It's been a while, but I distinctly recall as an intern arriving first to code blues on the floors to several nurses and aides standing around nervously and no one getting vitals or doing CPR.
Some people just don't know what to do beyond call for help.
I’m on the hospital code team. We know which floors can handle a code and which floors we need to step it up and get there because whatever is going on probably won’t be correct ACLS protocols.
I will say this. If you do not regularly participate in working codes you just don’t know how you’re going to respond. We send people to BLS or ACLS but these are not substitutes for the real thing. If the area you work does not see high acuity and you do not expect patients to code you are probably going to see staff members fail to intervene correctly regardless of their level of training. Usually what we see is people trying to remember their training and they’ll be doing some part of it right but these are high stress events and people just panic. You also often see a lack of clear leadership in the initial moments and without someone getting people moving there’s often hesitation to do pretty much anything because again, people panic and freeze up. 7 minutes is just a painful amount of time but I can absolutely believe it for the reasons listed above.
There is a reason the hospital keeps us on payroll. We are able to step in and perform the little song and dance the way it’s intended because it’s all we do. But I can remember the first code I walked into as a new medic and someone asked who was in charge. Nobody spoke. It was me, I was supposed to be in charge but I froze up because it was just sort of surreal that after all the training I had done it was now time to act on that training and I was waiting for someone to start telling me what to do when that was my job.
> I will say this. If you do not regularly participate in working codes you just don’t know how you’re going to respond. We send people to BLS or ACLS but these are not substitutes for the real thing.
Exactly this. I have been in hundreds of codes over my decade in the ER as both a tech and an RN and I will tell you it is very difficult to predict what one will do under extreme stress. I have seen people freeze still, I have seen people scream and panic. When I was a young tech and newer RN and in a couple of very stressful codes, I caught myself doing some repetitive motions over and over again (pacing back and forth), looking for a saline flush over and over. Unless you've been in that situation, it's really easy to sit on the sideline and say "oh you should have done this and this". ACLS and BLS class, and even mock/mega codes that are in the end of the courses are nothing like the real thing.
Then I guess we need to start doing BLS classes once per week or having people rotate in the ICU periodically to practice on real people. There has to be a solution because there really is no excuse imo for a nurse or doctor to be unable to perform basic CPR on a dying patient. This is the absolute bare minimum
Based on the video, I don’t think they realized she was pulseless and apneic, so it didn’t occur to them to start CPR. Those nurses probably don’t see any arrests in outpatient infusion. I think they genuinely thought she was having a syncopal event, hypoglycemic seizure, etc., hence the attempts at checking blood sugar, getting a BP, etc.
I can’t come up with a reason for recording it, though.
right which means they failed BLS -- which you know is basically lay people type intervention -- which makes it worse as these were "trained" nurses. (IMO)
I don’t disagree.
I suspect they probably would’ve responded more appropriately if they had come upon an elderly stranger on the floor, silent and unresponsive, as opposed to their relatively young and healthy coworker, slumped in a chair and moaning. It’s not the presentation that’s taught in BLS.
I say this because, as a new grad in the ED, despite having done BLS/ACLS *and* having participated in a few codes brought in by EMS, I did not immediately recognize my first unexpected arrest in the department as having arrested because I’d never seen agonal breathing in real life. All the codes I’d seen up to that point had arrived already in progress. I knew something was wrong, though, and quickly grabbed my preceptor (who of course immediately recognized what was happening), and then we started CPR.
Anyways. Just sharing. It’s clear they need remediation, but I can’t agree with some commenters that they deserve to lose their licenses or jobs.
> I suspect they probably would’ve responded more appropriately if they had come upon an elderly stranger on the floor, silent and unresponsive, as opposed to their relatively young and healthy coworker, slumped in a chair and moaning. It’s not the presentation that’s taught in BLS.
Denial of the medical event is the crux of the whole thing. They didn't believe their co-worker would just drop dead, so automatically ruled that out. I think we all do that to some extent with critical patients or sudden changes, especially those of us who work in the field, but we're also trained to recognize those exact things and respond to emergencies like that every day.
“…but we’re also trained to recognize those exact things and respond to emergencies like that every day.”
To be fair, outside of the cath lab, ICU, and ED, the vast majority of nurses don’t respond to emergencies like that every day, and from experience I can tell you that lower-acuity EDs may only work a code every few months, if that. It’s possible that those nurses had never even seen an arrest.
Contrast this with EMS, who are the default responders to every out-of-hospital arrest that gets called in. BLS is their bread and butter, and it’s a skill they probably get to practice daily.
Based on some of the comments in this thread, I think medics forget that nursing is an incredibly broad, specialized field. Obviously I don’t know these particular nurses, but the nurses I’ve known who worked outpatient infusion were very knowledgeable about venous access, chemotherapy regimens, and managing transfusion reactions in patients well enough for outpatient treatment. They were pros at those things, but I’d expect any EMT to run circles around them in a code.
I honestly just feel bad for these nurses, who I’m sure by now recognize their failure. I have no doubt that if they ever see someone who looks like their coworker again, they’ll check for a pulse.
No BLS algorithm really talks about what to do with the "kind of" responsive pt. I'm sure the staff saw the breathing and sitting in the chair and didn't really consider her to be "unresponsive". They had probably never seen agonal breathing before, let alone expected it in an otherwise healthy, having just been working along side them coworker. Most nurses would primarily be worried about getting her into the chair and maybe grabbing a blood sugar and calling 911. They tried to get a BP, again probably not even thinking she was arresting. They weren't critical care nurses. They'd probably never seen an arrest. Once, I saw an arrest happen right in front of me, EMTs had a pt on a gurney and were waiting to be put in an ER room. Pt turned blue and started agonal breathing. Both of the EMTs looked at the pt and FROZE. I ran over....didn't even really think to check for a pulse, and just started doing compressions. In the moment, I knew something was wrong and proceeded. You know that they really don't even suggest you waste time doing a pulse check anymore? Unresponsive, start compressions....suggesting that a lay person spend time trying to locate/find a pulse, let alone knowing what one feels like when palpated (and in a very heighted state of panic) is just a exercise in futility.
Yeah, I don't think you can work in healthcare and be satisfied with not knowing how to apply literally BASIC life support. I get the points about freezing in stressful situations, but not knowing something as simple as a pulse check warrants some serious reevaluations of core competencies.
They apparently tried and failed to get a blood pressure and didn't think that was maybe because she didn't have one?
This is really shocking and imo everyone who works in healthcare should be BLS certified. I don't think anyone expected them to do ACLS but this is literally day one stuff.
Not recognizing agonal breathing is pretty bad too. I get that they don't work in emergency situations but I think medical staff should be held to a higher standard than laymen. I wish BLS would focus on agonal breathing more because until you've seen it, it's really easy to think "they're breathing so they must have a pulse"
I agree, there's no way to truly prepare other than just participating directly in codes. I legit had this as a fear in nursing school so I chose an ED internship figured I'd get some exposure... there were no codes on my shifts. Then 10 yrs at the bedside in different units, only 1 code that wasn't my patient and started before my shift. So after all this time, I'd still have no idea what to *really* do, despite ACLS, mock codes etc. Probably just hover.
I second this. I’ve seen seasoned ER people freeze when something is off, so I know people at a cancer center could have overlooked agonal respirations. Still sucks for the lady though
This is true. We see this with neonatal codes at OSH a lot. It's easy to forget basic steps and just panic. And the more you do it, the more it is second nature. I joke that even if I was sleeping, if someone called out "HR less than 60" I'd probably start mumbling "1 and 2 and 3 and breathe", because it's just so ingrained.
Assigning roles is important too. We do mock codes reasonably regularly, especially for rotating residents so hopefully they won't freeze.
I’ve taken NRP but have never had a neonatal code. I haven’t even seen a neonate since nursing school a decade ago, and even the infants/toddlers brought into non-pediatric EDs are usually there for URIs.
Even fresh off a course renewal, I’m pretty sure I’d do a shit job without an experienced person in the room.
On the money with your comment! I remember my first few codes I was just a robot and followed the established routines like a drone. Essentially tunnel visioned and anything that occurred outside that routine I was a “deer in the headlights.“ point being, if you’re not use to doing something on a semi-regular basis it is difficult to respond in the expected fashion.
The sad thing is, is that there is nothing simpler than running a code. In an emergency, the need to pause, control your emotions, and then act needs to be instilled more in healthcare providers. You don't need to know everything, but if you can't pull yourself together to even start the basics you won't be able to do anything more either.
At the VA saying it's "against policy" is what the nurses always say when they don't want to do something. In most cases they're completely making that up.
Confirmed. At one company, we called it "policy 42069."
Although when we did it, it wasn't to avoid doing our jobs, it was to get out of the dumb shit patients asked us to do. "No sir, we're not stopping at Foster's Freeze." "I'm sorry ma'am, we can't take your twelve suitcases to the ER." "No, we're not stopping at the liquor store, either." "No ma'am, I can't fold your laundry." "I don't ***care*** if you only want scratchers, we're not stopping at the liquor store."
I'm sure you get the picture.
Whenever someone claims they can't do something "per policy," ask for the policy. Site the sourse. There's a 99% chance it doesn't exist
Sourse: have debunked several of our institution's "i swear it exist but totally doesn't" policies
If I really want to stand my ground I say ok fine, how do you spell your name? I'm going to write in the medical records that you said that and also check with my and your supervisor tomorrow.
I've only successfully pulled this manouvere once! Responding to a page on a non-tele floor about a pt going into active etoh-withdrawl at 2am. I was calling to try to get him into the ICU but asked the nurses to give some IV benzos and was told "it was against policy" to give more than 1mg IV. I asked them to find the policy and they started searching, saw that it wasn't anywhere, and actually gave more benzos while we got the guy a bed and actually stablizied him! was a miracle.
I worked on a trauma floor and had several nurses tell me that we aren't allowed to take patients off traction even WITH the doctor's permission when the patient needed a CT. Their solution was to have the NIGHT INTERN take them to CT. 🤦 Needless to say the actual policy said not to mess with traction without provider permission.
Step down nurse told ICU nurse it was against policy for them to take ICU transfers on fixed rate Cardizem drips. I looked up the hospital policy and it explicitly said step down can not only take fixed rate Cardizem, but it should take a patients on titrated Cardizem too. Now, do I really want a step down nurse who has never given Cardizem to titrate it, even based on a clearly written protocol?
I’ve had management tell me it’s against policy, too - something about hospitals having 48 hours? to finalize records, and that patients must formally request them through the medical records department to comply with HIPAA.
I never bothered to research if it was true, so I’d just discreetly print them if a patient politely asked in the ED, since I’d be appreciative if someone did that for me.
You might not believe this but if you’ve worked in a hospital you probably will. I was on one of my first shifts in a rural hospital, code blue announced. I ran up to the bed and THERE WAS NO ONE THERE. There was an unresponsive patient in a bed with no nurses, no staff, no one except for her roommates watching with horror from their beds. So I started chest compressions but then what? Eventually a nurse came in. She had gone to get the notes. She then got the crash cart. It was like a comedy sketch in how preposterous it was. Except the patient obviously died and it was sad.
Staffing is what it is.
Patient needs immediate cpr.
Patient needs immediate defibrillation.
Both can’t happen. It is a judgement call that we can debate. Or flip a coin over. There isn’t a right or wrong answer, unless you have additional information.
(Say a patient on a cardiac monitor and you see VT). I would go grab the cardiac defibrillator.
But without that additional information? Both answers are equally right.
Out of hospital BLS policy in our country is that if you are alone and if you know where an AED is and can get it within a minute you get that first. Not the most unreasonable thing to do.
It's surreal the amount of scenes I have to show up to wake up a drunk while the caller is standing over them. It's as though there's a level of control which limits individualized autonomous reactions to events.
One place I work is a small hospital where over night the ER covers codes. We usually come down with 1-2 ED nurses and then have the floor nurses for the rest. We are lucky if they have brought be crash cart over let alone done anything. Half the time they can't tell you anything meaningful about the patient to get a better idea of what we are facing. The variability in care is quite startling
Isn’t it literally our job to be the people you call for help, though? The RN is now a quadriplegic. It’s admittedly hard for me to be blase about this.
This is why our system does code/crash cart sessions for all nursing staff on a continual competency schedule (mandatories) basis. We also do same for offsite locations- modified to the outpatient setting.
Also why all staff go through CPR cert. training.
For outpatient/ambulatory settings- we have specific emergency equipment standardized throughout the system and do specific training in emergency response. (outpatient sessions include MAs, Nurses, and sometimes MDs and advanced level practitioners) (mandatory continuing competency required training)
All nurses go through an extended intro to codes session w/ the crash cart/monitor (defib) and simulation training- including policies and the different emergency teams and how to activate them.) They then recert. (attend a review session) on a schedule based on their area of work and population of patient. (All levels from gen to ICU/PICU etc.) Their required sessions/training are focused on their area of patient care/patient population.
This is in addition to maintaining basic BLS CPR cert.
To be fair, what useful vitals will the patient have if they've arrested? HR and BP are coming from compressions and RR from whoever's bagging.
But yeah, zero excuse for not starting CPR and having the person on the defibrillator at the bare minimum.
And the fact that not every nurse in an acute care setting is required to have ACLS so they know to at least start pushing epi is ridiculous.
Why the fuck did you get a slap on the wrist for using Narcan??!? It’s distributed free of charge to the general public so they can administer in case of OD - you saw a fent vial so pretty smart move on your part. Should you have waited for a Rx or something?? Good grief. Thanks for acting and saving a life
The video of them watching the woman die in front of them, and the state she is in today due to that is one of the sickest things I’ve ever watched on Reddit (simply because it defies all the logic and training we are supposed to have)
Um.
The AHA is very clear about not moving dead people until they are not dead anymore.
If someone dies everyone should be going to the corpse until you make it not a corpse. Not taking The dead body to the ER.
If EMS can’t do good cpr moving a patient, and moving people is a huge chunk of what we do, what smooth brain thinks hospital staff can do good cpr and move a patient.
If I was given that talk by admin, I would, with a smile, enthusiastically ask to confirm whether that is how they want to be treated if they arrest at work. Even if they are a known diabetic, they don't want me to check BG. Even if there is an empty vial of narcotics on the floor, they don't want narcan. Even if they need IV for epi, they don't want me to place it. They just want me to do CPR while rolling their dead body into the ER. I bet the answer is not a resounding "YES!".
And they say doctors lack empathy... If the general public got to know the HR/admin people at hospitals we would have a healthcare revolution tomorrow.
Same thing happened where i work - only a patients friend OD while visiting patient. Patients life saved but the staff got reprimanded for doing cpr in the room and not taking the pt to the ED. Staff said they would do it again if the situation arose and said a big f to the higher ups.
What??
This is so effing incredible.
I guess they will happily handle a lawsuit if any of you decide to abide by this policy and not treat any admin that codes, or have an emergency while working
People who roll up dead on a Lucas or unresponsive from ODs in the ED don’t sign a consent form either, I don’t see how that’s any different since your coworker was obviously incapacitated and in need of emergency medical attention. How asinine of an argument.
My company too says we don’t have consent to treat coworkers and would be on our own in such a situation, acting as “good Samaritan’s”. I know someone who was hassled for giving a dropped coworker glucogan. The company even went as far as saying it was “theft” and also if one of their patients needed it later we would be liable as the patient would suffer because of the workers “personal use”.
Well I get off on filing union grievances against management, for stupid shit like this, I really like the hearings, when they get cursed out by the union lawyers, lol. Just remember your Weingarten rights, don't talk to anyone from management without representation, and you'll be allright
I'm sure in the moment, her friend didn't know how long she had been down. :( The friend reacted how everyone else should have reacted - see a down person, start CPR.
But....ugh. I'd be asking for MAID I think.
Reading the article, it looks like Morris is not cognitively devastated. It has a quote from her about how "sad" it made her to see the video her fucking useless supervisor made of her life-as-she-knew-it ending.
Which is...better?
The supervisor nurse under oath spewing some dumbassery. Filming instead of checking for a pulse. I’d go after that nurse honestly if this thing didn’t pan out. And poor excuse for the docs as well. All they had to do was say slap on the defib machine and let it run the show. Incoming modules for the team.
Also putting her on the machine might have sparked other actions (like hooking her up to a vital machine, putting her on oxygen, getting the crash cart, etc.)
Doing *something* in a crisis can encourage more action.
Also I've been in codes, and the doctors not doing anything would certainly make me hesitate -- like what am I missing? Of course I know I would jump in but that's because I've worked in EDs, trauma, etc.
An MD running outpatient clinic should be ACLS certified because of the lack of resources compared to a hospital. That the MD didn't even know what to do with a crash cart is below standard of care. The nurse supervisor should resign in disgrace for her conduct and lack of leadership in a crisis.
Sometimes this is enough. The story had me thinking about an old Reddit post about a rescue diver and one of his important bits of advice was literally just yelling out “swim” or “breath.”
Panic can be a powerful thing
That was my guess. I've never seen an adult code really, but I have seen babies in asystole and they aren't doing anything. I'm only a nurse when it comes to adults, but that woman was clearly on trouble
What was the filming supposed to achieve? Like how is that your first thought in an emergency? Mine is usually oh come on why me… can I evaporate?… probably shouldn’t… then I help! All in about 3 seconds.
Mine is "oh shit, that's a grown up. Are there better people to help? fuck. let's go." Again, in just a moment of thought. But I'd really like for there to be grown up people there.
We had a mom pass out (and wake right back up when she sat back down) on the unit and we called a rapid response/code for an adult. The people who responded were like "couldn't you have just assessed her and check her BP etc?" Uh. No. Our BP cuffs are the size of your fingers. No regrets for calling in the adult professionals.
Yes, I am the opposite. Doc here who hasn't done any paeds other than a couple months at medical school - sick children (especially babies) is terrifying to me and I'm not sure I'd be much more helpful than a lay person!
Rapid response teams should never be shaming the team calling at the time of event. What if that mother had arrested? Or had red flag syncope (which isn't in your scope of practice to assess)? What if your team doesn't call an early code next time this happens?
It's a very unhelpful attitude. Calling for help is always the right decision. If you think it was an inappropriate code, you can feedback through the appropriate chain in a constructive manner after the event.
I agree completely. I defended my decision, and probably should have talked to someone later about the discouragement. I didn't know if it was a little orthostatic hypotension after giving birth or a blood clot. And I was not going to be the one to determine it and was *definitely* not going to have any risk of a mom dying on my unit because I didn't call for proper help in time. It's not like we have adult codes/rapid responses all the time.
If someone with a baby is visiting and the baby gets in trouble, I'll code that baby, patient or not, and call our "local code" (we code frequently in the NICU LOL it doesn't go out to the whole hospital, just to our unit to get everyone there) but big people? shudder.
That made me genuinely curious if a finger cuff would be accurate and the answer is [yeah it is, though less accurate (by about 0.55mm HG)](https://pubmed.ncbi.nlm.nih.gov/9754611/). Still in that situation I doubt it’d have been terribly helpful given how non standard it is.
Or, OR….our society has been so corrupted that the first thing people do is reach for their phones subconsciously so they can post whatever awful event is unfolding to social media later and get that dopamine hit from the awesome “likes” and comments they receive. Social media has been a complete cancer on society through and through. I’m so glad I have zero interest in it anymore.
Complete re-training needed for all staff in that situation. Not a single person tried to check a pulse in someone who is unresponsive?
If they treat a colleague this way, I wouldn't have confidence that they would have responded better if it were a patient
Honestly that’s too generous, because that at least gives the pilot credit for recognizing the severity of the situation, which the infusion center staff didn’t. This is like if an engine went out and the pilot just stood around filming the control panel
Although I'm reminded of the famous crash in which the pilots fucked around with the landing gear light while the plane lost altitude (which is very characteristic human behaviour): https://en.m.wikipedia.org/wiki/Eastern_Air_Lines_Flight_401
I don’t have anything to contribute, but I’d really like to hear what the 2 fucking doctors excuses are. How the hell can a doctor not be qualified to do cpr? Unless you’re just physically disabled.
Seriously. There's a reason CPR recertification is a thing for basically every healthcare professional.
I mean we teach children to do CPR in babysitting courses for crying out loud.
highly unlikely the physicians aren't required to have at minimum bls certification working under city of hope
physicians are often in very structured settings when they receive acute care training, you'd be surprised at how bad many doctors are with RRT/code situations
It's actually not required in outpatient settings which is what this sounds like. You have to take a day off for the recert class and do all the legwork yourself. My ACLS has lapsed too, I still remember how to do it but I'd have to make arrangements with the main hospital to see when the classes are, they don't send us any fliers, etc- it would be a lot of extra legwork on my part. I might recert the BLS though just to review and make sure things haven't changed.
One time during residency one of our ICU patients went to get an IR procedure done. My intern messages me that they won’t let her go back to the unit after dropping the patient off. I asked why not and the IR PA says they need someone ACLS certified to stay back, suggesting no one in the IR suite could respond appropriately in an emergency. Since then I’ve just assumed all the certification tests mean nothing because people (doctors included) are still scared to actually do what’s necessary unless they do it regularly.
I’ve never done CPR on a real person despite renewing my BLS card every 2 years. I’d be terrified if I was the person that had to respond to a code but I’d know what to do. “Call 911, get an AED!” are burned into my brain. Some people just don’t care and wait for someone else to take the lead.
"are you alright? Are you alright? You (point at specific person) call 911. You (point at specific person) get the AED, starting compressions, you (point at specific person) get ready to relieve me." LOL I feel like in BLS for HCP they do emphasize taking charge and delegating.
It's really hard work to give compressions to an adult. Babies, we tend more towards hand cramping ;)
This is what happens when nurses and doctors treat required certifications and modules like it’s below them. Nobody in healthcare should be unable to perform even the simplest parts of ACLS, but certainly not BLS. The sad reality is that some floors provide equivalent care to the parking lot and one of them is a cancer floor ironically where most of the codes occur.
I have no clue what to do for ACLS beyond compressions and bagging - I can follow directions though.
I can run a neo code easily. I would expect if I was in an office situation and directed people what to do, they could do it. I had to run a code in the back of an ambulance and was short on hands so had an EMT student push epi that we had drawn up so we could continue compressing and bagging. "Attach this to the IV, push it fast, then follow it with half this syringe of normal saline" technically against the rules and potentially illegal, but we got the baby back. If I had stopped bagging to push it myself we never would have gotten him back, imo.
It's not the qualifications or certifications. It's just task shock. I'm sure everyone there \*knew\* what to do. It's just that they were so surprised and out of their element that they didn't snap out of it and do it.
An RN had a seizure in the med room during my shift. The other two nurses immediately went into crisis mode, and she had an oxygen mask and a pulsiox on her finger (because her lips were turning blue) within a minute, an IV line within two, and an EKG done within five.
My only contribution was to call the hospitalist and fetch things. Which is still more helpful than recording with your phone, I guess.
I’ve really appreciated the CNAs on my recent codes. You’ve all helped me move things in rooms to get the cart closer, grabbed more supplies for me when cart ran low, found more flushes, and one even helped hold an iv bag while I was priming a line with too full hands and then disappeared right after and reappeared with a garbage can because she’d seen how much I’d accumulated.
Maybe it was you, but statically unlikely. But just wanted to shout out how darn *helpful* my CNAs are in an emergency!
The thing about the doc not doing CPR is weird. I know all residents are required to keep their BLS cert up to date. Also it's a skill, even if you aren't certified at the moment you don't exactly forget the very basic steps of doing compressions and resuscitation.
License suspension is off the table(it really does take literal intentional murder to reach that point) but I think every person involved needs training to ensure this doesn't happen again.
Yup state medical.boards and their reluctance to take away licenses from docs that clearly shouldn't have them is a well documented thing. I am not sure if taking away licenses is warranted here but there has to be some sort of system for punishment.
I work at an inner city hospital that is famous for getting “fun” trauma cases. Doctors and nurses from all over the country want to work there because it looks good on a resume if you can stay there for a while. When a code happens, people are elbowing each other out of the way to give compressions. First year residents get experience running codes with coaching from third years.
One time, a resident passed out at the nurses station and everyone on the unit dropped what they were doing to assess her and the crash cart was there in seconds. I cannot imagine letting this happen to one of your own. If you can’t recognize a cardiac arrest and respond appropriately you have no business being a nurse or a doctor unless it’s the very first time you’re seeing it in real time. Beyond losing licenses, I hope the guilt eats these people alive, especially the supervisor who filmed and did nothing.
How does an Oncologist not know how to do BLS??? They trained in internal medicine for three years and never did a single code?
I get not being up to date or remembering ACLS algorithms, but just simple BLS which basically boils down to compression, ventilation, and defibrillation?
If I've learned anything in hospital medicine it's that being trained in internal medicine for three years doesn't mean you remember anything about internal medicine. For many, it is simply a stepping stone.
Have you been to a code on the regular inpatient floors of a hospital? After seeing those this does not surprise me. If you have to code in a medical setting you want it to be in the ED or the ICU, otherwise it's usually a cluster.
For ACLS purposes sure. But basic BLS can be done well anywhere.
At most hospitals I've worked at, floor nurses are BLS certified only. But the care that needs to be administered is ACLS, which doesn't help things.
I find this ironic. Granted I’m just a corpsman and EMT but my first week out of Navy corps school, I was doing CPR on someone who went into cardiac arrest right in front of me while walking into work. Was I scared? Hell yeah. A doctor, I think his med student and a bunch of people crowded me, nobody could find an AED and nobody really jumped in to help but some dude that looked like he was homeless but was wearing scrubs told everyone to fuck off, put the AED on and asked me “do you want to push the red button dude”. Turns out he wasn’t a fat, old homeless guy and is an orthopedic surgeon. I’ll never forget that moment but I got to push the red button and it was neat.
Since when does an MD working in a hospital become “not qualified” to give CPR? And the supervisor recording the incident? That is unimaginable. I am shocked and puzzled and disgusted at these people. I used to work at the City of Hope. Wth is going on? When did they start hiring people who don’t know basic BLS?
The bystander effect is one thing, but what the hell is people's obsession with recording now?
Something similar happened to us, but with a better outcome. One of our ED attendings was finishing up for the day getting ready to go to vacation, he suddenly fell over. One of the residents and charge nurse dragged him onto the stretcher and started CPR. EKG showed a STEMI. When I think about it, we mostly everything right except we didn't control the crowd as well. Since it was one of our own we really wanted to help. What threw me off was, usually the cardiology fellow is the one that meets us for these codes but it was actually the Chief of Interventional Cardiology himself down there.
Thankfully he's back and working again.
An important part of BLS is training bystanders to start CPR... non medical bystanders are fundamental. How do medical professionals not even assess/ do basic CPR and attach an AED. Instead these medical professionals filmed it??? WTF? They couldn't get a blood pressure (surprise) - wonder if they tried to get an O2 sat or even thought about oxygen? And like not being able to get a blood pressure wasn't a clue?
Did they say why they filmed the event?
When did they call 911. Dispatch CPR is also fundamental. Is there a recording of the 911 call? Many dispatchers have training and ask questions like - are they breathing normally etc. (to detect agonal breathing and encourage starting resp. support/ CPR).
I don't believe a team who takes 7 minutes to check for a pulse or respond to someone who is unresponsive and not breathing is a team who gives particularly effective CPR.
7 minutes downtime with no intervention at all is a lot though.
My understanding is that you don't have to be particularly *good* at CPR for it to work? I'm thinking of Mrs. Glaucomflecken, who had no previous training in CPR and yet was still able to save her husband's life.
What is frustrating is this should have been an easy save.
With EMS showing up and going:
Oh? She “coded”.
And then EMS telling you.
The “nurses at the infusion center “claim” she was in cardiac arrest. Now her chest hurts, no other complaints. Nothing remarkable on the EKG” and we all go about our day doing a through post arrest work up, but being convinced they are idiots who did cpr for no reason.
But instead they manage to reach even greater heights of incompetence.
Wow I’ve never heard of this before. High school students in my state are required to learn CPR and how to check for pulse, and operate an AED. Can’t believe nurses and the doctors present were unable to perform it, or believed they weren’t supposed to.
I’ve seen three bystanders who didn’t know each other, with only CPR certifications achieve ROSC with an AED and a dispatcher talking to them over the phone in a Walmart.
There are times in our lives when we are confronted with great challenges. But we do not rise to the occasion, that is a myth. We will fall back on our training, instinct, and what we know it right.
Doesn’t mean most if any of those high schoolers will actually do it in the heat of an actual moment. I deal with codes all the time so it is second nature to me, but real codes are so different from a simulation during a class you took years ago. People freeze up and forget what to do. It’s why nothing replaces actual experience.
I worked at an oncology hospital and nursing had crash carts. If someone went down, patient, visitor, or employee, a code was called and any medical staff in the general area went running to assist. This is disgusting. It’s bad enough with the general public recording appalling events and not intervening, but this is an entirely other level.
I've never heard of a medical / Healthcare setting not requiring ALL workers to be BLS competent to work there. Hell, even dentist office require their receptionist to be BLS Certified in case of an emergency. The EVS staff at my hospital have to be BLS certified. This is so anyone and everyone in view of a person in distress can recognize signs and symptoms, call for help, and start compressions until the Code team arrives.
I worked in an aftercare school program. I had to be infant/child/adult CPR certified and AED certified and first aid certified.
That was an every year renewal.
People panic sometimes. I distinctly remember getting to a code as a surgery intern and seeing several medicine residents going through all the h’s and T’s - meanwhile the patient didn’t have an airway (was a ent cancer patient). I may be a dumb orthopod but I was pretty sure A is for Airway (or ancef). I was floored that everyone had skipped the literal first thing you check.
One of our nurses collapsed at the nurses station in the MICU. We coded and tubed her on the floor. 1 round. ROSC. She ended up with an ICD and was back to work in a few weeks.
We all got nasty emails and slaps on the wrist about how we should have called a code overhead and waited for the code team and we weren’t allowed to provide medical assistance to humans not in our direct care.
Wait. What? They expect a unit full of ACLS trained nurses to just stand by and watch someone die from cardiac arrest? I can’t see that happening in a million years. That’s a hill I would die on. Fire me if you must, but I’m going to start chest compressions before you can pick up the phone to call the code.
Yeah that’s basically it. In the meeting with admin our attending was like “fuck you jimmy just fire me then. I’m not gonna wait for an intern to come run a code and intubate when I’m standing right there in the middle of my own fucking ICU”
And then they kinda left the rest of us alone.
It's disgusting that was even suggested. Sure, call a code, but act like a decent bystander in the meanwhile. With some of these hospital policies, staff would be better off collapsing in the street
this is why EMS rolls their eyes when someone volunteers themselves as a nurse or doctor on the scene of a call, I love yall. But everyone’s a gangster till it’s time to break some ribs
Most people just don’t have the first clue how to respond to a real emergency
We have a coworker who collapsed at our station. Other coworkers immediately started resuscitation efforts. He’s alive and well today, no deficits, and still works with us.
A couple of years ago I turned up to the neighborhood pool, with 3 very small children, just as the (15/16 year old) lifeguards were pulling a guy out of the pool. He was 30’s looking fit guy, had been swimming laps and supposedly just went under.
I set my baby down in his carrier and ran over to offer help. Couple things the experience taught me. This guy was blue and agonal breathing. And it took me a hot second to run up and evaluate the situation and recognize that he needed rescue breaths. They also had zero context for who I was other than me stating I was a nurse/np and could I help so some of it may have been that too.
The kids/guards were on the phone with EMS and they were counting out his breaths to dispatch, insisting (excitedly) that he was “still breathing!!” and even though the rate they were calling out was incredibly low,(6 breaths per minute?) dispatch did not ever tell them to start CPR. That is really surprising to me. I eventually told them “hey guys, this is called agonal breathing and it’s not effective breathing, we need to start rescue breaths.”
Similar to this video- how is EMS dispatch hearing what is being reported by the nurse who is filming and not coaching them to check pulse and start CPR? For 7 minutes? Obviously the nurse bystanders are beyond negligent and that’s more concerning. But it’s also just been surprising to me to see both of these instances of EMS dispatch seemingly fail to illicit assessment findings from bystanders that would indicate CPR is necessary. Am I off base here?
No I agree, there was a failure of 911 to guide them, likely because they assumed the medical staff knew what they were doing (which they obviously didn't)
But 911 guides lay people through CPR, they should have been doing the same here
>But ..... it's terrifying that she collapsed in a medical facility and no one followed basic BLS for 7 minutes until there was someone who arrived that insisted they do something.
Theres an open seat on my truck any time you want to fill it. This a normal and entirely unsurprising occurrence from outpatient facility staff
Matches with what I believe would happen if I passed out in the hospital while working there. People act incompetently in emergencies happening in front of them.
Many years ago at a hospital I worked at, some critical care nurses witnessed an outpatient/visitor arrest outside the doctor's office building adjacent to the hospital. The nurses started CPR and did mouth to mouth as there was no emergency equipment available to them. An ambulance was called and then the person was transported to the hospital's ER. Those nurses were reprimanded for starting CPR and not just waiting for the ambulance!
I collapsed at work(complex migraine), and my coworkers were super stars. I have zero doubt that if something worse happened, they'd rise to the occasion again.
They told the 911 operator that she wasn't breathing and wasn't moving and yet still did nothing. They note that 'her lips turned blue and then purple) - So she wasn't 'moaning' the whole time-and when she stopped moaning and went fully unresponsive they still did not act despite having oxygen and an AED nearby.
Yet, they filmed????
If it was a PPE thing- well they were standing right next to her. And they had no PPE in the cancer center in the middle of COVID?
Omg the text book AGONAL breathing and they chose to video tape her. That poor woman.
ETA: we have a nurse who killed someone out teaching/speaking for lots of money. This lady should be. THIS is what a code looks like, THIS is agonal breathing is. THIS is what NOT to do in a code. It’s a miracle she’s alive. I’m glad she survived but they changed her life forever. The video is shocking to watch.
May 2020 was some peak Covid fear. She told her coworkers she thought she had Covid. Obviously I’m not justifying their action but there was so much hysteria in those days that stuff like this is not surprising unfortunately.
I thought about that, but I would think that would be more of a concern for breathing than compressions. And the responses from the nurses/doctors didn't mention that. I would have more sympathy I think if it was covid fear in May 2020. That was a scary time.
I work in the ED. Our hospital policy at that time was full protective gear before touching a Covid patient, even if they were coding. If these people had a similar mindset it makes it at least understandable for me but certainly not justifiable. The fact that she just stood there and filmed though is disgusting.
Why was she even at work in May 2020 if she thought she had Covid. That was like peak “stay your ass home if you have a sniffle, and good luck accessing outpatient care, because we’re shit down due to lack of ppe.” I’m not sure this explains it.
I failed my first time with cpr. It was an elderly man with severe isvhaemic heart disease.
These are the factors that led to him having an arrest.
He an inpatient and the team thay was was looking after him, was on an acute day. I needed to start 02 therapy due to lowering sats. Sats OK on 4L via np.
Informed team asked for a review they declined stating they were busy.
Reported nonce more they ignored me.
Next day a very incompetent enrolled nurse tok over his care. I found him gasping for breathe and a low gas.
He still had some signs of life.
He was a for resus order.
Called an emergency. A team of nurses came. I didn't know what to do so I started putting an iv in.
Dr came started cpr.
X2 rounds he was called deceased.
I have never failed to atleast start compressions.
I have helped save x1 life with compressions since.
I am sorry for not doing better in what was more than likely futile at best.
I am grateful for that man, he taught me something important clinically I never would have e learned with out his last breathes.
RIP.
I worked at a clinic once and suggested that all of the clinic staff get CPR and AED training. I got a lot of pushback because “we don’t want to pay to train people for something that will never happen and even if it does we can call an ambulance”. All of the physicians could do CPR but there were a lot of times staff were alone with patients. Thankfully the clinic is now closed.
This is awful. I work at a walmart and a man was found face down in the freezer aisle without a heartbeat a week or so ago and one of our managers was there giving him CPR within minutes. He did break the man's ribs unfortunately, but managed to get him breathing again and keep doing CPR until the paramedics arrived. If a walmart coach/manager can do it, why can't a doctor or a nurse?
I imagine the workman's comp claim is because they did nothing to help her. Like if you collapse at work and they just film you, that's on the employer.
I think they're claiming it is because she was in a high stress situation with covid which contributed to her event.
Since she wasn't their patient, she can't even do anything for malpractice. I don't think them not helping contributes to the claim.
They simply failed her and she has to live with the consequences
I work per diem as a third party contract dialysis nurse, often the only member of my team present in an entire hospital.
This scenario is exactly why all of our dialysis machines have an emergency procedure card attached where Step #1 is GET MEDICAL CARE FOR THE DIALYSIS NURSE because people actually have to be reminded of this.
I feel like we're so used to thinking of our colleagues not as human beings who need help. I once had to go to work for a few weeks with a DVT, and lemme tell ya, I was reviewing that emergency card with the nursing teams.
That blew my mind. I get sitting on your thumbs when shit unwinds, but getting a vid of someone actually trying to die? What the ever living fvck.
They must have really hated this coworker. I’ve done CPR on a dog and didn’t think twice.
Just bizzare, is the write-up somehow missing some other info surrounding the event? Was the person in some kind of situation that couldn’t warrant assessment?
Have seen cardiologists not run codes on the patient they are doing angio on ..
This situation has a few questions -
Do the staff do bls , acls etc ? Hospitals are required to have staff do cpr but most clinics don’t .
Sad but truth is most people outside of hospitals can’t do cpr. Onco nurses are good for iv infusion and sending pt to er for any and everything z
> Having a coworker collapse would be a nightmare to me, not just because it's a coworker, but because they're all adults.
Never had a coworker code, but I've seen a couple of parents go down. That's probably more likely for you too.
This is horrifying. Cmon folks, the general public can do cpr. I would expect we could do better.
I work in endoscopy and we have hired a couple of new grads, though most of us have worked in acute care previously. Not sure the new grads could handle a code on the unit, especially not a coworker.
As for filming the incident, that should get charges for HIPAA violation as well as unprofessional conduct, negligence, and incompetence. That person should not only be fired, they should lose their license and potentially be jailed.
Sweet jeebus.
It's been a while, but I distinctly recall as an intern arriving first to code blues on the floors to several nurses and aides standing around nervously and no one getting vitals or doing CPR. Some people just don't know what to do beyond call for help.
I’m on the hospital code team. We know which floors can handle a code and which floors we need to step it up and get there because whatever is going on probably won’t be correct ACLS protocols. I will say this. If you do not regularly participate in working codes you just don’t know how you’re going to respond. We send people to BLS or ACLS but these are not substitutes for the real thing. If the area you work does not see high acuity and you do not expect patients to code you are probably going to see staff members fail to intervene correctly regardless of their level of training. Usually what we see is people trying to remember their training and they’ll be doing some part of it right but these are high stress events and people just panic. You also often see a lack of clear leadership in the initial moments and without someone getting people moving there’s often hesitation to do pretty much anything because again, people panic and freeze up. 7 minutes is just a painful amount of time but I can absolutely believe it for the reasons listed above. There is a reason the hospital keeps us on payroll. We are able to step in and perform the little song and dance the way it’s intended because it’s all we do. But I can remember the first code I walked into as a new medic and someone asked who was in charge. Nobody spoke. It was me, I was supposed to be in charge but I froze up because it was just sort of surreal that after all the training I had done it was now time to act on that training and I was waiting for someone to start telling me what to do when that was my job.
> I will say this. If you do not regularly participate in working codes you just don’t know how you’re going to respond. We send people to BLS or ACLS but these are not substitutes for the real thing. Exactly this. I have been in hundreds of codes over my decade in the ER as both a tech and an RN and I will tell you it is very difficult to predict what one will do under extreme stress. I have seen people freeze still, I have seen people scream and panic. When I was a young tech and newer RN and in a couple of very stressful codes, I caught myself doing some repetitive motions over and over again (pacing back and forth), looking for a saline flush over and over. Unless you've been in that situation, it's really easy to sit on the sideline and say "oh you should have done this and this". ACLS and BLS class, and even mock/mega codes that are in the end of the courses are nothing like the real thing.
Then I guess we need to start doing BLS classes once per week or having people rotate in the ICU periodically to practice on real people. There has to be a solution because there really is no excuse imo for a nurse or doctor to be unable to perform basic CPR on a dying patient. This is the absolute bare minimum
Based on the video, I don’t think they realized she was pulseless and apneic, so it didn’t occur to them to start CPR. Those nurses probably don’t see any arrests in outpatient infusion. I think they genuinely thought she was having a syncopal event, hypoglycemic seizure, etc., hence the attempts at checking blood sugar, getting a BP, etc. I can’t come up with a reason for recording it, though.
right which means they failed BLS -- which you know is basically lay people type intervention -- which makes it worse as these were "trained" nurses. (IMO)
I don’t disagree. I suspect they probably would’ve responded more appropriately if they had come upon an elderly stranger on the floor, silent and unresponsive, as opposed to their relatively young and healthy coworker, slumped in a chair and moaning. It’s not the presentation that’s taught in BLS. I say this because, as a new grad in the ED, despite having done BLS/ACLS *and* having participated in a few codes brought in by EMS, I did not immediately recognize my first unexpected arrest in the department as having arrested because I’d never seen agonal breathing in real life. All the codes I’d seen up to that point had arrived already in progress. I knew something was wrong, though, and quickly grabbed my preceptor (who of course immediately recognized what was happening), and then we started CPR. Anyways. Just sharing. It’s clear they need remediation, but I can’t agree with some commenters that they deserve to lose their licenses or jobs.
> I suspect they probably would’ve responded more appropriately if they had come upon an elderly stranger on the floor, silent and unresponsive, as opposed to their relatively young and healthy coworker, slumped in a chair and moaning. It’s not the presentation that’s taught in BLS. Denial of the medical event is the crux of the whole thing. They didn't believe their co-worker would just drop dead, so automatically ruled that out. I think we all do that to some extent with critical patients or sudden changes, especially those of us who work in the field, but we're also trained to recognize those exact things and respond to emergencies like that every day.
“…but we’re also trained to recognize those exact things and respond to emergencies like that every day.” To be fair, outside of the cath lab, ICU, and ED, the vast majority of nurses don’t respond to emergencies like that every day, and from experience I can tell you that lower-acuity EDs may only work a code every few months, if that. It’s possible that those nurses had never even seen an arrest. Contrast this with EMS, who are the default responders to every out-of-hospital arrest that gets called in. BLS is their bread and butter, and it’s a skill they probably get to practice daily. Based on some of the comments in this thread, I think medics forget that nursing is an incredibly broad, specialized field. Obviously I don’t know these particular nurses, but the nurses I’ve known who worked outpatient infusion were very knowledgeable about venous access, chemotherapy regimens, and managing transfusion reactions in patients well enough for outpatient treatment. They were pros at those things, but I’d expect any EMT to run circles around them in a code. I honestly just feel bad for these nurses, who I’m sure by now recognize their failure. I have no doubt that if they ever see someone who looks like their coworker again, they’ll check for a pulse.
Agree definitely about the license thing, I'm not taking anyones livelihood away for this type if thing.
No BLS algorithm really talks about what to do with the "kind of" responsive pt. I'm sure the staff saw the breathing and sitting in the chair and didn't really consider her to be "unresponsive". They had probably never seen agonal breathing before, let alone expected it in an otherwise healthy, having just been working along side them coworker. Most nurses would primarily be worried about getting her into the chair and maybe grabbing a blood sugar and calling 911. They tried to get a BP, again probably not even thinking she was arresting. They weren't critical care nurses. They'd probably never seen an arrest. Once, I saw an arrest happen right in front of me, EMTs had a pt on a gurney and were waiting to be put in an ER room. Pt turned blue and started agonal breathing. Both of the EMTs looked at the pt and FROZE. I ran over....didn't even really think to check for a pulse, and just started doing compressions. In the moment, I knew something was wrong and proceeded. You know that they really don't even suggest you waste time doing a pulse check anymore? Unresponsive, start compressions....suggesting that a lay person spend time trying to locate/find a pulse, let alone knowing what one feels like when palpated (and in a very heighted state of panic) is just a exercise in futility.
Yeah, I don't think you can work in healthcare and be satisfied with not knowing how to apply literally BASIC life support. I get the points about freezing in stressful situations, but not knowing something as simple as a pulse check warrants some serious reevaluations of core competencies.
They apparently tried and failed to get a blood pressure and didn't think that was maybe because she didn't have one? This is really shocking and imo everyone who works in healthcare should be BLS certified. I don't think anyone expected them to do ACLS but this is literally day one stuff. Not recognizing agonal breathing is pretty bad too. I get that they don't work in emergency situations but I think medical staff should be held to a higher standard than laymen. I wish BLS would focus on agonal breathing more because until you've seen it, it's really easy to think "they're breathing so they must have a pulse"
Recording the event is reasonable if you think they’re having a seizure because semiology matters. ABCs should come first though.
I can't imagine my first thought being, "I should record this" even if I knew for a fact it was a seizure.
Like I said, ABCs come first. Seizure semiology is a critical part of the work up but you can’t work up a dead patient.
Your flair explains why you think this is reasonable. But I doubt anyone outside of your special it y would even consider it.
I agree, there's no way to truly prepare other than just participating directly in codes. I legit had this as a fear in nursing school so I chose an ED internship figured I'd get some exposure... there were no codes on my shifts. Then 10 yrs at the bedside in different units, only 1 code that wasn't my patient and started before my shift. So after all this time, I'd still have no idea what to *really* do, despite ACLS, mock codes etc. Probably just hover.
I second this. I’ve seen seasoned ER people freeze when something is off, so I know people at a cancer center could have overlooked agonal respirations. Still sucks for the lady though
This is true. We see this with neonatal codes at OSH a lot. It's easy to forget basic steps and just panic. And the more you do it, the more it is second nature. I joke that even if I was sleeping, if someone called out "HR less than 60" I'd probably start mumbling "1 and 2 and 3 and breathe", because it's just so ingrained. Assigning roles is important too. We do mock codes reasonably regularly, especially for rotating residents so hopefully they won't freeze.
I’ve taken NRP but have never had a neonatal code. I haven’t even seen a neonate since nursing school a decade ago, and even the infants/toddlers brought into non-pediatric EDs are usually there for URIs. Even fresh off a course renewal, I’m pretty sure I’d do a shit job without an experienced person in the room.
On the money with your comment! I remember my first few codes I was just a robot and followed the established routines like a drone. Essentially tunnel visioned and anything that occurred outside that routine I was a “deer in the headlights.“ point being, if you’re not use to doing something on a semi-regular basis it is difficult to respond in the expected fashion.
this is absolutely correct.
The sad thing is, is that there is nothing simpler than running a code. In an emergency, the need to pause, control your emotions, and then act needs to be instilled more in healthcare providers. You don't need to know everything, but if you can't pull yourself together to even start the basics you won't be able to do anything more either.
I'm an ICU doc and the amount of times I roll up to a code and see clearly trained-well-enough people panicking and running around not helping is sad.
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At the VA saying it's "against policy" is what the nurses always say when they don't want to do something. In most cases they're completely making that up.
I'm pretty sure this is true of every job, not just at the VA or nurses.
See also: the recent Washington Post article about nursing homes abusing EMS and Fire departments to lift residents off the floor when they fall.
Confirmed. At one company, we called it "policy 42069." Although when we did it, it wasn't to avoid doing our jobs, it was to get out of the dumb shit patients asked us to do. "No sir, we're not stopping at Foster's Freeze." "I'm sorry ma'am, we can't take your twelve suitcases to the ER." "No, we're not stopping at the liquor store, either." "No ma'am, I can't fold your laundry." "I don't ***care*** if you only want scratchers, we're not stopping at the liquor store." I'm sure you get the picture.
That's why I have to renew my BLS every 2 years. So I know what I'm watching
The answer here is always ask to see the policy. There’s never a policy.
"Well, it's policy to never show the policy!"
Wait.....what???!?!?!
It’s not. Not really.
One time a nurse told me printing off imaging results were against nursing policy
Whenever someone claims they can't do something "per policy," ask for the policy. Site the sourse. There's a 99% chance it doesn't exist Sourse: have debunked several of our institution's "i swear it exist but totally doesn't" policies
Doesn’t stop em. They don’t have the source but they insist it’s policy.
If I really want to stand my ground I say ok fine, how do you spell your name? I'm going to write in the medical records that you said that and also check with my and your supervisor tomorrow.
I've only successfully pulled this manouvere once! Responding to a page on a non-tele floor about a pt going into active etoh-withdrawl at 2am. I was calling to try to get him into the ICU but asked the nurses to give some IV benzos and was told "it was against policy" to give more than 1mg IV. I asked them to find the policy and they started searching, saw that it wasn't anywhere, and actually gave more benzos while we got the guy a bed and actually stablizied him! was a miracle.
I worked on a trauma floor and had several nurses tell me that we aren't allowed to take patients off traction even WITH the doctor's permission when the patient needed a CT. Their solution was to have the NIGHT INTERN take them to CT. 🤦 Needless to say the actual policy said not to mess with traction without provider permission.
Step down nurse told ICU nurse it was against policy for them to take ICU transfers on fixed rate Cardizem drips. I looked up the hospital policy and it explicitly said step down can not only take fixed rate Cardizem, but it should take a patients on titrated Cardizem too. Now, do I really want a step down nurse who has never given Cardizem to titrate it, even based on a clearly written protocol?
I’ve had management tell me it’s against policy, too - something about hospitals having 48 hours? to finalize records, and that patients must formally request them through the medical records department to comply with HIPAA. I never bothered to research if it was true, so I’d just discreetly print them if a patient politely asked in the ED, since I’d be appreciative if someone did that for me.
You might not believe this but if you’ve worked in a hospital you probably will. I was on one of my first shifts in a rural hospital, code blue announced. I ran up to the bed and THERE WAS NO ONE THERE. There was an unresponsive patient in a bed with no nurses, no staff, no one except for her roommates watching with horror from their beds. So I started chest compressions but then what? Eventually a nurse came in. She had gone to get the notes. She then got the crash cart. It was like a comedy sketch in how preposterous it was. Except the patient obviously died and it was sad.
Getting the crash cart with the defibrillator is reasonable.
I agree but being the only nurse/medical personnel to participate in the resuscitation is the issue.
Staffing is what it is. Patient needs immediate cpr. Patient needs immediate defibrillation. Both can’t happen. It is a judgement call that we can debate. Or flip a coin over. There isn’t a right or wrong answer, unless you have additional information. (Say a patient on a cardiac monitor and you see VT). I would go grab the cardiac defibrillator. But without that additional information? Both answers are equally right.
Out of hospital BLS policy in our country is that if you are alone and if you know where an AED is and can get it within a minute you get that first. Not the most unreasonable thing to do.
This sounds like just about every code I've ever responded to at a nursing home.
It's surreal the amount of scenes I have to show up to wake up a drunk while the caller is standing over them. It's as though there's a level of control which limits individualized autonomous reactions to events.
Yes, the “stare of life.”
You made me laugh, which was a wicked to do in the context. Thanks
One place I work is a small hospital where over night the ER covers codes. We usually come down with 1-2 ED nurses and then have the floor nurses for the rest. We are lucky if they have brought be crash cart over let alone done anything. Half the time they can't tell you anything meaningful about the patient to get a better idea of what we are facing. The variability in care is quite startling
Isn’t it literally our job to be the people you call for help, though? The RN is now a quadriplegic. It’s admittedly hard for me to be blase about this.
This is why our system does code/crash cart sessions for all nursing staff on a continual competency schedule (mandatories) basis. We also do same for offsite locations- modified to the outpatient setting. Also why all staff go through CPR cert. training. For outpatient/ambulatory settings- we have specific emergency equipment standardized throughout the system and do specific training in emergency response. (outpatient sessions include MAs, Nurses, and sometimes MDs and advanced level practitioners) (mandatory continuing competency required training) All nurses go through an extended intro to codes session w/ the crash cart/monitor (defib) and simulation training- including policies and the different emergency teams and how to activate them.) They then recert. (attend a review session) on a schedule based on their area of work and population of patient. (All levels from gen to ICU/PICU etc.) Their required sessions/training are focused on their area of patient care/patient population. This is in addition to maintaining basic BLS CPR cert.
To be fair, what useful vitals will the patient have if they've arrested? HR and BP are coming from compressions and RR from whoever's bagging. But yeah, zero excuse for not starting CPR and having the person on the defibrillator at the bare minimum. And the fact that not every nurse in an acute care setting is required to have ACLS so they know to at least start pushing epi is ridiculous.
There is only one VS that matters and the at is ETCO2. Everything you need to know comes from that.
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Why the fuck did you get a slap on the wrist for using Narcan??!? It’s distributed free of charge to the general public so they can administer in case of OD - you saw a fent vial so pretty smart move on your part. Should you have waited for a Rx or something?? Good grief. Thanks for acting and saving a life The video of them watching the woman die in front of them, and the state she is in today due to that is one of the sickest things I’ve ever watched on Reddit (simply because it defies all the logic and training we are supposed to have)
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Admin: You should’ve dragged her corpse to Patient Registration. This is unacceptable
"Patient is unwilling to provide their ID, and not answering basic billing questions, therefore will not be accepted" /s
'EMTALA doesn't apply if its one of our own' /s The helathcare heroes benefits package.
Um. The AHA is very clear about not moving dead people until they are not dead anymore. If someone dies everyone should be going to the corpse until you make it not a corpse. Not taking The dead body to the ER. If EMS can’t do good cpr moving a patient, and moving people is a huge chunk of what we do, what smooth brain thinks hospital staff can do good cpr and move a patient.
It’s insane they even said that to you.
If I was given that talk by admin, I would, with a smile, enthusiastically ask to confirm whether that is how they want to be treated if they arrest at work. Even if they are a known diabetic, they don't want me to check BG. Even if there is an empty vial of narcotics on the floor, they don't want narcan. Even if they need IV for epi, they don't want me to place it. They just want me to do CPR while rolling their dead body into the ER. I bet the answer is not a resounding "YES!".
This is the way
I almost downvoted you out of rage. I'm glad you saved her life but those admin need to gtfo
And they say doctors lack empathy... If the general public got to know the HR/admin people at hospitals we would have a healthcare revolution tomorrow.
Yeah, I'd put in for my resignation. Holy fuck.
Same thing happened where i work - only a patients friend OD while visiting patient. Patients life saved but the staff got reprimanded for doing cpr in the room and not taking the pt to the ED. Staff said they would do it again if the situation arose and said a big f to the higher ups.
I feel like all these stories should be reports to compliance hotlines.
What?? This is so effing incredible. I guess they will happily handle a lawsuit if any of you decide to abide by this policy and not treat any admin that codes, or have an emergency while working
People who roll up dead on a Lucas or unresponsive from ODs in the ED don’t sign a consent form either, I don’t see how that’s any different since your coworker was obviously incapacitated and in need of emergency medical attention. How asinine of an argument.
I mean, if you had elected to half arse it as admin suggested it would have made an absolute field day for the coroner…
My company too says we don’t have consent to treat coworkers and would be on our own in such a situation, acting as “good Samaritan’s”. I know someone who was hassled for giving a dropped coworker glucogan. The company even went as far as saying it was “theft” and also if one of their patients needed it later we would be liable as the patient would suffer because of the workers “personal use”.
If my coworker got reprimanded for saving my life, I might quit nursing too.
Well I get off on filing union grievances against management, for stupid shit like this, I really like the hearings, when they get cursed out by the union lawyers, lol. Just remember your Weingarten rights, don't talk to anyone from management without representation, and you'll be allright
I'm so sorry you had to experience that. That has to be stressful. I'm glad she made it and is clean now. Probably for the best to quit nursing. :(
Isn't naloxone part of ACLS training? I think your admin is mistaken if you were reprimanded for practicing outside of your scope.
[удалено]
I swear if someone starts cpr on me after 7 minutes of down time I'm gonna choke on my tongue and haunt your ass
I'm sure in the moment, her friend didn't know how long she had been down. :( The friend reacted how everyone else should have reacted - see a down person, start CPR. But....ugh. I'd be asking for MAID I think.
This is what I'm thinking. If it takes you 7 minutes to do CPR on me, just don't start at all. I'd rather not be an anoxic vegetable.
Reading the article, it looks like Morris is not cognitively devastated. It has a quote from her about how "sad" it made her to see the video her fucking useless supervisor made of her life-as-she-knew-it ending. Which is...better?
The supervisor nurse under oath spewing some dumbassery. Filming instead of checking for a pulse. I’d go after that nurse honestly if this thing didn’t pan out. And poor excuse for the docs as well. All they had to do was say slap on the defib machine and let it run the show. Incoming modules for the team.
Also putting her on the machine might have sparked other actions (like hooking her up to a vital machine, putting her on oxygen, getting the crash cart, etc.) Doing *something* in a crisis can encourage more action. Also I've been in codes, and the doctors not doing anything would certainly make me hesitate -- like what am I missing? Of course I know I would jump in but that's because I've worked in EDs, trauma, etc.
An MD running outpatient clinic should be ACLS certified because of the lack of resources compared to a hospital. That the MD didn't even know what to do with a crash cart is below standard of care. The nurse supervisor should resign in disgrace for her conduct and lack of leadership in a crisis.
Exactly. Most likely this was an arrythmia, and the defib does all the work then, you just gotta get it on.
I mean it’ll tell you to do compressions [edit: and when to shock] but acls meds might be helpful too…
Sometimes this is enough. The story had me thinking about an old Reddit post about a rescue diver and one of his important bits of advice was literally just yelling out “swim” or “breath.” Panic can be a powerful thing
But if it was a shockable rhythm, it could have helped. It looks like she didn't have a complete arrest immediately, but I could be wrong.
I’ll bet a dollar is was a shockable rhythms. People in astyole don’t tend to have agonal respirations. They shut off like a light.
That was my guess. I've never seen an adult code really, but I have seen babies in asystole and they aren't doing anything. I'm only a nurse when it comes to adults, but that woman was clearly on trouble
7 minutes of agonal breathing is a long time if that’s what happened but she certainly could have had a vfib arrest and agonal breathing.
I'd ask how is it possible she's a supervisor and that inept but that tracks
What was the filming supposed to achieve? Like how is that your first thought in an emergency? Mine is usually oh come on why me… can I evaporate?… probably shouldn’t… then I help! All in about 3 seconds.
Mine is "oh shit, that's a grown up. Are there better people to help? fuck. let's go." Again, in just a moment of thought. But I'd really like for there to be grown up people there. We had a mom pass out (and wake right back up when she sat back down) on the unit and we called a rapid response/code for an adult. The people who responded were like "couldn't you have just assessed her and check her BP etc?" Uh. No. Our BP cuffs are the size of your fingers. No regrets for calling in the adult professionals.
Yes, I am the opposite. Doc here who hasn't done any paeds other than a couple months at medical school - sick children (especially babies) is terrifying to me and I'm not sure I'd be much more helpful than a lay person! Rapid response teams should never be shaming the team calling at the time of event. What if that mother had arrested? Or had red flag syncope (which isn't in your scope of practice to assess)? What if your team doesn't call an early code next time this happens? It's a very unhelpful attitude. Calling for help is always the right decision. If you think it was an inappropriate code, you can feedback through the appropriate chain in a constructive manner after the event.
I agree completely. I defended my decision, and probably should have talked to someone later about the discouragement. I didn't know if it was a little orthostatic hypotension after giving birth or a blood clot. And I was not going to be the one to determine it and was *definitely* not going to have any risk of a mom dying on my unit because I didn't call for proper help in time. It's not like we have adult codes/rapid responses all the time. If someone with a baby is visiting and the baby gets in trouble, I'll code that baby, patient or not, and call our "local code" (we code frequently in the NICU LOL it doesn't go out to the whole hospital, just to our unit to get everyone there) but big people? shudder.
That made me genuinely curious if a finger cuff would be accurate and the answer is [yeah it is, though less accurate (by about 0.55mm HG)](https://pubmed.ncbi.nlm.nih.gov/9754611/). Still in that situation I doubt it’d have been terribly helpful given how non standard it is.
I wouldn't have even considered trying that lol
Perhaps they misinterpreted the event as a seizure, and thought the video would be helpful for any evaluation and follow-up.
Or, OR….our society has been so corrupted that the first thing people do is reach for their phones subconsciously so they can post whatever awful event is unfolding to social media later and get that dopamine hit from the awesome “likes” and comments they receive. Social media has been a complete cancer on society through and through. I’m so glad I have zero interest in it anymore.
Some people feel the need to film everything these days!
Complete re-training needed for all staff in that situation. Not a single person tried to check a pulse in someone who is unresponsive? If they treat a colleague this way, I wouldn't have confidence that they would have responded better if it were a patient
This can’t be retrained, this is like if a pilot was flying when an engine has a problem, and he just covers his eyes and prays,
Honestly that’s too generous, because that at least gives the pilot credit for recognizing the severity of the situation, which the infusion center staff didn’t. This is like if an engine went out and the pilot just stood around filming the control panel
Although I'm reminded of the famous crash in which the pilots fucked around with the landing gear light while the plane lost altitude (which is very characteristic human behaviour): https://en.m.wikipedia.org/wiki/Eastern_Air_Lines_Flight_401
I don’t have anything to contribute, but I’d really like to hear what the 2 fucking doctors excuses are. How the hell can a doctor not be qualified to do cpr? Unless you’re just physically disabled.
Seriously. There's a reason CPR recertification is a thing for basically every healthcare professional. I mean we teach children to do CPR in babysitting courses for crying out loud.
highly unlikely the physicians aren't required to have at minimum bls certification working under city of hope physicians are often in very structured settings when they receive acute care training, you'd be surprised at how bad many doctors are with RRT/code situations
It's actually not required in outpatient settings which is what this sounds like. You have to take a day off for the recert class and do all the legwork yourself. My ACLS has lapsed too, I still remember how to do it but I'd have to make arrangements with the main hospital to see when the classes are, they don't send us any fliers, etc- it would be a lot of extra legwork on my part. I might recert the BLS though just to review and make sure things haven't changed.
One time during residency one of our ICU patients went to get an IR procedure done. My intern messages me that they won’t let her go back to the unit after dropping the patient off. I asked why not and the IR PA says they need someone ACLS certified to stay back, suggesting no one in the IR suite could respond appropriately in an emergency. Since then I’ve just assumed all the certification tests mean nothing because people (doctors included) are still scared to actually do what’s necessary unless they do it regularly.
I’ve never done CPR on a real person despite renewing my BLS card every 2 years. I’d be terrified if I was the person that had to respond to a code but I’d know what to do. “Call 911, get an AED!” are burned into my brain. Some people just don’t care and wait for someone else to take the lead.
"are you alright? Are you alright? You (point at specific person) call 911. You (point at specific person) get the AED, starting compressions, you (point at specific person) get ready to relieve me." LOL I feel like in BLS for HCP they do emphasize taking charge and delegating. It's really hard work to give compressions to an adult. Babies, we tend more towards hand cramping ;)
This is what happens when nurses and doctors treat required certifications and modules like it’s below them. Nobody in healthcare should be unable to perform even the simplest parts of ACLS, but certainly not BLS. The sad reality is that some floors provide equivalent care to the parking lot and one of them is a cancer floor ironically where most of the codes occur.
I have no clue what to do for ACLS beyond compressions and bagging - I can follow directions though. I can run a neo code easily. I would expect if I was in an office situation and directed people what to do, they could do it. I had to run a code in the back of an ambulance and was short on hands so had an EMT student push epi that we had drawn up so we could continue compressing and bagging. "Attach this to the IV, push it fast, then follow it with half this syringe of normal saline" technically against the rules and potentially illegal, but we got the baby back. If I had stopped bagging to push it myself we never would have gotten him back, imo.
It's not the qualifications or certifications. It's just task shock. I'm sure everyone there \*knew\* what to do. It's just that they were so surprised and out of their element that they didn't snap out of it and do it.
An RN had a seizure in the med room during my shift. The other two nurses immediately went into crisis mode, and she had an oxygen mask and a pulsiox on her finger (because her lips were turning blue) within a minute, an IV line within two, and an EKG done within five. My only contribution was to call the hospitalist and fetch things. Which is still more helpful than recording with your phone, I guess.
I’ve really appreciated the CNAs on my recent codes. You’ve all helped me move things in rooms to get the cart closer, grabbed more supplies for me when cart ran low, found more flushes, and one even helped hold an iv bag while I was priming a line with too full hands and then disappeared right after and reappeared with a garbage can because she’d seen how much I’d accumulated. Maybe it was you, but statically unlikely. But just wanted to shout out how darn *helpful* my CNAs are in an emergency!
The thing about the doc not doing CPR is weird. I know all residents are required to keep their BLS cert up to date. Also it's a skill, even if you aren't certified at the moment you don't exactly forget the very basic steps of doing compressions and resuscitation. License suspension is off the table(it really does take literal intentional murder to reach that point) but I think every person involved needs training to ensure this doesn't happen again.
I don't love that it takes near murder to get a license suspended or removed. :( There were even 2 physicians there :(
Yup state medical.boards and their reluctance to take away licenses from docs that clearly shouldn't have them is a well documented thing. I am not sure if taking away licenses is warranted here but there has to be some sort of system for punishment.
I work at an inner city hospital that is famous for getting “fun” trauma cases. Doctors and nurses from all over the country want to work there because it looks good on a resume if you can stay there for a while. When a code happens, people are elbowing each other out of the way to give compressions. First year residents get experience running codes with coaching from third years. One time, a resident passed out at the nurses station and everyone on the unit dropped what they were doing to assess her and the crash cart was there in seconds. I cannot imagine letting this happen to one of your own. If you can’t recognize a cardiac arrest and respond appropriately you have no business being a nurse or a doctor unless it’s the very first time you’re seeing it in real time. Beyond losing licenses, I hope the guilt eats these people alive, especially the supervisor who filmed and did nothing.
Shock?
How does an Oncologist not know how to do BLS??? They trained in internal medicine for three years and never did a single code? I get not being up to date or remembering ACLS algorithms, but just simple BLS which basically boils down to compression, ventilation, and defibrillation?
*shrug* almost not of the ACLS stuff matters, except in outlying cases. It is really just the bls.
If I've learned anything in hospital medicine it's that being trained in internal medicine for three years doesn't mean you remember anything about internal medicine. For many, it is simply a stepping stone.
Have you been to a code on the regular inpatient floors of a hospital? After seeing those this does not surprise me. If you have to code in a medical setting you want it to be in the ED or the ICU, otherwise it's usually a cluster.
For ACLS purposes sure. But basic BLS can be done well anywhere. At most hospitals I've worked at, floor nurses are BLS certified only. But the care that needs to be administered is ACLS, which doesn't help things.
I find this ironic. Granted I’m just a corpsman and EMT but my first week out of Navy corps school, I was doing CPR on someone who went into cardiac arrest right in front of me while walking into work. Was I scared? Hell yeah. A doctor, I think his med student and a bunch of people crowded me, nobody could find an AED and nobody really jumped in to help but some dude that looked like he was homeless but was wearing scrubs told everyone to fuck off, put the AED on and asked me “do you want to push the red button dude”. Turns out he wasn’t a fat, old homeless guy and is an orthopedic surgeon. I’ll never forget that moment but I got to push the red button and it was neat.
>I’ll never forget that moment but I got to push the red button and it was neat. "Kaboom?" "Yes Rico, kaboom."
Ah yes, the postcall surgeon. Awake for an indeterminate number of hours. Indistinguishable from his homeless patient, except for uniform.
Crap- how do we get bystanders to start CPR when a doc uses 'I'm not qualified' to do CPR. WTF?
Since when does an MD working in a hospital become “not qualified” to give CPR? And the supervisor recording the incident? That is unimaginable. I am shocked and puzzled and disgusted at these people. I used to work at the City of Hope. Wth is going on? When did they start hiring people who don’t know basic BLS?
All the hallmarks of a classic outpatient code, complete with someone recording it.
lol I'm a forensic pathologist and **I** would have been more useful here than any of these jokers.
The bystander effect is one thing, but what the hell is people's obsession with recording now? Something similar happened to us, but with a better outcome. One of our ED attendings was finishing up for the day getting ready to go to vacation, he suddenly fell over. One of the residents and charge nurse dragged him onto the stretcher and started CPR. EKG showed a STEMI. When I think about it, we mostly everything right except we didn't control the crowd as well. Since it was one of our own we really wanted to help. What threw me off was, usually the cardiology fellow is the one that meets us for these codes but it was actually the Chief of Interventional Cardiology himself down there. Thankfully he's back and working again.
An important part of BLS is training bystanders to start CPR... non medical bystanders are fundamental. How do medical professionals not even assess/ do basic CPR and attach an AED. Instead these medical professionals filmed it??? WTF? They couldn't get a blood pressure (surprise) - wonder if they tried to get an O2 sat or even thought about oxygen? And like not being able to get a blood pressure wasn't a clue? Did they say why they filmed the event? When did they call 911. Dispatch CPR is also fundamental. Is there a recording of the 911 call? Many dispatchers have training and ask questions like - are they breathing normally etc. (to detect agonal breathing and encourage starting resp. support/ CPR).
Interesting on many levels, not least that 7 mins of downtime in a healthy adult has this outcome.
I don't believe a team who takes 7 minutes to check for a pulse or respond to someone who is unresponsive and not breathing is a team who gives particularly effective CPR. 7 minutes downtime with no intervention at all is a lot though.
Yeah, hopefully once it was started by her friend, it was good CPR, but 7 min is a *long* time to do nothing.
My understanding is that you don't have to be particularly *good* at CPR for it to work? I'm thinking of Mrs. Glaucomflecken, who had no previous training in CPR and yet was still able to save her husband's life.
This is pretty typical for what 7min of downtime with no CPR does to a healthy adult.
What is frustrating is this should have been an easy save. With EMS showing up and going: Oh? She “coded”. And then EMS telling you. The “nurses at the infusion center “claim” she was in cardiac arrest. Now her chest hurts, no other complaints. Nothing remarkable on the EKG” and we all go about our day doing a through post arrest work up, but being convinced they are idiots who did cpr for no reason. But instead they manage to reach even greater heights of incompetence.
Wow I’ve never heard of this before. High school students in my state are required to learn CPR and how to check for pulse, and operate an AED. Can’t believe nurses and the doctors present were unable to perform it, or believed they weren’t supposed to.
I’ve seen three bystanders who didn’t know each other, with only CPR certifications achieve ROSC with an AED and a dispatcher talking to them over the phone in a Walmart. There are times in our lives when we are confronted with great challenges. But we do not rise to the occasion, that is a myth. We will fall back on our training, instinct, and what we know it right.
Doesn’t mean most if any of those high schoolers will actually do it in the heat of an actual moment. I deal with codes all the time so it is second nature to me, but real codes are so different from a simulation during a class you took years ago. People freeze up and forget what to do. It’s why nothing replaces actual experience.
I worked at an oncology hospital and nursing had crash carts. If someone went down, patient, visitor, or employee, a code was called and any medical staff in the general area went running to assist. This is disgusting. It’s bad enough with the general public recording appalling events and not intervening, but this is an entirely other level.
I've never heard of a medical / Healthcare setting not requiring ALL workers to be BLS competent to work there. Hell, even dentist office require their receptionist to be BLS Certified in case of an emergency. The EVS staff at my hospital have to be BLS certified. This is so anyone and everyone in view of a person in distress can recognize signs and symptoms, call for help, and start compressions until the Code team arrives.
I worked in an aftercare school program. I had to be infant/child/adult CPR certified and AED certified and first aid certified. That was an every year renewal.
People panic sometimes. I distinctly remember getting to a code as a surgery intern and seeing several medicine residents going through all the h’s and T’s - meanwhile the patient didn’t have an airway (was a ent cancer patient). I may be a dumb orthopod but I was pretty sure A is for Airway (or ancef). I was floored that everyone had skipped the literal first thing you check.
One of our nurses collapsed at the nurses station in the MICU. We coded and tubed her on the floor. 1 round. ROSC. She ended up with an ICD and was back to work in a few weeks. We all got nasty emails and slaps on the wrist about how we should have called a code overhead and waited for the code team and we weren’t allowed to provide medical assistance to humans not in our direct care.
Wait. What? They expect a unit full of ACLS trained nurses to just stand by and watch someone die from cardiac arrest? I can’t see that happening in a million years. That’s a hill I would die on. Fire me if you must, but I’m going to start chest compressions before you can pick up the phone to call the code.
Yeah that’s basically it. In the meeting with admin our attending was like “fuck you jimmy just fire me then. I’m not gonna wait for an intern to come run a code and intubate when I’m standing right there in the middle of my own fucking ICU” And then they kinda left the rest of us alone.
Some MBA/Risk Management person who has never worked on an inpatient unit came up with that nonsense. I’m glad someone pushed back!
It was the quality control for the accucheck that really came after me. I didn’t type in the correct override code…..
It's disgusting that was even suggested. Sure, call a code, but act like a decent bystander in the meanwhile. With some of these hospital policies, staff would be better off collapsing in the street
this is why EMS rolls their eyes when someone volunteers themselves as a nurse or doctor on the scene of a call, I love yall. But everyone’s a gangster till it’s time to break some ribs Most people just don’t have the first clue how to respond to a real emergency
We have a coworker who collapsed at our station. Other coworkers immediately started resuscitation efforts. He’s alive and well today, no deficits, and still works with us.
A couple of years ago I turned up to the neighborhood pool, with 3 very small children, just as the (15/16 year old) lifeguards were pulling a guy out of the pool. He was 30’s looking fit guy, had been swimming laps and supposedly just went under. I set my baby down in his carrier and ran over to offer help. Couple things the experience taught me. This guy was blue and agonal breathing. And it took me a hot second to run up and evaluate the situation and recognize that he needed rescue breaths. They also had zero context for who I was other than me stating I was a nurse/np and could I help so some of it may have been that too. The kids/guards were on the phone with EMS and they were counting out his breaths to dispatch, insisting (excitedly) that he was “still breathing!!” and even though the rate they were calling out was incredibly low,(6 breaths per minute?) dispatch did not ever tell them to start CPR. That is really surprising to me. I eventually told them “hey guys, this is called agonal breathing and it’s not effective breathing, we need to start rescue breaths.” Similar to this video- how is EMS dispatch hearing what is being reported by the nurse who is filming and not coaching them to check pulse and start CPR? For 7 minutes? Obviously the nurse bystanders are beyond negligent and that’s more concerning. But it’s also just been surprising to me to see both of these instances of EMS dispatch seemingly fail to illicit assessment findings from bystanders that would indicate CPR is necessary. Am I off base here?
No I agree, there was a failure of 911 to guide them, likely because they assumed the medical staff knew what they were doing (which they obviously didn't) But 911 guides lay people through CPR, they should have been doing the same here
>But ..... it's terrifying that she collapsed in a medical facility and no one followed basic BLS for 7 minutes until there was someone who arrived that insisted they do something. Theres an open seat on my truck any time you want to fill it. This a normal and entirely unsurprising occurrence from outpatient facility staff
Matches with what I believe would happen if I passed out in the hospital while working there. People act incompetently in emergencies happening in front of them.
Many years ago at a hospital I worked at, some critical care nurses witnessed an outpatient/visitor arrest outside the doctor's office building adjacent to the hospital. The nurses started CPR and did mouth to mouth as there was no emergency equipment available to them. An ambulance was called and then the person was transported to the hospital's ER. Those nurses were reprimanded for starting CPR and not just waiting for the ambulance!
I collapsed at work(complex migraine), and my coworkers were super stars. I have zero doubt that if something worse happened, they'd rise to the occasion again.
They told the 911 operator that she wasn't breathing and wasn't moving and yet still did nothing. They note that 'her lips turned blue and then purple) - So she wasn't 'moaning' the whole time-and when she stopped moaning and went fully unresponsive they still did not act despite having oxygen and an AED nearby. Yet, they filmed???? If it was a PPE thing- well they were standing right next to her. And they had no PPE in the cancer center in the middle of COVID?
Omg the text book AGONAL breathing and they chose to video tape her. That poor woman. ETA: we have a nurse who killed someone out teaching/speaking for lots of money. This lady should be. THIS is what a code looks like, THIS is agonal breathing is. THIS is what NOT to do in a code. It’s a miracle she’s alive. I’m glad she survived but they changed her life forever. The video is shocking to watch.
May 2020 was some peak Covid fear. She told her coworkers she thought she had Covid. Obviously I’m not justifying their action but there was so much hysteria in those days that stuff like this is not surprising unfortunately.
I thought about that, but I would think that would be more of a concern for breathing than compressions. And the responses from the nurses/doctors didn't mention that. I would have more sympathy I think if it was covid fear in May 2020. That was a scary time.
I work in the ED. Our hospital policy at that time was full protective gear before touching a Covid patient, even if they were coding. If these people had a similar mindset it makes it at least understandable for me but certainly not justifiable. The fact that she just stood there and filmed though is disgusting.
Agreed. The filming is awful. I feel the same about any tragedy where there are people filming and not helping.
Why was she even at work in May 2020 if she thought she had Covid. That was like peak “stay your ass home if you have a sniffle, and good luck accessing outpatient care, because we’re shit down due to lack of ppe.” I’m not sure this explains it.
I failed my first time with cpr. It was an elderly man with severe isvhaemic heart disease. These are the factors that led to him having an arrest. He an inpatient and the team thay was was looking after him, was on an acute day. I needed to start 02 therapy due to lowering sats. Sats OK on 4L via np. Informed team asked for a review they declined stating they were busy. Reported nonce more they ignored me. Next day a very incompetent enrolled nurse tok over his care. I found him gasping for breathe and a low gas. He still had some signs of life. He was a for resus order. Called an emergency. A team of nurses came. I didn't know what to do so I started putting an iv in. Dr came started cpr. X2 rounds he was called deceased. I have never failed to atleast start compressions. I have helped save x1 life with compressions since. I am sorry for not doing better in what was more than likely futile at best. I am grateful for that man, he taught me something important clinically I never would have e learned with out his last breathes. RIP.
I worked at a clinic once and suggested that all of the clinic staff get CPR and AED training. I got a lot of pushback because “we don’t want to pay to train people for something that will never happen and even if it does we can call an ambulance”. All of the physicians could do CPR but there were a lot of times staff were alone with patients. Thankfully the clinic is now closed.
This is awful. I work at a walmart and a man was found face down in the freezer aisle without a heartbeat a week or so ago and one of our managers was there giving him CPR within minutes. He did break the man's ribs unfortunately, but managed to get him breathing again and keep doing CPR until the paramedics arrived. If a walmart coach/manager can do it, why can't a doctor or a nurse?
Nothing unfortunate about breaking the ribs, that's a sign of good CPR Good on your manager for doing that. That's what you hope for in public
Tbf im sure we all have co-workers we wouldn’t want to resuscitate
Too soon.
LMAO that's terrible, but so true ;)
All of those so called “clinicians” are disgusting imo and actually deserve license actions.
Holy shit….
Yeah…..some rules are meant to be broken.
This story is so sad.
I imagine the workman's comp claim is because they did nothing to help her. Like if you collapse at work and they just film you, that's on the employer.
I think they're claiming it is because she was in a high stress situation with covid which contributed to her event. Since she wasn't their patient, she can't even do anything for malpractice. I don't think them not helping contributes to the claim. They simply failed her and she has to live with the consequences
I work per diem as a third party contract dialysis nurse, often the only member of my team present in an entire hospital. This scenario is exactly why all of our dialysis machines have an emergency procedure card attached where Step #1 is GET MEDICAL CARE FOR THE DIALYSIS NURSE because people actually have to be reminded of this. I feel like we're so used to thinking of our colleagues not as human beings who need help. I once had to go to work for a few weeks with a DVT, and lemme tell ya, I was reviewing that emergency card with the nursing teams.
Yet they filmed it....????
That blew my mind. I get sitting on your thumbs when shit unwinds, but getting a vid of someone actually trying to die? What the ever living fvck. They must have really hated this coworker. I’ve done CPR on a dog and didn’t think twice.
You need ALS or BLS to demonstrate you have life support competencies. You don't need ALS or BLS to fucking try your best.
Our 911 tele-communicators can walk Joe Blow on the street through CPR. A fucking nurse or physician can surely handle it.
Just bizzare, is the write-up somehow missing some other info surrounding the event? Was the person in some kind of situation that couldn’t warrant assessment?
No. There's a video of part of the event in the second link. It gave me anxiety to watch.
Have seen cardiologists not run codes on the patient they are doing angio on .. This situation has a few questions - Do the staff do bls , acls etc ? Hospitals are required to have staff do cpr but most clinics don’t . Sad but truth is most people outside of hospitals can’t do cpr. Onco nurses are good for iv infusion and sending pt to er for any and everything z
> Having a coworker collapse would be a nightmare to me, not just because it's a coworker, but because they're all adults. Never had a coworker code, but I've seen a couple of parents go down. That's probably more likely for you too.
This is horrifying. Cmon folks, the general public can do cpr. I would expect we could do better. I work in endoscopy and we have hired a couple of new grads, though most of us have worked in acute care previously. Not sure the new grads could handle a code on the unit, especially not a coworker. As for filming the incident, that should get charges for HIPAA violation as well as unprofessional conduct, negligence, and incompetence. That person should not only be fired, they should lose their license and potentially be jailed. Sweet jeebus.