Helping non-patients

[kgrise09]

I was once told by an instructor that if a nurse is working in the hospital and is told that a person is hurt on the street outside, by law, the nurse is NOT allowed to assit until that person is INSIDE the hosptial. Is this accurate? If so, what is this law called?

[morte, LPN, LVN]

call security first, don't go out alone. potential lure. calling ambulance if needed.

[loriangel14, RN]

A visitor fell in our parking lot and was injured. They had to call 911 for an ambulance . Once a employee fell and broke her hip INSIDE the hospital. They still had to call for the paramedics.

[Ruby Vee, BSN]

I don't know of any laws -- but hospital policy may prohibit nurses from going outside the hospital while on duty to help. I've worked in a number of hospitals that had that policy.

[KelRN215, BSN, RN]

When I worked for a major Boston Hospital in security, we could call a medical emergency code for anyone inside the hospital main buildings. A team of Doctors and Nurses would respond to assist. If the person was outside and I mean right outside the doors we had to call an ambulance because the code team was not allowed to work outside the main hospital. That was true for the medical office buildings as well. The code team could not respond.

I don't believe their was any law associated with this but a hospital policy.

Same city and, as I recall, our hospital code team would respond anywhere on hospital property- including in the parking garage.

[MunoRN, RN]

When I worked for a major Boston Hospital in security, we could call a medical emergency code for anyone inside the hospital main buildings. A team of Doctors and Nurses would respond to assist. If the person was outside and I mean right outside the doors we had to call an ambulance because the code team was not allowed to work outside the main hospital. That was true for the medical office buildings as well. The code team could not respond.

I don't believe their was any law associated with this but a hospital policy.

If the facility is subject to EMTALA, as most are, then this would be illegal. EMTALA pertains to all parts of the contiguous property, inside or outside makes no difference.

[Spinmass, ADN, BSN, RN, EMT-B]

I'm not sure how emtala works and what the actual wording is, but a poster above mentioned responding properly. They had a protocol for incidents that happened on hospital property but outside the response area of the code teams. Security was sent to the call and the contracted paramedics responded and transported to the ED.

[jadelpn, LPN, EMT-B]

Hospital protocol.

There are situations where a non-patient is hurt on the grounds. And an ambulance needs to be called in my facility. Most to do with the fact that nurses (and other medical personnel) don't usually run out with the bells and whistles that one would need in a fall--ie: splints, cervical collars, backboards...that type of thing.

With that being said, I can see a continuity of care issue--if one's patient is walking the grounds and gets hurt. It could be a liability as well. Again, depends on what your hospital policy is.

However, should someone need CPR on the grounds of the hospital, I would think that there is a duty to act as well.

This is such an interesting scenario. But completely policy dependent. Be sure that when you start working, you know what this policy is.

[MunoRN, RN]

Here's a general description of the EMTALA rule including where appropriate care must be provided:

"EMTALA expands the definition of an emergency department to the entire "campus" and defines "campus" as "within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider's campus."

So inside vs outside by itself makes no difference. Appropriate care can include arranging for transport to the ER by outside services. If there is reason to believe the patient may require CPR to be initiated before transport arrives they would need to provide that and sending security officers alone would probably meet the rule so long as they are competent to recognize the need for, and provide CPR. Basically, whether they're at the ER desk or outside (within 250 yards), the hospital's obligation is the same if the person has an emergency medical condition.

[morte, LPN, LVN]

that 250 feet, in boston, could be in the building across the street.....

Here's a general description of the EMTALA rule including where appropriate care must be provided:

"EMTALA expands the definition of an emergency department to the entire "campus" and defines "campus" as "within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider's campus."

So inside vs outside by itself makes no difference. Appropriate care can include arranging for transport to the ER by outside services. If there is reason to believe the patient may require CPR to be initiated before transport arrives they would need to provide that and sending security officers alone would probably meet the rule so long as they are competent to recognize the need for, and provide CPR. Basically, whether they're at the ER desk or outside (within 250 yards), the hospital's obligation is the same if the person has an emergency medical condition.

[psu_213, BSN, RN]

To the OP (sorry, my quote button is missing for the OP): Who does the instructor recommend respond to and intervene in such an emergency situation? As mentioned, EMTALA applies and someone has to do something. I don't want to be the nurse standing around doing nothing until EMS arrives.

[Wrench Party]

Inside our hospital, it's various code teams, in the outpatient clinics and other campus buildings, it's EMS. The lines get blurry when defining who transports non-critical patients inside the hospital, and what constitutes an emergency.

Generally speaking, it makes sense to me to send EMS for most non-hospital calls- if only because they have the equipment to deal with a change in condition.

[psu_213, BSN, RN]

Generally speaking, it makes sense to me to send EMS for most non-hospital calls- if only because they have the equipment to deal with a change in condition.

I someone collapses on the sidewalk in front of the hospital--sure EMS has the equipment, but we can have them in the ED (where we have even more equipment) faster than it would take for EMS to get there.