Duck boat accident victims rushed to hospital

07/16/10, 10:58 p.m. EST

BOSTON — Several victims were taken to Massachusetts General Hospital after a duck boat accident in Boston on Friday.

The victims included five adults and one child, however no life threatening injuries were reported.

“This big white thing come right down the side of my car, it just started banging. It took me a minute to actually realize it was the duck boat,” said Tim McDonald, one of the victims.

Tim McDonald’s Ford pickup truck was one of the vehicles hit by the duck boat.

“It didn’t make sense that it just kept going, and I’m saying, ‘My God, it’s hitting more cars and more cars,’ and cars were being pushed aside, and it was like a tank coming through and just hitting us little cars out of the way,” said McDonald.

McDonald was taken to the emergency room with neck and shoulder pain.

“It didn’t seem like people got drastically hurt, thank God, for that size vehicle hitting all those cars,” said McDonald.

“I got hit two or three times, and my daughter had just had surgery, and so they’ve taken her back over to Mass. General” said Marjorie Ross, another victim.

Despite the accident, McDonald had words of praise for the driver of the duck boat.

“The driver actually did a very good job of minimizing the damages because he could have probably also gone over to where the vehicles…he probably could have went over the side of the bridge if he had decided not to hit us and took it the other way,” said McDonald.

According to McDonald the driver of the duck boat got out of the vehicle and began apologizing to everyone.

The driver said he lost his brakes and had to throw the vehicle into park to get it to stop.


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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