their known DM student population  - the 'medical control' is the family doctor or endocrinologist who prescribes the student's  meds ...

certainly from a right pondian prespective it would be the case that each student who may need it would need to provide  the med  in it;s original packagign with a correct pharmacy / dispensary label


vs. a protocol for EMS personnel to give it to anyone  they have arrived at a working diagnosis of hypoglycaemia...


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## zippyRN (Sep 15, 2008)

reaper said:


> I still want to know the legal aspect of this? Glucagon is a prescribed medication that needs a Dr's over-site. We as Paramedics are extender of the MD's license and have over-site by the MD.
> A teacher has no state license to administer a medication. So, did the school system find a Medical control Dr.? Did the state issue some kind of special medical license to teachers? These are all legal questions that I would like to know, for my own knowledge.



there is an existing PATIENT SPECIFIC direction to administer 


it's no different helping grandma take her prescribed meds or giving prescribed meds to a toddler you are babysitting for.

the direction to adminster the medication exists  becasue the med has been prescribed for the patient  by an MD 

vs the situation where EMS adminsiters drugs to an 'unknown'( to the doctor providing the direction to adminster) patient  so the bar is somewhat higher


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## zippyRN (Sep 15, 2008)

VentMedic said:


> I know in Florida, for inhalers and epi-pens, this information is known by the teachers and the children have known scripts. Essentially the teachers are assisting the child in administering what they themselves or their parents would be giving in case of an emergency. I seriously doubt a teacher would be giving anything if the condition was not known.



exactly 


EMS drug protocols are for 'unknown' patients  these protocols are for a number of known patients whose own doctor ( whether the family doc or an endocrinologist if we are talking glucagon) has prescribed the med - here is the Direction to adminster - the training is aobut giving the med safely and effectively


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