HOSPITAL, HOSPITAL NAME: Lemuel Shattuck Hospital DEPARTMENT: Medical floor IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 04/02/1954 SCENE CONTACT NUMBER(S): Demographic Information AGE: 66 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 023-42-3812 SEX: Male RACE: White MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 127 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: 1 Harvard Road Shirley
POLICE, TOWN: IF HOSPITAL, HOSPITAL NAME: Health Alliance Hospital Leominster DEPARTMENT: ICU IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 03/02/1961 SCENE CONTACT NUMBER(S): Demographic Information AGE: 59 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: SEX: Male RACE: White MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 157 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: Harvard Road Shirley
HealthAlliance Leominster Hospital - 60 Hospital Rd, Leominster, MA 01453 DEPARTMENT: ICU IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 08/05/1945 SCENE CONTACT NUMBER(S): Demographic Information AGE: 74 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 580-07-5052 SEX: Male RACE: Black MARITAL STATUS: Divorced APPROXIMATE WEIGHT (lb): 182 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: MCI-Shirley - Harvard Rd Shirley
NAME: Umass Memorial University Campus DEPARTMENT: Medical floor IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 01/04/1957 SCENE CONTACT NUMBER(S): Demographic Information AGE: 63 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 034-46-7774 SEX: Male RACE: Hispanic MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 441 APPROXIMATE WEIGHT(g): 200033.2 DECEDENT ADDRESS: 100 Harvard Road Shirley
TOWN: IF HOSPITAL, HOSPITAL NAME: Lemuel Shattuck Hospital DEPARTMENT: Medical floor IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 02/14/1934 SCENE CONTACT NUMBER(S): Demographic Information AGE: 86 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: SEX: Male RACE: White MARITAL STATUS: Widow APPROXIMATE WEIGHT (lb): 130 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: MCI Shirley 1 Harvard Rd PO BOX 1218 Shirley
TOWN: IF HOSPITAL, HOSPITAL NAME: Leominster Hospital DEPARTMENT: ICU IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 07/06/1974 SCENE CONTACT NUMBER(S): Demographic Information AGE: 46 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 014-58-1408 SEX: Male RACE: Black MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 212 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: MCI Shirley Harvard Road Shirley
IF HOSPITAL, HOSPITAL NAME: Health Alliance Hospital Leominster DEPARTMENT: Medical floor IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 11/04/1950 SCENE CONTACT NUMBER(S): Demographic Information AGE: 69 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: SEX: Male RACE: White MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 212 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: 1 Harvard Road Shirley
Per reporting doctor the D is an inmate at the Mass Correctional Institution in Shirley, MA. Today on 10/28/20 the D was coming out of the bathroom when he had a witnessed collapse. MCI Shirley medical staff responded and performed ACLS. Shirley FD/EMS responded to the facility and transported the D to UMASS Memorial Health Alliance ER - Leominster. Upon arrival the D continued to go back and forth between asystole and PEA.
POLICE, TOWN: IF HOSPITAL, HOSPITAL NAME: Umass University DEPARTMENT: Cardiac ICU IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: SCENE CONTACT NUMBER(S): Demographic Information BIRTH DATE: 10/22/1992 AGE: 27 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 023-76-5486 SEX: Male RACE: Hispanic MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 300 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: Harvard Rd Shirley
TOWN: IF HOSPITAL, HOSPITAL NAME: Lemuel Shattuck DEPARTMENT: Medical floor IF NURSING HOME, NURSING HOME NAME: IF ANY OTHER FACILITY, SPECIFY: OFFICER ON SCENE: BIRTH DATE: 08/07/1942 SCENE CONTACT NUMBER(S): Demographic Information AGE: 77 GESTATIONAL WEEKS (BABY): SOCIAL SECURITY NUMBER: 021-32-0826 SEX: Male RACE: White MARITAL STATUS: Single, never married APPROXIMATE WEIGHT (lb): 120 APPROXIMATE WEIGHT(g): DECEDENT ADDRESS: 1 Harvard Road Shirley
DECEDENT IS: MVA: No TOWN OF MVA: STATE OF MVA: ACCIDENT DETAILS: INJURY: Yes INJURY AT WORK: No DATE OF INJURY: APRIL 9, 2020 TIME OF INJURY: UNKNOWN HOW INJURY OCCURRED: HANGED SELF PLACE OF INJURY (TYPE): CORRECTIONAL CENTER BODY DECOMPOSED: No LOCATION OF INJURY: 100 HARVARD ROAD, SHIRLEY, MA 01464 BONES INVOLVED: No Emergency Contact/ Person at Scene EMERGENCY CONTACT: ADDRESS: CONTACT NUMBER: EMERGENCY CONTACT RELATIONSHIP: OTHER, SPECIFY: Next