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goldmund
05-13-2014, 05:33 PM
Hi!

I'd like to ask you for help with hospital security concerning intensive care units and coma patients.

In my story‚ the protagonist is a patient in an ICU of a small French hospital after an accident in which he lost consciousness. In the same ward his girlfriend lies in a long-term coma (2 years) in a separate room. One night he visits her and he disconnects her ventilator to kill her. As her ECG monitor starts alarm he gets scared and turns the ventilator back on. The nurses rush in and he convicts them he has no idea what happened and they leave him in peace as a patient.

Does that sound plausible? My instincts tell me he got off too easy‚ but I need that for the story. Would they investigate?

Thank you!

Trebor1415
05-13-2014, 08:27 PM
Hi!

I'd like to ask you for help with hospital security concerning intensive care units and coma patients.

In my story‚ the protagonist is a patient in an ICU of a small French hospital after an accident in which he lost consciousness. In the same ward his girlfriend lies in a long-term coma (2 years) in a separate room. One night he visits her and he disconnects her ventilator to kill her. As her ECG monitor starts alarm he gets scared and turns the ventilator back on. The nurses rush in and he convicts them he has no idea what happened and they leave him in peace as a patient.

Does that sound plausible? My instincts tell me he got off too easy‚ but I need that for the story. Would they investigate?

Thank you!

I can't speak for France, but in the U.S. if someone is in a coma for two years they won't still be in a hosptial ICU bed. There are only so many of those to go around. Instead she'd be transfered to some sort of long term care facility.

Plus, being in a coma for two years is pretty much the definition of "stable" and not needing ICU care. (Not "stable" in a good way, but stable all the same)

sheadakota
05-13-2014, 10:01 PM
Ok- first- a person in a persistent vegetative state- which is what being in a coma for any extensive length of time would be considered. ( it has other definitions too) would never be in an ICU. they would be in a skilled nursing facility for those type of patients.

Second- this person would have a tracheostomy and the vent would be attached to the trach.

after about five seconds of the ventilator coming loose the vent will alarm- loudly- this is not like unplugging the thing- unless turned off correctly it will continue to alarm even if unplugged-

third- you need to sign in and out of these types of facilities.

last- her EKG alarm will not be what is alarming - she most likely has the ability to breath somewhat on her own this it would take a long time for her heart rate to be affected by the lack of sufficient oxygen. again not like in the movies where they unplug the vent and boom flat line- it simply does not happen like that- ever.

I have no idea what this is like in France this is all based on my own experience in USA.

Also if eh does mess with her vent- the nurses aren't stupid, they are gonna know by the alarms - her o2 sats, and cardiac arrythmias that occur with hypoxia. so no he can't just walk in think hes going disconnect her vent and change his mind and fool the nurses.

PLUS if he is in the hospital- there is no way he's getting to another facility on his own. she would not be in the same place as him.

mirandashell
05-13-2014, 10:05 PM
Yeah, I'm afraid this isn't going to work. Mainly cos she won't be in an ICU. Intensive care is very expensive and a long term coma doesn't really need that level of care. She would be in a specialist unit, nowhere near him.

Also, if he is in ICU, there is no way he is getting up and going over to her bed without a nurse noticing. His alarms will be going off way before hers do.

goldmund
05-14-2014, 01:09 AM
Thank you!

I'm miserable now ;-)

Forget the ICU part, I wrote that because that's where they take folks in a coma from what I've heard.

It's a small hospital. He's recovering from an accident, no longer attached to anything.

She's in a separate room with another coma patient. I've read that there are hospitals with separate coma wards.

Anyway, that's not the part where I fear for the reader's suspension on disbelief. Rather, it comes too easily for him. At night sneaks past the nurse station, into her room, and turns off the vent (she's after tracheotomy, that's correct, but I thought she can't breathe on her own at all -- there are such people, aren't there?)

Thank you for the hint about the ventilator setting off alarm by itself, that's a useful piece of info!

So, provincial hospital, lax control, a guy turns off a patient's vent then turns it on again. What would happen next from the personnel's point of view?

mirandashell
05-14-2014, 01:17 AM
Don't be miserable, it's what we are here for. Better you find out now then have to rewrite the whole thing!

sheadakota
05-14-2014, 01:53 AM
agreed don't be miserable! Better to find out now when it's easier ( sort of) to fix.

One comment about your coma patient. If she has been in a coma for 2 years most likely she can breath on her own- if she can not she has significant brain damage- so I don't know if you were planning on waking her up, but yes there are pt's who can't breath on their own and are on vents for the remainder of their lives.

In the US once a pt is stable but still need medical attention for basic care ( coma patients) they are taken to a rehab or permanent skilled nursing facility. initially she may have transferred to a floor that takes intabated coma patients but she would never have stayed there. Hospitals have quick turn around times for patients. they do not do long term.

sheadakota
05-14-2014, 01:58 AM
a guy turns off a patient's vent then turns it on again. What would happen next from the personnel's point of view?

No no, the vent does not turn on again it simply will not shut off and will alarm that someone is messing with the settings.

When it does alarm, a nurse, aid who ever is going to come into the room to see what is wrong- if it looks like the guy is or did mess wit the vent- she will not be happy and in a big way.

I actually had a pt's husband who did try to disconnect his wife from a vent while I was taking care of her- ( this was in an ICU setting) he thought he had the right. Nope he didn't and we had to call the police on him and he did get arrested for a a variety of charges not the least of which was attempted manslaughter. so yeah there's that.

cmhbob
05-14-2014, 02:27 AM
But as far as security goes, most US hospitals will typically have (unarmed) security guards making rounds, or posted at the ER. Some states allow hospitals to create a police department where the officers have full arrest authority (and are probably armed), and some other hospitals will arm their security officers. I'd doubt thought that many will station security or police in an ICU.

goldmund
05-14-2014, 02:54 AM
Wow, Sheadakota, that's some story!

Seem I knew where to ask, though ;-)

I think I'll make the guy hide somewhere in the room when the nurses come. As for breathing on her own/brain damage -- yes, the lady will never be healthy again.

But, are you saying a ventilator has no on/off switch? How could one cause hypoxia by messing with it?

sheadakota
05-14-2014, 03:09 AM
Wow, Sheadakota, that's some story!

Seem I knew where to ask, though ;-)

I think I'll make the guy hide somewhere in the room when the nurses come. As for breathing on her own/brain damage -- yes, the lady will never be healthy again.

But, are you saying a ventilator has no on/off switch? How could one cause hypoxia by messing with it?

No, they have an on off switch- sorry to confuse you, but they don't just shut off. they are going to make a noise. some will alarm for a few minutes in case the shut off was accidental before they go quiet-now of course if you know what buttons to push you can circumnavigate all that.

One can cause hypoxia by disrupting the pt's flow of oxygen by either disconnecting the vent or changing settings.

goldmund
05-14-2014, 03:43 AM
You're a treasure :-)

So maybe he'll just grab the tube and squeeze it! That way, the ECG alert will kick in as she starts to die, right?

sheadakota
05-14-2014, 03:52 AM
You're a treasure :-)

So maybe he'll just grab the tube and squeeze it! That way, the ECG alert will kick in as she starts to die, right?

cardiac arrest by hypoxia- which is what you are describing- will take several minutes- is he going to stand there and crimp the ETT for that long? with the vent alarm going off? Bottom line- the vent alarm is going to go off before anything else.

One other thought to consider- if she is a chronic vent pt, she very well may not be on a monitor at all. But hey its your story :) write what you need.

WeaselFire
05-14-2014, 04:26 AM
I actually had a pt's husband who did try to disconnect his wife from a vent while I was taking care of her- ( this was in an ICU setting) he thought he had the right. Nope he didn't and we had to call the police on him and he did get arrested for a a variety of charges not the least of which was attempted manslaughter. so yeah there's that.
Nobody called the police when this happened to me in the ICU. Oh, wait. I extubated myself. :)

And no, they were not happy either. Especially since I was under full sedation and in restraints when I did it.

For the OP, long term coma care is also expensive and not for everyone. Usually, once all medical options are exhausted, the patient gets sent to Hospice to die.

Jeff

goldmund
05-14-2014, 12:37 PM
Sheadakota -- so, the vent alarm would go off even if he just crimped the tube without messing with the controls?

WeaselFire -- well, the public health care system is much more magnanimous in Europe.

sheadakota
05-14-2014, 02:43 PM
Sheadakota -- so, the vent alarm would go off even if he just crimped the tube without messing with the controls?

WeaselFire -- well, the public health care system is much more magnanimous in Europe.

Oh you betcha. Anything that increases or decreases pressure. You have to understand, or maybe you don't but I'll tell you anyway :) when you breathe naturally it is with negative pressurre, your diaphragm expands and air rushes in.

When you breathe on a vent it is with positive pressure. A tube is placed down your trachea into your lungs and oxygen is forced into them but the percent of O2 is calculated, the PEEP, positive end airway pressure and a lot of other things I won't bore you with- my point is all of these settings are tweaked until we find the ones that help the pts breathe the best.

If any one of them is interrupted stopped or in any way messed with the sucker is going to let you know because it could mean something is wrong with your pt and you better get your but in there to find out what. Pts often bite the tubes cutting off their own oxygen. We put bite blocks around the tube to prevent this, in trachs they can pop off get clogged, but it's hard to crimp off a vent to a teach. It's a very direct connection.

goldmund
05-15-2014, 03:27 AM
Fascinating -- and very helpful.

Thank you so much!