Bicyclist dragged by garbage truck in South End

A rider on a bicycle rented from the city’s bike-sharing program is expected to survive after a garbage truck making a turn Tuesday at a busy South End intersection dragged the bicyclist underneath, trapping his leg.

The collision — the latest of many involving bicyclists in Boston, including a fatal accident this spring — happened at Massachusetts and Columbus avenues just after 10 a.m. Police did not release the names of the truck’s driver or the cyclist, citing the ongoing investigation.

Boston firefighters freed the 33-year-old cyclist in less than 30 minutes, according to officials and witnesses.

“It was quick,” said Adil Garnaoui, a clerk at a Shell gas station across the street.

Garnaoui said he witnessed the accident and rescue, which unfolded about 50 feet away from the convenience store’s front window. He said he saw the bike go under the truck as the vehicle turned right.

Many cyclists use the strip of Massachusetts Avenue for their daily commute, especially to go to Cambridge, said Pete Stidman, executive director of the Boston Cyclists Union.

A map created by the Boston Area Research Initiative, housed at the Radcliffe Institute for Advanced Study at Harvard, based on police reports shows that Massachusetts Avenue between Tremont Street and Commonwealth Avenue sees a relatively high number of collisions.

At least six accidents occurred at the intersection of Columbus and Massachusetts avenues between 2009 and 2012, according to the map.

In Charlestown in April, 34-year-old Owen McGrory died after being run over by a garbage truck. His death, along with that of a Wellesley man in 2012, increased calls from cycling groups for greater public recognition of bicyclists’ rights.

This month, a bicyclist was trapped under the rear wheel of a truck after it turned right onto Mass. Ave. from Westland Avenue, just blocks from Tuesday’s accident. The rider was taken to the hospital with a leg injury.

The bicyclist involved in Tuesday’s collision was taken to Boston Medical Center with injuries that did not appear life-threatening, said Officer Rachel McGuire, a Boston police spokeswoman. The driver of the garbage truck is cooperating with police and no charges had been filed, she said.

Sunrise Scavenger, the waste management company that owns the truck, could not be reached for comment.

The bike the man was riding had been rented through Hubway, the city’s bike-sharing program, said Gabrielle Farrell, a spokeswoman for Mayor Martin J. Walsh. Tueday’s is the latest of 19 serious accidents involving Hubway bikes recorded by the city, out of about 2 million trips since the program launched in 2011, she said.

Matt Olivero, a postal carrier delivering mail nearby, said he saw the rider talking with paramedics as they carried him on a stretcher to an ambulance. The man’s leg had been caught under a tire, but didn’t appear to be bleeding, Olivero said.

The Fire Department’s technical rescue team used several tools, to free the cyclist.

Collisions in which drivers make abrupt right turns after passing cyclists are known as “right hooks,” though it is unclear whether this was the case in Tuesday’s accident. Under Massachusetts law, drivers are required to let bicyclists pass first before turning right.

Such collisions account for a significant percentage of cyclist-involved accidents, said Stidman, the Boston Cyclists Union official.

“We always advocate for protected lanes,” he said. “This would have been prevented, but thankfully he’s alive.”

One measure that might reduce such accidents are blind-spot mirrors, which most vehicles do not have, Stidman said. His group also advocates the use of side guards on trucks, which close the gap between wheels and lower the risk of people falling underneath and being run over.

The garbage truck in Tuesday’s collision did have side guards, which are required in many European and Asian countries but not in the United States.

Irene Soares, who has lived down the block from the accident site for more than 30 years, said she has witnessed several accidents and many close calls involving bikes and vehicles there.

“There’s always something,” she said. “Sometimes, I feel like the bicyclists don’t look enough.”


Source: Boston Globe

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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