Gas tanker crashes in Mass., driver dies

SAUGUS – A gasoline tanker truck crashed and exploded in a fireball just north of Boston early Saturday, triggering smaller explosions, sending fire streaming down a nearby brook and killing the truck driver, state police said.

Gasoline from the tanker spilled onto Route 1 in Saugus, flowed into a drainage ditch and ignited, carrying flames down a brook that runs near the highway. The floating fire ignited a home and two greenhouse buildings, which were still smoking several hours after the 2:30 a.m. crash on the north side of the highway.

“The whole brook was in flames,” said Karen Staskawicz, whose home burned in the fire.

Staskawicz heard a loud crash and several minutes later was warned to get out of her house as the flaming gas ran behind her house and set her porch on fire. About two hours later, her entire house went up in flames. Staskawicz suspects that gas seeped into the basement and fueled the larger fire.

Later Saturday morning, she walked through her charred living room, trying to salvage sentimental photos and figure out what was next for herself, a roommate and her 19-year-old son.

“I don’t know where we’re staying, to be honest,” said Staskawicz, 44. She added, “We have a lot of friends.”

The truck driver, 59-year-old Neal Michaud, of Manchester, N.H., was killed, state police spokesman David Procopio said. The truck belongs to PJ Murphy Transportation Inc. of Methuen. A call for comment to the company wasn’t immediately returned.

Four other motorists were hurt trying to avoid the crash and gushing fuel, including one, Kevin Fitzgerald, 60, of South Hamilton, who was taken to a Boston hospital with severe burn injuries, Procopio said. The other three suffered less severe injuries.

Police were investigating what caused the tanker to slam into a median and roll over.

About 120 people were evacuated from a neighborhood, but they were allowed to return to their homes several hours after the crash, Procopio said. The fires were out three hours after the accident.

Sandra Dion, who lives right off the highway, was awakened by the crash and soon after saw “a huge mushroom cloud of fire and smoke” in the sky over the road. Smaller, sporadic blasts followed as flames began riding down the brook, and there was another massive explosion in a nearby culvert that set off car alarms.

“The gas came down the gully, and everything just blew up,” said Dion, 42.

Embers began falling, prompting a neighbor with a baby to leave the house, Dion said. Dion turned on the lawn sprinkler, knowing it might not do much good.

“It’s one of those things, you just can’t believe it,” she said.

Police were checking a bridge over the highway for possible structural damage, Procopio said. Officials were also checking gas lines after an underground line to a nearby fast-food restaurant apparently ruptured from the explosion, he said.

As of late afternoon, two lanes had reopened on each side of the highway in Saugus, about 10 miles north of downtown Boston. The far left lanes on both the northbound and southbound sides were expected to remain closed well into Sunday for road and guardrail repairs.

Source:  USAToday

Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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7 days ago  ·  

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