7 yr old girl died at school in VA on 1/2/12

[CMdeux]

Right-- if the number is low then you have to wonder why.  Is it that schools are not administering when they SHOULD?

Probably.

But if the number is high, that might be even MORE worrisome in its own way, since it suggests that while response is good-- prevention SUCKETH mightily, and frankly, without prevention getting better, it's only a matter of time before other failures in an individual instance result in a child's (preventable) death.

Of course, this may also be heavily dependent in an individual school district on the individual students involved.  I can easily see a kid like my DD needing two to five Epi administrations annually at school-- even with good allergen control measures in place, I mean.

[ajasfolks2]

Here is link to OLD discussion as to LTFA policy in Virginia, in Resources at OLD boards.

http://allergy.hyperboards.com/action/view_topic/topic_id/4247/start/121

I am finding that MANY of the old links from Fairfax are now not working.

Crap.

[ajasfolks2]

Latest article at Richmond paper has this quote from the school district:

Earlier this week, a school spokesman said a little more than 600 students out of a total student enrollment of 60,000 have health plans on file that permit school officials to give them an epinephrine injection if they have an allergic reaction to food, bee stings or latex.

Given the latest studies and numbers of allergic, shouldn't this number be MUCH higher?

[TabiCat]

So the emergency responders used an AED but no epi?  Can this possibly be true?  That is horrible!

My Dr warned us that not all ambluance companies carry epi. So if she didn't have her's well. I have never understood that why wouldn't paramedics and EMT's be able to have and use epi. We are always talking about how simple andsafe the use of epi is so why so much fear of it out there.

Are we worng?

[CMdeux]

Tabi it is not really a matter of right/wrong here.  It's not that simple.

It's all about the route of administration.  Inhaled or intramuscular epinephrine is VERY safe.  Even in those who might ordinarily have cardiac contraindications to epi otherwise.

Intravenous administration, say, in a hospital setting, uses epinephrine as a drug of last resort.  (Welllll...not "last" resort, certainly, but it is higher risk than some others...)

So yes, Epinephrine is a powerful, indiscriminant beta agonist and potent cardiac and CNS stimulant.

It is also a locally-acting, instant and effective asthma drug that opens airways like little else.

It is also a VERY safe intramuscular drug for treating the widespread effects of anaphylaxis.

Beta agonists are also used very safely as adjuncts in dental anesthesia so that the anesthetizing agents have better longevity clinically.

Pharmacologists, well-trained pharmacists, and physicians with a good understanding of pharmacology probably do not regard epinephrine only as a cardiac drug with a (relatively) narrow dosing window.  KWIM?  But volunteer EMTs, nurse's assistants, pharmacy technicians?  They well may, and so does the general public.  They all seem to envision the scene from Pulp Fiction without realizing that while plausible (though just very barely so) it's not exactly realistic, nevermind 'normative.'

[Arkadia]

So the emergency responders used an AED but no epi?  Can this possibly be true?  That is horrible!

my guess is they werent ALS, in which case most likely its closest definitive care/ grab and go.

[CMdeux]

Yes, what you get when you call 911 is state-dependent and highly variable.  We were horrified to realize that in MN (when we lived there) only EMT-C's were epinephrine authorized, and that included IM administration.  Most ambulances weren't equipped with Epi at all. 


This is the same thing that killed a girl in WA state over a decade ago.  http://www.pbs.org/newshour/bb/health/jan-june99/medicine_6-8.html

It's just appalling to me that we're more than a decade past that and this is STILL happening.   

[Momcat]

It makes me so sad that rules and regulations were given higher priority than a child's life.  There must have been an epipen in that office someone could have used on her.   

[gufyduck]

Yes, what you get when you call 911 is state-dependent and highly variable.  We were horrified to realize that in MN (when we lived there) only EMT-C's were epinephrine authorized, and that included IM administration.  Most ambulances weren't equipped with Epi at all. 


This is the same thing that killed a girl in WA state over a decade ago.  http://www.pbs.org/newshour/bb/health/jan-june99/medicine_6-8.html

It's just appalling to me that we're more than a decade past that and this is STILL happening.   

Just FYI - I have been told by a local fire fighter that while they cannot administer epi, if they saw I had one they would "assist" me, even if I was unconscious or otherwise unable to use it, by first wrapping my hand around it. 

[Mfamom]

There was a death in NJ that spurred bill to allow epi in ambulance. 

I'll look for the story I'm thinking of....not long after the bill was introduced/implemented, having an epi in the ambulance saved a boy in Princeton area

[hopecha]

Just FYI - I have been told by a local fire fighter that while they cannot administer epi, if they saw I had one they would "assist" me, even if I was unconscious or otherwise unable to use it, by first wrapping my hand around it.


This bothers me.  Why does our legal system think this is an effective solution for liability avoidance ? Is it tacitly saying it is okay to lie? (I did not really administer it, the unconscious, or struggling person did). Not to go off on a tangent -- but this is New York states solution for camps. I was baldfacedl told that my three yr old would have to "self -administer" in order to go on a two hour nature walk.  And ever since, camp after camp has adapted this.  My problem is -- it leaves no clear-cut action plan.  And, how much time gets wasted in wrapping fingers and correctly choreographing the charade ? And it means either 'wink, wink", of course we'd save your kid, or FU - go away.  BUT in an ambulance ? I geuss its better than saying we cannot administer period.  But it is silly. 

[gufyduck]

This bothers me.  Why does our legal system think this is an effective solution for liability avoidance ? Is it tacitly saying it is okay to lie? (I did not really administer it, the unconscious, or struggling person did). Not to go off on a tangent -- but this is New York states solution for camps. I was baldfacedl told that my three yr old would have to "self -administer" in order to go on a two hour nature walk.  And ever since, camp after camp has adapted this.  My problem is -- it leaves no clear-cut action plan.  And, how much time gets wasted in wrapping fingers and correctly choreographing the charade ? And it means either 'wink, wink", of course we'd save your kid, or FU - go away.  BUT in an ambulance ? I geuss its better than saying we cannot administer period.  But it is silly.

That is exactly my attitude. I wish all rescue squads had epi and would give it, but at a minimum i'm glad someone with a known allergy would be given their meds. I'd rather they bend their rules to help than just stand there.  I'm not sure if it is general firemen have this limit or how wide spread the limit is in California. 

[rebekahc]

I just merged the two different discussions on this topic.  The discussion from Schools was merged in and moved here.

[lakeswimr]

I hope the district gets stock epi pens into schools, esp with their numbers they gave--must be many more in their schools with FAs and other ana who don't have epis at the school. SCARY. 

[ajasfolks2]

Latest article at Richmond paper has this quote from the school district:

Earlier this week, a school spokesman said a little more than 600 students out of a total student enrollment of 60,000 have health plans on file that permit school officials to give them an epinephrine injection if they have an allergic reaction to food, bee stings or latex.

Given the latest studies and numbers of allergic, shouldn't this number be MUCH higher?

I'm thinking there is a LARGE undiagnosed LTFA population in these schools  . . . 

and they are playing Russian Roulette by not having stock epipens and better training for staff.