What is the appropriate action to take?

Nurses General Nursing

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Specializes in ER/Forensics/Disaster.

This is just a totally random question I thought of on a trip home from New Orleans recently. There was a very bad accident off one of the exits and it got me thinking.. If I were to witness a bad car accident, pulled over to assist--and for whatever reason it was clear that the person probably had neck injuries--but was not breathing/no pulse and needed CPR.. What is the appropriate action to take? I'm a student nurse, and I realize that I could get sued for potentially paralyzing someone in an effort to help, but the person would die without CPR.. So what would be the appropriate action to take? Hope this makes sense.

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If the person has obvious neck injuries (badly out of alignment, etc.) and no pulse and is not breathing, chances are the spinal cord has injuries not compatible with life. In other words, he's already dead.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Good Samaritan laws should protect healthcare workers who are assisting the injured on their own time, as long as they are not accepting payment or gifts from the patient. Under these laws, you cannot be sued for providing care to the injured while you are off-duty at the scenes of vehicle collisions, fires, slip-and-falls, etc. As long as you do not accept money for the services rendered, you cannot be sued if the injured person goes downhill.

Good Samaritan laws were enacted to encourage healthcare workers to help the injured without fear of litigation.

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But this is only true as long as the healthcare worker renders aid within his/her scope of practice. If a nurse attempts, albeit in good faith, to perform an emergency trache, which is normally a physician's procedure, the nurse can indeed be sued if anything negative happens.

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Specializes in ER/Forensics/Disaster.

Well, for the patient's sake---would you take them out of the car and perform CPR?

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At that point, with obvious neck injuries, no I would not.

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Another way to look at it: accident victims who have no pulse almost never make it back because they have injuries not compatible with life: severe head trauma, spinal cord severance, ruptured aorta/heart, etc.

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Specializes in ER/Forensics/Disaster.

But then if I didn't do anything--I could be in trouble, right?

Sorry, I'm still learning!! Thanks for your input everyone!

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No. You are not considered a medical professional since you are a student, so you would be held to the same standards as any other bystander.

If, after you are licensed, you identify yourself and still do nothing, yes you could be in trouble but only if it can be proven that your inaction caused the death.....very hard to prove if the person was dead when you arrived on scene.

Because medical personnel are not protected by the Good Samaritan Law once they identify themselves as medical personnel, many choose not to reveal this fact and will either help silently or not help at all.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

IF you WITNESS the accident, you should stay at the scene for the purpose of giving a WITNESS STATEMENT to the law enforcement officers.

In this CASE - you must stay to give a statement. END of LEGAL duty.

As to rendering aid - I'll try to be succinct.

As a rule - I DO NOT stop at accident scenes (yes, I have stopped before - but it has to be an exceptional circumstance). This is a personal decision. I DO NOT have red lights, decals, license plate, etc. on my POV that would identify me a nurse or paramedic. I will call 911 and give as much info as I can - exact location, # vehicles, possible resources they may need (fire truck, etc). Stopping at accident scenes that you have no duty to stop (witness) will firmly land you in the 100% accountable for your actions.

Reasons I DO NOT stop:

• Traffic scenes that are "fresh" are very unsafe, No LEO control puts you at the mercy of the scene gods - I've found that they can be punishing.

• No equipment, increases my chance of exposure (blood, haz mat, unstable vehicles, fire, electricity, other drivers, wreckage) - all the while, I am acting in an independent nature - so, if I became ill/injured as a result of my hero actions I alone suffer the consequences.

• Litigation. I know, go save lives - alleviate suffering - yada, yada, but, although I KNOW that I can be prudent and make good decisions and provide excellent care - I just cannot reconcile with the potential for a BAD OUTCOME for me. MVC's are often events that produce injury, injury = pain+suffering+economic damages. This equation makes a lawsuit. I choose not to be a factor.

A CAUTION on the GOOD SAMARITAN laws. Most states have found them to be unconstitutional - a law generally CANNOT limit one's rights to be "made whole"/recover damages. It is also NOT an AFFIRMATIVE defense. As such, I act in a manner consistent with my DUTY to ACT only. ANYONE can sue ANYONE for ANY REASON. Now, they may not win - but, you can bet that defending yourself will not be free/easy.

HoorahFLY - In the case that you describe - NO I would NOT start CPR. Blunt force trauma that has NO VITAL SIGNS on scene has a ZERO 0% factor to survive, no matter what is done. But as a student you probably did not know that. Also, I know of NO STATE that REQUIRES anyone to stop at a scene (unless they are the witness of the accident themselves). This includes NURSES. Now, is there a moral duty (personal choice)? :)

Anyway, I encourage all to be clear on your state laws.

Know your duty to act.

Make good decisions as it relates to your safety in UNCONTROLLED situations (no training, equipment, etc.). DO NOT become a victim.

The difference between HERO and (scape) GOAT is very narrow.

Stay safe.

;)

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Specializes in cardiac/critical care/ informatics.

Wow you gave a lot of food for thought!

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Good Samaritan laws should protect healthcare workers who are assisting the injured on their own time, as long as they are not accepting payment or gifts from the patient. Under these laws, you cannot be sued for providing care to the injured while you are off-duty at the scenes of vehicle collisions, fires, slip-and-falls, etc. As long as you do not accept money for the services rendered, you cannot be sued if the injured person goes downhill.

Good Samaritan laws were enacted to encourage healthcare workers to help the injured without fear of litigation.

I don't think this is totally true. I think the helper still has to do things correctly or can be sued. I think. She should consult an attorney for definitive answer in her state.

As for the original question - I have no idea what she should do. I think I would be loathe to begin CPR, for fear of paralyzing someone. HOweve, that answer is probably not right, because courts tend to follow the doctrine of life at all cost, even paralysis, so would say to do the CPR. Sorry, I'm just not sure. Maybe we need attorneys and ethicists to weigh in. :uhoh21:

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