First Responder Question

[Benj2610]

This morning as my bus turned the corner entering the bus stop, I heard a shreik from the back & saw that a woman had been hit by a car. She was lying prone with her cheek pressed against the ground. Two guys were standing over her. I ran over & found that she was responsive & one man was on the phone trying to answer 911 operator questions... to which I said "she's responsive."

I didn't want to mover her as I didn't see her get hit and nobody else did either. So I don't know if she bumped her head or whatever neuro or muskoskeletal problems there may have been. But I asked her if she could hear me & in a soft dreamy voice she said yes (& her pulse was +2 and didn't seem tachy).

So while waiting for EMS & NYPD (which were there in less than 5 min), should I have asked her to tell me her name and/or asked her to wiggle her toes/squeeze my fingers? Anything else I should have assessed while waiting for EMS?

Sorry for all the detail... new RN still trying to learn how to give report!

Thanks...

[JustBeachyNurse, LPN]

Not really. Establish scene is safe. Call 911 determine if responsive. Look for obvious life threatening injuries (labored breathing, compromised airway, open fracture, arterial bleed) but only intervene if you are absolutely certain that you know what you are doing and await EMS. (As an EMT we watched a "helpful nurse" bystander nearly cause an internal decapitation by incorrectly trying to stabilize cspine )

Most nursing schools do not cover basic first aid and none cover EMS skills as EMT/paramedic are a different training/scope working under physician protocol in the field. Asking a person to move extremities, etc can possibly cause harm and will be of little assistance to EMS.

If you witnessed the incident you could relay the info to police and EMS (regarding mechanism of injury so the EMTs and paramedics can anticipate potential issues). Just keep them calm and await the professionals.

You could always take a standard first aid, first responder or EMT class if you want to have other skills.

[Lunah, MSN, RN]

I think you did the best thing under the circumstances - you spoke with the patient. Sometimes that is exactly what they need, a friendly voice to reassure them and keep them calm and still while waiting for EMS. I am sure she appreciated it!

[Benj2610]

Thank you all... I figured not to do anything more than CPR if it was needed (which I am qualified & certified to do). And I certainly know/knew not to try to move her. Even feeling her pulse... her arm happened to be conveniently accessible. Its interesting to read your response JustBeachy because I once read a discussion about an EMT (or someone in that area) describing a dispute with an RN regarding Hi or low flow O2 in a COPD patient in an emergency situation. And the take I got from it after several comments was that RN's need to be aware that the bedside setting is very different from emt/first responder situation. And I detected a little frustration from the EMS side that this point is not emphasized in Nursing school. I can tell you from my experience as a 39 year old nursing student (when I was in school that is), I really resented the pressure put on us in clinicals to (for lack of a better term) "jump right in." Its good to be ambitious, but you don't want to be reckless.

[JustBeachyNurse, LPN]

Exactly. Just like when I worked in the ED and they hired EMTs as techs many EMT/ED Techs had a difficult time not "running the show" and needing orders (whether direct or standing order protocol) to perform many tasks. In the hospital only RRTs, physicians and RNs could deep suction or suction advanced airways. A few techs were were disciplined for crossing the line not realizing that the EMS field work is actually physician signed standing order protocols. These were good EMTs that could arrive on a scene, establish safety. & control, rapidly assess a patient, safely package & transport an ill or injured person and deliver to the ED with a concise, accurate report. Also assist with proper removal of field equipment (HARE traction (not removed until OR for femur fx back then) MAST pants, KED, backboard, etc) where most nurses knew it was used by EMS but not necessarily how to operate these items. I know EMTs that could do full manual vitals accurately while traveling in the back of rig sirens blasting, including manual BP but had a hard time taking direction from the nurse they were paired with at work.

There is crossover in skills but hospitals have supplies and resources (usually) readily available while sometimes EMS has to improvise with what they have such as splinting a fx leg to the good leg with triangular bandages and loading on a a board for transport

It think knowing the limitation of your knowledge and skills is key when stopping to help others. Often calling 911 is the simplest and best answers nearly every EMS dispatch team has protocols they can direct a caller to start life saving measures in the field while waiting for EMS such as initiating CPR or how to stop bleeding or even coach through an imminent childbirth.

[NurseOnAMotorcycle, ASN, RN]

You assessed the situation and reacted appropriately, making sure that EMS was called and additional damage was not inflicted.

You did great! Good job!

[akulahawkRN, ADN, RN, EMT-P]

On the whole, I'd say you did just fine. You established that the scene was safe, you established that the patient was responsive, had a patent airway, was breathing, had a pulse, and was at least talkative. You kept the patient and everyone around her from moving her around. You also noted that EMS had already been contacted and (hopefully) you related your findings to the EMS crew that responded.

These are all good things and all things that I would do (and I'm a Paramedic also) if I were in your situation. Good job!