(I am in the middle of a EMR course, but I have current FA and ASHI CPR cert)
I was at a trampoline park today and saw a young boy collapse and go into grand-mal seizure. His father was there with him so I approached and told him I had CPR certification and asked if he needed any help. Turned out to be a special needs 13yo male, prior history of seizures "when he gets hot". His mother arrived with a small medical kit that included a rectal medication that was supposed to stop the seizure.
The father had rolled him into the recovery position, however as he was on a trampoline the weight of his body pressing on the center of the trampoline meant his face was actually upwards, not downwards. He was fully unconscious (had stopped seizing) but was still at risk of his airway being blocked by his tongue.
Knowing there was no trauma I used the head-tilt-chin-lift and listened closely for breathing. He has a good clear airway, breaths were about 60 (short, panting). Skin dry and warm, pulse 110 (mother said that was normal for him) and at this point was simply unconscious with no immediately apparent further risk. His mother said the medication would bring him around, would take a few minutes, and they would go home. She refused EMS stating this something they just have to deal with from time to time.
I suggested we move the kid to the rest areas off the trampoline where he would be in a better recovery position (and would be suitable for CPR if he got worse, but I didn't say that out loud).
We used a two-person side-lift (kid was 130lbs, his dad not much bigger!) and placed him on the floor of the rest area. His dad provided emotional support as the kid started to come around. I monitored his airway, breathing and pulse on a one minute cycle, his airway was patent at all times, his respiration rate to 40-50 per minute. His radial pulse was steady at 110. I got a little more history from his mother and pretty much came to the conclusion that is was a sort-of-not-unexpected result of him getting overheated. His dad had been fairly frantic to begin with but calmed down to my pace as the event went on. He asked if I was a medic, I told him I was still in training to be an EMR, and couldn't use any of my EMR training yet as I wasn't certified, but had my CPR card and that's all I needed for this situation.
The kid came round enough to be lifted into a wheelchair and taken out to his parents' minivan. They refused EMS/911 again, and I wished them good luck as they took him home.
Did I do anything wrong? Did I miss anything?
Considerations in my head:
1) His mother gave him the medication - I was not involved in that at all, I know I am not allowed to give / recommend medication (even as an EMR, except a patient's own epi-pen I think)
2) His mother refused EMS, so I feel that the point at which I discontinued care was appropriate even without higher level care taking over - it was a patient refusal (mother of a minor), not an 'abandonment'.
3) I have my ASHI CPR card from August 2012 and I just passed the Professional CPR certification last week, so I felt comfortable limiting my help to what I am certified for, I would not have done any EMR-specific interventions (OPA, NPA etc). Would have called 911 had that been needed.
I am doing EMR because of the number of times I find myself in these types of situations. I am not making EMS a career and will not be working for any agency or have a medical director. This year alone I have help with a broken ankle at a skate park, a vehicle entrapment on the freeway, a spun-out wreck on a freeway, a broken arm at karate, a possible ankle sprain and knee sprain (to different events) at the trampoline park, a hypoglycemic student at karate... The list goes on. I must be a jinx or something.
I was at a trampoline park today and saw a young boy collapse and go into grand-mal seizure. His father was there with him so I approached and told him I had CPR certification and asked if he needed any help. Turned out to be a special needs 13yo male, prior history of seizures "when he gets hot". His mother arrived with a small medical kit that included a rectal medication that was supposed to stop the seizure.
The father had rolled him into the recovery position, however as he was on a trampoline the weight of his body pressing on the center of the trampoline meant his face was actually upwards, not downwards. He was fully unconscious (had stopped seizing) but was still at risk of his airway being blocked by his tongue.
Knowing there was no trauma I used the head-tilt-chin-lift and listened closely for breathing. He has a good clear airway, breaths were about 60 (short, panting). Skin dry and warm, pulse 110 (mother said that was normal for him) and at this point was simply unconscious with no immediately apparent further risk. His mother said the medication would bring him around, would take a few minutes, and they would go home. She refused EMS stating this something they just have to deal with from time to time.
I suggested we move the kid to the rest areas off the trampoline where he would be in a better recovery position (and would be suitable for CPR if he got worse, but I didn't say that out loud).
We used a two-person side-lift (kid was 130lbs, his dad not much bigger!) and placed him on the floor of the rest area. His dad provided emotional support as the kid started to come around. I monitored his airway, breathing and pulse on a one minute cycle, his airway was patent at all times, his respiration rate to 40-50 per minute. His radial pulse was steady at 110. I got a little more history from his mother and pretty much came to the conclusion that is was a sort-of-not-unexpected result of him getting overheated. His dad had been fairly frantic to begin with but calmed down to my pace as the event went on. He asked if I was a medic, I told him I was still in training to be an EMR, and couldn't use any of my EMR training yet as I wasn't certified, but had my CPR card and that's all I needed for this situation.
The kid came round enough to be lifted into a wheelchair and taken out to his parents' minivan. They refused EMS/911 again, and I wished them good luck as they took him home.
Did I do anything wrong? Did I miss anything?
Considerations in my head:
1) His mother gave him the medication - I was not involved in that at all, I know I am not allowed to give / recommend medication (even as an EMR, except a patient's own epi-pen I think)
2) His mother refused EMS, so I feel that the point at which I discontinued care was appropriate even without higher level care taking over - it was a patient refusal (mother of a minor), not an 'abandonment'.
3) I have my ASHI CPR card from August 2012 and I just passed the Professional CPR certification last week, so I felt comfortable limiting my help to what I am certified for, I would not have done any EMR-specific interventions (OPA, NPA etc). Would have called 911 had that been needed.
I am doing EMR because of the number of times I find myself in these types of situations. I am not making EMS a career and will not be working for any agency or have a medical director. This year alone I have help with a broken ankle at a skate park, a vehicle entrapment on the freeway, a spun-out wreck on a freeway, a broken arm at karate, a possible ankle sprain and knee sprain (to different events) at the trampoline park, a hypoglycemic student at karate... The list goes on. I must be a jinx or something.
