# When should a school call EMS?



## MMiz (Nov 25, 2005)

I'm currently working as a student teacher in a local middle school.  There have been instances where I would have called EMS but the school did not.  I have not questioned their policy, though I'm not sure it's the right one.

When do you call EMS?  

What if a boy breaks his arm and it's visually broken and "messed up".  Do you call?

If we call and they transport than the parent may be pissed when they get the bill for $500.  If we call and they don't transport, then we have an ALS unit stuck waiting for the parent to come so we can get a refusal.

When is the right time?


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## Wingnut (Nov 26, 2005)

As a parent, the money be damned, I would have the school's *** if they didn't call for one of my kids. Broken things I think warrant an ambulance, I didn't feel this way until I broke a bone myself, but any kind of "real" problem with a child can turn emergent quickly, I think it might be easier to define the guidelines for when EMS is not needed and to call the parents instead.


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## Jon (Nov 26, 2005)

If it is an "ALS" level emergency (Chest pain in adult, resp. diff, unconscious, OD, etc) - EMS should probably be called - however - a near-syncope/cycopal episode, or asthmatic who is SOB can probably be handled appropriatly by the school nurse.

Fractures / sprains / strains, cuts, etc - unless there is an imminant danger to life or limb (-PMS in extremity and/or shock). Parents should probably be called first and given the option of taking the child POV to Doc and/or ED - where they can't do anything without parental consent anyway.

Jon


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## Chimpie (Nov 26, 2005)

Remember, it all goes back to the basics.

Have them take a Red Cross class.  Any CPR or FA Red Cross class.  We teach the C-C-C.

Check, Call, Care.

If the person is unconscious, call.
If the person has a broken bone with obvious deformity, call.
If the person is having difficulty breathing, chest pains, strong abdominal pain, seizures, stroke, shock, extensive bleeding, call.
If the person has burns to the face, neck, hands, feet, genitalia, call.
Other than that, when in doubt, call.


Edit: I should know by now not to post before eating breakfast.  Hunger = bad spelling.


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## Jon (Nov 26, 2005)

> _Originally posted by Chimpie_@Nov 26 2005, 07:23 AM
> * Remember, it all goes back to the basics.
> 
> Have them take a Red Cross class.  Any CPR or FA Red Cross class.  We teach the C-C-C.
> ...


 My only thing is that the school nurse "should" be able to manage most of the asthma patients in house, even after a bad attack. Also, a fracture with good PMS and no signs of shock, if mom/dad can pick up the child, going POV to the ED or MD's might be the best idea in the long run.


Jon


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## Chimpie (Nov 26, 2005)

Asthma patient... unless the attack is over, call.  Asthma is not something to mess with.


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## MedicRN (Nov 27, 2005)

Having acted as the medical resource person for a private school, I provided the parents with my parameters.  Paraphrased, it said to the effect, if it's a non-life threatening situation (examples were listed), the school would contact the parent/emergency contact.  If they wanted the student transported, we would call EMS and they would be responsible for the bill.  If it were a life-threatening (examples listed) situation, parents/emergency contact would be notified that EMS had been called and was on the way.  Again, they were responsible for the bill.  This would also hold for non-life threatening if no one could be reached.  And the parents signed that they had recieved and understood this policy.

A school nurse is (generally) not equiped to handle anything more than minor medical emergencies.  IMO, the school needs to have something in place for the school's and student's protection.


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## Chimpie (Nov 27, 2005)

MedicRN,

Thanks for the response but that's pretty much common sense.  Or at least I hope it would be.  Can you provide the list of life threatening and non-life threatening situations?

Chimp


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## Stevo (Nov 27, 2005)

school nurses here are given student particulars, and operate with intervention as needed. 

unfortunately the specture of liability once again eneters the pix if extrodinary measures are not called for in the presence of the inane

which is exactly why ems is BB crazy

so, _on one claw_, we can't blame the school for being overly reactive, and on the other we can't for being conservative can we?

meanwhile, we just go down to the elementary for our annual _'show and tell' _gig , and let the kids play doctor

methinks they would make a more unbiased decision than 1/2 the adults asked...

~S~


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## TTLWHKR (Nov 27, 2005)

The school I went to never called EMS, for anything, which caused them to lose a liability suit.

If someone were k/o'd on the ball field, they were loaded on a army stretcher, and toted off in a pick up to their parents house. From my expirence instructing first aid to teachers, they now have slips that allow the school to administer first aid, and the parents sign it to give permission at the beginning of the term. Maybe Mr. Matt (I never feel comfortable calling any teacher by their first name, out of respect for their position) can elaborate on such policies?

The last incident while I attended school there involved a underclassman falling, and the school trying to halt treatment before a parent arrived. I used my own jump kit on that one, but I had to send a kid to my house to get it first. I believe the school was sued over that, at least for medical bills. It was a stair banister that had been cut off, wooden stairs, it caused a severe lac over the right side of the face and temple, and I could see bone chunks. Completely unconscious, blood EVERYWHERE, running down the stairs, splattered on the walls.. It was like a friggen horror film, they determined the temporal artery was lacerated. 

The 'acting principal' didn't want to call an ambulance, said he needed the parents permission and signature. His parents were nowhere to be found, noone on his emergency list.. I sent someone across the street to call from a pay phone. Then they made a big scene about not releasing the patient.. The principal was pissed because I treated the boy before a parent could be contacted, gave me 3 days out of school. The Sheriff signed off as a parent, and rode along to complete the ambulance crew as a driver. The kid would have exsanguated with out the first aid and quick ride to the hosp. 


<spelling... hit me w/ a ruler>


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## Jon (Nov 28, 2005)

> _Originally posted by Chimpie_@Nov 26 2005, 08:17 AM
> * Asthma patient... unless the attack is over, call.  Asthma is not something to mess with. *


 You are correct, however my school had several children who would go to the nurse's office for nebulizer treatments for asthma when they were having resp. diff. - they had rather severe asthma (common in this area).  What I was saying is your "run of the mill" asthma attack - take albutorol inhaler and you feel better - can be handled by the nurse if the child has their inhaler. If they don't - it becomes a problem.

If symptoms worsen, EMS should be called, but not for a run-of-the mill asthma attack in someone who gets several attacks a month.


Jon


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## Jon (Nov 28, 2005)

> _Originally posted by MedicRN_@Nov 27 2005, 05:16 PM
> * Having acted as the medical resource person for a private school, I provided the parents with my parameters.  Paraphrased, it said to the effect, if it's a non-life threatening situation (examples were listed), the school would contact the parent/emergency contact.  If they wanted the student transported, we would call EMS and they would be responsible for the bill.  If it were a life-threatening (examples listed) situation, parents/emergency contact would be notified that EMS had been called and was on the way.  Again, they were responsible for the bill.  This would also hold for non-life threatening if no one could be reached.  And the parents signed that they had recieved and understood this policy.
> 
> A school nurse is (generally) not equiped to handle anything more than minor medical emergencies.  IMO, the school needs to have something in place for the school's and student's protection. *


 Good policy.

My High School nurse had splints, O2, an AED (Donated by a local FD), BVMs, B/p cuffs, etc.

She also had a crash cart full of kid's perscription meds she handed out.


I was in the Nurse's homeroom for 2 years - after I got my EMT (only guy in the last 8 years) - Most mornings during homeroom we did the yearly health exams on 1 homeroom - Height, weight, eye exam for 9-12 graders, and hearing tests for 11th graders.

The nurse knew I was an EMT, and a couple of times would pull me into her office to help her when she had too much going on, and I could do something simple to ease her workload - like a teacher who wanted his B/P checked while she had 10 kids who wanted to get thier lunch meds. I was able to help her with the staff member.

My School nurse knew that by senior year she had 4 EMT's running the halls of the high school with pagers, and we would all show up if she called an ambulance    (Although the 6 times it was called, I was in a test or a Student Council meeting w/ pager off, or was home sick that day).

Jon


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## TTLWHKR (Nov 28, 2005)

> _Originally posted by MedicStudentJon_@Nov 28 2005, 01:02 AM
> * My School nurse knew that by senior year she had 4 EMT's running the halls of the high school with pagers *


 The Bandaid Patch Kids?

get it?

Cabbage Patch... Bandaid Patch?

 :lol:


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## MedicPrincess (Nov 28, 2005)

I spoke with my sons school nurse and Asst Principal extensivley about this.  First off, the school "Nurse" is not a nurse.  She is a "Health Technician."  She works for a private company contracted by the school.  They have Nurse oversite.  I asked specifically about her medical background, she has the Red Cross first aid course and Currently the American Heart CPR course.  

We got to talking about when they would call 911.  She stated if the child was unconscious she would summon the Asst Principal and simultaineously they would call 911 and the childs parents.  Then the parents could arrive at the school to refuse transport if they wish.

During the midst of the coversation, the Asst Principal decided to pull out SOP on calling an ambulance.  Turns out, in the SOP, it is stated "only in the case of immediate threat to life" will EMS be called without parental consent.  It goes onto state "immediate threat to life consists of a student who is not breathing or without a pulse."

Nothing is covered in the case the parents cannot be reached.  I asked them what they would do then and their answer was "common sense would prevail."

I now have an appointment with my school board rep.  I don't like to think I have to rely on the "common sense" of the people who don't think an unconsicous child is a true emergency.


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## AnthonyM83 (Nov 28, 2005)

Uhh...if there's no pulse, it's a bit more than a THREAT to life...the child has already died. So, a child must actually die in order to get an ambulance immediately called... grrr...


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## TexasMedic (Nov 28, 2005)

If I may add my 2 cents worths, I think that a school should call the parents first and make it their decision.  exceptions are respritory, AMS, or any other severe life/death situation.  For broken bones I would never call an ambulance unless something else warrented it (BP lack of distal pulse) 
 I might be lopsed though ive broken many bones in my young life and there no big deal anymore.   
  The  school district to which we run will call us for anything that is out of the "school nurse" ability to treat.  I do believe however that we make many calls that are completly warrenting EMS or the parents $500.


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## MedicRN (Nov 28, 2005)

> _Originally posted by Chimpie_@Nov 27 2005, 05:38 PM
> *MedicRN,
> 
> Thanks for the response but that's pretty much common sense. Or at least I hope it would be. Can you provide the list of life threatening and non-life threatening situations?
> ...


Life Threatening = status seizure, unresponsive of any type (with or without pulse), status asthma, DM not responding to treatment, trauma with deficits, etc

Non Life Threatening = obviously fractured limbs, non-use of limb (no obvious deformity) after fall/incident, lac requiring suturing, isolated seizure in know seizure child, asthma with multi visits in the day.

Would encourage EMS transport for dislocation of major joints; lac with bleeding difficult to control.

These lists are not all-inclusive.  It's what I could remember off the top of my head.  It's been about 5 years since I've been in that position.


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## TTLWHKR (Nov 28, 2005)

> _Originally posted by MedicRN_@Nov 28 2005, 01:59 PM
> * Non Life Threatening = obviously fractured limbs *


 I disagree.

Femur fractures, if left untreated, could be fatal... Lacerated arteries, etc.


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## AnthonyM83 (Nov 28, 2005)

But no one is talking about not treating it, rather the nurse giving treatment or the parents transporting the child to the hospital.


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## squid (Nov 28, 2005)

One point made here that I never even thought of is the level of care the school health person can provide. There's a difference between an RN, whch is pretty common, and the sort of worst-case scenario (especially likely in tiny schools) where the principal has a CPR class or something.  So I guess one couldn't make blanket policies for every school. But at my school, the nurse is pretty well-equipped to handle a lot of health situations. She's got a trauma kit and epi and inhalers and glucose. Of course, she can treat the routine asthma attacks and low blood sugar of kids with known chronic conditions, but if it's new or more serious than usual she should and does send the kid on for further treatment.

But about calling parents in an emergency? I have to say, nope. When a child is in school, the school is in loco parentis. They legally act as guradians during school hours. It is nonsense to say a parent has to sign off on emergency medical care -- they actually don't. Now, I'm not saying a school shouldn't contact parents first in non-emergency situations; after all, when a kid is going home with a cold they call the kid's guardian, not an ambulance. But the school personnel have the right to decide if the kid needs something more or quicker than that.

Anything where one would transport a person alone at home or in public, the kid should be transported. No one at the school can drive the kid to a doctor or the hospital -- that's not allowed at all. If calling home would delay care, it's probably not a good idea either. After all, why should a kid sit there with a broken arm for 45 minutes while they find mum and she comes to pick him up, then drives another 15 minutes to the hospital? 

Also, most parents are not immediately reachable, or cannot be immediately released from work. If the odds were 98% of hitting a parent within a couple minutes, it might be a good idea to call first more often, but the odds are probably about 35% of finding a parent who can come immediately to pick a kid up in my school.

Anyhow, just my two cents as a teacher. I really think the imitation principal who thought he needed to call home instead of calling an ambulance when some kid is lying on the floor should be... ah, don't get me started on bureaucratic administrators


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