Teachers Administer Glucagon, Why Can't You?

[Flight-LP]

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.

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

 

[MMiz]

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.

 

[MMiz]

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.

 

[Flight-LP]

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

 

[firecoins]

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.

 

[firecoins]

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.

 

[firecoins]

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.

 

[Clibby]

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.

 

[Ridryder911]

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

 

[VentMedic]

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.

 

[Flight-LP]

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.

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.



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.

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!

 

[Flight-LP]

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)....................................................

 

[VentMedic]

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.

 

[Clibby]

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.

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.

 

[Flight-LP]

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

 

[RESQ_5_1]

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.

 

[VentMedic]

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.

 

[reaper]

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.

 

[VentMedic]

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

 

[Clibby]

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.



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.

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.