what to know @ scene of accident

[NurseNature]

I graduate in May but I feel like I don't know very much, especially about emergency care. If there was a car accident or other trauma before me I don't know what I could do. Stop bleeding, CPR, comfort. That's all I have to offer at this point. Anyone have ideas on what I could search on my own to be prepared if such a situation arises? I really want to be able to help if a situation warrants and I just don't feel educated enough yet.

[pagandeva2000, LPN]

Nope. ER nurses would know, and ICU/PACU, since those nurses see these victims fresh out of the ambulance. I would not expect a medsurg nurse to know just because they're RNs.

You have made me feel a bit better.

[PoppaD]

I'm going to play the part of the Devil's Advocate. In my home state, the Good Samiritan Laws really only applies to lay persons. So, if your are a RN, you are held to the same standards that a RN with similar training and experience would be held to in your given situation. So...you might want to really sit back and ask yourself, "do I really know enough to help this person rather than harm him?".

[pagandeva2000, LPN]

I'm going to play the part of the Devil's Advocate. In my home state, the Good Samiritan Laws really only applies to lay persons. So, if your are a RN, you are held to the same standards that a RN with similar training and experience would be held to in your given situation. So...you might want to really sit back and ask yourself, "do I really know enough to help this person rather than harm him?".

In NY, the Good Samaritan Law applies to nurses as well. But, I can see how this is controversial. I would be leery to assist a person at this moment, because I don't have the experience to just jump in. In fact, many nurses I know change uniforms once they get off of work because they don't want to be confronted with such a situation and somehow, be held legally responsible should things go south for the person in need.

[kstec, LPN]

Just the other night a kid on my son's baseball team got hurt and I hoped and prayed noone would say "Hey, she's a nurse". I would of freaked. I've only been a LPN for a year and no I absolutely wouldn't know what to do besides the basics to help anyone. It's comforting to know that trauma is a specialty and not expected right out of school. But I have had people say well you know what to do, you're a nurse and somehow I BS my way through it verbally and explain that I'm not a ER or ICU nurse. I think most people assume if you're a nurse of any type that you know it all and I know I sure don't.

[MrsMommaRN]

my question is in regards to this thread is: don't all rn's come out of school knowing exactly what to do in a traumatic event? i know as a lpn, i don't. i would know the abc's and cpr and thats about it. i could casually assess the situation and do the above and then i would probably stand there looking dumb. are rn's who do this specifically trained on the job?

um no. as a new grad i can say yes we had a few weeks or a week or so on trauma and are bls certified but that's about it. if i came up on an accident scene i would call 911, see if the scene is safe and see who i could help. unless you spend your last few months on a trauma rotation no you don't have any special trauma skills as a new rn.

[pagandeva2000, LPN]

Just the other night a kid on my son's baseball team got hurt and I hoped and prayed noone would say "Hey, she's a nurse". I would of freaked. I've only been a LPN for a year and no I absolutely wouldn't know what to do besides the basics to help anyone. It's comforting to know that trauma is a specialty and not expected right out of school. But I have had people say well you know what to do, you're a nurse and somehow I BS my way through it verbally and explain that I'm not a ER or ICU nurse. I think most people assume if you're a nurse of any type that you know it all and I know I sure don't.

That is one of the unfortunate things about being a nurse; people automatically assume that you are supposed to know EVERYTHING and that is not true. We usually master our particular practice, but there is no way to know or remember all of that information. What they provide is basic information for us in class, and from there, what we gain is where to look for the resources we need to answer questions, may it be a drug guide, policy and procedure, the computer or periodicals. I am at a point where I don't always mention that I am a nurse as the first topic of conversation because then, many like to test and see what we know.

[vampiregirl, BSN, RN]

When EMS first arrives at a scene and takes over patient care, there are a couple of things that you can do that are very helpful if you are willing to assist. If there are any upset bystanders or family members, helping to calm them down and keep them from interfering with or distracting from patient care. Also, if the patient is unable to communicate well, if you can obtain patient medical history, meds, allergies etc and pass into on to the EMS crew, this is great.

[DutchgirlRN, ASN, RN]

It has happened to me twice. The first time the patient suffered a cardiac arrest and fell in the parking lot at K Mart. I did compressions only. She survived, spent several days in a CCU, was transferred for open heart surgery and died on the table.

The second time it was an MVA that I witnessed. The man was very dead instantly. I did compressions until the ambulance arrived because it was what I felt I should do even though I knew he was dead. His autopsy showed massive internal bleeding. I could feel the blood slushing around inside of him while doing the compressions. The illegal alien who was driving, high on coke, got off with a slap on the wrist.

Should I witness anything else I will only do compressions. I would definately try to stop any bleeding. I keep gloves in my glove compartment and a regular tournaquet like we use to start IV's. Also IV supplies enough to access a vein. Fluids would have to wait on the amblance. I've thought of getting an ambu bag. You may think, why...? Those supplies are in my car when I'm at my parents home and at other family and friends homes. That's the reason I carry them. However, when faced with a chance to save a life I would do so. When it happens you don't think you just do whatever it is that you can with what you have available. When EMS arrives, back off, it's then all up to them.

[EricJRN, MSN, RN]

I know this will sound callous and I'm going to hear about it, but I wouldn't bother with CPR. Traumatic arrests happened because of things that just plain CPR will not be able to reverse: brain death, cardiac trauma, aortic transection, etc.

Tazzi brings up a great point. In fact, ITLS (the organization/course that teaches ALS EMS providers about trauma management) has long held that pulseless victims of massive blunt trauma are dead.

If we're talking about a one-car/one-victim accident, starting CPR may not be a bad idea, but when there are many injured parties, CPR is a resource-intensive activity that will usually detract from efforts to treat the salvageable patients.

[DutchgirlRN, ASN, RN]

I know this will sound callous and I'm going to hear about it, but I wouldn't bother with CPR. Traumatic arrests happened because of things that just plain CPR will not be able to reverse: brain death, cardiac trauma, aortic transection, etc. You can compress to your heart's content and you will not bring these people back. With medical codes CPR keeps the blood circulating until the heart can be jump-started. In traumatic arrests there often isn't any blood to circulate, or no where for it to go.

I truly understand what you're saying and although I do agree I can't help thinking this is somebody's mother, sister, father, brother, husband, wife, etc...what would I want someone to do for my loved one if there was the slightest chance of survival??? I would agree with Eric that priority would have to be considered if there were more than one victim. The most salvagable should be helped first. Unless of course they simply had a cut or a broken bone.

[kstec, LPN]

My first response would be not to perform CPR due to the fact that if there is internal bleeding, this will just antagonize the situation. Correct? I would assume that if an IV were started then maybe yes, but not before. I guess I really need to take an EMT class, don't I? Knowledge is power, and I feel powerless in this situation.

[EricJRN, MSN, RN]

My first response would be not to perform CPR due to the fact that if there is internal bleeding, this will just antagonize the situation. Correct? I would assume that if an IV were started then maybe yes, but not before. I guess I really need to take an EMT class, don't I? Knowledge is power, and I feel powerless in this situation.

If there is no pulse, you don't have to worry about internal bleeding.