Death after two-hour ER wait ruled homicide

I've followed this thread pretty much from the begining, but haven't posted on it until now.

There are a large number of posters who keep commenting on how neglectful the triage nurse was.

It realy isn't that simple. At least, not with the info that has been provided. (Or will likely ever be provided).

Though not as experienced as many of the nurses that have posted before me, and not a full-time ER nurse, I have done triage.

You know what? It would be so wonderful if everyone that came to the ER gave a complete/accurate answer to the question "what brings you here tonight?"

It would be great if your patient actually let you get out the statement "On a scale from 0 to 10, with 0 being no pain and 10 being the most pain you could possibly imagine, where would you rate your pain?" before abruptly cutting you off and barking "10, it is a 10." (Now, again, I don't triage daily, or even weekly, but I can count on ONE HAND the number of patients who have given a number LESS THAN 10 when answering this quesiton. Makes it difficult to prioritize patients based on their perception of pain when everyone gives the same answer.)

It would be nice if the patients who are dragged in by their families didn't try to down-play their very serious signs and symptoms because: they don't want to be admitted; they are scared and in denial; they don't want to be a bother; "you need to attend to that young lady crying in the waiting room;" whatever.

It would be a flat-out relief if every patient who was sick of waiting didn't suddenly come start having chest pain/shortness of breath/"the worst headache of my life" when it becomes evident that the wait is going to be a long one.

And, it would be really, really great if everyone who was having an acute MI had predictable signs/symptoms, ones that screamed "I'm the big one."

The bottom line is that we don't know the true story. We don't know what the patient told the triage nurse. We don't know what the patient's vital signs were. And unless I've missed something, we don't even know if they DIDN'T do an ekg upon presentation. EKGs can be normal even during an MI, depending on the timing. We don't know what the patient load was like that day. We don't know how many other patient's with c/o chest pain there were that day/that hour. (Or major trauma. Or severe HA with elevated bp. Or outrageously elevated blood sugar. Or severe SOB with crappy sats......) We just don't know, and probably never will.

Until you've done triage, you'll never understand that weight of responsibility that drags on your shoulders all shift. The constant checking, second guessing, dodging the angry hangnail patient who "has a right to medical care and I demand to be seen!!!".

Triage is it's own little microcosm of nursing and it's got to be one of the toughest I've ever done. If 10 people sign in a the same time to be triaged, you do your best to go in order. Does the chest pain go before or after the guy with the bullet in his abdomen (yep had that WALK in), the lady with the SOB and crap sats and hx of CHF with intubation, the 3 other people with chest pain? If you have 3 chest pains at once (it happens) who do you triage first? The oldest? The one who yells the loudest, or the one who sits quietly waiting (that's the one who's gonna code on ya, btw). And what if you've got all these people come in within 30 minutes, and the ER is FULL FULL FULL and has 4 ICU holds, 3 tele holds and minor care is closed? That is the weight that sits on every single triage nurses' shoulders.

Every nurse I know loves her license and protects it as best she can. I cannot even remotely imagine a triage nurse who would blow off the symptoms presented. So my assumption is... there was way more going on. Systems issues as someone above stated. I simply cannot imagine that this triage nurse sat there with an empty ER and said "yeah sweetie go have a seat, we'll get to ya" as she merrily went into the back to check her email. Just can't see it.

I'd love to see ALL the details of this case. If it's ANYTHING like my lil ER, then she needs to be given a valium and a big hug - NOT criminal charges!