While on vacation outside of the US a few days ago, I had two chances to intervene in medical situations. I'm curious what you would have done if you had been in my situation.
Case 1: In a southern coastal city in the UK, an elderly woman reportedly "just fainted and fell" while crossing a street. No one there knew her. Several bystanders were trying to help, including a man who identified himself as a "medic" and woman who worked at a pharmacy. The injured woman was obese, lying awkwardly on her right hip with her torso twisted, her upper chest on the pavement and her head twisted toward her left shoulder. Her head was lower than her body, and she was bleeding from a scalp laceration. The medic knelt beside her and held pressure on the scalp wound. She denied any pain and tried to get up several times, but they held her down even when she vomited, insisting that she should not move. Her breathing was heavy. EMS had been called, and I could hear a distant siren.
Case 2: Halfway between Amsterdam and New York, they paged overhead for a doctor to come to the back of the plane. No one moved. I went back and told the flight attendant I was an ER RN, not a doctor. Apparently, I was their best option.
He took me to an elderly man who was worried about moderate swelling and mild redness in his right lower leg and ankle. With his daughter translating, I learned the swelling had started during our flight, but he'd been on a plane for three hours prior to ours. He had a large scab on his lower right lower shin from a scrape three days ago but denied any pain. He was sitting on a jump seat with his leg propped up on a window well, straight and level with his hip. They were applying cool compresses.
I've second guessed myself a bit on one of these two. What would you have done?
In the second situation, it sounds like you didn't know what the situation was when you said "yes", so watching to see if it was enough of an emergency to warrant the risk of identifying yourself as an RN wasn't an option, is that right?
I feel as though once you've ID'd yourself as an RN, then whatever you say carries some risk. If you say "Oh, that's not worth my input, carry on", you're still in some way approving of their actions.
I think personally, I'd ID myself because I'd worry about it being a much more serious situation, and then once I've done that, I feel as though I'd be stuck and need to follow through.
You are right. You don't know what you are responding to and by responding at all you are putting yourself in a position of responsibility. I have no reservations about responding on the plane because clearly I was the most capable person willing to respond--no one else did. I also have no fear about defending my advice in the extremely unlikely event that it should become necessary to do so.
I held c-spine in a parking lot a few months ago after an elderly person got knocked down by their spouse in the car... So, yeah. I can't not. Lol. But I don't expect people without prehospital training to spring into action.
I held c-spine in a parking lot a few months ago after an elderly person got knocked down by their spouse in the car... So, yeah. I can't not. Lol. But I don't expect people without prehospital training to spring into action.
You go Pixie.RN. That's the courageous spirit I'm hoping to find. You have EMT-P and TCRN, so can you clarify what "hold c-spine" means? Align and maintain, or maintain the position the patient was found in?
Align and maintain, or maintain the position the patient was found in?
If you don't have enough people to align safely then you maintain, as long as the airway is not compromised, until you do. In your first post you said you could hear the sirens. That would indicate to me just a few minutes until more help arrived. Although I would not have "restrained" the person I would have done my best to keep them from moving to avoid further injury.
FTR I'm not trying to be contrary in my responses nor am I speaking out of turn. In addition to my 31 years of nursing which included significant time as a flight nurse I am also a paramedic and a 40 yr National Ski Patroller so I've got more than a little scene time under my belt and I do strive to stay up to date.
If you don't have enough people to align safely then you maintain, as long as the airway is not compromised, until you do. In your first post you said you could hear the sirens. That would indicate to me just a few minutes until more help arrived. Although I would not have "restrained" the person I would have done my best to keep them from moving to avoid further injury.
Yep, agree 100%. Honestly, I don't expect people without prehospital training to jump in anywhere.
Although I would not have "restrained" the person I would have done my best to keep them from moving to avoid further injury.
This is the part that really bothered me intuitively. I felt they were restraining her against her will and she was lucid and communicating. I'm not discounting guarding c-spine, but there were several clear advantages to allowing her to re-position herself, primarily improving her airway, reducing risk of aspiration, and decreasing intracranial pressure. After my suggestion, the medic did allow her to roll onto her right shoulder (from the awkward position described above) and a bystander supplied a rolled blanket which he placed under her head to improve the alignment.
I appreciate your thoughts and those of all who choose to engage on the topic.
I was riding my horse at a horseshow once when another rider fell off and started seizing when she hit the ground. I jumped off my horse and ran over to her, just as a man and a woman from the sidelines reached her, as well as several onlookers. I identified myself as a neuro ICU nurse, and the man identified himself as a paramedic. The girl who fell was on her back, face up during her seizure and her airway was patent. The paramedic went to hold her neck to stabilize her cspine, and as he was about to do it, the women who had approached grabbed her forcefully and turned her on her side. We both protested loudly and told her not to move the patient, but she essentially screamed at us that she knew what she was doing and refused to listen. At that point I stepped back, and I have not identified myself as a RN in any situation like that since. It's crappy, but we're not licensed to practice independently in situations like that. It was a rude awakening to realize that the actions of a bystander who was 'helping' the wrong way would affect me and my license/livelihood.
In would not jump in and help. I would probably keep walking in both situations. That being said, if I saw a kid choking on candy at the 4th of July parade, I would probably help.
I was riding my horse at a horseshow once when another rider fell off and started seizing when she hit the ground. I jumped off my horse and ran over to her, just as a man and a woman from the sidelines reached her, as well as several onlookers. I identified myself as a neuro ICU nurse, and the man identified himself as a paramedic. The girl who fell was on her back, face up during her seizure and her airway was patent. The paramedic went to hold her neck to stabilize her cspine, and as he was about to do it, the women who had approached grabbed her forcefully and turned her on her side. We both protested loudly and told her not to move the patient, but she essentially screamed at us that she knew what she was doing and refused to listen. At that point I stepped back, and I have not identified myself as a RN in any situation like that since. It's crappy, but we're not licensed to practice independently in situations like that. It was a rude awakening to realize that the actions of a bystander who was 'helping' the wrong way would affect me and my license/livelihood.
Wow. That sounds frustrating. Do you know whatever happened to the girl?
I ran the scenario of the lady who fell in the street by three different paramedics who are currently working on local EMS crews as they passed through our ER today. Each of them quickly responded they would let her sit up. In her case, the significant factors were that she was alert, oriented, denied pain, and wanted to sit up. They stated they would apply a collar after she sat up due to the head injury prior to transporting her, but they would not put her on a backboard.
RobbiRN, RN
8 Articles; 205 Posts
You are right. You don't know what you are responding to and by responding at all you are putting yourself in a position of responsibility. I have no reservations about responding on the plane because clearly I was the most capable person willing to respond--no one else did. I also have no fear about defending my advice in the extremely unlikely event that it should become necessary to do so.