1st on scene of accident yesterday...what would you do?

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I'm a newly licensed LPN. Driving home, I passed a small convertible all smashed up and on it's side in a ditch. I stopped to find two teenage boys at the scene. The driver was barefoot and walking around with a small gash on his ankle. The other was sitting and complaining of leg pain 4/10. When I saw the car I was astounded that they weren't seriously injured. The passengers side door was completely smashed in and the windshield was cracked. They had extricated themselves from the vehicle and police were notified but not yet on the scene. Both were A&Ox3, not in any apparent distress. I assessed for signs of shock, internal bleeding, altered LOC, tachycardia... but I didn't know how to help them. I couldn't think of anything else to do. I knew I needed to stay with them until the ambulance arrived but I just felt helpless. What else could I have done?

TIA

Specializes in none yet, but I'm VERY excited!.
Thanks all!

I'm going to put together a little bag to keep in the car: gloves, bandages, blanket, flashlight, scissors, extra stethoscope.

Better late than never. :wink2:

That's splendid, but I'd be careful with it. My EMT-B instructor has been a paramedic for years, and he says he doesn't carry a single band-aid in his truck off duty. Why?

He does care about people, but he is concerned about lawsuits. Incredible! No?

If you do decide to help in the future, just remember that you cannot leave until someone of your skill level or higher relieves you. If you leave and anything happens, the dregs of the law profession will be all over you.

Regards,

Kenny B.

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"He does care about people, but he is concerned about lawsuits. Incredible! No?"

In most states, when you are off duty and stop at an accident, you are covered by the Good Samaritan Act. To be so concerned about lawsuits you would let someone die is unacceptable. You would have to do a gross act of negligence, and if you don't have , there is NO LAWSUIT! And in some states, NOT stopping and rendering aid is illegal too.

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Specializes in none yet, but I'm VERY excited!.
"He does care about people, but he is concerned about lawsuits. Incredible! No?"

In most states, when you are off duty and stop at an accident, you are covered by the Good Samaritan Act. To be so concerned about lawsuits you would let someone die is unacceptable. You would have to do a gross act of negligence, and if you don't have malpractice insurance, there is NO LAWSUIT! And in some states, NOT stopping and rendering aid is illegal too.

I never said he doesn't render aid. He administers CPR and basic first aid if necessary. He won't got beyond that because of liability issues. It's the easiest thing in the world to judge him and talk about what's not acceptable, but he saves lives for a living.

Your wrong about the idea that a gross act of negligence is required for legal liability. It's unfortunate in the extreme that people are held responsible for negligence by ignorant juries all the time. Surely you're aware of this. At any rate, our response time is 8 minutes here. Pretty darned good. His basic aid should be sufficient. If it is not, well, at least he's available to aid the community rather than embroiled in some stupid lawsuit that punishes great people who try to do a difficult job.

Regards,

Kenny B.

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Specializes in Emergency.

Hi there,

I have been a nurse for less than 2 years, so I don't have much experience with trauma (I work on a telemetry unit). However, I am ACLS certified, and have once been the first responder at an accident scene coming home from work (it was a weeknight after midnight). I do carry a CPR mask in my car as well as gloves, but nothing else. Luckily, in this case the people in the car were not badly hurt (a few cuts and bruises), and so I called 911, and then talked to the couple in the car, I assessed their injuries, but no major bleeding, etc. When police and EMS arrived, I told them I was a nurse, what my evaluation was, and then left ( I did not witness the accident) the pros to do their job, giving my name and phone # in case they needed me for whatever reason.

Another time, I was on my way to work, and saw the aftermath of a REALLY BAD accident involving a kid on a "Crotch Rocket" and EMS had not yet arrived. I could tell the kid (sadly) was already DOA, so I did not stop.

As far as I know, if I stop to render assistance, and have to do CPR or try to stop bleeding, etc. I cannot be sued under the Good Samaritan Law mentioned by other posters. I would protect myself first, but would try to help in any way I could within my scope of practice as an ACLS certified provider.

I would NEVER do CPR or anything involving body fluids without proper protection. If you don't have it with you, or are not comfortable, don't do it!

Amy

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Specializes in none yet, but I'm VERY excited!.

As far as I know, if I stop to render assistance, and have to do CPR or try to stop bleeding, etc. I cannot be sued under the Good Samaritan Law mentioned by other posters.

I'm not trying to argumentative here. I just think it's important that people know possible repercussions of their actions. When I started my EMT class I asked where I could get a jump pack for my car so that I could assist if I ever saw an accident.

The response was that EMTs work under the authority of an MCEP (the ER doc who defines their scope of practice). That authority only applies when they are on duty. If they do anything beyond basic life support (CPR and First Aid), the Good Samaritan Law no longer applies.

And all it takes to be held liable for negligence is for a lawyer to dig up another EMT who says he or she would have acted differently in a given situation. In many cases an EMT can't even assist someone with their own inhaler without online permission from an MCEP.

So yes, the Good Samaratin Law provides protection as long as we do what a common citizen would do.

Regards now,

Kenny B.

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Specializes in none yet, but I'm VERY excited!.

And I haven't met a single firefighter or paramedic who disagrees with this assessment. They all seem to feel that the response is adequate and they either won't stop, or they'll provide minimal aid.

Rgds

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Specializes in ER/ICU/Flight.
And I haven't met a single firefighter or paramedic who disagrees with this assessment. They all seem to feel that the response is adequate and they either won't stop, or they'll provide minimal aid.

Rgds

I have been involved in emergency services for a long time (17 years) and I do agree that I would only render basic first aid (CPR, stop a bleeder, try to relieve an a/w obstruction, etc.) and I only carry a jump bag in my truck off duty because I carry my fire dept radio and will volunteer as a first responder if I'm able to (e.g. not on the way to one of my kids' games, school events, etc.)

But your interpretation of the law isn't entirely correct. Anyone can be sued for anything at any time, all they need is a lawyer willing to take their case. But you state:

"And all it takes to be held liable for negligence is for a lawyer to dig up another EMT who says he or she would have acted differently in a given situation."

This is untrue, it may unduly influence a juror but it certainly doesn't prove liability for negligence. As you remember, negligence is proved by a duty to act and proof that harm occurred either as a result of the action, or possibly as a result of failing to act appropriately. The mere fact that you are not at work negates your "duty to act", of course we all feel some moral obligation to help someone in need, legally we are not required to unless we're "on the clock".

In order to be liable for negligence under the Good Samaritan Act, you would have to do something grossly negligent. Such as convince a victim to refuse treatment/transport. But take a very real example, you see a car wreck. the car is now in flames and the driver is entrapped. You rush in and extricate the driver, removing him to a safe distance away from the car. After he is evaluated in the ER, he's found to have a spinal cord injury and is irreversibly paralyzed. Would a paramedic do a neuro check prior to extricating a MVC victim? absolutely. In that circumstance? No, I wouldn't. Do we know if the injury was before or after being moved without full spinal immobilization? Nope. So who's to blame? No completely accurate way of knowing. Could everyone involved be sued? Sure. But you have to dig up a lawyer who's going to stand in front of the jury and say

"yeah, my client probably would've been burned alive if this person hadn't saved his life. but now let's make him pay dearly for his heroism and selflessness because my client's confined to a wheelchair instead of a grave."

There are lawyers out there who'll do it. My $$ is banked on the jury of peers who won't let them get away with it.

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Specializes in LTC.
I'm a newly licensed LPN. Driving home, I passed a small convertible all smashed up and on it's side in a ditch. I stopped to find two teenage boys at the scene. The driver was barefoot and walking around with a small gash on his ankle. The other was sitting and complaining of leg pain 4/10. When I saw the car I was astounded that they weren't seriously injured. The passengers side door was completely smashed in and the windshield was cracked. They had extricated themselves from the vehicle and police were notified but not yet on the scene. Both were A&Ox3, not in any apparent distress. I assessed for signs of shock, internal bleeding, altered LOC, tachycardia... but I didn't know how to help them. I couldn't think of anything else to do. I knew I needed to stay with them until the ambulance arrived but I just felt helpless. What else could I have done?

TIA

You done good, keed. ;)

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Specializes in LTC.

I'm glad you found them in non-critical condition and they both wound up ok.

About a year and a half ago, outside my apartment window, I heard tires squeal and a horrible crash, and looked out my window and saw a stopped car and a bicycle shorn in half lying in the street. I called 911 and ran down with a couple of towels.

The victim was lying crumpled in the gutter, facedown. Another responder had already covered him with her coat. He had a weak carotid pulse and that was the only pulse I could get to. He was breathing. There was no blood that I could see. It would have been way beyond my skill level (not to mention I had no equipment) to try to turn him over to assess further. Nothing I could do.

I found out later that after the car hit him he went headfirst into a tree. He was not wearing a helmet. I went back upstairs and watched from my window as the EMTs put O2 on him and loaded him into the ambulance.

I read the next day that he was DOA. He was 24 years old. His friends and family have a memorial to him at the tree with pictures, flowers, and candles. I drive past it almost every day.

It still haunts me that I saw such a traumatic situation and despite my nurse training was unable to do anything. :crying2:

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Specializes in midwifery, ophthalmics, general practice.
That's splendid, but I'd be careful with it. My EMT-B instructor has been a paramedic for years, and he says he doesn't carry a single band-aid in his truck off duty. Why?

He does care about people, but he is concerned about lawsuits. Incredible! No?

If you do decide to help in the future, just remember that you cannot leave until someone of your skill level or higher relieves you. If you leave and anything happens, the dregs of the law profession will be all over you.

Regards,

Kenny B.

this I agree with. You do have to be incredibly careful what you do. The Code of Conduct here is slightly different to yours (I think) and we can be held to be negligent if we dont help.. and neglegent if we do and get it wrong (practicing outside our sphere of competence!). Nurses have been sued here- my friend was sued for grievous bodily harm after she performed CPR on a man who had collapsed in a pub. she broke 2 ribs doing it and he sued her! it was thrown out of court. But I would be very careful, and I would think twice and maybe three times before offering to anything more than maybe call for help.

gloves in the car are never a bad idea but I dont carry anything else. the British Resucitation council has recently changed the advice on CPR and mouth to mouth is no longer recommended unless you have a mask between you and the patient. so chest compressions fine, you dont have to do anything else. The gloves are useful for when i check the oil on the car or need to change a tyre- never needed them for anything else!

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Specializes in LTC.
this I agree with. You do have to be incredibly careful what you do. The Code of Conduct here is slightly different to yours (I think) and we can be held to be negligent if we dont help.. and neglegent if we do and get it wrong (practicing outside our sphere of competence!). Nurses have been sued here- my friend was sued for grievous bodily harm after she performed CPR on a man who had collapsed in a pub. she broke 2 ribs doing it and he sued her! it was thrown out of court. But I would be very careful, and I would think twice and maybe three times before offering to anything more than maybe call for help.

gloves in the car are never a bad idea but I dont carry anything else. the British Resucitation council has recently changed the advice on CPR and mouth to mouth is no longer recommended unless you have a mask between you and the patient. so chest compressions fine, you dont have to do anything else. The gloves are useful for when i check the oil on the car or need to change a tyre- never needed them for anything else!

I was told at my last CPR certification that the American Heart Association is also most likely going to stop recommending mouth-to-mouth as well; seems compressions are what make the difference.

LOL at the glove thing...they do come in useful for other things!

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Specializes in Peds.

Hi,

I think you did a comendable job - given the circumstances you described.

I've responded on one scene myself (a four car spin/wreck on I-90).

- Safety first! And that means YOU first! As someone already mentioned, the last thing EMS needs is another patient.

- Call 911. Don't assume someone else has already called. It can't hurt to make that extra call.

- Don't try to be a hero. I'm serious. Stop and think before you do anything. It's better to spend the extra 10 seconds to think than to jump in gung-ho and make a bad situation worse.

- If EMS/First responders are on scene - defer to them. Remember, they're trained for this. You're not (this applies to physicians not involved with trauma/ED too). When EMS arrives on scene, identify yourself if you have to but back off ... unless they ask for help/assistance - they already have a hard enough job to do. And if they ask you to do something you are not comfortable with/feel you can't handle, let them know. They won't think any less of you, but they will accomodate and re-prioritize as needed.

- As someone already mentioned - probably the most important thing you can do is be the "calm voice". Try to reassure victims. Anxiety exacerbates symptoms. Often just knowing that they are not "alone" has a calming effect on pts. Try to get a 'body count'. Meaning? "How many people were travelling in your car?"

- Even if they are "walkie-talkies", try to get them to calm down and lie down (preferably on a straight hard surface) and not move. It's not uncommon for walkie-talkie pts. to have neck/back fractures and they could potentially exacerbate them by movement.

- Lastly, If at all possible try to get baseline estimates - pulse (weak, thready, bounding, irregular etc), resps (shallow, deep, irregular etc.), mental status (passed out, babbling, incoherent, hallucinations etc.), seat belt/airbag status etc. Pass this info onto EMS when they arrive. It helps health care providers gain a better picture of what to look for.

thanks,

Matthew

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