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 Geriatrics, pediatrics.

Thanks Matthew for that good, sound advice.

I was in my street clothes, and I told the accident victims I was a nurse, but when the police & EMS arrived they didn't acknowledge me. In fact, the police officer was more interested in determining the cause of the accident and I had to get his attention to tell him the passenger was in need of medical assistance. He completely ignored me, so I left when the ambulance arrived.

Looking back, I have a better understanding of safety issues, keeping your head, and effective communication. Next time I'll keep that in mind although I hope there'll never BE a next time. It really shakes you up!

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm a pre-hospital RN as well as an advanced practice nurse and I volunteer on my rural rescue squad. I'm also a very experienced EMS provider. Unless I am on my way to a call (in my ambulance or POV), I only stop if there is no one on the scene. Then...I ensure scene safety - ALWAYS NUMBER ONE and one which a lay person or someone not experienced in EMS is not going to be able to do, and then and only then, I render basic first aid. Sorry, but if there are multiple victims, triage comes into play too. Again, another skill best left to the pros.

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Specializes in Flight, ER, Transport, ICU/Critical Care.
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.

Great Post and Advice

I just want to add a few things - I don't want to SCARE folks - but, I want to impress CAUTION and DELIBERATE ACTION among our community of amazing healthcare providers --

As for being sued. Good Sam laws were written in the spirit of protecting those selfless enough to help their fellow man (remember the biblical example). However, ANYONE can be sued for ANY reason. I'd like to think that any court system would toss a suit out - but, in reality - it could cost you $$$ defending yourself EVEN if you do NOTHING wrong or improper. Sad reality - but, just be aware ---

I am never afraid of a jury of my peers (I pray if I need a jury they will find nurses, paramedics, fire folks) - but, it will not be that way. I just always act in a deliberate manner.

It is still not always an easy decision for me to stop and "render aid". Like RNREMT-P - I will only do the "basics" as well. I think that often the thing I can best offer is informed direction in the call for help. I do consider a few things -

1. Are others there? "Official" folks or civilian? Once Fire/EMS is there I would not stop unless it looked like a disaster and minimal help was on scene. Police only with obvious injury to folks - I would generally stop and assess, offer.

2. Can I do this safely (get off the highway)?

3. Am I prepared - do I have gloves/blanket/flashlight/etc? Do I have the necessary shoes/clothes? (High heels - dark clothing at night, etc could be deal "killers"). I find that it is usually best to be dressed protectively for "rescue" work

A New High in Self Deprecation in a Low Cut Dress Story

I was in my primary response area (employed there-knew help would take 15-20 minutes to arrive once called) and so, one night several years ago I watched a car (I was the second car behind) drive off an embankment (about 10 feet down a steep incline and roll over) I had been to a really dressy event. (Warning: I am not an idiot or nut...It is not possible to make up the rest of this - but, I will share because it is absurd and funny.)

* I had on 4" heels, dressy (and high dollar) dress, garters/stockings (it was a phase). Luckily, I had on a full slip (nice one - thankfully) under the dress. I had a pair of Keds tennis shoes in my car. So, once I got stopped, off the road and while still "dressed" looked over and yelled to the occupants (one yelled back a bit hysterical that her little girl was really hurt). I took off the dress beside my car, left the slip on, donned the Keds and went down the hill small trauma pak in hand. The little girl (unrestrained) had a LOC (remained unconscious for about 10 min), impressive head lac - maybe some ortho injury but mom was right she was "really hurt". I maintained her c-spine, controlled the bleeding from lac and waited. Well, the calvary arrived (I was so glad to see them I didn't even care if they made fun of me) and here I was nearly naked (and far more dolled up than the boys had ever seen me) basically in nice lingerie, in a overturned car holding the head of a kid. Everything turned out okay for the patients - but, I was "scarred" forever. The boys have never let me forget it and have gotten lots of mileage out of my choice of "rescue attire" :p . I still never regretted it (too much).

Now, that may have been a nice tale of lore - but, there are some things I will not do.

* I will not put myself at risk of being hit by a car, or covered in the blood of a stranger.

* I will not do CPR as a bystander on a victim of a traumatic injury. Nil chance of survival.

Just think - I know that most everyone will help and has the best of intentions. I know of "rescuers" that have been hit and killed by other vehicles while working controlled "scenes". I also KNOW that accident scenes have more dangers than I can even list.

Just be safe - be cautious and don't become a victim. Helping is such a amazing selfless act - just, don't let that decision be the last one you make.

Practice SAFE!

;)

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Specializes in Flight, ER, Transport, ICU/Critical Care.

I want to try and CLEAR UP a MYTH

UNLESS you are working (on duty volunteer or paid) you DO NOT have any DUTY to ACT. Now, if you witness the accident - you are a witness to an accident and the police may want your statement. But, lots of folks think that you can be "liable" for failure to render aid if you just pass by a wrecked car - now, if you a party to the accident in some manner the rules change. Imagine if everyone stopped on the interstate with a wreck - there would be carnage without a doubt.

DUTY to ACT is a legal definition held in professional response. Lay folks may feel ethically compelled or morally inclined - but, I can find NO EXAMPLE of any LEGAL ACTION (and I have researched this) for a FAILURE to RENDER AID from a non party.

Also -

There are folks that identify their persons/vehicle (heck, maybe even have a yard sign :p ) that detail they are a FF, EMT, PARAMEDIC, LPN, RN or other healthcare professional. That is a personal decision. I do not have and never will have any identifying insignia. I do carry ID in my wallet if it necessary to prove any credential. I understand pride in a profession - but, I also know that a little knowledge in the wrong hands can be dangerous indeed.

Practice SAFE!!!

;)

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In April, I finished a med mal case because of a medical incident that took my husbands life. It was a real eyeopener on just how med mal cases are handled. You can listen to all the lectures on med mal and hear stories, but until you have spent many hours with a top med mal attorney, and been in the courtroom, you don't get the full story.

No = no lawsuit

Due to the high cost of med mal, (my expert witnesses ran $150,000), attorneys will not take frivolous lawsuits. They only get pd if they win, and they have to pay the expert witnesses and all court costs if they lose.

I was a paramedic/RN for years and will always assist on an accident scene. And a paramedic doing a neuro exam on a pt in a burning car--it would never happen. Even if he was paralyzed, he be a dead crispy critter by the time you did a proper extracation. Rapid extrication is better than letting a pt. die in a burning car.

Great job! Thanks for taking the time to stop and care. The world needs more people like you!

And in some states, including the one I live in, it is a state law that you must stop and render aid.

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Specializes in Geriatrics, pediatrics.

I LOVE the story about rendering aid in a slip and sneakers!

That was a selfless act guaranteed to get you into heaven.

:fnypst::hehe::lol::dncgbby::lghmky::lghmky::lol2:

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

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.

Sure, but I didn't say anything about proving negligence. I said "held liable."

Your comment about unduly influenced (or confused) juries lies at the core of my point here.

I know it's cynical, but there are cases in which people have been held liable for rendering perfectly appropriate care, and it frustrates me. Just as it frustrated me that I was advised not to carry a jump pack after I receive my license.

Thank you for the perspective of an experienced responder.

Regards to you, and thank you for your service to the community.

-Kenny B.

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This morning I had a very abrupt wake-up. A screech and BANG!!!! I have a little over a year of experience and have never been at the scene of a accident. This was a very bad accident...

I jumped out of bed, threw clothes on and then ran out of the house. One vehicle was on fire. I stepped back out of the way and called 911. People ran and got water and threw it on the fire and finally put it out. I told the operator how many people were involved. I told them two unresponsive trapped, she asked if I any knew CPR... They were still pinned. People at the scene was able to get the driver out, and seeming he had blood on him but only a small cut on his head (unable to see how deep). I found out later the 1 passenger was DOA, and the other probably died shortly after. THere was so much blood, but I have no clue where it came from or even who. I was so scared, I did even know what to do first, the lady stayed on the phone with me until a firefighter showed up.... Looking back, I could have, I could have. It was raining, we didnt even cover up the guy that got out of the car. I didnt even reasure him. EMS arrived, I stepped away and let them in. I didnt even say a word. I am really not good in any situation when I have no control, and my legs go all weak and shaky.

I have been trying to say busing, tryin not to think about it. When I turn on the tv, it is all over the news. It is like I relive it all over again. I still see their faces, and bodies, and all the blood. I cant even close my eyes right now.

I am trying not to beat my self up over this, but this was just such a horrific event. Please any advice would be greatly appreciated.

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

I am trying not to beat my self up over this, but this was just such a horrific event. Please any advice would be greatly appreciated.

The EMS folks have resources for dealing with this kind of thing. You might contact them about it.

I know this may not help, but when you look back at it practically, it sounds like you did the most important thing. The main thing they always drill into us during CPR classes is Call EMS first, and you did.

Also, it sounds like anything else you could have done would have had a long-term effect. Sure, you could have covered him and reassured him, but that doesn't matter now at all. You activated a response and provided important details to the responder so they could prepare for the scene.

I think you're great!:wink2:

Please see if there is some resource out there for you. If you could talk to a professional, they could give you the techniques you need for processing and closure. Truly I think the EMS people could be helpful in this regard.

Stay in touch and let us know how it goes.

Regards,

Kenny B.

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http://www.texmed.org/template.aspx?id=2107

volunteer protection act of 1997 federal law

good samaritan law: liability for emergency care

the texas good samaritan law limits the civil liability of persons administering emergency care in good faith at the scene of an emergency or in a health care facility. the law limits the civil liability of these persons unless their actions are wilfully and wantonly negligent. this protection does not apply to care administered for or in expectation of remuneration, or by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration. also, the limited civil liability is not available for a person whose negligence was a producing cause of the emergency for which care is being administered.

i found this on the net.....i wouldn't be worried about any liability....only if i didn't stop and somehow someone new i was a nurse. the law was designed to protect those people who do stop to render aide and to encourage people to stop and render aide. if its to dangerous to pull someone out of a vehicle (which you learn your not supposed if thier is no immenent danger) then really all you can do is hold pressure if someone is bleeding, reassure them help is on the way. i won't hesitate to do cpr on someone that may drop on the ground at the gas station. i wouldn't want someone to just stand there and watch me die.....

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Funny about the kotex! But you are right, they are perfect for absorbtion initially. By the way, my daughter was skiing when her first mensus began. In desperation she asked the wife of the ski resort owner for help and she said, "No problem, let me find one of the ski patrol guys; they all carry kotex pads for emergency use with lacerations on the slopes!" And that's where I got the same idea!

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Funny about the kotex! But you are right, they are perfect for absorbtion initially. By the way, my daughter was skiing when her first mensus began. In desperation she asked the wife of the ski resort owner for help and she said, "No problem, let me find one of the ski patrol guys; they all carry kotex pads for emergency use with lacerations on the slopes!" And that's where I got the same idea!

Some of the "latest and greatest" resources say not to use sanitary pads anymore. A lot of them now have something in them that helps "pull" fluid deeper into the pad, so they can actually increase bleeding instead of helping to stop it. I don't really know how accurate that is, but I do know that the paid ambulance service near here took all of the sanitary pads off their trucks.

I stop for accidents and things if I am in my fire district...I am going to be dispatched there anyway as soon as they page it out, so I might as well get a jump start. I'll also stop if I am somewhere that the local EMS providers are likely to know me. but I only give very basic care and I back off as soon as the local providers show up.

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