What would you do if.....

  1. My husband and I had this discussion while waiting in an airport and he saw an AED on the wall. We chatted about the "it's nice they're available...etc" and then he asked...

    Is a healthcare professional who is certified in CPR (BLS, ACLS, Whatever) OBLIGATED by law to jump in when someone on the street or in a public place goes down? At first it seemed very cut and dried, at least from an ethical point of view, but he kept coming up with scenarios (love my DH, he does come up with things! So I told him I'd ask around the forum club...

    First - are we REQUIRED by law, State Practice Act, whatever, to jump in when someone goes down in public and we're off duty.

    Do we HAVE to perform mouth-to-mouth if we don't have a shield of some kind? What if there's secretions, vomitus or whatever?

    Do we have to jump in if two people are already attending to the person, and seem to be providing proper CPR? What if they're doing it wrong?

    If there's a traumatic injury, would you jump in to stem the flow of blood with your bare hands?? Would how the victim looks make a difference? IE - if they looked sick, homeless, drug using, as opposed to a business-looking guy in a suit or a LOL in her sunday hat?

    Would instinct take over beyond our automatic Universal Precautions when those precautions are NOT available right away in a public situation? If they don't, and you DO concern yourself with your safety, are you liable for not acting, or not doing all you could if you had proper equipment.

    If you don't act (for whatever reason) and someone finds out you were there and are a trained HCW, would you be legally liable if the victim died? On the other hand, if you did jump in and did the best you could, does Good Samaritan cover us as licensed professionals, or only the 'man on the street' samaritan?

    Leave it to my DH, who thinks devil's advocate is a career to come up with all these "what ifs", but I am curious as to what others' think of all this?

    My own first thought was SURE I'd jump in ... but then, mouth-to-mouth with an unknown person? Stemming blood with my bare hands (I bite my nails, donchaknow)? What if I did what I felt was ethically my responsibility and got a disease like HIV or Hep C - who's going to address THAT? Not my work if I'm not on duty. And as an aside, I had a LOL patient who was sweet as could be and nearly 100, and she was HIV+, so I don't think I could make a call in the regard based only on appearance.

    What do you all think? Nothin's ever easy...
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  2. 12 Comments

  3. by   Roseyposey
    In my state, HCWs are not legally obligated to assist when off-duty. I believe law enforcement officers and paramedics, however, are. As far as assisting without proper protection - personally, I don't know. I think in the end, I probably would because on the flip side of that I would hope someone would assist a family member of mine even though they didn't have a mouth shield, gloves, etc...
  4. by   Altra
    I don't know about the legal aspect regarding whether I'm required to assist, so I can't address that.

    I will say that my very first CPR class years ago, even before I went to nursing school, made a huge impression on me. The instructor said to us, "I want you to think about this -- if you're not willing to use what you've learned here, on a moment's notice, this class is of no use to you or anyone else."

    I carry a shield on my keychain - small, inexpensive, and would be a temporary fix if I had to give rescue breaths.

    Thinking about the dynamics of a scene that would require my intervention to stop bleeding (the "stop bleeding with your bare hands" scenario) ... if the scene was safe, yes, I would, although I would try to grab a plastic bag or other material. That would be my first thought - is the scene safe. If I jump into a situation without a quick assessment of the surroundings and get injured, I'm not only not helping the person I intended to assist but I have also become an additional burden to other emergency services personnel when they arrive.

    The appearance of the person requiring assistance would not matter ... I work in an urban Level I ER and treat the homeless, crime victims & perpetrators, jail inmates and addicts on a daily basis.
  5. by   TazziRN
    Off duty, we are not obligated to jump in, nurses or other EMS personnel, unless and until we identify ourselves as EMS or nurses. Then the obligation starts, and the Good Sam law does not apply the same way as with Joe/Jane Blow. We would be held to the standards of other prudent nurses. If Joe Blow moves something and does further damage, he is protected by Good Sam because he was trying to help. If a nurse or other EMS personnel does that, we would not be protected because we know better.
  6. by   mom2michael
    Quote from TazziRN
    Off duty, we are not obligated to jump in, nurses or other EMS personnel, unless and until we identify ourselves as EMS or nurses. Then the obligation starts, and the Good Sam law does not apply the same way as with Joe/Jane Blow. We would be held to the standards of other prudent nurses. If Joe Blow moves something and does further damage, he is protected by Good Sam because he was trying to help. If a nurse or other EMS personnel does that, we would not be protected because we know better.
    According to my Quick Facts on Legal Nursing book, each state has it's own statue called the Good Sam Act which provides some form of personal immunity for actions or omissions of medical care by a volunteer (the key is the volunteer, when you recieve compenstation, this no longer applies). The term volunteer can encompass EMS, doctors, nurses, etc.....It really stresses that the Good Sam Act for each state only applies if you do not recieve $$$$ for your services.

    Also according to this book, these laws help encourage everyone to assist in emergencies w/o fear of civil or criminal liability. It goes on to point out that it only protects you from ordinary negligence and not gross or negligence reckless behavior.

    It also points out that in most states, except for Vermont (who says you must do so unless there is a danger to yourself), there is no obligation to render emergency services to strangers.

    However, the book also points out that this doesn't help the fact that people will still sue regardless of what you did or didn't do while on scene.
  7. by   BJLynn
    Legally, no obligation. Morally, very different story.

    I agree with the "safe scene" senario. That's what I was taught in life gaurding classes eons ago. Never create TWO victims in the attempt to save one.

    As for the Good Samaratin laws (at least in Illinois), nurses and doctors are protected in an emergency situation outside a clinical setting. The only event which would change that is if we as said nurses accept payment for our services rendered. THEN we become totally litigation worthy in the eyes of the law. Here is an section of the Illinois Good Samaratin law (the:

    Any person licensed under the Medical Practice Act or any person licensed to practice the treatment of human ailments in any other state or territory of the United States, who in good faith provides emergency care without fee to a person, may not, as a result of his or her acts or omissions, except willful or wanton misconduct, in providing such care, be liable for civil damages. Full text can be read here: SALF - Save A Life Foundation - Illinois Good Samaritan Law

    This was a clarification/amendment that wasn't passed, but would clarify even further legally who falls under the GSL: ...Amends the Good Samaritan Act. Provides that a physician licensed to practice medicine in all its branches, a physician assistant, a nurse, a paramedic, an emergency medical technician, or a First Responder who, in good faith and without fee, or with a fee not to exceed $1, to a person, provides assistance to a law enforcement officer while the officer is engaged in law enforcement critical incident, tactical training, or tactical operations is not liable for civil damages as a result of his or her acts or omissions in providing the care, except in cases of willful or wanton misconduct.

    Having said all that, have I ever helped out in an emergency? You betcha. I live by an accident prone intersection. Two or three nasty accidents a year. Over the years I have lived in this house, on days where I should have just been sitting around enjoying my time off, I have found myself doing things ranging from stabilizing suspected neck injuries to crawling in a crunched up car full of glass to comfort an infant who wasn't hurt, but was extremely scared (mom was hurt pretty bad). As soon as on duty personel show up (usually 3-5 min) I give them a report as to what I've seen and done, and exit the scene.
  8. by   ItsyBitsySpider
    I would help absolutely but definitely would not give rescue breaths w/o a mask. As far as the bleeding, if nothing was available I would probably hold pressure w/o gloves. This is why I carry both. I also keep gloves in my car so I hope to never be in the situation without these things. I would hope someone would help my loved one if they were in this situation as well but I would never expect anyone to risk their own health for that reason. I've also seen LOL and lots of cute kids that are Hep and HIV+.
  9. by   DusktilDawn
    Quote from EmerNurse
    My husband and I had this discussion while waiting in an airport and he saw an AED on the wall. We chatted about the "it's nice they're available...etc" and then he asked...

    Is a healthcare professional who is certified in CPR (BLS, ACLS, Whatever) OBLIGATED by law to jump in when someone on the street or in a public place goes down? At first it seemed very cut and dried, at least from an ethical point of view, but he kept coming up with scenarios (love my DH, he does come up with things! So I told him I'd ask around the forum club...

    Leave it to my DH, who thinks devil's advocate is a career to come up with all these "what ifs", but I am curious as to what others' think of all this?

    My own first thought was SURE I'd jump in ... but then, mouth-to-mouth with an unknown person? Stemming blood with my bare hands (I bite my nails, donchaknow)? What if I did what I felt was ethically my responsibility and got a disease like HIV or Hep C - who's going to address THAT? Not my work if I'm not on duty. And as an aside, I had a LOL patient who was sweet as could be and nearly 100, and she was HIV+, so I don't think I could make a call in the regard based only on appearance.

    What do you all think? Nothin's ever easy...
    First - are we REQUIRED by law, State Practice Act, whatever, to jump in when someone goes down in public and we're off duty.
    Actually that is not entirely accurate, only some states have enacted laws that make it punishable not to render aid. Contacting emergency services could also be the minimum requirement of rendering aid in these states. What one may be LEGALLY required to do and what is MORALLY & ETHICALLY the right thing to do are not the same thing.
    If you don't act (for whatever reason) and someone finds out you were there and are a trained HCW, would you be legally liable if the victim died? On the other hand, if you did jump in and did the best you could, does Good Samaritan cover us as licensed professionals, or only the 'man on the street' samaritan?
    Good Samaritan laws do cover us licensed professionals. As long as our actions do not constitute gross negligence and are provided without fee or compensation. Good Samaritan laws do not protect anyone from being sued, however it becomes the plaintiff's responsibilty to prove any deviations from normal care or a connection between negligence that results in injury/death.
    Do we HAVE to perform mouth-to-mouth if we don't have a shield of some kind? What if there's secretions, vomitus or whatever?
    If there's a traumatic injury, would you jump in to stem the flow of blood with your bare hands??
    Would instinct take over beyond our automatic Universal Precautions when those precautions are NOT available right away in a public situation? If they don't, and you DO concern yourself with your safety, are you liable for not acting, or not doing all you could if you had proper equipment
    Good Samaritan acts do address the issue of safety. If continuing to give aid puts the responder's safety at risk (ie: such as inadequate protection against HIV due to lack of gloves) they can cease to give aid. A responder can never be forced to give aid if doing so puts them or others in danger.

    Do we have to jump in if two people are already attending to the person, and seem to be providing proper CPR? What if they're doing it wrong?
    Not necessarily. If you have identified yourself at the scene, than you can be held accountable. If CPR is already being administered properly, you may only need to assist if one of the responders is unable to continue administering CPR (ie: exhaustion). If it is being done incorrectly, you would be obliged to step in.

    Once you become a responder to the situation you cannot cease to give care until:
    1. someone of equal to higher training arrives to take over.
    2. it is necessary to call for needed medical assistance.
    3. continuing to give aid is unsafe.
    4. you become incapable of continuing to give aid (ie: exhaustion).
    Would how the victim looks make a difference? IE - if they looked sick, homeless, drug using, as opposed to a business-looking guy in a suit or a LOL in her sunday hat?
    Again I reiterate, what you may legally be required to do and what is ethically & morally the right thing to do ARE two different things. Morally and ethically one would consider that any victim, regardless of appearance should be helped, if you would help one, why not the other? Legally, one may only be required to contact emergency services to fulfill their obligation of rendering assistance under the law.

    Good Samaritan law - Wikipedia, the free encyclopedia
    Good Samaritan Statutes
    STATE OF MICHIGAN
    Michigan - PA 173
  10. by   ann945n
    I would never give mouth to mouth on someone i didnt know without a shield. This is the first thing we learned that you have to protect yourself. Like when you come across the scene of a accident you first stop and look at the area to see if its safe. Is gas leaking from the car is a power line down ect... Same with bodily fluids. If you say gave CPR to someone who is covered in blood or other fluids and later you get HIV or Hep and say die 10 20 30 years from now what about all the people in the future you wont be there to help because you are sick and dying? You always look out for yourself first cause no one else will
    Also we learned if you really want to help and dont have gloves or a shield you can use your coat or other fabric in place of gloves to like stop bleeding ect... But for this reason just keep a set of gloves and a shield in your purse, i also keep a mask in my car. Just my thoughts!
  11. by   elizabeth321
    One of the first steps of CPR is ensuring the rescuer is safe...if you are not safe...you are not expected to put yourself at risk....exposing yourself to body fluids etc.

    Liz
  12. by   S.T.A.C.E.Y
    Quote from elizabeth321
    One of the first steps of CPR is ensuring the rescuer is safe...if you are not safe...you are not expected to put yourself at risk....exposing yourself to body fluids etc.
    EXACTLY!

    I would absolutely not touch any blood or bodily fluids without gloves, and WILL NOT give mouth to mouth without a mask either. If it was a family member or a close friend, then that principal would likely be negotiated. For a stranger, absolutely not. I want to make sure I come home every night to my family. And as for the airport....no way! Who knows where people have been, and what they've brought back with them? SARS made it across the oceans via airline passengers. Or, what about TB??
  13. by   All_Smiles_RN
    I'm no fan of giving CPR without a barrier or coming in contact with blood without gloves. The only time I think I would put this aside (besides for friends or family) is for a child.
  14. by   AnnieOaklyRN
    I am not sure about nurses (I am still a student), but I do know as a paramedic I am legally oblicated to stop and help, not that I do that all the time, but I also do not advertise with silly stickers all over my car like some do.

    About the mouth to mouth the new AHA guidelines for CPR indicate that mouth to mouth is no longer required, even with a sheild. Compresions only. Personally I would'nt care what they say if there is no BVM around the person is getting compresions only. I work in a city and cannot beleive some of these people that do mouth to mouth on heroin addicts, YUCK!!!

    The good samaritan law in most states protects poeple who are not working and being payed if something bad should happen and the person and they are jerks and try and sue you.

    Swtooth

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