Horror Story.... from NH.

[MedicRN]

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.

This goes along the same lines of each service/state/country does things differently. From my past experience, if I have an unstable patient (from ANYWHERE) without a DNR readily in the hand of the next of kin/nurse/President of the United States of America, then I have to treat my patient accordingly. I don't have time to wait around while they dig through a pile of paper where they THINK the form may be. DNR does not mean do no treat. By waiting on them, my treatment of a critically ill patient is delayed considerable.

[Ridryder 911]

Unfortunately America neglects its elderly more than European countries. We place our elderly into nursing homes, care centers etc. I am not blaming or excusing either one. It is difficult to take care of an elderly person, and is a full time job as well. Yes, it can be done, but like I said it can be very difficult.

From my years experience elderly people are placed into these homes for 2-3 reasons. One is to recuperate until illness is better and or arrangements can be made, the other is to place the patient in the facility to die.

I place a lot of the blame on the physicians not addressing the situation of DNR's. Many are still uncomfortable of discussing with the immediate family or even the patient. If things were discussed in detail, patient and family members could make a better rationale decision. True many family member want to make the final decision, and unfortunately we are not allowed to carry out the wishes of the patient.

True, we have an obligation to our patients. That service is to care for them, the best we can. Too many have the idea of DNR is not to treat, and I have seen more than my fair share of situations like that.

As well I have a poor tolerance of not having the patient information prepared for treatment and transport. I do understand the difficulty of taking care or being responsible for 150 patients, but having the DNR status in hand should be easy enough. It appears that recently we are getting more and more apathetic medical providers.

Maybe it is my age, or years of experience, but I will no longer tolerate such behavior. I now will call and discuss the matter with the D.O. N . or administrator if need be. More we allow or tolerate, the more it will occur.

Be safe,

R/R 911

[brock8024]

I do not know how others feel, but if I was dying and DNR or not does not mean I do not want to be treated. I also do not agree with the dying in a unfamiliar place. I somewhat do I guess. I mean the ER staff is jsut as caring as the NH staff. And how would you explain to a jury that you with held treatment from a patient while waiting for a nurse to find a DNR. A DNR to me is good for when the pt dies not to see if you need to treat them. That is just my 2 cents.

[WelshMedic]

I'm not advocating doing nothing in a critical situation, we all have a duty of care to our patient. I do however think that we need to be very critical before unleashing the full force of ALS interventions on someone that would never have wanted it and, ultimately, doesn't benefit from it. We don't have such a culture of litigation here in Europe, so I would gladly take the time to find out the wishes of the patient and his or her family. Take an asystolic cardiac arrest, I'll ask the family what the patient would have wanted (and what they want, of course) whilst I'm bagging the patient, and depending on their answer I'll stop the attempt.

Carl.

[andrean678]

How about the rest home administrator in our town who has instructed his employees not to perform CPR on anyone. They could be the 40 y.o. psych patient or the 90 y.o. grandma. When they asked about him sending them to a class, he said why bother? You can't perform it anyway.

Hm, as long as I am not working when they "can not obtain vitals on a pt."

[PrissyEMT]

Not too long ago down here we had a woman who went "missing" from one of the nursing facilities for nearly a week. The police department and entire city put on a massive search for her, and she ended up being in one of the supply closets still inside the facility. One of my friends was on the truck that picked her up, and he said it was one of the the most horrible things he's seen- she was in the floor for about 5 or 6 days, not able to move and barely alive. Needless to say even after they rushed her to the ER, she died a couple of hours later. It's sad that these facilities who are responsible for taking care of the elderly don't have their act together.

[Eric]

I'm sorry to go off topic here but a have a story about a PT and a DNR i was doing a transport to the ER PT was not feeling well and had something done to his knee of i remember right i seen the dnr and some other paper work about a livening will well i ask my pt about the dnr he told me he did not know what it was i told him about it and what it meant if something happened and we showed up he ask me for the DNR and riped it up in front of me so youu never know some times is ok to ask a PT about them

[NYAEMT-I]

In Upstate NY where I live a DNR does not mean do not treat.. All it means to us is that if they happen to code while in my care, I can't do CPR. It does not mean that if they are sick and need fluids, heart meds or anything that we do not do that... Personally I believe that if you have a pt who is a MI or A stroke, and they have a DNR I am going to make sure that I do everything that I can up to the CPR point to make sure they make it..

:?

[cosgrojo]

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.

As I'm sure you can appreciate, my telling was not a complete and comprehensive report of the incident, only a highlighted section to point out the problem we had. Before going into the room we attempted to get report. Actually sat there for 5 minutes trying to harangue a report out of the staff. They didn't know anything, and didn't suspect anything more than a foley change. We had already wasted enough time trying to get a report from these people, when we saw the condition of the patient, we were not waiting around for them to find some paperwork that may be buried in the lower level paperwork bin. Furthermore, by the time we got packaged and rolling toward the elevator, they finally got the paperwork and handed it to us on our way out the door.

We didn't do anything that violated the DNR. We took a 3 lead strip and established an IV for our low b/p, dehydration pt. I think well within our scope of practice. We didn't do anything "heroic," just followed protocol. And yes, if the man was conscious and able to look at us or show any sign of life, we may have taken an opportunity to hold hands. But he didn't look like he was in a hand holding mood. Non-verbal, delirious patients aren't good at fine-motor activity and heart-felt conversation, sorry to dissapoint.

Strange faces? The point is, that if the nursing home recognized the problem as for what it was "yesterday," the patient would not have died at all! He would have lived and not suffered the pain and delirium that he had in his final two days. Don't forget the part where I said this patient up until a day or so ago, was talking and coherant.

Oh and as it may not be policy to take vitals every 4 hours.... if you are sending a patient to the hospital, I would think that you might want to evaluate the patient before they go. You know..... because, they are going to the hospital..... and patient conditions change..... and well..... they are going to the HOSPITAL. Not staying at nursing home without complaints..... hospital.... a set of vitals would be appropriate.

Maybe my bare bones account of the story made you think that we neglected being kind or compassionate to the patient. Let me assure you that that is not the case, I was trying to stick to the basics so as to create a readable post that illustrated a simple point...... Some times we see stupid things and experience things that make us sad, and this was my way of constructively venting what had happened. Telling these stories can be cathartic, and I was just getting it out of my system. But don't turn this into a EMS doesn't know how to communicate thing, the nurse at the home wasn't speaking any language. It's not that we weren't listening.... they weren't talking!

[Richard B the EMT]

What follows is not witnessed by me, and falls under the label of "EMS Urban Legend".

Nursing home call for an "Unconscious". The Fire Department First Responder Engine, and EMS BLS and ALS teams arrive simultaneously to find the patient in a wheelchair, in rigor, full dependent lividity, cool to the touch. Patient reportedly was in the chair from 0930 hours, wheeled to lunch and didn't eat, and it's now 1600 hours (local time). The patient in the chair was parked all day across the hallway from the Nursing Station!