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

Posted
by wannabecnl wannabecnl Member Nurse

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

You are reading page 7 of RN responsibility--how far do you go in being a first responder?. If you want to start from the beginning Go to First Page.

SummitRN, BSN, RN

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

That means (as an example that I cited earlier)....if a layperson moves a person with an unknown spinal injury that results in further injury when there was no immediate threat of life ie. fire...then it is going to most likely be chalked up to an honest mistake....if an RN does that? You can bet he/she will be sued because an RN should know better than to try to move a victim without the proper equipment.

I suggest you look up Van Horn v Watson where Van Horn crashed, Watson (a friend of Van Horn) thought Van Horn's car was smoking and would burn/explode, then pulled Van Horn out of the car. Van Horn was paralyzed from the accident and successfully sued Watson for negligence. The CA supreme court ruled that Watson was NOT protected by the CA Good Samaritan law because it only covers medical acts, not rescue acts.

On a somewhat similar note to another example, there was a case from the late 90s where two NJ paramedics under the orders and guidance of an ER doc successfully performed a field c-section and saved a baby (mother was already deceased). Their NJ paramedic certifications were revoked for their actions.

I would really like to see your source if I am an RN that assists at a scene and Mr. Ego Paramedic can't seen to get it in his thick skull that a patient is having a possible MI and needs O2 NOW because he is fiddling with non-essential things (Which I have personally witnessed, by the way)...that as an RN that has been trained in BLS, ACLS, PALS and NRP, I can assure you that I would be WELL WITHIN my scope to apply O2 if available in an EMERGENCY.

Oxygen is a prescription drug, one you don't presumably carry around. You don't have an order for it since you are off-duty. Is someone going to knock you for that? They could but it seems highly unlikely, asinine even. However, you don't have jurisdiction over an accident scene if EMS is there so if you initiate patient care interventions when told not to by the proper authority, that may be something you do get in trouble for. You don't outrank, as it were, the EMS responders even if they happen to be an idiot in your estimation. Maybe you are making the better patient care judgement, but you may find yourself having to defend your actions from a different perspective in a legal sense or before your BON.

No problem with making observations on good choices of care and trying to convince those running the call of it. Isn't that what you do at work? You seem to have had some negative experiences with EMS though and are quite eager to share them. Sounds tragic.

Edited by SummitRN

OhioCCRN, MSN, NP

Specializes in SICU. Has 11 years experience. 572 Posts

I assure you i'm far from confused.

My problem is fear mongering.

I have nothing against people offering first aid etc.

I have a problem with people thinking they HAVE to act, or their licenses will be taken away or they will be arrested.

Let us not argue for the sake of arguing.

wannabecnl

wannabecnl

Specializes in PACU, presurgical testing. Has 4 years experience. 2 Articles; 341 Posts

God help me for starting this. All I was saying is that I feel like my role and level of public responsibility have changed since getting my RN, and I want to have some idea of what I'm legally obligated to do. I'm not trying to be a hero, but I'm not going to sit by and watch someone suffer without going up and seeing what I can reasonably and safely do to help. That's just me. Sorry to have touched off an argument.

xtxrn

xtxrn, ASN, RN

4,266 Posts

God help me for starting this. All I was saying is that I feel like my role and level of public responsibility have changed since getting my RN, and I want to have some idea of what I'm legally obligated to do. I'm not trying to be a hero, but I'm not going to sit by and watch someone suffer without going up and seeing what I can reasonably and safely do to help. That's just me. Sorry to have touched off an argument.

Not your fault :o There are always topics that light peoples' fires, and turn it into something that it wasn't meant to be.... :)

linearthinker

linearthinker, DNP, RN

Specializes in FNP. Has 25 years experience. 1,688 Posts

So if you start an IV, draw a lab off an IJ, give blood products, administer a medication, start a foley, under whose authority are you performing these actions? You have orders, direct or policy.

Is it legal for you to do these things on the side of the road on Joe Schmoe just because it would be the right thing for you to do at work where you have policies and orders? No, you'll lose your license.

As a RN, you do not have the ability to perform any interventions at the RN level when you not on duty at your place of employment. You can use your knowledge, reasoning, assessment, and judgement, but you may not perform to the full extent of your scope of practice. Few interventions can be performed by a RN without a direct or standing order from an MD/DO. It is not much different for an EMT-B or EMT-P except they usually have more standing orders while RNs usually have direct orders for each patient.

Once, I had a nurse on an accident scene. It was a 4 patient MCI and she had stopped on her way home from work. She was providing useless CPR to a DRT entrapped victim in a car. She later jumped into our ambulance and started trying to tell us what to do with another patient and demanding we take her along to the hospital. Long story short, she had to be escorted away when she grabbed our supplies and stuck the patient with an IV from our ambulance despite being told to get out. The officer asked us if we wanted her arrested. We were do busy trying to save the critical patient to bother with that at the time. She technically should have been arrested. She could have easily lost her license over it.

Oh, your misstatement confused me. You said RNs practice under the MD. That is not so. I see what you meant to say is that we initiate MD orders in the hospital setting. It is not splitting hairs, there is a significant difference.

Who the hell would be independently starting IVs on people out in public, lol. I thought we were talking about first aid and CPR. I still wouldn't even be likely to go that far, but I am certainly within my scope and province if I am so moved.

GadgetRN71, ASN, RN

Specializes in Operating Room. Has 16 years experience. 1 Article; 1,840 Posts

I would really like to see your source if I am an RN that assists at a scene and Mr. Ego Paramedic can't seen to get it in his thick skull that a patient is having a possible MI and needs O2 NOW because he is fiddling with non-essential things (Which I have personally witnessed, by the way)...that as an RN that has been trained in BLS, ACLS, PALS and NRP, I can assure you that I would be WELL WITHIN my scope to apply O2 if available in an EMERGENCY.

I also saw a Mr. Ego Paramedic refuse to drive a conscious victim 8 miles to the hospital while he tried to start an IV (which was not emergent at the time) and he didn't have the skills to start one....and she was having early stroke symptoms and he got mad when I said the IV could wait that he needed to get on to the hospital NOW because he was taking so long he could have already been there. The husband was getting ready to pull her off the ambulance and take her to the hospital himself before Mr. Ego finally figured out he couldn't start the IV and had the driver pull out.

Oh yeah, then there was the other case where RN's told EMTs not to lay a COPD patient supine because he couldn't breathe when transporting him to another facility, because he was in a crisis..that he needed to stay in high-fowlers. They argued with the RN's about it...well, they killed the guy by the time they got to the receiving hospital and when the RN's from the first hospital called the other one to find out HOW the patient was positioned upon arrival? Supine.

I mean, darn those RN's.

Then there were the paramedics in my state that intubated a patient, but failed to check that the ET tube was in the right place...brain dead 39 year old was the result.:rolleyes:

I figured the posts were coming from someone who has the big ego paramedic thing going on, so whatever. Good for entertainment value though.:lol2:

xtxrn

xtxrn, ASN, RN

4,266 Posts

Then there were the paramedics in my state that intubated a patient, but failed to check that the ET tube was in the right place...brain dead 39 year old was the result.:rolleyes:

I figured the posts were coming from someone who has the big ego paramedic thing going on, so whatever. Good for entertainment value though.:lol2:

You checked the info, too, eh? :D Always someone who's not actually doing the job in question with all the answers :lol2::yeah:

ppfd, BSN, EMT-P

Specializes in ED, Critical Care. Has 13 years experience. 80 Posts

WoW! How'd this go from simple personal response question to RN's vs paramedics?

I work as a Paramedic Firefighter for over 20 years now. Been an RN for a few years now.

I run into the RN's that think medics have an "ego" occasionally. I send em on their way pretty quick.

OP, here is some hard and fast information for you.

You most likely have the most important tool you will ever need.

A cell phone, get on it and call for help.

Stop at a scene, a person down? Thats your personal choice

Do I stop or Help out? Hardly ever

All4Seasons

All4Seasons

Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT. Has 31 years experience. 155 Posts

In my country,it is illegal as a citizen to not stop at the scene of an MVC if you are first on the scene; even if all the help you provide is calling 911 -you must stop. However, you are not obligated to approach a crash scene if it is not safe to do so, and you are not obligated to provide specific care.

At the same time,we have a Good Samaritan clause which protects all of us from liability concerning any care we citizens do provide - RN or otherwise.We are not liable if we forgot to do something or if we didn't do something in the correct order. You do the best you can -that's all. Don't get too caught up in "I don't have a first aid course"....you have the important basic knowledge already,namely CPR training -how to open an airway safely,chest compression and breathing;how to staunch bleeding,how to try to turn a seizing victim on their side, performing the Heimlich maneuver/chest compression on a choking victim. The fancy splinting,bandaging,thorough systems assessment,etc is all left to the 911 responders. And none of this is expected of us if it puts our own safety into jeopardy.

As an aside,I am stymied as to linearthinker's general position - if I understand you correctly, you have had occasion to be first on scene of distress and have chosen to walk/ drive past?!

How would you feel if you were in the midst of a code in the hospital and a visitor walked up and started taking over cpr, saying "I am a paramedic and I can help"? Do not interfere with rescue services on the street. Same thing.

wannabecnl

wannabecnl

Specializes in PACU, presurgical testing. Has 4 years experience. 2 Articles; 341 Posts

How would you feel if you were in the midst of a code in the hospital and a visitor walked up and started taking over cpr, saying "I am a paramedic and I can help"? Do not interfere with rescue services on the street. Same thing.

Wasn't referring to walking up to paramedics in the street and taking over, just offering to lend a hand if needed. I did go buy a pocket mask the other day, though.

MikeyBSN

MikeyBSN

Specializes in ED. Has 7 years experience. 439 Posts

I was a first responder before I became an EMT and an EMT before I became an ER nurse. At one point in my life I stopped at almost all accidents. I have now created guidelines for stopping, or should I say not stopping at accidents. As I have grown slightly more cynical, my list of guidelines has grown as well. I will stop at an accident unless:

-There does not appear to be any safe place to park my vehicle

-The accident is in such a place that would create an unreasonable risk of another car hitting the my car, myself or the damaged vehicle(s).

-I am not carry flares or other safety warning devices in my vehicle

-The people in the accident are already standing outside their vehicle

-The police are already on scene (I don't like dealing with police)

-EMS/fire Dept. is already on scene

Otherwise I will just call and report the accident.