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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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23483 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 07:47:07 AM

starsrift: 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".


I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.
 
2013-03-04 07:54:59 AM

hardinparamedic: starsrift: 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".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.


Not at all. I don't disrespect dispatchers, and certainly not EMT's, but I am - generally speaking - more inclined to trust a nurse in situ than a non-practicing certified person who isn't there. Even when senior's homes have a reputation for bad staff. :/
 
2013-03-04 08:06:03 AM
The more you eat the more you fart:  /one of the FEW professions where LITERALLY everyone is out to get you

This.
Patients, families, strangers, other nurses, doctors., especially online couch medics... EVERYONE!!  Quick to wharrgarbl manufactured media outrage, slow to figure out what the facts actually are, too damn stubborn to admit it when they find out they were wrong.

I don't do my job for the money like someone above posted.  If I did, I'd pick a much easier job to do for the same money!  I couldn't go to one of those desk type of nursing jobs until my every joint and limb quit on me and then I'll do telephone nursing till the day I'm forcibly removed.

I'm really pissed that people are passing judgment on someone who was probably NOT a nurse on the phone but a CNA or less.   No one here knows what happened other than shallow breathing and died at the hospital, so how do you even know if she did right or wrong?  The family is happy that they did what they could do.

MDs, nurses, EMS, fire dept...  we do our best every day to save your farkin asses so you have the ability to tell us what greedy pieces of shiat you think we are.

You're welcome.

/I love my job
//fark all of you
 
2013-03-04 08:07:03 AM
The more you eat the more you fart:
Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

Remember the cruise ship that sank in Italy, some time ago? And remember how the Coast Guard was on the radio telling the Captain to return back on the ship?

I don't know what rank the CG on the radio had. But it's possible that it was lower than a Captain, and either way he wasn't there, in the middle of it. Yet, the CG on the radio had charge of the situation.

When you call 911, the dispatcher takes charge of the rescue. Just like when you call for Coast Guard's help, they take charge of the rescue. This continues until they expressly give up the command to someone else.
 
2013-03-04 08:27:39 AM

hardinparamedic: starsrift: 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".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.


Meh. When we were trying to get mom into an assisted-living facility, no-CPR clauses were universal.

Also on the train that the "nurse" was probably an unlicensed caregiver. It's an assisted living facility. The only nurses on staff are probably the DON/ADON who fills out paperwork in an office and takes call from home.
 
2013-03-04 08:36:01 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.


Ummmm..... if you think nurses are getting rich I am going to assume you have never actually known one.
 
2013-03-04 08:36:04 AM

Abacus9: Lady Indica: To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).

Oddly, "Another One Bites The Dust" also works (roughly the same beats per minute)...


But its not nearly as optimistic...
 
2013-03-04 08:37:39 AM

Medic Zero: 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.

Gee thanks! Got any racism to go with your broad brush?


Sure! White nurses are more squeamish than non-white nurses. Whitey's afraid of cooties.

Feel better, now?
 
2013-03-04 08:39:51 AM

SpectroBoy: 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.

Ummmm..... if you think nurses are getting rich I am going to assume you have never actually known one.


There's a difference between "rich" and "lots of money."  Nurses make more than the average retail or service industry worker and most of them chose the career because of that fact.

Yes, it's a generality, but it's becoming more and more true as the years go on. Medicine isn't a calling anymore; It's a career path.
 
2013-03-04 08:41:13 AM
That is so farked up.

Nope, not gonna break the rules. I would rather watch this old woman gasp for air and die like a fish on the beach. Rules are rules.

Fortunately this biatch's life is about to become as miserable as she deserves.
 
2013-03-04 08:44:45 AM

lyanna96: The more you eat the more you fart:  /one of the FEW professions where LITERALLY everyone is out to get you

This.
Patients, families, strangers, other nurses, doctors., especially online couch medics... EVERYONE!!  Quick to wharrgarbl manufactured media outrage, slow to figure out what the facts actually are, too damn stubborn to admit it when they find out they were wrong.

I don't do my job for the money like someone above posted.  If I did, I'd pick a much easier job to do for the same money!  I couldn't go to one of those desk type of nursing jobs until my every joint and limb quit on me and then I'll do telephone nursing till the day I'm forcibly removed.

I'm really pissed that people are passing judgment on someone who was probably NOT a nurse on the phone but a CNA or less.   No one here knows what happened other than shallow breathing and died at the hospital, so how do you even know if she did right or wrong?  The family is happy that they did what they could do.

MDs, nurses, EMS, fire dept...  we do our best every day to save your farkin asses so you have the ability to tell us what greedy pieces of shiat you think we are.

You're welcome.

/I love my job
//fark all of you


Also people tarring RNs, RPNs, HCAs and PSWs with the same brush. They're all profoundly hard jobs that a lot of people just plain vanilla can not do, but here come these poor bastards with expertise and equipment in hand to make you slightly less miserable while your dignity is out of commission. They should not be able to walk down the street without a high-five free coffee blowjob and a doughnut but instead we treat them like the handle on the malpractice slot machine.
 
2013-03-04 08:49:05 AM

nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?


If my mother was 87, yes.  Even if she was 80.  If I make it to be that old I'll have DNR paperwork filled out as well.  All four of my grandparents made it to 80, and all of them filled out DNR orders at about that time.  My parents have expressed that they will do the same and that they don't want their family to go through years of watching them sit in bed, half coherent, pumped up with drugs, and spending any half-lucid time they have staring out the window wondering when someone will visit.  I don't believe in keeping people clinging to life just to keep them around, especially when there isn't much time left anyway and what little time there is will basically be spent in bed waiting to die.

And like I said in my post, if I'm someone that should still have some quality time on the clock I hope someone will try to keep me around.  If I'm 87 and living in a home, just let me go.  I had a great-aunt that didn't take that path.  She had a stroke and went full-code.  They managed to bring her back, then she spent the next several years being spoonfed, needing someone to move her every couple hours so she didn't get bedsores, shiatting and pissing in a bag, not knowing who any of us were, asking where her mother was, then if we told her that her mother had died (30 years ago) it was like she was just finding out for the first time, so we decided we'd just lie and say she was out getting groceries or something.  It was heartbreaking, especially for her kids.  I don't want to do that to my family, and I'd rather their good memories of me aren't tarnished and overwritten with years of that awful shiat.
 
2013-03-04 08:54:50 AM

Bumblefark: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

...and then, some families are a bit to eager to be done with the person that has become an inconvenience.

It cuts both ways. Which is why I intend to check myself out, before that decision has to fall to anybody else...

/Brave words, for somebody not on their death bed.


Story time...not related to TFA but related to the notion of clinging to a dying parent for one's own sake
rather than the parent's:

My dad was diagnosed with stage 4 esophageal cancer that had metastized just before Christmas 2005.
I went to visit him a month or two later (he was living in TN, I'm in FL) and made him swear to me that he
would not give up or quit fighting. An understandable reaction on my part - I didn't want to lose my dad if
there was even another day left in him.

Flash forward another 5 months. My mother (she and my dad had been separated until he got sick) had
moved down to TN to be with my dad at his parents place. They have a home on a lake and being on
the water was my dad's favorite place to be. So hospice set him up in the living room overlooking the
water. So, I get the phone call that it could be any day now and I needed to get up there. I tell my dad
that I'm coming and to hang on. I hopped on a greyhound and made the trip.

He went downhill fast once I got there. He went from being able to carry on a short, breathy conversation
to not being able to talk at all inside of a couple of hours. I was sitting with him in the middle of the night
and it hit me how selfish I'd been, demanding that he hang on when he was obviously miserable and in
agony. He seemed to know that I had something I needed to tell him, because he woke up just then.

I told him that I know I had made him promise not to stop fighting but that I'd been wrong to demand that
of him and that sometimes there does come a point where you've fought long enough and hard enough
and that its ok to stop fighting and rest. I never said "give up" or anything like that. i just told him that i
know how hard he fought and how much he hurt. i told him that i loved him and that it was OK to rest.

The next day, surrounded by family and friends, with old Redskins games on the TV and great music on
the stereo, he passed away. One moment he was there and we were all going about our conversations
and the next moment everyone in the room looked up like a shadow had passed overhead. We looked
at my mom who was sitting next to my dad and knew that he'd gone.

My dad loved me unreservedly even though he didn't have to (he is my mom's second husband) and
even though I was a complete shiat to him as a kid at times. He is the one who made music such a
critical part of my life, who made sure that i'd never be stranded on the side of a dark road with a flat
tire just because I was a girl. He was mom AND dad to me when my mom was too sick to be functional.

God I miss my dad.
 
2013-03-04 09:17:00 AM

HectorSchwartz: 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".

This.  They still call 911 because it's a helluva lot easier when they die in a hospital.  Most of those poor old farts have been circling the drain for years and are quite ready to go.

/ my mom has a DNR, for example.
/ I have pretty specific instructions in a living will, and all you you should think about it if you don't already have one...


Read the article much?
 
2013-03-04 09:20:54 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".


You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.
 
2013-03-04 09:27:31 AM

RubberBabyBuggyBumpers: You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.


Wat.

No, a DNR has everything to do with CPR. Tennessee's POST (physicians orders for scope of treatment) has, as it's first selectable section: CPR or NO CPR. This leads to zany DNR combinations in my state, like "Give Resuscitation drugs" and "Intubate" but NO CPR.

You're thinking of advanced directives, or a living will.
 
2013-03-04 09:39:45 AM

RubberBabyBuggyBumpers: 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".

You are misinformed. A DNR order has nothing to do with CPR. It specifies against using extraordinary means such as defibrillation and artificial ventilators.


Nope. "Do Not Resusitate" means just that. If a facility has a different definition for DNR, it needs to be spelled out. Most facilities have "care directives" in place that granny and/or the family agree to.
Usually 3 or 4 level directives ranging from 911 CPR  to comfort measures only.
 
2013-03-04 09:53:53 AM
http://dmanager.streamtheworld.com/media/default_audio_player.php?aud i o_file_id=102204171

Here is the full 911 call. I agree with the operator hearing the full call in context.
 
2013-03-04 10:01:21 AM
DNR means no compressions, no edison medicine. Period.
 
2013-03-04 10:04:06 AM
Everyone, except the medical personnel and family who have posted here, and have not been through anything like this "end of life situation", are talking through their hats.
Prepare for your own "end of life" situations by having open and concise conversations with your spouse, parent, or loved one before you are there.
The lady in the article, along with her daughter, were no doubt aware of the "care directives" in place at the facility when mom went in there, and would have agreed to it.
The media and armchair experts love this kind of shiat, especially when it sounds "callous" or uncaring from the facilities standpoint.
This happens everyday, everywhere.
You will be in this end of life position at some point in your life. Prepare for it.
 
2013-03-04 10:15:42 AM
Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation
 
2013-03-04 10:16:01 AM

RandomRandom: Relatively Obscure: None of that being relevant to why this particular person did what they did.

If the reporting is accurate - the only relevant issue is that the 911 dispatcher should never have told the nurse to start CPR on a person who was still breathing.

If the reporting isn't accurate and the patient wasn't breathing, the nurse still shouldn't have performed CPR, because it rarely works on healthy young people, let alone nursing home patients.


No.

First. CPR is indicated with severely abnomal respirations, such as agonal breaths. Suppose she was breathing 4 times a minute. That's not good, and at the very least, her breathing should have been assisted.

Second. The patient certainly had the right to have a DNR if she chose. The article said she did not have a DNR. Believe it or not, you don't get to decide other people's healthcare. It isn't up to you, the ambulance staff or anyone other than than the patient to say "CPR is a low-percentage play, so let's forget it." The only one who gets to decide if she gets CPR is herself, and she does it in advance by having DNR paperwork ready.

Third. CPR doesn't "work" on anyone, as in it doesn't restart hearts. Recipients of CPR don't cough and sit up after a 20 tense seconds of it, Baywatch-style. It is a stop-gap effort to delay tissue death long enough to attempt other interventions, such as defibrilation and administration of cardiac drugs.

Lastly, the effectiveness of CPR goes through the roof under certain conditions. A witnessed arrest with early CPR and defibrilation gets circulation back 75% of the time and a survival rate of over 20%.
 
2013-03-04 10:16:13 AM
Dumski:
Prepare for your own "end of life" situations by having open and concise conversations with your spouse, parent, or loved one before you are there.


Does it have to be concise? Can I at least ask them how their day was first?
 
2013-03-04 10:16:22 AM
Bleh, sorry, that didn't copy over at all :-/
 
2013-03-04 10:43:19 AM

seniorgato: Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation


It also depends on what area of the United States you're in, and millions of other factors. Google "2010 AHA Guidelines Circulation" and there's a 100+ page document which outlines the science behind the guidelines.

/sorry for sporatic typing. Posting between tubing kids for biannual surgical intubation competencies. -.-
 
2013-03-04 10:49:50 AM

hardinparamedic: seniorgato: Just for kicks I went and tried to look up that 3% claim.
Not that I didn't believe it, just that I figured there had to be more to it.


Type of ArrestSurvivalSourceWitnessed In-Hospital Cardiac Arrest48%22%Unwitnessed In-Hospital Cardiac Arrest21%1%Bystander Cardiocerebral Resuscitation40%6%Bystander Cardiopulmonary Resuscitation40%4%No Bystander CPR (Ambulance CPR)15%2%Defibrillation within 3-5 minutes74%30%As I figured, it's more complicated than even this graph.  Training plays a huge factor too.  Well anyway...
http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

It also depends on what area of the United States you're in, and millions of other factors. Google "2010 AHA Guidelines Circulation" and there's a 100+ page document which outlines the science behind the guidelines.

/sorry for sporatic typing. Posting between tubing kids for biannual surgical intubation competencies. -.-


You really shouldn't be talking about tubing kids on a public forum, perv :-P
 
2013-03-04 10:53:18 AM
Thanks, Obama!!
 
2013-03-04 11:13:46 AM

Coming on a Bicycle: Yeah. CPR has a lifesaving potential of about 5%. That's because it's mostly applied to very old people in hospital-like situations who are about to die anyway.


CPR only has the possibility of saving your life if the problem that stopped your heart in the first place is fixable.  Usually it isn't.
 
2013-03-04 11:13:55 AM
nmemkha:

 [Y]our(sic) not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.


If letting my mother go was called for I'd have no problem with it. Why cave in her fragile ribs and maybe leave her brain damaged from lack of oxygen? She's miserable enough already.

That remind me, I've got to update my Final Directive to make it VERY clear they should "Just let me die damn you!"

How many languages should I have "Do Not Resuscitate" tattooed on my chest in? English, Spanish and Chinese sound obvious, but there should be no doubt.
 
2013-03-04 11:17:57 AM

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.


and the rate of compressions is changing too.... but have not seen the newer guidelines in a while and cant remember what it is.
 
2013-03-04 11:26:57 AM

hardinparamedic: 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 Instructor.


Call your shenanigans.  HIPAA states that unless you are directly involved with the care of a particular patient, you are not allowed to look through their charts, etc.

If a nurse working the same facility sees a patient fall out, and starts CPR, unless that particular patient is a patients of his or hers, there is no way he or she would know.

So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about.  Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.
 
2013-03-04 11:34:43 AM

hardinparamedic: 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


So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.

So...like I was saying earlier...you dont know.  You weren't there, I wasn't there, the 911 dispatcher was not there.

Sounds like the nurse acted appropriately to me now...before I was questionable..but considering the patients was clearly alive during transport and even after arriving at the hospital.
 
2013-03-04 11:36:04 AM

Relatively Obscure: WhoGAS: You don't do breaths any more.

That isn't true everywhere.


Back when I took my CPR training that's what they told me too. It is better to keep the blood circulating with depleted oxygen than to stop CPR to try and put more oxygen in the lungs (which is a questionable attempt if the heart isn't beating well already). The blood still has oxygen in it, so just keep it moving.

/that was a few years ago
 
2013-03-04 11:39:32 AM

finnished: The more you eat the more you fart:
Regardless, no nurse is gonna get in trouble for refusing an "order" given by someone less qualified than her to make medical decisions.

Remember the cruise ship that sank in Italy, some time ago? And remember how the Coast Guard was on the radio telling the Captain to return back on the ship?

I don't know what rank the CG on the radio had. But it's possible that it was lower than a Captain, and either way he wasn't there, in the middle of it. Yet, the CG on the radio had charge of the situation.

When you call 911, the dispatcher takes charge of the rescue. Just like when you call for Coast Guard's help, they take charge of the rescue. This continues until they expressly give up the command to someone else.


Sorry...you are incorrect.
 
2013-03-04 11:41:18 AM

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.


It's 5 compressions, then breath. 30 compressions then a breath would leave a person without a heart compression to pass the oxygen into the bloodstream and thus leaving the person dead from asphyxiation to the cells of the body that needed them or at the very least Hypoxia. Time to brush up on your CPR Training. This is why during training, that is exactly what they teach you, be it a baby or an elderly person or anyone in between. You have to think about what a person does while maintaining their own live support. Try not breathing 30 times at one sitting and see what happens. Doesn't feel very good nor does it feel natural or appropriate.
 
2013-03-04 11:55:06 AM

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.


/looks like someone got paid.
 
2013-03-04 12:02:08 PM
How disturbing.   In other places they have enacted laws where it is a crime to do nothing.
 
2013-03-04 12:09:23 PM

The more you eat the more you fart: Sorry...you are incorrect.


Actually, he's quite correct for out-of-hospital emergencies which turn into a Pre-Arrival Instruction Protocol, like Childbirth, Suspected MI or Cardiac Arrest. Those protocols are considered to be medical orders, given by a proxy acting under the physician. You're  more than welcome not to follow them, especially if you are a trained healthcare provider, but you are given no legal protection if you cannot justify why you did not to a reasonable man standard.

I.e. "I didn't give him asprin because he has a history of bleeding ulcers, I didn't give CPR because his head was cut off"

Priority Dispatch has it's own special card for interfacility transfers where an MD is directly involved in the patient's care that do not lead into the pre-arrival protocols.

Example: If you refuse to follow the instructions for childbirth, and that patient suffers a birth anoxic brain injury because of your actions, you're held responsible for that. Especially if you're a healthcare provider.

The more you eat the more you fart: Call your shenanigans.  HIPAA states that unless you are directly involved with the care of a particular patient, you are not allowed to look through their charts, etc.


And administering CPR is not being directly involved in a patient's care? And actually, there are very specific exceptions to that rule pertaining to emergency situations as well as QA/QI and auditing, as well as legally mandated release of PHI. At any rate, there are more jailhouse lawyers who don't know as much as they think about HIPAA.

I've had emergency runs where trained nurses have refused to allow the crew to know the allergies, medication history, or medical history of a nursing home patient because of HIPAA. All of which are legally allowed disclosures.

The more you eat the more you fart: So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.


Actually, according to the story that is making rounds on the Nursing and Paramedic Facebook groups, she was pronounced AT the hospital. Not dying later.

You'll forgive me for believing them.

Also:

The nurse asked for paramedics to come and help the 87-year-old woman who had collapsed in the facility and was barely breathing.  The woman was later declared dead at Mercy Southwest Hospital.

An elderly woman being cared for at a California retirement facility died following the refusal of a nurse at the facility to perform CPR on the woman after she collapsed, authorities said.
 
Collapse with ineffective or questionable breathing leads into the Questionable Life Status - CPR protocol on Priority Dispatch.

The more you eat the more you fart: So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about.  Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.


Considering I work in a regional pediatric level 1 Trauma Center for a Pediatric Flight Team, I'd think I know a little about HIPAA. I also spent two years working as a CNA in a LTC facility while going to EMT school.

I have horror stories of LTC centers I could set down all day and tell you.

LTC nurses are not the cream of the crop. They're not even the bottom of the barrel. They're there because they either can't get a job somewhere else, are getting job experience to go to a higher acuity level of care, or maybe 1 in 100 actually WANT to work in Elder Care.

CutBoard: It's 5 compressions, then breath. 30 compressions then a breath would leave a person without a heart compression to pass the oxygen into the bloodstream and thus leaving the person dead from asphyxiation to the cells of the body that needed them or at the very least Hypoxia. Time to brush up on your CPR Training. This is why during training, that is exactly what they teach you, be it a baby or an elderly person or anyone in between. You have to think about what a person does while maintaining their own live support. Try not breathing 30 times at one sitting and see what happens. Doesn't feel very good nor does it feel natural or appropriate.


Uh, What? I think it's time to brush up on YOUR CPR training, because you're completely incorrect.

3:1 Ratio is NRP for Neonates fresh out of the chute. It's not for adult and pediatric BLS providers. Adult is 30:2, Pedi 1 Man is 30:2, and 2 man Pedi is 15:2. The body does NOT need very much oxygen during a cardiac arrest, and hyper-oxygenation during cardiac arrest will actually cause MORE cellular damage. Ventilation and removal of CO2 is not even all that necessary in a primary cardiac arrest until approaching ROSC, when ETCO2 will peak. Even performing rescue breathing and NOT CPR, you're taught to breath 6-8 times a minute with oxygen according to AHA, and 10-12 without oxygen for adults in arrest.
 
2013-03-04 12:13:42 PM

The more you eat the more you fart: If a nurse working the same facility sees a patient fall out, and starts CPR, unless that particular patient is a patients of his or hers, there is no way he or she would know.


And I'm telling you you're not telling the full story of what happened by saying these three nurses were successfully sued for starting CPR on a patient when it was indicated, and when it was not known the patient had a DNR order.

If you want to post the civil case or the names of the people involved, I'll be happy to call a Legal Paramedic friend of mine and have him pull the case history and brief. Otherwise, as a Healthcare Provider (which I'm assuming you are, based on your language in this thread), it's  farking irresponsible to scare people from performing CPR when it's indicated by telling them they'll be sued for it.
 
2013-03-04 12:19:34 PM

Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.


As someone who recently lost their father (in the same age range)

FARK YOU you cock. He wanted to live just as much as you do, and yet that life got wasted on a piece of shiat like you. Life is not fair.

May you die a long, lingering death - attended by caring souls just like yourself.
 
2013-03-04 12:29:46 PM
A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.
 
2013-03-04 12:33:31 PM

The more you eat the more you fart: hardinparamedic: starsrift: ...And according to the nurse at the scene, the patient was breathing.

So she was still alive when she arrived at the hospital then...because they pronounced her dead LATER, after she arrived at the hospital and had been there.

So...like I was saying earlier...you dont know.  You weren't there, I wasn't there, the 911 dispatcher was not there.

Sounds like the nurse acted appropriately to me now...before I was questionable..but considering the patients was clearly alive during transport and even after arriving at the hospital.


Yes you are right. Here's my final thought.
 When the First Responder/EMT/Paramedics arrived, they would have assessed the patient (unless it was a "scoop and run" decision - usually done by less qualified responders), otherwise they would have stabilized her, then took her to hospital. Higher up the Paramedic qualification training would be a team that could intubated her, and then assist her breathing and do CPR , if they thought it was necessary.

The more likely scenario is this: Team arrives, assesses, treats as they feel is necessary (O2), speaks with facility staff and maybe the daughter. The decision was made that she was dying and that because she probably was essentially taking her last breaths at the scene, the crew took her to hospital where she passed away.
The other possibility is that she was breathing her last when team arrived, none of the team can pronounce her death so they take her to hospital where she is declared.
Either way her death was imminent, and staff, medical responders, family and finally the hospital ER make hard choices when it is necessary. The 911 operator, even though was not at the scene and didn't know the circumstances, was doing what she was trained to do. She cannot be faulted for responding the way she did. In the end, every person involved in this lady's care decided that CPR and ALS was not indicated, and it would appear from how I read it, was the right decision.

/Retired RN - Critical Care, Emergency, Med/Surg, Psychiatry, Manager. Dad died at home with family care. Mom died in care facility with appropriate DNR comfort measures only. I've worked and lived the scenario.
 
2013-03-04 12:36:27 PM

Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.


I've had a person walk up to me, shake my hand, and tell me thank you for doing CPR on them two years after I did it.

I've seen a 17 year old athlete survive after two hours of CPR while being crashed to ECMO for myocarditis, neurologically intact.

I've also seen people live long enough to have their family say goodbye to them, and die in the surrounding of their loved ones rather than alone in the middle of the grocery store.

And I've seen people end up in the nursing home from it.

That's not going to stop me from doing my job, and doing it for people who need it. Because I don't get the choice to play God, and decide who's going to have a CPC outcome of 1 when they walk out of the hospital. I do what I do because I know it's the best chance that patient has to survive, and I act on the assumption that they would want to live until proven otherwise, or it's proven to be futile to resuscitate them.

No healthcare provider gets to make that choice, and even Doctors have to justify why. The thought that people wouldn't help another human being because it "might not work" is sickening, and contrary to the oath every healthcare provider - nurse, RT, MD, DO, Paramedic - takes when they enter their profession.

CPR doesn't work every time, for a myriad of reasons. Some reversible in the field, some not. It's not a magic bullet like TV portrays it, but it is the best, and only chance for survival in a patient who is in a non-perfusing rhythm.
 
2013-03-04 12:39:43 PM

Dumski: Either way her death was imminent, and staff, medical responders, family and finally the hospital ER make hard choices when it is necessary. The 911 operator, even though was not at the scene and didn't know the circumstances, was doing what she was trained to do. She cannot be faulted for responding the way she did. In the end, every person involved in this lady's care decided that CPR and ALS was not indicated, and it would appear from how I read it, was the right decision.


As much as I want to down on the nursing home nurse for this, you're absolutely right.

I think what's infuriating to me more given the situation and tape is that there is a "facility policy against doing CPR".
 
2013-03-04 01:04:39 PM
Fark lawyers
 
2013-03-04 01:14:24 PM
images.sodahead.com
 
2013-03-04 01:16:42 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.


I guess the ones who don't put keeping their job before matters of life and death aren't working there anymore.
 
2013-03-04 01:32:03 PM

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


"Freedom to choose" implies a choice between two or more alternatives.  In order for people to be able to choose to die naturally, we need to have the option of choosing a "follow your damn oath and try to keep me alive" order instead of a "do not resuscitate" order if that is what some people prefer.  If everyone gets the DNR treatment whether they want it or not, that's not a choice.
 
2013-03-04 01:35:30 PM

The more you eat the more you fart: Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.


The more you eat the more you fart: but you CAN bring a braindead person back with it.


Take your own advice.
 
2013-03-04 01:47:16 PM

Don't Troll Me Bro!: Seems like a stupid policy.  Are they worried that their staff will do it wrong?  Is it a liability thing?  I'd have to imagine they could should hire people that are qualified to do things like this, especially being a senior living center and all.

Also: The elderly woman was identified by KGET-TV as 87-year-old Lorraine Bayless. She died Tuesday at Mercy Hospital Southwest, KGET reported.

It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.  If this had been a child, or a healthy person that should have some time left on the clock, I'd be pretty disgusted.


I'm pretty disgusted that you just arbitrarily decided 87 was old enough to let someone die.  You don't know that she may have made it only a few more years.  Shrugging your shoulders and walking away because the person is old is pretty heartless.
 
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