005 下班时碰到紧急情况怎么办？ - 医护前沿 - 奥医教育-奥医资讯-厦门奥医教育咨询有限公司

下班时碰到紧急情况怎么办？各州的政策是否一致？根据作者的经验，紧急情况通常可以分三种情况，不同的情况应有不同的处置。

What Can I Do in an Off-Duty Emergency?
Carolyn Buppert, MSN, JD

Question

What can a registered nurse do, treatment-wise, if he or she comes across an emergency situation outside of the work setting?

The question was: What can a registered nurse do, treatment-wise, if he or she comes across an emergency situation outside of the work setting? Does this vary on the basis of your state?

I can think of at least three levels of "emergency situations," and in my opinion, a reasonable nurse might act differently in each. The first category is an automobile accident, where the nurse arrives before emergency services is on the scene. A nurse may be able to initiate cardiopulmonary resuscitation or apply pressure, and a state's Good Samaritan law is likely to apply.

Good Samaritan laws have the objective of encouraging healthcare providers to stop at accidents and offer help, without fear of lawsuits. In general, the laws preclude an injured person from suing a "Good Samaritan" clinician who does the best that he or she can under the circumstances. Good Samaritan protections vary from state to state.

Here is an example, from New York:
...[A]ny person who voluntarily and without expectation of monetary compensation renders first aid or emergency treatment at the scene of an accident or other emergency outside a hospital, doctor's office or any other place having proper and necessary medical equipment, to a person who is unconscious, ill, or injured, shall not be liable for damages for injuries alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such emergency treatment unless it is established that such injuries were or such death was caused by gross negligence on the part of such person. Nothing in this section shall be deemed or construed to relieve a licensed physician, dentist, nurse, physical therapist or registered physician's assistant from liability for damages for injuries or death caused by an act or omission on the part of such person while rendering professional services in the normal and ordinary course of his or her practice.^[1]

The second category of "emergency" that a nurse might face is coming upon a person who apparently has fainted in public. This may be an "emergency" under a state's Good Samaritan law, or it may not.

The problem is that a nurse who attempts to help someone who seems to have fainted might feel called upon to make a medical diagnosis. For example, has the person simply had a vasovagal reaction, which will resolve spontaneously in under a minute? Has the person had a cardiac arrest? Has the person sustained a head injury? A nurse who tries to diagnose could be accused of practicing medicine and possibly could be liable if the individual cared to sue the nurse.

In general, a nurse can stop and ask the person "Are you OK?" and initiate the appropriate steps of cardiopulmonary resuscitation (CPR), as indicated by the individual's condition, without getting into much trouble. Nurses and others always can activate emergency services. But be aware that this is a gray area, Good Samaritan-wise, if a nurse becomes involved in treatment.

The third category of "emergency" is exemplified by a nurse who responds, while sitting on a beach, to a call for help from a person who has perhaps injured his ankle. This is not an emergency, and Good Samaritan laws most likely do not apply. A nurse who offers an opinion on whether the ankle is broken is getting into risky territory and most likely will not have the protection of a Good Samaritan law, because it's not an emergency.
All states have some form of Good Samaritan protection. In preparation for becoming involved in emergencies, nurses should read the Good Samaritan law of their state, note what is covered and what is not covered, note whether the law covers nurses and how the law defines "emergency," and form a general plan for themselves when and if one encounters an emergency. An online resource for state-by-state Good Samaritan laws can be found here.

Note that a nurse is never required by law to offer assistance to someone outside of his or her employment (although in a few states, physicians are). Any professional liability insurance the nurse has through his or her employer is not likely to apply. And even if a nurse becomes involved in a situation covered by the state's Good Samaritan law, he or she will need to stay within his or her scope of practice under state law. For example, a nurse might perform CPR but would not perform a tracheostomy.

These principles remain the same if the emergency takes place during a flight. A federal aviation law provides Good Samaritan protection if the flight is above the United States, but it is not as clear internationally.^[2] Under either circumstance, one needs to stick to one's own scope of practice. No law requires a nurse or physician to respond to a request from a flight attendant for "a doctor or nurse on board the aircraft," and there are no known case of lawsuits against those who did respond.^[3]

Each nurse, when coming upon an individual who needs medical attention outside of his or her workplace, will need to make his or her own decision about whether to become involved. Liability is one thing to consider; one's ethical views and feelings about social responsibility are others. In general, people do not sue healthcare providers or others who generously come to their aid, but still, clinicians would be wise to consider their own liability.

原文网址：http://www.medscape.com/viewarticle/840797

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