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Education Resources for EMS and Fire professionals

Exploring the Decision to Respond...REALLY?

Posted by Jessica Carmichael on 5/30/13 2:37 PM

(Article from ECSI eNews: May 2013)

For those of us who are (or have been) both ECSI Education Center Coordinators and Emergency Responders, the sight of blood or other bodily fluids is commonplace, and taking action in ambiguous situations, sometimes at risk to ourselves, is merely a line or two of our job description. We accept these situations and learn to become comfortable with them in order to do our jobs. We utilize barrier protection as a matter of routine and, unlike the average citizen, are not usually queasy when it comes to touching icky stuff.

As responders, we've all seen it: you arrive on a scene where several concerned citizens are standing around gawking at the injured person – but few (if any) are actually taking action.

I believe people generally act in the best interest of others. So why is the average citizen reluctant to help? This question has been posed, discussed, researched, and written about time and again. Personally, I usually hear answers along the lines of the following:

  • “I didn't want to get sued.”
  • “I was afraid I'd mess something up and hurt them more.”
  • “I was afraid I'd catch a disease.”
  • “They don't owe me money.”

Admittedly, that last one is a joke, but my point is clear: people are afraid of acting in these ambiguous situations. The desire to act must overcome that fear. Would-be responders need to have an acute sense that what they think they need to do is the right thing to do, and that it's relatively safe. For those of us who are presented with these situations every day, taking action is second nature – but that’s not true for those who aren’t.

It is incumbent upon as educators to provide a full picture to our students. They need more than just a bulleted list of steps to take at a scene. While there are indeed reasons not to respond in certain situations (for example, if the scene is unsafe), it is up to us as educators to clarify the line between informed discretion and irrational fear. It is essential that our students know when to respond and when not to respond, how to avoid causing more harm, and the realities of disease transmission.

I tackle these issues in courses I teach by turning to the snarky Saturday Night Live’s skit: “Weekend Update: Really? With Seth and Amy."

In class, I might ask: “Name one reason you wouldn't take action to assist an injured person.”

Student response: “I didn't want to get sued.”
Me: “Really?”

Is it possible for you to have to answer for the care you have rendered? Sure – but you'd have to be deemed grossly negligent in your actions for this to happen. What's the best way to ensure that you don’t find yourself in this situation? Take a class (CPR, First Aid, etc.) and re-certify yourself as required. The truth is you're more likely to be sued for rear-ending the car in front of you while looking away from the road than you are for offering first aid assistance.

Less Stress Instructional Services, an ECSI Education Center, posted a helpful listing of all statewide Good Samaritan Laws. While there are state-by-state variances in these laws, there are three common themes:

  1. You possessed no “duty to act” (in other words, weren’t responding as a professional rescuer and expected no compensation).
  2. The action you took is the same that a reasonable and prudent person would have taken (in other words, you were not grossly negligent in your actions).
  3. Once you began rendering care, you remained with the individual (provided your personal safety was assured) until the professional rescuers arrived.

Student response: “I was afraid I'd mess something up and hurt them more.”
Me: “Seriously?”

I remember when CPR practically required a mechanical engineering degree to perform correctly. I think you had to perform 15 compressions unless another person was there (then you had to tap dance on one foot while singing “Stayin' Alive” by the Bee Gee's...). Kidding aside, CPR used to be a complex series of steps and substeps. As we've learned over the years, however, just about any form of compressions (hands only, two-rescuer, etc) will yield some kind of a result. Unless the scene is obviously unsafe for you to enter, or professional emergency services personnel are already on scene, your inaction is generally more harmful than your action will be. Much of what any responder can do in a first aid situation is based on common sense, so the first pulse any responder should check is his or her own. “Slow down, take a breath, and the training will kick in,” is a common phrase in my classes.

As instructors, our training in the classroom will resonate with our students in the field and likely may tip the balance when they're faced with the internal debate of whether or not to take action. I've had success in turning learning into a positive experience, not just with dry wit, but by having frank conversations about students’ fears and misgivings associated with rendering aid to a stranger. Plus, no one forgets my CPR lessons after I bust out the disco ball and leisure suit, and no, I'm not kidding...

In reality, this fear is the easiest of the three to dispel, especially once the person making the statement is gently reminded that they're sitting in a CPR/First Aid class. Learning what to do is half the battle.

Student response: “I was afraid I'd catch a disease.”
Me: “Really? Oh, ok – I see your point...”

Yes, communicable disease is something we must be cognizant of any time we interact with an injured or ill person. That said, the reality is that it's highly unlikely a caregiver will become infected if he or she follows basic steps for self-protection, not the least of which is good old soap and water. Some guidelines:

  • If it's wet and sticky, and it’s not yours, do not touch it! Seriously though, the use of protective barriers such as examination gloves, glasses, and a rescue mask will go a long way to protect you.
  • Ensure any cuts, scrapes, or open sores of your own are covered.
  • Wash your hands with soap and water after rendering care.

Let’s not forget, there is nothing wrong with teaching “compression-only” CPR as a technique. On average, only 10% of people who need CPR actually receive it from bystanders. Cities with civilian education programs, such as Seattle’s Medic One program, report bystander-initiated CPR rates of 2 to 3 times the national average.

Even if an individual cannot overcome his or her fear of responding, we should still strive to equip that person with common sense steps they can take for every emergency, every time.

  1. Recognize when an emergency exists.
  2. Make a decision to take action of some kind.
  3. Activate 911 as soon as possible.
  4. Remain with the individual until help arrives.

I take great pride in hearing stories of former students who rose to the occasion and took action when needed. The fears of those who might not be inclined to respond can likely be overcome if we do what we do best – educate.

Topics: Respond, Safety, Bill Kimball, CPR & AED, ECSI, First Responder, response

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