Boy choked at nursery. Advice needed from medic -minded mnetters

[bubble99]

And subsequently died. I was so, so upset to hear about this.
It's got me thinking. If an accident happens in a nursery, however serious, there is usually a lot that a first aider can do to keep the child alive until an ambulance arrives. Effects of shock can be minimised, blood loss can be controlled etc. With an obstruction of the airway there is nothing anyone can do in a first aid situation if the object cannot be removed. What is striking though, is that simple suction will (usually) easily remove the object. If an ambulance crew can get to a child in time and administer suction, the outcome is usually good.
We run two nurseries and I've been wondering whether we should have a basic suction machine in each nursery and train the staff to use them. If the police and some train drivers can be trained to use onboard defib equipment, wouldn't a suction unit in a nursery make sense. Hopefully it would never be used, but littlies do have a habit of choking. I (obsessively) cut up grapes, cherry toms etc for the tinies (18 months) but even then, some children seem pre-disposed to having chewing/swallowing difficulties.
I am an RN with current registration and have spent the last few years suctioning post-op gunge out of airways in a recovery room. I also hold the ENB998 Teaching and assessing cert. (but as this is for teaching within a clinical setting, would I need another cert to teach in another setting?) I would feel totally confident in teaching the staff how to use suction equipment. What do you think? Even if the equipment is never used, doesn't it make sense to have treatment for one of the most common childhood emergencies?

TIA for any thoughts.

[FrightfullyPoshFloss]

I take it this is where you mean Bubbs?

My main thoughts are that you would have to get parents to sign some kind of disclaimer and discuss plans with them to see if they are in agreement. Otherwise you may be put in the position where if harm is done you might get sued/blamed etc.

The other thing that strikes me is that it is easy to suction gunge out. I'm not 100% sure that it would be so easy to obtain the object. Is a larynoscope usually used? Would it be with a yaunker or suction catheter? I have no direct experince of choking in a child, other than when DS choked on some vomit and started to turn blue. I just panicked! Could not remember what to do for what seemed like forever.

Could you discuss this with local paramedics? I'm sure they would be delighted that you want to take some action to prevent what should be a preventable death. I would also ask them if they would be happy to do the teaching, as they are the ones who do it most frequently. Again, then, less 'responsibility' would be on you. They would know about the legal side of these things a bit more too. You never know, if they think it is a good idea it may be rolled out further! You might become famous! I hope this helps, although I'm sorry I'm not as knowledgable on this as you probably hoped. xx

[startingtobehalloweenylover]

i think it's a great idea... but i am totally non-medical! but i would feel happy sending ds to a nursery which had equipment to deal with choking

but... would it raise your insurance a lot?

[bubble99]

Floss. I would imagine a suction catheter would be needed, rather than a yaunker (I'm pleased you knew how to spell that ) as an obstruction not easily coughed up or removed, would probably be further down the trachea.

Great idea about the paramedics. We can incorporate their visit into our littlies' 'People who help us' topic, too.

I am prepared to encounter a lot of 'computer says no' obstructions (excuse the pun) on the way. But if lay-carers in the community are deemed able to suction patients, I would hope that trained NNEBs are thought even more able.

SL. Good point about insurance. I've just talked to Mr Bubble who thinks it may even reduce our insurance if there is an RN (me) and suction trained staff on-site.

Christie. Have you needed to suction these children at school? Hats off to you, BTW. I have a lot of respect for teachers, even though you finish work at 3.20pm and have so many holidays.

[FrightfullyPoshFloss]

Yes thats where I think I got a little confused. I shall do some experiments with the suction at work when I'm in next and see what it can pick up!

I'm sure the paramedics will be keen to help. Keep us updated!!

[nooka]

bubble, you would need to be very careful, and make absolutely sure that you got advice on insurance, upkeep of any equipment, training etc. Some of this will depend on the qualifications that your staff hold, but I know from work (I work in the NHS for a PCT) that this can be a problematic area. For example did you know that if you are a non practicing but registered nurse, and you give first aid at an accident you can be disciplined by the NMC? I think it is a great idea, but do check out the fine print first, or you could (potentially) be putting your nursery at risk. I am sure that the paramedics could give you advice on this, and there may be accredited advanced first aid courses that might do the trick.

[moondog]

Bubble,would all the training,upkeep,and general worry be worth it? It is extremely unlikely to happen..
Do your staff get regular first aid training? Could dealing with choking incidents be part of this?

I live in a Sure Start area and all mothersare offered Baby Safe training by the Resucitation Council. I have attended twice and fell fairly confident about being able to deal with a choking child (which I sincerely hope I never have to do.)
Incidentally one of the women who attended the session was driving home some time ago and noticed a woman shouting in panic with achild on the pavement. She got out of the car,saw the child was choking and carried out what she had been taught.

All was well.

Said she got home,burst into tears,smoked half a packet of fags and had a huge brandy.

[startingtobehalloweenylover]

hmm i was thinking though that you may have to be insured to USE the equipment in case of anything going wrong.... that could be costly

[Janbo25]

I think it is a 110% excellent idea i know i would change my son tomorrow to a nursery which offered this!

[bubble99]

Thanks nooka. Will deffo get advice on insurance. Upkeep should be covered by daily recorded checks (as for any resus equipment in a clinical setting) and annual (at least) servicing. Despite having a new baby and business, I'm still up to date with PREP requirements and manage to squeeze in enough shifts (child-friendly hours, once every two weeks) to maintain my 'practising' status.

I'll look into accredited training, as well.

[bubble99]

MD. Yes, all of our staff (including our trainee) have had first aid training. The problem in this case was that the staff (who Asquith claim carried out first aid) were unable to dislodge the obstruction. If something is too far down in the trachea, no amount of first-aid will help. Also, someone who attempts to help, who has not had first aid training, is likely to try and fish the thing out of the throat, thus pushing it down and obstructing it further. First aid training, as you know, teaches that you should only attempt to remove an obstruction if it is clearly visible.

[moondog]

The RC training really spells this out bubble, and shows you how to put a baby over your forearm and thwack the little back.

Actually the woman who trained us told us she'd had to do it to one of her kids who had a bad cough and ingested a long thin ice lolly he was eating mid whoop.
She had thumped him so hard to dislodge it that the blood vessels in his eyes had burst. (Standard I gather.)

Anyway,sorry,I'm rambling with personal anecdotes rather than supplying you with useful info.

[bubble99]

Ramble away, MD Is it still cold in Turkey?

[northender]

I don't think that a suction catheter would be strong enough to hold the obstructing item and pull it out. Also if you had that option staff might try it at too early a stage without exhausting other options and the potential dangers of suction would concern me. Rambling a little, does that make sense?

[edam]

Sounds like a good idea Bubble, hope the more information you get the more it comes together.

This was an Asquith Court nursery, I gather? Have just taken ds out of one of them. The more I find out about that company the worse it is, frankly.

[edam]

It wasn't in Herts, was it?

[FrightfullyPoshFloss]

northender, thats what I have been thinking too. I suppose though, that on higher suction it might be doable. Like I said I will try and experiment!

The other thing that I wonder, is, say one parent said they would not want this done. And then that child choked. Would be very hard to make decisions.

[moondog]

Well heating is on! Alim the ineffectual concierge and his harem (I aint joking!) obviously got the boiler working.
We did here a lot of random clanking and hammer thuds last night which must have been him.

The great thing about here is that it is nearly always sunny and cloudless.Skies are huge,we're surrounded by snowcapped mountainsand on the edge of an aquamarine lake.
Amazing place.....it will be crawling with tourists in twenty years.

Bubble,I am worried I was flippant on the 'addicted to MN' thread about your situation (and Lonelymum's.) Didn't mean to be at all but it could have come out wrong. There is an apology there. Don't know if you saw it.

I really hope I haven't offended....

[northender]

the more suction, the more potential trauma though? Litigation nightmare i would think. On a personal basis, I wouldn't be happy with the idea of dds nursery doing that and I think the nursery and the staff are great. I'm a respiratory physio and I take a lot of convincing before I let junior staff loose on np or op suction. Suctioning via a trache is a completely different animal imo

[bubble99]

No edam, Middx (the bit near Surrey)

No, it makes sense to me northender. I suppose it depends on the type of obstruction, I know in the Asquith case it was a meatball. The whole procedure would only be effective if, as you say, the staff tried conventional first aid first.

But this child died because whatever it was was lodged so deeply in the trachea that nothing would get it out and the ambulance arrived ten minutes later. Ten minutes is a fantastic response time for a Thursday lunchtime in the outskirts of London but not, obviously, soon enough.

As a parent, would you prefer (suitably trained) staff to have the option of using suction equipment, even if only in the hope that it may succeed in an otherwise fatal situation?

Edam. We took DS2 out of one PDQ.

[FrightfullyPoshFloss]

As a lay person, yes Bubble I probably would. But you know how a little big of knowledge can be a bad thing . I've seen things go so horribly wrong. And have just seen possibly the most tragic case I've experienced at work last week. Put it this way, I don't think I will be getting DS operated on for his tongue tie anymore.

[bubble99]

Edam. Thinking about it, you may be right as well. I met one of the Asquith staff who was telling me the whole story (confidentiality?!) and she was saying how this most recent death was the second one this month for Asquith.

[bubble99]

So. What's the consensus? A good or bad idea?

[edam]

OMG Bubble, that's terrifying. The thing is, ds's nursery was fab, until a few months ago, as far as I could tell. He was happy, secure, staff were warm and reliable - in fact often he didn't want to come home, used to grab my hand and take me round the room to show me everything he'd been playing with. Acted as if he wanted us to move in there!

But it's been going downhill for a while now due to staff turnover. And ever since we started to plan to take him out, I keep finding out more and more worrying things about this company.

[bubble99]

It always comes back to staff turnover. High staff turnover = poor care. Always.

Their main problem seems to be a total absence of the concept of teamwork. At DS2's nursery there were always at least three (NNEB trained) bods in suits who occupied 'management' roles. This seemed to prevent them from going anywhere near a child even though, for the purpose of OFSTED ratios, they were counted into the staffing numbers.

We took on an ex-Asquith deputy at one of our nurseries and we're planning to get rid of her soon. (God, I hope she's not reading this!)

Turned up and shone at two interviews. Raved about a 'hands-on, uniformed role. After six months started turning up in a power suit and saw her role as 'monitoring' the nursery.

Asquith trained. It says it all. The staff-turnover was frightening at DS2's nursery. All agency staff except one on a lot of ocassions.