An absolute way to avoid a 911 incident in your senior living community.
A few weeks ago I attended the Northern California Assisted Living convention. One of the breakout sessions was a dissection of the Bakersfield Glenwood Gardens 911 incident that made national headlines. The entire discussion was fascinating and helpful, but the panel made one great point that would have kept the entire event from spiraling out of control.
Caveat
I am not an attorney and nothing in this article should be construed as legal advice. More specifically, with respect to the rest of this article, the points made may or may not be applicable outside of California. Any specific decisions you make for your senior community or your senior company should be made with the advice of an attorney.
The Glenwood Case: A quick review
A resident who lived in independent living collapsed in the dining room and per community, protocol the staff called 911. Over the course of the next few minutes the 911 operator demanded that the staff member perform CPR and when the staff member refused, the operator demanded that someone else . . . anyone else be put on the phone to receive instruction on how to perform CPR. The 911 operator was demanding to the point of being abusive.
The Big Lesson
It is clear that the 911 operator exceeded her authority. That excess was compounded when she or someone else in the Emergency Medical System (EMS) released the recording to the media. Here is the thing I never considered of but makes perfect sense. In the State of California, with or without a DNR, no independent living or assisted living community is required to perform CPR. In fact, CPR training is not even a requirement to work in a California Assisted Living Community. The only thing an assisted living community is required to do is call 911. At Glenwood Gardens and for that matter at most independent living communities all they promise . . . really all they can do is call 911. Most importantly, once 911 has been called, there is no obligation to stay on the phone with the 911 dispatcher until help arrives. In many cases (on the street or in a personal residence) it makes sense to stay on the line, both to provide directional information to EMS if needed and most importantly to reassure the caller, but it is not required. Once the 911 operator turned abusive the better thing to have done would have been TO HANG UP ON THE 911 OPERATOR . . . in effect to tell the 911 operator to pound sand. Sure she would have called right back, but that call would have likely gone to the front desk and there would have been no requirement to transfer the call to the dining room. Hanging up would have eliminated the bad publicity and the personal pain and abuse inflicted on the staff members. In fact, the staff members would have been able to devote their effort to comforting the woman who had collapsed and the other residents who witnessed the event.
Do you have a policy for dealing with an abusive 911 operator? Have you experienced an abusive 911 operator? How did you handle it?
As an RN for 35 years who has worked in all aspects of adult care (acute care, home care, AL, SNF) I find this information absolutely frighting. It is one really big reason I would not ever move to California in retirement. The state has so many wonderful things to recommend it but this is an extrordinarily low standard of care.
Further, my license as an RN obligates me to do what I am trained to do for anyone, anywhere as long as I have no knowledge of a DNR order and it does not place me in danger. If I had been in that RN’s position, I would have done CPR unless I knew there was a DNR order. If my employer chose to fire me for following the nurse practice act, they should be ashamed. It is one thing not to promise something you cannot provide (CPR availability 24/7/365). It is another thing entirely to refuse to do what is right.
This incident was very unfortunate. I do not have enough information to weigh in on what went wrong but there are ways for facility and staff to meet their ethical obligation while complying with the residents wishes. In my 20+ years in a continuing care retirement facility 911 was called many times. As a result, the RESIDENTS purchased three AED machines to be located throughout the facility, including one in the dining room. Staff in each area were trained on it’s use. There are residents who want to be resuscitated. There are some who do not. In a skilled setting keeping track of each persons wishes is more manageable. In independant, it gets more difficult. We made it very clear to independant residents that if they did not want CPR they had to wear a bracelet or necklace identifying their wishes. If they werent wearing such, they were going to get CPR. We made identifying jewelery easy to obtain through social services as part of making sure each resident had a DPOA or Advanced Directive document. With health care professionals on site, it does not seem ethical to withhold treament without knowing the residents wishes.
As a 20 year geriatric nurse,I agree with not remaining on the phone once the dispatcher lost control of her professional demeanor. She was then shifting the attention away from the resident in need and placing the attention firmly on herself. There is no law that states we must, as healthcare providers, remain on the phone with 911 operators as they have no authority. Once he/she has the pertinent information required to safely direct emergency responders to our site, our obligation has been met. Remember, most dispatchers are high school graduates reading from a book or a computer program prompting them on their responses to the emergency. At no time are we expected to subject ourselves to that level of abuse and humiliation – “she’s not breathing enough, so you need to breathe for her”. I believe I would have terminated the call at that point -before it reached the point of disgust.