LTC Nurse Has Concerns About EMS Call at Work...

[cotjockey]

I’m not really sure how I should handle this…or if I should just shut up and smile. Wednesday night, I worked night shift…not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway…it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well…there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3…while smiling and patting the nurse on the hand and telling her how sweet she is. So…there are no real deformities, but her right arm just didn’t look right. No bruising, no swelling, nothing that looked like it shouldn’t look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm. I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident’s room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, ”Well, I think I know how to package a patient and I don’t even know what a patho-whatever fracture is.” I then said, she fractures really easily…and without known cause…she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed. She went into the resident’s room and asked me why I hadn’t put her back in bed. I again stated that she fractures very easily and because her arm didn’t look right that I didn’t want to move her without proper splinting. The EMT then informed me that she hadn’t brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the ‘bus.’ When I was in paramedic school, we learned to splint with all kinds of “inappropriate” things like pillowcases, magazines, duct tape, etc, so I said…”Oh…they taught us how in paramedic school.” She asked me if I am a paramedic and I admitted that I am. She informed me that I am “not a paramedic here, so it doesn’t count.” The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job…she then said, “I really don’t think there is anything wrong…you people call us all the time for nothing.” The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis. She resident had three fractures…one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So…my DON told me that she wants me to handle this one…I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what?

I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.

[AZCEP]

Sounds like an EMT that read too much into their night school first aid course. :roll:

The lack of professionalism is not entirely surprising from the sound of the system, but that does not excuse it.

[JPINFV]

What did paragraphs ever do to you to make you hate them so much? Making peoples' eyes bleed by confronting them with a wall of text is not a good way to start a thread.

I’m not really sure how I should handle this…or if I should just shut up and smile.

Wednesday night, I worked night shift…not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway…it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well…there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3…while smiling and patting the nurse on the hand and telling her how sweet she is. So…there are no real deformities, but her right arm just didn’t look right. No bruising, no swelling, nothing that looked like it shouldn’t look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm.

I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident’s room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, ”Well, I think I know how to package a patient and I don’t even know what a patho-whatever fracture is.” I then said, she fractures really easily…and without known cause…she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed.

She went into the resident’s room and asked me why I hadn’t put her back in bed. I again stated that she fractures very easily and because her arm didn’t look right that I didn’t want to move her without proper splinting. The EMT then informed me that she hadn’t brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the ‘bus.’ When I was in Paramedic school, we learned to splint with all kinds of “inappropriate” things like pillowcases, magazines, duct tape, etc, so I said…”Oh…they taught us how in Paramedic school.” She asked me if I am a Paramedic and I admitted that I am. She informed me that I am “not a Paramedic here, so it doesn’t count.”

The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job…she then said, “I really don’t think there is anything wrong…you people call us all the time for nothing.” The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis.

She resident had three fractures…one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So…my DON told me that she wants me to handle this one…I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what?

I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.

Now with paragraphs.

They have to be certified through a government agency somehow. Furthermore, if any of the fractures could be attributed to the transport, you could go for malpractice (splinting in the ambulance instead of on scene? Dude, take a minute and walk your [the EMT, not the original poster] fat ass back outside and get your own damn kling and splinting material, or have the police officer go and get it. For bonus points, get a few ice packs while your at it). Alas, I fear that any action would ultimately require much more work than it's worth outside of a strongly worded letter to the certifying agency.

[Asysin2leads]

This is a fairly easy situation to deal with. I know that if you live in a smaller, close knit community and rely on XYZ volunteer rescue squad for patient care and transport that going the formal route is frowned upon, but in situations like these, it is absolutely necessary.

First off, just because she is the captain of her squad doesn't mean anything. My joke about someone claiming to be captain of the squad is "Yeah well, I'm treasurer of my Dungeons and Dragons club, you don't hear me bragging about it." Don't let the titles fool you, the person responding is a state or nationally certified EMT, nothing more and nothing less. That means they answer to generally the State Board of Health, though you might want to check in your specific state, sometimes a state will put EMS under transportation or something silly. The bottom line is that the medical provider who responded to your 911 call was rude, uncooperative, and displayed a lack of knowledge of recognizing and treating extremity injuries in addition to failing to recognize the changes the aging process brings on the body, all key components of the EMT curriculum at all levels. This needs to be reported. Report it professionally and stick only to the facts, and then let the state take it from there. However, before you do, you might also want to check to see if you are a mandated reporter for elder abuse, and if so, make sure you file appropriate paper work about what you witnessed and what the patient reported before you file your complaint with the state.

I know that we try and adhere to working things out without going the pen and paper route in EMS and probably the rest of the health care field, but as I get older and crankier, I find that it becomes more and more necessary. Yes, I have a duty to try and work out problems at a personal level with other providers, but I also have a duty to protect my patients and also to perform CYA procedures. I'd rather be the bad guy than hang for someone else's attitude or mistakes.

The way I see it, you are a nurse legally responsible for the care and well being of the patients at your facility. You've pretty much written an account of witnessing poor patient care bordering on elder abuse of one of those patients. I would use that as your jumping off point, and let that supersede who is captain or married to which chief.

[Richard B the EMT]

During that brief time that I was the Chief of Operations at my Volunteer Ambulance Corps, when I was on the ambulance, all I was, was an EMT. I wasn't there as the chief.

I liked that comment of the Dungeons and Dragons club, as it describes that one can only wear one "hat" (of responsibility) at a time.

[DwayneEMTP]

It sounds like you tried to talk to her while she was at your facility.

You don't owe her anything else.

Burn her down if you can.

Dwayne

[JPINFV]

Burn her down if you can.

Burn? She's a witch, BURN HER, BURN HER!

[itku2er]

Well being a nurse in a LTC facality I see this all the time and get why did you call us etc speech alot. But that was very unprofessional and I would call her supervisor and report it. I have personally on numberous occasions reported people like her and yes some of them are still my friends. There is no excuse for that, but what is worse is when a MD calls the facality to see if I am working cause he dont his sleep interrupted. Yep that him a good little vacation from ER for a few days. The way I see it my job is to look after those residents and the EMS job is to take them to the hospital when 911 is called. I hardly ever call 911 anymore I call directly to a service that always comes fast and never ever gives any lip they are always professional. Some day all these people that grip about LTC facalities are gonna be old and I hope that when they need help they get professional help not some of the attitudes that ones I take care of do. But in the end what goes around comes around.

terr

[zippyRN]

Sounds like an EMT that read too much into their night school first aid course. :roll:

The lack of professionalism is not entirely surprising from the sound of the system, but that does not excuse it.

although rightpondian i am a RN and Ambulance crew qualified - i think AZCEP has hit the nail bang square on the head there...

[zippyRN]

During that brief time that I was the Chief of Operations at my Volunteer Ambulance Corps, when I was on the ambulance, all I was, was an EMT. I wasn't there as the chief.

I liked that comment of the Dungeons and Dragons club, as it describes that one can only wear one "hat" (of responsibility) at a time.

although i am considered a 'manager' in my volunteer EMS work - becasue i can and do undertake bronze and silver cliinicla and operational roles and have ongoing responsibility for parts of our clinicla audit programme) i'm not a manager if i'm there as ambulance crew or as the only nurse / health professional on the duty ...