VictoriaO Posted January 16, 2012 Share Posted January 16, 2012 So last night I had my first taste of being a responder in a public setting. I was out with a large group at a downtown sushi bar, my friend ran into the restroom and grabbed me, one of their friends was having a seizure. Understandably many folks were quite freaked out. It ended up being a pretty cut-and-dry situation, young guy with known glioblastoma s/p-debulking, undergoing radiation, forgot Keppra dose today, ~3 min ton/clon, actually came around pretty quickly post-ictal, medics arrived, vs/fingerstick wnL, pt went to ED for level check and more keppra. This situation got me thinking, what are some of the potential ramifications (legal and otherwise) of responding in this type of scenario? (I must have said "No, I'm not a doc, I'm a PA" about 10 times last night). Have many of you seasoned PAs been in situations like this? (I don't necessarily feel like I DID much, just safely positioned and monitored ABCs, got some history from friends, chatted with the medics, nothing really requiring my PA school education) Are we covered by the "Good Samaritan" laws in every state? Does this law cover you in a state where you don't have a PA license? How does this technically work legally, as we don't have a supervising physician with a practice agreement if we're out of state? Or between jobs? How much can and should we help out the paramedics as a random on-scene PA at a restaurant or other public setting? If say, I were a rock-star residency-trained EM, CC or trauma PA (as I hope to someday be), medico-legally how much can and should we help with interventions when the goody bags and toolkits arrive? Would it really depend on your comfort level in resus medicine and whether you have a state license/SP, or are there other factors that go into it? (I must guiltily admit this also prompted me to think about ways to "Macgyver" a few interventions in a number of restaurant settings. Can't wait to get some real practice with crichs on those sheep tracheas in an airway class.) Link to comment Share on other sites More sharing options...
Acebecker Posted January 16, 2012 Share Posted January 16, 2012 My take has always been to walk away from those scenes with a clean conscience - did I do the max that I can comfortably do to save a life or prevent harm coming to someone? As long as your CPR and ACLS certs are current then there is a lot that you can do on the basis of those, PA or otherwise. I come from a slightly different background, though - I was an EMT prior to PA school, so I am accustomed to that role. If you are a FP PA and sftart doing trachs on people on the street, you'll likely run into legal trouble - if I'm not comfortable with a procedure in hospital, there's no way I'm going to do it outside the hospital, unless that patient is my responsibility and there are no other options - then I'll be uncomfortable and in deep water no matter what. I say good on ya' for stepping up. Link to comment Share on other sites More sharing options...
MediMike Posted January 16, 2012 Share Posted January 16, 2012 Hmmm...Good Sam laws protect you as long as you act in accordance with three criteria: Acting in Good Faith-(You're not sitting there next to someone crashing asking for money to help) Acting Within Your Scope of Practice-(You're well trained/certified/licensed in the interventions you are performing) No Gross Negligence-(No CPR with the steel toed boots) I apologize for the lack of polish on these statements, I taught linemen for years and this is what has stuck in my head Link to comment Share on other sites More sharing options...
Joelseff Posted January 16, 2012 Share Posted January 16, 2012 Hmmm...Good Sam laws protect you as long as you act in accordance with three criteria: Acting in Good Faith-(You're not sitting there next to someone crashing asking for money to help) Acting Within Your Scope of Practice-(You're well trained/certified/licensed in the interventions you are performing) No Gross Negligence-(No CPR with the steel toed boots) I apologize for the lack of polish on these statements, I taught linemen for years and this is what has stuck in my head We may be covered by Good Sam laws (this depends on what state/country etc you are in BTW) but it still does not prevent someone to file suit. A good question is, can we be liable if we DON'T respond? hmmm...I am not saying that we shouldn't respond to avoid suit just something to consider.... To the OP: I was on a flight to Maui this past August when I heard "is there a doctor onboard?" over the P.A. and I stood up and told the attendant that i was a "Physician Assistant" and he told me that "oh, it's ok we need a doctor." LOL, I told him that i practice medicine and may be able to help. Short of it, a guy was diaphoretic and felt dizzy. I did orthostats and he was definitely orthostatic, perhaps due to the 5 alcoholic beverages he had that morning and whatever alcohol he consumed the night before. I laid him down in the back when an ER nurse, a plastic surgeon and a paramedic stepped up. I told them my assessment, started an IV (planes got the hookup on emergency meds/equipment) and had the RN and Paramedic watch the patient while me and the Plastic Surgeon (who volunteered to speak with the airline's liability insurance company) sat down and finished the in-flight movie in the seats beside him(Arthur with Russell Brand-awful movie) The guy's vitals stabilized and he felt better after two bags of saline and when we landed, they transported him off, I gave a statement, and my family and I had the best Vacay ever. When I got home, I got a letter from Hawaiian airlines thanking me for my ability to help a fellow passenger blah blah blah-what no free flight??? Link to comment Share on other sites More sharing options...
Friction Posted January 16, 2012 Share Posted January 16, 2012 I'm not a PA, but out of common sense and what I've read/heard, it seems that your role as a good samaritan has much less scope and responsibility than that with which you practice in a clinical setting. Obviously sans equipment and assistance your ability to treat a patient dramatically decreases, and I don't think anyone with an ounce of common sense would argue otherwise. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 16, 2012 Moderator Share Posted January 16, 2012 ALWAYS respond I was in a foreign country (on honeymoon) and caught wind of an little girl in trouble - never did anything as the bus we were on was leaving and it was my first time to a 3rd world county.... that day still haunts me!!! nothing is as bad as inaction..... now having been to other countries I would help out in flash is just about any situation (except maybe inner city/ghetto as I am a country boy....) liability wise - as far as I know we are covered under good samaritian laws everywhere - basically you have to commit gross negligency and the patient has to suffer an injury to have any worries Liability insurance - unlikely it will cover you if you do not have your own policy from the research I have done, but they might defend it merely on the point of protecting the Doc. I would keep my own level of care administered to BLS stuff - I do not carry a jump kit with me so that there is never a question..... remember you have to hand off the care to the EMT's and you put in a line and they are EMT-B you might have to ride in with the patient (to where ever they are going) since an EMT B is not IV certified.... my own moto - do the basic's (literally ABC's!) till professional help arrives - an ambulance with EMT-B's and first responders is better equiped to handle anything in the field (and this is coming from a past EMT and ER PA) Most the benefit I have given people is verbal reassurance and letting them know that help is on the way.... Link to comment Share on other sites More sharing options...
taotaox1 Posted January 16, 2012 Share Posted January 16, 2012 Why would you have to ride with the emts because they have iv access? just disconnect your saline or whatever a.nd hand them off. EMT-Bs can txp with iv access... they just cant use it (usually, but not always) Sent from my PC36100 using Tapatalk Link to comment Share on other sites More sharing options...
winterallsummer Posted January 16, 2012 Share Posted January 16, 2012 Cool story and good post. Link to comment Share on other sites More sharing options...
DizzyJ Posted January 16, 2012 Share Posted January 16, 2012 This has happened to me twice, within 2 weeks of each other, just a couple months ago. One was a seizure out on the dance floor and the second was someone, tweeked out on something, who went down to the ground. With both I just watched ABC's. EMS was called for the seizure, but friends swooped her out before EMS even arrived and the second one was also taken away by her friends before EMS called. I recommended they take her to the ED, but who knows. The bartender gave me a free beverage for helping haha! Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 16, 2012 Moderator Share Posted January 16, 2012 Why would you have to ride with the emts because they have iv access? just disconnect your saline or whatever a.nd hand them off. EMT-Bs can txp with iv access... they just cant use it (usually, but not always) Sent from my PC36100 using Tapatalk can't hand off care to a person not certified to deal with the level of care being provided - ie running IV can't go to a BLS EMTB - as for caping off - yeah could, but again, why bother with this - just do BLS AMC's and leave it to the professionals - if you have never had pre-hospital experience you are likely a liability so don't get upset if the medic's tell you to leave their scene..... that's what they should do. They can likely do far more, far faster then any non pre hospital trained provider could ever even imagine..... (those who have been on calls when $%^& hit the fan can understand...) Link to comment Share on other sites More sharing options...
MikeyBoy Posted January 17, 2012 Share Posted January 17, 2012 NYE this year, some drunk twenty-something passed out into a table (at 10pm), landing him a nice 4cm lac on his forehead. I saw this pretty simple accident happen from my seat at the bar, but that didn't stop the 70 person private party from grinding to a halt, as my friends came to ask my girlfriend (an ER PA) and myself for help. After an INTENSE 8 round (due to best of 3 rules) battle of rock-paper-scissors, I went over and looked at the little lac, and told him to go to the ER. A life saved- huzzah!... Thank goodness for PA school :) Link to comment Share on other sites More sharing options...
SocialMedicine Posted January 17, 2012 Share Posted January 17, 2012 I recerted my EMT for this very reason. I was nervous that I would assist someone in the field and it would challenge me PA license. Not sure if it even offers protection but unless it is a family or friend I am an EMT on the street and that is it. Link to comment Share on other sites More sharing options...
hrjames Posted January 17, 2012 Share Posted January 17, 2012 I have some kind of public disaster bad luck, I think. I've have 3 public emergency encounters: #1 I was on a plane that was taking my 21 month old daughter to California for her last cardiac surgery. A complete repair after multiple palliative procedures. To say I had a vested interest in keeping that plane in the air, on course, is a massive understatement. They called for a "doctor or nurse" to assist with a medical emergency. Myself, an ICU intensivist I happened to know from long ago and a breast surgeon took care of a 20-something dude who vomited & passed out. He came round with some IV fluid and an oral dose of my daughter's Zofran. The plane had compazine, but no one felt comfortable giving it, since the guy was already a bit goofy. We only had 750ml of nl saline but it helped. We were about to cross the rockies and had to make the call whether to divert. I am so glad the icu guy felt he was okay to finish the flight. My conflict of interest was immense. I did NOT want to divert and knew it was clouding my judgment. I guess the guy did okay - ambulance met the plane and then we ran into him in the rental car garage afterwards. Weird. And my duaghter had her repair and while never completely normal/healthy, is doing well. I still can hardly believe that happened. #2 & #3 Twice during a single 10 day vacation I came across a 65 y/o women face down in a pool of blood. First in an icecream shop - type 2 diabetic (not on insulin) with what sounds like a viral illness who hadn't been eating/drinking much & passed out, (scalp lac). why she was in an icecream shop I had no idea. EMS took 20+minutes to arrive. Second was in a state park on a steep hill where biker's reach dangerous speeds. She crashed her bike, apparently right before I came around the corner on my bike with my husband and 2 y/o in the trailer. 20 minutes before park ranger, another 30 minutes before the ambulance. My husband directed traffic at the bottom of the hill. In both cases, strangers gave us first aid kids that had lots of bandaids and a single latex glove. In both cases I basically checked abcs, asked about meds, hx, pain and kept them still and hoped they didn't lose consciousness. Pressure on the wounds with my one gloved hand. I only checked radial pulses on them because I was not putting my bare hand on their blood coated necks without gloves. I mentally planned to do compression only cpr since on vacation I have no mask. They both left by ambulance and I'm guessing both got CTs. Bike crasher was pretty confused but the diabetic seemed fine. We still go to that ice cream shop and bike that hill, but I get a bit nervous each time. I'm a walk-in clinic PA and don't have any other "real" pre-hospital experience. I much prefer my clinic. And nurses. And plentiful gloves. Link to comment Share on other sites More sharing options...
MediMike Posted January 17, 2012 Share Posted January 17, 2012 We may be covered by Good Sam laws (this depends on what state/country etc you are in BTW) but it still does not prevent someone to file suit. A good question is, can we be liable if we DON'T respond? hmmm...I am not saying that we shouldn't respond to avoid suit just something to consider.... Excellent point. The Good Sam law will not protect you from having a suit brought against you, but it will pretty much guarantee you'll win it as long as you meet the above criteria. Unfortunately you will still incur all the costs of a trial. As for being liable for not responding, I can speak only of WA, and there is no requirement to provide aid. There is a law that will get ya if you witness an incident and don't call for help, but that's it. Other states do require you to respond (this is from a prehospital provider's perspective). For instance, I believe it is Illinois that requires off-duty responders to stop at any MVCs they might come across, believe me, very few providers over there represent the star of life or IAFF sticker on the back of their person rigs! Link to comment Share on other sites More sharing options...
climber Posted January 19, 2012 Share Posted January 19, 2012 First off, I am not a PA so I hope that I’m not out ofline in responding. I am however a practicing paramedic. I can tell you that,when an individual presents stating that he/she is a(insert higherlevel care provider here) and wishes to give any form of direction, he/she mustbe willing to 1) Maintain patient care throughout, ie.go to the hospital and 2)provide proof of their provider status. I have yet to have anybody do this. Iwill say that depending on the call, I am often more than happy to have somehelp with some of the BLS stuff. Think holding c-spine, chest compressions ect.These things can really be a big help and can help free me up to drop a line,draw up meds, or prep my tube, ect. Just my 2c Link to comment Share on other sites More sharing options...
Just Steve Posted January 19, 2012 Share Posted January 19, 2012 I am curious...of the folks who read this particular thread and are concerned about liability...have you ever been really hurt or in the need of greater assistance from strangers? Ever been in a spot where another set of willing hands would make life so much more manageable? I haven't. Fortunately (knock on wood) every time I have totally FUBAR'd myself (fallen off a cliff resulting in a broken back...another time caught in a river hydraulic and ended up hypoxic for a bit...I was either with friends who bailed me out (figuratively) or I was able to eventually beat the odds and get myself out whatever jam I was in. I can tell you though...if a stranger would have happened upon me prior to my extraction, I would have kissed their feet for helping out where they could. I have however been that Good Samaritan on a rather regular basis. From the commercial jet, the urban street, to the remote woods, I have seemed to have managed to become engaged in medicine while off duty in a variety of States spanning Maryland to Oregon and many in between. I learned that a smile, eye contact, and the performance of needed interventions were not only accepted by all involved (rescuers and patients), but they were appreciated. I am willing to bet my house that a PA stands a MUCH MUCH MUCH higher chance of being sued from one of their patients seen in the clinical setting, while "on the job" than by someone who is scared and in need of help. No, I am not a PA, but I am professional paramedic who can be sued just as easily as a PA. Link to comment Share on other sites More sharing options...
jmj11 Posted January 19, 2012 Share Posted January 19, 2012 It is strange that I was reading this thread the other day and thinking to myself, it has been a decade or more since I've been in this situation. Then came yesterday. It was a bad day to start. The night before I had to put down my beautiful, 13 year-old Saint Bernard. Loved her dearly. Spent the night in the woods digging a huge grave in the pouring snow. Then I get up and make my way into our little fishing village (over the snowy mountain road). I meet my son (Freshman at UW) waking up the highway. He was suppose to be on a bus to Seattle and school but the buses weren't running. Then my wife called (ICU nurse) and told us that my son's best friend and college roommate (who was suppose be catching the bus with him) was intubated and in ICU near death from a drug overdose. Just wait the story is coming So, I take my son to ICU to see his friend. That was tough. Then I had to get to work, not only to see my patients, but I now have THE key to the entire office building (since I'm the first in and the last out) and had to unlock their doors (beautiful building though). I saw a couple of patients but as the snow fell harder, so did my patients . . . cancelling their appointments. So, I walk down to Thrive, one block down. I'm in the gym trying to run off my sadness. I saw people running around like something was going on . . . I choose to block them out. Then a man, husband of one of my patients, ran up and said, "Hey Mike, I think they might need you in the shower." Okay, I thought geewhiz. I just want some peace of mind. I go in the shower and it is chaos. The AED open but no one seeming to know how to use it. A man, about 30, was laying face down in the shower. The employees screaming "don't move!" I walked over and saw that he was breathing . . . even talking. The employees were trying to shoo me away from their chaos. I simply said, "I'm medical." (Dumb statement but I knew if I said I was a PA they would be confused). I squatted down and looked at the man up close, still face down on the tile with the employee's hand holding his face against the floor. I whispered, "Are you okay?" He said,"I'm fine they won't let me up." I asked, "Do you have any medical problems are you on any meds? Having any chest pain or SOB." He said, "No." I asked, "Did you just pass out?" To which he replied, "Yeah." "Has it ever happened before?" He said, "No." His pulse was regular. I said, "Okay." So, I left him on the floor with the crowd around him. I went about my business. I striped down for the shower, but by that time medics arrived and I couldn't get to the open shower. I was impressed with them. They were very calm and downplayed the panic that everyone was in. So, I remembered why I don't like being in these situations. It's because everyone is in a panic. Often, not in this case, some well-meaning citizen is taking charge because they got a First Aid Merit Badge . . . 45 years ago. They are usually cutting peoples clothes off and screaming for water, and ice and a claw hammer and duct tape, and the poor patient is just trying to get up. BTW, here is a related cartoon I did a number of years ago when I was doing PA cartoons. Link to comment Share on other sites More sharing options...
Joelseff Posted January 19, 2012 Share Posted January 19, 2012 Sorry about your son's friend and your dog mike....funny cartoon though! And best of luck with the practice! Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 19, 2012 Moderator Share Posted January 19, 2012 Mike. Ugh hang in there. Sounds like a tough time but it sounds like you are an amazing person and will get through. Certainly wishing you the best Link to comment Share on other sites More sharing options...
Cideous Posted January 20, 2012 Share Posted January 20, 2012 I took care of a car salesman that had a seizure in our local Honda dealership when my wife and I were buying a new car. They gave me 4k extra off the price of any car I wanted <basically cost>. It was funny. Several car accidents as well over the years. I use to pass car accidents on my way into the ER. I would stop and treat them on the scene if I was the first one there, then head into the ER where I would see them again. It would leave some very confused LOL. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 21, 2012 Share Posted January 21, 2012 Like Just Steve, I'm a PA student and paramedic with more than a few years on (sigh... the AARP card & grey hair). Some things to think about: 1) In most circumstances you'll have no medical equipment to use, unless you happen to have something with you. So, your ability to do any advanced interventions will be about nil. I always keep gloves and a CPR barrier device on my key chain. Unless I'm in my car that I use for my vollie dept., I don't have anything else. So, you can do vitals and as much H&P as you can with brain, hands, eyes, ears (yes, you can hear breath sounds with your ear on the patient's chest), and nose. Interventions will be pretty much limited to patient positioning, C-spine control, and direct pressure on external bleeds. I'm sure not going to do a cric with my pocket knife. 2) If you are in a setting with some equipment, coordinate with the staff on hand. They may defer to your greater experience, like passenger aircraft flight crew. I've had lifeguards hand me O2, etc. 3) Good Samaritan laws will only protect you from the judgement, not the hassle of being sued. The standard in Ohio is what a reasonable provider with your level of training/certification do in similar circumstances - including the equipment & meds that were available. So, if you're not trying something odd - like the pocket knife cric, you'll be OK. Plus, you'll probably win the PR battle. 4) Turn the patient over to EMS as soon as possible. Done it a number of times, never had a problem. Link to comment Share on other sites More sharing options...
Contrarian Posted January 21, 2012 Share Posted January 21, 2012 I taught and adhere to the Tactical Combat Casualty Care (TCCC) protocol when encountering medical emergencies. I limit my focus to the management of MARCH: M- Massive Hemorrhaging A- Airway protection R- Respiration C- Circulation H- Hypothermia I keep 1 of these in every vehicle I drive. [ATTACH=CONFIG]856[/ATTACH] http://www.itstactical.com/store/its-eta-trauma-kit/ Link to comment Share on other sites More sharing options...
jsfelder0417 Posted January 23, 2012 Share Posted January 23, 2012 Ahh the good old MARCH assessment. Taught that one during many a CLS class. I made it a little more difficult for my CLS's though by making the H encompass Hypothermia and/or Head Injuries. My treatment would default to the MARCH RTA, and BLS protocols, if in an area that provided for an AED. Link to comment Share on other sites More sharing options...
jsfelder0417 Posted January 23, 2012 Share Posted January 23, 2012 Ahh the good old MARCH assessment. Taught that one during many a CLS class. I made it a little more difficult for my CLS's though by making the H encompass Hypothermia and/or Head Injuries. My treatment would default to the MARCH RTA, and BLS protocols, if in an area that provided for an AED. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.