What's wrong with this picture?

I finally got my first 9-1-1 call of the year on Friday morning, and it didn't play out the way I would have hoped.

I happened to be in the main office, two doors down from my own office, when the secretary answered a call. I could hear surprise in her voice as she said, "Yes she is, I'll let her know." She hung up the phone and turned around to tell me that the preschool needed me and that it was "kind of an emergency." [This elementary school has a preschool site attached to it, for special needs 3-5 year olds.] I jogged out of the school, across the blacktop, and through the gates to the preschool building. The rest of the kids were coming out, ushered by the adults, who directed me inside. Inside, I found the teacher and a three year old autistic boy, and the teacher told me he had just had his first grand mal seizure. I asked if 9-1-1 had been called already, and she said yes, that they had called down to the main office who then calls 9-1-1. I thought that was odd because the fire station is literally across the street from the school's soccer field, but okay. I asked when it had happened, because the boy was sitting up when I found him, and this was the gist of the teacher's description: "He went into a shaking seizure on the bean bag, which began ten minutes ago. It lasted for about two minutes, and afterward he was unresponsive and his breathing was labored. He still isn't his normal self." Sure enough, within a minute or so, the boy snapped to alertness, and I could hear sirens leaving the fire station. The teacher said that the boy's mom was on her way, and that she had called 9-1-1 because it was his first seizure of this kind - he normally has absence seizures - and I nodded in support. Soon enough, the firemen and paramedics arrived, and the mother did too - who, as she and son were being loaded into the ambulance - explained to her panicked husband who arrived shortly thereafter that teacher had explained to her why 9-1-1 was being called, giving the same reason she had given me.

Now, I am the school nurse to the elementary school, and there is another nurse - a co-worker of mine - responsible for the preschools around town. However, when emergencies happen, and I am there, I am obviously going to do what I can to help - in this case, thankfully, it only involved observing for a few minutes before the paramedics arrived. In this particular case though, there were several things screaming at me that these people need to be better prepared for future emergencies. So, without further adieu: Can you find what went wrong?

1. Why did they call down to the main office to have them call 9-1-1? The dispatchers ask questions in which it is quite helpful to be directly observing the patient in question (e.g., Is the child conscious?), and not only that, it wastes precious time. The preschool has a direct outside line, one on which they called the mother of the seizing student - but not 9-1-1.
2. Why did it take so long to call 9-1-1? I learned afterward that it took so long to hear sirens because they didn't call for 9-1-1 until AFTER they called the main office to check if I happened to be on site. (I think my blood pressure rises just thinking about it.) They knew to call 9-1-1 and why, and for the life of me, I can't figure out why it took TEN - that's 1- 0 - minutes to act on that knowledge.
3. Related to number 2, if a child is unresponsive after a seizure - his first grand mal - that would be a clue to me that if for some reason 9-1-1 hadn't already been called, now would be the time. But the teacher also mentioned to me that although he was breathing, it was "labored" after the seizure. Tip: if a three year old without respiratory issues is having difficulty breathing, please call 9-1-1. Immediately.
4. My own areas in need of improvement: turns out I don't have a health alert list for the preschool kids. They may not be mine, but they really are when I'm there, and it would be nice to know who has seizures, and who has Epipens (yes, preschool-aged kids do have them). I'll be getting that from the preschool nurse. Second, I wasn't wearing a watch, which is tortuous in case of emergency, particularly related to a seizure. No one will probably believe this, but I noticed my naked wrist on my way into work and thought that with my luck I'd have an emergency. Murphy's Law strikes again, and to heck with watch tans: I'll be wearing a watch from now on.
5. A child having his first grand mal seizure is not "kind of" an emergency. That is an emergency.

In my efforts to stay positive this semester, I'm going to see this for what I want it to be: this is a serious learning opportunity for everyone. I've already discussed with the principal the need for the preschool to make their own 9-1-1 calls - they can notify the main office after they call for assistance - and I asked the preschool nurse to do some in-service training for the staff's benefit. Unfortunately, they beat me to her with a different story - one that involved calling 9-1-1 three minutes in and the paramedics taking 11 minutes to arrive. Must...Stay...Positive...


  1. Anonymous18/1/12 06:46

    I worked for a big city school district's special education department. We were repeatedly told never to call 911, we were to call the main office and it was their responsibility to call 911. One of our sped students was having a seizure and trouble breathing one day and the sped teacher immediately called 911. She was then reprimanded by the principal for not having called the main office instead. I don't understand- it is absolutely ridiculous.

  2. Get a pin-on fob watch - both my nurse and paramedic daughters have them. No tan line!

  3. Personally, if a child in my care is experiencing something that warrants a 911 call, I am not calling anyone else but 911. If I get written up or fired for not following "procedure," to hell with it. I would know I did what's best for that child.

  4. Hmmm... I wonder if the dispatch records would show the same delayed response time to make it across the street?

  5. A watch is important, no? Carry two, because two is one; and one is none -- i.e. the one watch may break/have a dead battery/be home on your dresser when you need it most.

    My iPhone has a clock built into it, and a stopwatch function as part of the built-in clock app. Getting the stopwatch running will at least allow you to recount as "ten minutes ago....

    And since it counts up in seconds, it will let you time vitals. Keeping time and taking notes is also one of those things you can assign to bystanders.