Four-year-old child suffers life-threatening injuries after car flips over in Big Dig Tunnel

A two-car crash inside the Tip O’Neill tunnel early Sunday morning sent several people to the hospital, including a 4-year-old girl who was partially ejected from one of the vehicles.

According to Massachusetts State Police reports, officers responded to a rollover on the northbound side of Interstate 93 around 12:24 a.m. after receiving calls from other motorists about an accident inside the tunnel.

A preliminary investigation of the accident indicates that a Toyota 4-Runner, driven by a 26-year-old Malden man, traveling in the middle-left lane, swerved to avoid colliding with a car that allegedly tried to switch into the 4-runner’s lane.

That car, a Malibu, was driven by a 29-year-old East Boston woman, police said.

To avoid the cars crashing into one another, police said the Malden man swerved to his left, and then swerved right again to avoid smashing into the highway barriers.

“The sudden maneuvers caused the driver to lose control of the 4-Runner, which rolled over and slid to a final resting position on its driver’s side across the middle left travel lane,” according to a police report.

There were several other occupants in the 4-Runner, including a 4-year-old girl who was “partially ejected” from the car.

The child, as well as a 24-year-old Malden woman, a 24-year-old Dorchester man, a 21-year-old Dorchester woman, and a 5-year-old boy, were sent to various Boston-area hospitals following the rollover.

One of the adult women was also ejected from the car, police said.

No charges have been filed at this time, according to police, however, if the investigation confirms that the child was not in a car seat as required by law, the driver of the 4-Runner will be charged accordingly, they said.

The crash is still under investigation.


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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6 days ago  ·  

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