Nurse performs tracheotomy

diane227, LPN, RN · Sep 7, 2009

This story sounds fishy to me. I can't imagine a nurse leaving the scene. Some nurses have taken advanced trauma courses where they have learned advanced airway skills, but performing a surgical procedure such as a trach was not one of them. This does not make sense. I would question the actions of anyone leaving the scene. I have stopped to render aid many times and have left the scene only after EMS arrived and I was able to provide full report to EMS personnel including my name and phone number in case they needed to reach me.

Also, the Good Samaritan law does not protect you if you go outside your scope of practice and it may not protect you at all if someone has a good lawyer. That is the reason that a lot of health care providers do not stop to render aid, because they are held to a different standard than the general public.

SpaceCoastRN · Sep 7, 2009

This was done a long time ago on MASH by Father Mulcahy utilizing a pocket knife and ballpoint pen, makes for good television, not a good plan to go outside your scope of practice though and test the legal system. I have cric'ed patients in the past while working as a paramedic, it is very rare that it is needed (most I have seen are due to the provider's poor ability to preform endotracheal intubation and not actual patient need (such as a clenched jaw and no paralytics).

BabyLady, BSN, RN · Sep 7, 2009

Hello,
I'm a recent LVN grad here in cali. I haven't even taken boards yet, but I passed an advanced placement exam and plan on starting my 1 year RN bridge in February...so I really don't know the answer to this question. My buddy is an EMT and told me a story about a couple of nurses stopping at an emergency scene before an ambulance arrived. The injured person was going to die, but the 2 nurses performed a tracheotomy, and fled the scene. The patient lived. Would these nurses have been protected by the Good Samaritan law had they stayed? I said..most likely not since they performed out of their scope of practice, but he says they would be protected since the patient survived and would have died if the tracheotomy wasn't performed. Any input here is appreciated. Thanks!!!

No, they would not have been protected, but I highly suspect it's an urban myth.

You are only protected by the Good Samaritan law if you perform within your scope of training...you are not protected if you do something outside of it.

deyo321 · Sep 7, 2009

While I often consider myself to be Maguyvering things at work due to limited supplies and how creative most nurses have to be, I'm thinking urban legend.

allnurses Guide · Sep 7, 2009

Don't forget some of you that in order to have a viable lawsuit, the plaintiff has to show actual damages. If you stop at an accident and render aid within your training and abilities, and you don't do anything wrong, I don't know how much you would have to worry about lawsuits. Admittedly though, I'm not from the US and you guys do like to sue

There's no way in hell I would do a trach at the side of the road. But in addition, I suspect someone who did go to those extraordinary measures, would not then leave the patient to die alone without waiting for EMS.

Vapermedic · Sep 7, 2009

Performing a crichoidthyrotomy is a skill taught to many paramedics and flight nurses. It doesn't happen very often but I've had to do it a couple of times....I've been a paramedic for 20 years and a flight nurse for 10 years. It wouldn't be hard to do with a penknife and it really isn't too complicated. If it were myself or a family member that was lying on the roadside and truly needed an airway...I'd hope anyone with even a clue would attempt it if needed. That said, crichs are pretty rare these days with all the rescue airways available such as LMA's, Aitraq, King airways, etc.

Mike

ProgressiveThinking, MSN, CRNA · Sep 7, 2009

The story could very well be fake. He called and asked me because he and his girlfriend's sister were debating this issue. She was arguing that if she were one of the nurses, she would have left the scene in fear of losing her license. He said he would have stayed because the patient lived and he'd be a hero. I personally would never even attempt anything out of my scope of practice. Even though I want to work in the ER or ICU, I'm not sure if I would stop at a scene at this point in my career d/t lack of experience. BUT.. you never know until you're actually put in a situation like this..and even then I would not open up a trach.

GilaRRT · Sep 7, 2009

And there you have it, a story born out of a lovers spat. To emphasize proper terminology again, we do not perform a tracheal puncture, we go through the cricothyroid membrane. Hence the proper term cric. The cricothyroid membrane is superior to the tracheal rings and inferior to the thyroid cartilage.

**canoehead, BSN, RN** · Sep 8, 2009

I would do it if there was no other choice. There are a lot of things to try though before any incision gets made, and the pt would probably be apneic by the time I got to that point. Then, clearly, I would have done no harm, even if I had moved out of my scope of practice. I would be working on an already dead patient.

GilaRRT · Sep 8, 2009

I would do it if there was no other choice. There are a lot of things to try though before any incision gets made, and the pt would probably be apneic by the time I got to that point. Then, clearly, I would have done no harm, even if I had moved out of my scope of practice. I would be working on an already dead patient.

Unfortunately, such invasive techniques are well beyond what any nurse should do in the United States. If fact, very few nurses are even educated to perform such a procedure say for flight nurses and CRNA's, let alone performing this procedure without any medical direction on the side of the road. While you may see it as working on a dead person, things would turn out very bad for you when it was all said and done.

Again, I bring up the two flight nurses in California. They performed this procedure while on shift with protocols that allowed them to do so, there was a poor outcome (patient died), and now these nurses are looking at spending allot of time in prison. Obviously, this means loss of license, a civil suit, and no lively hood to support what remains of their families when they get out of jail.

Clearly a risky move if you are in a situation where you are being paid to make these decisions and perform this procedure. I simply cannot imagine many people would risk the loss of their life (in essence) to perform a procedure without medical direction, proper equipment, and in an environment where chances of failure will be quite high. Performing a cric is NOT a simple procedure and it is NOT benign. In fact, many people cannot even properly identify the cricoid cartilage and cricothyroid membrane, let alone successfully puncture it and place a patent airway.

If you are off duty, stick to basic life support care guys. This is really nothing more than an exercise in common sense.

kittykatty · Sep 8, 2009

So I have to assume since these flight nurses had the protocols to do the trach and the training--then if they made the decision not to do it they would have been sued also--right? So damned if you do and damned if you don't--How scary---Let's hope we see tort reform soon.

GilaRRT · Sep 8, 2009

So I have to assume since these flight nurses had the protocols to do the trach and the training--then if they made the decision not to do it they would have been sued also--right? So damned if you do and damned if you don't--How scary---Let's hope we see tort reform soon.

I am not sure. I have a thread in the transport nurses forum specific to this situation. I am not clear on specific details; however, the cric did not go well at all. At one point the patients airway was being managed with a BVM, how effectively, I am not sure. However, I have learned the following over the years: The enemy of good is better. If something works good for a given situation, taking aggressive steps to make it even better can be disasterous.

I think this applies to the phantom car crash scenario as well. We know BLS can work good until help arrives, taking steps to make it better can be met with severe consequences. In addition, another case that is still in the courts could radically change this good Samaritan protection. A girl pulled her wounded friend from a car following an accident. The girl stated she thought her friend was in danger. The friend sustained spinal trauma and permanent disability. Form the move, who knows. I venture to say she already had this damage from the primary injury. In any event, the civil case has gone to court. So, we have an untrained person being sued by her friend. I think this case is in California as well.

Things to consider before you whip out your trusty old Swiss Army knife eh?