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

[LisaO925]

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 .

BWhahahahahaha

Oh, I am so stealing this...

[spenac]

With only one side of the story I would say a report must be filed. If all you said is true this patient received sub par care.

Now with that said it would be nice to hear how the EMT relates it. Might be complete opposite.

No offense meant just in my old age I realize that each person involved perceives things in different ways. But if you are convinced that neglect took place you are obligated to report it.

[CodeBlueEMT]

In North Carolina we have The Division of Health Service Regulation that would investigate an incident like this.

Shayne

[Chief1C]

An ambulance staffed by a Vol. EMT and a Cop.. You're not in New Jersey, are you?

[spenac]

An ambulance staffed by a Vol. EMT and a Cop.. You're not in New Jersey, are you?

Could be Texas. If granted an emergency variance an EMS system can run with one certified person and a driver. My old paid service started this after myself and some others left. Scares the hell out me since my family might need the ambulance someday.

[cotjockey]

Well...I have some information that I didn't have a week ago. According to the EMT, the reason for the long response time is that dispatch paged it out as a "transport," which apparently means non-emergent, so according to the squad's SOP means they have up to an hour to respond. I took for granted that calling 911 meant that I had an emergency. From now on, we have to specify that we need an emergent transfer.

The squad has been called to our LTC for complete nonsense more than once, so they have a bit of attitude about responding there. The EMT admitted this when my administrator talked to her. (Yeah, I was supposed to talk to her, but the administrator called her first).

The EMT said that she was upset when she came in because the resident was still on the floor and because no one was holding her hand or trying to comfort her. I thought about moving her back to bed, but really didn't want to move her without appropriate splinting. No one was holding her hand because this lady isn't the type that would put up with it. We could have held her hand for about five minutes before she would say something like, "OK...you can find something else to do now." There was a CNA in the room with her the whole time.

The EMT didn't know I am a nurse. I didn't have my name tag on...it was on my jacket, which was hanging over a chair at the desk. My fault completely. The EMT also said she was upset because she has "never seen an RN" there. We are required to have an RN there 8 hours out of 24...and that is about all do we have. I don't really think it is the best thing not to have RN coverage 24/7, but that is how it is...I don't make the rules.

The squad only has four EMTs and two were out of town. The two that were available both had to work that morning and both hoped the other one would respond. The closest mutual aid is 15 miles away and protocols don't allow paging them out until 15 minutes without a response.

So...it sounds to me like their squad needs to make some changes…so does our LTC. Our LTC needs to be more careful about what we call 911 for...we need to be more assertive when the doctor tells us to transport when we really just need orders for an antacid. We also need to specify to dispatch that we have an emergency. I need to make sure I am wearing my name tag.

We're supposed to have a meeting with the fire department officers and our department heads...we'll see what happens.

[spenac]

We're supposed to have a meeting with the fire department officers and our department heads...we'll see what happens.

Great idea. We get called for people that could have gone by the nursing home van. We also get calls that say transport and by policy they wait till we have an ambulance free. We do not rush over. Sadly because they just request transport it sometimes leads to people that need immediate care not getting it. We keep asking the nursing home to request emergency response rather than transport.

Maybe both sides can discuss when an ambulance should be called and how to request it so it gets proper attention. It will also allow both sides to learn about each others true situation rather than relying on what each other thinks. It really sounds like ya'll need to have a paid service. Any community big enough for a nursing home is big enough for a paid service.

[DwayneEMTP]

So...it sounds to me like their squad needs to make some changes…so does our LTC. Our LTC needs to be more careful about what we call 911 for...we need to be more assertive when the doctor tells us to transport when we really just need orders for an antacid. We also need to specify to dispatch that we have an emergency. I need to make sure I am wearing my name tag.

+5...The original post was frustrated and angry, for very good reason, yet the thread continues with lessons learned, personal responsibility taken, and ideas for eliminating like issues in the future. Are you SURE you work in an LTC?

Just a fair warning...should you insist on continuing with this type of behavior, and it should by accident spread, to other facilities and EMS...well, hell, in a year or so we will run out of reasons to hate each other...Completely unacceptable! :wink:

I hate nursing homes (by any name) but have a feeling I would like working with you just fine. Thanks for the great posts, and showing us all that we can change things for the better if we attempt to eliminate our own faults first.

Your post reminds me that I've been frustrated and angry about nursing home calls...yet haven't posited a single theory for resolving the issues I have (if burning them down doesn't count). It reminds me that I've become part of the problem. I'll pay better attention in the future to becoming part of the solution.

Dwayne

[cotjockey]

I can relate to how EMTs can be frustrated by nonsense calls at LTCs. I’ve responded to calls where the patient has been dead for a long time and had nurses wanting me to do CPR. I’ve also responded to “needs transport for x-rays” to find a patient who is cyanotic and breathing less than 5 times a minute. I’ve also been told a patient is “in his room” when asking where the patient is and watched a C N A kiss a resident good-bye (on the mouth!) while her boob popped out because she was leaning over so far. I know how they feel about the nonsense calls and calls where inadequate information is given to dispatch. I was not aware that I had to specify that calls were emergent…I thought dialing 911 indicated that already. I also know that the dispatcher that was on that morning once paged out a “transport” for someone who was unconscious and not breathing. I honestly dread responding to the nursing homes here and I equally dread calling 911 when I am at work.

I really wish there were a way for all of us to have a better understanding of how and why we do what we do, but I know that it isn’t something that could be fully explained if we shadowed each other for a shift or two. (That is what my administrator suggested).

I still don’t like this EMT…I think she has attitude and a half and I know she is really burned out. I feel bad for her. I talked to my medical director at lunch today (saw him in the local burger joint) and he is going to talk to their medical director and see if they will let me help out a bit. I’m in their town more than I am in mine and would be happy to run with them between shifts if they are agreeable. I don't want them to think I am being pushy or trying to play the hero or anything, but it when I am sitting in their apartment doing nothing between shifts, it might be fun to respond with them.

[Chief1C]

Any community big enough for a nursing home is big enough for a paid service.

Nursing homes should have contracts w/ paid, transport services, to do their Non-Emergency transports. "911" Ambulances, should not be doing Non-E transports. It's a waste of resources and manpower.

This is where many paid services fail, and go belly up, they expect a lot of Non-E business to pay the way, but see that a lot of people had that idea. Little more business can never hurt..