Here's my rant

[Kaisu]

We get called out for "respiratory distress" at a local nursing home. It's me (paramedic student) and two paramedic preceptors. (wonderful people too). They're griping that there is a MVA in an area we run intercept for and now we'll miss that because we've got this BS nursing home call . (I'm too green to think any call is BS - I'm happy to be on the road and moving toward something).

The first clue should have been the nursing home attendant (torn herself away from the crosswords) to meet us at the door and escort us to the patient room. I can hear the guy gasping out in the hallway - peek in the door and see a man on his way out of this world - eyes rolled up in the back of his head and too obtunded for CPAP.

He'd been that way for 45 minutes. They had a nasal canula on him!

This man had 7 different mestasteses and should have had a DNR bracelet. Typical F*******G nursing home he's not wearing it. This is the ONLY legal form of DNR in Wisconsin. It's in the file they tell us - so off to the file they go and guess what? can't find the bracelet.

The man's wife is in the room and she is insisting he goes on a ventilator because she wants the family to all have a chance to say goodbye. We load and go and of course, intubate on order of Medic control. WTF??????? Does the wife think that after everyone has had their weep and goodby at the door that we just pull the tube out and let the guy die? What gets me (among a million other things) is this guy was diagnosed last fall and he knew what he wanted.. and he didnt get it.. now he's going to be on the vent for days? weeks? months? - cranking up god knows how much in bills and costs that are never going to be even close to being recovered... and more importantly, this is my patient and he didn't get want he wanted.

Thanks for listening

[spenac]

I hear you. Seeing death so often sadly we almost become cold. But it does piss me off when people do not follow the wishes of their loved ones. It hurts me more knowing what I am doing goes against the patients wishes but legally I have no choice. My grandfather was illegally revived by an ambulance crew even though they were presented with a legal DNR. He was alert and aware of his pain for several more weeks. Just not right. Respect a persons wishes.

[steph1030]

it amazes me when this kind of crap happens the family knows of his wishes hes in nursing home obviously because they cannot care for him and come on now rent dnrs supposed to accessible at a moments notice ?my grandmother had one and her dor a copy on fille to prove it she died at home but when ems got there they asked to see a copy of it maybe each state is different but to me it would make sense for this to happen and this would be produced on request i know the family wanted to say goodbye n all but wow isnt his comfort the most important concern ...this is the crap that makes our job all the more harder .............

[Dustdevil]

Any decent lawyer could make a money-winner out of this case.

Neglect. You would be hard pressed to find a jury who was not incensed by this story.

[Kaisu]

so who's gonna sue ? the guy's wife ? as executor of his estate ? She's the one that insisted on the tube. I have no standing - all I am is someone who cared for the man. It's frustrating as hell.

[Dustdevil]

so who's gonna sue ? the guy's wife ?

Yep. Little old lady crying on the stand is gold in the bank.

[Richard B the EMT]

so who's gonna sue ? the guy's wife ? as executor of his estate ? She's the one that insisted on the tube. I have no standing - all I am is someone who cared for the man. It's frustrating as hell.

As the song states, I'm "Stuck in the middle with you!"

[brock8024]

Any decent lawyer could make a money-winner out of this case.

Neglect. You would be hard pressed to find a jury who was not incensed by this story.

Correct me if I am wrong dust, but what you are saying if they DID NOT tube him then the wife could have sued.

I know sometimes it is hard to do the opposite of what you patient wants if family is around. i have been made fun of somewhat for keeping DNR's in my truck. In oklahoma a pt can sign when ever as long as they are competent. I have actually had a pt tell me that she did not want anything done if she died and if I would have had one then I would have let her sign it.

This is the way I keep myself sane most of the time.

WHEN IT IS THEIR TIME TO GO THEN IT IS THEIR TIME TO GO!!!!

No matter what you do they will die if it is their time.

These are two important things to remember when you get ur stuff and your on your own.

1) At the end of your day be comfortable and confidant in the treatment you provided. If something did not go how you wanted make sure you change it so it does not happen again.

2) BE ABLE TO DEFEND YOUR TREATMENT!!! if you are called into the your supervisors office or court be able to defend your treatment plan.

How far was you from the hospital?? Would he have been able to make it with just a oral airway and bagging him. This is what I would have more than likely done. I am lucky that the nursing homes and assisted living homes are all within 4 mins of the hospital. So if this came up I would more than likely had just oral airway and bagged til someone found the DNR or I let the ER doctor settled it.

[Dustdevil]

Correct me if I am wrong dust, but what you are saying if they DID NOT tube him then the wife could have sued.

No, I was referring to the NH not having their shit together, creating the confusion that lead to this guy's care turning into a cluster fark. They'd had him all this time, never put his bracelet on, and lost it. That's about like losing his meds and never giving them to him. That DNR is "care". They had a duty to provide, and the failed. This just has negligence and neglect written all over it.

[JPINFV]

Dust, either your exaggerating the potential and magnitude of the lawsuit or I need to modify my retirement plan to:

1. Place parents in any number of So. Cal's not so fine nursing establishment.

2. Wait for lapse in care (it's a question of when, not if).

3. Sue

4. Retire

Problems with having proper DNR paperwork is all to common from both the hospice agencies and the nursing homes.