Three teens hurt in head-on crash in Medway

MEDWAY – A head-on collision Friday night sent three local teenagers to the hospital — two by medical helicopter — with serious injuries.

Police received multiple 911 calls around 9:45 p.m. reporting that two vehicles had struck head-on near 170 Holliston St., just south of the intersection with Fairway Lane, police stated in a press release.

Responding officers found two girls, ages 17 and 18, in one car, and a 16-year-old boy in a second car. Both drivers were trapped in their vehicles.

The names of the teenagers were not released at press time, but Police Chief Allen Tingley said he believes the girls are from Medway, and the boy is from Holliston.

Firefighters and police officers from Medway, Holliston, Millis and Franklin used several sets of hydraulic rescue tools to free the trapped teens, police said.

The drivers were taken by helicopter to the trauma center at UMass Memorial Medical Center in Worcester. The male driver was critically injured, while the female driver had serious injuries.

“The boy appeared to be pretty badly injured,” Fire Chief Paul Trufant said. “We were working on both cars at the same time with two groups of firefighters.”

The female passenger was taken by ambulance to Milford Regional Medical Center with injuries that were not life-threatening.

“It was a unique situation for us because we had three separate scenes to tend to,” Tingley said. “We had people trapped in two separate vehicles, and then the scene at the middle school for the helicopters’ landing zone, so it stretched our manpower.”

Paramedics from Events EMS also responded to the scene with ambulances equipped with Advanced Life Support, Trufant said.

Initial investigations showed that the male teenager was driving northbound on Holliston Street when he crossed the center line and struck the southbound vehicle nearly head-on, police said.

A third vehicle, driven by the 18-year-old brother of the male driver, was also involved in the crash, but he was not injured, police said.

“Preliminary investigation shows that (the 16-year-old driver) was trying to pass his brother, and he crossed the centerline and hit the girls,” Tingley said.

John Garvey, 22, of Medway was killed in a car accident on the same stretch of Holliston Street in early April. His passenger, 22-year-old William Choate, also of Medway, was seriously injured.

Medway police and fire and the Massachusetts State Police Accident Reconstruction Unit were on the scene until 2:30 a.m. investigating the crash, Trufant said.

Holliston Fire Department covered Medway’s station during the investigation, which is ongoing, according to the police report. Police did not say whether speed was also a factor.


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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Nursing Home Negligence
Dropped Patients

Each year, one in four people over 65 fall at least once, and many of these victims sustain serious injuries, like broken bones and head injuries. Certain physical issues, such as Vitamin D deficiency, limited vision, medication side-effects, and a hazardous walking surface, multiply the risks exponentially.

Nursing homes have a duty of care to prevent their patients from being injured, especially when it comes to everyday activities like moving from a bed to a wheelchair. So, many nursing homes follow legal protocols, such as this three-point plan from the National Institutes of Health, when performing such operations. A failure to follow established guidelines is clear evidence of fault in negligence cases.

Types of Transfers

Many residents are in long-term care facilities, at least in part, due to mobility impairment. Therefore, staff members must do whatever possible to prevent falls during procedures like:
•Bed to Wheelchair: Inspecting the surroundings, like the physical condition of the wheelchair and the rugs on the floor, is one of the most important, and most overlooked, steps in these transfers.
•Wheelchair to Bath: Many falls occur in bathrooms, so staff must be especially diligent during such transfers.
•Hoyer Lift Falls: To lessen the physical strain on staff and residents, many nursing homes use hydraulic lifts to move patients, at least in some situations. If they are not used properly or working properly, these devices can cause serious injury.
•Chair to Chair: Many residents break their hips when they stand because they use their legs for additional leverage, and many staff members are not as cognizant of this danger as they should be.

In many cases, normal medical protocol requires that two or more staff members assist a resident during these and other transfers.

Possible Injuries

Many nursing home fall victims are already in a somewhat frail physical condition before the incident. To make matters worse, they are often in elevated positions and sometimes unable to break their falls. This combination usually results in serious injuries like:

•Broken Bones: These wounds often require extensive and painful surgical correction and long-term physical therapy.
•Brain Injury: Often, the jostling alone (like a raw egg sloshing against an eggshell) is sufficient to cause permanent injury, including personality changes, loss of function, and even death.
•Internal Bleeding: Emergency responders are often preoccupied with outside trauma injuries to the point that they neglect internal injuries.

In addition to compensation for medical bills, victims and their families normally receive compensation for their pain and suffering.
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