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MMiz
12-07-2009, 08:10 PM
For the record, I'm trained, certified, and licensed as an EMT-Basic. My level of training goes beyond the EMT-Basic to include limited medications and advanced airways, but that's it.

I've been asked to administer Diastat to a student in the school setting, and I don't feel comfortable doing it. I know far too little about the drug, and am concerned about my lack of tools needed to monitor the student's condition after administering the medication. I'm most concerned about potential liability as an EMT-Basic carrying out a skill beyond my normal scope of practice.

I've been trained in the administration of insulin, Glucagon, Epi (auto-injector), and a few others, but I just don't feel comfortable admistering diazepam without medication direction or tools.

Am I making a big deal out of nothing?

Lifeguards For Life
12-07-2009, 08:15 PM
For the record, I'm trained, certified, and licensed as an EMT-Basic. My level of training goes beyond the EMT-Basic to include limited medications and advanced airways, but that's it.

I've been asked to administer Diastat to a student in the school setting, and I don't feel comfortable doing it. I know far too little about the drug, and am concerned about my lack of tools needed to monitor the student's condition after administering the medication. I'm most concerned about potential liability as an EMT-Basic carrying out a skill beyond my normal scope of practice.

I've been trained in the administration of insulin, Glucagon, Epi (auto-injector), and a few others, but I just don't feel comfortable admistering diazepam without medication direction or tools.

Am I making a big deal out of nothing?

isn't Diastat administered only per rectal?

MMiz
12-07-2009, 08:16 PM
Sure is.

Lifeguards For Life
12-07-2009, 08:19 PM
what is your roll in the school setting? how old is the kid and are his seizures often, particularly violent, long in duration, idiopathic?

MMiz
12-07-2009, 08:21 PM
I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

I feel as though I need to know his medical history, current medications, etc.

firecoins
12-07-2009, 08:25 PM
I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

I feel as though I need to know his medical history, current medications, etc.

why are teachers administering meds?

MMiz
12-07-2009, 08:26 PM
why are teachers administering meds?
I haven't seen a school nurse in ages. Neither in wealthy Michigan districts with strong unions, nor in rural North Carolina. Most districts have teachers or teacher assistants administering medications, though that doesn't make it right.

Lifeguards For Life
12-07-2009, 08:29 PM
I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

I feel as though I need to know his medical history, current medications, etc.

my best advice to you would be to decline, if at all possible. It is not fair to you or your patient/student to have you more or less blindly administer a drug to him. Diastat typically has few untoward effects, the ones that would most likely effect your situation would be diahrea, aggravation of asthma, head ache, nausea, abdominal pain.

And I don't know of many school age kids that would wan't their teacher(are you his teacher) administering a drug in such a "personal manner." at about 12 kids start developing that "extreme sense of privacy". Also, it would not be desirable for any other students to discover what medication you are giving him, let alone how.

But bottom line, I see it unethical to ask you to administer any drug, or treatment without knowing the essentials of why you are giving it, and what may potentially go wrong. you are absolutely correct in saying you need to know the pertinent medical hx and medications. While Diastat is relatively safe(especially in the pre measured syringe), once you give a drug. rarely can you "take it back".

Lifeguards For Life
12-07-2009, 08:31 PM
I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

I feel as though I need to know his medical history, current medications, etc.

If you are responsible for administering a drug, then you ARE entitled to know the medical hx and current meds. especially if there is no one else on scene with more medical training

Mountain Res-Q
12-07-2009, 08:54 PM
If I was you, the answer would be "Nope... ain't gonna do that under these circumstances."

Here is the reason for my answer:

I worked for a short while as the OnSite Medic at a Youth Correctional Facility. The medical staff was comprised of EMTs and CNAs. Part of the job was to administer a wide variety of medications that EMTs are not typically allowed to administer. The State provided an exemption waiver that allowed us to administer a limted number of OTC Meds (IBU, Pepto, Decongestants, etc.) and any medication that was perscribed by the Doctor that made a visit to the facility twice a week (Antibiotics, Narcotics, Sleep Aids, etc...). In this case the law allowed me (someone hired to work in a medical capacity) to adminster these meds (all oral). While I agree that knowing what you are giving, why you aer giving it, and the contraindications for giving it is a MUST, in this case all that was needed was an order given specifically to us from the kids primary doctor.

However, in this case you are not working in a medical capacity. Even if you were, the law would prevent you (unless there were exeptions provided) from giving the medicaion. You are a teacher who is being asked to RECTALLY administer a medication to a student and not because you are medically trained (although not to give this med) but because you are an adult? Sorry, but I would see trouble coming. Concerns like this need to be mulled over by you with the local EMSA, the school officials, and the parents... and things need to be legal and on paper to protect your butt. But, in the end, you are not under any obligation that I am aware of to comply and if you feel inky about this... don't. In fact, from my perspective (and I mean no offense by this, just a liability concern) I would be very uncomfortable about being a school teacher whose duties include sticking things (although they may be medications) up a students butt. Sorry for being blunt, but in this day and age and with all those sickos out there, I think you could be opening yourself up for trouble. You are not the school nurse or even an EMT when you are working as a school teacher. Teach them... don't treat them... IMHO.

atropine
12-07-2009, 09:15 PM
Why don't you just call 911 and let the medics handle it?

MMiz
12-07-2009, 09:22 PM
Why don't you just call 911 and let the medics handle it?
Calling 911 is part of the protocol. Though there is an EMS station about a mile from the school, the school says that EMS could be up to ten minutes away. Is a seizure really an emergency that requires Diastat? Is it a medical necessity?

Lifeguards For Life
12-07-2009, 09:25 PM
Calling 911 is part of the protocol. Though there is an EMS station about a mile from the school, the school says that EMS could be up to ten minutes away. Is a seizure really an emergency that requires Diastat? Is it a medical necessity?

it's important but it's not that urgent.

VentMedic
12-07-2009, 09:34 PM
Have you checked out this link?

http://www.diastat.com/6-Resources/8-Back_to_School.html

Many associations have continued their effort to see that kids with special needs can be placed in the school systems. Teachers often know their children better than sometimes even the parents who have come to trust their educators. We have had too many deaths in the school systems from waiting for EMS. Even then EMS is sometimes not familiar with the childhood conditions as pediatricss is a very, very weak section in an EMT(P)s education. However, you as an educator should have the resources available to you to do what the parent would do. We have even taught teachers who have no prior health care training except for CPR to work with children who have ventilators in their classroom.

If you are serious about providing equal opportunities in eduation for all children, check what your state education system recommends for education and their stance for liability. You as an educator should have prior knowledge of your students's special medical conditions and your responsibilities should NOT be confused with your EMT cert.

While you may have a very short response for EMS, other schools may not. Denying a child access to an education in a school system because of a medical condition should not happen. Yes, it is sad that cutbacks in schools to where the School Nurse is a rare commodity is a sad statement for the U.S.

MMiz
12-07-2009, 09:45 PM
Vent,

Thanks, I've read the information. As a teacher I'm committed to meeting the needs of all of my students. I am required by law to meet the medical needs of my students in the least restrictive environment possible. In injected students with insulin and Epi in the past, and we have students with some of the most bizarre medical disorders. I've sometimes changed decade-long habits to meet those medical needs.

I'm just concerned about the medical necessity and liability for the administration of Diastat to a student. With my limited medical knowledge I don't believe that a seizure is a must-stop abnormality. How will waiting for EMS negatively impact the patient's condition or outcome?

I'm not about passing the buck or saying pulling the "That's not my job" deal. This is about ensuring one of my students is provided the best care possible.

VentMedic
12-07-2009, 09:49 PM
You might also find these articles interesting. The California Nursing Association is now even drawing fire from nurses who have children in the school system that have seizure disorders.

http://www.ocregister.com/articles/school-214516-diastat-administer.html

http://www.epilepsyfoundation.org/epilepsylegal/upload/diastatschool.pdf

http://www.womeningovernment.org/files/file/a-z/DiastatinSchoolsChartCurrent2.pdf

http://www.epilepsyfoundation.org/epilepsylegal/upload/lancasteramicus.pdf

We've gone through this before with albuterol, epipens and AEDs.

MMiz
12-07-2009, 09:52 PM
I've read all of those, thanks.

Unfortunately my state, like many, does not provide immunity for the administration of medications in times of emergency. Neither my EMT insurance or my professional liability insurance (for teaching) will cover the ministration of medication.

VentMedic
12-07-2009, 10:03 PM
I've read all of those, thanks.

Unfortunately my state, like many, does not provide immunity for the administration of medications in times of emergency. Neither my EMT insurance or my professional liability insurance (for teaching) will cover the ministration of medication.

Again forget the EMT cert. It does not prepare you for most medical conditions which are now common. You are functioning as a caregiver with the assumption you have little to no medical training except for this medication.

No one is ever protected fully from liability but if you can save a child's life who is in your care for several hours per week, some things will be taken into consideration when it comes to assigning liability.

Diastat is not new in the schools and there so far have been very few liability issues cited in any of the arguments from even the CNA in California. However they have also expressed concern that the California Paramedics are not trained any better than the teachers to give the meds or deal with medical emergencies with children.


Follow the events in California which is in this link.
http://www.ocregister.com/articles/school-214516-diastat-administer.html

MMiz
12-07-2009, 10:04 PM
Thanks, I appreciate the feedback.

I always assumed that a seizure was generally not life threatening. My research on the internet seems to back that up. Am I generally correct?

VentMedic
12-07-2009, 10:07 PM
With my limited medical knowledge I don't believe that a seizure is a must-stop abnormality. How will waiting for EMS negatively impact the patient's condition or outcome?
.

Heard the same argument when it came to albuterol and epipens. Unfortunately it took 5 children dying in one year from asthma whle in a school system that they had limited access to their medications for some to realize how deadly asthma could be.

Read the information provided by the epilepsy foundation and see just how serious a seizure is for a child. Adults may have more reserve but it doesn't take long for a child to suffer dire consequences. It is a medical emergency that requires immediate attention.

Lifeguards For Life
12-07-2009, 10:08 PM
Thanks, I appreciate the feedback.

I always assumed that a seizure was generally not life threatening. My research on the internet seems to back that up. Am I generally correct?

if it is a known re occuring condition, as i am guessing it is if your student has been prescribed diastat

MMiz
12-07-2009, 10:12 PM
Heard the same argument when it came to albuterol and epipens. Unfortunately it took 5 children dying in one year from asthma whle in a school system that they had limited access to their medications for some to realize how deadly asthma could be.

Read the information provided by the epilepsy foundation and see just how serious a seizure is for a child. Adults may have more reserve but it doesn't take long for a child to suffer dire consequences. It is a medical emergency that requires immediate attention.
If I were to believe everything I read from an advocacy group, we'd have the kids in plastic bubbles. I have students that have accommodations and plans will remove the carpet from our classrooms, require me to wear unscented deodorant, use unscented dryer sheets, and not use white board markers. All of these are deemed life threatening by some advocacy group and expert.

I guess I long for the good 'ole days.

VentMedic
12-07-2009, 10:22 PM
If I were to believe everything I read from an advocacy group, we'd have the kids in plastic bubbles. I have students that have accommodations and plans will remove the carpet from our classrooms, require me to wear unscented deodorant, use unscented dryer sheets, and not use white board markers. All of these are deemed life threatening by some advocacy group and expert.

I guess I long for the good 'ole days.

In the old days these kids could not participate in phys ed and often had to be home schooled. Most of these children that are now attending school with medical needs would also have died at birth or had a very limited life expectancy. We couldn't save the 23 weekers that grew up to have multiple medical issues. Organ transplant was unheard of and cancer was a death sentence shortly after diagnosis. Let's not put us back to the 60s.

Medications have improved to where diseases are better controlled. However, for those with a break through, it is nice to know someone is there to help.

I guess you have never seen a child die from asthma or a seizure. It is truly not a nice thing for either the provider or the family and definitely not for the child as they struggle for their last breath.

I can't remember the last time I wore scented deodorant or perfume. I also don't have carpet in my house even though no one has asthma. The more I learned the more I applied in my own life and believe it or not a healthier lifestyle did emerge be it diet or decreased chemical exposure.

If you do advance your medical education, you will see where prevention can go much further than relying on EMS for everything.

May I suggest a field trip for yourself to a large children's hospital?

VentMedic
12-07-2009, 10:33 PM
I also forgot to mention that children with HIV didn't attend school in the good 'ole days. Children with trachs were unheard of in the classroom and a ventilator was never a thought.

If a child did have a medical condition and allowed to attend school it was by way of the "short bus" regardless of their intelligence level.

So please let us not long for the good 'ole days and be advocates instead when it comes to education opportunities for children

Linuss
12-07-2009, 11:15 PM
Calling 911 is part of the protocol. Though there is an EMS station about a mile from the school, the school says that EMS could be up to ten minutes away. Is a seizure really an emergency that requires Diastat? Is it a medical necessity?

Yes, a seizure can get to the point that it can cause life threatening threatening situations or anoxic brain injury, albeit it's rather rare looking at the big picture.


If someone goes in to sustained seizure, or has recurring seizures, they can go lengths of time without taking adequate / any breaths which as you know can cause hypoxia / hypoxemia which causes damage.




As for my advice on the drug? You're an EMT. You know how to study up on drug indications, contraindications and such. Read up on the drug, and get stuff signed by the kid's parents and your school board authorizing your use of the drug. Cover your butt, but don't be afraid to use the drug in a situation that requires it.

JPINFV
12-07-2009, 11:19 PM
Another thing to think about in terms of liability is that this is a special case. You can't compare what you can do for everyone (whether operating as an EMT-B or as a lay responder) to situations where you have a patient specific protocol. I don't remember where, but I've heard of a handful of EMS systems (and yes... classroom!=EMS) that have started to produce special protocols for patients in their area that have special needs. I could see a problem if they gave you a medication and said, "Anyone that looks like they're having a seizure should get this medication," and "This student has a known seizure disorder. Here is a rescue medication that has been prescribed by his PMD and you should administer it if he starts seizing. Call 911 regardless of if the rescue medication works."

VentMedic
12-07-2009, 11:29 PM
The child who will get this medication in the school system will have their own prescription.

The severity of the seizure will depend on the disease processs that is the reason for the seizures and the duration. Unfortunately in EMS education, only "seizure" discussed as if they are a disease by itself and rarely discusses the etiology or basic physiological process that has initiated the disorder. Thus, different seizure disorders and their orgins will have different maintenance and expectations as to risks if a seizure does occur. This medication will be prescribed for those who may be more at risk to where immediate treatment should be initiated.

medicdan
12-07-2009, 11:59 PM
I understand what you are saying-- being held to a different standard because you are an EMT as well.
Would you feel better about the protocol or procedure if you have specific orders from an MD authorizing you to give the med? Almost like creating a patient-specific protocol for just your's and the patient's use?

VentMedic
12-08-2009, 12:07 AM
Forget the EMT thing. He is not working for an ambulance when in the school system. He has a much bigger responsibility in the situation he is in as a teacher. He has to function under the guidelines of his job as a teacher and the responsibilities of it. If he wants to use "I'm just an EMT" excuse and throw away 6 years of college education as an educator then no one benefits least of all the child.

The child has a prescription from a doctor which just about any lay person can assist in giving with a little instruction.

Unfortunately it is those in EMS that do not always get the training.

Too many limit themselves because of that 110 hour first aid certification. Some even refuse to apply for certain hospital jobs because "phlebotomy" is not in their EMT scope but fail to realize the are working under a different title and medical director.

Believe it or not but in a school system, a teacher with an RN license but not working as a school nurse would have to function under the guidelines of the school system as any other teacher would. Their assessment skills would be just a little better. Even in the colleges where there are Paramedics and RNs in the classrooms, they are limited by what they have access to and are not working under a medical director for administering medical care. They are educators and follow the same guidelines in their system as the other teachers.

rescue99
12-08-2009, 12:27 AM
I'm a teacher, and as far as they know I'm not trained in CPR. I know nothing else, nor am I entitled to know anything else.

I feel as though I need to know his medical history, current medications, etc.

There is some active interest in training (volunteers) school staff here in Michigan right now. The second group if MFR candidates just began class last week in fact. The first group was trained during the summer of 2008 and reported a positive outcome after the first school year already. I think the program will be a great addition to our school districts in the years ahead.

Note: None are trained to administer anything beyond their scope as far as I am aware.

VentMedic
12-08-2009, 12:33 AM
There is some active interest in training (volunteers) school staff here in Michigan right now. The second group if MFR candidates just began class last week in fact. The first group was trained during the summer of 2008 and reported a positive outcome after the first school year already. I think the program will be a great addition to our school districts in the years ahead.

Note: None are trained to administer anything beyond their scope as far as I am aware.


Again, that should NOT be meant to limit what teachers can do in a state. We have fought too long to get these kids into the school system and to give teachers the ability to given prescribed medications. It would be a shame to have a few MFRs and EMTs upset because a teacher can do more than they can. First aid training is great but generally there are teachers in a school system that have much greater knowledge about first aid than a MFR. As well, the school systems that do have several medical needs children offer educational programs for their teachers that definitely exceeds the knowledge of an EMT and probably most Paramedics (U.S.). They are taught about many medications that the EMT may never even hear about in their training.

Maybe because EMS is 40 years behind in its education about medications, diseases and pediatrics that it seems so unbelievable that teachers could be trusted with the care of children.

rescue99
12-08-2009, 12:47 AM
Again, that should NOT be meant to limit what teachers can do in a state. We have fought too long to get these kids into the school system and to give teachers the ability to given prescribed medications. It would be a shame to have a few MFRs and EMTs upset because a teacher can do more than they can. First aid training is great but generally there are teachers in a school system that have much greater knowledge about first aid than a MFR.

In the impaired class room settings it is true, there is a fairly high level of training compared to the average school building. The MFR's in the particular district I know about have proven their worth from the reports I'm hearing thus far. I thought it interesting that most of the first group were either special ED or Para-pros. Their MFR training included PAT and Start/JumpStart with additional focus on MCI. The new (and group 1) candidates will have PEPP. It'll be interesting to keep following this study to see how well it develops over time.

VentMedic
12-08-2009, 12:52 AM
In the impaired class room settings it is true, there is a fairly high level of training compared to the average school building. The MFR's in the particular district I know about have proven their worth from the reports I'm hearing thus far. I thought it interesting that most of the first group were either special ED or Para-pros. Their MFR training included PAT and Start/JumpStart with additional focus on MCI. The new (and group 1) candidates will have PEPP. It'll be interesting to keep following this study to see how well it develops over time.

But again, they should NOT limit what a teacher can do just becaue they are an EMT or MFR. The ARC classes might even be more appropriate since the "cert" would not be such of an issue. The chances of having a child with epilepsy, asthma or some allergies are greater than a MCI. To restrict teachers is just doing the chidren a disservice and limiting the educational opportunities of the student by putting them back on the short bus or having a parent remain with limited employment opportunities to stay "on call" with the child's medication either for emergent or routine administration. Thus, more hardship for the family.

rescue99
12-08-2009, 12:59 AM
But again, they should NOT limit what a teacher can do just becaue they are an EMT or MFR. The ARC classes might even be more appropriate since the "cert" would not be such of an issue. The chances of having a child with epilepsy, asthma or some allergies are greater than a MCI. To restrict teachers is just doing the chidren a disservice and limiting the educational opportunities of the student by putting them back on the short bus or having a parent remain with limited employment opportunities to stay "on call" with the child's medication either for emergent or routine administration. Thus, more hardship for the family.

The MFR's are an adjunct aid to staff and the low, low numbers of nurses available in today's public schools. Districts make the rules and until there is incentive to change that, things will remain as they are. Programs like the one I am familiar with may be just the conduit needed.

Ditchmedic
12-08-2009, 11:55 AM
Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

rescue99
12-08-2009, 12:32 PM
Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

As a medic and mom, I have adminstered rectal valium a lot. Parents are quickly trained all the time to give meds per rectal. Staff can be as well.

One of our daughters went to a school for multiply impaired children. The "short bus" children, if anyone doesn't know what multiply impaired means <_< The staff there is well familiarized with the needs of the children attending and nursing is available all of the time. FD was right next door too, so we were all set :) Not a single issue cropped up for us however, there are quite a few emergencies in general. 10 a year maybe...dunno exactly.

The public school knew exactly what they were taught by me and our oldest's cardiologist. There was but 2 issues with her during school thank goodness. One scared the willies out of them but, they only became more dedicated to helping keep her in school. To the present day, we volunteer time to keeping the staff up to date on at least CPR/AED/FA. I would love to do more if only the district would allow....

When our son had his hip rebuilt twice, Tylenol 3's and IB were on hand in case he needed it. Those were prescribed by his surgeon and directions written exactly as I suggested. In every case with our oldest and youngest we had to meet with school nursing and get approval for the kids to return to school. It worked out well. Guess that's why we love the Plymouth/Canton area schools :)

MrBrown
12-08-2009, 12:40 PM
What Mike might have to deal with would be "status epilepticus" rather than a "seizure" as in my education, the two are differentiated just like "asthma" and "status asthmaticus".

Diastat is PR diaz, it's a benzo like midaz which our ALS Paramedics use for stat ep, it's frickin great stuff and works wonders.

I am no expert on your FUBAR legal system but the dose in there is probably very low and not going to do any harm. Our system allows us to administer midazolam to a known seizure patient and provided they meet certain criteria to leave them at home so that should say something about risk right there.

Interestingly kids at school here are being loaded with auto injector adrenaline (epi-pen) in some sort of media fuel'd hype about nut allergies; I know one school where like 1/10th of the students have them! The common regurg line is "oh but Timmy only has five minutes to get adrenaline or he dies!" .... um, has Timmy HAD life threatening anaphylaxis before? Cue the blank stare and "whats that?".

VentMedic
12-08-2009, 05:23 PM
Where I come from, unless there has been an act of God, you would be in violation of an number of laws if you administer Diastat. Tell them no thanks.

Did youi not read the list of "laws" for teachers in the different states I posted earlier? Post the "law" which states teachers can not give prescribed medications. This is absolutely not a "new thing". It just happens to be the first time MMiz has seen a child on the medication that he is responsible for during class time.

Forget the EMT cert if you have a higher responsibililty to students.

MMiz
12-08-2009, 06:34 PM
I appreciate everyone's feedback on the issue, and I continue to work through it with my administration and available medical resources.

Vent, you keep saying that I need to forget that I'm an EMT while I'm at school. The truth is, I'm not part of the school's Emergency Response Team, and it's safe to say that few of my colleagues know of my background and involvement in EMS. Unfortunately it is quite clear, at least in my state, that I don't qualify as a lay person. I am held to a higher standard.

Unfortunately I've seen many of my teaching colleagues partake in the legal system due to their actions and acts of what I see as goodwill. It's essential for both my career and my well being that I ensure the safety of not only my students, but also myself.

VentMedic
12-08-2009, 08:41 PM
Vent, you keep saying that I need to forget that I'm an EMT while I'm at school. The truth is, I'm not part of the school's Emergency Response Team, and it's safe to say that few of my colleagues know of my background and involvement in EMS. Unfortunately it is quite clear, at least in my state, that I don't qualify as a lay person. I am held to a higher standard.


Unfortunately I've seen many of my teaching colleagues partake in the legal system due to their actions and acts of what I see as goodwill. It's essential for both my career and my well being that I ensure the safety of not only my students, but also myself.

Knowing first aid and actually working under a medical director as an EMT are two very different things. Do you know how many people got an EMT cert just for general knowledge or because an ARC course was not available in their area? If you are not working directly under a medical director you are no more than a lay person or in this case a teacher in a school system which is a much higher standard as you have been trusted by the school system and the parents to do things a first aider aka EMT can not.

However, if your Medical Director is covering you while at school and you are receiving some compensation or it is specifically written into your school's job description that includes the word EMT and lists the responsible doctor for you, you are NOT an EMT at school unless you were hired as one. The other teachers may look to you for guidiance in some situations but that is the extent your EMT training should be. All the Paramedics serving burgers an McDonalds while waiting for a job at the FD are not held to a higher standard if someone chokes on a fry. When I moonlight as a bartender with both a Paramedic cert and an RRT license, I am still basically a lay person if someone falls off a bar stool injuring themselves.

Now, has this discussed amongst your fellow teachers and addressed at the state level? It is of little use to discuss it on an anonymous forum with the majority of the members not being at all in your situation and who only know the "EMT" scope of practice. Your responsibility as a teacher is much different and times are changing since the good 'ole days as kids are living longer with diseases they should have died from. For the past 20 years they have been entering the school systems and I have been very happy with the way I have personally seen the teacheres in my area accept them. They have been more than receptive to their changing roles. I seriously believe you are letting the very limited training the EMT has provided you blind you from seeing your changing role as an educator and caregiver for these students in your care. Educators are changing even if EMS never does. It is also very sad that the textbooks for EMS have not changed to reflect the needs of a changing community and patient population.

triemal04
12-08-2009, 08:55 PM
Blahblahblahblahblah...christ it's like a broken record. Repeated for it's importance:
Unfortunately I've seen many of my teaching colleagues partake in the legal system due to their actions and acts of what I see as goodwill. It's essential for both my career and my well being that I ensure the safety of not only my students, but also myself.
Really, that's the end of the discussion. The only important thing to take away from this is that Matt needs to discuss this issue with people who know and are familiar with the law IN HIS STATE, and have experience with this type of issue IN HIS STATE. Anything else, while interesting and worth knowing, does not fully help with the issue he's facing.

triemal04
12-08-2009, 09:12 PM
For the record, if you are allowed by your school and state laws to administer insulin, glucagon, epi and others to your students when needed, and are comfortable in doing so, then giving diastat shouldn't be an issue. If it's a comfort issue then you should have all the tools needed to learn about it's uses, route of admin, indications, contraindications and so forth so that's easily fixed.

If it's a concern about the liability issue...that's something you'll need to look into on your own and is particular to your state. Even if you aren't technically covered by state law, if you have the full support of your school/district, that should go a long way towards helping if it were to go to trial. Especially if you used the med in the appropriate way.

It's also personal issue; not necessarily an ethical one or moral, but along those lines; with your state not giving you protection to give a med during an emergency, and unless there is some other statute that protects you due to your job, it will come down to whether or not you are willing to risk your livelihood for a student.

daedalus
12-09-2009, 12:32 AM
I once attended a special campus in high school run by the local school district, because I wanted to attend a CISCO computer networking class. The staff there was forbidden to do first aid, CPR, or even call 911 in a medical emergency. We had to sign a waiver that said if we had a medical emergency on campus, 911 would not be contacted by school staff, and no aid would be rendered due to the potential liability of a teacher calling 911 and the paramedics hurting you by mistake or doing something to cause a lawsuit. This school also posted all over the school a legal opinion written by the local school districts chief legal console that described how discriminate against gay/lesbian/transgendered students without crossing the line too much, so that you get away with it.

Talk about lawyers destroying society...

Lifeguards For Life
12-09-2009, 12:43 AM
I once attended a special campus in high school run by the local school district, because I wanted to attend a CISCO computer networking class. The staff there was forbidden to do first aid, CPR, or even call 911 in a medical emergency. We had to sign a waiver that said if we had a medical emergency on campus, 911 would not be contacted by school staff, and no aid would be rendered due to the potential liability of a teacher calling 911 and the paramedics hurting you by mistake or doing something to cause a lawsuit. This school also posted all over the school a legal opinion written by the local school districts chief legal console that described how discriminate against gay/lesbian/transgendered students without crossing the line too much, so that you get away with it.

Talk about lawyers destroying society...

we had a kid get knocked unconscious with a baseball bat at a local high school and a teacher got reprimanded for calling 911. (another student had made the bat in shop, and it wasnt built so well. he swung it and the bulk of the bat flew off and hit this poor chick in the face )

rescue99
12-09-2009, 12:43 AM
I once attended a special campus in high school run by the local school district, because I wanted to attend a CISCO computer networking class. The staff there was forbidden to do first aid, CPR, or even call 911 in a medical emergency. We had to sign a waiver that said if we had a medical emergency on campus, 911 would not be contacted by school staff, and no aid would be rendered due to the potential liability of a teacher calling 911 and the paramedics hurting you by mistake or doing something to cause a lawsuit. This school also posted all over the school a legal opinion written by the local school districts chief legal console that described how discriminate against gay/lesbian/transgendered students without crossing the line too much, so that you get away with it.

Talk about lawyers destroying society...

Seriously? This actually happened? :o:lol:

Saytuck99
12-09-2009, 10:23 AM
Knowing first aid and actually working under a medical director as an EMT are two very different things. Do you know how many people got an EMT cert just for general knowledge or because an ARC course was not available in their area? If you are not working directly under a medical director you are no more than a lay person or in this case a teacher in a school system which is a much higher standard as you have been trusted by the school system and the parents to do things a first aider aka EMT can not.

However, if your Medical Director is covering you while at school and you are receiving some compensation or it is specifically written into your school's job description that includes the word EMT and lists the responsible doctor for you, you are NOT an EMT at school unless you were hired as one. The other teachers may look to you for guidiance in some situations but that is the extent your EMT training should be. All the Paramedics serving burgers an McDonalds while waiting for a job at the FD are not held to a higher standard if someone chokes on a fry. When I moonlight as a bartender with both a Paramedic cert and an RRT license, I am still basically a lay person if someone falls off a bar stool injuring themselves.

Now, has this discussed amongst your fellow teachers and addressed at the state level? It is of little use to discuss it on an anonymous forum with the majority of the members not being at all in your situation and who only know the "EMT" scope of practice. Your responsibility as a teacher is much different and times are changing since the good 'ole days as kids are living longer with diseases they should have died from. For the past 20 years they have been entering the school systems and I have been very happy with the way I have personally seen the teacheres in my area accept them. They have been more than receptive to their changing roles. I seriously believe you are letting the very limited training the EMT has provided you blind you from seeing your changing role as an educator and caregiver for these students in your care. Educators are changing even if EMS never does. It is also very sad that the textbooks for EMS have not changed to reflect the needs of a changing community and patient population.

I felt the need to jump in, there is some confusion that could be taken from what is said here. I speak only for my area, however, for the purposes of legal liability only take the above with a grain of salt. Be aware that the above mixes to separate legal issues. First, the duty to act and second the legal liability you incur from that action. In my state, as medic, emt, or lay person you are not required to act when you observe someone in a medical emergency when not on duty (volly or employment). You can watch them die and not incur any liability. However, if you choose to act you will self impose a duty to act reasonably under the circumstances. For the lay person, you are required to act as any other reasonable person would under the circumstances, (if the person is bleeding to death and you try and stop the bleeding that is reasonable even if you unintentionally cause more damage-but if you intervene and do something unreasonable such as wrap his head in saran wrap to stop the bleeding and suffocate him your in trouble.) If you are an EMT, medic or other professional and you choose to act out of goodwill then you are held to the higher standard of your individualized training. In other words you would be judged by what a reasonable EMT, Medic etc would have done in the same scenario. For example I am in the legal field, however, if I choose to aid my employer who is having a seizure and I administer a prescribed medication beyond my protocols and it kills him (even though the med is prescribed to him, its helped him before and he told me to) I am liable for his death. Not only will I be sued, but I will lose my EMT card as well.

In addition, and departing from the above, depending on the age of the child we are talking about, you need consent to treat in certain circumstances. Implied consent only extends to the treatment necessary to aid the patient within your training level.

Finally, not to beat an already buried horse, but if you happened upon a car accident, as an EMT-B and decided to help, would you assist a child with medication at the direction of the parent that you were not otherwise authorized to give at your training level-or would you call medical control for authorization.

I will not weigh in on what should or should not be done. It is STATE specific. But from a legal standpoint if it were me, I would find another way to deal with the situation or go through the appropriate channels to ensure that my butt was covered legally prior to administering any medication to any child.

sorry for the rant......

VentMedic
12-09-2009, 10:59 AM
If you are an EMT, medic or other professional and you choose to act out of goodwill then you are held to the higher standard of your individualized training. In other words you would be judged by what a reasonable EMT, Medic etc would have done in the same scenario. For example I am in the legal field, however, if I choose to aid my employer who is having a seizure and I administer a prescribed medication beyond my protocols and it kills him (even though the med is prescribed to him, its helped him before and he told me to) I am liable for his death. Not only will I be sued, but I will lose my EMT card as well.


That is if you act in a manner other than what a lay person would do. Those who carry all their EMT equipment with them to play whacker 24/7 may inflict their own pain with the legal system. However, for an EMT to do CPR just as any lay person would do will not give cause the legal system to come after the person JUST because he is an EMT. If he attempted to pull out his whacker bag and try to do a cric off duty, then there might be a cause. But as we all know you can sue anyone for anything in the U.S. You should not discourage someone who holds a medical license or certification from providing first aid if appropriate for their own safety in fear of losing their license. This is also why some Good Samaritain laws have included off duty health care professionals who act in good faith.

In addition, and departing from the above, depending on the age of the child we are talking about, you need consent to treat in certain circumstances. Implied consent only extends to the treatment necessary to aid the patient within your training level.


The school systems have consent forms from the parents. The teachers are not running around at random giving out these meds to anyone who looks like they are having a seizure. This is nothing knew but it took years of lobbying to given students and teachers these opportunities. This is not about some advocacy fanatics as MMiz has suggested in a previous post but rather very involved professionals with the interests of the child in the school system. Those in EMS really should step out of their ambulance to see what the rest of medicine is involved in.

You might check out some of the wordings in various statutes as well as the cases that have brought about change.


I will not weigh in on what should or should not be done. It is STATE specific. But from a legal standpoint if it were me, I would find another way to deal with the situation or go through the appropriate channels to ensure that my butt was covered legally prior to administering any medication to any child.



This is why he should be addressing his concerns with the school system and not on an anonymous forum with mostly 110 hour trained EMTs on it. Many here do not understand how other medical professions have fought for the CHILD and his right to an education as well as swift medical care. These statutes written for the school systems have also taken into consideration that in many areas of this country, ONLY an EMT-B will be responding who can do very, very little for these emergencies except to drive real fast to the ED which could be many miles away. Even in FL where we have all ALS response, it has been noted that a response could be 4 minutes or 15 minutes even in the best of cities. We also have the death count in the school systems before implimenting these programs to show the need for school systems to be more proactive in the health of the children.

If a teacher takes the necessary training for CPR, AED, the medications they can deliver and some information about the diseases, their training can add up to some impressive hours which can out number that of the EMT. Couple that to the time spent in college, you may have a much more mature person responding to the needs of that child who they already know their history.



Finally, not to beat an already buried horse, but if you happened upon a car accident, as an EMT-B and decided to help, would you assist a child with medication at the direction of the parent that you were not otherwise authorized to give at your training level-or would you call medical control for authorization.



You have definitely made a great argument as to why the U.S. EMT-B is a very inadequate certification. Hopefully the future will eliminate these issues with an increase in education and training.

Saytuck99
12-09-2009, 11:22 AM
Vent:

I agree almost 100% with you. I feel for the children and with a little training and adjustment teachers would be in a position to aid special needs children in a classroom setting, whether it be meds, accommodations or other. Unfortunately from my experience in my field, and not experience as a newly certified EMT-B, the same parents that consent to the meds, accommodations and teachers participation in treatment will turn on a dime and take that teacher for everything he has, or does not have as well as take his ability to make a living both as a teacher and an EMT.

Companies, school districts, public officials etc. are not known for backing the little guy when push comes to shove. While one may be able to secure adequate coverage for such an incident from either the school or union, when that parent get on tv and blames the school for killing a child, that teachers job is history regardless of fault, union affiliation or otherwise. In addition, the powers that be will suspend all licenses pending investigation and if they can will pin the blame on that teacher to avoid there own liability. And its not the admin of the school doing it, it is the lawyers for the school that will do it and admin will follow suit.

Unfortunately good intentions, good will and good faith cannot protect someone from trying to do the right thing if an adverse outcome happens to be the result. Again, I agree with you whole heartedly in principle, both that as an EMT-B I have very little ability to actually help someone in need Yet I am held to a standard that defies common sense) and that something needs
to be done to address the growing population of children in schools who require additional attention. What that solution is? Who knows-maybe with a bigger budget every school can have an MD on site, but until then sometimes doing the right thing may wind up depriving your own family, wife, kids etc...its a sad wold we live in--

VentMedic
12-09-2009, 11:36 AM
Vent:

I agree almost 100% with you. I feel for the children and with a little training and adjustment teachers would be in a position to aid special needs children in a classroom setting, whether it be meds, accommodations or other. Unfortunately from my experience in my field, and not experience as a newly certified EMT-B, the same parents that consent to the meds, accommodations and teachers participation in treatment will turn on a dime and take that teacher for everything he has, or does not have as well as take his ability to make a living both as a teacher and an EMT.

Companies, school districts, public officials etc. are not known for backing the little guy when push comes to shove. While one may be able to secure adequate coverage for such an incident from either the school or union, when that parent get on tv and blames the school for killing a child, that teachers job is history regardless of fault, union affiliation or otherwise. In addition, the powers that be will suspend all licenses pending investigation and if they can will pin the blame on that teacher to avoid there own liability. And its not the admin of the school doing it, it is the lawyers for the school that will do it and admin will follow suit.

Unfortunately good intentions, good will and good faith cannot protect someone from trying to do the right thing if an adverse outcome happens to be the result. Again, I agree with you whole heartedly in principle, both that as an EMT-B I have very little ability to actually help someone in need Yet I am held to a standard that defies common sense) and that something needs
to be done to address the growing population of children in schools who require additional attention. What that solution is? Who knows-maybe with a bigger budget every school can have an MD on site, but until then sometimes doing the right thing may wind up depriving your own family, wife, kids etc...its a sad wold we live in--

This is not just one child. We are talking about many children that are entering the school systems taking some type of medication. Many times the child is allowed to administer their own medication. But, even at that, do you know how many years it took and how many children had to die before an albuterol inhaler could be carried by the child instead of being locked up in a school nurse's office who was often at another campus?

We've already gone from having a school nurse available and even RRTs on some campuses. And yes, MDs have been involved. Right now the MDs are very involved with petitioning the legislators to empower the school systems. Some states are so broke they can not afford schools and now have massive layoffs of teachers and are closing schools. Healthcare for children has also taken a big hit.

EMS has so many problems of its own it has little time to concern itself about its own education with some of the medical issues of children or what is happening in their own community. Maybe if they raised their own knowledge level, they would see why some of these issues are of importance. And yes, there is concern in the school systems among the school nurses who must delegate in certain situations and among the teachers who feel their inservices were not adequate. However, those who did receive adequate education and training are very supportive of the healthcare needs of the children to allow them access to education. Thus, if MMiz feels his inservices for these medications are not adequate, that should be what is addressed and bringing his EMT cert into the issue. If anything that should be used as an example of what can happen when inadequate training is provided as now seen in the U.S. EMS levels.

Aidey
12-09-2009, 11:41 AM
I personally would consult a lawyer, just to have everything clarified and see how your state/county etc look at it and make sure that they don't see any issues.

If I were an educator I would be very hesitant to also step into a caregiver role for medical issues. It is such a huge issue for legal problems and liability that I would be very concerned. The more I think about it the more I go "ehhh" and cringe to myself.

Teachers are having larger and larger class sizes these days, and you have to think about all of the students. If you have 30 students in a class room how can one person take care of a seizing kid, while keeping track of the other 29 and keeping them calm and out of the way?

In a case like this, how is Matt supposed to handle administering the medication? Does he usher all his other kids into the hall and leave them there unsupervised so he can give the Diastat in an empty room? Does he move the seizing child to somewhere private? Does tell everyone not to move and administer it while trying to preserve the kids privacy as best as he can?

What happens if the child has a seizure on the play ground, or the cafeteria, where there are even more bystanders. Will the school have privacy screens they can move around the child, or is the school going to be equipped to safely move a child having tonic-clonic activity to a private place? Are they going to have the resources to keep all the other children away?

What happens if a teacher waits to give the diastat in order to get all the other kids out of the room so they can administer it in private and the child suffers a brain injury or dies?

Now that I've probably thoroughly freaked you out Matt, you can see why I say consult a lawyer. There are just so may variables that I don't see how the liability isn't too great.

I can understand teachers being allowed to give* a student their own medication when they ask for it, like an inhaler, or assist with a medication the student states they need, like an inhaler or epi pen. What starts to bother me is allowing teachers to decide when the student needs it. (*By give, I mean hand over if it's in the teachers possession)

I also understand that more students are in schools today with complicated medical devices. Again, I think it's one thing to have a class explaining to all the teachers what the device is and what it does and how it works, and it's another to expect the teachers to program/run/troubleshoot it.

One of the big things I think that prevents blanket statements from being made is that each child's case has to be looked at differently to determine how big of a role teachers can be expected to play in their medical care.

Honestly, teachers are already expected to play so many different roles to kids, I don't think adding medical caregiver should be another one. I don't think it's fair to the teachers, or the students. If a school has children enrolled that may need medications administered or have special medical devices the school should be required to have a medical professional on site.

And yes, I understand that many of these kids do not have medical caregivers at home and their parents handle all of their needs. These parents have probably spent years working with their kids and their medications/equipment and have talked to the doctors and attended classes and have been educated by their child's health care team. And they don't have to worry about watching 30 other kids at the same time. The teachers do not have anywhere near the same chance to learn as much and I think expecting them to care for their students medical needs is too much.

Aidey
12-09-2009, 11:48 AM
I want to add that I know funding is an issue, but unless they change the equal access to education laws (which I doubt is going to happen) people are going to have to accept that having heath care professionals available to assist these students is necessary. I think this is a really good example of where the reality has far exceeded what people expected could be achieved and no one planed for it.

Also, I'm not saying that teachers shouldn't be involved at all. I absolutely think we should be educating teachers so they know what is going on with their students. My issue is the increasingly advanced level of medical care they are being expected to provide.

VentMedic
12-09-2009, 12:09 PM
I personally would consult a lawyer, just to have everything clarified and see how your state/county etc look at it and make sure that they don't see any issues.

If I were an educator I would be very hesitant to also step into a caregiver role for medical issues. It is such a huge issue for legal problems and liability that I would be very concerned. The more I think about it the more I go "ehhh" and cringe to myself.

Teachers are having larger and larger class sizes these days, and you have to think about all of the students. If you have 30 students in a class room how can one person take care of a seizing kid, while keeping track of the other 29 and keeping them calm and out of the way?

In a case like this, how is Matt supposed to handle administering the medication? Does he usher all his other kids into the hall and leave them there unsupervised so he can give the Diastat in an empty room? Does he move the seizing child to somewhere private? Does tell everyone not to move and administer it while trying to preserve the kids privacy as best as he can?

What happens if the child has a seizure on the play ground, or the cafeteria, where there are even more bystanders. Will the school have privacy screens they can move around the child, or is the school going to be equipped to safely move a child having tonic-clonic activity to a private place? Are they going to have the resources to keep all the other children away?

What happens if a teacher waits to give the diastat in order to get all the other kids out of the room so they can administer it in private and the child suffers a brain injury or dies?

Now that I've probably thoroughly freaked you out Matt, you can see why I say consult a lawyer. There are just so may variables that I don't see how the liability isn't too great.

I can understand teachers being allowed to give* a student their own medication when they ask for it, like an inhaler, or assist with a medication the student states they need, like an inhaler or epi pen. What starts to bother me is allowing teachers to decide when the student needs it. (*By give, I mean hand over if it's in the teachers possession)

I also understand that more students are in schools today with complicated medical devices. Again, I think it's one thing to have a class explaining to all the teachers what the device is and what it does and how it works, and it's another to expect the teachers to program/run/troubleshoot it.

One of the big things I think that prevents blanket statements from being made is that each child's case has to be looked at differently to determine how big of a role teachers can be expected to play in their medical care.

Honestly, teachers are already expected to play so many different roles to kids, I don't think adding medical caregiver should be another one. I don't think it's fair to the teachers, or the students. If a school has children enrolled that may need medications administered or have special medical devices the school should be required to have a medical professional on site.

And yes, I understand that many of these kids do not have medical caregivers at home and their parents handle all of their needs. These parents have probably spent years working with their kids and their medications/equipment and have talked to the doctors and attended classes and have been educated by their child's health care team. And they don't have to worry about watching 30 other kids at the same time. The teachers do not have anywhere near the same chance to learn as much and I think expecting them to care for their students medical needs is too much.

It all comes down to training and proper education. This is again NOT a new issue. In some areas it is a necessity since only BLS with EMTs is the only EMS available.

But, if you want to talk about liability, what about EMTs taking responsibility for a child when they have NO ability to administer that medication or any medication? There is very little education in the EMT curriculum that even prepares them for the basic medical emergencies of a child or adult. Hospitals and LTC facilities must trust their patients to the care of an EMT for transport knowing that they have very little knowledge about medical issues since their training is largely about first aid. EMTs accept patients with very complex medical conditions when they transport dialysis patients or most medical needs patient. Again, their first aid training gives them very little knowledge on how to care for that patient other than a ride to the ED. Some even believe "dialysis" is a diagnosis rather than a medical procedure. Yet, EMTs do these transports every day. The trust that hospitals and LTC facilities must place with EMTs is not that much different than what parents must place in the teachers of their school system. The difference should be in the education and training which should be made available to the teachers. At least teachers are questioning their limitations and do know there is a need for more education/training before these medications can be given safely.

Assuming responsibility and knowing that anyone can be sued is part of being a professional be it in medicine or education. Educators can be sued for just about anything and it doesn't have to be about giving a medication. You accept your responsibility and make sure you have been provided with adequate training to do your job. One shouldn't let their fear of lawsuits paralyze them.

EMS plods along every day with inadequate education (U.S.) in many areas but still some rush out to do it even if they don't know anything other than a few protocols. A teacher can read a protocol just as easily as an EMT.

Aidey
12-09-2009, 12:28 PM
If an area does not have ALS that is an issue for that area as a whole, and what they are willing to pay for via taxes. An individual teacher should not be expected to make up for a whole county or city's decision not to support a tax levy to fund full time ALS(Or whatever other scenario applies). You can't blame the teachers or the staff members of LTC facilities for the 911 system in their area, nor can you expect them to make up for any deficiencies it has.

All I have to say about the transfer issue is this. On non-911 transfers the sending medical provider has the ability to state whether the pt is an BLS or ALS patient. If they pick BLS that is their choice. If they don't understand the difference that is a problem with their education, not the EMTs and Paramedics.

If they don't have the option of ALS transfers, then see point 1 above.

Every profession comes with its own areas of liability. The issue I see here is taking one profession and exposing them to the liability of another profession they didn't sign up for. They are teachers because they want to teach, not because they want to provide medical care. It's like becoming a Paramedic and then being told I'm going to be responsible for maintaining all the electrical on the ambulance and here is a 2 hour class to explain how. I'm not an electrician or mechanic, that is another profession all together, and suddenly I'm being given all their liability without any of their resources.

VentMedic
12-09-2009, 12:45 PM
It's like becoming a Paramedic and then being told I'm going to be responsible for maintaining all the electrical on the ambulance and here is a 2 hour class to explain how.


As ridiculous as you wanted your example to sound, it actually is not. A Paramedic should know some basics about their electrical system on the ambulance for safety of other medical equipment (plugging in a CCT/Flight team vents, isolettes, med pumps etc) and malfunctions with the emergency lighting. However, they are not responsible for the detailed maintenance that requires a professional electrician/mechanic anymore than the teacher is required to do more than what is asked by his/her guidelines and instructions from the child's parents and MD. The teacher is not prescribing the medications.

Teachers entering the profession now are aware of the medical needs students in their classroom and that they may have to take responsibility as a caregiver as well. This again is NOT a new issue. We are not rewriting any legislation here. MMiz just needs to clarify the education/training concerns he has with what he has been provided. He should also address this from his role as a teacher and not that of an EMT.

Maybe some should just see what is happening in their own communiity and school systems.

EMS providers just don't seem to have any interest in getting involved in anything that concerns community issues or even what happens in their own profession. Some are not even willing to take CEUs or inservices about these issues that concern the health of children.

Many healthcare professionals and their associations (RNs, MDs, NPs, RRTs, PAs, etc), each with their attorneys, have been involved in seeing that school professionals and children have access to medications. This is not just an "EMS decision" especially when some in EMS do not even know what the issues are.

Get involved in what is going on around you in your community and in medicine. EMS is part of medicine and part of the community. You shouldn't be so jaded to believe there are not more health care issues than what was mentioned in your EMT(P) text book.

daedalus
12-10-2009, 12:11 AM
It's like becoming a Paramedic and then being told I'm going to be responsible for maintaining all the electrical on the ambulance and here is a 2 hour class to explain how.
I actually think this makes a good case for educators to be able to provide simple medical care to their students. I personally have researched some of the non medical equipment in my ambulance so that I am truly knowledgeable in my job as an EMT, and soon Paramedic. If you are working in a class room with a group of high risk children, while your primary job is education, you should have some training in the medical issues of these children because not only does this affect the type of teaching you are going to do, but you as a teacher are in a great position to see changes in student conditions because you are with them for most of the day during the week. You are in a great position to intervene in acute episodes in these children and save lives.

On the other hand, aidey made a great point about privacy. Since diastat is per rectum, what about patient privacy when administering, and what about the rights of others to not have to watch such a procedure.

VentMedic
12-10-2009, 07:08 AM
On the other hand, aidey made a great point about privacy. Since diastat is per rectum, what about patient privacy when administering, and what about the rights of others to not have to watch such a procedure.

I've also known EMS providers to strip a child naked before teachers could remove the other kids. Can't always control every situation as well as one would like but one can try.

redcrossemt
12-10-2009, 08:59 PM
Unfortunately my state, like many, does not provide immunity for the administration of medications in times of emergency. Neither my EMT insurance or my professional liability insurance (for teaching) will cover the ministration of medication.

Actually, as a teacher in Michigan, you are exempt from both civil and criminal liability for administration of medication to a student in an emergency situation as long as:

1. The medication is prescribed to the student and has directions for use by the physician.
2. There is an authorization note from the parents.
3. You give the medication in the presence of another adult.

This is all from MCL 380.1178 if you want to look it up.

if it is a known re occuring condition, as i am guessing it is if your student has been prescribed diastat

I don't get this! Diazepam does save lives, and prevent permanent disability. Hypoxia is a big concern in kids. Diastat is usually prescribed to those most at risk for status epilepticus and hypoxia. Just because someone has a diagnosed seizure disorder doesn't make the risk of status any less...

Aidey
12-11-2009, 08:02 AM
I think the comparison works considering I don't think teachers shouldn't be involved at all. As a paramedic I should know how my ambulance works, but I shouldn't be expected to be able to re-wire the siren if it fails. Teachers should know about their students conditions and devices but I don't think they should be expected to give them medical treatment.

Like I said before, handing an inhaler to a student so they can self administer or moving furniture away from a child having a seizure is one thing. Providing medical treatment is another.

redcrossemt
12-11-2009, 11:51 AM
I think the comparison works considering I don't think teachers shouldn't be involved at all. As a paramedic I should know how my ambulance works, but I shouldn't be expected to be able to re-wire the siren if it fails. Teachers should know about their students conditions and devices but I don't think they should be expected to give them medical treatment.

Like I said before, handing an inhaler to a student so they can self administer or moving furniture away from a child having a seizure is one thing. Providing medical treatment is another.


So.... the teachers should let their students die from asthma attacks, anaphylaxis, and seizures while waiting for the ambulance? Even when legally protected by the state, with a prescription from a physician and authorization from the parents?

Or should these students just not be allowed to go to school?

VentMedic
12-11-2009, 01:06 PM
I think the comparison works considering I don't think teachers shouldn't be involved at all. As a paramedic I should know how my ambulance works, but I shouldn't be expected to be able to re-wire the siren if it fails. Teachers should know about their students conditions and devices but I don't think they should be expected to give them medical treatment.

Like I said before, handing an inhaler to a student so they can self administer or moving furniture away from a child having a seizure is one thing. Providing medical treatment is another.

That puts the school systems back to the 1960s which much of EMS is still stuck.

It is sad that the Paramedic education does not include more about the medical needs children or more about pediatrics to see how broad this issue is and that is it often the teachers that do know their students. The Paramedic might then understand where time is the issue and not their own delicate issues of insecurity that a teacher can do what they can. That essentially is what this is about. Other medical professions have given their support to the teachers in legislative issues and with preparing them for medical needs children.

It is also sad that you don't see that if you take the meds out of the schools that it will also include the inhalers out of the hands of children and where does it stop? Definitely take away the AED and the emergency O2! The kids will no longer able to attend schools again or at least be denied the same opportunities as others. This has been a lengthy process starting in the 1970s and really getting noticed in the 1980s. It was not a spur of the moment decision and has been hashed out in the court systems across the country. Again, a sad note that some do not pay attention to the many medical issues around them and that goes for the EMTs who may even have school age children. Times are changing and the attitudes of EMS providers need to change and to enhance their own education to change with medicine and education as they evolve.

rescue99
12-11-2009, 02:27 PM
[QUOTE=redcrossemt;196051]Actually, as a teacher in Michigan, you are exempt from both civil and criminal liability for administration of medication to a student in an emergency situation as long as:

1. The medication is prescribed to the student and has directions for use by the physician.
2. There is an authorization note from the parents.
3. You give the medication in the presence of another adult.

This is all from MCL 380.1178 if you want to look it up. = QUOTE]

Redcross,
Isn't Michigan doing a good job! While there may be a ways to go yet, we've pioneered progress going way back to the 60's. Do ya suppose having 3 major children's hospitals in the area might have had something to do with it??

redcrossemt
12-11-2009, 04:17 PM
Redcross,
Isn't Michigan doing a good job! While there may be a ways to go yet, we've pioneered progress going way back to the 60's. Do ya suppose having 3 major children's hospitals in the area might have had something to do with it??

A lot better than many states, but there's still much to be done. I do like the school MFR program here, but it still doesn't solve the medication administration problem.

Also, no reason why lay responders can't give albuterol MDI and epi-pens without a prescription or authorization from the parents. These are life saving things that are available without a prescription for your first aid kit in many countries.

rescue99
12-11-2009, 04:29 PM
A lot better than many states, but there's still much to be done. I do like the school MFR program here, but it still doesn't solve the medication administration problem.

Also, no reason why lay responders can't give albuterol MDI and epi-pens without a prescription or authorization from the parents. These are life saving things that are available without a prescription for your first aid kit in many countries.

Laypersons can help administer prescribed epi pens and nebulized treatments. Been teaching that standard in school/corporate settings for the last 3-4 years. Sometimes it gets right down to a district's or business' own policy on the subject.

New teachers in MI have to have CPR/AED/FA however, only a select number are required to keep their certs current. Coaches, most special ed (including para-pro's), nurses, gym teachers and pre-school for sure. Our district bus drivers even have to recert in CPR yearly. Not sure about FA though.

Aidey
12-11-2009, 06:38 PM
That puts the school systems back to the 1960s which much of EMS is still stuck.

It is sad that the Paramedic education does not include more about the medical needs children or more about pediatrics to see how broad this issue is and that is it often the teachers that do know their students. The Paramedic might then understand where time is the issue and not their own delicate issues of insecurity that a teacher can do what they can. That essentially is what this is about. Other medical professions have given their support to the teachers in legislative issues and with preparing them for medical needs children.

It is also sad that you don't see that if you take the meds out of the schools that it will also include the inhalers out of the hands of children and where does it stop? Definitely take away the AED and the emergency O2! The kids will no longer able to attend schools again or at least be denied the same opportunities as others. This has been a lengthy process starting in the 1970s and really getting noticed in the 1980s. It was not a spur of the moment decision and has been hashed out in the court systems across the country. Again, a sad note that some do not pay attention to the many medical issues around them and that goes for the EMTs who may even have school age children. Times are changing and the attitudes of EMS providers need to change and to enhance their own education to change with medicine and education as they evolve.

It doesn't put the school system back in the 60's or 70's because I never said no medical care, I said no advanced medical care by TEACHERS. It should be a requirement that these schools have a medical provider on site. Period. End of discussion. I never said to take anything out of schools, I never said don't have teachers who know CPR or rescue breathing or supportive care.

Leave the teaching to teachers and the medical care to medical professionals.

I also believe I said that some things, like assisting with Epi pens or inhalers should be allowed with proper training. As I said before, in those cases the teacher is assisting with a medication the student could administer themselves, and can sometimes tell the teacher they need.

VentMedic
12-11-2009, 07:18 PM
It doesn't put the school system back in the 60's or 70's because I never said no medical care, I said no advanced medical care by TEACHERS. It should be a requirement that these schools have a medical provider on site. Period. End of discussion. I never said to take anything out of schools, I never said don't have teachers who know CPR or rescue breathing or supportive care.

Leave the teaching to teachers and the medical care to medical professionals.



Do you realize how many school systems there are in this country? What about the daycares? Of course every school would love to have their own nurse but that hasn't been possible since the 60s and 70s. EMTs would be of no use since they have way less training than most of the teachers about pediatrics and these meds. Their scope of practices would also not allow them to do much more than call 911 and start CPR. The teachers aren't "advanced" by giving prescribed medicine.