Who puts the skill in skilled nursing facility?

No one.  Skilled nursing facilities have always fascinated me.  I’m not entirely sure why.  It has nothing to do with the first two words though, they’re nowhere to be seen.



A nurse has called asking for a code 2 transfer from the facility to the local ER for a possible bowel obstruction.



We’re out the door code 2 after stopping for a quick piece of bread at the now completely set dinner table.  The salad is about to be served.  No wonder we caught a job.

Wandering through the streets we wonder why a skilled nurse at the skilled nursing facility can’t remove an impaction, but assume they know something we don’t.  Stop laughing, this is a serious story.

Arriving on scene a middle aged woman is in the street doing the parking valet dance.  Both arms over her head waving, then pointing us to park where we always do.  Does she not know we’re here so often we could classify as residents?

“What floor?” I ask, expecting a response with a number.  Instead she gives me letters.

“They’re doing CPR!”

Grabbing the red bag while my partner grabs the O2 and monitor I key up the radio and ask if they have a second call at this address.  They do not, just our code 2 bowel impaction.  It appears to have worsened.  “Send me an engine” is my report and I hear the dispatch come out while we climb the stairs.

Upstairs in the cafeteria is a man in his late 80s being physically assaulted by two young Asian women.  Sitting somewhat upright in a wheelchair, his chin is down against his chest almost as if trying to hide.  He may have been since they were doing the most bizarre chest compressions I have ever seen.  On a man seated in a chair.  Go ahead, think about it.  It’s weird.  A third woman is nearby holding a cup of water just in case, I’m assuming, he bursts into flames.

“What happened?” I ask while pushing myself through the throngs of robe wearing elderly who have come to see something new for once.

“He stopped breathing!” One of the women shouts.

“Give him more water!” Suggests the one with the glass and she hands it over.  Like a good EMT partner should the glass has been intercepted and he’s along the patient’s other side ready to move him to the ground.

As we do the water is pouring out of his mouth like a babbling desktop water feature and it is now readily apparent that he has cleared the bowel impaction without our help.  Amazing what the body can do when stressed.

The sirens outside have stopped and I hear familiar voices coming up the stairs, they must have been nearby.

He is log rolled and suction begins to gather the fluids forced on him by his skilled nurses.  To say his airway was compromised was putting it lightly.  The decision was made to transport him on his side, feet elevated to try to keep as much of the water out of his lungs as possible.

Down in the ambulance I’ve got the medic from the engine and my EMT with the EMT from the engine driving us the short 8 blocks to Saint Closest.

My radio report was short and we had just filled our only spare suction canister.

After transferring care I approached the woman who so kindly showed us where to park and asked her what had led to her father being nearly drowned.

“I think he choked” she sobbed “and they were trying to wash it down.”

Skilled my ass.

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6 thoughts on “Who puts the skill in skilled nursing facility?”

  1. I always tell the wife that when I am tired of waiting for the life insurance I will speed it up by admitting her into the local Premortuary Facility…

    I think anyone of us with a couple of years in EMS can relate this call to one they had.

  2. After my first few calls to ‘care’ homes, code 3 for hypertension, only to arrive to a very happy patient with a BP of 150/80 and a very stressed nurse who’s unwilling to call the doc on call (and who only checks the patients pressure once a month or less), I decided that care homes’ caring is broken. 

  3. This is far more activity than I’ve seen at any Skilled Nursing Facility (three lies in one) over the years. Not productive activity, but activity none the less.

    Had a complaint lodged against me for a response to a rehab type facility, which is half a step above a SNF. THEIR patient went into cardiac arrest for no known (to them) reason. We arrived to find the staff doing compression only CPR while the AED remained safely in it’s mount 50 feet away. Fire first responders were not sent because the facility had said AED and oxygen on scene.

    We worked the poor guy up and transported down the street to a real hospital.

    Their complaint was that it took us 25 minutes to respond (it took less than five), we hadn’t follow their wishes to go to a further hospital, and we were rude.

    I’d probably have to plead guilty the the last one if you count laughing at the nurses as they barked silly orders rude.

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