When to call 911

[princess626]

Our organization is looking to do a training to reinforce the importance of calling 911 when pt's need to be transported. The issue we're running into is that on the 3-11 shift, the RN cannot be pulled from our skilled section to PC. Our PC employees are not required to have extensive medical training, but they are hesitant to call 911 for the wrong reasons.

Do any of you have guidelines that your organization follows for when to send a pt out?

My belief is "when in doubt, send them out". I am also an EMT and a former 911 dispatcher, so I understand the frustrations from all ends, but believe ensuring the residents receive the proper care while reducing our risk of liability is most important.

And a second question... we are technically a no-lift facility. With residents beginning to age in place, PC aides are being asked to do a lot more lifting. Does your organization call 911 (in this county both 911 and the non-emergency numbers go to the same center, so I use them interchangeably) for list assists of residents when there are no apparent injuries?

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi,

That is a tough situation. I would not use 911 every time you need a lift assist, as that is truly a wast of money and resources that someone else may need. Personally if I was fire chief in a town where a facility was calling for that I would have issues with it. Your facility needs to work out a policy where you can assist people up off the floor if they are uninjured if you intend to continue caring for residents that are at high risk of falling. You have to remember every time you call 911 you are potentially taking EMS away from some who may truly need the ambulance, and who now has to wait longer possibly for assistance.

As far as training your staff that have little to no medical training on when to call 911 you need to put a protocol in place. It would be extremely high liability for you to tell them "use your own judgement" and leave it at that. I would recommend doing some sort of chart type algorithm kind of similar to what you see in ACLS. Another alternative is that they could reach an RN by phone, and the RN could make the decision. I use to cover an area with an assisted living facility and we had a patient in full CHF who told the aide to call 911, the aide refused and told the lady she had a "cold" and did not need to go to the hospital. So an aide "using her own judgement" almost killed this patient. The family arrived and then demanded 911 be called, which of course they did. This sort of thing cannot happen, thus that is why you need the algorithm or some other straight forward protocol that is written as a policy.

Annie

[princess626]

Annie

We're trying to avoid having them use their own judgement, and many of the PC aides have told us they don't feel comfortable making those decisions. I like the idea of a flow chart, thank you for that!

As for the lift assists, in our county is it a police response only call. So it will not be a full ems/fire dispatch unless pd requests it. At this point, we are remaining a no-lift facility, which is why I was wondering if any other agencies treat falls the same way.

[Triddin]

Why doesn't the facility want to install lifts, or even get a floor lift in cases of falling etc. Seems like an occupational health risk for back injuries

[princess626]

I'm not sure of the reasonings behind it. We do have lifts in our skilled unit, but PC has always been no-lift. Up until recently, the residents in PC only needed minor assistance throughout the day. But with the recent swing to aging in place, PC residents are needing a lot more assistance.

[brillohead, ADN, RN]

At $4K, this product isn't cheap, but it would be a lot cheaper than paying a Worker Compensation claim if an employee were to be injured trying to lift a patient....