This article was filed Nov. 11, 2011 See also the newer article from Nov. 22 here .
The parents of a 6-year old Montreal girl who died of an asthma attack or allergic reaction are upset that a newly released Quebec Coroner’s report assigns no blame in the case and makes no recommendations for school emergency procedures. The girl’s parents fault school employees for waiting too long before calling 911 when Megann Ayotte Lefort was having symptoms of breathing distress.
According to the details given in the Coroner’s report, on Sept. 16, 2010, Josée Ayotte, Megann’s mother, dropped her daughter off at the school’s child-care program at 6:15 p.m. so that she and her former husband could attend an hour-long parent-teacher meeting.
Over the next three-quarters of an hour, Megann cried and complained of missing her parents. At 6:45, one of the teachers gave the little girl two doses from her Ventolin inhaler for breathing troubles. At 7 p.m., Megann was still crying, which the teachers noted was not normal behaviour for her. She also complained of itching (and one of the teachers had noticed skin welts on the girl when she arrived).
When her breathing failed to improve, the teachers sought out Megann’s mother, who tried to administer another dose of Ventolin while a teacher called 911. The girl wasn’t able to take the dose.
Firefighters arrived on the scene first, and began cardiopulmonary resuscitation (CPR). The firefighters’ pediatric ventilator was defective, and a new one had to be found. Paramedics soon arrived, and transported Megann to hospital, where an emergency team took over, to no avail. The vivacious youngster was pronounced dead at 8:20 p.m.
Megann’s father, Sylvain Lefort, is angry that the Coroner did not find fault with the school’s actions. The report’s only recommendation is that the fire department more regularly monitor its resuscitation tools to ensure they are functional.
“There are no recommendations for the school. Why?” Lefort said to the La Presse newspaper. (He spoke to the reporter in French. Allergic Living has translated his comments.) “If we don’t want this situation to happen again at another school, the report ought to have made recommendations.”
Meantime, the school board is upset at Lefort’s efforts to hold the school accountable. “We understand [the family’s] distress,” a board spokesperson told La Presse. “But the school has nothing to do with it.”
Next: Was It Asthma or Food Allergy?
(from previous page)
Megann had a history of severe asthma and anaphylaxis to cow’s milk. The young girl had been hospitalized 13 times for severe bronchospasm triggered by colds and/or exposure to cigarette smoke, dogs and cats. Earlier on the day of her death, Megann had used her Ventolin inhaler after playing. Before the parent-teacher night, Megann had eaten a submarine sandwich from a restaurant.
Evidence obtained by the police differs among the witnesses interviewed. For example, it’s unclear exactly how many puffs Megann received from her reliever inhaler. It’s also unclear whether or not Megann might have already had facial erythema (redness of the face) and skin welts when she was dropped off at the child-care program.
Coroner Dr. Hélène Lord concluded that Megann died from anaphylaxis and/or severe asthma, which she lists as “natural causes”.
“The distinction between the two can be difficult to establish clinically,” Lord says in the report. Although the autopsy found no urticaria (hives), Lord says that can be explained by Megann’s falling blood pressure as the reaction progressed.
The Coroner was ultimately unable to specify what triggered the asthma attack, adding that it could have been a serious food-allergic reaction, but it also could have been stress, seasonal allergy or something else.
In a person with both severe asthma and food allergy, it can be difficult to determine whether they died from anaphylaxis or asthma. “It’s very hard to know,” says Dr. Susan Waserman, a Hamilton, Ontario allergist and columnist for Allergic Living. “Severe asthma is part of an acute anaphylactic episode. [Megann] had both conditions and one occurs in conjunction with the other.”
The Coroner’s report says it’s “hard to say” whether the situation would have been improved by an epinephrine auto-injector. But Waserman believes it definitely should have been used in this case because of the girl’s history of food allergy. “With someone who is at risk, we [allergists] certainly would recommend the EpiPen,” she says.
The exact timeline of the events that led to Megann’s death are not clear. Some media reports say the teachers waited almost an hour to call for help, while the Coroner’s report suggests it was less than that. While the precise circumstances are hard to determine in this case, as Allergic Living has reported many times in the past, when it comes to asthma and anaphylaxis, timing can be the difference between life and death.
When a person with known food allergy and asthma is having trouble breathing and Ventolin isn’t working, 911 should be called immediately and, in most cases, allergists recommend that epinephrine should be administered. When in doubt, call for help and use the auto-injector. It’s not a cliché when it comes to allergy and asthma: always better safe than sorry.