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(LA Times)   911 dispatcher "Is there anybody that's willing to help this lady and not let her die?" Nurse at senior living center "Um, not at this time"   (latimesblogs.latimes.com) divider line 438
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23502 clicks; posted to Main » on 03 Mar 2013 at 9:13 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-03-03 10:46:30 PM  
I would not be at all surprised if this "nurse" is actually no more than a CNA (certified nursing assistant).  Nursing homes use mostly CNAs, with a scant handful of LPNs / LVNs, and hardly any actual RNs.

Also, nursing homes suck.  I was stuck in one for three weeks once, and it was pure hell.  How bad was it?  Watching a Lawrence Welk rerun on a Saturday night was a high point.
 
2013-03-03 10:47:21 PM  

NightOwl2255: I was in the waiting room of Mercy hospital here in Oklahoma City. A guy pulled up by the doors, opened the car door and made it about half way to the doors of ER and passed out. He was laying maybe 25 feet from the doors. The people working in the ER called 911. They would not go outside and get him. Me and two other guys walked out and picked him up and carried him into the ER and he was treated. I asked a nurse WTF? She told me that they normally have ambulance crew onsite, but if they are out on a run the policy in this situation is to call 911, they are not allowed to walk out of the doors to help anyone.

/Dude lived, low blood sugar.


Several good reasons for that:

- The hospital's insurance policy does not cover any care given outside of the building. Even if the patient is brought inside, the care given by the hospital started outside (cf. "the care given by the paramedic before the patient was handed over to the hospital inside the hospital building") so the insurance company isn't responsible for when something goes wrong.
- A nurse is not a paramedic. They don't have advanced life support equipment, training, insurance and most importantly, the help of a second paramedic.
- The ER nurse is responsible for everyone in the ER. If he turns his back to go outside and play paramedic, and someone inside has a grievous change of condition, that's his ass. Even if there was someone else there. Even if every RN, RPN, HCA and agency jackoff with stolen scrubs and a forged green card were crammed into the ER. The insurance company and the lawyers will say the level of care was diminished because someone who was required to be there farked off to someone else's job after specifically being told not to.
 
2013-03-03 10:47:47 PM  
At least she died doing what she loved.
 
2013-03-03 10:50:34 PM  

Korzine: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.


She's dead. Soooo, no.
 
2013-03-03 10:54:00 PM  

Xanadone: I would not be at all surprised if this "nurse" is actually no more than a CNA (certified nursing assistant).  Nursing homes use mostly CNAs, with a scant handful of LPNs / LVNs, and hardly any actual RNs.

Also, nursing homes suck.  I was stuck in one for three weeks once, and it was pure hell.  How bad was it?  Watching a Lawrence Welk rerun on a Saturday night was a high point.


What a bug you've got up your ass. What's wrong? They take your rings? They take your Rolex?
 
2013-03-03 10:54:38 PM  

rga184: ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.

Correction: she has a piece of paper with a title on it. In reality, she's barely a human being. MOST nurses I know wouldn't think of losing their job over saving the life of a patient.


Then most nurses you know are older ones who are in it mainly for the warm fuzzies.  Nurses I've known wouldn't even give a handy for less than $20.  Of course, I always insist on the young, cute, underpaid ones who are supporting three babbies.
 
2013-03-03 10:55:00 PM  

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


What happened to "one-one-thousand-two-one-thousand-three-one-thousand-four-one-thousan d-five-one-thousand-BREATHE" ?
 
2013-03-03 10:57:14 PM  
It's been replaced by Mississippis.
 
2013-03-03 10:57:32 PM  

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


An old lady, one of many, or your kids?

Pick one.
 
2013-03-03 10:58:02 PM  

SpdrJay: Well if she didn't wanna die she shouldn't have gotten old!



img811.imageshack.us

Shanna, they bought their tickets, they knew what they were getting into. I say, let 'em crash.
 
2013-03-03 11:02:00 PM  
The nurse signed the oath. Let her wait on tables the rest of her life.
 
2013-03-03 11:02:15 PM  
My not so CSB...
My father was in a senior care facility, very bad diabetes, half of his heart basically destroyed, no circulation to his lower extremeties, and advanced alzheimers.
My mother, my sister and I came together as a family and issued a DNR so as not to prolong his suffering, he was 70.
At the facility he arrested one one evening and was taken by ambulance to the hospital, where he was promptly put on a ventilator, in clear defiance of the family ordered DNR.
Upon receiving news of said event from my frantic sister and mother, I promptly left work, drove 200 miles back home to the hospital, where I was met by my entire family in tears..
After ripping the nursing staff a new asshole, I ordered him to be removed from the ventilator, and doped to the gills..after comfirmation from my mother it was ordered.
We got the oh so great honor of watching my father gasp for breath for 2 hours , before he finally let go
 
2013-03-03 11:02:51 PM  

Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.


What oath?
 
2013-03-03 11:04:08 PM  
lh4.ggpht.com

doglover: An old lady, one of many, or your kids?


Godwin'd, beyotch!

/I only keed.
 
2013-03-03 11:04:17 PM  

BarkingUnicorn: wedun: FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks

try smoking crack, fast cars, hookers, cocaine.

All of those increase your odds of ending up in a nursing home against your wishes.  Live prudently, be realistic about your health, and keep a pistol handy.


My plan is cigarettes, alcohol, and the diet of a prediabetic teenager until I get too old and decrepit to make it on my own. Then I'll take out an ad on Craigslist.

Wanted: Thrill seeker or psychopath willing to end old man's life. Murder fantasies and extreme sports considered. Must bring own weapons. I have only done this once before.
 
2013-03-03 11:05:05 PM  
Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.
 
2013-03-03 11:06:02 PM  

Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.


Ummm..i thought the new CPR rules are NO breathes...just compressions?
 
2013-03-03 11:06:06 PM  

Cyno01: 911 dispatchers are not medical personnel, non story.


That's not true everywhere.  That's not true where I live.
 
2013-03-03 11:06:49 PM  

Keyserroll: Ummm..i thought the new CPR rules are NO breathes...just compressions?


AHA's rules are, I think.  Not everyone's.
 
2013-03-03 11:07:32 PM  

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.


To this day I remember my first code / cpr.  Brutal.  Crunch, crunch, crunch.  Ribs were snapping like twigs.  Broke me in as to what I should expect though.  Patient died.
 
2013-03-03 11:07:42 PM  

Relatively Obscure: [lh4.ggpht.com image 188x270]
doglover: An old lady, one of many, or your kids?

Godwin'd, beyotch!

/I only keed.


Rommel?
 
2013-03-03 11:08:46 PM  

BafflerMeal: Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.

What oath?


The "Nightingale Oath" that nurses recite at their graduations.  Has nothing to do with Florence Nightingale.  It has no more to do with certification or licensing than the Pledge of Allegiance does.
 
2013-03-03 11:10:08 PM  

doglover: Relatively Obscure: [lh4.ggpht.com image 188x270]
doglover: An old lady, one of many, or your kids?

Godwin'd, beyotch!

/I only keed.

Rommel?


Don't think so.  Just a generic Nazi search.  Even more of a butt-chin than Rommel's I think.
 
2013-03-03 11:11:05 PM  

JMacPA: Korzine: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.

She's dead. Soooo, no.


Only in this specific case where we already know the outcome. What if they began chest compressions, shattered her ribs and sternum, only to find out she fainted because of low blood pressure (not sure this is 100% appropriate comparison, but it's the best I can think of off hand) or some such. Then we'd all be reading a story on how the nursing home was brutalizing patients with unnecessary medical procedures. There really is no win for the nursing home. Do or don't the end outrage will exist depending only on the outcome. Since the outrage outcome will eventually be the same no matter what they do, they simply choose the path of least liability.
 
2013-03-03 11:11:12 PM  
I realize the woman was old, but that 911 call was some cold shiat.
 
2013-03-03 11:12:01 PM  

BarkingUnicorn: BafflerMeal: Pointy Tail of Satan: The nurse signed the oath. Let her wait on tables the rest of her life.

What oath?

The "Nightingale Oath" that nurses recite at their graduations.  Has nothing to do with Florence Nightingale.  It has no more to do with certification or licensing than the Pledge of Allegiance does.



Ah yeah, that.  I remember all that now.  I white washed a lot of that night in my head.
 
2013-03-03 11:14:46 PM  
No modified lemon party?

Live, dang you!
 
2013-03-03 11:15:26 PM  
I learned CPR back in the 7th grade as a unit in health class. I think we all got certified, but
it was so long ago (decades) I can't remember.

At any rate, I only had to use it once. It was probably 12 years ago or so. I was home with my
son and we were out on the balcony of our apartment. The woman downstairs comes screaming
out of her apartment looking for someone - anyone - to help her. Her husband had collapsed
and wasn't breathing.

A couple of people just eyed her sideways and carried on. I hesitated for a moment (I'm still a
bit ashamed that I even hesitated) then grabbed my 4 year old and went downstairs. The
husband was collapsed on the floor of the bedroom. The woman's older son was there and
all of the 7th grade stuff came rushing back. I told the son how to do the compressions and I
did the breaths

Sadly, it was ineffective. I felt the man's life leave him before the paramedic (yes, as in one) got
there. Since he didn't have anyone with him, the paramedic had me stay and do compressions
while he bagged him.

Turns out the husband had had a stroke. I felt awful that I hadn't been able to help but when I
went downstairs a couple of days later to see how the woman was doing, the son told me that
they were just glad that *someone* tried to help.

I had to do the heimlich on my dad once too. Fortunately I met with more success that time.
 
2013-03-03 11:15:27 PM  

IanMoone: So, if I was the family, I would sue the 911 dispatcher for telling someone to start CPR when someone is still breathing.

Good Samaritan Laws mean NOTHING if you are trained (or should have been trained) and do it wrong.  Heck even California knows this where a survivor sued the person who took her out of a burning car because her actions caused her injuries. (not the car crash, and nevermind that she probably would have suffered a fiery death had she remained in the car)


Countersue to set the survivor back on fire and finish the job.
 
2013-03-03 11:15:52 PM  

The Evil That Lies In The Hearts Of Men: James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.

Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.


I'm also thinking Out of Court settlement. When there's a 911 recording of a facility's screw-up from beginning to end, they probably don't want this going to trial.
 
2013-03-03 11:22:49 PM  

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


Bingo. Hard time come to terms with that. But it's very true
 
2013-03-03 11:23:38 PM  

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.


Says who? The derpity derp "nurse" who was more concerned about her personal stress level?
 
2013-03-03 11:24:17 PM  

JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?


Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.
 
2013-03-03 11:28:08 PM  

DoctorCal: No modified lemon party?

Live, dang you!


Not safe for Featured Partner Fark
 
2013-03-03 11:29:12 PM  

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


Yep.  CPR is done on folks who are clinically dead.  They may not be biologically dead yet, but clinically they are (excluding the bit about state laws regarding who says 'call it' for legal purposes)

I have never lost a patient through CPR.  The use of CPR indicates they were dead when I started.  With that framework understood, I've never 'gained' a patient either.  They've all been dead when I started, and dead when I was done.
 
2013-03-03 11:32:05 PM  

NutWrench: The Evil That Lies In The Hearts Of Men: James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.

Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.

I'm also thinking Out of Court settlement. When there's a 911 recording of a facility's screw-up from beginning to end, they probably don't want this going to trial.


I could be wrong on this, but it seems to me that if it's their policy, as in they admit it freely, then wouldn't they have made sure that it's legal?  I can't see them making an official policy that gives people grounds to squeeze them for settlements.

In fact I bet it's the opposite, that they have this policy specifically because it's the least likely approach to cost them settlement money down the line.
 
2013-03-03 11:33:14 PM  

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


yeah.. you should probably take one, as you are dead wrong.
http://firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm">http:// firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm
 
2013-03-03 11:35:56 PM  
Peter von Nostrand:

That's odd, I've done CPR on a person who was breathing and had a heart beat. But I guess you would know better than those of us in emergency services

What do you mean by "heart beat"? Electrical activity or a pulse?
 
2013-03-03 11:36:52 PM  

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


i am sorry, but where the hell did you get trained??  CPR is exactly what is performed on a choking casualty, and doesn't kill them.  i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try.  Most likely she was going through agonal respirations, not proper breaths.  i posted this already, and it seems pretty self explanatory even in laymans' terms...
http://firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm">http:// firstaid.about.com/od/cprbasics/f/09_Gasping_CPR.htm
 
2013-03-03 11:37:33 PM  

gwendolyyyn: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

I was thinking that exact same thing...it said she was still breathing. Barely, but even so.


I don't know if it was the right choice, but I'm inclined to believe the trained nurse over the news here. If she didn't preform CPR, there was probably a good reason.
 
2013-03-03 11:44:56 PM  

Lawnchair: AirForceVet: Why bother calling 911 in the first place?

Guess I'll scratch that senior center off my list of retirement homes.

I could go for a place with that much restraint, if I got that old (exceedingly unlikely).  Besides being disindicated for a breathing person, basically no 87-year-old is going to survive the year of rehab from breaking every rib in her body, which would be the outcome from any CPR procedure that's worth the bother.

Why call 911?  Well, she's dying, and if she didn't write a DNR, it's easier for the hospital to deal with that.


All that may be true, but absent a written DNR order, it's not the NURSE'S decision to make. Your patient is going to have a bunch of broken ribs? Sorry, if CPR is indicated, you do CPR. They have a flailed chest from a steering wheel impact? You start CPR anyway. She's old and dying and you don't want the bother? Too bad, if she needs CPR and you don't want the pants sued off you, you initiate CPR.

And if you're on a recorded 911 line and the dispatcher is giving you contraindicated advice--like the lady is still breathing and CPR is not advised at this time--you say "I don't think CPR is advised, so we're not initiating it at this time." You DON"T say "I'm feeling stressed and she's yelling at me" like a whiny biatch. You don't make it sound like you're a callous whore who just called 911 to pick up the body, even if it's true.
 
2013-03-03 11:45:06 PM  

ignacio: I don't know if it was the right choice, but I'm inclined to believe the trained nurse over the news here. If she didn't preform CPR, there was probably a good reason.


Her boss would be mad and she likes paychecks.
 
2013-03-03 11:45:09 PM  
djh0101010:
Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job.

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


You're not the first to point out that she was already breathing, but I agree that it doesn't make sense to revive a breathing person.  When I was a kid the first thing ever said about CPR was 'When you find a person NOT BREATHING...........'.  Also, I do question if the 911 dispatcher was trained in anything besides being a glorified phone operator.  Most are, and it is an important job, but to second guess a trained professional just seems like a silly overreaction.  I listen to Flint's dispatchers and they are not always professional, well sometimes the cops aren't either.  I noticed an officer hitting on the dispatch over the radio, I don't care but it happened.  Usually they just pass calls onto the officers and look up background information for the officers.

/on a side note, a few months ago, I had mentioned how Flint officers could get a lot of criminals off the street by doing some traffic stops.  It worked, they have been and almost every car they stop has no license and/or outstanding warrants.  Surprise!
 
2013-03-03 11:45:12 PM  

digitalrain: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

What happened to "one-one-thousand-two-one-thousand-three-one-thousand-four-one-thousan d-five-one-thousand-BREATHE" ?


it takes a minimum of 30 compressions to circulate blood through the body once.  sing staying alive under your breath and you will have the right speed.  1.6 compressions per second.  compression only cpr is fine for non-drowned adult casualties, but not in situations where they were already oxygen deprived.  aim high in the center of the chest, compress at least two inches, and allow the chest full recoil.

and yeah.  i teach it for a living.  i also teach health care provider levels, which is teaching nurses cpr.  i am horrified by this whole concept that a nurse would abrogate her duty like this.
 
2013-03-03 11:47:46 PM  

AJisaff: CPR on a living patient is a good way to kill them. The lady was breathing. CPR is the wrong treatment. Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.

i am sorry, but where the hell did you get trained?? CPR is exactly what is performed on a choking casualty, and doesn't kill them. i agree that CPR on an elderly patient will probably not have a positive outcome, but the lazy biatch didn't even try. Most likely she was going through agonal respirations, not proper breaths. i posted this already, and it seems pretty self explanatory even in laymans' terms...


You seem to be confusing the Heimlich Maneuver with cardiac compressions.  Totally different mechanism, different action, different part of the body, and for a different reason.  If you're doing CPR on a choking patient, you missed the "airway" part and jumped all the way up to "circulation".
 
2013-03-03 11:48:51 PM  

djh0101010: JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?

Here's as good of a place to jump in as any.  If she's the typical little old ladies, those ribs are FRAGILE.  Like, bag of potato chips fragile.  Since the purpose of chest compressions in CPR is to circulate blood, if the patient's heart is still running, it's much better to let it do its job. 

CPR on a living patient is a good way to kill them.  The lady was breathing.  CPR is the wrong treatment.  Turn up the O2, maybe even bag her, but the dispatcher was wrong telling the nurse to do CPR on a living patient.


You can still have agonal breathing but not a BP that's compatible with life. My best guess would be PEA, so no palpable pulse. In that case you would start CPR.

The dispatchers usually have a flowchart they follow.
 
2013-03-03 11:53:03 PM  

WhoGAS: Acravius: Here is CPR: 30 compressions 2 breaths,
                      Repeat 5 times in approximately 2 minutes
                      Assess patient for 10 seconds, listening/looking/feeling for pulse, breath or rise/fall in chest.
                      If no change, resume CPR
                      If AED is available then hook up AED, (Turn On, listen to instructions)
                      Shock, as advised by AED
                      After 3 shocks maximum
                      Assess Patient, as before
                      If no change Resume CPR 5 cycles per 2 minutes, repeat until more qualified personelle come on the scene.
Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

So yes it could be instructed over the phone, and still be covered by the Good Samaritan Law.

You don't do breaths any more.


Only true some places, and even then only in layperson CPR. The nurse is at least certified in BLS, so she'd be doing breaths if she was doing CPR
 
2013-03-03 11:53:42 PM  
Gyrfalcon:
All that may be true, but absent a written DNR order, it's not the NURSE'S decision to make. Your patient is going to have a bunch of broken ribs? Sorry, if CPR is indicated, you do CPR. They have a flailed chest from a steering wheel impact? You start CPR anyway. She's old and dying and you don't want the bother? Too bad, if she needs CPR and you don't want the pants sued off you, you initiate CPR.

And if you're on a recorded 911 line and the dispatcher is giving you contraindicated advice--like the lady is still breathing and CPR is not advised at this time--you say "I don't think CPR is advised, so we're not initiating it at this time." You DON"T say "I'm feeling stressed and she's yelling at me" like a whiny biatch. You don't make it sound like you're a callous whore who just called 911 to pick up the body, even if it's true.


See, because of that I don't think this so-called nurse was even properly assessing the situation. The patient probably wasn't breathing but meh, I'm stressed and being yelled at, my feelings are hurt.
 
2013-03-03 11:55:36 PM  
I'm waiting to see what BronyMedic says.

But regardless of what he says, I waws thinking of having Do Not Resuscitate tattooed on my chest; now I think it should be "Let me die, fool!" tattooed all over my face.

At 37 I had to quit smoking because 1) I was having trouble trouble breathing and 2) this hot chick would let me move in but she was allergic to cigarette smoke (and she is). So I took to drink instead. (And once I became a crazy drunk after 9 years we broke up: that I'd rather drink than screw is not a reflection on her, I swear.)

It's not length of life but the quality of it: if I somehow make it to 60 (10 more years) I'll take up meth and Russian Roulette. The only reason I'd bother sticking around that long is my dog loves me and based on his breed & size he's got maybe 10 more years. Y'all might scoff but I never had a real reason to live before.

But still: if there's ever any indication that "this dude might live but he'll be farked up" then SMOTHER ME WITH A PILLOW!! What good am I if I can't walk my dog till he's tired and then carry him home?
 
2013-03-03 11:56:00 PM  

Cyno01: Patient was breathing, CPR should not have been performed, 911 dispatchers are not medical personnel, non story.

And yeah, from my meager training, CPR on the elderly is not always the best idea, even on a healthy person if you do CPR right youre likely to break a rib or two. One thing i explicitly remember from training is to make sure youre doing compressions high enough on the patient, or youre likely to break the xiphoid process and cause internal bleeding. I remember that so well because the instructor kept saying regarding the possible internal hemorrhaging that it would "bleed like stink" and that was really funny for some reason.

CPR is not the panacea you see on television.


What about the magical defibberallator machine? That ALWAYS works, whether it's heart attack or poison or drowning or dyspepsia or whatever.
 
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