Would you stop at a road accident and offer assistance when off duty?
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Would you stop at a road accident and offer assistance when off duty?
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Picture it, its dark and you come across a road accident. No emergency services are present. Would you give emergency assistance?, would you worry about being sued?
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Would you stop at a road accident and offer assistance when off duty?
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 1/9/2011 2:06 PM BST
on bmj.com
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Posts: 138
First: 25/5/2011 Last: 24/5/2013 |
I guess a big feature here is whether we are visualising the situation of an unconscious patient (ABC drill) or one is fully conscious and perhaps badly injured. Most people hearing that a doctor was in attendance at an incident might, I suspect, be tempted to interpret this in terms that some active treatment was being undertaken to a recognised professional standard. I wish to be certain that these expectations are lowered. The patient's family, in the event of calamity, might have the mistaken belief that an unequipped doctor had some unrealistic capacity for intervention over and above that of a trained first-aider. |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 2/9/2011 2:02 PM BST
on bmj.com
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Posts: 2060
First: 12/3/2010 Last: 24/5/2013 |
Ah, so, kerked! And from your perspective, kerked, is there any risk as long as the 'good samaritan' followed accepted guidelines for resuscitation? That is important, because as soon as you do go to someone's assistance and say that you are a doctor, you have a duty of care (?). As above, I would suggest that any competent doctor (or nurse) should be able to provide potentially life saving ABLS, and that need not be qualified. But should one also say something like, "I'm not a trauma specialist, but I will do my best to help."? (In the scenario given, there's no one to say anything to, but I think the point remains) I've been told in the past that no British court would allow an action against a doctor who did their best, as long as they did not exceed their competence, which should include ABLS. Would you agree? John Adrian, Trauma, unconciousness, overdose, diabetic crisis, stroke, "feeeling a bit queasy", it's all ABC! That's the basics of resuscitation. Airway, Breathing, Circulation. The badly injured patient needs their airway secured. If their airway is obstructed, all the high-tech, advanced resuscitation on the world won't save them! Not even Breathing and a Circulation! First aiders know how to do this - surely a doctor can learn? Not many doctors join up to 'save life' and few get to actually do so, but this is one situation where you can! J. |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 3/9/2011 2:04 AM BST
on bmj.com
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Posts: 4
First: 12/8/2011 Last: 29/6/2012 |
I received a call at 0200 am , its an acute abdomen, I manage to exlpore and went home just on time to receive another call, ? appendicitis..so I head back to the Ot again, and finish at around 5 oclock..Finally..I drove back home just in time again to witness a MVA, boy I was tired.... so I said to myself well I'll just skip this one and hopefully the ambulance will pick them up...I'll just wait at home and wait If I received a call, t luckly I didnt received a call....two reasons, they kick the bucket or minor injury.. Sadly they kick the bucket...I fail myself...I could have save a life that day...
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 3/9/2011 2:23 AM BST
on bmj.com
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Posts: 4
First: 12/8/2011 Last: 29/6/2012 |
Its true that somtimes we can be inadequate without our tools...not till I did this Primary trauma Course, its a fantastic course specifically designed to improvised and used clinical skills without the use of fancy equipment on the spot anywhere anytime.... |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 3/9/2011 7:43 AM BST
on bmj.com
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Posts: 963
First: 15/7/2011 Last: 24/5/2013 |
The general principles are as follows: 1. Nobody has a legal duty to come to someones aid unless there is already a pre-existing duty (or of course you are in the Ambulance Service for example and are called to a MVA scene). 2. Legally, a Doctor does not have to stop if he/she comes across an accident. However, the BMA say there is an ethical duty to stop and see if you can help. Once you stop and attend a patient you are self imposing a Duty of Care to the patient. 3. The legal test will be that of the ordinary skilled doctor in all the circumstances present. So for example a Psychiatrist would not have the same level of duty as a Pre Hospital Trauma Anaesthetist in the given circummstances. But, the same level of care is expected in so far as the Doctor must not exceed their skill level nor cause further harm to the patient. 4. There is a rider. It would be reasonably assumed that if you declare yourself to be a doctor at the scene you would be expected to - at the very least - perform Basic Adult Life Support. The law would not expect the ordinary skilled Doctor on a dark road without equipment to improvise a chest drain with a biro and water bottle or open a chest to perform open cardiac massage. But as already stated ABLS can be performed by lay people with the most basic first aid skills - for a Doctor of any speciality and seniority it would be indefensible not to be able to perform this. 5. I know of no case in the last 50 years where the courts have imposed a penalty on a doctor for stopping to assist at an incident. The only time a court will intervene is when a Doctor, or any rescuer made the situation worse, for example by moving a casualty with a suspected spinal injury unnecessarily and causing harm. 6. If you stop at an incident and offer help I would recommend you simply say to those present 'I am a Doctor but I am not in a position here to do very much more than basic first aid' because that is literally what you will be providing. When the Paramedics are present and if you have the appropriate skills (as in your case) you can of course tell the Paramedics you are a Doctor and assist with more Adanced skills if they are appropriate. 7. Finally, Doctors and Nurses should never travel from or to work with uniforms on or identity badges or a stethoscope draped around the neck. It is simply asking for trouble. Nurses are the worst at doing this. It is also poor infection control practice. It should not matter how out of date the Dr may be nor that they are not Emergency Care physicians - the Dr will only be able to adopt the ABC approach and if they can't do that than they must be pretty incompetent.
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 3/9/2011 11:27 AM BST
on bmj.com
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Posts: 2060
First: 12/3/2010 Last: 24/5/2013 |
Thank you, kirked! It's most useful to have that view of how the Law sees this situation, which should reassure anyone put into it. I'mglad to help you if I can - let's hope NOT in an RTA! On that, Bauro, I agree with your action in not responding. Senior doctors at the top of the tree have no one to call on for help when they are exhausted, so they must be selective. But take care - I know of at least one such who crashed and died while driving home in the early hours. John PS RTA/MVA? The latter sounds American, and Injun Joe uses it, but you use it, kirked, and I assume you are UK based? |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 4/9/2011 11:40 AM BST
on bmj.com
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Posts: 2
First: 4/9/2011 Last: 9/9/2011 |
I stopped at a road accident as a final year medical student, when a young man had been knocked off his bike. He was concious, and had broken his nose and teeth. There was a lot of people "milling" about, and someone had phoned the ambulance, but no one was talking to him really. I could do nothing for his nose, or his teeth, but I could sit and have a chat with him (luckily he was quite chirpy!), and I although that's not essential, at least when the paramedics came he was pretty calm. Did I make a huge medical difference? Not at all. But I would do the same again. |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 4/9/2011 12:52 PM BST
on bmj.com
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Posts: 963
First: 15/7/2011 Last: 24/5/2013 |
eleanor_c makes a great point. It may be that it is not possible or necessary to make profound medical interventions but just reassuring and calming a distressed patient and/or bystanders has a remarkable effect upon the situation. After all, essential humanity is at the heart of any doctor / patient relationship. In just about every complaint or claim I deal with concerning healthcare professionals a recurrent theme is poor communication. Basic courtesy can often make the difference whether a patient complains or not about poor or unexpected treatment outcomes. In Emergency Care it can be very difficult when a Doctor is tired and pressurised to be courteous, patient and empathic with every patient - particularly if they are a frequent attender, intoxicated or otherwise demanding. But always trying to remain professional however trying the situation is a doctors best defence. Whilst I have gone off the point somewhat from this thread the principle I am trying to reinforce is, if you stop at an incident whilst off duty, it may be enough just to foster a calming influence and give reassurance rather than feel that you must be actively seen to be doing something!. |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 5/9/2011 3:04 PM BST
on bmj.com
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*Moderator*
Posts: 1451
First: 7/4/2011 Last: 24/5/2013 |
Response from Twitter:  @pspindler Paul Spindler RT @doc2doc new poll on helping at RTAs when off duty - t.co/aqojPeJ. Good 2 see drs debating your key issues @gooddoctoruk #doctordebate |
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Re: Would you stop at a road accident and offer assistance when off duty?
posted at 5/9/2011 5:00 PM BST
on bmj.com
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Posts: 340
First: 12/7/2010 Last: 24/5/2013 |
In Response to Re: Would you stop at a road accident and offer assistance when off duty?: I stopped at a road accident as a final year medical student, when a young man had been knocked off his bike. He was concious, and had broken his nose and teeth. There was a lot of people "milling" about, and someone had phoned the ambulance, but no one was talking to him really. I could do nothing for his nose, or his teeth, but I could sit and have a chat with him (luckily he was quite chirpy!), and I although that's not essential, at least when the paramedics came he was pretty calm. Did I make a huge medical difference? Not at all. But I would do the same again. Posted by eleanor_c I completely agree! I'd stop and help if I knew how best to medically manage that situation. If it was something out of my element, I'd call those who can help. And while we wait for help, I'd just hang around; sometimes its just that reassuring physical presence or a conversation that abates what follows. It's the least I can do. One night, I got to witness a death and I really wasn't mentally prepared for the way it all happened. Even though the whole scenario is graphically recorded in my mind, what affected me the most was that the patient died alone. The patient's family abandoned him and it is my opinion that nobody, not even the worst of us, deserves to die alone. So in the presence of the injured, choose to HELP; be it medically, emotionally or even physically (where appropriate) eg: holding their hand. Dying (or the idea of it) can be a scary and tragically lonely feeling and I am sure most of us would want somebody around. |
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