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EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.
It's about lunchtime when you get a call to an elementary school about a mile from your station for an unconscious child. There's an engine responding, but they're coming from a distance. There's no other information, so you pull up in front of the main entrance and carry your gear inside. The secretary at the front desk seems surprised to see you. She walks casually across the hall and asks the principal if anyone called for an ambulance. The principal, who has apparently been on the phone, seems distracted by the question and says no. She does not come out of her office.
After fiddling with the phone system, the receptionist points to a door at the rear of the office and says "in the mod." When you inquire what that means, she describes a modular classroom on the opposite end of the campus. You hoof it out the door and across the 700-student campus, and arrive at a double-wide modular building—right next to a big gate you could have used. Inside you encounter a crowd of kids at the front of a classroom. There's a teacher kneeling on the floor next to a cyanotic, unresponsive eight-year-old. The teacher is sponging the child's face with some moistened paper towels. (That should save her.) When you ask the teacher what happened, she mumbles but can't seem to put together a helpful response.
The child is apneic, with a clear airway and a weak carotid pulse of about 50. She's blue above the clavicles, and her skins are otherwise pale and moist. She's flaccid and appears to be incontinent of urine. You insert a basic airway, ventilate and prepare a tube. When the engine company enters, one of them grabs an IV and the captain resumes questioning the teacher. It turns out the girl fell asleep at her desk. When the teacher investigated, the child crumpled and was eased to the floor. The teacher has no clue about medical history. She thinks it might be mentioned in the student files, which are locked in the main office.
Q. This whole call was a mess. Nobody at this school did their jobs, from recognizing the emergency to communicating it internally or externally, to directing us in, to managing the other students, to stabilizing this child. Don't school staffs receive any training in how to handle emergencies?
A. Good question. Actually, it's part of our jobs to know the answer to that question in our own response areas, and that won't happen by accident. One of the things fire departments have done well for years is preplanning. EMS texts don't really discuss it, but I think we should all be doing it. As for the staff doing their jobs, it's possible they did everything they thought they were supposed to do. It may be a good idea to get together with them and do some teaching of your own.
Q. Healthy eight-year-old kids don't just lose consciousness, unless they have seizures or airway obstructions. What's the deal, here?
A. Actually, that brings up a major point: Not all eight-year-olds are healthy. Schools everywhere are doing their best to accommodate kids with all kinds of developmental disorders. Not only that, but even "normal" kids suffer strokes, heart attacks and pulmonary emboli just like adults do. In many cases their teachers are completely clueless, and the schools are already starving for the funds to train them.
Q. Two-thirds of the land mass of the United States gets its EMS from volunteers. Obviously, we have financial issues of our own. So what, we're supposed to fix the schools, too?
A. We could make a difference, and it wouldn't have to cost money. This summer, invite your school nurses and principals to meet with you. Ask them in advance for a list of the kids in your school district who have known health issues. Kids suffer from an incredible array of things most EMTs have never heard of. (Our school district even has a student with a transplanted heart.) Then, teach them about their special-needs kids. Explain how your EMS system works, when to call 9-1-1, why history is so important, and how to save time by guiding you in when you arrive. Add a CPR/AED class. Do that every year at about the same time. And there's one more thing...share what you learn with the rest of your crews.
Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.
author: By Thom Dick