Emergency Nursing Care Outside of the Hospital

RotorRunner · Jun 21, 2017

Call 911 and let the pre-hospital EMS providers do their jobs. :)

Seriously though, I'm a flight nurse who responds to the scene of accidents when EMS calls, and I am not even considered a first responder. EMS is trained for management and transport of the pre-hospital patient.

Now, I have had friends and coworkers who've been in situations where they've witnessed someone go into cardiac arrest at the grocery store or something and provides excellent bystander CPR in the minutes before fire/EMS arrived. That is completely appropriate.

Long story short - let EMS do what they're trained to do. Stay up to date on your BLS.

Lev, MSN, RN, NP · Jun 21, 2017

Do chest compressions, have someone else call 911 and have a 2nd person locate an AED. Call out to see if someone has naloxone/narcan if you suspect an overdose.

Have the weak/pale/faint/dizzy/chest pain person sit down. Call 911.

If it's a diabetic and they have supplies to check a blood sugar, do so. If it's low and they are alert give them some carbs. If they are unconscious, check a pulse, if there is none start compressions, otherwise, put some sugar under their tongue and let it dissolve and call 911. If their blood sugar is high and they are lethargic call 911.

That is it.

JustBeachyNurse, LPN · Jun 21, 2017

Easy call 911. You aren't a first responder, EMT or paramedic. Basic first aid and calling for help. There is no "emergency nursing outside hospitals". There are prehospital RNs that work on ALS ambulances though.

**NICU Guy, BSN, RN** · Jun 21, 2017

If you come across a car accident, you will be unable to do anything but basic first aid which would be common sense and not in depth research. Anything beyond that and you are exceeding the Good Samaritan Law and would be liable for any harm you do. EMS would arrive within 5-10 minutes, what would you want to be doing in those 5-10 minutes?

JKL33 · Jun 21, 2017

Hello all! So, I'm a new nurse and one of the things that has me rather freaked is rolling up onto a vehicle crash (or any such event) and giving emergency nursing care. I was wondering if there are any really great websites, books, or other resources that can provide nursing care outlines for such events. Any tips would, also, be so much appreciated and thank you very much in advance!

Assuming this isn't a troll post:

I mean this sincerely - I'm not sure why this of all things is of significant concern to you as a new nurse. Some may think your avatar is cute, but of course the truth is you haven't suddenly morphed into superman/woman. I know people enjoy the 'good samaritan'/altruism feelings, but the average nurse simply does not have as much to offer at a fresh crash scene as s/he might imagine. For starters, scene safety is actually a "thing", and totally disregarding it due to adrenaline and/or wanting the excitement of being first, having a story to tell...all of that is just...extremely unwise.

Earlier in my career I was second at a crash scene. The person who had arrived first was a nurse who had opened the passenger door and was advising the driver to wrench open the smashed driver-side door "so help can get to you". Meanwhile the driver was returning to consciousness, pale, diaphoretic, complaining of neck pain and had other obvious injuries.

You have many, many other aims to focus on as a new nurse. Best to leave this off your list of things to worry about for now.

**NICU Guy, BSN, RN** · Jun 21, 2017

scene safety is actually a "thing", and totally disregarding it due to adrenaline and/or wanting the excitement of being first, having a story to tell...all of that is just...extremely unwise.

100% agree. Witness a car accident where a car smashes into a power pole and your first reaction is to open the car door not realizing that the power line is laying across the car. When EMS arrives they have an additional victim because you are in cardiac arrest from the electrical shock.

brownbook · Jun 21, 2017

First on the Scene of an Auto Accident - What to do? - Road & Travel ..

I am terrible with computers. But the above is a pretty good article. First protect yourself, is the area safe, warn other approaching cars so more cars don't crash, stuff you don't think of.

I have to add, this has been bugging me. One of the injured children at the Ariana concert in Birmingham. Her father picked up his injured daughter and ran with her cradled in his arms....yikes I can just imagine the further trauma he may have done to her!

Don't move injured people unless they are in the way of a fire, rising water, falling buildings, etc.

SouthpawRN · Jun 21, 2017

Make sure you understand the applicable good Samaritan laws in your state. You are under no obligation to stop or render aid, but you do open yourself up for liability if you do. Thank you American legal system. Even if you do everything right, the family can sue you because they feel you did not do enough or did too much. It will cost you thousands of $$ to defend yourself in such a case even if you are totally innocent. As others have said, stick to basic first aid, BLS. I would not even identify myself as a nurse or paramedic etc. to the patient or bystanders in most situations (esp traffic accidents). It sucks but that is the America for you. I have a dash cam in my vehicle, so if I do stop now, I will position my vehicle where my actions are recorded and also to protect me from other traffic on the highway) this is where scene safety comes into play. Skills that become instinct after years as a paramedic, but you may not have those as a new nurse.

**canoehead, BSN, RN** · Jun 21, 2017

Having been at an accident scene, remember that when you are stressed and out of your home environment, you are only half as smart as you usually are. Just ABC's and hold Cspine.

allnurses Guide · Jun 22, 2017

Everyone here has given really sound answers and advice. I have trained for all kinds of disaster preparedness but because I live in one of the most litigious state in the union I hesitate to provide care at accident scenes. My malpractice insurance does not cover me for care I give outside my employment. On a side I witnessed a pretty bad accident about a year ago and did stop to help get the several children involved to safety at the side of the road and provide basic first aid until people with higher medical authority arrived.

I never offered or was asked for my name and faded out as soon as I was no longer needed at the scene.

Hppy

Cvepo · Jun 22, 2017

My thoughts are this: I'm sure if you a witness a situation such as a car crash, your basic nursing instinct would come into play. But please, let the trained professionals do what they do. I wouldn't want to walk into one of my patient's rooms and have, say, a visitor who is an EMT, touching my pumps, my monitor etc. Not because they don't understand what's going on, but because I'm the professional in this situation, and their knowledge (while possibly appropriate) is not warranted. Maybe that's a bad example. But the point is the same: leave emergency medicine to the EMTs, let them work.

Now if you're at a restaurant, are BLS certified, someone chokes and turns blue and the family is screaming for help, that may be a different story where at least BLS would come in handy. I've had a few s/p cardiac arrest patients saved by bystander nurses/healthcare professionals who have had successful recoveries!