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May 27, 2003


Question from Larchmont, New York, USA:

My five and a half year old son will enter a town-run/sponsored camp. They have an EMT on staff, but they’ve informed me that ‘technically’ their guidelines say that they are not to administer medication, they will only supervise self-medicated children. My son can take his own bolus, but obviously needs to be told how much insulin he should take, and he can’t give himself glucagon! Is this legal? Don’t town or publicly sponsored activities have to provide more accommodation to children with disabilities (especially given that I am a taxpayer!)?


From: DTeam Staff

I think this might be a big miscommunication. The purpose of giving glucagon is implicit with an emergency situation whereby the patient is unable to help themselves because of a serious episode of hypoglycemia with loss of consciousness or convulsion. The E (which stands for “Emergency”)MT should well be within their parameters to administer glucagon during an emergency. Maybe a calm, explanatory discussion with the EMT people and your child’s doctor can clarify matters for all involved.

Additional comments from Dr. Larry Deeb:

If it isn’t part of the school system, I doubt they have responsibility. Seems reasonable to me for the EMT to call you at lunch, tell you the glucose and the carbs eaten and for you to give him an “order” for the bolus of insulin. That’s how we do it at school now. As for glucagon, I expect he could get an order from the doctor at the ER if it was needed.

Additional comments from Dr. Stuart Brink:

Sounds like this might be the wrong program for a five year old with diabetes. You should discuss this with your diabetes team since they will know the local rules and laws.

Additional comments from David S. Holtzman, Esq.:

The ADA requires that the town run program must provide services make a reasonable accommodation to kids with chronic health conditions who need assistance in managing their health while at the camp. An EMT is not permitted to prepare or administer injections in NY State.

I suggest that you meet with the town parks superintendent and attempt to work out a solution that is reasonable for your child and for the town. Maybe have a school nurse available around lunch time to assist your son. As for administration of glucagon, I advise my clients that if a child is in such extremis to require glucagon, they must call the local rescue squad to treat the child. And by the way, the fact you pay taxes does not change the dynamic of the issue.