Teachers Administer Glucagon, Why Can't You?

[MMiz]

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?

 

[mycrofft]

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".

 

[BossyCow]

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'?

 

[mikie]

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?

 

[BossyCow]

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?

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.

 

[reaper]

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!

 

[firecoins]

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

 

[mikie]

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

 

[mycrofft]

I was unconscious! Sorry!

du-oh!:blush:

 

[zacdav89]

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.

 

[mikie]

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:

 

[Flight-LP]

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............

 

[Flight-LP]

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...........................

 

[mikie]

. 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.

 

[reaper]

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.

 

[Flight-LP]

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.

 

[reaper]

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

 

[Buzz]

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)?

 

[Clibby]

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............

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.

 

[VentMedic]

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.