How I Used PAC™ Skills in the Emergency Room

A few weeks ago on a Saturday afternoon, I had a phone call from the nurse on dad’s floor. She told me that dad had a fall and was complaining of a lot of pain. The doctor had been called. I told her I would be right over.

By the time I got there, the doctor had assessed dad as not having a hip fracture because he was able to walk. Dad, however, was not able to sit comfortably in a chair and complained of pain in his hip and buttock area. The doctor thought he most likely had a hematoma and advised me not to go to the emergency room.

As care partners, we sometimes (or often) have to make difficult choices and tough calls. The stories of people who have walked on a broken hip flashed through my mind. I feared the worst knowing that a broken hip is often the beginning of a downward slide for many older people. So against the doctor’s advice, I decided to take dad for an x-ray. I knew I wouldn’t be able to sleep not knowing for sure. And if the situation worsened over night or the next day, I would be consumed by guilt thinking I hadn’t done the right thing for dad.

The ambulance was called and we arrived at the emergency room around 5:30 pm. As you can imagine, there is never a good time to visit ER and in particular, a Saturday evening is not ideal. We waited several hours in a noisy hallway. The rooms were full and a dozen or more stretchers were lined in the hallway with patients, families and paramedics waiting their turn. In Nova Scotia, paramedics must wait with the patient they bring to the hospital until the patient is transferred to the care of a doctor. They spend hours and hours of each shift just waiting. That is a story for another day.

I quickly learned that paramedics have little to no training in dementia. When they arrived at the nursing home and began asking him questions like “where and how did you fall?” and “where does it hurt?”, I took them aside to explain that he has dementia and will not be able to answer their questions. This would be the first of many times that evening that I would have to explain to health care professionals that he has dementia and as a result, is not able to communicate very well with words.

Dad, in the beginning, was okay with the situation and rested as comfortably as he could, on the stretcher. As hours wore on, he like all of us, was becoming more and more restless and wanted to leave. He was more comfortable walking than sitting or lying down so he wanted to move around and find the exit. Thank goodness for Hand-Under-Hand®. I directed his movement down the long hallways and away from all the rooms that he wanted to go into.

The paramedics, like many care partners, used a lot of words to give dad instructions for what they wanted him to do. Primarily, they wanted him to stay on the stretcher and remain there but that wasn’t going to happen. They’re not allowed to let the patient out of sight so they followed along on our walks around the emergency room. They were very uncomfortable with dad’s diminished verbal communication skills. When asked by dad “did you see me play hockey last week?” they looked at me with a very puzzled expression. I whispered, go along and agree, say “yes.” They did but were still very unsure of why they were having such strange conversations.

More than once, I implored with the paramedic to please talk to the charge nurse to see if they can get dad triaged as a higher priority patient. His pain was becoming worse and the paramedics were not able to administer any pain medication. Leaving him in pain over several hours was causing unnecessary distress and suffering. I also explained that the pain may be worsening the responsive behaviours that we were seeing. He was becoming more restless, aggressive, angry and verbally abusive. One paramedic in particular, was very interested in what I was saying and wanted to help but his hands were tied. I knew the information I shared with him was completely new to him.

Eventually a doctor came out to assess him. She wanted to examine his hip and buttocks in the hallway with everyone around. The two paramedics were trying to help her and the three of them were leaning over him. He told them “no, no, no” and that he didn’t “like this crowd of people”. I went into supportive stance and Hand-under-Hand® by the side of the stretcher. Matching his tone, I firmly agreed that it was awful that all these people were around and they should leave. I motioned for the paramedics to back away which they did. The doctor still couldn’t get close enough to examine him but with empathy for the situation she didn’t push it. She felt that the hip probably wasn’t broken because of the way he was kicking his legs at them. She arranged for an x-ray and moved us into a room.

A few more nurses came in wanting to examine him. Again, that wasn’t going to happen and by this point, it was after midnight. I wanted the x-ray and to leave as soon as possible. One nurse asked him his name and when he said he didn’t know, she giggled and said “you don’t know your name?” I wanted to cry at the disrespect and disgrace of it all.

Finally, the x-ray confirmed that there was no fracture and we were able to leave. Dad got on the road to recovery and is all better now. It was an eye opening experience. Our emergency room like many around the country are over stretched and under staffed. I am sure that the lack of knowledge around dementia was a contributing factor that kept him in the hallway untreated for far longer than what should have been. A few of the health care professionals I encountered were very kind and helpful and a few were not. All of them need more knowledge and skills.

Have you had an experience with bringing a person with dementia to the emergency room? I would love to hear how you handled it!