Just over a year ago, I wanted to find a way to help and support the community in which I live. I joined my county's Medical Reserve Corp as a way of "helping out". I joined this forum a few months back to gain additional knowledge and feedback for responding to community wide emergencies, so far, most of the information I've read here has been helpful and extremely insightful.

Today though, as I was browsing through the groups on this forum, I came across one particular group entitled "Nursing Homes are killing me", I clicked on it, partly out of curiosity and partly because, in my "day job" I am a nurse in LTC and I was interested in reading what some EMS personnel's views of LTC and how we care for our patients involves them. I was TOTALLY taken aback as I read the posts. I simply could not believe the whining and moaning several of the members were doing regarding responding to calls in nursing homes and other LTC facilities. Several of the posts seemed to follow the thought that most nurses in LTC are complete idiots that do not know how to care for their patients or when or when not to call for transfer to an acute care facility. Several of them even commented on the fact that they were called to transfer a patient to the hospital who had a code status of DNR CC.

I'm sure that in some areas of the country there are facilities who abuse the EMS system and contact EMS to "send out" their patients for trivial reasons, I'm not disputing that. But please, do not lump all LTC facilities and for that matter all nurses together in one heap.

Another distinct impression I got from browsing through some of the posts was that some people felt that responding to LTC facilities was a "waste of their time". That was the point that disgusted me the most. When someone enters the EMS field as either an EMT or a Paramedic, I am quite certain that they were trained to care for all people, whether they are a newborn baby in the richest section of town or the elderly downtrodden individual in the public housing project or a resident in a LTC facility.

To anyone who feels that the nursing staff in all LTC facilities have no idea what they are doing or that they call for medical transfer for "stupid reasons", all I can say is, what if that person in the LTC facility that your squad responds to was your mother, father, grandmother or grandfather, wouldn't YOU want them to receive the best care possible with compassion and dignity?

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Comment by Mike Schlags (Captain Busy) Retd on September 20, 2008 at 3:57am
Ok, so maybe I'm not wild about the nursing home calls but mostly because the bad ones have such an awful odor of urine and feces. I just want to get in and get out but in doing so, be professional and show absolute respect for both the patient and the staff. I've made it a point for years to learn the names of the staff personnel when I go on the runs because we all know that we are going to be back. After some initial communication, you will eventually be able to figure out what each of you want, which of course is what's best for the patient, the patient's family and the staff. You have to figure that if your getting the medical alarm in the first place then something significant occurred to trigger a 911 phone call and your response. If you are an EMT or Paramedic, here's what I did not know until I helped by wife go through nursing school. The major difference is that the amount of time they spend completing a nursing degree and state certification can in no way compare to what EMT and Paramedic curriculum covers. Nurses are trained to evaluate and assess patients to a degree that many doctors rely on these specific nursing skills to render a diagnosis or treatment plan. Think about it, are there always doctors hanging around ICU's or CCU's? How about on medivac helicopters? All these nurses, whether they work at a LTC, resthome, convalescent home, private home, board and care facility, rehab center, whatever... all have to get the same license and take the same classes, and looking at the depth of detail spent studying the profession, you have to respect their knowledge base. To not take advantage of always talking with them on these calls to continue to learn better assessment skills will make you a better emergency responder and show a good example to others why we consider this a profession with honor. Treat everyone with respect.
Comment by Art "ChiefReason" Goodrich on August 16, 2008 at 12:05am
Karen:
Please remember that some of the folks who responded to that discussion thread were hopping around on one foot because the other foot was in the mouths.
They are the ones who joined up for the glamour and romanticism of the job and haven't yet found compassion in their job description.
Just as you don't want to be "broad brushed"; neither do we.
Many of us are in it for the RIGHT reasons.
Both of my parents were in LTC facilities at one time or another. They received high quality care.
TCSS.
Art
Comment by ROOKIELZ on April 24, 2008 at 5:01pm
I may be late commenting on this but here is a reality check, gentle readers:

I work in a Long Term Care facility who states the facility has a "Do Not Recusitate" policy. However, IF a resident states they want CPR in their admission papers, it is LAW that we must call EMS to come.
We know how to to CPR; our policy states we may not initiate.

I understand that CPR is most effective when started immediately. I can feel the frustration of the EMS staff when they realize we have done nothing.

We're stuck.

Don't providers ever wonder if we aren't just as frustrated and dearly want to initiate CPR? No offence but EMS has their specialties and we have ours. Of course, we could do CPR while we transport to the local hospital. It isn't rocket science, is it? Nope. In fact, I can run with my FD and do CPR if needed.

Karen is absolutely correct. It is the Physician's decision based on the Nurse's condition update which dictates whether EMS is called for transport.

This is not just my facility. The policy carries for an entire region which encompasses probably a quarter of my province.

It may not be right. But that is the reality.

So if there are those that resent me for this; oh well. I am trying to provide for my residents wishes. What a silly thing for care providers to do.

There are BS calls in a nursing home too. They come in the form of people that for one reason or another abuse the Nurse Call system.

The area of care that a person works doesn't matter. We all have to love the good and deal with the bad.
Comment by Art "ChiefReason" Goodrich on April 14, 2008 at 8:32pm
Karen:
I think what some of them don't realize YET is that, a time might come in their lives when they will need that type of care for someone in their lives or for themselves.
If they think it's crappy GOING there on a med call, what are they going to think when they are sitting in a nursing home and need someone else's help.
God is watching us.
TCSS.
Art
Comment by Karen on April 14, 2008 at 7:12pm
Thanks to all of you who have responded to this blog. I'm seeing now that the comments of a few are not the feelings of all.
Yes, I'm sure those that work in EMS have seen their share of substandard care and treatment of residents in nursing homes, and a few of you actually feel that calls to nursing homes are a waste of your time, but as it has been stated, you chose the profession as either an EMT or Paramedic, and as far as I know, you can't pick and choose who you want to care for.
The facility I work in is classified as a "skilled nursing facility", which basically means we can care for persons with feeding tubes, trachs, IVs and advanced skin wounds as well as the residents who suffer from dementia or chronic health conditions.
When caring for the residents on my wing, it is my duty, both morally and professionally to provide these people with the best medical care. If one of them develops a problem that we cannot take care of at the facility, a phone call is placed to the resident's physician and he is made aware of the current condition, it is HIS CALL as to whether they are sent out to the hospital or not. The only time a resident is sent out to an acute care facility without a doctor's order is if the person is a full code and they go into cardiac arrest or develop some other life threatening condition that demands immediate medical care.
Comment by Oldman on April 14, 2008 at 7:54am
I'll add my two cents. I normally choose not to pay much attention to the whining babies who make comments concerning another health care profession. However, What is evident by the rantings by some is they simply do not understand how the system works. Just as there are different levels of hospital care, there are the same levels of SNF's or LTC's if you wish. Some can handle more intensive treatment modalities than others. But they have one thing in common. A patient cannot be transfered without a physician's order. I will only speak about Texas but I have seen more than my share of EMS providers who couldn't pour "water" out of a boot with instructions written on the sole. They can pass a written test, but their skills just aren't there. Like-wise, I have seen the same with physicians, nurses, administrators, firefighters, and the list goes on and on. The point of my ramblings is this; If you live in a glass house, don't throw stones. A doctors order is a doctors order. If you want to complain, go jump the doctor. Although I don't feel this would be conducive to career longevity.
Comment by Joe Stoltz on April 13, 2008 at 6:59pm
As it happens, my mother-in-law resides in what I’ll call a semi-LTC facility, and from what I can see the people who work in these facilities are saints. Whether the residents are gentle and agreeable, or verbally abusive, or have unpredictable mood swings, the staff has to keep a uniform professional demeanor at all times. Not everyone can do that; I know it would get to me sooner rather than later.

Now, let me say a few words to the EMTs and para-gods complaining about calls to these facilities. Gallows humor aside, if they truly believe that it’s a waste of time transferring seniors from one facility to another, or “think” that this happens for “stupid reasons”, I think they should start looking for a different line of work. They’re done in EMS. I don’t care how many or how few years they have in the service - if they have lost their ability to see all people as being equal and equally worthy of compassionate, top-notch medical care regardless of situation, it’s time to move on.

I wouldn’t let the opinion of a few jackasses discourage you from your very important work, paid or volunteer.

By the way, welcome to FFN!
Comment by Jojo on April 13, 2008 at 2:46pm
Karen,
I am one of those that comment on nursing homes are killing me. I am most likely guilty of talking to generally. I have no problem with transferring pts and myself have a grandmother in a nursing home whom I love dearly. However, if she was treated as some of the pts I pick up at the local nursing home like those at these homes treat their pts I would be very angry. I have come into the nursing home where if they had done something simply like sit them up and give them the correct amount of o2 through the NRB then the pt would have never had to have been transferred and could have stayed comfortable in their own room.
At the same time I have no problem transferring pts that either need it or who the nursing home feels need to be transported I just wish for the general respect of both the pts and of us that the pt really does need it.
I am truely sorry if I offended you or anyone in any way but as Art said I was guilty of being too lazy and generalizing. I in no way meant all nursing homes or other SNFs are like that.
JoAnn
Comment by Karen on April 13, 2008 at 1:51pm
LTC stands for Long Term Care, a common term here in Ohio. Thanks for your comments.
Comment by Art "ChiefReason" Goodrich on April 13, 2008 at 9:56am
Karen:
Many here aren't give to deep thought before they post their comments. That's why they paint their comments with broad strokes. Actually, it's laziness. Thinking about what you want to say and thinking about its consequences is too much like work.
And besides, if they say something somebody doesn't like, they just sit back in their anonymity and won't reply to the subject again.
I am particularly fond of the posts that says ALL firefighters are heroes. But the truth is that we have our scumbags just like most other professions.
My mother spent time in a nursing home before she died and if I knew that someone like you described was in charge of her care, I'd have gone in there with OUR ambulance and crew and moved her out.
There are some in our services who are too hung up on the selfish/glamorous side; you know, the stuff movies are made of. They want to be the next headline. Thanks isn't enough for them. They want the spotlight, the soundbyte and statues raised in their honor.
Note that I said "SOME".
I'm not lazy.
Your points are well made and well taken.
TCSS.
Art

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