Does your 9-1-1 PSAP provide EMD? Do your calltakers give pre-arrival instructions, including CPR instructions? If so, you’ve probably already taken note of the story that hit the news this week of the self-identified nurse who — despite the pleas of the 9-1-1 calltaker — refused to give CPR to an elderly woman because it would “violate company policy.”
“Is there anybody that’s willing to help this lady and not let her die,” asks dispatcher Tracey Halvorson on a 9-1-1 tape released by the Bakersfield Fire Department aired by several media outlets on Sunday.
“Not at this time,” said the nurse.
“It was truly upsetting listening to the 9-1-1 call about the incident and knowing that the caller was a medically trained person who was under orders not to provide medical treatment,” says APCO Life Member Mark Pallans, a communications consultant in North Las Vegas, Nev. “But if a plain, ordinary citizen had made that same call would be the uproar still be there?”
The 87-year-old woman who had collapsed in the dining room of the retirement home was later declared dead at Mercy Southwest Hospital. According to Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was first on scene, she did not have a Do-Not-Resuscitate order on file. However, her family has told reporters that she “wanted to die without life-prolonging intervention.” The 9-1-1 calltaker could not have known the woman’s wishes.
The calltaker assured the nurse that she would not be liable for delivering CPR, and pleaded with her to perform CPR or to flag down someone else who would be willing to do CPR.
It’s unclear whether CPR would have saved the woman’s life, but the nurse’s refusal to perform CPR has sparked controversy throughout the U.S.
Attorney Doug Wolfberg of Page, Wolfberg and Wirth, a Pennsylvania-based law firm specializing in EMS law, discussed the potential liability issues in an interview aired on National Public Radio on March 6.
Wolfberg said that “by and large, states have Good Samaritan laws in place.” These laws would protect someone from being held liable for injury to or death of someone they were trying to help. Such laws “provide qualified or a limited form of immunity against civil lawsuits,” he said.
For bystanders trying to decide whether to help, Wolfberg had the following advice: “Be a human being first, and the law side, the liability side will take care of itself.”
We asked several 9-1-1 communications center directors, training coordinators and employees what their take-away from this call would be.
Craig J. Scholl, RPL, president of the APCO Atlantic Chapter and senior emergency communicator for Clinton County (N.Y.) Emergency Services, says, “After listening to this call, I feel that the dispatcher performed well. We must remember she is the advocate for the patient. I cannot help but wonder why the nurse (or any) would want to work for a company whose policy seems to violate the ethical oath the nurse must have taken when she obtained the certification that holds her (his) title. Interestingly enough, we have the same type of facilities in our county, and their employees are also not allowed by their company policy to provide health care (not just CPR).”
“For calls from a nursing home or care facility in Douglas County, Kansas,” says Marjorie A. Hedden, supervisor at Douglas County Emergency Communications, “if the call is the result of an evaluation by a nurse or doctor we use the MPDS transfer card (protocol 33), which does not provide instructions for CPR. If the call was not the result of an evaluation by a nurse of doctor, it would be handled as a medical emergency cardiac arrest. Our dispatchers here in Douglas County would attempt to provide CPR instructions. If the caller then advised that he or she was not willing to provide CPR, the dispatcher would only ask him or her twice before moving forward with the call.”
Hedden continues, “After listening to this call, I feel that the dispatcher could improve her customer service skills. She did not reassure the caller that help was on the way. The dispatcher did not remain in control of her own emotions. She ended up arguing with the caller and not accomplishing anything. It appeared as though the dispatcher was trying to shame the caller into helping the patient rather than taking a more proactive approach in trying to gain the caller’s help in providing patient care. In the future, I would suggest that she try the following: ‘Together we can help her.’ Or she could have tried to provide CPR instructions rather than asking the caller to provide CPR. “Okay, here is what we can do to help her. I want you to lie her on her back and remove all pillows. …’ This was a very difficult call for the dispatcher, and it is very hard remain in control of your own emotions when you feel helpless and unable to provide the level of care that you know you could with the help of the caller.”
On the other hand, C.J. Nash Jr., a retired telecommunicator from Gaithersburg, Md., says, “My take is that the telecommunicator should be commended—in public—and frequently, for doing everything she could to keep that poor woman alive.”
According to LexisNexis and Associated Press news reports, Brookdale Senior Living, which operates the independent living community in California where the incident took place, says the employee misunderstood the company’s policy for providing emergency aid and the company will undertake a thorough review of its emergency medical care policies.
What’s your takeaway? Please keep the discussion going and add your comments below.