So today I left work and was on my way to meet hubby and kiddo to run errands. I was about 5 minutes away when I get a call from him saying they've been in a car accident! "We're ok though".
I arrive on scene, police had just gotten there as well. I see the car and someone sideswiped the passenger side of his 2 door coupe. My son was in the back seat passenger side. I do a look over of him, quick assessment and take him out of the car. He's blabbing on and on about his new crazy experience. (6 yr old aspiring race car driver) looking good.
The officer asked if I wanted an ambulance to come and I said yes.
So ambulance arrived on scene. My kid is just yapping away and enjoying all the attention. The medics take one look at me and say "but you're a nurse, you could've handled this, he seems fine". (Still had my badge on from work)
I said "yes but I'm an OR nurse so not exactly my forte plus I'd feel much better if he got a full assessment and some vitals".
So all in all everything is fine, the medics were really great but this raised a thought for me......
I would have done the same thing.I refuse to assess my loved ones. I have too many emotions regarding my loved ones I couldn't possibly think clearly. Besides for insurance reasons I would want an accurate medical evaluation the same day of accident so hopefully injuries are not up for dispute.
Another thing is we hate getting called to "evaluate" someone, whether child or adult, we are not physicians and cannot diagnose . . .
Funny, we got called for a police assist to evaluate a nosebleed just last week. The cop wanted to know if the subject's nose was broken. The paramedic I was riding with looked at the officer and said "Sorry, but my x-ray vision's been screwed up all day." Have all the respect in the world for our boys in blue, but the new(ish) cop didn't understand that we can't diagnose in the field.
EMS does NOT determine if you should go to the hospital or not. We can't understand why we are constantly called to "JUST evaluate" at the scene of accidents. Well here's a fact, you only have two options when we get there, 1. We evaluate, treat AND transport to the hospital or 2. We evaluate, treat AND you sign a refusal form acknowledging that you went against our advice (who's is always to go be evaluated by a physician) to be transported to the hospital for definitive care. See? EMS services must protect themselves against claims by patients later when things happen. In our EMS system not getting a refusal form signed when patients decline transport is grounds for termination. If the patient refuses to sign that we must document appropriately and when possible have a witness sign.
Our service has the same requirement. I've been told, though, that the refusal forms aren't enough to save a tech in court, so we're also very thorough in the rest of our documentation as well.
It's also frustrating in the hospital setting, too. A patient comes to the ER, gets evaluated by the nurse, and decides they want to go home because they're feeling better. We have to explain why it's still AMA since the actual physician/mid-level hasn't checked them out yet.
EMS does NOT determine if you should go to the hospital or not.
Yes, that is true for the vast majority of EMS systems. I realize in my above post I was speaking as an RN, not an EMS provider, and the person I was responding to was speaking as an EMS provider. I agree with you that the liability is too high for EMS providers to be making that judgment call in the field.
In this instance, if Mom was worried enough to call an ambulance, the kid should have been transported or an AMA form signed.
I do have one question though. Is it protocol for the police to call an ambulance in every motor vehicle crash, or was it reasonable for this officer to offer the choice?
Yes, that is true for the vast majority of EMS systems. I realize in my above post I was speaking as an RN, not an EMS provider, and the person I was responding to was speaking as an EMS provider. I agree with you that the liability is too high for EMS providers to be making that judgment call in the field.
In this instance, if Mom was worried enough to call an ambulance, the kid should have been transported or an AMA form signed.
I do have one question though. Is it protocol for the police to call an ambulance in every motor vehicle crash, or was it reasonable for this officer to offer the choice?
Thanks, I agree. As for the appropriateness of the police to call or not call EMS, I don't know.
Personally, I would not have been very objective with my family members and you made the right call. As we all know, those who look "normal" at the scene can develop complications hours or days later, having them checked out through the hospital was the correct method of action. Best of healing for your family.
I agree that you should not have been expected to do an objective nursing assessment on your own family, but I disagree with your choice to tie up an ambulance and its crew for this. You could have called a taxi or a friend to transport to a Convenient Care for vitals and a quick check up if you didn't have access to a vehicle of your own, then gone to an ED if Convenient Care recommended a more thorough exam.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
You cannot give a medical diagnosis, but you can give your impression. Telephone triage nurses do it all the time. In my state, RNs are qualified to perform a Medical Screening Evaluation to determine if a medical emergency exists.
Don't sell yourself short. You most certainly *are* qualified to determine whether someone should go to the ER or not.
Of course, you should always cover your behind with the disclaimer that you are not a physician, there may be something you don't know, and that if the person feels they may be having a medical emergency, then they should go to the ER- which it sounds like what you are already doing. But to play dumb, like you don't know anything, is really short changing yourself, and potentially setting the patient up for a huge medical bill that is not warranted.
If you don't think a person is having a medical emergency that warrants emergent intervention, you can tell them so and direct them to the the appropriate level of care, as long as you include the disclaimer above. It is not the same as giving a medical diagnosis, and telephone triage programs across the country would not exist were this not true.
If you're not comfortable with this, then say you're not comfortable with this. But to claim that it is outside of the RN scope of practice- and that by extension, no RN should give medical advice- is erroneous.
Actually no we cannot legally tell someone whether they should go to the hospital or not, nor will we, given the liability. Yes, sometimes it is REALLY obvious that a person does not need a hospital or ER, but we always say it is your choice, not ours. We are not hear to provide medical advice to patients, as a triage nurse would be and would have the appropriate protocols to follow, we are hear to give you a ride to the hospital and treat as appropriate should you choose to go.
I have been in EMS for many years and am well aware of what I can and cannot do, do I generally have a good idea about what is going on with a patient and whether they need a hospital, yes. Given this sue happy society will I advice anyone that they do not need a hospital, NO! I have taken countless lectures as well done by lawyers who say the say thing, NEVER tell a patient they do not need a hospital.
*To give you an example... Joe's wife calls the ambulance because he cut his finger, just a minor laceration, no big deal, it doesn't even look suterable. Does Joe need a hospital, probably not, so you tell Joe, no sir you do not need the ER, just clean it, put some bacitracin on, and put a band aid on it, it will be fine, after all he says he is up to date on his tetorifice shot.
Joe never mentioned that he cut his finger on a dirty engine part from a 20 year old car that has been sitting outside for months, and within 24 hours Joe's finger is twice the size and becoming rapidly necrotic. Joe's wife takes him to the ER by car, because the ambulance said he didn't even need a hospital yesterday.
In the end multiple attempts are made to save Joe's finger, but it has to be amputated along with part of his hand a few days later after several failed antibiotics. *
This is not a far fetched story, thus this is a perfect example as to why EMS should NEVER tell a patient they do not need to go to the hospital. If it is minor we will suggest going by POV, but never ever say they do not need to go, there is absolutely no need to open oneself up to that kind of liability!
Specializes in Adult and Pediatric Vascular Access, Paramedic.
Yes, that is true for the vast majority of EMS systems. I realize in my above post I was speaking as an RN, not an EMS provider, and the person I was responding to was speaking as an EMS provider. I agree with you that the liability is too high for EMS providers to be making that judgment call in the field.
In this instance, if Mom was worried enough to call an ambulance, the kid should have been transported or an AMA form signed.
I do have one question though. Is it protocol for the police to call an ambulance in every motor vehicle crash, or was it reasonable for this officer to offer the choice?
Yes, in most cases and in most towns it is protocol to call the ambulance if the damage is fairly significant, there is airbag deployment, or there is a small child or other individual that cannot reliably state whether they are injured or not, or in this case if the party involved requests EMS be called for any reason.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
"Sorry, but my x-ray vision's been screwed up all day."
As a school nurse, whenever I am asked if something broken, I say, "my xray vision glasses are in the shop today. You're going to need to go get one done if you want to know for sure"
What a great post! I'm loving it! And here I thought I was the only one with this issues. For years I've been trying to make people understand that just because I'm an RN it does not mean I'm a cardiologist, ER nurse, NICU nurse, ICU, and all other specialties bundle into one. We are not first responders. Given the situation I would have done the same. I know many nurses who have not done bedside their entire RN careers let alone given a proper assessment in an ER situation.
Recently, I was in the airport with my scrubs on since I left my job straight from the airport, a man fell on the floor and the first thing everyone said was aren't you a nurse or something ? Yes I'm but please call airport ER team, thanks oh and have a safe flight. People think that just because your a nurse your supposed to save the world and respond to every ER ,News flash ! 👊ðŸ¾I'm not a ER responder! Granted of course it is in my nature to help and be a Good Samaritan but you have to be careful and protect the license and know when a situation is not your call.
Everyone has a role to play. I cannot pretend I'm a peds nurse when I'm a home care nurse! ✊ðŸ¾Everyone has a a specialty, reason why ER hires ER nurses , NICU hires NICU nurses and so forth 90% of the time, is that simple. ðŸ˜
MandieeRN
93 Posts
I would have done the same thing.I refuse to assess my loved ones. I have too many emotions regarding my loved ones I couldn't possibly think clearly. Besides for insurance reasons I would want an accurate medical evaluation the same day of accident so hopefully injuries are not up for dispute.