Ok. I love old people. They have alot to teach us. I feel bad that they have to spend whats left of their lives in long term care. There are some great homes out therebut there are some bad ones too. When I became an emt it wasnt to transport for elevated labs, or get up at 3am for a fever. (ever hear of tylenol) I love going in a nh for an altered mental status find an o2 sat of 84 and the pt has no oxygen on. duh. The other day I had to give narcan to a 70 year old pt unresponsive from a new F-patch. A drug od in a NH. I pulled the patch, gave 0.4mg and she woke up and started talking. When I got to the ER the Doc says "I'ts a miracle" in a sarcastic tone. Whats worse, is these nurses call you at all hours day and night. You have to fight to get your cot in most of the rooms. They rarely have the paperwork ready, and you can never get help transfering from the staff. I worked in a home for 9 years as an aide I don't remember it ever being like this. Whats going on? Anyone else feel this way?
I think the nurses need better trained in what is an emergency and what is a transport. Also they need to practice common sence (oxygen) and not be so affraid to act in the patients behalf. We have protocols and nursing homes have standing orders USE THEM! We have a duty to act in an emergent situation and so do nursing homes. Why then are we finding so much negligence when we go into these places. Give the patient what they need.
I agree with you guys on this.I think our nursing homes do need better training. One thing I have run into, Is that nurses coming on and nurses going off don't talk.I have found that most calls are for things that have been happening most of the day. When night shift notes something they are the ones who call us.Most of the time the night shift in my area a aids not nurses.
OK they struck again, sent a 80 year old man out for low sats and increased heart rate. He was a DNRcc. Then later on sent a woman with a fx hip out. She had a leg imobilizer on. Shes had it for a month and they never removed it not even to bath her, She had decubitus ulcers to the bone. You could smell the rotted flesh the minute we hit the door. Now how on earth could you not notice something like that?
Whew, I am so glad that it isn't just my area that this happens in. It is like the same exact calls. I have even been called for the Alzheimers Pt that is confused before!!! WOW what quality care our elderly get!! Just a few days ago we went to a NH for the "General Illness, Pt not feeling well." We got there and the Pt had a pressure of 80/40 and decreased LOC, I asked the nurse how long the Pt had been that way, she said all morning. Gee!! You think maybe that is why he isn't feeling well? I just am really dreading getting old, and in our line of work, that is rapidly approching!
We've got three homes in our first due, a couple of assisted living (oxymoron), and some elderly warehouses- retirement communities. The calls are the same, the complaints are the same, the lack of results are the same. I can't believe that no one, not even the state regulating agencies, can see these huge issues of "care."
Last call was for "altered level of consciousness." It was 0200 and my consciousness was altered never mind the poor 90 year old that they woke up to take vitals becasue someone didn't take them the previous shift. NH is beginning to stand for "no hope."
Thanks for letting me rant.
What's so bad in our area, is most of the nurses are from the islands and can't speak or understand simple English. They must be trained different than our nurses because they can't do most simple nursing procedures. Somehow I think this is a common problem for all NH nurses. When they walk in that door they no longer know what to do. The 0330 lab results that are two days old is common. Best I've done lately is a 0100 hand lac that happened at 1830. Suposedly pouring blood.......bandage was dry.
Hey guys here in the VOLUNTEER STATE we have whats called Tenn Care or state insurance for people who can't or won't work to have insurance, either way if the call is non-emergency the nursing homes have to call TennCare to get an approval number so they have started dancing around having to get a number by calling 911 for some of the sillest sh@t ever (ie pt needing an X-RAY secondary to docotors order).
Thanks folks for sharing. The homes continue to irritate me. Had a 90 year old that got the sh-t beat out of him by another resident. Both residents gave it their best but one lost big time. Told them to change their name to wwf health care. (got wrote up for that one.) My pt had several lg bites of skin gone. (good poligrip) and had his head continuously slammed under his own bed rail. God I love my job. Only question was Where were all the nurses in the home? Later found out they were all in the lounge watching the biggest looser. fitting.......
I'm mystified by the difference between the dispatch, and what the call actually is. My personal favorite was a 'patient unresponsive' that became a 'bowel obstruction'. Unresponsive to what, exactly? And they gave a woman with chronic bowel obstruction chili for dinner. I've had several 'altered level of consciousness' calls for 95 year old people in the middle of the night without their hearing aids in. I like it when I ask a NH employee 'So, what was the reason you called 911?' and they SHRUG. I've developed something I like to call the thousand yard stare, where I gaze into the middle of their souls unblinking until they say something that makes sense. Or they get out of the way. And as we're leaving "They'll have to stay at the ER until the morning because there isn't anyone here to come and get them", which guarantees us another round of stinkeye from the ED.
I almost lost it last shift. NH calls for "facial palsy." We get there, I go to the desk for paperwork and ask the nurse(?) what's going on with the patient. She flops the papers on the desk and pulls a doctors order out and uses her pen for a pointer and points to the scribbling on the order. Doesn't say a word, just points. I looked at her and said, "So what does this mean?" Her reply(with Island accent)....."She has palsy to her face and doctor wants her sent out." I walked away mumbling. Patient had a cold for two months and on antibiotics.
I've had plenty of the "I don't know whats going on with the patient", and the NRB's on 4lpm, or even the N/C or 12lpm lol. Nothing made me more mad at nursing staff than a call I had a couple shifts ago. Responded to a local NH for severe dementia patients around 20:00hrs on the 2nd floor for DIB. The enterance doors are on a security system the only way to open them is from the inside at the front dest, and only staff have a key. Took about 3 minutes to get the attention of one of the aids to let us in. Elevators in the building are on the same security/key system. Entered the room to find the patient in severe respiratory distress with NO O2 in place, but atleast they had her sitting up. Found edema in both lower legs, and severe congestion in both fields, RR 10, no pneumonia. Sounded to me like a classic CHF problem, come to find out it was, pt was on lasix *spelling* at 40mg per day. The nurse we were talking to had no idea what CHF was. Did the usual, loaded the patient on the stretcher, place pt on O2-15lpm via NRB, sitting straight up, basically scooped and ran. While we were getting the patient ready for tx, the nurse ran off with the paper work and the key for the elevator. Took another 3 minutes to track her down. Finally getting to the first floor, just realizing no one was around to open the front door for us, cause the key is still needed to exit the building. Literally yelling to get someone to open the door, finally after about 6 shouts of wanting to exit, the aid came to open the door. Mean while our patient is about ready to check out due to fluid build up in her lungs. Finally loaded pt into the rig, set up IV, administered meds, heart monitor, the usual. All in all the pt made out ok, but it could have been alot worse for the pt if it took a couple minutes longer for us to enter the building or exit. Really frusterating call. I just don't understand where these certified nurses and certified aids get their certifications. I agree with everyone, I don't want to grow old after seeing this basically every shift and in every nursing home in my response area. Sorry for the length.
We have 12 con homes (short for convalescent home) or SNIFFS (skilled nursing facilities) in our city. Like ya'all we go to them all of the time. Throw in the residential board n'cares and assisted living and we can run all day and all night. Our engine 2 did 2,950 calls last year and half of them were to con homes. So he is our plan. We are broke like every other fire department in California. He are going to strat billing the con homes, doctors offices. anybody licensed to provide medical care for our BLS services. Either we recover between $100,000 and $200,000 a year or we reduce the dependence of private medical providers on the public 911 system. We'll see.............