I (kind of) understand the policy. I believe that it's a policy of my husband's PRN job (private ambulance) that their employees will not provide medical care to a non-patient (meaning, someone who's not paying them) while wearing their company uniform. I'm pretty sure H would say F it and get fired if it's a life-saving situation, though.
And that's what bothers me about this situation. Not that the nurse didn't do anything (well, a little)- but that she had no emotion, no passion or anxiety, and wouldn't just hand over the phone to a lay person. If she didn't want to get fired, hand the phone to a passerby, or to the cook or gardener or whatever, someone protected by Good Samaritan laws, and attempt to save that woman's life. The fact that she didn't try, and didn't even seem to care that she wasn't trying, is shit, IMO.
OK, another article said the woman didn't have a DNR.
It seems to me that the policy is that in independent living staff doesn't provide *any* medical care. Maybe they were so short-sighted that they didn't carve out an exception for emergencies? I could see how training could scare a nurse into not touching a non-patient for any reason, but that would be hard to follow. There was a code red in the row in front of me on the last flight I was on, and I was watching closely, ready to help if needed. It's just kind of an instinct thing.
Medically, though, I'm still confused. The woman was breathing apparently. As a generalization, this means her heart was doing something functional. Which means no CPR. Slap some oxygen on her and get her transported asap.
If this was an exception to the generalization, I would wonder how dispatch would know and direct cpr. Something's just not adding up with this story, and since every one I've skimmed says almost exactly the same thing, I'm thinking journalism sucks and everyone's going off just a brief blurb released that has no details.
I saw the admin try not to grimace as I casually said "Mom, you do know you're allowed to read that before you sign, right?".
Try being the patient pointing out inaccuracies on the form as to the statute cited. Nurse was not amused.
Lol. Three days ago I was the mom of the toddler who had just had surgery, pointing out a couple of inaccuracies on the discharge instructions I was told to sign to the discharge nurse, who was also not at all amused. Arrival to her floor from PACU to walking out of the building was thirty minutes at the most; it was obvious every minute in between that she was rushing to get us out of her way.
One inaccuracy was that DD was to have albuterol every eight hours, but the doctor verbally said to give only as needed. DD gets extremely upset and agitated when I give it to her, so yeah, I'm not doing that for shits and giggles. The other inaccuracy was "patient did not bring home med list". Um, yes I did; I distinctly remember the admissions nurse going over it with me. "Well, she didn't document it". Sorry, not my mistake.
But then again, I had already pissed her off because she was counting on me signing without reading. About halfway through reading, she said impatiently "I just need you to sign right there" and I calmly replied "I'll sign it when I've finished reading it" and kept on reading.
OK, another article said the woman didn't have a DNR.
It seems to me that the policy is that in independent living staff doesn't provide *any* medical care. Maybe they were so short-sighted that they didn't carve out an exception for emergencies? I could see how training could scare a nurse into not touching a non-patient for any reason, but that would be hard to follow. There was a code red in the row in front of me on the last flight I was on, and I was watching closely, ready to help if needed. It's just kind of an instinct thing.
Medically, though, I'm still confused. The woman was breathing apparently. As a generalization, this means her heart was doing something functional. Which means no CPR. Slap some oxygen on her and get her transported asap.
If this was an exception to the generalization, I would wonder how dispatch would know and direct cpr. Something's just not adding up with this story, and since every one I've skimmed says almost exactly the same thing, I'm thinking journalism sucks and everyone's going off just a brief blurb released that has no details.
It would take an incredible amount of shortsightedness in order to fail to anticipate the possibility of old people going into cardiac arrest.
Also, it's possible for someone in cardiac arrest to continue breathing, provided it's early enough in the arrest process.
Another thing: AEDs are everywhere these days. Malls, Disney World - EVERYWHERE.
Post by SusanBAnthony on Mar 3, 2013 20:45:52 GMT -5
What if the patient was breathing, as sibil said, and that is why the nurse (if that is what the worker was) refused to do CPR or hand off the phone to a passerby? Maybe the nurse(?) was calm bc there was no need for CPR and the 911 operator was a moron?
Just trying to think of possibilities. We really don't have enough info to assign blame, IMO.
What if the patient was breathing, as sibil said, and that is why the nurse (if that is what the worker was) refused to do CPR or hand off the phone to a passerby? Maybe the nurse(?) was calm bc there was no need for CPR and the 911 operator was a moron?
The article states that the nurse is heard telling the operator that CPR is against the facility's policy. Why would she say that if there was no need for CPR?
What if the patient was breathing, as sibil said, and that is why the nurse (if that is what the worker was) refused to do CPR or hand off the phone to a passerby? Maybe the nurse(?) was calm bc there was no need for CPR and the 911 operator was a moron?
The article states that the nurse is heard telling the operator that CPR is against the facility's policy. Why would she say that if there was no need for CPR?
I have no idea. It all just seems sketchy, like some major details are missing.
Post by imojoebunny on Mar 3, 2013 21:22:20 GMT -5
I find this strange. My grandfather lived in assisted living for 5 years. They had a portable defibrillator that they would use on patients that did not have a Dnr. It is pretty cheap. I looked into getting one for my parents. Anyone can use it. I was trained on it as the emergency floor person for my office building. it is easy and requires no training.
This sounds like a case of the lawyers eating the lawyers and killing people in the process.
I find this strange. My grandfather lived in assisted living for 5 years. They had a portable defibrillator that they would use on patients that did not have a Dnr. It is pretty cheap. I looked into getting one for my parents. Anyone can use it. I was trained on it as the emergency floor person for my office building. it is easy and requires no training.
This sounds like a case of the lawyers eating the lawyers and killing people in the process.
They are fairly idiot-proof (fairly, theres always a better idiot out there), but you still need to know CPR. The ones I'm familiar with will only shock a specific rhythm (forget which) and advises to continue CPR if the shockable rhythm isn't detected.
What mesh said. You do cpr while someone gets the aed. Then it will deliver a shock if indicated (it's not always). You keep doing cpr in between shocks if it didn't work.
She didn't know how to do CPR. At least that's the way I'm reading it. That's why the operator was trying to walk her through it. So she was not "medical personnel." She might have been the equivalent of an RA.
That's kind of what I'm thinking as well.
Then why did she refuse to hand the phone to someone else? And why did the executive director say it was against their policy? I'm wondering what "in these situations" means. I agree that there's not really enough to go on here, but I can't think of a scenario where no one present could have followed the operators instructions to give CPR.
Wow, I just heard the phone call on CNN. The caller identified herself as a nurse, and I believe she said she knew how to do cpr but that it was against their policy, their protocol was only to call for emergency help and wait. At no point did she indicate that her objection was due to cpr not being called for in this circumstance, just that they wouldn't do it.
The 911 operator was understandably losing it, asking if there was anyone there who was going to help the lady or were they just going to let her die? The nurse said her boss wouldn't allow any fellow senior citizen or passerby to perform cpr on the woman and refused to hand the phone to anyone else.
The center said that the independent living residents are not offered medical care. Maybe it was a fluke that it happened to be a nurse that called in the emergency - but since she was there, I don't see how she could refuse to help. At that point I would think her personal professional obligation would overrule whether or not this resident had paid for medical care from the facility.
Medically, though, I'm still confused. The woman was breathing apparently. As a generalization, this means her heart was doing something functional. Which means no CPR. Slap some oxygen on her and get her transported asap.
This is what I was thinking. The article says she was "barely breathing," but barely breathing is still breathing. If she was breathing, then her heart was pumping. CPR was not warranted in this case.
Regardless of the situation with this patient though, it is absurd to me that a retirement home of any sort would have a policy like this. They should be fully trained to deal with situations like this all the time. I work at a country club and we have CPR and first aid training every 6 months. Our GM recently saved a member's life by administering CPR. It's insane to me that anyone working in a facility like that would refuse to treat the patient. I'm aware it's not illegal, but I strongly disagree with the policy.
I misread the OP and thought she was in assisted living. I could understand if an independent living place said medical assistance generally wasn't available so residents shouldn't expect it. But when someone happens to be there at the right time, I can't imagine refusing to help.
Post by redheadbaker on Mar 4, 2013 7:57:56 GMT -5
Good Morning America had a short statement from the family. They don't indicate whether or not they were aware of the policy beforehand, but they said they did not blame the nurse or the facility for not administering CPR.
Regardless, on a moral level, I just wouldn't be able to live with myself if I knew how to administer CPR and refused to do so.
Good Morning America had a short statement from the family. They don't indicate whether or not they were aware of the policy beforehand, but they said they did not blame the nurse or the facility for not administering CPR.
That's decent of the family. Definitely not the way I expected it to go.
Yeah, so now, I'm just throwing everything that's reported about this out the window. Â Even the reporters don't know what the fuck they're talking about. Â Like the reporter is calling this a "nursing home" when it's an independent living facility, which is like calling a bike a truck. Â I'm curious, so I'm going to read a little more, but it sounds like the people reporting this story don't even understand the basic definitions relevant to the story. Â
And the subject line on CNN called it "assisted living", so it could be any one of the three.
This sketchy info is part of the reason I'm not yet convinced that this no-CPR policy actually exists.
This is what I was thinking. The article says she was "barely breathing," but barely breathing is still breathing. If she was breathing, then her heart was pumping. CPR was not warranted in this case.
This is false. If a patient has agonal respiration for example, CPR can and should still be performed depending on the circumstance. We've done CPR on patients who were technically still breathing and not fully unconscious.
Ah, ok. I definitely make no claims to being a medical professional. This is just what I understand from the classes I've taken. Regardless, the policy of not helping at all is insane.
This is what I was thinking. The article says she was "barely breathing," but barely breathing is still breathing. If she was breathing, then her heart was pumping. CPR was not warranted in this case.
This is false. If a patient has agonal respiration for example, CPR can and should still be performed depending on the circumstance. We've done CPR on patients who were technically still breathing and not fully unconscious.
Yes, I get that agonal breathing is an exception. I'm just inclined, with the dearth of any details, to consider there's something missing from the story. There's no logic to it.
This is false. If a patient has agonal respiration for example, CPR can and should still be performed depending on the circumstance. We've done CPR on patients who were technically still breathing and not fully unconscious.
Yes, I get that agonal breathing is an exception. I'm just inclined, with the dearth of any details, to consider there's something missing from the story. There's no logic to it.
I have taken CPR classes from several different providers (maybe 5?) and I do think for a layperson with just the very basic First Aid/CPR certification it might be hard to determine if CPR is indicated when the patient is in fact breathing (and has a pulse). So, if this were a passerby on the street with a 4-hr Red Cross class who doesn't know what to do that's one thing. But a nurse?
I wonder if they have been sued before and how much this place charges per month? Also you arent required to preform cpr even w/the direction of a 911 operator if you are a bystander are you? Its a dick move but not illegal
Correct: if you're a bystander who hasn't taken a class that addresses what you are and are not required to do, then you won't get any legal trouble for declining to help. If you've had medical training such as First Responder or EMT then you learn in which cases you are or are not required to provide care (even if you're not employed by a medical-type provider). Some training also enables you to get in much bigger trouble for going outside of the scope of that training compared to no training.
Yeah I briefly skimmed 1 article and it said "The woman would still be alive if CPR had been performed."
Umm, how the hell do you know that? CPR has a pretty poor success rate, especially out in the field.
Sometimes I feel like reporters just make shit up.
Yeah, that made me ^o). When they teach you CPR they tell you up front that if you're preforming it, odds for that person aren't good. It ain't like the movies.
Yeah, I'm also assuming this person isn't a nurse, so I'm thinking about it from a lay perspective. In the lay CPR classes I've done, I'm pretty sure they emphasize no pulse AND no breathing because a pulse can be difficult to detect, especially in the elderly. Agonal respirs can look like regular breathing, just far less frequent. But, then wouldn't the "nurse" tell dispatch she wasn't going to do CPR because she resident was breathing? So I'm back to thinking it really is policy. My only consistent thought has been how awful the reporting is
Do you guys listen to radiolab? They had a short on how medical providers view end of life care vs everyone else. It was fascinating. Actually, it's what I thought about first when I read the story yesterday because I was thinking I wouldn't want CPR if I collapsed like this woman, not that my wants bear any relation to this case.
I have taken CPR classes from several different providers (maybe 5?) and I do think for a layperson with just the very basic First Aid/CPR certification it might be hard to determine if CPR is indicated when the patient is in fact breathing (and has a pulse). So, if this were a passerby on the street with a 4-hr Red Cross class who doesn't know what to do that's one thing. But a nurse?
I'm still not convinced she was a nurse. Someone upthread said she identified herself on the 911 call as a nurse, but I haven't heard the whole 911 call. Everything I'm seeing is other people saying, "She identified herself as a nurse" which I'm only side-eyeing because these are the same sources that can't seem to differentiated between an independent living facility and a "nursing home." Like, she might have said, "I'm a patient care tech." "What's that? A nurse?" "Yeah, it's sort of like a nurse."
That's a good point. I just wanted to get enraged without considering original source material. If I get it off my chest here I can do better in my real job.
I definitely agree that the reporting is terrible and I will go back to withholding judgment without knowing the true story.
Yeah, I'm also assuming this person isn't a nurse, so I'm thinking about it from a lay perspective. In the lay CPR classes I've done, I'm pretty sure they emphasize no pulse AND no breathing because a pulse can be difficult to detect, especially in the elderly. Agonal respirs can look like regular breathing, just far less frequent. But, then wouldn't the "nurse" tell dispatch she wasn't going to do CPR because she resident was breathing? So I'm back to thinking it really is policy. My only consistent thought has been how awful the reporting is
Do you guys listen to radiolab? They had a short on how medical providers view end of life care vs everyone else. It was fascinating. Actually, it's what I thought about first when I read the story yesterday because I was thinking I wouldn't want CPR if I collapsed like this woman, not that my wants bear any relation to this case.
Actually when I first saw the headline I wondered if it was some kind of minimal-intervention DNR type facility, like hospice lite.
That chart is really interesting. It seems like there are things on there that are certainly plausible to need and recover from, like antibiotics or even a vent. Is this after some age or when in assisted living?
ETA: okay, I read. Irreversible brain damage without other injury. Yeah, I'm good with pain meds too. I think that's a lot different than someone living independently who collapses, unless we're operating on the assumption that need for CPR = irreversible brain injury. Which is a fair point.
That's for end of life care. I listened to it a couple months ago, so I can't remember if they were specifically asked if they had a terminal illness or if it was age.