Staying 1 hr + away from ER on vacation?

Posted on: Fri, 05/26/2006 - 12:46am
Ethan Mom's picture
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Joined: 03/27/2006 - 09:00

We were invited to our friend's beach house for the long weekend (maybe leaving tonight). I searched on-line and the place we would stay is 1+ hrs away from the newest hopital/ER.

Son is 3, has SEVERE nut allergy and asthma. If we go, we plan on bringing 6 Epis and his own food. Our usual allergist is out-of-town, but I spoke to the on-call doctor, who said "I can't tell you what to do -- it's a judgment call" vague type answer.

Any opinions? Too risky to be that far from ER care?

Posted on: Fri, 05/26/2006 - 1:52am
gvmom's picture
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I can only offer my own experience. We went on a 1 week vacation to a vacation house my family used to have, with our two boys. At that time, we only knew our older son was PA/TNA. Our younger son was an infant, just breastfeeding. This house was also 45 minutes from the nearest hospital, and that is with no cars on the road -- a winding road that frequently had lots of traffic. So, our drive to the hospital would have most likely taken much longer.
All I can say is that it was an incredibly stressful vacation. Just from the standpoint of constantly knowing the odds we were playing just by being there. And once we were home, about a month later, our infant son -- at 5 months old -- accidentally touched my DH's scrambled eggs, and though we wiped his hand off, he still broke out in hives from head to toe when he stuck his hand in his mouth. We considered ourselves very lucky that we weren't still on that vacation, because that trip to the doctor only took 8 minutes (from the OMG!, put pants on, drive and get to the office).
So, from then on, learning we had two FA children, how lucky we were not to have our discovery of DS#2's allergy happen there and the stress of it all, we don't take that risk right now. If we go on vacation -- which we don't often do -- hospitals are already mapped out, and not far away. I don't know how to make vacation & relaxation pair with worry & stress.

Posted on: Fri, 05/26/2006 - 3:33am
LisaM's picture
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Joined: 11/04/2005 - 09:00

One other thing to consider: would it be safe to give your child so many epis (even at 10-15 intervals?)
I once asked my former allergist about how many epis would be considered an "overdose." He asked me about my most severe reaction (the first dose of epinephrine in hospital was not effective at all--thankfully the second dose kicked in). Then he kind of refused to answer the question. He said that I was basically asking him whether it is better to die from anaphylactic shock or from a drug overdose. When pressed, he said if I had to ask that type of a question that I should always be close to the hospital. (In truth, I'm not comfortable being too far from the hospital, but sometimes I do go hiking near my family home.) Then he wrote me a prescription for 6 epis. I asked him whether he thought I should fill them all at once? He said I could do whatever I wanted with them.
So I take from this that there *is* some concern about the number of epis given at a particular time.
But I still wanted to know the answer. (Even though I don't carry 6 epis on me, if I am with my sisters, both of whom carry epipens, there are potentially a lot of epinephrine available.) I talked to my pharmacist who did some research on this for me. He said theoretically, epinephrine is metabolized by the body quickly. So it sounds from that like there is no such thing as an "overdose"---but then he said that there is a maximum daily recommended dose. I wish I had written it down---I think it was 3 or 4 epipens. But it might be different for children.

Posted on: Fri, 05/26/2006 - 3:47am
Ethan Mom's picture
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Joined: 03/27/2006 - 09:00

Hmmm. Thanks for the replies. I am still on the fence about going bc it is so far away.
I didn't even think about the Epi-pen overdose (bad mommy). When I talked to the (on-call, not our regular) allergist earlier, I said "we'll be over an hour away from the hospital" and she said "well make sure to bring TWO epipens." I replied "I thought Epis only staved off reactions for about 15 min, if something happened, wouldn't we want more than 2?" Not overly impressed with her response to that -- she said she wasn't too sure of exact time Epi works for, depends on the severity of the reaction.
Anyhow here are my concerns:
1) we would be staying at our friend's house, so while we would bring all of son's food, I know their house is not nut-free, in terms of past food prep (and maybe even food prep when we are there). I feel like it would be different if we were going and staying alone with our son.
2) distance from hospital.
3) planning to go out to dinner on Sat - again, bringing son's food, but on the off-chance he has a rxn to something from the rest?

Posted on: Fri, 05/26/2006 - 4:21am
starlight's picture
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Joined: 01/16/2004 - 09:00

Have you tried calling the hospital? I mean, what do they do for people in that area who are having heart attacks, strokes, seizures? They must have a helicopter or something for quick transport. Ask about ETAs and if there are paramedics who can start treatment beyond the epi-pen in the ambulence. Also check and see if there are walk-in outpatient facilities and call and see if they're equipped to handle anaphylaxis. Or check with the local allergist offices, in theory they should also be able to stave off a reaction until an ambulence arrives.

Posted on: Fri, 05/26/2006 - 4:59am
becca's picture
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Joined: 05/22/2001 - 09:00

You said the new Er, is it the only option, or the best facility? Just wasn't clear.
We are going camping this weekend, and I still have to check the nearest hospital, but it could be an hour away. However, my dd is 6, has never had an anaphylactic reaction, and she will not eat anything unsafe(and camping, we are all right there together anyway). But I do worry. It is stressful. Off to check into ER's in western MA! Best of luck with your decision!
I worry more about ds, 2, because he would eat something. Even though he has nka, I have a feeling he is nut allergic, and will have him tested soon. He seems to get funny eyes and itchy eyes at the checkout at our farmstand, right where all the nuts and birdfeed stuff is. He has no epis either, as dd's are adult does.
I suppose, if it seemed his life were in danger, I could give him hers, and I carry two expired Jrs around(not that old). But that is the scarier thing, the unknown, for me. becca

Posted on: Fri, 05/26/2006 - 5:15am
Ethan Mom's picture
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Joined: 03/27/2006 - 09:00

Thanks for the replies -- just called the "local" hospital. Talked to the nursing supervisor who told me that "epi-pens [when used to treat a reaction] last [to treat symptoms] for two hours" and was sort of rude on the phone. When I asked how they would treat an ana. emergency said "call 911" and that she "had no idea whether ambulances have life support,and thinks they do have paramedics" ?! She really had no idea how to answer my ?s and finally told me to call the "other" hospital, which is not any closer. Not getting warm fuzzy feeling here.

Posted on: Fri, 05/26/2006 - 5:22am
Ethan Mom's picture
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Joined: 03/27/2006 - 09:00

Well this is not encouraging ER transport --- the place we are staying is on Chincoteaque Island, VA (see article below)
Supervisors upset at state funding road not taken --- County says U.S. Route 13 and island drawbridge need help now in Richmond
--------------------------------------------------------------------------------
WHAT IT MEANS
The Accomack County Board of Supervisors will ask the state for some financial help for transportation problems involving the Chincoteague drawbridge replacement and U.S. Route 13 improvements. Last Friday, a drawbridge malfunction meant that hospital transport for two people injured on Chincoteague was delayed.
ACCOMAC -- A recent incident in which medical transport for two Chincoteague Island patients was delayed by a malfunction of the island's drawbridge is an example of Accomack County's need for additional state transportation funding, some feel.
The incident, in which the U.S. Coast Guard ultimately transported one of the patients to the mainland, happened last Friday -- only two days after Accomack County Supervisors voted to ask the state for more transportation money to fix for the drawbridge, the adjacent Black Narrows bridge and U.S. Route 13.
Although a new Chincoteague bridge was approved by a state board in 2000, construction is not slated to begin until 2008 at the earliest.
Various studies have shown that limiting driveways and median breaks would improve safety on U.S. Route 13.
Board Chairwoman Wanda Thornton was authorized at a Sept. 7 county worksession to present information on Route 13 and the Chincoteague bridge to the Commonwealth Transportation Board and elected state officials.
Thornton said Thursday she is preparing a package of information to present to the state, and added that county supervisors will study the highway issue further at their October worksession.
The requests will come at a time when the state is beleaguered with highway spending needs and no clear way to fund them all.
A recent Virginian-Pilot editorial said that, over the next two decades, the state has $108 billion in identified transportation funding needs, and Del. Lynwood Lewis, in a General Assembly legislative preview published Wednesday, called the issue a "crisis."
The effect of it all hit home on Chincoteague on Sept. 9, when two patients -- one with potential life-threatening injuries sustained in a fall from a roof -- could not get to the mainland in Island ambulances because the drawbridge was stuck open, according to a report by Chincoteague EMS Supervisor Bryan Rush.
"There appeared to be intermittent power failures to the gates and lights and the tender was having trouble raising either of the two gates," said Rush in a Sept. 14 letter to Thornton, who requested a summary of the day's events.
Rush called for assistance from the Coast Guard, which transported to the mainland the victim who had fallen. There, an ambulance from the NASA-Wallops Flight Facility picked up the patient for transport to a local hospital.
The bridge became operational just as the second patient, suffering complications from pregnancy, was being loaded onto a Coast Guard vessel. That patient was taken by Chincoteague ambulance to the hospital, Rush wrote.
Dispatcher Mollie Cherrix said in a separate letter that there was a 22-minute delay in each case due to the bridge malfunction.
"Delays such as this could result in a subject losing their life," she wrote.
Both patients arrived at the hospital "alive and stable," according to Rush.
"Thankfully no one has perished as a result of these ongoing bridge issues, but one never knows when we may not be so thankful," wrote Rush, adding, "our transportation issues are compounded by a failing, antiquated bridge, inexperienced operators and a deaf ear to our problems."
Thornton said she feared someone would die before needed repairs are approved for the Chincoteague drawbridge. "VDOT needs to expedite this," she said.
Highway officials including VDOT Resident Engineer Will Cumming have said the bridges are in poor condition and in danger of being posted for weight limits. The bridges suffers from 80 to 90 percent structural loss in some areas.
Thornton also added that Route 13 is the most dangerous highway in terms of fatalities in the state, saying, "We should ask for a large chunk of money and then prioritize (highway improvements)."
According to a June 2005 draft transportation update of the county's Comprehensive Plan, there were 37 fatalities on the highway from 1997-1999, 16 of which were in Accomack County.
In 2000 alone, there were 17 fatalities on Lankford Highway.
Accomack County's death rate per 1,000 drivers was 0.62 for the years 1998 through 2003, compared to the state average of only 0.21, although the highway was not to blame for some -- 40 percent of traffic fatalities in the county during those years were alcohol-related.
Still, the study attributes Accomack's higher death rate in part to the high percentage of through traffic on Route 13.
The state highway department is not planning to improve Route 13 for 20 years, according to Thornton. "We can't wait that long," she said.
Supervisors want the state to begin improvements by closing some median cuts in the highway, which is "probably the easiest problem to try to fix" in terms of cost, said Thornton.
The state Department of Transportation in 2002 recommended that 40 percent of the median breaks on Route 13 be closed. That would mean closing 109 breaks, 66 of which are in Accomack County.
A transportation study completed several years ago said shoulders and medians are too narrow to accommodate school buses and other large vehicles, utility poles, trees and other fixed objects are too close to the road for safety, that there was a lack of left turn lanes and poor night visibility.
Some proposed solutions are the consolidation of driveways and crossovers, lengthening and consolidating driveways and crossovers, lengthening and adding turn lanes, widening medians to a minimum of 50 feet and constructing limited highway access.
Originally published

Posted on: Fri, 05/26/2006 - 5:55am
Daisy's picture
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Joined: 01/16/2006 - 09:00

EthansMom,
Good Heavens! The article you posted makes my heart race just thinking about it! Personally, I would not go (I am the allergic one). Would base this on distance to the hospital PLUS being around another family that *might* result in some contact-type reactions.
Is DH really keen on going?
Daisy

Posted on: Fri, 05/26/2006 - 6:14am
Ethan Mom's picture
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Joined: 03/27/2006 - 09:00

Alright --- so after many many phone calls, here is what I found out by talking to someone at the local police dept on Chincoteaque Island:
1) The only ambulance available on the island is on "a volunteer" basis, and they cannot guarantee that someone will answer the call. If an ambulance is not available on the island, they dispatch one from the mainland (again volunteer -- assuming that one is available). The closest "paid" ambulance service, thus available all hours and weekends, is one + hours away.
2) Some ambulances that are dispatched to the island have ALS, some do not. It all depends if one is available when you call.
3) She could not give me a ETA for emergency calls -- said it could be 20 min, could be one hr, depending on where it comes from.
4) They is a Medic-vac type helicopter system 1.5 hrs away (drive time). They do not dispatch the helicopter until the ambulance arrives (whenever the heck that is -- see 1) and 2)! above -- and the ambulance crew would call for the helicopter.
5) The closest hospital that the ambulance transports to (if and when they show up) is 1+ hrs away and there are no medical facilites on the island open on the weekend to treat medical emergencies.
I guess I just answered my own ?s -- heads up to anyone heading toward Chincoteaque this summer. Just talked to DH about all of the above with ER med care and he said "well, we can mull it over and decide later?!" Umm, it is only moms that worry about these things???

Posted on: Fri, 05/26/2006 - 6:34am
becca's picture
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Joined: 05/22/2001 - 09:00

I hear ya. Thankyou for raising this, as I might honestly have forgotten to make my call today and been left scrambling tomorrow.
I got better news. Twenty miles, and ambualnce service on call 24 hours via 911. Advised to call them, as opposed to driving ourselves, to get quicker transport and they have epi. Also right near the campground(the ambulances(2), so quick response time, he said.
I would not go in your situation. We declined a wedding invite when I was pregnant for similar reasons. Less than a month from my due date, on an island, requiring ferry transport, and a few guests ended up with Lyme disease!
Trust your instincts. You will be so worried if you go, you will have a horrible time. Maybe these friends can come see you sometime? becca

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