Horror Story.... from NH.

[Cookie]

We got called to the nursing home at 4 am on a Monday morning. Pt. had pain in the right thigh/hip area and needed to go to the hospital. Now mind you this is 4 am Monday Morning. While trying to get pt. ready, she is screaming in pain at unbelievable decibels. What the ?????. Seems that on Friday evening they were moving the patient after dinner and they heard a snap. They did nothing, noted it on the chart and that was it. Patient told nurse and aides throughout the weekend she was in pain. So finally at the unbelievable hour of 4 am they decided she needs to go to hospital. Our paramedic really reamed out some of the staff that morning. This same nursing home had a patient who had a stroke, they sent her to the hospital and never even called her son who is her only living relative, who visited her all the time. He found out that she had a stroke and was in the hospital when he went to visit. He visited on Monday morning, she had the stroke that afternoon and he went to visit her on Tuesday afternoon and that is when he found out. There are other stories about this place. It changed hands and never used to be that way. The guy who bought it gets rich off of the elderly.

[bandaidpatrol]

I noticed a pattern over the years... Most common hour to find a DOA in a nursing home? Shift Change. :roll:

[cayer]

In my experience I have been to 1 Nursing Home that truly has their act together. Everytime I go in there is a nurse waiting for me with two copies of the paper work..briefing me on the way to the room..and then in the room there are usually two more nurses with the pt. A great relief from the normal walk in the front door with no one at the front desk..find the room yourself to find the pt. with one CNA who is asking where the nurse went.....

[icebergmedic]

It's truly a dilemma, I can say as a Canadian, (Eh?) and working transport around Vancouver, BC that MOST of the NSG homes are good. Good enough to put my family into if required. However, some of the General Hospitals...

My unit, aka:Car (not BUS see:transit) was called non emergency to a Med/Surg ward in a large General Hospital, (also a level 1 TC) to take an elderly man back to his NH. It was a Saturday morning, approx. 0900 and upon arrival at the unit, my partner, (newbie @ time) went to patient to prepare for movimg to our cot. He came back a few minutes later with a distressed look on his face.

At the same time at the nurse station, a Nurse "magically" appeared. We three, went to the Pt's room. The general appearance was very ashen, and mentation level was low. I then queried stats, and admission reason. I returned to station w/Nurse, and reviewed chart. Four day's prior, query Pneumonia. Sat's were low 90's and nurse St's "pt taken off o2 before our arrival" we bagan vitals, and I instructed partner to get our o2. On our o2, and transporting the pt the 15 Min's to NH, pt resp. began to slow, down to 15, shallow, effective as we arrived.

When we entered tha facility the staff were surprised that we were back w/Mr.X, as his family had been informed that he would not be "discharged from the Hospital" Family had already come, and cleared out his room... as he had been expected to die in Hospital...

[LasVegasEMTI]

Dump the whole thing into him in the 4 mile transport, B/P got up to 70/46. BS of 511, 4 lpm got him to 94%. Monitor showed rapid A-fib.

In ER, they dropped another 1000 bag NS, B/P still <100 systolic. His color is better, he isn't as hot and flushed, he's started to blink his eyes. Talk to MD, he asks me about DNR, I say maybe... He smiles and says, "Foley change, eh?" (and no, I don't think he's Canadian.) I reply, "Run 'o' the mill Doc..." Doc says, "He's not leaving this ER alive..." We shake our heads simultaneously and pray that our loved ones never end up in that place.

And yes.... the man died 2 hours later.

I can only imagine which one of the amazing facilities you were at ;-)

(All is well out here...)

[xselerate]

My unit, aka:Car (not BUS see:transit)

I'm a little confused as to what this has to do with anything or where it came from. I'm not sure if your referring to NYC where an ambulance is called a bus.... if you are then what's the problem? It's just the local terminology.... you get it everywhere....

[WelshMedic]

OK Guys,

Everyone has their own horror story when talking about nursing facilities, it would seem. Most of the comments that have been made are justified, however I would like to put a few things into perspective as I also sense that there's a lot of misunderstanding between EMS and nursing facilities.

Let's take the first example: Mr Brown, 89 years old, has had a devastating hemiparetic CVA that has left him unable to speak or mobilize and he is, in fact, bedridden. Over the course of time Mr Brown has also been prone to developing urinary retention, for which he now has a urinary cathether. He has already stated on a number of occasions that he does not wish to be treated in the event of a life threatening illness , however his son does not want to hear any of this and has actively blocked a DNR order.

The same catheter has, this time, caused a UTI for which oral antibiotics have been prescribed, The antibiotics are not working and Mr Brown is developing dehydration caused by a lack of fluids (he doesn't want to drink any more) and persistent pyrexia. A hospital admission is arranged and EMS is called. The EMS crew is a BLS volunteer crew and they, after measuring vital signs, ask for ALS support. Why? the patient has a BP 95/60 and a pulse of 120. What then happens: Mr Brown is given a full ALS work-up and taken to hospital where he dies 2 days later.

Nothing wrong there, you'd think as an EMS provider. But as a patient, I'm not so sure. You've just just subjected a dying old man to theoretically unnecessary ALS interventions and taken him out of his trusted surroundings to die in a hospital bed. Now, before anyone shouts: "yes, but we didn't call ourselves in, did we" - this I know, but there as a huge gap between respecting the wishes of a dying man and using blanket ALS interventions to prevent a lawsuit. And we all tend to choose the latter rather than the former, don't we?

EMS is wonderful thing, but don't subject everyone to it's full force - it's neither dignified or particularly useful in the longterm. We should all have to right to die in a dignified manner, and that seems to have been forgotten in some quarters.

Carl Ashman

(for the record: RN and an ALS provider in a prehospital setting).

[MedicNorth]

A sad story, but... what choice would they have? The problem here is not the issue of ems intervention - it is the problem of the man's son who would not respect his wishes. A lawsuit is a real (read likely) result of withholding treatment from this patient, probably from that same son. Leaving the gentleman there without treatment would qualify as negligence. The bottom line is that we cannot make those choices for our patients. We can only do our job in a professional and caring manner, respecting the dignity of those we serve.

[WelshMedic]

I ask, "What was his last set of vitals and when were they taken?"

RN replies, "116/72 with a pulse of 76, temp of 99.6, 94% RA....... and that was at 0845."

Well it is now 1230..... We take vitals... 60/40 with a pulse 136 weak & thready (carotid... no radial pulse attainable), temp 102, 88% RA.

I ask, "Does he have a DNR?"

RN replies, "Why?"

I reply, "'Cause we're gonna' need one!"

RN: "I think so... let me check..."

Me: "No time... bye."

In truck, partner puts an 18 gauge in Left forearm and a 1000 bag wide open. Dump the whole thing into him in the 4 mile transport, B/P got up to 70/46. BS of 511, 4 lpm got him to 94%. Monitor showed rapid A-fib.

In ER, they dropped another 1000 bag NS, B/P still <100 systolic. His color is better, he isn't as hot and flushed, he's started to blink his eyes. Talk to MD, he asks me about DNR, I say maybe... He smiles and says, "Foley change, eh?" (and no, I don't think he's Canadian.) I reply, "Run 'o' the mill Doc..." Doc says, "He's not leaving this ER alive..." We shake our heads simultaneously and pray that our loved ones never end up in that place.

And yes.... the man died 2 hours later.

This sums up my point beautifully. Go on, read it again. And then consider a number of things that scream out to me from this piece:

1) 4 hourly signs are not the norm in any Nursing facility, if you're that ill you need to be elsewhere i.e. in hospital. I believe that's the reason why you were there.

2) So you ask for a DNR, and because the nurse in question can't produce it there and then, you decide to totally ignore him/her. Potentially also ignoring the wishes of a dying man. The man had been in that condition for some time, you could and should have waited for them to find it. I find it arrogant that you can't find the time to listen to staff at the home and felt that at that time they had no more useful input.

3)"an 18 gauge in th eleft arm and a 1000 bag wide open" Yes, but did you guys hold the man's hand and talk to him?

4) Despite the EMS heroics, the poor man died 2 hours later in a strange place full of strange faces........

This is not a personal attack, I would just like to offer a different perspective on things. I genuinely believe that the job would be made a whole lot easier if we just listened to one another instead of just bitching. There is no excuse for sub-standard care in any field of healthcare, but just because a nursing facility doesn't speak the same language as an EMS crew, it doesn't give us the right to stop listening to one another.

I wish you all a very fine day from a very sunny (but oh so cold) Holland.

Carl.

[WelshMedic]

A sad story, but... what choice would they have? The problem here is not the issue of ems intervention - it is the problem of the man's son who would not respect his wishes. A lawsuit is a real (read likely) result of withholding treatment from this patient, probably from that same son. Leaving the gentleman there without treatment would qualify as negligence. The bottom line is that we cannot make those choices for our patients. We can only do our job in a professional and caring manner, respecting the dignity of those we serve.

Medic,

You're so right with that last comment, and that's indeed what it's all about. However we're all more likely to respect the wishes of a court of law than the wishes of a patient, and that I find sad....

Take Care,

Carl