first "trauma" call

[emtbass]

My first call ever was a DOA... and im still here.. LoL

After a few weeks of clinicals, I was starving for a great trauma call. So as we sat at a local diner eating, we hear ..."EMS 931 A Response on a fall at the Windor Nursing home. Pt. fell and beleives she has broke hip, and states that she is bleeding profusly."

I of course got excited, and didnt even mind having to leave my meal. So we got the nuring home, and found the patient... First off... hip was not broke at all.. the pt was up walking in no pain, and the blood... we it came from her nuckle that she busted when she fell. I wasnt even actually bleeding, just a few drops.

BUMMER !!!!!!!

I love how things can get exaggerated by the time it gets to the truck....

PT > NURSE > 911 > DISPATCH> CREW its just amazing.. LoL

 

[TTLWHKR]

Since you're new to EMS, let us fill you in on Nursing Home EMS.

If the patient is still alive, or the injury just happened...and the call comes in quickly. That patient is lucky.

Most of the time, patients with pelvic, extremity, or 'hip' fx's either lay on the floor in pain for hours, or get put back in bed and lay in pain for hours before EMS is activated.

Nursing home full arrest calls will come in at shift changes, and you are to assume that any respiratory problems are not sudden onset, they have been that way for hours and you are now treating neglect.

This will never change. There is no good call from a nursing home, the elderly are not treated as well as they should be, less than human in some cases. It's pathetic and sickening.

 

[Flight-LP]

I remember those days of feeling the Epi running through my body when grannie fell out of bed.......... God I feel old!!!

 

[emtbass]

Oh I completly understand the whole nursing home subject.. my Great Grandma on both sides are both in them now, and my great grandfather died in one less than a year ago.

And I have experience plenty of it on the truck.

 

[TTLWHKR]

Originally posted by emtbass@Aug 10 2005, 12:27 AM

And I have experience plenty of it on the truck.

I thought you just got your first job?

 

[MMiz]

I hate nursing homes. There is just nothing positive or good about them.

I rarely am dispatched correctly for a NH call. We can get dispatched Priority 3 (normal non-RLS) and the patient is a full code. When we get a Priority 1 at a NH we know it's something serious, or a shift change just happened and the "Oh crap I don't want to be blamed for this" mindset happens.

I hate nursing homes. I keep trying to find a really nice one but all I see are not-entirely-crappy ones.

It's always fun coding to a call though, good job

 

[KEVD18]

nursing homes are terrible. they never get the c/c right. they never know hwats going on. they deliver horrible pt care. i hate the whole system

the only thing that i can say is good about metro boston are nh's is when we take a 911 out of a facility, they usually have all the paperwork i need ready to go. i dont have to ask for it and i have everything i need. thats about ti

 

[kyleybug]

Originally posted by TTLWHKR@Aug 8 2005, 10:07 PM
Since you're new to EMS, let us fill you in on Nursing Home EMS.

If the patient is still alive, or the injury just happened...and the call comes in quickly. That patient is lucky.

Most of the time, patients with pelvic, extremity, or 'hip' fx's either lay on the floor in pain for hours, or get put back in bed and lay in pain for hours before EMS is activated.

Nursing home full arrest calls will come in at shift changes, and you are to assume that any respiratory problems are not sudden onset, they have been that way for hours and you are now treating neglect.

This will never change. There is no good call from a nursing home, the elderly are not treated as well as they should be, less than human in some cases. It's pathetic and sickening.

we get calls that the pt's are having difficulty breathing and they are blue, we get there and find them with a NRB with O2 @4lt :huh: ........gotta love those calls, take off the NRB and they start turning pink again....imagine that? :blink:

 

[TTLWHKR]

Since you're new to EMS, let us fill you in on Nursing Home EMS.

If the patient is still alive, or the injury just happened...and the call comes in quickly. That patient is lucky.

Most of the time, patients with pelvic, extremity, or 'hip' fx's either lay on the floor in pain for hours, or get put back in bed and lay in pain for hours before EMS is activated.

Nursing home full arrest calls will come in at shift changes, and you are to assume that any respiratory problems are not sudden onset, they have been that way for hours and you are now treating neglect.

This will never change. There is no good call from a nursing home, the elderly are not treated as well as they should be, less than human in some cases. It's pathetic and sickening.

Well, you have to understand that it really can't be improved upon, until every nursing home can afford to staff a doctor every shift. We have protocols to provide a level of standard care for every situation. Nursing homes go by what the doctor of the patient tells them to do. Every person needs a different level of care, they can't do what we do for every patient. On average, EMS is with a patient anywhere from 5 minutes to two or more hours in the most rural areas. If a nurse in an NH found a patient with SOB, they call the doctor- at least they should. He tells them what to do. Most can't even suction the airway with out the doctors permission, and some can't even perform resuscitation with out making the call (to the MD). If they put the patient on 10-15LPM by NRB, and leave them like that till the end of the shift, they may come back to a dead patient. I.e. loss of hypoxic drive equals loss of the need for them to continue to spontaneously breathe which leads to respiratory arrest, cardiac arrest and brain death.

If we put them on 10LPM by NRB, etc, it really doesn't affect their "need to breathe", because up to two hours really doesn't make that big of difference. Really, I don't use the "15LPM by NRB" for every patient. Why waste expensive medical gasses? Just because you give them 25LPm, doesn't mean they are getting MORE oxygen, it just means your bleeding your tank off really fast. As long as the bag on the NRB is full, they are getting plenty of oxygen. I usually set the regulator or flow meter to 8LPM, to keep the bag full. 4LPM may not be enough to keep the bag inflated, even with regular respirations, if the bag goes flat, that will make them breathe more, hyperventilate, basically suffocating them. That's why they have standards for use of delivery devices. 4LPM is fine, for a Nasal Cannula. If you come upon a situation as you described, I would rather turn the flow up, that discontinue it completely. The nurse was just doing, literally, all she is allowed. We blame them for the problems, some of them can be avoided, if they weren't in the "I don't want to be blamed" phase, but other can't be. Patients look to the nurses for help, but really are severely limited in what they can do b/c of the wide variety of patient needs. We're lucky EMS has more control when we arrive on scene.

 

[Wingnut]

Thia may sound dumb, but you're saying nurses don't have as much control as EMS does? From what I'm reading it seems that EMS is better trained than most nurses working in these homes. They're supposed to be able to accurately assess a patient and monitor them, even when under dr's orders. I would think they would know when there is a real emergency and to call us rather then let the pt die slowly uinder dr's orders.

 

[TTLWHKR]

Originally posted by Wingnut@Aug 11 2005, 09:32 AM
Thia may sound dumb, but you're saying nurses don't have as much control as EMS does? From what I'm reading it seems that EMS is better trained than most nurses working in these homes. They're supposed to be able to accurately assess a patient and monitor them, even when under dr's orders. I would think they would know when there is a real emergency and to call us rather then let the pt die slowly uinder dr's orders.

We've already covered the answer to your comment/question. They can only treat what the doctors tell them to treat, as in most cases, the patient may be a DNR. Also, you don't know what kind of nurse it is. An assistant, an LPN, a CNA, an RN, who knows. They operate under the orders of the patients physcian.

Why don't they call when the patient first becomes ill?

Understaffed, patients are not checked as often as they should be. By the time the patient is found to be ill in many cases, it may be hours afterward. In the case that a nurse treats the patient in a way that the doctor may not approve, they could very well lose their job. In some cases, the family wants to be notified before an Ambulance is notified. If they have a DNR, they treat it as Do Not Treat.

 

[Wingnut]

I'm referring to them being responsible and checking thier pt's more often/ acknowledging earlier that there is a problem, not going against the dr's orders.

 

[TTLWHKR]

Originally posted by Wingnut@Aug 11 2005, 11:48 AM
I'm referring to them being responsible and checking thier pt's more often/ acknowledging earlier that there is a problem, not going against the dr's orders.

That would make sense and be easy to comprehend. Why would you expect them to do that?

 

[rescuejew]

my biggest pet peeve is all of EMS is these nursing homes. The elderly deserve so much more than what we give them, here, half the nurses are imported from other countries and cant even speka enough English to understand me let alone a half-deaf 80 year old with Alzheimers. But its okay, the DFS will just let them go on and kill folks...

I think the dumbest thing I've ever seen at a NSG home is attempted resuscitation on a seated patient. (Which, in itself, for them, is not all that bad, until you factor in attempting to put the bed down and the pt stays seated because s/he is in full rigor....)

Its a beautiful system we have that ignores the people we should most respect.

 

[KEVD18]

the plain truth of the matter is that nursing home are overworked and understaffed. with the baby boomer generation in or entering the stage of their life when long term care is necessary, there arent enough people to staff all of the facilities. so of course they'll hire anyone with a license.

as far as scope of practice, as mentioned earlier its very limited. there arent any facilities in my are that have the equipment, much less the orders to deliver more than 5lpm o2. this is due to the fact that they use the o2 machines, not tanks. sure they might have a d tank or two kicking around for emergencies, but not more.

as far as checking on pt's more often, i have a story that might help put that into perspective. one of the facilities i vist fairly frequently has a resident that, without a word of a lie, knows only one word: help. she sits in her w/c all day and says help help help help help help help help until she runs out of air. takes a few seconds to catch her breath and starts up again. while it would be innaccurate to say theres nothing wrong with her, let it suffice to say that shes in no acute distress. thats just all she says. multiply that sort of this times 20-30 pt's per floor. these folks cry wolf. the nursing staff cant possibly keep up with this

please dont in any take this as support for the level of care recieved at a ltc feacility. i just understand why they have some of the problems they do

 

[Cap'nPanic]

Ok as far as NHs are included in this discussion I will add my thoughts.

I used to work in a NH facility that had roughly 100 residents, many of which suffered from either dementia or hypochondria (sp?) or some other form of mental illnesss that left them out of touch with reality.

I worked both D/S and N/S. On D/S they keep the residents pedaling from one activity to the next, we had to start getting them up at 4 am for breakfast at 6, with some of these residents I can see needing two hrs to get ready but not all. Also 95% of these residents are on some kind of medication, many of which take up to 10 or so pills a day, there are only 6 nurses on staff for the D/S crew with 4 CNAs on each wing. they give you two hours to do a "round" meaning you check your residents to make sure they havent peed on the floor, hanvet gone DOA or for the more sane ones need anything such as water, etc. Some of these aids would do nothing but simply stick their sorry heads in the door and call it a thourough, mostly because they have another resident 10 rms down the wing riding the call light threatening to call "mama".

N/S was far worse, 2 CNAs on each wing, rotating "middles" to where you are responsible for up to 40 pts at any given time, you do not get a break for doing middles. (even though it is taken from your check) On N/S you must "turn" bed pts every two hours, not a minute late. you have to get others up to the B/S commode or take them to the bathroom, some will holler, scream, bite, hit you, kick you, throw their walker at you. (Ive had all done to me as an aide). Each N/A CNA was responsible for 15-20 pts at a time. It is not fun when granny and pa who share the same room are fighting.

NHs are not governed by the same overseeing powers that EMS is. The Office of Long Term Care is responsible for the oversight of NHs, often they are the ones implementing the N/C at 4 lpms max, even though grandma over here is having labored respirations, cyanotic, her BP is 160/82, R is 32, and her pulse Ox is dropping stedily.

It is when the CNAs and nurses stand there with their hands up their butts and act like they dont know that grandma is dying that I start gettin angry.

I have had to be the one to take action many atime in the facility I worked for, ranging from stabilizinf a Fx, to helping grandma breathe a little easier until EMS could arrive.

Im not downing anyone who works for a NH, but that is one thing I will never do again, as I learned it is not my cup of tea.

Sorry to be so long winded but that is my input on the subject.

-Cap'nPanic

-The one, the only, the village idiot......

 

[rescuejew]

I'm certainly not knocking CNAs, I WAS one for 4 years, BUT I never treated anyone with disrespect, malice or cruelty. We all get busy, but damn, thats no excuse to abuse the elderly, because it IS abuse. Being a CNA defined my career for me, and elder abuse, for whatever reason, is something I get ridiculously sensitive about. my two cents is that I am going to be stubborn (as usual) andstick my fingers in my ears while I la la la away excuses made on theses persons behalf. I'm not trying to be argumentative, and certainly not trying to offend anyones opinion, but if I could take all the LOLs out of all NHs and blow the fu**ers up with the Fat Boy, I would do it in a heart beat. We need people that care about our elderly and there arent many, which is why the good people that inevitably work in NHs do so for short stints, because they get tired of coming home in tears.

Too bad I dont have tllywhackers soapbox icon...it would be soooo useful right now...sigh...

 

[Cap'nPanic]

I was also the one to question whether a certain resident "fell" out of bed or was dropped.

During such a case that I was feeding one morning on a male resident who had been suffering from cancer for quite some time.

I noticed he was bruised from head to toe with a severe laceration on his hand that was obvious that needed sutures. Now I will say that the elderly due to their thin skin they do bruise easily and they can get cut easily. But this one resident had been in this condition for approx. 3-4 days. I finally put my foot down and went to the head nurse and asked her why Mr. So-and-so was not transported to the hosp. to be checked out and patched up. She promptly told me that I did not know the full situation and that I had limited medical knowledge and I needed to keep my nose out of it as I was the outgoing shift. That was enough for me. I went to the director who asked me if I was questioning the entire facility's practices in regards to long term care, I said I was if there was elderly abuse. She first suspended me for a day w/o pay. I came back and EVERYONE made it hard to do my job. I filed a formal complaint with my supervisor and it fell on deaf ears. A week later I was fired. Gee I wonder why?

After that experience I dont care to work in a NH ever again, mostly because I hate seeing elderly abuse and being muzzled when I try to be an advocate for the residents.

-Cap'nPanic

-The one, the only, the rebel with a cause

 

[Jon]

Originally posted by TTLWHKR+Aug 11 2005, 12:41 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (TTLWHKR @ Aug 11 2005, 12:41 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Wingnut@Aug 11 2005, 09:32 AM
Thia may sound dumb, but you're saying nurses don't have as much control as EMS does? From what I'm reading it seems that EMS is better trained than most nurses working in these homes. They're supposed to be able to accurately assess a patient and monitor them, even when under dr's orders. I would think they would know when there is a real emergency and to call us rather then let the pt die slowly uinder dr's orders.

We've already covered the answer to your comment/question. They can only treat what the doctors tell them to treat, as in most cases, the patient may be a DNR. Also, you don't know what kind of nurse it is. An assistant, an LPN, a CNA, an RN, who knows. They operate under the orders of the patients physcian.

Why don't they call when the patient first becomes ill?

Understaffed, patients are not checked as often as they should be. By the time the patient is found to be ill in many cases, it may be hours afterward. In the case that a nurse treats the patient in a way that the doctor may not approve, they could very well lose their job. In some cases, the family wants to be notified before an Ambulance is notified. If they have a DNR, they treat it as Do Not Treat. [/b][/quote]
Yeah... often I'm told that the nursing staff can't change o2 settings... or a facility has a protocol that, after EMS is called... allows staff to initate o2.. but only to the 6lpm their regulator goes to...

Jon

 

[rescuejew]

Poor Cap'n'Panic....sorry you had to go through that. NH suck plain and simple, there are no words to describe them. At least you tried to be that mans advocate, and I hope that didnt weaken your spirit...the poor elderly on way low on people who care.