RN responsibility--how far do you go in being a first responder?

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by wannabecnl wannabecnl Member Nurse

Specializes in PACU, presurgical testing. Has 4 years experience.

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BabyLady

BabyLady, BSN, RN

Specializes in NICU, Post-partum. 2,300 Posts

In my state, it is MY decision, whether or not to become involved if I am not at work.

When I touch a victim, I am legally required to perform "to my highest level of training" and you are legally responsible if you do anything that is OUTSIDE of your scope of training/practice.

Before I became an RN and was a student, I did not realize that trauma care required very specialized training to do this out in the field. You will typically not have the equipment if you respond by yourself.

Don't think that you have a secret "super RN" cape flapping behind you. People go 190% of the deep end (with no legal case to back it up) that you have anything nurse related ie. bumper stickers on your car and drive by an accident and do not stop that you can be sued....that is about as big of a myth as the Easter Bunny.

You could have a child in the car, you could be on your way to another emergency, or even better, it may not even be YOU driving the car.

Now, some states do require that if you are the first to come upon an accident that APPEARS to have injury, you are required to GET assistance, not necessarily RENDER assistance...but I don't live in one of those states.

Two situations occurred today that made me start to wonder exactly what my responsibility is, now that I have my RN license, in the event of an accident, etc.

First, I saw a woman slumped over on a bench in town, but firefighters were already there checking her out (they are typically the first responders in our town and have AEDs and such on their trucks).

If you see first-responders on the scene, STAY AWAY FROM IT. They are there, they have the equipment to transport and they are trained...you don't worry about it. There is no help you can lend that isn't there already or at least coming. If you stop and touch the victim and something goes wrong, congrats, you just signed up for a lawsuit.

Then this afternoon, from my home I heard a car collision somewhere outside the neighborhood but not that far away. Within 2 minutes I heard sirens, and it turns out that the accident was on a main road near my house.

This is even more obscure...do you think that every healthcare professional within earshot of an accident is REQUIRED by law to respond?

Seriously...think about that.

I know that states have laws about professional responsibility--i.e., if I had seen the woman on the bench before anyone came to treat her, because of my RN license I would be expected to do so.

Morally, you would be expected to call for help. You can render CPR if it is warranted. But think about it...that is the same responsibility as any layperson (assuming they are CPR trained) would have.

If that had been the case today, I would have immediately assessed her and called 911 as needed. Similarly, had I been in the vicinity of the car wreck, I would have immediately called 911 and gone to help the people involved in the accident.

Like I said....think about what you are asking...do you really think EARSHOT obligates you? Use common sense.

But where is the line? Should I have gone over to see what I could do for the woman on the bench once the first responders were there?

No...because you knew they were first responders and they are trained and have the equipment to handle the emergency. Don't get involved in cases where TRAINED HELP IS ALREADY PRESENT.

Should I have thrown my kid in the car and driven in search of the accident?

Only if you wish to traumatize your child....see my above statement.

Was I wrong to assume (turns out correctly) that at rush hour there would be hundreds of cars going by who could call 911?

I FREQUENTLY call 911 if I witness something that it should be called for. I have no issue with that.

I am eager to help and would do so in any case where I was needed. I just wonder what people's experiences are with this sort of thing or if anyone knows how to get info about it. Thanks in advance.

Use your head....did you learn anything in school regarding your LEGAL REQUIREMENT to respond outside fo the facility?

Of course you didn't....there is a reason for that.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience. 4,448 Posts

If I come upon a scene and there are no 1st responders there then I will stabilize their head/neck while awaiting them. Or do CPR if needed. Or stop bleeding with pressure. That is it. I would do those things if I wasn't a nurse. 1st responders are my favorite sight to see!:smokin:

Rob72, ASN, RN

Specializes in Infectious Disease, Neuro, Research. 685 Posts

But why make yourself a potential victim?

When I go on a call (as a volunteer ff), I have 12 yrs experience/training to do this, I have taken several defensive driving courses to insure you don't hit ME while trying to render aid, I have the equipment (including extrication equipment), and I have enough similarly trained folks (whom I would and do trust with my life) at my side.

Please don't interfere.

:D Or, as a Para friend responded to an individual who ran up to him at a scene, saying, "I'm a doctor!..."

Para: "Are you a trauma surgeon or intensivist? No? Then **** and go sit down."

I have quite a bit of trauma background, and I carry a full jump kit (sans ACLS drugs) on long road trips, but that is basically for catastrophic family injury. My wife and I have stopped a few times, secured and stabilised, then disappeared into the flow of traffic.

As noted, your safety is priority #1. If you aren't able to maintain that 360* awareness, then render care, many times its better to just dial. I would recommend doing ride-alongs with your EMS or fire crews, more than Red Cross, to develop that situational awareness.

Good luck! Your heart is in the right place, just make sure your mind is in charge before your heart runs you out into the street...;)

floridanurse1983

floridanurse1983

169 Posts

Please do not believe you can't get in trouble for not stopping to render aid. Some states require it. I've lived in them. If you are caught not stopping at an accident site, you can be sanctioned by the board. Please check with the laws in your state.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 12 years experience. 1 Article; 13,952 Posts

Most nurses do not have basic or advanced first aid training/certification as it is generally not necessary to work in a hospital or LTC. School nurses often get the additional first aid/first responder training (at least in my area they do) so they are qualified to intervene as they are usually first on the scene.

I was a bit disturbed by the news article recently posted about a RN who stopped at a motorcycle accident and "secured" her 2 yr old daughter in the car (ALONE!) to stop and render aide. The first rule of EMT training was a dead or injured EMT does no one any good.

As far as Red Cross training--they offer first responder, first aid (basic/standard and advanced) and sometimes CNA training (depending on the chapter). I used to be a disaster services training coordinator (volunteer) for my local regional Red Cross chapter. Individuals were NOT trained to act as first line disaster responders, that was left to local fire/ems/police agencies. The training opportunities for LPN's and RN's were in disaster health services (working in a disaster shelter, care management (assisting a diabetic patient in replenishing needed supplies lost in a disaster (whether local house fire or more large scale like flooding) situation), ensuring shelters were not health hazards (public health type nursing--training was provided and coordinated with health departments), securing referrals to health care providers and services, follow up with injured disaster victims (status, needs, location). And in Disaster Mental Health Services if the RN had experience in psychiatric/mental health or was a psychiatric APN, otherwise disaster mental health was limited to LPC, PsyD, Psychiatrists, LCSW, licensed clinical psychologists, and other licensed mental health providers.

LuxCalidaNP

LuxCalidaNP

Specializes in Family Practice, Urgent Care, Cardiac Ca. Has 3 years experience. 224 Posts

Basics Basics Basics! BLS stuff, ya'll. I've been a first responder, to pedestrian vs. vehicle, syncope, chest pain, etc. The risk in identifying your self as an RN/APN is that you have to properly hand off the pt to EMS, and not abandon until then. Do the minimum to keep the pt safe and stable until EMS arrives. If you don't know how, and someone is on the way who DOES KNOW HOW, and the pt can wait, DON'T DO IT! For example, if I was the first to respond to an MVA in a rural area, and I had called 911, I would assess my own safety first, assess the scene, and assess victims for IMEDIATE LIFE-THREATENING issues: airway, circulation, pressure to a bleeder, etc. If I could do something simple (jaw thrust, pressure, etc,) I might, but extraction? meds? H# NO! splinting? no. If EMS were delayed, and I was recieving direct guideance over the 911 call...maybe, but even then...

I would also say that while there is the good samaritan clause, there is no law stating that I have to respond, but I have an ethical obligation to not leave someone roadside or streetside without at least assessing whether or not they're ok. EMS can do the rest.

For example, 30 yo guy was drunk, got hit by car going 35, flew 30, head to the curb and bounced, unconscious and apnic. We called EMS, assessed the scene, held his head and spine still, told him not to move, looked for sign's of external bleeding, and waited while a friend made sure traffic was going around. EMS was there in

BabyLady

BabyLady, BSN, RN

Specializes in NICU, Post-partum. 2,300 Posts

Please do not believe you can't get in trouble for not stopping to render aid. Some states require it. I've lived in them. If you are caught not stopping at an accident site, you can be sanctioned by the board. Please check with the laws in your state.

Don't confuse RENDERING aid with CALLING for aid.

No state wants someone with zero training to try to pull someone from a crashed car only to find out that had they been stablized properly, that their broken back probably wouldn't have severed their spinal cord.

No state wants a mother to stop with babies and toddlers in the car and leave them unattended to RENDER aid.

Those laws are designed to make sure that people don't drive by and totally ignore them without even calling 911...I agree with those laws.

But you are not required to TOUCH anyone.

BabyLady

BabyLady, BSN, RN

Specializes in NICU, Post-partum. 2,300 Posts

Basics Basics Basics! BLS stuff, ya'll. I've been a first responder, to pedestrian vs. vehicle, syncope, chest pain, etc. The risk in identifying your self as an RN/APN is that you have to properly hand off the pt to EMS, and not abandon until then. Do the minimum to keep the pt safe and stable until EMS arrives. If you don't know how, and someone is on the way who DOES KNOW HOW, and the pt can wait, DON'T DO IT! For example, if I was the first to respond to an MVA in a rural area, and I had called 911, I would assess my own safety first, assess the scene, and assess victims for IMEDIATE LIFE-THREATENING issues: airway, circulation, pressure to a bleeder, etc. If I could do something simple (jaw thrust, pressure, etc,) I might, but extraction? meds? H# NO! splinting? no. If EMS were delayed, and I was recieving direct guideance over the 911 call...maybe, but even then..?

It makes no difference if you hand off someone and identify yourself as an RN. This is why...

An RN has a scope of practice and you are only responsibile for legally performing to your highest level of training...so that would differ in NO WAY from any layperson that would sit with a victim until EMS arrives to explain what you know so far and what has been done so far.

Unless you have SPECIFIC training in trauma you are not trained to render that type of aid...so you are not going to be obligated to splint, remove a victim from a crash area....RN or not, unless you have been trained to do so and have the certifications to back it up.

Seriously...you don't have to be a nurse to know that is information that is needed. An RN wouldn't leave someone until EMS arrived anyway.

Not identifying yourself as an RN, for professional and moral reasons I would NEVER render aid to start with and hide who I was...to me, that is wrong on 300 levels.

AJPV

AJPV

366 Posts

"Not identifying yourself as an RN, for professional and moral reasons I would NEVER render aid to start with and hide who I was...to me, that is wrong on 300 levels." - not sure I understand... Are you saying it would be wrong to render aid and fail to mention you are an RN? I don't understand why in light of your argument that a simple RN who isn't trained in trauma is legally held to the same expectations as a lay person. If your training and the expectations placed upon you are the same as a lay person, your identity as an RN is irrelevant to the situation at hand. In that case, identifying yourself as an RN would be as relevant as another person announcing they are a chef or a roofing contractor before rendering aid. The only reason it would make sense for an RN to be required (legally or morally) to identify themself as an RN would be if the RN has certain legal expectations imposed on them due to the fact that they are an RN.

nurseprnRN

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

i walked out of a department store to see a guy on the pavement in a full-blown seizure. i pointed to the first person i could make eye contact with and told him to go inside and have them call 911 (this was before everybody and their baby sisters had cells), and stayed to watch airway and keep the guy from further injury. he gradually stopped. when the ems showed up i told them to be sure to tell the ed that this guy had had opisthotonos because he wasn't doing that now, and the ed needed to know that.

then....melt away into the crowd.

over the years i've had lots of opportunities to be first on the scene-- the theater where someone passes out and falls out of the seat, the car ahead of me drifting into the median strip with the driver having a seizure at the wheel, the little girl pulled out of the water not breathing, the teen who fell out of the tree at camp, the confused old man wandering down the street in his jammies, the guy that fell off my roof and landed on his back on the concrete step and a loose brick, the lady who took a foul ball right in the face ... you do what you can do within the limits of your training and experience, stay until relieved by someone more competent, and sleep well at night knowing you did your best. not someone else's best, yours. or you don't get involved at all. your call.

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 10 years experience. 2 Articles; 1,567 Posts

It makes no difference if you hand off someone and identify yourself as an RN. This is why...

An RN has a scope of practice and you are only responsibile for legally performing to your highest level of training...so that would differ in NO WAY from any layperson that would sit with a victim until EMS arrives to explain what you know so far and what has been done so far.

Unless you have SPECIFIC training in trauma you are not trained to render that type of aid...so you are not going to be obligated to splint, remove a victim from a crash area....RN or not, unless you have been trained to do so and have the certifications to back it up.

Seriously...you don't have to be a nurse to know that is information that is needed. An RN wouldn't leave someone until EMS arrived anyway.

Not identifying yourself as an RN, for professional and moral reasons I would NEVER render aid to start with and hide who I was...to me, that is wrong on 300 levels.

What are you even talking about?

Your RN license lets your practice under a MD. If you aren't at work, you aren't allowed to function as an RN. You can function as a first responder under your good samaratin law. Similarly, an off duty paramedic cannot show up off-duty with their personal Lifepack 12 and field cric kit. That's illegal.

Being an ER nurse from a trauma 1 vs a med surg nurse, there is no difference in what you can do for a patient when all you have is some gauze and gloves. You will function at a first responder level because that is all that is legally allowed and that is all that is practical with the resources you have until EMS arrives.

People talk about first air or first responder like it some huge class. I have news for you. First aid is an 4-8 hour class and you covered it in nursing fundamentals. It takes longer to become a CNA than a first responder. The name of the game is mindset.

It is not your emergency. Don't risk yourself. You are there to help if you safely can. That's all. Make good decisions for the simplistic care you can perform.

SineQuaNon

SineQuaNon, MSN, RN, NP

Specializes in ED, Family Practice, Home Health. Has 15 years experience. 35 Posts

I don't really understand the idea the that first responder training is all that. As the previous poster said, first aid is a 4-8 hour class. Anyone with basic common sense could figure it out. TNCC cert is only a two day course, most of which is also common sense. Another poster made it seem like scene safety is a constant battleground.....really? As a former firefighter, medic, Search and Rescue tech, and current trauma nurse, unless you live in Compton, the scene survey takes all of 15 seconds and 99% of the time is completely benign. Keep your wits about you, but it's not rocket surgery. First responders have a basic, elementary school level skill set....and I say this as one of them. It's not some unattainable holy grail that requires 15 years of experience to do properly. I've saved lives by pulling over and being of service when no one else was around. In the instances that happened any competent nurse would have been able to do the same, whether med/surg, NICU, or ED. Also, the numerous times I've stopped to see if I could be of help it has never been for some nefarious scammers. The media makes it look as if that is the norm but it isn't. That should never influence your decision to help....the likelihood that that is what's actually going on is very, very slim.