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Would you treat this person or call 911?

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Last night I was driving home and saw a person exiting my driveway with a walker, turn and start shuffling up the sidewalk...  lets go back four weeks to December 27th.

I was working in the den in front of the house and heard a loud bang somewhere outside and then some screaming.   I have heard enough gunshots to know that this was not a firework, which is so common here in my neighborhood between Christmas and New Years Eve, so I went outside to see what was going on.

About three houses down I could see a neighbor on the sidewalk screaming, and another neighbor yelling into the phone about a person being shot.  I ran into the garage and got a tiny trauma kit that kept since my last tour in Afghanistan and went down to help.  The patient was lying beside his vehicle on the sidewalk, had vomited on himself (yes this is somewhat common), there was arterial spray coming from the medial aspect of the L upper leg, with a large amount of tissue and bone visible though a hole in his denim pants.  This person was already going into shock and was having difficulty communicating with me.  

I had already put on gloves while running down the street, and immediately opened two large rolls of kerlix and shoved them directly into the exit wound, and then placed one on top of the entrance wound (I have no combat gauze in my kit).  I had only one Israeli dressing, so I applied this sideways on top of the two rolls of Kerlix, and then wrapped it around the leg using the straps to hold the Kerlix in place on the entrance wound.  This was not enough to stop the bleeding, so I applied a CAT tourneqit as close to the groin as I could which stopped almost all the bleeding.  I was very grateful for this as I did not wish to go search for or tie off a blood vessel on the sidewalk.

I was able to talk to the person who had called EMS, (they arrived approx 12+ minutes after calling) and found out that they were loading rifles into a vehicle to go hunting and that the patients deer rifle, a 7mm magnum that he thought was empty, discharged, striking the victim in the inner thigh.   The delay of EMS is due to neighborhood being relatively new, many of the streets are going up faster than they are mapped, and the county EMS station is > 10 miles away.  I gave EMS and update on my treatment and they stayed on scene only long enough to place two IVs, three sheriffs vehicles arrived as I had finished gathering my belongings and returned back home.  I walked off before I could give a statement, and they never came looking for me.

There are only 6 people who know about this incident, including myself, with the exception of the patient and neighbor of course.  I told the 5 PA's I work with about this a few weeks after it happened at a work function when we had time away from everyone else at the meeting.  Much to my surprise, 4 of them said that they would have let EMS handle this and would only offer comfort and reassurance to the patient, only one of them sided with me regarding treating on scene and he is also an ex-military medic.

The reason 4 of the PAs gave for not wanting to do anything was fear of running afoul of the state PA board or running afoul of our states good samaratin law if something went wrong.  Providers do not have immunity under our states good samaratin law, which states "someone who normally provides emergency care, such as a nurse or emergency room worker" does not have protection from liability, and our states Physician Assistant board is the original home of knee jerk reactions and I could easily see them trying to charge a provider with performing medical care at a place other than his listed address or working without first telling his supervising physician about the patient.  Since I had left the scene before the Sheriff's office arrived and went to pick up by foster girls from school, and never gave my name to EMS my name is on any documentation and I never had to give a statement.

With so many of my fellow PAs stating that they would not have treated, but would have only offered supportive care and assisted with the 911 call, I began to second guess myself.  Not the treatment, I have treated multiple traumatic injuries and gunshot wounds in the past, but I became very concerned about an overreaction by my states medical board and my liability under the good samaratin law.  I was very worried about this over the past few weeks to the point that it was keeping me up at night.  Until last night...

Last night, that person using the walker and shuffling out of my driveway was my neighbor, who was discharged from the hosptial yesterday after 29 days and had come over to thank me for saving his life.  Now I know I did the right thing.

 

 

 

 

 

 

 

Edited by Bohuntr
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You did the right thing. I hope you don't get punished for it, although I don't see how you could with the description you gave. 

 

Keep us updated. 

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Your four colleagues are ethically impaired.

In the United States, where 'Hippocratic medicine' is a distinct subset of 'Medicine,' that's not all that surprising.  Many contributors to this site are similarly ethically impaired, just like many medical practitioners in all disciplines and specialties.

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You did the right thing.  Another way to think about it: you did nothing invasive.  Everything you described is well within 1st aid or the new vogue "stop the bleed" training.  I won't presume to guess what a board in another state would do, but I can't see where 1st aid interventions would get you in trouble.  You were wise not to leave you name.  Wouldn't surprise me if the EMS crew was trying to help you by not asking for it.  I always document "by bystanders" on my EMS run reports for just that reason.

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You are one of nature's noblemen. I like to the that I would do the same

Your coworkers might consider a new line of work!

Sent from my XT1254 using Tapatalk

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I’ll once again play devil’s advocate.  Gunshots? I’m not going outside unless armed.

With regard to treatment in field, belt tourniquet to proximal thigh, wait on EMS, and no, I’d leave the IV starts to EMS.  It’s their show after they arrive on scene and if there were a complication from the initiation of the IV/attempts to start it could get THEM in trouble.  

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Of course I'd have been armed. Hell I'm armed right now.

I THINK (but can never be sure until it comes up) I'd probably do whatever I had the ability to do if I thought the patient's life was at risk including IVs. Like many other things (if that was my kid I'd.....) I think you never really know until it happens to you.

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I wonder how much of the "Good Samaritan" Law applies to a trained licensed provider? The layman isn't expected to "meet the standard of care", while it may be applied to one of us in a court of law. Yes, my experience as a former Army Medic and a trained practitioner make my first impulse to assist kick in, but I now look to not just my physical safety, but my legal safety and my family's welfare in this litigious world we exist in. The actions taken by the OP were sound and appropriate medicine with a good outcome, but assume a bad outcome and how that could have played out. I know of physicians who don't keep medical items at hand outside of their practice environment due to litigation risks and I no longer keep anything past a few bandaids in my vehicle for like reasons. I witnessed a woman struck by a car and tossed down the road followed an "EMT" organizing onlookers to pick her up and move her to a bench nearby! This person couldn't understand my unwillingness to get involved in her "Good Samaritan" activity. The OP did good and hearing a thank you for saving my life is the ultimate professional reward, I remain hesitant to jump into on the street emergency medicine. Not judging but voicing my concerns and $.02 worth.

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It's difficult to meet "Standard of Care" for a fully equipped ER in the street when you're out for a run (true story - out jogging, ran by two dudes with no first aid training trying to deal with another dude via 911 operator - I actually ran about 200m past, then had an attack of conscience and jogged back) or out for a drive (2 other occasions for me) or minding my own business in Costco when my wife texts me that a guy had hammered in and could I please come help...Luckily courts here recognize that little bit of common sense and drop the hammer on frivolous lawsuits.

Most Good Samaritan Laws in Canada go by the "Reasonable Person" principle (some are actually called "Reasonable Persons Acts") - what would a reasonable person in an unreasonable situation do?  If a person not trained in brain surgery tries putting a burr hole in someone's noggin just because that person was unconscious and they had seen something like that on Rescue911, that would be unreasonable...if a person plugged bleeding holes and tied a tourniquet off because that was at hand and necessary, that's a reasonable thing for that person to do...even more so if trained to do so.  If the dude needed a burr hole, you were trained but not able to (no drill, hammer/chisel, CT scanner, etc), it would also be considered reasonable - you can't be held responsible for silliness like that...as long as you act in good faith.  

As Rev noted, some people tend to lean towards the "Hypocritical' oath vs the "Hippocratic" one...sounds like a number of your medical boards and a lot of judges do as well.

And BTW Bohuntr, BZ .

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Well like I said, I never second guessed it until I talked with my co-workers, and they had very valid points.  I am by no means holding their points against them, and hope tht if something similar ever happens again I won't think of the issues they brought up.

I just took TCCC for the third time this past September for a pending job this spring, which was going to be in Afghanistand and now looks like it might be in Syria, so the training was pretty fresh in my mind. 

Thanks for all the input!

 

 

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you did well

 

I would have also helped - 

 

 

A thought ...... let time go by, then approach you state PA board or PA group - with AAPA's help and try to be the agent of change to the laws/regs so that there is never a doubt in the future....

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you did the right thing. I would have as well. 

Not on the same level of severity, but I had a recent good Samaritan experience as well. 

I recently was on a plane flight and answered the call for "medical assistance in the back bathroom". literally no one else on the plane came to help. what is the chance that I was the only medically trained person on a flight to Boston? Anyway, diabetic was light headed and passed out on the toilet. helped her out of the bathroom. asked her if she had eaten that day, she mumbled no. gave her a sip of coke and she perked right up. watched her for 5 min as she ate more and felt fine. on board crew gave me 2 chocolate bars, 2 glasses of white wine, and a certificate for $250 off my next flight. 

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I had the same thing happen on a flight from Germany back to the states. The paged for a doctor and I didn't answer. Then they paged again and I identified myself and they took me back to a semi conscious diabetic patient. Couldn't get him to drink. The pilot came down the isle and asked med if we needed to divert because "we're gonna have to dump fuel and land in England". I had been a PA about 2 years and I thought "no pressure..." The flight attendant said "here is the first aid kit and, because I was getting pretty tense by now, I said "I don't think a big ass box of band-aids is gonna be much help right now." She opened it up and there were IVs and drugs and everything needed for most emergencies. I swear I saw a rainbow come out of that box. Quick IV, one amp of D50, problem solved.

I got a nice letter in the mail with my name misspelled thanking me for "doing my duty."

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47 minutes ago, sas5814 said:

I had the same thing happen on a flight from Germany back to the states. The paged for a doctor and I didn't answer. Then they paged again and I identified myself and they took me back to a semi conscious diabetic patient. Couldn't get him to drink. The pilot came down the isle and asked med if we needed to divert because "we're gonna have to dump fuel and land in England". I had been a PA about 2 years and I thought "no pressure..." The flight attendant said "here is the first aid kit and, because I was getting pretty tense by now, I said "I don't think a big ass box of band-aids is gonna be much help right now." She opened it up and there were IVs and drugs and everything needed for most emergencies. I swear I saw a rainbow come out of that box. Quick IV, one amp of D50, problem solved.

I got a nice letter in the mail with my name misspelled thanking me for "doing my duty."

And the lifetime travel pass with club access. 😄

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2 hours ago, sas5814 said:

I got a nice letter in the mail with my name misspelled thanking me for "doing my duty."

Duty??!! 

The words "Chuck You Farley" come to mind...followed by "Good luck getting my to fly your friendly skies again".

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1 hour ago, sk732 said:

Duty??!! 

The words "Chuck You Farley" come to mind...followed by "Good luck getting my to fly your friendly skies again".

guessing he was active duty military at the time. 

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I was more than happy with the thanks from my neighbor🙂

I treated with the kit I had and couldn't have done more; I'm grateful I had the experience to treat and that my kit was in the garage next to my range bag.  I doubt my neighbor will raise any issues with the good samaratin law after talking with him, he's glad to be alive and was on his way to bleeding out when I got to him.

Truth be told, I have no faith, trust or respect in our state PA board could even recognize that it was ethically right to treat, so they are still a concern, but it's been a month so it's doubtful that anything will happen there either and I'm keeping my fingers crossed.

Thank you again for all your input.  It really sucks that doing the right thing causes so much second guessing and hesitancy...

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Imo you did the right thing.

You knew you had the skills to save that man's life and you acted.

Now,

If someone isn't confident in the skill required then I could understand a dermatology provider not jumping in to tourniquet and place an IV if you don't regularly practice those skills. 

I also think it's an individuals choice whether to enter a scene they may not feel is safe. Rescuer safety first. (I'm in mountain rescue but no combat experience)

In regards to lawsuit, do what you can with the patient's best interest in mind and don't be negligent. I'm sure lawsuits have been filed in cases like this, I can think of one in particular that was quicky dismissed, but I think that's a tough case to try to bring against someone acting in good faith and within their training to save a life. Had the posters above who stepped up to the plate not done so, people would have died. 

So I'd rather be sued for doing the right thing ethically than for doing being present and doing nothing. 

Just in case some of y'all care, I'm of the younger generation of PAs. 1yr out of school and 29. There's Hope for our generation yet 😉

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As I recall from years past there is no evidence showing isotonic/hypertonic solution in a hemorrhaging patient improves long term survival but that's another discussion.  That's why I commented on a proximal thigh belt tourniquet only if I were helping out a neighbor, especially if in a municipality where response time would be reasonable (<6").

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On 1/29/2019 at 11:59 AM, EMEDPA said:

you did the right thing. I would have as well. 

Not on the same level of severity, but I had a recent good Samaritan experience as well. 

I recently was on a plane flight and answered the call for "medical assistance in the back bathroom". literally no one else on the plane came to help. what is the chance that I was the only medically trained person on a flight to Boston? Anyway, diabetic was light headed and passed out on the toilet. helped her out of the bathroom. asked her if she had eaten that day, she mumbled no. gave her a sip of coke and she perked right up. watched her for 5 min as she ate more and felt fine. on board crew gave me 2 chocolate bars, 2 glasses of white wine, and a certificate for $250 off my next flight. 

This happened to me on a flight to Hawaii after I graduated and was practicing for about 6 mos. I was the first to step up but then an EMT and an ER Nurse came up and then a Surgeon who was the chief at a hospital in Hawaii-same hospital as the ER RN. Pt was middle aged australian drunk out of his mind and severely dehydrated with palps and CP. EKG was NL. I put him in the back of the plane put him on O2, started an IV and pushed a few bags of NSS and he felt better. the Nurse EMT and MD stepped up after all this was done lol. I had the doc talk to the Hawaiian airlines office on the phone instead of me because they were asking for my malpractice insurance info and i really did not know it was since i was a new grad.  The pt was on a binge drinking holiday with his wife. Arrived in SF, drunk from Las Vegas where they had been drinking a lot per the wife and heading to Maui drinking the whole way lol. 

All I got was a thank you letter from Hawaiian Airlines...Missed my meal, movie and No voucher, not even an extra POG juice 😞  

Edited by Joelseff
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