Car Crash into Braintree Business Prompts Hazardous Cleanup

A vehicle crashed into Champion Cleaners in the Braintree Highlands Tuesday evening, leading to a response from Braintree police and fire, plus state hazmat crews.

UPDATE 2:45 p.m. Wednesday: Deputy Police Chief Russell Jenkins reported this afternoon that the driver of the car in last night’s accident may have had a seizure moments before the crash.

The driver, who was alone in the car at the time, was not named by police because he has not been charged with a crime, Jenkins said in a statement.

“He did not appear to be injured and made statements to rescue personnel regarding his medical history,” Jenkins said. “He was transported to South Shore Hospital with non-life threatening injuries. No one else was in the vehicle and no one in any of the businesses was injured. No one was in the cleaners at the time of the crash.”

Route 37 was re-opened at 2 a.m. after a Tier 2 Hazmat team removed a container from the dry cleaner’s labeled “hazardous waste.”

Just before 6:30 p.m. Tuesday evening, Braintree police and fire departments responded to a report of a vehicle that had struck a building at 1721 Washington St. (Rt. 37) in the Highlands section of town.

Upon arrival, officers found a new model Dodge Caliber resting on it’s side with the driver pinned behind the wheel. It took firefighters almost a half an hour to cut a hole in the roof using the Jaws of Life in order to free the trapped driver. The unidentified driver was taken by ambulance to an area hospital for treatment of unknown injuries.

The vehicle had left the roadway and crashed through the front of Champion Cleaners, shattering all of the windows and door frames in the front of the store. The impact of the crashed caused a small gas leak at the scene, and National Grid was called in to shut down the gas service.

The Braintree Electric Light Department also arrived to cut power to the building, which contains four businesses including the dry cleaners. Due to the nature of the chemicals kept in the dry cleaners, a hazmat order was requested by command staff. The Massachusetts Department of Fire Safety arrived and immediately ordered a Tier 2 Hazmat response to treat the spill of unknown chemicals.

Members of the DFS District 2 Hazmat Response Team arrived on scene from across the eastern part of the state. Decontamination showers were set up on Rt. 37, and a two-man team entered the building dressed in full hazmat suits. They exited with multiple samples of chemicals that were spilled when the crash occurred. Traffic was diverted around the scene starting around 8 p.m.

Emergency personnel started clearing the scene just before midnight. The crash is still under investigation by the Braintree Police Traffic division.


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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