I’m not really sure how I should handle this…or if I should just shut up and smile. :) Wednesday night, I worked night shift…not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway…it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well…there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3…while smiling and patting the nurse on the hand and telling her how sweet she is. So…there are no real deformities, but her right arm just didn’t look right. No bruising, no swelling, nothing that looked like it shouldn’t look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm. I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident’s room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, ”Well, I think I know how to package a patient and I don’t even know what a patho-whatever fracture is.” I then said, she fractures really easily…and without known cause…she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed. She went into the resident’s room and asked me why I hadn’t put her back in bed. I again stated that she fractures very easily and because her arm didn’t look right that I didn’t want to move her without proper splinting. The EMT then informed me that she hadn’t brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the ‘bus.’ When I was in paramedic school, we learned to splint with all kinds of “inappropriate” things like pillowcases, magazines, duct tape, etc, so I said…”Oh…they taught us how in paramedic school.” She asked me if I am a paramedic and I admitted that I am. She informed me that I am “not a paramedic here, so it doesn’t count.” The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job…she then said, “I really don’t think there is anything wrong…you people call us all the time for nothing.” The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis. She resident had three fractures…one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So…my DON told me that she wants me to handle this one…I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what?
I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.
