Teachers Administer Glucagon, Why Can't You?

[firecoins]

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.

 

[VentMedic]

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.

 

[BossyCow]

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.

 

[VentMedic]

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.

 

[Clibby]

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.

 

[reaper]

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.

 

[firecoins]

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.

 

[VentMedic]

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.

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.

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.

 

[reaper]

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

 

[Buzz]

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?

 

[Flight-LP]

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

 

[Hastings]

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.

 

[firecoins]

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.

 

[MMiz]

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?

 

[VentMedic]

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.

 

[Hastings]

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.

 

[VentMedic]

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.

 

[Hastings]

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.

 

[VentMedic]

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.

 

[Hastings]

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?

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.

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

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.