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). 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..
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. 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. 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? Should I have thrown my kid in the car and driven in search of the accident? 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 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.
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.
The case known as Van Horn v. Watson ended with the CA Supreme Court finding that California's Good Sam Law, as written at the time, covered only medical acts, not rescue acts. The State Legislature then amended that portion of the law to cover rescue acts as well, specifically. So if someone would be in greater peril by remaining where they are vs being moved, move them to safety.
The NJ Paramedics did have their licenses revoked and the MD (who should also have known better) was simply admonished and still retains his Medical License.
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.
Without appropriate authorization to intervene beyond BLS measures (at least in California) simply starting an IV independently in public may not be covered by Good Sam, and could result in at least a complaint against your license. Attempt to provide measures above BLS or attempt to provide medical control while on my scene and I will have you ejected from my scene. I'm always open to suggestions, but on scene, unless a Physician or a Flight RN is there, it's my scene.
In a way, I'm pretty lucky. My County explicitly authorizes Off-Duty Medics that are employed by an ALS agency (in any manner, btw) to use their full scope. Every other EMS system that I'm familiar with does NOT authorize Paramedics this latitude. Most Medics are limited to BLS when off-duty, so that's not too much different from RN's, however off-duty medics will still be usually safer in the field because they are educated in scene safety considerations.
Remember, this isn't a bash against RN's... it's just that Nurses aren't normally trained for the pre-hospital environment.
Would I turn down advice from a trauma nurse, MICN, or Flight RN that's off duty? No. But I won't have that RN try to run my scene either, off-duty or not.
The case known as Van Horn v. Watson ended with the CA Supreme Court finding that California's Good Sam Law, as written at the time, covered only medical acts, not rescue acts. The State Legislature then amended that portion of the law to cover rescue acts as well, specifically. So if someone would be in greater peril by remaining where they are vs being moved, move them to safety.
The NJ Paramedics did have their licenses revoked and the MD (who should also have known better) was simply admonished and still retains his Medical License.
Looks like akulahawk and I were doing the same research this afternoon.
Interestingly, if you read down the page, 1799.104 states "No physician or nurse, who in good faith gives emergency instructions to an EMT-II or mobile intensive care paramedic at the scene of an emergency, shall be liable for any civil damages as a result of issuing the instructions." I'm honestly not sure how this is meant to be interpreted, since nurses do not outrank EMTs/paramedics out in the field. Maybe the paramedics or EMTs on this thread can clarify? I know that paramedics receive phone orders from physicians to perform certain things in the field, but are there ever nurses at the other end of that phone call?
looks like akulahawk and i were doing the same research this afternoon.
i did my research a few years ago...
interestingly, if you read down the page, 1799.104 states "no physician or nurse, who in good faith gives emergency instructions to an emt-ii or mobile intensive care paramedic at the scene of an emergency, shall be liable for any civil damages as a result of issuing the instructions." i'm honestly not sure how this is meant to be interpreted, since nurses do not outrank emts/paramedics out in the field. maybe the paramedics or emts on this thread can clarify? i know that paramedics receive phone orders from physicians to perform certain things in the field, but are there ever nurses at the other end of that phone call?
the physician/nurse language has to with giving instructions, while acting as medical control, to a paramedic or emt-ii (now aemt) in the field, who follows such instruction. the language is there to protect the people giving the instructions from civil suit should something go wrong.
You would be surprised what a trained RN can do in a non facility situation. I was eating in a Mexican restaurant. A lady began choking on (it turns out) a nacho chip. Before I could think it through I was already at the table asking her if she needed help. She could not speak. I performed the heimlich maneuver on her. Who knew that sh it really worked ??!! But it did and the lady survived. She thanked me her family perfusely thanked me and the restaraunt gave me the first responders discount. Free! Now if I didn't even try and watched that lady choke to death while waiting for 911 I think there would have been a part of me that felt a little guilty. And full of the what ifs. If you are the only one who is nearby and to wait for help may cause life or limb at least do the basics. BCLS and first aid.
The Physician/Nurse language has to with giving instructions, while acting as Medical Control, to a Paramedic or EMT-II (now AEMT) in the field, who follows such instruction. The language is there to protect the people giving the instructions from civil suit should something go wrong.
Thanks akulahawk!
I understood that it was protecting the person who gives the instructions, I was more just stumped by the fact that it sounded like RNs can act as Medical Control; I didn't think they could. I'm a new grad and I've been wondering how the Good Sam laws apply to me now that I'm a nurse.
I understood that it was protecting the person who gives the instructions, I was more just stumped by the fact that it sounded like RNs can act as Medical Control; I didn't think they could. I'm a new grad and I've been wondering how the Good Sam laws apply to me now that I'm a nurse.
Good Sam Law and the protections for giving instructions are different. Basically, as long as you provide care without compensation or expectation of such, at the BLS level, you'll generally be covered by Good Sam. When you're working, you have a duty to respond, and therefore you're not covered by Good Sam. The medical control thing has to do with Base Hospital contact. When you, as an MICN, are giving instructions to the field crew, you're doing so on behalf of the Base Hospital Physician. You'll have specific protocols as to what the MICN can authorize the Paramedics to do without having to have the Paramedics consult with the Physician directly.
Many years ago I was trained to always look around your environment, make sure it is secure, before responding to an emergency when alone. Let your inner nursing instincts guide you because there are situations where nurses have been set up in sinister ways as targets because of our known compassion. If in doubt observe, carefully check out your total surroundings, stay safe, call 911 to assist. This advice was given to me back in 1976 and again in 1990's at seminars given by the State Police. Life is different for me I live in a town that is very close to a big city. Just a thought!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I came upon this today and before we as nurses go responding to emergency situations that we shouldn't be there are a few things that should be noted. It is with specialized knowledge and training that we as health care professionals have that makes us up held to certain legal requirements and the very important medical-legal concepts such as negligence, abandonment, duty to act, as well as assault and battery.
The care you give to a patient is and your limitations is outlined in your particular scope of practice. This scope of practice is most often defined by state law. Legally, a medical director (whether medical control for medics, medical directors for nurses) is the one that authorizes you the privilege to provide patient care. For EMS workers this done via telephone, radio or standing orders and protocols. You must report any problems, such as possible liability, exposure to airborne diseases and blood borne pathogens to your medical director immediately.
Dealing with Advanced Directives:
Without written documentation from a doctor such as an advanced directive or{ DNR}do not resuscitate this request puts you in a conundrum. Medical directors of ambulance service companies must have written protocols for these situations and guidelines vary from state to state so check your states guidelines and scope of practice.
As the guidelines do vary there are 4 statements that are considered general guidelines:
1. Patients have the right to refuse treatment, including resuscitation if they can communicate that.
2. In a healthcare facility, a written Dr.'s order is required for a DNR to have validity.
3. Review your local and state protocols regarding advanced directives as codes do change.
4. When in doubt resuscitate.
If death is obvious by rigor mortis, liver mortis, or levidity or obvious destruction of body parts such as brain or heart-Your responsibility is to cover the body and follow the protocols of your coroner and medical examiner.
Consent:
Consent is a long established legal right, for instance a person can NOT touch another person without permission or consent. Expressed Consent: This occurs when a patient expressly says you can care and transport them. Expressed consent may be as simple as a nod, it need not take the form of words. You should always try to obtain expressed consent whenever possible. For expressed consent to be valid, the patient must be of legal age and able to make a rationale decision agreeing to consent. Verbal consent is valid and binding, albeit may be difficult to prove.
Implied Consent:
The law assumes that a patient who needs immediate medical attention to prevent death or permanent impairment would consent to care and transported to a medical facility. This is called Implied Consent- Implied consent is limited to true emergency situations. An example of this type of situation is appropriate when you have an unconscious, delusional patient under the influence of drugs or alcohol or incapable of giving expressed consent. If the patient is so unresponsive that he/she is unable to express consent, you should try to getconsent from a family member who is responsible and obtain permission from that relative. In most cases the law allows for the right of a spouse, close relative or next of kin that are available. As a caveat minors can and do give consent, for example a 17 year old girl is likely to give a informed consent rather than a 3 year old child. The laws and principles related to consent of minors only determine who has the right to give consent-not if consent is needed. If a true emergency arises, the consent to treat the minor is implied, just as an adult yet you should the parent's consent if possible.
Consent of the Mentally Ill:
A mentally incompetent adult is NOT capable of giving informed consent. If the patient is declared mentally incompetent, a guardian or conservator can give consent on the patient's behalf. You will come across patients who appear confused or in distress and you need to consider all the factors weather the patient can give valid consent. The rule is when a TRUE emergency situation exists; you can assume implied consent applies.
Assault and Battery:
Very serious legal problems can occur in situations where a patient has NOT given consent for treatment. Assault is the unlawful placing a patient in fear or bodily harm. Even touching a patient or providing emergency care without consent is considered battery in the eyes of the law. If you do so, the patient may have grounds to sue you for assault, battery or both. In order to protect yourself from these charges, always make sure you receive expressed written consent or that the situation allows for implied consent.
Abandonment:
Once you begin to give care, you must follow through all the way with appropriate treatment. You must continue to provide care until that care is transferred to another medical professional of appropriate level of training or the proper medical facility. Failure to continue treatment at any of these levels is considered patient abandonment. Out of all the legal pitfalls abandonment is legally and ethically the most serious act you can commit.
Negligence:
Negligence consists of 4 elements: duty, breach of duty, physical or psychological injury, and cause. Once you are called or you declare yourself caregiver to the scene to provide care, you have a duty to act and help the patient. Your failure to act or give care that is not in a manner consistent with the level of care another similarly trained first responder would give is called breach of duty. If physical or psychological harm is caused by doing something or failure to do something to the patient then you have acted in a negligent manner. If that's the case you may be liable to the patient for harm. The important thing to understand here is that all 4 elements must be present for the doctrine of negligence to apply.
1)Failure to provide care to patient once you have arrived on scene
2)Failure to perform important or necessary techniques and also......
3)providing care in a manner not consistent with the skill that other similarly trained first responders would give under similar circumstances.
4)If your actions are judged reckless, careless, lacking in skill, you have violated the standard of care and may be found negligent.
Duty to Act:
One a unit responds to a call,or you declare yourself caregiver, you have a duty to act. if you are off duty and you or happen upon an accident scene you are not legally obligated to stop and assist any victims. However, if you happen upon an accident you have a Moral and ethical duty to act due to your training and expertise, the same goes for nurses and doctors who have the required skills. BUt then only with in the expertise of YOUR scope and practice.
No one is saying don't do CPR or the heimlech maneuver........but be very careful with accidents and moving people unless they are in immediate danger. I have stopped at accidents that have occured right infront of me.....including someone ejected out of the windshield on a major highway. I called 911 and made it very clear I was a nurse and I needed help NOW and we needed a helpcopter....the rest of it was to keep the crowd away, maintain c-spine precautions on the kid unconcious in the street, and pray very hard for EMS to come..
:lol2:
lancedac
19 Posts
Care to say why?