Heart Attack on a Train

[EMTBell]

I am a 16 year old Emergency Medical Responder licensed in Connecticut. I was having dinner with my girlfriend and her mom in New York City and we took the Metro-North train back out to the county where we live after dinner. The conductor came over the loudspeaker stating that there was a medical emergency and anyone with medical training should identify themselves to the crew. They announced this a second time so I assumed that nobody had come forward, so I identified myself and the conductor ran me back to a man who was having a myocardial infarction. He was pale, diaphoretic, complaining of retrosternal chest pain and nausea, and he showed shallow breathing. So I did a quick size up of the scene and as I finished, an internal medicine physician came forward and took over.
I am just wondering if I should have identified myself at all (even though I didn't know the situation when I did), considering there's really not much I could do besides monitor him for a cardiac arrest. I'm technically not even supposed to administer aspirin or nitroglycerin. I'm further wondering if I could have gotten in any legal trouble considering I was licensed in Connecticut and was in New York at the time.
Thanks for reading, I kind of wanted to write it down.

 

[Anjel]

There isn't anything you could get in trouble for. Technically as a MFR all you would be doing is first aid or CPR. And since you weren't licensed where you were then it would all be under the Good Samaritan law.

Honestly, I probably would checked out the situation, If no body had come forward after a little while just to make sure someone wasn't bleeding to death, in labor, or something else that I may of been able to assist with. Once I found out it was a medical pt, I would of stepped aside. I'm a paramedic and there is absolutely nothing I could of done for the patient. He needs monitor, O2, vs, 12 lead, IV, ASA, nitro, and transport to a hospital with cardiac capabilities. None of those things could be done on the train.

You did the right thing, don't sweat it.

 

[Christopher]

I am a 16 year old Emergency Medical Responder licensed in Connecticut. I was having dinner with my girlfriend and her mom in New York City and we took the Metro-North train back out to the county where we live after dinner. The conductor came over the loudspeaker stating that there was a medical emergency and anyone with medical training should identify themselves to the crew. They announced this a second time so I assumed that nobody had come forward, so I identified myself and the conductor ran me back to a man who was having a myocardial infarction. He was pale, diaphoretic, complaining of retrosternal chest pain and nausea, and he showed shallow breathing. So I did a quick size up of the scene and as I finished, an internal medicine physician came forward and took over.
I am just wondering if I should have identified myself at all (even though I didn't know the situation when I did), considering there's really not much I could do besides monitor him for a cardiac arrest. I'm technically not even supposed to administer aspirin or nitroglycerin. I'm further wondering if I could have gotten in any legal trouble considering I was licensed in Connecticut and was in New York at the time.
Thanks for reading, I kind of wanted to write it down.

ASA is an over the counter medication. The patient can take it on their own.

You get into trouble when you do not act in the patient's best interest. You obviously acted in their best interest so you're fine

 

[firetender]

Oh God, not another one!

I'm a paramedic and there is absolutely nothing I could of done for the patient. He needs monitor, O2, vs, 12 lead, IV, ASA, nitro, and transport to a hospital with cardiac capabilities.

Not directed specifically at you, Anjel, but listen to what's being said here.

I must respectfully disagree. You (generically) are thinking like a mechanic without his/her tools. You've got a human being in distress there and the most important thing you can offer -- as a professional trained in life-saving work -- is to BE WITH the patient even if and as a more highly trained pro takes care of the mechanics. The psychological/emotional state of that patient -- especially so far from home and NOT near a medical facility -- is especially vulnerable and easily able to turn an uncomfortable situation into a fatality.

Do you want to save lives? That's where you start. Do you think for a hot second that lives were not saved by the thousands of first responders who had, at best, 8 hours in Red Cross First Aid?

There's something that only one accustomed to working on the edge of life and death can provide. It's called reassurance and being the physical embodiment of "You're not without hope."

...and if worries over the legality of stepping in concern you and cause you to delay offering assistance, then maybe McDonalds would be a better career choice.

Jesus, some times I wish you guys would think like healers instead of flesh mechanics!

I'm lying. I think this all too often.


(Rant over.)

 

[Av8or007]

Does the train have a drug bag/med kit, oxygen or aed? If so the grab the gear and treat the pt.

Do standard mi tx. Administer o2 if pt is hypoxic or spo2 is less than 94%. If no spo2 then give them an nc at 4 unless obvious resp distress.

Give asa, hold off on the nitro unless pt has rx to avoid dropping preload in rvmi.

Good Samaritan laws will cover you and besides, worry about practicing the best medicine you can w your level and the cya part takes care of itself.

 

[Tigger]

Does the train have a drug bag/med kit, oxygen or aed? If so the grab the gear and treat the pt.

Do standard mi tx. Administer o2 if pt is hypoxic or spo2 is less than 94%. If no spo2 then give them an nc at 4 unless obvious resp distress.

Give asa, hold off on the nitro unless pt has rx to avoid dropping preload in rvmi.

Good Samaritan laws will cover you and besides, worry about practicing the best medicine you can w your level and the cya part takes care of itself.

In this country, most (not all) providers would not be covered by Good Samaritan laws if they were to administer medications.

 

[Av8or007]

Isn't ASA publicly recommended for mi's, i.e. the commercials telling you to chew 325 mg of ASA and call 911 if you have cp?

 

[Sharps]

No matter what state you have your EMT certification in, you can always help no matter where you are. Weather your in another county or another state, your acting as a good Samaritan and took the time to help someone else. Being that there was nothing you could do without the proper equipment, you cannot be held accountable. Also, You will probably not get in trouble for administering medications if you were under the supervision of an internal medicine physician. In my EMT class, we were taught how to assist with epinephrine, nitroglycerin, and inhalers. Also, note there is a difference between "administering" medications and "assisting" with medications.

For future knowledge, the only time you are obligated to render medical services "off duty" is if you are within your state, wearing apparel that would identify you as a certified EMT. Think of it this way. If you bought a FDNY job shirt that said FDNY paramedic, but your not a paramedic, you have no duty to perform because anyone can obtain apparel like that. If you have a shirt that says Certified EMT or paramedic and it says station 55 and you belong to station 55 and something happens, you need to perform your duties or negligence and other legal problems apply.

 

[Scott33]

For future knowledge, the only time you are obligated to render medical services "off duty" is if you are within your state, wearing apparel that would identify you as a certified EMT.

This is incorrect.

If you have a shirt that says Certified EMT or paramedic and it says station 55 and you belong to station 55 and something happens, you need to perform your duties or negligence and other legal problems apply.

This is also incorrect.

As discussed ad nauseum, there is a difference between a moral obligation, and a legal obligation.

 

[DesertMedic66]

No matter what state you have your EMT certification in, you can always help no matter where you are. Weather your in another county or another state, your acting as a good Samaritan and took the time to help someone else. Being that there was nothing you could do without the proper equipment, you cannot be held accountable. Also, You will probably not get in trouble for administering medications if you were under the supervision of an internal medicine physician. In my EMT class, we were taught how to assist with epinephrine, nitroglycerin, and inhalers. Also, note there is a difference between "administering" medications and "assisting" with medications.

For future knowledge, the only time you are obligated to render medical services "off duty" is if you are within your state, wearing apparel that would identify you as a certified EMT. Think of it this way. If you bought a FDNY job shirt that said FDNY paramedic, but your not a paramedic, you have no duty to perform because anyone can obtain apparel like that. If you have a shirt that says Certified EMT or paramedic and it says station 55 and you belong to station 55 and something happens, you need to perform your duties or negligence and other legal problems apply.

That's a negative on the second part of your statement. Each state is different. I can be wearing my full uniform off duty and I still don't have to help.

 

[Sharps]

This is incorrect.



This is also incorrect.

As discussed ad nauseum, there is a difference between a moral obligation, and a legal obligation.

^^ Things might be different elsewhere but here, If I'm wearing any type of issued apparel with any state EMT patches we are suppose to render care or atleast that's what I have been told by several people.

 

[Hunter]

^^ Things might be different elsewhere but here, If I'm wearing any type of issued apparel with any state EMT patches we are suppose to render care or atleast that's what I have been told by several people.

Once uniforms become involved I honestly think it's an agency policy issue. Pr people might not wanna get involved if something goes wrong, or it might look bad if someone sees you in uniform and you do nothing. As far as I knew, you don't have a legal obligation to render aid unless you are on duty. Like someone said, it's a moral issue.

Talking the patient through what's happening and reassuring them it's better thann noting in my opinion, lower the stress and anxiety the patient is having and it'll help, even if it's only a little. Then step aside when someone more qualified/equipt shows up.

 

[Wes]

Generally speaking, few, if any, states have created an affirmative legal duty to act. At least, not my state.

 

[xrsm002]

Myself and some other people I work with will stop and render aid if we see an accident until the EMS/fire gets there then we will assist them, our medical director allows for us to render aid when not on duty and our SOGs allow for us to go to the scene of the call and start administering care.

 

[Handsome Robb]

This is incorrect.



This is also incorrect.

As discussed ad nauseum, there is a difference between a moral obligation, and a legal obligation.

I still don't even agree with a moral obligation but that's my own personal opinion. Once I'm off duty the Paramedic hat comes off and I'm just a normal guy like anyone else on the street. Do business people jump in and help with business deals when they're not at work? Do carpenters jump on random construction sites they see when they aren't wearing a hard hat? With that said I do understand how a moral obligation can be argued. It's one of those things that no one is correct and it comes down to personal beliefs. I will also say that there are certain situations where I would offer my assistance but I also wouldn't identify myself unless I had to.

EMS and medicine in general is a job just like any other.

OP I think you're fine, it doesn't sound like you did a whole lot before the physician showed up. If you want to ID yourself while off duty as a medical professional when asked that's your prerogative. Like others have said, keep it to basic first aid and CPR/AED and no one will have anything to use against you.