Jump to content

Emergency Kit

Has 12 years experience. Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

I attend a fairly good size church. Sunday there was a medical emergency, fortunately the person did not need an AED. My church refuses to purchase one due to liability. They are afraid some one will use it without knowing how to. I have explained, so has other nurses and a paramedic about the good samaritan law would protect them.

Anyway, we want to put together an emergency kit, something that would be useful, just in case. But we must do it within the realm of our license, thus no drugs, other than aspirin.

The church does have an oxygen tank, so I want a non rebreather mask, aspirin, gloves, stethoscope, bp cuff. I also thought about making a cheat sheet in the box, for CP and stroke guidelines.

Does any one else have any other suggestions?

nurse2033, MSN, RN

Specializes in ER, ICU.

You can't do CPR without a BVM or pocket mask, and OPAs or NPAs. You might point out that their liability could be higher by not providing the AED, since it is widely expected and common to have one in a facility that has large numbers of people. Ask your paramedic friend, they should be able to help with this.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I would not recommend any of those items other than gloves, just some gauze for a temporary dressing and MAYBE aspirin.. Applying O2 and obtaining vital signs crosses the line, in my opinion, from acting in a layperson "good samaritan" role to acting in a professional capacity. If I were out in a public setting with someone whose condition made me want to get their BP ... the appropriate thing for me to do would be to urge them to seek immediate medical attention or, if necessary, call EMS.

Kidrn911

Has 12 years experience. Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

I understand what you are saying, I know we called 911, it took over 20 minutes for them to come, the ER is only 1.5 miles away, it is in a rural area.

I do know many Malls have what I have listed, that also would be considered a layman public setting.

Kidrn911

Has 12 years experience. Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

You might point out that their liability could be higher by not providing the AED, since it is widely expected and common to have one in a facility that has large numbers of people. Ask your paramedic friend, they should be able to help with this.

I agree that has been pointed out by my paramedic friend and fellow nurses

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I agree with you about the AED. My (small) church has two. ;)

jkr2020788

Specializes in CCRN, ALS, BLS, PALS.

I think the Aspirin, gloves, guaze, tape, kerlix, and the oxygen (maybe Im not sure, still considered a "prescribed" drug, wierd huh?) are about the only things you will need. Aside from the AED, which I definitely do not see why they wont allow it. Anything else is would just be overkill I believe. I dont think you will need a stethescope, unless you expect someone to have a spontaneous pnuemo or flash pulmonary edema. If someone is having a breathing problem outside of the hospital/ EMS area, all you need to do is find out if the person is choking or if they are having an asthma attack, either way, they are going to need the abd thrust or oxygen. Id leave the needle deflation of a pneumo to the EMS team or at the ER. There is alot of liability of doing invasive things. I know you would be trying to do the right thing, but sometimes the "right" thing is the worng thing at the time. Just remember, even starting an IV on someone as a nurse without having the premission from an MD, is illegal. The IV even says Rx only on it. Stat emergency contact, CPR if ness, and supportive care, is all you can do until you are under the coverage of a hospital.

Esme12, ASN, BSN, RN

Has 40 years experience. Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I attend a fairly good size church. Sunday there was a medical emergency, fortunately the person did not need an AED. My church refuses to purchase one due to liability. They are afraid some one will use it without knowing how to. I have explained, so has other nurses and a paramedic about the good samaritan law would protect them.

Anyway, we want to put together an emergency kit, something that would be useful, just in case. But we must do it within the realm of our license, thus no drugs, other than aspirin.

The church does have an oxygen tank, so I want a non rebreather mask, aspirin, gloves, stethoscope, bp cuff. I also thought about making a cheat sheet in the box, for CP and stroke guidelines.

Does any one else have any other suggestions?

You have NO need for CHEAT SHEETS for your only obligation is to call 911. I know your heart is in the right place....I know it is.....but as an Emergency Room Nurse I am frustrated by the well meaning intentions of bystanders when it culminates into a delay. Have I done the Heimlich and CPR in the public setting? Yes I have....I happen to be one of those "feces magnets" where people drop in front of me.

Remind your church that AEDs are made for the general public. They are in Airports and Schools all across the country and have been documented to save thousands of lives every year. Young and old alike are saved every day by early defibrillation....this has been well documented.

I do caution you about the use of Oxygen and aspirin as those are, in the medical world, a physicians order. Without and order you are acting outside your "scope of practice" for you cannot give medical orders. EMTs when they are working are under the direction of the EMS director and protocols that is run by an MD.The use of these treatment/interventions and causing a possible untoward outcome from delay of treatment or death from anaphylaxis (aspirin), would increase YOUR liability.

I would have on hand....... gloves, bandages, gauze, maybe a splint or two, a couple of ace wraps and personal protection devices for mouth to mouth. Maybe a bottle of water, juice and hard candy and a prepaid charged cellphone. If a family member wants to give an aspirin let them do it.

Taking the B/P and giving advice (call 911/don't call 911do we give aspirin) IS out of the scope of the layman's "Good Samaritan" law and can buy you more trouble for "Delay in treatment"....... IF you hadn't taken that blood pressure the patient would have gotten to the hospital sooner and the thrombolytic could have been given......now they are paralyzed/dead because you held them up from calling 911.

In the layman's world.....all that is necessary about the B/P is, Do they have one? If they have a pulse....they have a B/P. If no pulse...start CPR. It is well documented that the calling of 911 is the essential key to survival and any delay can be deleterious to the outcome.

If you were over a hour from the EMS response team....MAYBE???? and that's a BIG maybe. But if EMS is a reasonable time away.....call 911 and perform CPR. This is where the AED is valuable and door to treatment is of the utmost importance.:loveya:

Kidrn911

Has 12 years experience. Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

I know many have questioned the need for bp and taking VS, funny thing was when we were on the phone with 911, which we called right away and would always be called right away, they asked if we had VS.

BelgianRN

Has 6 years experience. Specializes in GICU, PICU, CSICU, SICU.

I think the aspirin comment is based on the fact that in the recent CPR guidelines there is growing evidence of giving prehospital aspirin. I searched the US version of the guidelines to see if it said something similar to the European ones and it holds the following:

To improve ACS outcome, all dispatchers and EMS

providers must be trained to recognize ACS symptoms, even

if atypical. It is reasonable for dispatchers to advise patients

with potential cardiac symptoms to chew an aspirin (160 to

325 mg), providing the patient has no history of aspirin

allergy and no signs of active or recent gastrointestinal

bleeding.

I'm not sure how things are evolving in the US but in Europe it's getting more and more common for EMS dispatch to advise the lay person calling to administer aspirin based on the signs and symptoms he/she hears and asks about on the telephone. Callers are instructed to ask spectators if they have aspirin and if so to administer the above amount.

So in this respect I can imagine it's handy having aspirin at hand in an emergency kit. But at the same time make it clear to everyone with acces to this kit that it should only be administered if prompted to do so by the dispatcher on the telephone after calling 911 so no delay exists.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I think the aspirin comment is based on the fact that in the recent CPR guidelines there is growing evidence of giving prehospital aspirin. I searched the US version of the guidelines to see if it said something similar to the European ones and it holds the following:

I'm not sure how things are evolving in the US but in Europe it's getting more and more common for EMS dispatch to advise the lay person calling to administer aspirin based on the signs and symptoms he/she hears and asks about on the telephone. Callers are instructed to ask spectators if they have aspirin and if so to administer the above amount.

So in this respect I can imagine it's handy having aspirin at hand in an emergency kit. But at the same time make it clear to everyone with acces to this kit that it should only be administered if prompted to do so by the dispatcher on the telephone after calling 911 so no delay exists.

Agree -- I don't have a problem with giving aspirin because the public is urged to do just that in the event of onset of chest pain.

Bottom line, OP -- you have to think BLS here. BLS as it is taught to non-healthcare providers. (The "Heart Saver" course, if you will) Anything else is out of the scope of anyone, regardless of licensure, unless active duty EMS.

Kidrn911

Has 12 years experience. Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

Agree -- I don't have a problem with giving aspirin because the public is urged to do just that in the event of onset of chest pain.

Bottom line, OP -- you have to think BLS here. BLS as it is taught to non-healthcare providers. (The "Heart Saver" course, if you will) Anything else is out of the scope of anyone, regardless of licensure, unless active duty EMS.

Exactly,

Another thing I forgot to point out, is we do have a MD available as well, so for the 02 use, we would be covered.

Esme12, ASN, BSN, RN

Has 40 years experience. Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Exactly,

Another thing I forgot to point out, is we do have a MD available as well, so for the 02 use, we would be covered.

Well....you are going to do what you need or want to do. I think you are putting yourself in a precarious situation. I think you should do the very basics. For your liability. Is the MD going to step forward and say he'll handle this? I really think you should reconsider. I am sure that you identified the 911 operator as nurse/EMT/Medic/MD which prompted the vitals question for they normally do not ask the caller's the patients vitals.

Well bless you for your big heart. Tread lightly and carefully but you seem to feel this is the right thing to do. I wish you the best.

theantichick

Has 3 years experience. Specializes in LTAC, ICU, ER, Informatics.

Don't count on the MD in your congregation "covering" the orders. He's introducing himself to a HUGE liability if he does, especially if he wasn't present. We investigated this thoroughly a couple of years ago when I was on the Board of my church.

This is not wilderness medicine. Get a pre-prepped first aid kit with bandaids, neosporin, ace bandage, ice pack, a few OTC meds, etc. I would continue to push for an AED. You can use OPA's and a BVM or a face shield without a medical order, and I'd recommend that. Anything else is going to put someone on the line for "who ordered this". For the OTC meds, if they're just made available and the patient self-administers (or a parent administers to the kids) then no medical personnel have given a med without an order.

grownuprosie

Has 1 years experience.

I am not understanding why taking VS is a delay in calling 911. Person A calls 911. Person B slaps in the cuff and taks vitals. \

As far as your church not wanting to be liable, could you gather the documentation of the good samaritan laws and submit them to the Church? Clergy are not lawyers, so they might not understand how these laws work. Having that AED could save someone's life. Not having one because of an erroneous assumption of liability will be tragic if someone dies because of it. You could also include that they only respond to shockable rhythms anyway. I could slap AED pads on myself and turn it on and nothing would happen unless i was in Vtach or Vfib. Laypersons often don't know how they work. They think it is like TV where the rescuer charges the unit and delivers the shock.

Edited by grownuprosie

Murse901, MSN, RN

Has 13 years experience. Specializes in Emergency, Case Management, Informatics.

From an ER nurse and from a former EMS standpoint, vital signs prior to my receiving the patient are for the most part of very little importance to me, unless they're coming from EMS. It's nice to have extra data, but it's not something that is going to change EMS's treatment of the patient, your treatment of the patient, or the hospital's treatment of the patient.

If you're going to act under Good Samaritan laws, you need to stay well behind the line that delineates Good Samaritans from practitioners. In fact, the more equipment you have available, the more the law is against you if something goes wrong.

If you have an MD who is willing to be a medical director for your church clinic, then by all means have him/her write up a list of protocols, get a bunch of equipment, and go nuts with it (so long as it doesn't interfere with EMS or delay response times).

If you do not have an MD who is willing to be a medical director with written protocols, you need to decide where you draw the line, and that line needs to be very clearly in your favor if the patient has a negative outcome?

My advice is to go with what others say. Get an AED (cite AHA's resources showing improved outcomes) and stick with BLS supplies. No oxygen. MAYBE aspirin, but the patient should give it to themself. No other drugs.

If the church isn't even willing to get an AED, I doubt they'd be willing to let you have a clinic set-up. Leave it be and call 911.

Esme12, ASN, BSN, RN

Has 40 years experience. Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I am not understanding why taking VS is a delay in calling 911. Person A calls 911. Person B slaps in the cuff and take vitals. \

As far as your church not wanting to be liable, could you gather the documentation of the good samaritan laws and submit them to the Church? Clergy are not lawyers, so they might not understand how these laws work. Having that AED could save someone's life. Not having one because of an erroneous assumption of liability will be tragic if someone dies because of it. You could also include that they only respond to shockable rhythms anyway. I could slap AED pads on myself and turn it on and nothing would happen unless i was in V Tach or V Fib. Laypersons often don't know how they work. They think it is like TV where the rescuer charges the unit and delivers the shock.

As you continue on your nursing journey to become a nurse you will begin to understand and make decisions yourself. I wish more schools spent more time on ethics and liability.

In a court of law, and I am not a lawyer....just a very experienced RN who has been around the block in the ED/Critical Care/EMS-trauma flight, the law is based on what a "reasonable and prudent practitioner" would do in this situation and what is "usual and customary". The problem with these arguments as they are open for debate and discussion.

A huge portion of the population does not take vital signs when 911 is being called (that is now the standard)....so the "time it takes to take them" to call 911 comes into debate. It can be argued that the time it took to "find the B/P cuff and stethoscope" to take the vital signs, and possibly be heard on the 911 tape....what's the B/P-----Pause, Pause, Pause----when that information means absolutely nothing to the 911 operator....OR...the ambulance/EMT/EMT-P responding. Valuable seconds that can bite you later.

It may seem insignificant on paper but as those moments tick by.....can be interpreted in hindsight as valuable seconds that would have made a difference.

The dispatcher hearing the vitals is rolling their eyes thinking...."Like I really need this information"........the dispatcher relays that information to the first responders and they roll their eyes, look at each other and bust out laughing......"Yeah, like that has anything to do with anything, at least we knowing.....they have a pulse.

If there is a bad outcome and some unthinking person makes the comment.....if only you called a little sooner. All your actions will now be called into debate and scrutinized to see if they involved any delay in treatment that caused deleterious harm to the patient. While you might not be found guilty of "delay of treatment", "incompetence", and "unprofessional conduct" or "negligence" the lawyers, court fees, time spent, court fees, depositions and all else that is a part of this process is personally taxing and financially devastating.

Then if you say "I'm a nurse from xyz Hospital" they can sue you over your confidentially/non compete agreement that you sign upon hiring that you sign at the beginning of employment. For I an sure it says that you will NOT represent yourself for the hospital when you are not on duty but will conduct yourself accordingly.

After you have gone through the courts for the civil liability lawsuit. Your hospital for breech of agreement you will be dealing with your state nursing board for negligence.

Really not worth the liability of taking the time to check the B/P when the only information necessary is whether or not they have a pulse, are they breathing, are they awake, and are the oriented.

Esme12, ASN, BSN, RN

Has 40 years experience. Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

The AED is like on TV.....It analyzes the rhythm. It will tell you whether or not a shock is advised. It charges itself. It tell you to get back. It will shock the patient. Analyze the rhythm. Shock again or tell you to continue CPR. Just like TV....it delivers the same shock as the ones on TV and the hospital.

The question at the end of the day is......will this information, at this time, overall change the treatment of the patient by having this information available......in this setting...right now. If the answer is no...it is not needed. and to do it can place you at risk.

For me.....I'm in public. It looks like someone is having a heart attack. I tell someone to call 911 now. There is a middle aged male sitting on a chair they are ashen and diaphoretic rubbing their left arm and chest. They state they are a little SOB.

The patient is alert I check the pulse....good and steady. To make small talk I ask them for allergies and meds. Has this happened before? do they have a history? If they are diaphoretic...get a cool cloth. Nothing to eat or drink unless you think hypoglycemia or they could use a significant med like their own Nitro. Loosen tight clothing.

I ask if they are diabetic (diaphoresis can be low blood sugar) If they have nitro I will help them administer their own medicine. EMS arrives. I tell them the patient took his own nitro, has a heart history and is allergic to xyz.....they take over and I continue shopping.

That is all that is necessary. I am there in case they go unconscious from a lethal heart rhythm and need CPR performed and pray that EMS arrives soon. Apply the AED if available. That is all the EMS needs and wants.

It is that simple....remember to KISS the patients cheek. Keep It Simple Silly.....

grownuprosie

Has 1 years experience.

As you continue on your nursing journey to become a nurse you will begin to understand and make decisions yourself. I wish more schools spent more time on ethics and liability.

The poster ahead of you already explained to me why VS are not needed, which I did not know before. If experienced nurses think VS are important, then I think it was a reasonable thing to be confused about. I don't think calling into question my schools ethics standards was necessary.

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK