Managing medical concerns at school and on excursions is one of my biggest worries as a teacher! Anaphylaxis is at the top of that list, since a reaction can be almost instant from the allergen and has a cascading effect. This means the longer you leave it, the more difficult it is to recover. However, despite this serious concern, it just means effective strategies need to be in place to ensure preventative measures are the number 1 priority.
In outdoor education, we usually run our programs a considerable distance from emergency medical care. As a result, this adds an additional layer of risk to any trip away. However, rather than worry about this and feel as though it’s too risky to take kids away, my focus has always been on effective preparation and management. This ensures that the chances for an anaphylactic reaction becomes so low, it’s not an issue.
If a student’s medical profile is flagged with an anaphylactic allergy, I’ll phone home and talk to mum and dad. What I need to know when I call is what are the specific triggers? Can they have foods which might contain traces of the allergen? When was the last reaction and what happened? Even though this information might be in the medicals, I prefer the first hand information from parents, so I can effectively brief my staff. I also want to know how well their son or daughter manages their allergy. Are they aware of what can happen? Are they aware of what foods they can and can’t have? This information is vital in helping provide teachers with the best management strategies in the field.
As an example, on one program, I had 247 students out in the field for a week long camp. 11 of the students had allergies which could result in an anaphylactic reaction. Based upon the information from the parents, and the fact some activities were hours away from emergency care, I carefully placed students with the highest needs in the closest proximity to emergency healthcare facilities. In one of the extreme cases, given the number of allergens that the student was affected by, I asked his mum to provide and pack the week’s food in an esky for her son and I provided a clean stove which was specifically for his personal use.
At the end of the day, it about clear channels of communication between parents, teachers and the child. Even though all staff are trained in first aid and anaphylaxis treatment, effective preparation and prevention is far more important. For every activity we do, we go armed with a list of dietary requirements and only shop according to each individual excursion. We don’t plan meals months in advance to save time. It’s about providing the best meal options for each individual group. This way, we’re prepared and able to ensure we provide a safe environment for every child and a wonderful memorable experience away from school.
Nobody really likes taking kids into hospital. Most of the time it ends up being the teacher who’s got time off, or the last person out of the room! Let’s be honest it’s a crap job that nobody wants. Firstly you have to take at least two kids with you, so you’ve got one injured and one bored. Secondly the wait… there’s no such thing as a fast track in emergency unless you’re not breathing although arguably by this point you're probably beyond the services available in the emergency ward. Thirdly have you ever been able to get a decent coffee in a hospital?
The trip to hospital all starts when an injury is more serious than your staff can manage. I've had all sorts of visits with students, from fractures, to cuts, to unknown issues each visit if often a unique experience...
My longest wait was 8 hours and this gave me the opportunity to talk about all sorts of things with the student. It's amazing what you find out about life the universe and just about everything when chatting!
However, my weirdest experience was when I took one of the kids in with multiple cuts after he took a dive in a bed of oysters. I won't go into the gory details, but he was a mess to say the least. We sat and waited for some time after seeing the triage nurse, who rifled through the stack of papers which were suppose to be a medical 'summary'. When the nurse finally brought us in to the examination room, she took one look at him and proceeded to fill a tub with warm water and a dash of disinfectant. She then said to me 'here you go, take this into the waiting room and clean him up'. I looked at her for a moment wondering if she was serious... Yes she was!
I looked back at her and said 'can I at least have a pair of gloves'. She half indignantly grabbed me a pair of glove and off we went. I sat there apologising profusely to the couple sitting next to us as I cleaned out the painfully deep wounds and collected a pile of tiny oyster shells as I did. I've heard of cut backs but seriously do I get a discount on my Medicare levy for do it yourself work in hospital?
Anyway, we were there about another hour and a half and the boy ended up with stitches in his hand and bandages everywhere.
To be honest I still try and avoid the hospital trip (mainly because of the bad coffee), but at the end of the day when you're responsible for the kids welfare and safety, prompt action and quick decision making to get them to hospital can mean the difference between an injury becoming an extremely bad injury. So really it's always better to err on the side of caution and take them in to be sure, rather than risk it just to avoid a long wait. At the end of the day, you can always get a coffee on the way home!
Thinking back, can you remember the first time you had to deal with a real first aid emergency?
My first experience is something that's always stuck in my mind, as it was confronting and my reaction wasn't what it would be now. We were out on a night navigation exercise, ascending a spur under head torch light, when one of the students collapsed. As soon as I saw him go down, everything I learnt on my two day first aid course went out the window... I completely froze...
This left me feeling overwhelmed and helpless! I wasn't sure what I should be doing. I had this sudden debilitating feeling... I can't deal with this! Thankfully I had another really experienced teacher with me, who jumped in and took charge of the situation. The day had been ragingly hot and it turned out the boy was severely dehydrated and suffering from heat stroke.
It's hard to train for this sort of situation and until it actually happens, it's very hard to know what your initial reaction is going be and what it's going to feel like. It's even harder to know what to do about it. However, one important thing you can do in any situation, in the words of the Hitchhiker's Guide to the Galaxy, is 'Don't Panic'. Take a deep breath, be calm, collected and assess the situation. Run through the DRSABCD calmly in your head and look around assessing the area as you approach. This will give you time to put your gloves on, collect your thoughts and balance out the adrenaline that your brain has just shot into your body.
Don't let your body overwhelm you in this sort of situation. Calmness and common sense helps a great deal and first aid is not a solo effort, so if you can, call another teacher in to help manage the situation and provide support for the casualty whilst you wait for emergency services. Remember, most importantly, you're there stabilising and protecting your students from further harm until the ambulance arrives.
After that incident I decided I should upgrade my training beyond the basic two day course and so I studied wilderness first aid. This helped develop my confidence in treating injuries and managing casualties, but still nothing focussed and developed my skills more than the experience of a student walking up to me dripping with blood from massive cuts to his chest, hands and stomach! But that's a story for another time!