My husband plays hockey, and last night I was at his game when one of his teammates had a hard fall onto the ice. There were only a few of us in the stands watching, and I heard one of the players going to the opposing team's side asking if anyone was an EMT or a doctor. No one seemed to have any idea what to do and no one had medical training, so I jumped up and walked toward the ice.
My husband saw me walk up, and motioned for me to come on the ice. The ref wouldn't let me on the ice, but the player was able to get up by himself and come sit on the bench. I took his helmet off and did a neuro check on him and asked him what hurt. He never loss consciousness and his neuro check was fine, but was feeling dizzy, so I told his girlfriend to take him to the hospital down the street to get checked out.
It was kind of amazing how calm I was and how my learning in class became instinctive when the player sat down. It really felt good to be an asset and know what to do in those types of situations. Though, I keep replaying the situation again in my mind and wondering if I should have asked more questions or done things a little differently, but I know I did the priority items correctly.
I'm now re-considering this whole trauma nursing thing. :)
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You did the best with the knowledge you have thus far. It's important to remain calm in situations such as this & not panic. Clearly you were successful in this critical skill. You also remembered a basic neuro assessment in a time where many would panic & forget.
FYI Helmet removal is a specific pre-hospital/ED skill as c-spine precautions must be maintained. It's covered for EMTs & medics who take pre-hospital trauma life support (PHTLS). Athletic trainers are also trained in safe helmet/equipment removal.
It's good that you kept calm but when in doubt especially with s/s of a possible head injury, call EMS as even though with the dispatch time there are specific ways to position & transport a possible head or neck injury. The extra 5-10 minute wait can make a difference. Plus EMS can alert the ED of impending arrival so that they are ready.
You can always discuss with one of your instructors for advice for future situations to keep both your patient safe and your future license safe. Unless you worked EMS or first aid before little things like calling 911 or not removing helmets are not things most people think of and usually not covered in nursing school.
When I was an EMT we transported a patient with a closed midline femur fracture with a HARE traction splint. This is a piece of equipment rarely used as it is for one specific injury. The splint stays on until the patient is switched to hospital traction bed or goes to the OR for repair. The ED/trauma nurse had never seen one and went to remove it as much of EMS equipment (like backboards) are really for safe transport. Fortunately the doc in the room was our EMS liaison and stopped her & explained why. But this is just one example how some things are not taught in nursing school but are covered extensively in pre-hospital training. (We had to demonstrate competency in HARE traction splints during our state practical exam)
I agree....although hockey helmets lift off which is different than football helmets or a good motorcycle helmet.... that must have been a new RD nurse we see HARE traction in the ED ans she should have KNOWN not to remove it.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Seriously, I'm trying to share good news and you're literally shutting me down. I'm not looking for someone to point out everything I did wrong. I'm happy at what I did and I know I showed sound clinical judgment. Perhaps you can be a black cloud on another post.
It's great when you see it all come together...it is very cool. With the responsibility of being a nurse comes liability and that liability is very serious. The removal of helmets should be done only if necessary and if c-spine precautions are maintained.
While you showed that what you have learned up until now made sense for you... it wasn't necessarily "good sound clinical judgement".
Lets say...once he got to the hospital he actually had a cervical spine injury and suffered damage due to not being immobilized for then ride. Or that you hyper-extended his neck during the helmet removal causing nerve injury. Lets day he has chronic neck pain form the fall but decides to blame you for improper treatment at the scene. EMS would have placed him on c-spine precautions.
Did you check for orientation? Did you check hand grasps? Are you aware that pupil changes are usually a late or ominous sign? Did you palpate his neck for injury? Did you ask if he was experiencing any numbness or tingling? Were c-spine precautions maintained? What if he fell unconscious en-route from a head bleed and stopped breathing. Would there be any life support equipment in the car?
You, "the nurse", told them it was ok to go by family car...they followed your medical advice. They could sue you...and they would win.
No one is trying to darken your joy that you maintained you composure and could think through the process. However, those of us who have been there and done that might have valuable insight that will save you a lot of heartache and pain someday. You are going to be a nurse and with that comes great responsibility. People will look at you differently...what you say will have more value and impact...and you will be held liable for it.
I would say that overall, not too bad of a job. However, there's quite a bit of liability in doing what you did. Others have covered this. There's a LOT more to assessing head injuries than what's even been covered here to this point. Nurses are generally OK doing assessments, however they normally don't get a LOT of education in evaluating closed head injuries or pre-hospital management of injury (including cervical injury) in school. They just don't.
While it's good this guy denied loss of consciousness, did he see stars? Does he remember waking up? Have ringing in his ears? Oriented to person, place, time, event-current score/opponent team name? Can he do serial 7's backwards from 100 or spell world backwards? Does he have any tingling, numbness, or difference in sensation along the C3-T1 dermatomes? Any step-offs or tender spots when palpating the cervical spinous processes (midline and lateral)? Any weakness with shoulder shrug, shoulder lateral flexion, elbow flexion/extension, wrist flexion/extension, or finger abduction/adduction?
Any headache? Nausea/Vomiting? Dizziness? Pupil changes are a very late sign of increased ICP.
I'm trained as an Athletic Trainer (Bachelor's of Science), Paramedic, and I'm in nursing school. To date, only ATC education has taught me to evaluate for cervical injury in that much depth, and more. Removing helmets and pads is just a small part of the education I got, not to mention knowing when it's appropriate to do so.
Specializes in Complex pedi to LTC/SA & now a manager.
Plus as a student nurse if you implied that you are anything more than a student nurse and not yet a licensed nurse you could be in trouble before even getting your license.
You mentioned in another post that your school did not require liability/malpractice insurance. While your student malpractice would only cover you in a student role, if you choose to not carry coverage once you graduate and earn your license you might want to reconsider intervening in on scene emergencies whether first aid or potential trauma as if you did not meet the standard of care you would be solely liable if the injured party decided to file suit. Something to consider.
Seriously, I'm trying to share good news and you're literally shutting me down. I'm not looking for someone to point out everything I did wrong. I'm happy at what I did and I know I showed sound clinical judgment. Perhaps you can be a black cloud on another post.
Saying thanks and moving on wouldn't hurt either. What's with the sensitivity, people?
You did an amazing job of rising to an unexpected situation; positive reinforcement is always good for one's confidence level:).
Plus as a student nurse if you implied that you are anything more than a student nurse and not yet a licensed nurse you could be in trouble before even getting your license. You mentioned in another post that your school did not require liability/malpractice insurance. While your student malpractice would only cover you in a student role if you choose to not carry coverage once you graduate and earn your license you might want to reconsider intervening in on scene emergencies whether first aid or potential trauma as if you did not meet the standard of care you would be solely liable if the injured party decided to file suit. Something to consider.[/quote']
Unless Good Samaritan laws apply, which most states have, no?
Specializes in Complex pedi to LTC/SA & now a manager.
Unless Good Samaritan laws apply which most states have, no?[/quote']
Good Samaritan does not apply if you do not meet the prudent standard of care. Moving a spinal injury patient and causing death or disability as a licensed nurse or student nurse would not qualify for Good Samaritan protection. Most nurses should know to NOT move a patient with a suspected spinal injury or suggest transport in a private vehicle rather than call EMS.
Same issue neighbor having chest pains and a nurse/student nurse drives him or tells wife to drive him to hospital as waiting for EMS/medics (who have access to medical control,ACLS meds, oxygen, cardiac monitor. & defibrillator ) might take "too long". The neighbor suffers a fatal STEMI en route the nurse/student would be NOT covered by Good Samaritan laws as the standard of care is to call 911.
Good Samaritan does not apply if you do not meet the prudent standard of care. Moving a spinal injury patient and causing death or disability as a licensed nurse or student nurse would not qualify for Good Samaritan protection. Most nurses should know to NOT move a patient with a suspected spinal injury or suggest transport in a private vehicle rather than call EMS. Same issue neighbor having chest pains and a nurse/student nurse drives him or tells wife to drive him to hospital as waiting for EMS/medics (who have access to medical controlACLS meds, oxygen, cardiac monitor. & defibrillator ) might take "too long". The neighbor suffers a fatal STEMI en route the nurse/student would be NOT covered by Good Samaritan laws as the standard of care is to call 911.[/quote'] I'm under the impression that my state protects against everything but willful or wanton negligence, UNLESS you're a professionally employed ER health care provider. Meaning it doesn't matter what you "should" know, but what your intentions are.
Unless, of course, you respond to emergencies for a living.
Alright, I'm done defending myself. I feel good about what I did. None of you were there and didn't see what happened and what I did. I'm going to happy despite all of your comments.
Every state's Good Sam laws are different enough that you have to be aware of what's allowed/disallowed. Some states may specifically not cover EMS workers under Good Sam. Many do. Good Sam very well could cover any act that a person is trained/educated to provide as long as the act isn't grossly negligent. You just have to be VERY aware of what your state's Good Sam Laws cover before you just go ahead and help someone out.
Esme12, ASN, BSN, RN
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