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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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23492 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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2013-03-04 04:48:37 AM  
CPR has its merits, and some people do survive. However most "code saves" come from correcting fatal dysrhythmias (ventricular tachycardia/fibrillation). In those instances the underlying problem is an electrical disturbance of the heart. Early application of electricity by either an AED or a manual defibrillator leads to a correction of the rhythm disturbance and the restoration of normal heart function. Those instances are where you hear about people walking out of the hospital (even better outcomes with induced hypothermia). In these cases CPR serves to essentially buy the brain time. These saves are people who are normallyactive at baseline and by all means are viable, especially when even witnessed.However those cases are the rarity. Also the only ones that are viewed as viable in the national rankings for cardiac arrest save rates. The other arrests don't typically have an easily reversible causes and is a gradual progressive process (sepsis, anemia, respiratory conditions, neurological event, overdoses) and once they progress to cardiac arrest (normally PEA/asystole) even with aggressive resuscitation they'll never recover neurologically beyond potato. Most nursing home patients meet this criteria. DNRs and hospice are a great thing. /paramedic//27% of our viable arrests walk out in my city
 
2013-03-04 04:52:07 AM  

Lehk: as a nurse is there not a duty of care? She will be lucky if she does not go to jail


As a nurse, the nurse in the article followed policy. You are making a moral judgement based on your feelings....not facts.
 
2013-03-04 04:52:43 AM  

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.


Incorrect.
 
2013-03-04 04:56:10 AM  
My grandpop had dementia. He was terrified of nursing homes. He did NOT want to go into one. Ever. My uncles took care of him at his home (and did a wonderful job). My mom offered to take him (we live across the country). He and I were extremely close. I'd have happily taken him in as well. I have a really really wonderful Irish Catholic family and all the siblings did their part in helping out, some more than others as they were able (some had more time, others more money).

Near the end, he had to be in hospital/nursing care twice. The first time due to a back injury before the dementia got too terrible. My mother held the medical proxy, which I helped to arrange (just with family politics) because she's the least religiously batshiat of my relatives. I spent YEARS talking to them about end of life choices. I did not want to see my beloved grandpop suffering in a nursing home as his father had. (My Great-grandfather lived to 103, the home he was in was really good...but it's a nursing home). Due to bad religious advice, they were told by the church in no uncertain terms they HAD to do everything possible medically for him and not 'let him go'. So they did...he lived to 103.

Grandpop got a MRSA infection and the decision was made to make him comfy, no fluids no food, just pain meds. He lasted a week. He was not uncomfortable during that week...but it was agony on us. I couldn't go see him (he wouldn't have been aware of my presence, and if there was no benefit for *him* I couldn't do it). I also couldn't attend the funeral. It hurt too much. Still does.

It was so so so farking hard knowing he was DYING in that hospital, even though I was the first in the family to pretty much promote this. Part of me wanted to believe he'd somehow pull out of it. My relatives still struggle with it, my aunt especially, because people in our family are very long lived. He was 93, she felt he could have had another decade sans MRSA.

But what kind of decade?

I'm an atheist. So I don't believe there's anything else. He's gone, and I will miss him as long as I draw breath. My grandpop was a believer and wasn't afraid of death. He looked upon it as the next great adventure.

It's never an easy decision. I sincerely doubt there's many making such decisions out of any form of malice. Yes, it was HARD for relatives to take care of him. YES at times they were farking sick of it. But they loved him utterly. I know of no one who has five GOOD kids like my grandfather did.

I'm very grateful for the medical staff that made him comfy, took good care of him, and that the decision to allow him to die with peace and dignity could be made.

And frankly I don't give a fark what anyone else thinks. But my fist would prolly hit your face if someone was stupid enough to say they were 'selfish' or 'didn't want to take care of an old man' to my face.

Ok, it def. would.
 
2013-03-04 05:01:15 AM  

ZeroCorpse: People don't become doctors or nurses, or join the medical profession at all these day because they want to help people and save lives. These days, they do it because they want lots of money.

It's a disgrace that we even use the words "nurse" and "doctor" to describe these greedy animals. They bring dishonor to the words.


Diaf

Nurses are UNDER paid for their level of expertise....and considering a bsn takes 5.5 years...NOT 4 to obtain.

Plus, we have arseholes like u threatening to sue us constantly bc u dont agree with how/what we are doing, or because we refuse to act like your personal servant while u are in the hospital bc your kid has a snotty nose.

Go fark yourself.
/pissing your nurse off is at LEAST an order of magnitude less wise than pissing off your waiter
// think about it.
 
2013-03-04 05:04:00 AM  
This is par for the course.
Group homes and nursing homes have zero ability to do CPR.
They also don't do lift assists or attempt to do any life saving attempts.

Not sure why this is national news.
 
2013-03-04 05:05:45 AM  
That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.
 
2013-03-04 05:10:55 AM  

drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.


Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.
 
2013-03-04 05:14:25 AM  

The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.


Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.
 
2013-03-04 05:23:50 AM  

drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.


Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....
 
2013-03-04 05:28:00 AM  

BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....


Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.
 
2013-03-04 05:29:13 AM  
This wasn't the case of someone who "knew better" refusing to perform CPR on a person who was still, albeit barely, breathing.  This was someone who very clearly was in CYA mode.  You can hear it clearly in the recording.  No argument.  Nothing.  Just, "Sorry, I don't wanna do that."  Very pathetic and sad.  Fark your job and fark you, you stupid biatch!
 
2013-03-04 05:32:03 AM  

hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.


Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.
 
2013-03-04 05:34:44 AM  

erewhon: Abacus9: BarkingUnicorn:

Also, I know that it normally can break ribs and all, but I'm pretty sure there is a gentler procedure for small children and the elderly.

Not really - it's pretty much the same. If you have an infant and a two rescuer situation, you can switch to two thumb squeeze, but you're still compressing 1/3 of the chest depth in any situation.

The times I've done it I'm pretty sure I've broken ribs on every one. It's hard to miss that crunchy feeling. Sorta gives you the creeps. It does make it a lot easier to compress after that, though.

I've got ACLS, PALS and BLS certifications as the putative king of security at work, although none of us have ever coded thank FSM, we've got a Zoll but no rescue drugs other than a tank of O2 and a bag mask. I have done it three times 'in the wild', one lived, but he ROSC'd about round 2 and woke up a few minutes later.


Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.
 
2013-03-04 05:36:54 AM  

hardinparamedic: BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....

Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.


Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....
 
2013-03-04 05:38:43 AM  

The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.


This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!
 
2013-03-04 05:44:26 AM  
No cpr = heartless BIATCH.

Cpr= did she have a dnr? How do you know? Why did you do it with such force that you fractured her ribs? (a common side effect of cpr). Did you check her medical records to determine what her final wishes were?

In my experience, you answer far more questions if you DO cpr than if you dont. The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it..then be drug thru court case after court case for 5+ years bc you "should have known better" than to try.
 
2013-03-04 05:45:31 AM  

vrax: The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!


Walk a mile...
 
2013-03-04 05:46:33 AM  
Headed out on a call. Ill reply to your posts when I get back The more
 
2013-03-04 05:52:47 AM  

The more you eat the more you fart: No cpr = heartless BIATCH.

Cpr= did she have a dnr? How do you know? Why did you do it with such force that you fractured her ribs? (a common side effect of cpr). Did you check her medical records to determine what her final wishes were?

In my experience, you answer far more questions if you DO cpr than if you dont. The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it..then be drug thru court case after court case for 5+ years bc you "should have known better" than to try.


Sometimes doing the right thing is hard.  I couldn't live with myself knowing that I had actively refused to do anything.  I truly don't know anyone who could.  IMHO, this person is in the wrong profession.  She doesn't care about people or life, it's clearly just a paycheck.  If she wants to pretend to help people and draw a paycheck she should go work in AT&T phone support or something.  Though, that might stress her out.  Boo hoo!
 
2013-03-04 05:54:42 AM  
My guess is that once EMS arrived on scene, they began resuscitation attempts through CPR in addition to using a high volume of oxygen and a defibrillator (this is my best guess).  After all, the lady "died" at the hospital.

As for the dispatcher, she was using nationally used protocols called the Medical Priority Dispatch System. This system uses a program called ProQA. It asks the same basic questions you hear in the 911 recording. The ProQA system grades you on your performance and compliance with procedures that fall under the medical direction of a physician. If the call taker is non-compliant with doing EXACTLY what MPDS calls for, she too could lose her job and could also be held liable in the death of the patient.

You may think she's being pushy and over the top but she's doing exactly what she's supposed to do.

/I'm not an EMD but 911 is my number
 
2013-03-04 05:55:38 AM  

The more you eat the more you fart: vrax: The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: Because a licensed nurse has no obligation to accept any "order" of a medical nature from some random UNlicensed 911 dispatcher.

The sad fact: the nurse complied with the standard of care for the facility she was in.

Dispatchers are nationally certified, and often licensed at the state level to work in 911 centers. In addition, they work under standing medical orders through the Priority Dispatch system.

The fact of the matter is that CPR is considered a basic "standard of care", and requires no verbal or medical orders to perform. The only reason NOT to perform CPR is if the woman had a sign of death like decomp, had injuries obviously incompatible with life, or had a signed medical order known as a Do Not Resuscitate Order.

/Tennessee EMD #495. Kept it even after getting my Paramedic to say I had one of the original ones.

Or the nurse, a licensed medical professional who has faaar more working knowledge than a dispatcher, decided that it was inappropriate, or the facility's policy met the standard of care.

Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

This was not a medical decision.  This was purely a case of not wanting to take responsibility for anything.  Must have been fun watching the lady gasp for breath while standing there.  This "nurse" needs a farkin' falcon punch for the "I'm feeling stressed..." line.  OMFG!  Quit your job you useless piece of shiat!

Walk a mile...


I would, but I might get hurt or something.  Why take the chance?  Better to do nothing.
 
2013-03-04 05:58:50 AM  

The more you eat the more you fart: hardinparamedic: BatmanX: drxym: That's utterly disgraceful behaviour. Most countries have laws that cover a duty of care. If you call 911 and they tell you to start doing CPR NOW and you refuse, you should be held accountable under law. Death is a foreseeable consequence of refusing to perform CPR and this nurse and whoever else was there should be prosecuted. And as a nurse she should hang her head in shame. She has failed in her profession and should be thrown out on her ass.

Well, there is also no mention if there was a DNR/DNI on file.
Doesn't matter either way, but sadly there are cases of people gettign sued for doing CPR.....go figure....

Per the AHA 2010 BLS instructor book, no person has ever been successfully sued for providing CPR on a patient who needed it.

They have for failing to provide it.

Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....


Were they PERSONALLY sued, or was the facility sued for not making sure that the staff had proper awareness of the patient's requests and rights?
HUGE difference there.

Not that I'm not sympathetic or shiatting on the ppl you know...but it's a big big difference. The lawsuits I've seen regarding such have always been against the facility (though doctors and nurses are often named, they're not liable personally, just professionally. Doctors have malpractice insurance and generally the facility is liable for any *lawful* behavior of their staff. As long as they weren't acting outside the scope of their job or outside of 'standard of care' etc. Personal liability comes when they do something outside the scope, like sticking their dick into a patient.
 
2013-03-04 05:59:41 AM  

pedobearapproved: Medic Zero: 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.

Welcome to America. I'm sure the free market will sort it out eventually.

Because in the non-free market there aren't any rules and procedures that must be followed to a T? The same government that won't let you cut a tree blocking your driveway until an environmental review has been completed is the same type of regulation that a nurse in an old folks home might be under from her evil free market people.

I watched people from NASA install the wrong parts on non-flight critical systems because independent thinking will get you written up and sometimes fired. The check-list is there for a reason, and so is your brain. The answer is the woman should have helped as a human and if she'd been fired the outrage would have been against her employer.


Oh yeah, this in spades.

I've already related the sorry tale of my paramedic friend who got a write-up and 10-day suspension for saving a guy's life at Disneyland because he went way way waaaayy outside the chain of command and commandeered an AED and an ambulance crew he--gasp!--wasn't "signed off on" to use (and told the nurse off, btw, because he was a grade-A asshole). The issue becomes whether you as a human being can live with yourself saying "Yes, it's sad that the person died, but I was only following orders."

There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.
 
2013-03-04 06:07:37 AM  
So, a trained medical professional tells a phone jockey that she knows what is better for the patient, and the local media blows it out of proportion because, like the phone jockey, they think CPR is a magic wand.

Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.
 
GBB
2013-03-04 06:20:46 AM  

Gyrfalcon: There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.


I have a more condensed version of this I tell my trainees:

The difference between a bad dispatcher and a good dispatcher: knowing and following policies and procedures.
The difference between a good dispatcher and a great dispatcher: knowing when to ignore policies and procedures and actually help someone.
When a bad dispatcher screws up: more training.
When a great dispatcher screws up: under the bus.
How to keep your job: don't get caught screwing up trying to be a great dispatcher or fake being a bad dispatcher.

/ok, maybe not that condensed.
 
2013-03-04 06:21:17 AM  

The more you eat the more you fart: In my experience


The more you eat the more you fart: The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it.


Well, I'd certainly trust your experience completely. :\
 
2013-03-04 06:21:53 AM  

Gyrfalcon: pedobearapproved: Medic Zero: 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.

Welcome to America. I'm sure the free market will sort it out eventually.

Because in the non-free market there aren't any rules and procedures that must be followed to a T? The same government that won't let you cut a tree blocking your driveway until an environmental review has been completed is the same type of regulation that a nurse in an old folks home might be under from her evil free market people.

I watched people from NASA install the wrong parts on non-flight critical systems because independent thinking will get you written up and sometimes fired. The check-list is there for a reason, and so is your brain. The answer is the woman should have helped as a human and if she'd been fired the outrage would have been against her employer.

Oh yeah, this in spades.

I've already related the sorry tale of my paramedic friend who got a write-up and 10-day suspension for saving a guy's life at Disneyland because he went way way waaaayy outside the chain of command and commandeered an AED and an ambulance crew he--gasp!--wasn't "signed off on" to use (and told the nurse off, btw, because he was a grade-A asshole). The issue becomes whether you as a human being can live with yourself saying "Yes, it's sad that the person died, but I was only following orders."

There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.


And the nurse shouldnt worry about being fired, sued, etc right?

Because she can at least say she tried....while standing in the food stamp line trying to feed her kids bc she was fired then turned over to the State Board for failing to follow the company's policy on the standard of care.


Thats what i think MOST of you just are NOT understanding. This nurse KNEW that no matter what she did, she was farked...so she chose the path that had the least chance of her ending up fired and unable to provide for herself and her family.

/one of the FEW professions where LITERALLY everyone is out to get you
 
2013-03-04 06:22:42 AM  

starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.


I don't think you need to worry.  You're obviously already brain dead.
 
2013-03-04 06:23:15 AM  

GBB: Gyrfalcon: There are times to follow orders, of course, and times not to; and blindly obeying the workplace regulations may sometimes be necessary. But if you really can go to bed at night comfortably assuring yourself you've done the right thing by allowing someone to die when you could have saved them BUT IT WAS POLICY NOT TO, then people need to stop blaming the Germans for letting the Holocaust happen.

I have a more condensed version of this I tell my trainees:

The difference between a bad dispatcher and a good dispatcher: knowing and following policies and procedures.
The difference between a good dispatcher and a great dispatcher: knowing when to ignore policies and procedures and actually help someone.
When a bad dispatcher screws up: more training.
When a great dispatcher screws up: under the bus.
How to keep your job: don't get caught screwing up trying to be a great dispatcher or fake being a bad dispatcher.

/ok, maybe not that condensed.


Pretty accurate I'd say
 
2013-03-04 06:25:02 AM  

Relatively Obscure: The more you eat the more you fart: In my experience

The more you eat the more you fart: The person is already dead..you cant make them MORE dead by not doing cpr....but you CAN bring a braindead person back with it.

Well, I'd certainly trust your experience completely. :\


Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.
 
2013-03-04 06:39:21 AM  

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


Perhaps you could rtfa and see that she didn't have a dnr, which at her age is no accident, she wanted to be saved.
 
2013-03-04 06:41:52 AM  
So, putting gramma in an apartment downtown is better than this place.  At least downtown someone might help.
I hope this place goes out of business quick.
 
2013-03-04 06:46:22 AM  

The Envoy: starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.

I don't think you need to worry.  You're obviously already brain dead.


Like to explain why, or are you just picking a name at random to troll?
 
2013-03-04 06:52:32 AM  
Abacus9:
Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.

I guess you get used to it, I really never expected to have to use the training. But so far, three arrests and a Heimlich under my belt. The Heimlich was the most gratifying in that I popped that chunk of food about 4 feet when I hit the right spot, and the guy was immediately better. The CPR episodes were more like and 15 and 16 and (crack) oh my god and 18 and 19 (crack) jesus palomino and 21 and...

Of course, when the guys got there and relieved me it was "well, he was dead anyway" but still, it's sort of stressful to do to someone you aren't mad at.

The really odd thing was the bystanders, you get the wildest suggestions. "Here, stick this candy in his mouth!" Well, no, I'm pretty sure this isn't hypoglycemia...
 
2013-03-04 06:54:21 AM  

starsrift: Like to explain why, or are you just picking a name at random to troll?


 Probably because you have no clue what the FARK you're talking about.

starsrift: So, a trained medical professional tells a phone jockey that she knows what is better for the patient, and the local media blows it out of proportion because, like the phone jockey, they think CPR is a magic wand.


 Dispatchers  ARE trained medical professionals if they are giving pre-arrival instructions, like CPR. The Priority Dispatch system is not allowed, by the corporation's own words as well as the laws of most states, to be used by someone who is not, at the very least, a Certified Emergency Medical Dispatcher, and many dispatchers are at least trained to the EMT-Basic level in a 911 system. (It's actually very common to see EMTs and Paramedics in dispatch centers who have sustained field-career ending injuries.) In addition, this is not a "phone jockey thinking CPR is a magic wand", it's a dispatcher following the EMD protocol system. You see, dispatchers are NOT allowed to give medical advice outside of the protocol sets. In reality, what lead him to instruct the nurse on administering CPR was the Priority EMD system identified, based on the information the nurse HERSELF gave the dispatcher, that the patient was likely in cardiac arrest.  That system of protocols is signed off on by the 911 system's  Medical Director, and the entire EMD protocol set is evidence based and has been backed successfully in court multiple times.

starsrift: Well, I know a whole bunch of farkers in this thread I never want to pass out next to, in case they decide to start CPR on my breathing unconscious self.


Well, good news. If you pass out, according to the 2010 AHA Heartsaver BLS guidelines, someone will start hands-only CPR on you if you have signs of ineffective respirations, and poor circulation.

Laypeople aren't taught to check for pulses.

Also, you keep using that word "breathing". Define Agonal Respiration. Do you know how to recognize it?

The fact that this patient was in full cardiac arrest when the Paramedic team arrived tells me that it wasn't "effective' respiration.
 
2013-03-04 06:56:29 AM  

octopied: Perhaps the patients there have DNR orders.


Want to know how I know you didn't RTFA?
 
2013-03-04 07:00:07 AM  

The more you eat the more you fart: Incorrect. I know three nurses who were sued for performing cpr on a patient with a dnr.

Only...they were unaware of the dnr thanks to hipaa law...they saw it happen, gave cpr, then were later told they SHOULD have checked first.

And ppl wonder why the nurse in this article played CYA....


I'm calling shenanigans on you. First off, HIPAA does not prevent providers from knowing patient information who are involved in the direct care of that patient. Secondly, you're presenting a vague situation which turned into a legal case without knowing all the facts. Chances are they were not sued for performing CPR, but rather for performing heroic measures in violation of that patient's legal wishes. The proper thing to do is to perform CPR, and then once a DNR is in hand and known to be valid, to stop all resuscitative measures.

I've had to code people with a DNR before, because the family didn't have the paperwork to prove it, or because they wished the DNR ignored.

In addition to this, again, NO ONE has been successfully sued, according to the  American Heart Association for performing CPR when it was indicated. If you have an actual case where this has occured, please cite it. I would be very interested to bring this to the attention of my fellow AHA Instructors.
 
2013-03-04 07:06:41 AM  
As a RN, I find this story absolutely appalling.  Any nurse working in a patient care facility is required to maintain BLS certification (Basic Life Support) which is nothing more than providing the basics; obtaining an airway, providing breaths and giving chest compressions; quite similar to the CPR given to non-healthcare workers but with a few minor differences and tweaks.  BLS for healthcare providers (at least in most states/institutions/healthcare settings) also includes training and certification with an AED (Automated External Defibrillator). They are commonplace in healthcare and non-healthcare settings alike (even airports, universities, coffee shops, car dealerships, etc have them readily available for use for instances such as this). I can't imagine that a nursing home with would be without one, in fact I believe that they are required to have at least one functional machine at all times. The AED has a picture of where to place the two pads, automatically checks the heart rhythm to see if the patient requires shocking, and if required, delivers the shocks automatically at the correct time and and sequence under BLS guidelines, it even tells you when to start/stop CPR!  This machine is so simple to operate that my 5 year old son could use it properly with a near zero percent chance of screwing it up!  I find it absurd that a nursing home could have a protocol to withhold basic life support from patients who request to be full code (wanting CPR performed).  Code status options are reviewed and decided by the patient upon admission to ANY nursing home, that information is relayed to all staff and is required to be carried out in the event of the patient requiring CPR.  If it is the patient's wish to be "full code" and have CPR administered, every attempt to resuscitate the patient should be carried out by all available staff regardless of the nursing home's protocol of which I'm sure would not hold up to the state's standards of practice.  It sickens me to the point of projectile vomiting that there were several licensed and trained healthcare providers whose job it was to carry out whatever life saving measures the patient requested during the admission process and that all of these "professionals" were quite comfortable not performing CPR, watching someone die, merely calling 911, when the patient needed them the most. The inadequate response rendered to this patient wasted precious minutes to intervene when seconds count.  While their actions (or should I say in-action) were required by the protocol of the nursing home; I imagine that should an investigation by the state board of nursing and/or senior services would be launched, numerous violations to the states nurse practice act will have been found violated.  Hopefully, action will be taken by the board to ensure that these people will never again be placed in a position of trust to care for patients and have their licenses revoked. They had duty to act, they breached that duty; they deviated from the appropriate standards of care for their patient, which potentially led to her death.  Had they acted in a prudent and timely manner, within their expected scope of practice as trained professionals, this may have led to saving someone's life.  Instead, multiple people failed to act in a prudent manner as professional nurses, failed to act within their scope of practice and led to a patient death that may have been avoidable.
 
2013-03-04 07:06:58 AM  

starsrift: Like to explain why, or are you just picking a name at random to troll?


I see it's been covered for me.  But to clarify, my comment is based on you making a statement that has been discussed and shown to be wrong throughout TFT.  There are links and everything.
 
2013-03-04 07:08:19 AM  

The more you eat the more you fart: And the nurse shouldnt worry about being fired, sued, etc right?


Depending on what state she's in, firing a nurse for performing CPR when indicated, and providing resuscitative measures would qualify as wrongful termination. In addition, at least she would be keeping her license when the state nursing board found out about this.

Chances are, if this nurse avoids a lawsuit on her and the facility for failure to act within the expected standard of care, she's going to lose her nursing license.

The more you eat the more you fart: Because she can at least say she tried....while standing in the food stamp line trying to feed her kids bc she was fired then turned over to the State Board for failing to follow the company's policy on the standard of care.


That "facility policy" will not protect her when she goes before the State Board and has to explain why she acted with willful negligence and with wanton disregard for her duty to act. A facility CANNOT mandate you cannot perform CPR when it is indicated. The only time, by law, CPR can be withheld by a medical professional without an MD order is if a DNR is in place and valid at the time of the cardiac arrest, AND the family is not telling you to disregard it.

The more you eat the more you fart: Thats what i think MOST of you just are NOT understanding. This nurse KNEW that no matter what she did, she was farked...so she chose the path that had the least chance of her ending up fired and unable to provide for herself and her family.

/one of the FEW professions where LITERALLY everyone is out to get you


No. She committed the basic definition of malpractice and negligence, and her failure to act is the most probable reason a peri-arrest situation degraded into a full code by the time EMS arrived on scene.

And nursing homes and assisted living facilities are not known for hiring the "cream of the crop" of nurses. Elder care is NOT something that most nurses go into willingly.
 
2013-03-04 07:09:53 AM  

hardinparamedic: Well, good news. If you pass out, according to the 2010 AHA Heartsaver BLS guidelines, someone will start hands-only CPR on you if you have signs of ineffective respirations, and poor circulation.


...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.

The fact that this patient was in full cardiac arrest when the Paramedic team arrived tells me that it wasn't "effective' respiration.

Oh, was she in full cardiac arrest? I followed a couple of the other links in this thread, I never saw this mentioned. Link?
 
2013-03-04 07:15:10 AM  

Lehk: Acravius: Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.

good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best


It depends on which state you are in.  Here Good Samaritan Laws cover any medical professional trying their best in a situation in which they are out of their element.
 
2013-03-04 07:16:21 AM  

starsrift: ...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.


I'm drinking in the irony of this comment.

"I wasn't there, but I'll make insulting and informed statements about 911 dispatchers, and I'll defend a nurse who refused to act according to the basic standard of care. But you weren't there, how dare you question them!"

You're defending an indefensible act.

starsrift: Oh, was she in full cardiac arrest? I followed a couple of the other links in this thread, I never saw this mentioned. Link?


You're being obtuse now. Clearly, she died of that EMS crew's transport.

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead.

Read more:  http://www.foxnews.com/us/2013/03/02/elderly-woman-dies-in-california - after-nurse-refuses-to-do-cpr/#ixzz2MZZ8w7lR
 
2013-03-04 07:18:00 AM  
Ahem. "uninformed". Fsck you, autocorrect.

lyanna96: It depends on which state you are in.  Here Good Samaritan Laws cover any medical professional trying their best in a situation in which they are out of their element.


No good Samaritan laws protect medical providers while they are on the clock, as there is a legal and ethical duty to act, and an expectation for them to provide the basic standards of care of their respective license levels. Those that do protect them when they render aid off duty.
 
2013-03-04 07:26:39 AM  

starsrift: Like to explain why, or are you just picking a name at random to troll?


I'd like to add - sorry for being a dick about it.  I could have just said that others have covered it and that didn't seem to be the case.  Someone's got a case of the Mondays.  It's not an excuse, so apologies again for being a dick for no good reason.
 
2013-03-04 07:28:03 AM  

Fell In Love With a Chair: and even laypeople should give it a shot.


Yes, yes they should.  In it's currently taught form it's been stripped down to make it as un ambiguous as possible specifically so that lay people will just start doing it rather than hmmming and hawing over how many ribs they'll break.
 
2013-03-04 07:38:07 AM  

starsrift: ...And according to the nurse at the scene, the patient was breathing. Agonal respiration? Well, maybe you're right and the woman was gasping her last in the middle of the dining area. But, like the 911 operator, neither you nor I were there. The nurse was.


I'd like to add, for anecdotal experience, that I have worked some pure incompetence-related events in nursing homes. The last one, the call came in as "altered mental status" and fall. The patient was rolled to the dining hall in the exact same position he had been dressed by the CNA in that morning, and then appeared to be asleep during the meal. The LPN told the CNA that was normal for him, and that they had called the family in to discuss making him a DNR that day. The CNA couldn't get him to eat, and rolled him back to his room. Family comes in, find Pop not breathing, and has the nurse call 911. First Responding Fire crews start CPR, when we roll up, his jaw is already starting to rigor and stiffen, and he's cold as the room he's in.

MD at the pronouncing hospital thinks he's been dead for at least four to six hours.
 
2013-03-04 07:44:24 AM  

hardinparamedic: You're being obtuse now. Clearly, she died of that EMS crew's transport.

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead (Link to FOXnews).


Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".


The Envoy: I'd like to add - sorry...


Not at all, we're all dicks on the internet.
 
2013-03-04 07:45:31 AM  
Thank God for nurses, oh, wait.....
um, code of ethics, damn...
basic humanity?,
nope.

see you in hell

Nurse Ratched ha
 
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