Responding to Special Needs

      It's suddenly a bad day. The cold rain that had been forecast unexpectedly turned in the midmorning to ice so heavy it snarled traffic and began to tear down power lines already covered with wet snow. After a number of minor motor vehicle crash responses, Attack One is dispatched to a local school for a report of an ill girl.

   When crew members arrive on scene, the buildings are completely dark. They recognize the school as one that accommodates students with special medical needs. They have been there in the past to deal with emergencies for students using special modes of conveyance, as well as ventilators, nebulizers, infusion pumps and other devices.

   Inside, a school official guides them to a classroom where a number of students have been placed. On the way, he explains that the school has a sophisticated backup power generator, but for some reason it didn't turn on when the power went out. The school's emergency maintenance personnel have been activated, but can't get to the school through the icy streets. The entire school system has now cancelled classes, and the buses and parents are trying to get in to pick up all the students.

   The student for whom the call was received isn't acutely ill, but is being supported by a ventilator. The ventilator has a backup battery that isn't functioning, and there is no backup power in the building. The child needs support from the device, and is also due soon for a nebulizer treatment from another device. School officials have contacted her parents, but they can't get to the school in any short period of time. They've instead asked if the child can be removed to the hospital for support. The child's first vital signs are normal, but the nurse overseeing her reports she will need some type of ventilatory assistance before long.

   The Attack One crew leader recognizes there are likely to be other medical needs among students in the school, so he breaks away to evaluate other children in the building who may have powered devices rendered nonfunctional. As he finds those students, he asks if they can all be colocated in one room to facilitate care and prepare for orderly discharge.

   The girl with the ventilator has a special wheelchair and will require a different ambulance for safe transport to the hospital. It will take significant time for the vehicle to make it through the icy streets to the school, so the Attack One crew prepares to assist ventilations and deliver a nebulizer treatment to the patient. She has a tracheostomy in place, and the bag-valve mask device and adaptor will fit the tube. The crew fits an inline adaptor for the nebulizer and delivers an albuterol mixture to the patient. They also establish communication with the local children's hospital to advise them of the situation and confirm they will be transporting the patient in her wheelchair and using the BVM to assist her respirations.

   By now the room includes several other children with devices that have lost power. Among these are two with infusion pumps and one who needs a nebulizer treatment. The nebulizer treatment can easily be administered using the device from Attack One's supply, but the child requires medications, typically in the possession of her caregiver, that are not within the crew's standard protocols. The medical control physician from the children's hospital approves delivery of these medications using the nebulizer, and the crew documents this approval in their care report. Upon getting her meds, this child is fine to go home with her parents.

   The infusion pumps are more problematic. The two devices are the same model, and both have a trouble alarm indicator unfamiliar to the caregivers responsible for the children. Both devices are stamped with troubleshooting tips, but the instructions do not include the problem shown, and neither device is functioning. The caregivers locate a hotline number on the devices, but cannot contact it—the school's phone lines are also out of service. The paramedic instead uses his cell phone to call the expert help available from the manufacturer. After establishing contact, he hands the phone to the nurse who is the lead caregiver, and she works through a sequence of inputs to the devices that gets them functioning again.