Providing Emergency Care to non-patient

allnurses Guide · Aug 13, 2014

what a donkey's rump! Ask him if it was him, would he want all of you to just stare at him, or maybe go through his pockets?

It was emergent care, same as you would do anywhere for anyone. And "we" didn't provide care, he didn't participate. Nothing to do with the clinic other than location, not like you were transferring an established pt in which case you would have just done normal documentation.

If your front desk keeps a log of any kind, you might note the incident there, or write an incident report.... but again, you wouldn't if it had happened on the sidewalk.

MunoRN, RN · Aug 13, 2014

Depending on the specifics their may be requirements, such as if the clinic is on the same property as and affiliated with a CMS participating hospital then EMTALA would apply.

The bigger issue for this MD to consider however is if he really wants news coverage, potentially national news coverage of his clinic for refusing to help an actively dying person in his waiting room.

akulahawkRN, ADN, RN, EMT-P · Aug 13, 2014

As a prehospital provider, I would simply ask for report which would include all the relevant things, such as the initial rhythm, if/when CPR was performed, what drugs were given, and so on. If you have someone who functioned as a scribe and recorded that stuff, that's great! Once you start providing care for someone, they're a patient... your patient. The office or clinic may not have all the stuff needed to provide care, so calling 911 is a very appropriate thing to do.

My report might later end up stating something like: "Per office staff, Pt collapsed in Dr. Smith's office lobby. Staff found pt in arrest, initiated CPR at 1343 hours, attached an AED at 1346 hours and 3 shocks were delivered per protocol. Upon arrival, report received and care assumed from office staff..."

You might want to have some kind of form handy for events like this when people who aren't your normal patients have a medical emergency in the office/clinic. If you don't have such a form or some kind of paper with an outline of events, the info you give to me verbally will end up in my report. It just makes it a whole lot easier for me to do my own documentation if that info has been written down.

JustBeachyNurse, LPN · Aug 13, 2014

When I worked in an office only same care if someone was outside in front of office-- establish LOC, call 911, start CPR. AED if available. No drugs as not functioning as a prehospital medic and not your patient. Only CPR/AED trained personnel could initiate CPR-AED.

Report would be witnessed collapse at 10:43, unresponsive 911 called. CPR started at 10:44. AED attached at 10:47 no shock indicated.

Here.I.Stand, BSN, RN · Aug 13, 2014

My hospital has a large clinic and an office building attached. The campus is six connected buildings with multiple entrances. If someone--visitor, clinic pt, employee--arrests on campus grounds, they call the dumb code!

Seriously, not code someone in the waiting room? Is this MD wanting to be on national news? Maybe even one of the sensational news shows on HLN???

PMFB-RN, RN · Aug 15, 2014

The bigger issue for this MD to consider however is if he really wants news coverage, potentially national news coverage of his clinic for refusing to help an actively dying person in his waiting room.

I was thinking the same thing. Doctors and nurses standing by and doing nothing while a person died in their waiting room would be a media firestorm!

Also depends on your state. In my state nurses have a legal DUTY to assist.

duskyjewel · Aug 15, 2014

Look what happened to that LTC where the nurse refused to perform CPR and that lady died in the dining hall. The facility claimed it was a policy and people were aware when they signed up to live there, but did you notice how NO ONE in the media general public cared? There were two or three solid weeks of national media all about what a horrible facility and nurse they were.....so ask the doc if he wants to be that guy. By the way, aren't you legally obligated to render aid? As far as I know, in Arizona, nurses are once licensed, in contrast to the general public.

Karou · Aug 16, 2014

Those who know more than me, please correct me if I'm wrong on this....

I think you are obligated to provide basic first aid. As a medical professional, I suspect it would be some type of neglect if you did not act.

But then again...

I know if a non-patient requires emergency intervention at my facility then we call a code blue. Even if it's a RRT situation we call blue so the team arrives faster. The person gets sent to the ED. I'm the meantime as staff we cannot do any interventions (even take vital signs).

So I'm not sure ? Does your facility have a specific policy for this? They should...

Agree with PP who said that if you didn't act you would have a PR nightmare on your hands.

You have a really good question.

crispycritter · Aug 16, 2014

I have dealt with this a couple of times when I was an EMT, arrived at a call at a assisted living facility with an LTC on same property for a cardiac code (ems called by grounds worker/coworker prior to nurse arrival). Upon arrival nurse report was "patient was dead upon our arrival", so did you do cpr or AED? No he was already dead! Who made that determination? Our LPN, Really? An LPN cannot declare death, he is on your property, during business hours with trained medical staff present.

If even basic care is not rendered on a medical site with trained medical personnel present, depending on the state, it is basically abandonment, patient or not. If you are on duty, working under your license at time of incident, especially on your property, and basic care was not rendered, opens everything and everyone up to legal liability. "well we didn't have consent", Really? Implied consent is justifiable in these situations and everything should be done that is within the scope of practice of person present, which I am pretty sure CPR and AED is required for even housekeeping at most facilities.

As for documentation, you rendered emergency care to a person on your property, during business hours, documentation should be done and filed, just like he is a patient, even follow up documentation should be obtained and documented, even if it is "called ER to check on status of John Doe at 1300 hours, received Etc.. from Nurse Jane on patients condition" and should be filed just like he is a patient.

If this patient was my family member and basic care was not rendered on your property while during business hours, and he passed, the money I received from this lawsuit would pay for my medical school. To me it sounds like everything was done correctly, and for the MD to say that is ignorant.

My two cents

P.S. I also would not care about the policy of said medical office, I would rather help someone in need and face being fired, than do nothing in fear of the consequences! I still carry a full medic bag everywhere I go (minus the drugs), and stop at many and any accident site, to help, I don't care if all I do is hold C-spine on patient, while patching to EMS enroute. We are all there to help!

Fiona59 · Aug 16, 2014

Depends on where you live. This LPN can pronounce. The LPN might even know the code status of the patient on the ground that you are wanting to perform CPR on.

allnurses Guide · Aug 16, 2014

Absolutely provide BLS.

I would be very hesitant to provide more than that, including ALCS, in the primary setting for an individual not under my care.

I have given aspirin and called 911 for suspect ACS for and individual that walked into my office with crushing CP; I really wouldn't even do an EKG unless there was some extenuating circumstance.