Teachers Administer Glucagon, Why Can't You?

[VentMedic]

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?

 

[VentMedic]

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.

 

[Ridryder911]

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

 

[Hastings]

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.

 

[Ridryder911]

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

 

[Outbac1]

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.

 

[Ridryder911]

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

 

[rhan101277]

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.

 

[traumateam1]

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)

 

[reaper]

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)[/FONT]

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.

 

[MMiz]

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.

 

[traumateam1]

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.

 

[mikie]

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:

 

[firecoins]

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.

 

[MMiz]

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?

 

[mikie]

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

We should market it...make $$$

 

[reaper]

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.

 

[ffemt8978]

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?

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?

 

[MMiz]

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.

 

[ffemt8978]

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.