Woman hit by car in Framingham

FRAMINGHAM – An Edgell Road woman was hit by a car and badly hurt this afternoon after going across the street to shop at the Framingham Farmers Market.

Nurses with the Framingham Medical Reserve Corps, vendors and patrons at the market rushed to aid 36-year-old Aimee Johnston, a market regular, after she was hit by a Honda Accord just before 1:30 p.m. She was not in a crosswalk as she crossed Edgell Road, headed back to her apartment.

Johnston was taken by ambulance to the state police barracks on Rte. 9 and then flown by medical helicopter to Beth Israel Deaconess Medical Center in Boston.

Police said she was listed there in stable condition.

The driver of the car, James Mannion, of Fenwick Street in Framingham, who is in his 80s, police said, was taken to the hospital by ambulance to be checked out.

“I couldn’t be any sadder or sicker than I am right now,” farmers market manager Jacqueline Meninno said. “I pray for both of them.”

Police said they have not issued any citations as the crash is still under investigation.

The crash closed Edgell Road for several hours on both sides of the common, at Oak and Vernon streets.

The state police crash reconstruction team came out to reenact the accident, and the team is helping investigate.

The impact of the crash knocked Johnston out of her sneakers. She slammed into the Accord’s windshield, leaving a large dent, before falling into the street.

“I don’t remember him going very fast, and I remember her hitting the car very hard,” said witness Kelly Drummy, a registered nurse interning with the Board of Health.

She was with members of the Framingham Medical Reserves Corps, who were taking blood pressure readings at a community outreach tent at the market.

“She got first aid right away,” said volunteer Norma Robinshaw, a retired E.R. nurse, who monitored Johnston’s pulse and breathing.

“She could tell us her name after a while,” Robinshaw said. “She said, ‘What happened?’”

Johnston’s roommate, Susan McNitt, said they were at the market together, one of their favorite things to do. McNitt then left to go back home.

“She said, ‘Oh, I’m going to get some ravioli,’” McNitt said.

McNitt collected her roommate’s sneakers and called to notify Johnston’s family.

“She is a breast cancer survivor, so she is a tough broad in the best sense of the word,” McNitt said.People ran to help after the crash, detouring traffic, trying to stem Johnston’s bleeding and comforting Mannion.

“I’m in a little bit of shock,” Drummy said.

She said she thought there was a car parked along Edgell Road where there are not any marked spaces that may have obstructed the view.

Police spokesman Lt. Ron Brandolini said he did not have any information about how the crash occurred.

Millie Smith came running out of her home at 63 Edgell Road.

“There’s a very distinctive thump when you hear it,” Smith said, and instinctively you know, “Oh God, somebody’s been hit. And they were.”

Smith called Johnston “a lovely girl” and a great neighbor, who often walks dogs.

Robinshaw said Johnston had a head injury and may have broken both legs.

“Fortunately there were nurses here,” she said.

The crash left everyone at the market shaken.

“You take your life in your hands crossing the street, somebody just said to me,” Robinshaw said.


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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