Holy Cow! I Just Saved a Student's Life!
Laura L. Phillips, MPH, BSN, RN, NCSN
January 17, 2025
It was just before noon and I was in the conference room at my charter school documenting health information in a student’s IEP when one of my health aids came in and asked where the stethoscope was kept. This particular health aid is a registered nurse employed in a hospital as a flex NICU nurse as well as part-time in the school health room as an aid. This nurse does not need the money; as the nurse has previously asked to be a volunteer in the health room. But because of HIPPA, only staff can work in the health room and see students, so the school hired this nurse as a back-up to the regular health aid at the school.
It is important to know that in Colorado, the school nurse model is a consultant model. Meaning that there is not a school nurse in the building everyday. The registered nurse delegates nursing tasks to non-medical personnel. The Colorado nurse practice act is clear on delegation; and assessments cannot be delegated to non-medical personnel (CDE, 2024). But, this is a registered nurse, with assessment skills and nursing knowledge. This is a registered nurse, in which I can train but not delegate.
The registered nurse knew something was wrong and wanted to assess the student with a stethoscope. The nurse reported a student in the health room complaining of chest and heart pain. I immediately walked to the health room, the health room aide RN following closely behind me. The health room was next door to the conference room, so it only took seconds. I kept assessment tools, such as a stethoscope and a pulse oximeter, in a sling bag behind the health room door hanging on a hook, just in case I needed to grab the back quickly for a student in a classroom or or a student outside. I took the bag off the hook and reached in for the stethoscope. There was an additional health aid in the room measuring the student’s temperature with a temporal thermometer asking about hydration.
The student was sitting up in a chair against the wall. I sat down next to the student. I could see the fear in the student’s eyes. The student’s face was flushed. I asked the student to share symptoms with me. The student placed one hand on his chest and shared that “my heart is beating fast” and “my chest hurts as if someone is massaging my heart.”
The student was wearing a sweatshirt. I asked the student if he had anything underneath his sweatshirt in which he stated yes. I then asked the student to remove his sweatshirt. As the student pulled the sweat shirt over his head, I continued to see the anxiety in his face. I asked permission to listen to his heart as I placed the large end of the stethoscope on the left side of his chest to auscultate his apical pulse. The non-medical health aid standing close to me sharing his temperature.
The apical pulse was bounding and fast. Too fast to count. I continued to listen for a full minute, counting as best I could. My experience and knowledge of a pediatric nurse educated in pediatric advanced life support, led me to believe that the student was experiencing supraventricular tachycardia (SVT), a life threatening rhythm. I murmured SVT. I am not sure if anyone heard me, but chances are the non-medical health aid did not know the meaning of SVT. I turned to the non-medical health aid and instructed her to call 911. The student’s eye opened larger as he heard my request. As he stared at me, I could see the anxiety increasing in his face, tears coming from his eyes and he began to question-What? I gave him comfort placing my hand on his arm and shared, it’s ok, I am here with you.
I asked the student to bear down, hoping to stimulate the vagus nerve, as if he was trying to poop. Yes, I said poop! The student is only 13 years old! He shared frantically, if I bear down, I am going to poop. The health room has a large private bathroom for sick students to utilize and was across from where we were sitting. Let’s go then, as I helped him up from the chair. As I closed the door, I spoke through the unlocked door “bear down firmly.” During this time, all I can think of is please, don’t let him pass out on the toilet.
The principal came rushing down the hall with the non-medical health aid. Is he ok, the principal asked. I shared my assessment in that the heart rate was greater than 200 and 911 was called. However, the aid did not call 911 yet, she found the principal instead making him aware of the situation. Don’t they trust me? This time I said to the front office firmly, instead of the non-medical health aid -CALL 911.
One of the secretaries called 911 and asked what was going on to share with the 911 operator. Tell them we have a student with a heart rate greater than 200 beats per minute.
By this time the student came out of the bathroom. He sat down on the chair, and again I auscultated his apical heart rate, and again the apical pulse was too fast to count. OK, bearing down did not work. I instructed the student to move over to the health room cot. I sat on one side of the cot and the principal sat on the other side placing his hand on his shoulder comforting the student. I could see the urgency on the principal's face as I believe he noticed the anxiety on the student’s face. I asked both health room aides to find me a straw. I asked for the AED. “Where is it?”one replied, “ In the white box in the hall.” I shared.
“Has this happened before?”
“No.”
“What were you doing when this started?”
“I was in percussion class.”
“What were you playing?”
“Mallets on the drum.”
“Do you have any health conditions?”
“No.”
“Do you or did you take any medications?”
“No.”
The AED arrived. I kept the AED close to me and the student, placing the AED on the second cot. “I need a straw”, I asked once again.
“Do you have any siblings?”
“Yes.”
“Younger or older?”
“An older sister.”
“Has this ever happened to her?”
“No.”
“Does she have a heart condition?”
“No, she only has acne.”
I giggled.
“What about your Mom and Dad?”
“My dad has high blood pressure. My mom doesn’t have anything.”
The health aid RN passed me a straw. Since no straw could be found, the health aid RN pulled the straw out from her own personal water bottle and washed the straw prior to handing it to me. Nurses are innovative.
“Here, blow through this,” as I place the straw into the student's mouth.
The student immediately began breathing in and out of the straw as I placed the large bell of the stethoscope back on the left side of his chest to auscultate the heart beat. I noticed he was forcing the air in and out of the straw rapidly, his face red and fearful. “ Stop!” I removed the straw from his mouth. I then instructed him to breathe in through the nose and out through the straw. I placed the straw back in his mouth, breathing in through the nose and out through the straw. Again in through the nose, out through the straw. He did everything I asked, trusting my words, my judgement, my knowledge.
As he continued to breathe this way, I directed the health aid RN to locate the pulse ox from the sling bag, now located on the second cot next to the AED and place it on his finger. HR 200, oxygenation 86%. I once again returned my stethoscope to auscultate the heart beat as the student continued to breath in through the nose and out through the straw. THERE, I heard it, I can count the heart rate now.
“Your heart is slowing down. Are you feeling better?”
“Yes.”
“Keep breathing using the straw.”
The student’s heart rate continues to slow, but still tachycardic. At this point I notice the pulse oximeter reading 146 with an oxygenation of 86%. The principal notices this also, and sighs with some relief. The student’s face appears to be more calm, his eyes less fearful. I remove the straw reassuring the student that his heart is still beating fast, but is much slower than before and at a much better rate.
Paramedics arrive and I stand up, giving them room to assess the student as I introduce myself as the school nurse and the student by name. I ask the student to tell his story. The student shares his story to the paramedics as they attach him to a heart monitor and measure his blood pressure. The paramedics asked the student the same questions I asked earlier; which again the answer to all of them were no, except for his dad’s high blood pressure. He did not share about his sister’s acne this time.
I step outside the room as the EMT’s continue to monitor the student and obtain an ECG. I asked the front office if a parent was called. Yes, Mom is just minutes away.
As Mom arrived, the ECG was completed and indicated Wolff-Parkinson-White (WPW) syndrome. WPW is a heart condition that causes episodes of rapid heart rate. It's caused by an extra electrical pathway in the heart that allows electrical signals to pass between the heart's upper and lower chambers. The rapid heart rate can lead to SVT, atrial fibrillation, and even sudden cardiac death. Holy cow, I just saved this student’s life!
The paramedics transported the student to the Children’s Hospital located about 15 minutes away. The principal gave me a fist bump. The health aid RN shared-thank goodness you were here. I wouldn’t know what to do. Sure you would. A heart rate too fast to count? You would have known to call emergency services.
Later that day, the mom of the student came back to the school to retrieve the student’s personal belongings and chat with the principal. I wanted to know the disposition of the student. I knocked on the door and entered the room not waiting for an invitation to enter. The mom looked over at me, tears forming in her eyes-Laura-you saved my son’s life. You saved my son’s heart as she gave me a long tight hug-Thank you.
The student in this article was diagnosed with Wolf-Parkinson-White (WPW) Syndrome in the Children’s Hospital emergency department. The emergency room physician shared with the parents that Laura did everything right and if the fast heart continued for 5 more minutes that the effects on the heart may have been catastrophic with complications including death. Laura’s extensive experience in pediatrics and pediatric advanced life support enabled Laura to quickly act in simple life saving methods to convert the SVT rhythm that only a registered nurse in a school setting would know. Later that week, the student was seen by a pediatric cardiologist who prescribed a beta blocker to relax the smooth muscles of the heart and slow the heart beat followed by an ablation in 8 weeks. There is no history of WPW in the family.
School districts in Colorado utilize the school nurse consultant model. Most school nurse consultants in Colorado are registered nurses with a BSN from an accredited nursing school. All must be licensed through the Colorado Department of Education as a special service provider. Not all school nurses consultants have pediatric experience, yet alone advanced life support education and training.
The position of the National Association of School Nurses (NASN, 2021) is that every school-age child registered professional school nurses should have a minimum requirement of a Baccalaureate degree in nursing from an accredited college or university. Additionally NASN supports state school nurse licensure certification and national school nurse certification through the National Board of School Nurses (NASN, n.d.). No advanced life support or pediatric experience is required to be a school nurse.
NASN’s legislative priorities include the One School, One Nurse Act. The passing of the act would enable every public school to have a full-time registered nurse on staff so that children are safe, healthy, and ready to learn (NASN, 2024). In addition, NASN supports the Nurses for Under-Resourced Schools Everywhere Act (NURSE) Act, which would recognize the critical role of school nurses in providing students access to quality health care so that they are healthy, safe, and ready to learn (NASN 2024).
This is a true story and the school nurse consultant was on campus the day of the incident. What would have happened to this student if the school nurse was not there to make quick life saving decisions?
Laura Phillips has been a registered nurse since 1988 graduating with an ADN from Cypress College in California and a BSN from California State University Fullerton in 1993. Laura earned her Master degree in Public health from Walden University in 2010. Laura is a PHD candidate at Colorado University.
Laura's extensive employment history began at the Children’s Hospital of Orange County in 1988 as a bedside nurse on the oncology unit where she was quickly advanced to the position of charge nurse. Laura moved to Colorado in 1995 joining the then named “The Children’s Hospital” located in Denver, Colorado on the float team. As a natural born float and eager to increase her skill level, Laura became a critical care float and the resource nurse for the hospital. Laura became a school nurse consultant in 2002 and a nationally certified school nurse in 2017. Laura has been involved in legislation involving children with her time as a nurse at Children’s Hospital and later co-chair of the legislation committee with the Colorado Association of School Nurses (CASN). Laura served as President-elect of CASN, and is currently a Director of NASN representing Colorado.
It is important to know that the parent gave permission to share this story with anonymity. She feels that all school nurses need to be aware of this incident and that it could happen to any student without a known cardiac diagnosis as puberty approaches. The cardiologist appreciated the student’s description of the feeling as a “massage” on the heart, and plans on using the description in the future.
References
Colorado Department of Education. (2024). https://www.cde.state.co.us/healthandwellness/snh_ofcmgmt
National Association of School Nurses. (2021). Education, Licensing, and Certification of School Nurses. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-education
National Association of School Nurses. (2024). 2024 NASN Legislative Priorities. https://www.nasn.org/advocacy/legislation
National Association of School Nurses. (n.d). Professional topics: Certification. https://www.nasn.org/nasn-resources/professional-topics/certification.