What is the appropriate action to take?

  1. This is just a totally random question I thought of on a trip home from New Orleans recently. There was a very bad accident off one of the exits and it got me thinking.. If I were to witness a bad car accident, pulled over to assist--and for whatever reason it was clear that the person probably had neck injuries--but was not breathing/no pulse and needed CPR.. What is the appropriate action to take? I'm a student nurse, and I realize that I could get sued for potentially paralyzing someone in an effort to help, but the person would die without CPR.. So what would be the appropriate action to take? Hope this makes sense.
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    About flygirls2

    Joined: Dec '06; Posts: 100; Likes: 5
    Medical-Surgical; from US
    Specialty: Heme/Onc/Cardiac Stepdown

    21 Comments

  3. by   TazziRN
    If the person has obvious neck injuries (badly out of alignment, etc.) and no pulse and is not breathing, chances are the spinal cord has injuries not compatible with life. In other words, he's already dead.
  4. by   TheCommuter
    Good Samaritan laws should protect healthcare workers who are assisting the injured on their own time, as long as they are not accepting payment or gifts from the patient. Under these laws, you cannot be sued for providing care to the injured while you are off-duty at the scenes of vehicle collisions, fires, slip-and-falls, etc. As long as you do not accept money for the services rendered, you cannot be sued if the injured person goes downhill.

    Good Samaritan laws were enacted to encourage healthcare workers to help the injured without fear of litigation.
  5. by   TazziRN
    But this is only true as long as the healthcare worker renders aid within his/her scope of practice. If a nurse attempts, albeit in good faith, to perform an emergency trache, which is normally a physician's procedure, the nurse can indeed be sued if anything negative happens.
  6. by   flygirls2
    Well, for the patient's sake---would you take them out of the car and perform CPR?
  7. by   TazziRN
    At that point, with obvious neck injuries, no I would not.
  8. by   TazziRN
    Another way to look at it: accident victims who have no pulse almost never make it back because they have injuries not compatible with life: severe head trauma, spinal cord severance, ruptured aorta/heart, etc.
  9. by   flygirls2
    But then if I didn't do anything--I could be in trouble, right?

    Sorry, I'm still learning!! Thanks for your input everyone!
  10. by   TazziRN
    No. You are not considered a medical professional since you are a student, so you would be held to the same standards as any other bystander.

    If, after you are licensed, you identify yourself and still do nothing, yes you could be in trouble but only if it can be proven that your inaction caused the death.....very hard to prove if the person was dead when you arrived on scene.

    Because medical personnel are not protected by the Good Samaritan Law once they identify themselves as medical personnel, many choose not to reveal this fact and will either help silently or not help at all.
  11. by   Medic/Nurse
    IF you WITNESS the accident, you should stay at the scene for the purpose of giving a WITNESS STATEMENT to the law enforcement officers.
    In this CASE - you must stay to give a statement. END of LEGAL duty.

    As to rendering aid - I'll try to be succinct.

    As a rule - I DO NOT stop at accident scenes (yes, I have stopped before - but it has to be an exceptional circumstance). This is a personal decision. I DO NOT have red lights, decals, license plate, etc. on my POV that would identify me a nurse or paramedic. I will call 911 and give as much info as I can - exact location, # vehicles, possible resources they may need (fire truck, etc). Stopping at accident scenes that you have no duty to stop (witness) will firmly land you in the 100% accountable for your actions.
    Reasons I DO NOT stop:

    • Traffic scenes that are "fresh" are very unsafe, No LEO control puts you at the mercy of the scene gods - I've found that they can be punishing.

    • No equipment, increases my chance of exposure (blood, haz mat, unstable vehicles, fire, electricity, other drivers, wreckage) - all the while, I am acting in an independent nature - so, if I became ill/injured as a result of my hero actions I alone suffer the consequences.

    • Litigation. I know, go save lives - alleviate suffering - yada, yada, but, although I KNOW that I can be prudent and make good decisions and provide excellent care - I just cannot reconcile with the potential for a BAD OUTCOME for me. MVC's are often events that produce injury, injury = pain+suffering+economic damages. This equation makes a lawsuit. I choose not to be a factor.

    A CAUTION on the GOOD SAMARITAN laws. Most states have found them to be unconstitutional - a law generally CANNOT limit one's rights to be "made whole"/recover damages. It is also NOT an AFFIRMATIVE defense. As such, I act in a manner consistent with my DUTY to ACT only. ANYONE can sue ANYONE for ANY REASON. Now, they may not win - but, you can bet that defending yourself will not be free/easy.

    HoorahFLY - In the case that you describe - NO I would NOT start CPR. Blunt force trauma that has NO VITAL SIGNS on scene has a ZERO 0% factor to survive, no matter what is done. But as a student you probably did not know that. Also, I know of NO STATE that REQUIRES anyone to stop at a scene (unless they are the witness of the accident themselves). This includes NURSES. Now, is there a moral duty (personal choice)?


    Anyway, I encourage all to be clear on your state laws.
    Know your duty to act.
    Make good decisions as it relates to your safety in UNCONTROLLED situations (no training, equipment, etc.). DO NOT become a victim.

    The difference between HERO and (scape) GOAT is very narrow.
    Stay safe.
    Last edit by Medic/Nurse on May 24, '07
  12. by   jmgrn65
    Wow you gave a lot of food for thought!
  13. by   TrudyRN
    Quote from TheCommuter
    Good Samaritan laws should protect healthcare workers who are assisting the injured on their own time, as long as they are not accepting payment or gifts from the patient. Under these laws, you cannot be sued for providing care to the injured while you are off-duty at the scenes of vehicle collisions, fires, slip-and-falls, etc. As long as you do not accept money for the services rendered, you cannot be sued if the injured person goes downhill.

    Good Samaritan laws were enacted to encourage healthcare workers to help the injured without fear of litigation.
    I don't think this is totally true. I think the helper still has to do things correctly or can be sued. I think. She should consult an attorney for definitive answer in her state.

    As for the original question - I have no idea what she should do. I think I would be loathe to begin CPR, for fear of paralyzing someone. HOweve, that answer is probably not right, because courts tend to follow the doctrine of life at all cost, even paralysis, so would say to do the CPR. Sorry, I'm just not sure. Maybe we need attorneys and ethicists to weigh in. :uhoh21:
  14. by   scattycarrot
    the quote below is from the aha website. i went looking as i was under the impression that when the lack of pulse or respirations was the only time it is acceptable to move a suspected spinal injury patient or remove a helmet from a motorcyclist. i remember being told by a paramedic that the patients definately dead if you leave them but only maybe dead if you move them and provide cpr. however, even if you move them you need to maintain spine alignment and use jaw thrust not chin lift, difficult to do without proper equipment and at least a handful of rescuers if the patient is in a vehicle. the same paramedic told me they hate these cases as well but at least they have the equipment! i think thats a reason why medical professionals don't stop....they know that so much can go wrong and its not like it is in the movies, where a person looks dead, get pulled out of a burning car using no spine alignment and is given one cycle of cpr, opens their eyes and is fine!

    "if spinal cord injury is suspected, do not allow the victim to move in any direction. immobilize the victim’s head, neck, and trunk. if cpr is required, open the airway with jaw thrust (see "part 3: adult bls") rather than head extension. if the victim is stable and does not require cpr or lifesaving first aid, such as hemorrhage control, do not move him or her until ems personnel arrive. if movement is necessary (to provide cpr or lifesaving first aid or because of potential danger), support the victim’s head, neck, and trunk securely so that the head and neck do not move in any direction. (see previous section and references 100a and 100b regarding diagnostic studies.) "

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