Welcome back, me.

I won't complain about having a three week winter break, but I was ready to come back to work today. Good thing: my first asthma attack warranting EMS happened after recess this morning. A kid who has come wheezing into my office before came in again, except this time when I asked him to get his inhaler out of his backpack, he said he didn't know where the backpack was. I got his emergency card and we went through every number on the card, his parents twice. While he was dialing, I called the nursing coordinator to ask just at what point I should call EMS. As I began to give my assessment, I realized I didn't need to ask: his color was starting to turn, his coughing becoming unbearable, and his sweating became profuse. I hung up and dialed 9-1-1, because the best we had from any of his emergency contacts was that someone who knew someone who knew where his backpack was would tell her to bring it to school. After a tortuous wait (is it ever not?) the paramedics arrived and whisked him off. [Father called soon afterward asking why he wasn't called first. If he wanted to speak with me directly, I would be more than happy to tell him we tried and didn't have time to wait for a call back, but the secretaries got the brunt of that one.]

When I called the nursing coordinator back to tell her the end result, she said asthma attacks are one of the worst parts about this job; it's not usually a black and white decision, and watching and waiting for their condition to deteriorate is tortuous. Further, it's preventable, and in this case, disgustingly so: we've tried sending the medical forms home for this child to keep his inhaler in the office multiple times, plus, who lets their kid go to school without his backpack? Interestingly, the backpack did show up with the aforementioned emergency contact just before the paramedics arrived. I thought I was about to feel really stupid and have the paramedics find a perfectly happy healthy fifth grader, but the pack was inhaler-less.

Just before break I had received materials on asthma education distributed by the county. I was shocked to learn that kids die of asthma at school (only on the very rare occasion, but still), and I wasn't about to be one of the nurses at such a school today. The materials also included videos of wheezing. I felt ill watching them the first time around but in real life, it is even more sickening to watch a child with a severe asthma attack. The wheezing and coughing make me cringe, and it also makes me want to have a little chat with the parents who decided not to pack an inhaler for their severely asthmatic child on a cold winter day.

On a totally different note, a kid came in to ask for an ice pack for a crick in his neck. I told him his pillow must not have been fluffed right last night, and his accompanying friend said he got two pillows for Christmas. And a shotgun. "A real shotgun. My mom said it's for if anyone tries to fight me." These were first graders.


  1. A first grader with a shotgun. Wow! I'm cool with the Second Amendment, but come on...just wow...

    That is horribly sad to think of kids dying of asthma at school or anywhere. Generic Albuterol has been available for decades, and if you have health insurance, the newer meds are awesome at prevention. You are my hero. I would be afraid to be all by myself with a bunch of kids in my charge. School nurses rock.

  2. Re: guns.... yeah...

    Re: albuterol: It's awful, but so many kids are without health insurance and/or parents that won't take the initiative to do something for their kid. Also- I'm no hero. I am terrified of being responsible for the safety and well-being of hundreds of kids!

  3. Anonymous12/1/11 03:15

    As a Pharmacy Tech, I can tell you that one of the problems re: inhalers is that most insurances won't pay for more than 1 per month. I've made numerous phone calls trying to get a second, "school supply" inhaler for kids, and spent hours on the phone only to be refused. I don't know how your school system works- but at ours the kids need a separate inhaler, labeled and kept in the nurse's office- the kids are not allowed ( at least at an elementary level) to carry them in their backpacks. Which is stupid IMHO and a rant for another day. I mean- like breathing is optional for cripes sake!

  4. I've heard about the one inhaler issue, which is why I push the self-authorization forms on my parents. Kids aren't allowed to carry any sort of medication unless they have such a form on file, and kids of any age can get this form signed. For this kid in particular, I know he usually has an inhaler in his backpack, and I know he doesn't have the forms on file to do so... but I'm not about to confiscate a medication I know he needs. Despite repeated attempts to get this kid's parents to get the proper paperwork on file, we still don't have it, so I just pretend I don't know he carries it with him. A liability for me, yes, but I'd rather have the kid breathing.

  5. Anonymous13/1/11 01:21

    Erin- Thanks for the clarification on your policies. I'm glad to know that there's a school nurse that's willing to *bend* the rules in cases like this. I share your frustration about the degree of responsibility some parents have with their kids- I see it so often too in my line of work, and I have the *bruises on my forehead* to prove it. As a parent of 3, I just can't fathom things like that at times. I will also have to ask about those self-authorization forms in our district next time I'm in my youngest's school- that's something I had not heard about. Could be another idea I can suggest as well if it's available here.
    ( Just found your blog this past week- thanks for your hard work, and I will be back!)
    Peace, KCflacpht.

  6. Last week, I had TWO kids who "weren't feeling well" and, when I assessed them, found that both were wheezing. No hx of asthma recorded at school. When I called the parents (one of whom took 40 mins to get ahold of), each said that their child has an inhaler at home (one with an asthma dx and one without). HELLO! Send one to school, people--even if your kid "only uses it ever two years". Well, today's the day and your kid can't breathe well. Ugh. Thankfully, did not need to call 911.....