Emergency Transport To Hospital

[amarrian]

In our nursery school we have a child who is in danger of her life if she eats a peanut. Her mother has instructed us to take her by car to hospital and not to wait for an ambulance should such an incident occur (having administered the epipen). The school is in central London and not more than two or three miles from the hospital, although traffic is unpredictable and can be congested. However, I am unable to find any health professional who thinks that this is a better option than calling, and waiting for, an ambulance. Does anyone have any knowledge about the legal implications involved? Is one on shaky legal ground by acquiescing to the mother's instructions rather than following advice from the health professionals?

[Lucie]

Have you got it in writing, what she is asking? Are you insured to carry the child, and can you legally carry them - car seat?

 

I would say if you can legally do it and she has formally told you to do it, and you don't push ratio's at the setting by taking them then i cant' see why not. Obviousky im not an expert on the matter.

 

What if something awful happened bc you waited for an ambulance?

 

lucie

[Beau]

Hi,

 

Sorry to hear about your predicament. Obviously the parent will be very anxious about this and I can understand why they might think that taking their child straight to hospital would be the best option. However, when I was on my First Aid training, the trainer stressed many times that it is never a good idea to transport a dangerously sick child to hospital yourself for many reasons. Firstly, there is the issue of who will take the child and who will stay behind - either way you are likely to be jeopardising ratios in some way. Secondly, you are likely to be in a panic and more likely to have an accident with possible fatal consequences for yourself, whoever is with you and other members of the public. You probably wouldn't be covered by insurance in this case either - particularly if all the advice from professionals have stated that you shouldn't do this.

 

Am I right in assuming there is a high risk of them suffering from Anaphylaxis? If you ring for an ambulance and state that, then they will give that priority. An ambulance would be able to reach your setting much quicker than you can get to a hospital and would have all the necessary equipment on board to treat the child effectively.

[Rea]

I'd use an ambulance. Something awful could happen while you're driving and cause all sorts of upsets, what if she got worse, what if there is a traffic jam? After administrating the epipen relief is usually immeadiate, if an ambulance is called at the same time I cant see how you can be quicker. Dont they have motorcycle paramedics in London due to the congestion?

I'd take the advice of the medical people you've spoken to. You could well be going against the mothers wishes but you and your staff have to be covered too, and this might leave you open to question.

[Guest]

Amarrian, I agree with the previous responses, especially Beau's comment about what would you do if the child stopped breathing whilst you were driving.......

 

We had a child who had a severe peanut allergy and managed it the following way:

1. Health visitor and community health nurse came in and trained all the staff in Anaphylaxia and use of an epipen

2. Mum attended the training too and was comfortable that we all were competent in the event of an accident.

3. An additional 2 epipens were kept at nursery in case of emergency

4. In conjunction with the Health Visitor and Community Health Nurse we drew up a comprehensive Anaphylaxia plan for that child, including clearly displayed information together with photographs

Everyone was comfortable that in the event of an emergency we would keep the emergency services on the phone to talk us through procedure until the ambulance arrived. In our case we are about 10 minutes from the hospital.

Do you have the child's GP practice nearer to you than the hospital? Would they be able to help you if necessary? If you have the epipens (2) then you should be able to manage the situation until the ambulance gets there.

Could you put a staff plan in place so that the keyworker was always within a certain distance.....

We also communicated to all our parents and carers that we had a child with a severe peanut allergy and laid down guidelines for what was allowed to be brought to nursery (a) in lunch boxes, ( for junk modelling - i.e. no cereal boxes. We also ensured that everything that nursery provided was nut free (supermarkets will add you to their mailing lists for allergy information). We only used sunflower oil in our playdough etc.

All this takes time but is worth the effort!

Let us know if you need any further advice and good luck.

 

To encourage you, the mum has recently started working for us!!!

[amarrian]

Thank you all very much for your replies. They are very helpful

[Andreamay]

Hiya

Can i just add that you would not be allowed to take the child on your own which would surely mean you would not be covered by ratio and by the time back up arrived you would best waiting for an ambulance.im sorry but i would have to refuse but good idea having the health visitor in to chat to you all about epipens etc may put mums mnd at rest a little.

[Guest]

Just to ditto what has already been said - a definate no no! It was stressed emphatically on my most recent first aid course not to transport any injured / unwell child in your own vehicles for reasons mentioned already. Who then becomes responsible if the child's condition rapidly deteriorates? As Andreamay has also said any one using their own transport for children must have another adult with them in the car, and you may find that your own insurance does not cover you for 'business' use, which is what you would need. Not worth the risk involved.

[Inge]

good advice from all.

 

You would need 2 staff to use a car one to supervise the child , panic can set in for the driver making it unsafe, and in that time often the ambulance will be with you with all equipment to treat immediately before moving to hospital.

that along with insurance problems for use of car etc.. could you not contact your nursery insurers as well to see how you would stand if you followed mums instructions and there were complications on the way, would you be covered?

May be a way of explaining why you choose to call and wait for emergency services.

Perhaps a risk assessment on moving child and calling the emergency services to show why you made the decision. This would show how you have come to your decision.

 

Personally..I would wait for the ambulance and we are close to the hospital with relatively little traffic!!

 

Inge

[hali]

good advice from all... all your staff need epipen training so you can administer if needs be and call an ambulance... end of........

sorry to blunt but that covers everyone involved and you need it in writing from the mum that, thats your policy.

[Susan]

Also remember that patients arriving by ambulance are prioritised over walkins, generally. Maybe mum needs to be reminded to use an ambulance herself if the need arose?

[narnia]

completely agree with all of the above, and you would definately need two people to be with the child, which would probably compromise your ratios at your setting, where the other children might be in a state of distress over such an incident.I would ALWAYS opt for an ambulance.Yes there might be a short wait, BUT this is offset by them having all the necessary equipment, expertise AND the blue light for getting through traffic.It simply wouldn't be worth the risk for staff to try to get to a hospital themselves.Epipen training is a must, for all involved, and then pray that you never, ever, have to use it! Good luck

[Guest]

the anaphalaxis web site has good info for schools etc.

as a grandparent of a child with the same allergy and the manager of a setting I would advise you to go with an ambulance . what would you do if they stopped breathing or had a heart attack you would not have the resources to help them the ambulance service when pre warned would be ready set up when they arrived for these emergencies.

Like one of the other posts we had training as a setting for the children who have attended from our community nurse and as a family for my grandaughter have gone into school when the training has been delivered to staff so all are comfortable with procedures. At the school she first attended and where I worked as a NTA there was a list of staff who would administer the epi-pen though the whole staff team did the training not all staff where comfortable with it . I appreciate the implications and see the need for clear guidence and procedures your authority should have that guidence in place as it can be a bit of a legal mindfield.

good luck

sue

[Guest]

My son is at risk from anaphylaxis and I would not under any circumstances want him dying in a car with someone panicking at the wheel and someone else unqualified sitting with him and being unable to give him life saving treatment

 

I would want him in an ambulance where they are best qualified to save his life

 

Plus... think of the court costs if the child died - parents would need to blame someone

 

Sarahx