VCEMT
Forum Captain
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Tire iron.
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ABC works for a 911 service, but this question can apply to IFT discharges as well.
Assuming no Konx Box or key pad:
I would have a working callback number to use if we can't gain entry. I would have the dispatcher call the number a few minutes PTA to ensure someone is waiting at the entrance for us. I suppose knocking on windows may be an option, but from most NH's I've seen, only the rooms have windows, and the nuses stations are centrally located in the hallway, which is away from any windows, and possibly out of earshot from the horn/siren. I'd also be hesitant to sound the horn as this would wake up the residents, many who are ill and won't tolerate an ubrupt awakening very well.
The best thing to do would be to meet with the NH's director. Explain things from your side, what procedures can be put into place from their side to ensure that entry is no longer a problem, and that we'd like to avoid taking the door if possible. Mention that if there was a fire alarm activation, and the FD was called, they would have to take the door if there was no other recourse, so a knox box or some other method of rapid entry for emergency services can be put into place. Many fire companies have preplan books for various locations, that have the entry codes and phone numbers listed.
Edit: For IFT, we always had the social worker or sending RN call the receiving facility while we're on the floor and prior to departure, to give our ETA and to ensure that there will be someone available to let us in.