My daughter's school band performed at Disney's California Adventure Park yesterday. It was a great performance and a pretty incredible experience for the kids. They got to hang out at Disneyland all day and work with Disney Performing Arts behind the scenes.
My wife and I decided to go see the kids, but we were being good parents and allowed our daughter some semi-freedom. Rather than being official chaperones, we stayed in the same hotel and went to the parks on the same day. Our daughter knew we were there and knew we were available if she needed us. Of course, we were doing well if we got so much as a text to let us know how she was doing.
Until a kid got sick.
One of the children in our daughter's group got dizzy on a ride. Feeling nauseated, he started to panic a little. The poor guy has a history of anxiety and panic attacks. By the time our daughter got us on the phone and we got to him, he was having mild spasms in his hands and complaining of numbness and tingling all over; classic signs of a panic attack.
It was unseasonably hot in Anaheim yesterday. The sun was shining and there wasn't really a breeze. It's conceivable that this young man could have been suffering from a mild heat illness. Indeed, that's what we assumed we would find as my wife and I made our way to the kids.
Disney security thought the same thing. There were two security officers with the kids. They asked when we got there if we were chaperones. We confirmed that we were not official chaperones, but that we were parents from the same group. My wife, an EMT, started asking the boy questions while I was speaking to the security officer in charge. He explained that since the young man was complaining of some chest pain (a complaint he never repeated to any medical personnel, including my wife or me) the protocol was to send for a nurse.
The security officers were actively trying to cool the boy off. They brought soaked towels to put on his head and neck. They brought bottles of water for him to drink. There was one of those spray bottles with the fan on it there. It still had the price tags on it, but it had water in it and I got the impression that the security officers snagged it to use for him. While we waited, a third security officer showed up with a patio umbrella, clearly borrowed from a nearby outdoor dining area. The main security officers realized the questions my wife was asking the young man were medical in nature. He asked if we were medically trained and we identifed ourselves as a paramedic and an EMT.
It took an inordinately long time for the nurse to arrive. The first aid office for Disney's California Adventure is near the front of the park. We were about 500 yards from there. 500 yards of running the gauntlet through the crowds with a wheelchair bearing a gear bag. I estimate it took her 7 minutes from the time we arrived and the security officers had already been there for a while by that point.
The nurse was very pleasant. The security officer identified us as off-duty medics right away and she listened as my wife gave her a report. We stepped aside and continued to call chaperones. The nurse did a cursory evaluation and loaded him up in the wheelchair. My wife went to meet with the chaperones and bring one to the first aid office while I stayed with the young musician.
There are a few things that helped us identify his condition as being more about panic and less about heat illness. The most important one is that his condition resolved without any real treatment. The security officers were really great. They brought him shade, water and cooling towels. But you couldn't take away the heat of the asphalt he was laying on. His rapid pulse slowed as he calmed down and began to feel better. If his pulse had been fast because he was dehydrated, it would not have gotten better as my wife helped him by soothing his nerves.
I was disappointed in the fact that no one from Disney took vital signs. The first aid office is set up like a mini clinic. There are beds arranged with curtains for a modicum of privacy. There's an automated blood pressure machine on wheels parked in a corner. One nurse took his temperature, but no one took a blood pressure. If there was any serious concern about his condition, vital signs are the minimum that should have been performed.
The Disney nurse said their protocol is to observe the young man for an hour and not let him have anything by mouth. I'm not sure why she didn't want him to drink anything. Water would have been a good idea. However, it wasn't going to hurt him to not drink. It just wasn't going to help him, either. This brings me back to the vital signs. How can she make a decision to not allow him to drink anything whithout doing a proper assessment?
Maybe they just didn't want him to puke. The first aid office is brand new and for the moment it smells nice in there.
When a chaperone from the group finally arrived -- another parent -- he turned out to be a doctor. I won't say what his specialty was, but suffice it to say he is not an emergency physician. He was pleasant enough when he arrived, but when he learned the young man hadn't had anything to drink, he got snotty.
"Why not?" the chaperone asked. The only people in the room who knew he is a doctor are him, my wife and me. The nurse is walking into this one blind.
"Because the nurse says so," she said.
"Well the doctor says he needs some water." At this point my wife has to introduce our chaperone to the nurse as a physician, because in his sarcastic retort he didn't really identify himself. It was more of an assumption that his sparkling personality would proclaim his superior knowledge base. "And put some salt in it," he added.
Salted water? Really? It's time to step in. I pointed out that the young man's complaints had almost entirely gone away. Doctor/chaperone nodded at me and pinched the boy's fingernail. "He has very slow return," he said. He was trying to defend the water idea.
The problem is twofold. First, the kid had fine capillary refill. I doublechecked using his toes, which were closer to me. If anything, they should have refilled even slower than his fingernails. They took no longer than a second to return color completely. Second, if the young man did have slow capillary refill that would be an indicator of significant shock, a condition not remedied through drinking a glass of salted water. Plus, all of his other complaints -- hand cramps, numbness and tingling -- had gone away without anything more than the soothing voice of a momma figure.
Ok, time to leave. The young man was now in the hands of an official chaperone as well as the questionably capable hands of a very pleasant Disney nurse and an arrogant physician, both of whom find it perfectly appropriate to make decisions affecting their patient without actually conducting a history or physical assessment.
Overall, I have to give Disney a 'C-' on this medical response. The security officers were wonderful. If, indeed, the young man was suffering from heat illness -- which I doubt very much -- they were working to actively cool him off. They were attentive and did a great job prioritizing and focusing on this sick guest.
Where Disney dropped the ball was on the medical side. The nurse was absolutely sweet. She was great company and we talked for quite a while during this hour long encounter. Unfortunately during that entire time, no one took a single blood pressure. I'm not entirely sure than anyone other than my wife and the doctor/chaperone even counted a pulse, but I might have missed it.
Either way, the young man made it to the performance and now his story will be a little more interesting than the rest of his bandmates. I don't know if he had to drink any salted water.
