James E. George

The emergency nurse as a first responder.

am also a certified emergency medical technician (EMT). Although I am not a member of our local volunteer first aid squad, I often ride and assist squad members who are trained to render basic life support. The ambulances are equipped with cardiac monitoring and defibrillator equipment. If advanced cardiac life support is required, the first aid squad is required to call the paramedics. I have assisted paramedics in establishing venous access and in administering intravenous medications. I have also defibrillated patients in monitored situations where the paramedics were not yet on the scene. Have I acted beyond the scope of my legal responsibilities? If there is a lawsuit against me and the squad, how will I be judged? Answer The reader’s interesting question raises several interesting legal issues that must be addressed to answer the question. In the scenario presented, the emergency nurse is volunteering her efforts in assisting a volunteer first aid squad. In many jurisdictions, volunteer rescuers are provided immunity from civil liability under legislation generally known as “good Samaritan” laws. Raising the affirmative protection of any potentially applicable good Samaritan law may be the nurse’s first line of defense. If the court rules that the immunity provision applies to the facts and circumstances of the case, the suit against the volunteer nurse will be dismissed. If the nurse is not a volunteer or if for some other reasons immunity is not provided, the conduct of the nurse will be judged according to principles governing the law of torts (civil negligence). Generally, the law requires a person who provides professional care to exercise that degree of knowledge, care, and skill ordinarily possessed and exercised by a reasonably prudent average health care provider in the same or similar circumstances. In the scenario presented in the question, the emergency nurse would be expected to exercise that degree of knowlege, skill, and care possessed by the prudent average certified emergency nurse who is also a certified ACLS instructor and certified EMT as would be expected under the same or similar factual circumstances. Even though the nurse is also a licensed EMT, she will be held to the higher standards of a registered nurse working under the same or similar conditions. If the nurse has the knowledge, skills, and ability to provide care that exceeds that of an EMT, the law requires that the nurse do so, provided circumstances permit. Clearly, if equipment and medication is not available in the ambulance, the law will require only the level of care that is feasible under the circumstances. On the other hand, the nurse may not refrain from using his or her nursing skills and training because he or she is “wearing the hat” of an EMT. In lawsuits alleging professional negligence, the standard of care by which the conduct of the defendant is measured is generally presented to the jury through the testimony of expert witnesses. The courts have reasoned that lay persons should not be permitted to guess or speculate about what the professional conduct of the defendant should have been. When a case reaches trial, it is the job of the expert witness who testifies on behalf of the plaintiff and the expert witness who testifies on behalf of the defendant, to tell the jury what level of care should have been provided. The expert for the plaintiff will state his or her opinion that the defendant nurses’ conduct did not meet acceptable levels of care. The plaintiff’s expert can be expected to establish a high standard of care. The expert for the defendant will most likely disagree with the plaintiff’s expert opinion

The patient's legal responsibility

Abstract An emergency patient suffered a deep facial laceration as a result of an adverse encounter with a skateboard. A plastic surgeon was called to the emergency department for repair of the wound. The emergency nurse learned that the patient had not had a tetanus immunization for over 10 years. As a result, the physician ordered tetanus toxoid and tetanus immune globulin and proceeded to repair the wound. The emergency nurse intended to provide the immunization after the repair. Unfortunately, the patient was discharged from the emergency department before the nurse had the chance to give the immunization. The nurse was unsuccessful in attempting to reach the patient. The telephone number he had provided was not in service, the address was nonexistent, and the employer that he had identified had never heard of him. Even a computer check through the sheriffs office yielded no result. If the patient develops tetanus, can the emergency nurse be held liable?

Emergency nursing: Standards of care

A s emergency nursing continues to gain increasing recognition as a nursing specialty with certification examinations, emergency nurses can expect that there will be increasing pressure on hospitals to staff their emergency departments with nurses who have the skills and credentials to practice this demanding specialty. With the advent of emergency nursing certification, nurses who practice emergency nursing are concerned with the effect that certification may have in the context of emergency nursing malpractice suits. What legal standards are used to determine whether nursing care rendered by an emergency nurse is or is not negligent? In any nursing malpractice case, a critical question is whether the defendant nurse deviated from accepted standards of care and, if so, whether the patient suffered harm as a result. Generally, the law requires a nurse to exercise that degree of knowledge, care, and skill ordinarily possessed and exercised in similar situations by the average member of the nursing profession. Nurses who are certified in a specialty will be held to the accepted national standards of that specialty. Certified emergency nurses (CENs) can reasonably expect to be held accountable to the (CEN) standards of care promulgated by the Emergency Department Nurses Association. Those nurses who practice emergency nursing but who are not certified in emergency nursing will in all likelihood be increasingly held accountable to the standards of CENs. Courts are likely to reason that the nurse who exceeds the usual bounds of nursing practice, and who holds herself or himself out as capable of providing nursing services that fall within the realm of a specialty, should be held to the same standards of care as a nurse who has devoted full attention to that specialty.

Illegal drugs, police, and the emergency department.

Abstract Should the ED staff cooperate with the police if ordered to forcibly extract ingested illegal drugs from an ED patient by gastric lavage, emesis, or other means?

Consent and the mentally impaired patient

Abstract A retarded man was recently treated in our emergency department. He was over 21 and was able to sign his name on the consent form. There have been no repercussions from treating him, but I was wondering: Is his consent valid?