Moral, ethical, legal, honorable...how do these bind us?

[mycrofft]

Firecoins states we have no "Moral Imperative" to act if off duty. I feel that while ethics and legalities are exogenous, morals are endogenous (sorta). I'm curious how folks feel about this?
I'll toss a hypothetical:
I am driving home from Lowe's on my weekend off and I see a kid fall from his bike and hit his head on the sidewalk. He does not get up.
MORAL: I was taught since childhood to help the helpless if I am able and that "not to help" is incorrect action.I have this as a core vaslue as well.

ETHICAL: The ethics of my profession dictate that I try to help. Once I try to help I'm involved and cannot leave this case until relieved, or if forced to go get better hel (and then return).

LEGAL: Maybe my state has a law requiring RN's ro respond to roadside accidents.

HONORABLE: as a RN I have taken an oath to help people and the skills to do so. If I break this oath my honor is impunged, in my own eye if not in others'.

So, are EMT's, etc etc etc, bound by anything but law? Are you?

 

[stephenrb81]

My morals have not changed in my five years in EMS, nor do I see them changing. My moral fibers have been sewn in long ago, so to speak.

If I was driving along and saw a kid fall off a bike and not get up, I would check on him/her and act accordingly (check airway, 911, etc...)

If I was driving along and saw a kid with fire or ems present, then I will continue on my way and stay out of their way

Morally speaking, I would act the same pre and post EMS exposure

Ethics apply as a professional standard. Basically "Use the skills I have learned to help and not harm". As an EMT, check airway,hold c-spine, minimize movement. As an I/P, their advance skills only apply under protocol/medical direction, meaning their ethical standards in regards to ALS care apply more while on-duty, and if they are on-duty then they have "Duty to Act" and professional standards

 

[Hastings]

Call 911, keep moving on.

 

[traumateam1]

To help or not to help..

I got into this because I love to help people in need. That being said, if I saw a poor little guy fall down, smoke his head and then not get up, I would stop and check on him with 9-11 ready. I don't know how people can just say "call 9-11 and continue" I mean, this is a poor little kid, who is now motionless. (in this example). How can one, who is suppose to help people when in need just continue on as if nothing is going on? Check on him, do what you need to do. Keep him alive (if it's that serious) until EMS arrives, or provide emotional support until EMS arrives. To just call 9-11 and continue on, as if nothing has really happened.. while this kid could have seriously injured his head/face or any other part of the body is kinda mind baffling to me.

No I don't have the attitude of Mr. BLS Hero, who can save the entire world. I completely understand people will die, no matter what we do. But I just don't understand how people can just keep moseying along when someone needs help, and help isn't on scene yet.

If EMS/Fire & Rescue, Police are on scene, or even other bystanders, than I can understand not stopping, but how can you not stop if there is no one on scene...

I have a really cool, good idea for all of you that can't act while off duty because of medical control, or whatever. Go take a 8, or 16 hour first aid course. Have enough training to save a life while off duty, and actually be able to act.

Just my .02

 

[Hastings]

Because despite the name of this site, EMS is NOT my life. It is my job. And my job begins at 5am and ends at 5pm. During that period of time, it is my duty - in every manner - to help that kid. But when outside of that time period, I have no more obligation to that kid than any other civilian. As such, I will do my part as any other civilian. I will call the professionals on duty. It is now THEIR job.

 

[Buzz]

Because despite the name of this site, EMS is NOT my life. It is my job. And my job begins at 5am and ends at 5pm. During that period of time, it is my duty - in every manner - to help that kid. But when outside of that time period, I have no more obligation to that kid than any other civilian. As such, I will do my part as any other civilian. I will call the professionals on duty. It is now THEIR job.

I can understand that mentality in situations where there is no immediate life threat, but in a situation where there is an immediate life threat but no danger to yourself, do you still feel the same way? For example: You witness someone choking. Would you not do abdominal thrusts if no one else around was acting on it?





I've not had the situation arise yet... I'm honestly not quite sure what I would do. I think I would have a hard time setting what I feel is right aside to just leave someone aside until the rescue arrives, particularly if there may be a wait involved.

 

[Hastings]

I can understand that mentality in situations where there is no immediate life threat, but in a situation where there is an immediate life threat but no danger to yourself, do you still feel the same way? For example: You witness someone choking. Would you not do abdominal thrusts if no one else around was acting on it?





I've not had the situation arise yet... I'm honestly not quite sure what I would do. I think I would have a hard time setting what I feel is right aside to just leave someone aside until the rescue arrives, particularly if there may be a wait involved.

Choking would be an exception, yes, because there is absolutely no risk involved, a clear-cut Basic First Aid solution, and time is a factor. But in instances such as the one cited in the first post, there are too many other factors which makes it a situation best left for those on duty.

 

[FF-EMT Diver]

I would have to stop and assist someone to the level of my training no matter whether I am on or off duty to me I am an EMT 24/7 not just when I am drawing a paycheck, That being said I am also not going to chase down every little thing either if there is Fire/Ems onscene leave it to them.

Hastings you say choking is different, But you do not know what is going on until you asses the scene suppose the kid or anyone from 1-100 were riding their bike and choked on some candy, I realize I probably wont change your mind nor do I care to try we each have our ideas/way of doing things this is just my thought because I have to answer to myself for my action/inactions.

 

[piranah]

i would have a personal moral obligation to stop....if it was my child...i would hope someone would help him.....if i had driven by and just called 911 and i read in the paper that that child died of his injuries due to delay in care....i honestly don't know what i would do with myself....because ya we cant save everyone but at least i can say....I did what i could, and had the decency to help...say i did as much as i could....idk its all opnion....and thats mine..

 

[micsaver]

Call 911, keep moving on.

Hastings from reading your response to other threads like this it would seem that you have been "burned" by helping out while off-duty before. For the most part I couldn't just call and not check the kid, but I guess if I have been burned before extending a helping hand I would be more inclined to keep my distance and just call 911

 

[BossyCow]

I love posts like this because they ask for black and white answers to very gray areas. I don't think I could drive by a hurt child without stopping to see if he's okay. But, if I see others present who are not in a passing vehicle, I'm probably going to allow them to handle the situation.

I live in an extremely rural area. If I see an MVA occur, I may be the only one driving by for several hours. In some areas it can be 15 - 20 minutes for a crew to arrive. But, if it's late on a weekend and the car is driven by a drunk logger who is 380lbs and 6'8", I'm going to carefully weigh my options.

For someone who lives in an urban area where there are systems in place, and a response time of less than 10 minutes, I don't know what if any help a passing motorist can be. I mean think about the time involved. You can dial 911 and report it, then stop (is there traffic?), find a place to safely park your vehicle, (is there a panicked mom racing towards the kid from across the street) Do you have gloves? Do you have a kit? The time to glove up and get your kit out also factors in. By the time you are prepared to do anything to help, 911 will be driving down the street with more resources than you have available to you.

So before we all jump over Hastings, I think we need to understand that stopping 'to help' is not always helpful.

 

[FF-EMT Diver]

I totally agree with your theory and do not want to sound as though I am jumping on any one, We all have our ways and I respect everyone's own personal way even if it doesn't match mine, I was answering the OP's question about obligation.

 

[Hal9000]

If someone needs help, I'm going to help. If they have help, I don't need to.

If someone died because I was scared I might get sued or something, I wouldn't sleep well at night.

I have a job that involves helping people. That does NOT change my 24/7/365 attitude where I do onto others as I'd have them do unto me.

If I smack my head and don't get up, I'd love to have people on this board helping me. Those of you who continue on...well, I won't think very highly of you.

 

[emtgirl515]

I would stop and see if he was okay, then based on my assessment of him act accordingly.

 

[Hastings]

Hastings you say choking is different, But you do not know what is going on until you asses the scene suppose the kid or anyone from 1-100 were riding their bike and choked on some candy, I realize I probably wont change your mind nor do I care to try we each have our ideas/way of doing things this is just my thought because I have to answer to myself for my action/inactions.

The fact that it requires an assessment means there isn't a clear, citizen-level First Aid solution immediately identifiable. And I wont get involved unless I can tell from 20 yard away that something is clear cut and basic. Choking and Cardiac Arrest (CPR) are the only ones I can think of right now. Any other situations with a basic solution often have potentially large amounts of bodily fluids or blood involved which would prevent me from getting involved.

I'm not burnt out. This is what was nailed into me during medic school, and it is what I have always done. Worked out pretty good for me. Have I decided to continue driving past someone that obviously needed help? Yes. Have I lost any sleep over it? Absolutely not. I did what is expected of any average citizen. I called 911.

I've only stopped once to help. First and last time ever. Person lying face down on the sidewalk, not moving. I approach, and after getting no responses from the patient, I had my friend help log roll them over. 3 stab wounds, a dead person, their blood on my hands, and 2 hours of dealing with the aftermath with police.



Edit: Then again, a lot of the differing point of view may come from location. Many of you seem to be in a more rural area where medics might not be so close. I live in the city where the fire department, police, AND paramedics can be on scene within 2-3 minutes of calling 911.

 

[KEVD18]

I've only stopped once to help. First and last time ever. Person lying face down on the sidewalk, not moving. I approach, and after getting no responses from the patient, I had my friend help log roll them over. 3 stab wounds, a dead person, their blood on my hands, and 2 hours of dealing with the aftermath with police.

i usually look at this debate from a purely med/legal standpoint(i.e. malpractice etc).

hastings brings up an incredibly valid point. i cant even imagine dealing with the police as a person of interest in a murder/wrongful death type of deal.

this just further cements my position. while I'm being paid and am there for covered by my companies insurance and legal protection, I'm more than happy to do my job to the fullest extent possible.

off duty, i remain unwilling to place my life and livelihood in jeopardy. granted, i live in the epitome of urban settings. i can reasonably expect a response time of 4 minutes for the first on(may be an engine or pd) and the first on ambulance within 6. so, there's very little in the way of compelling circumstances for me to get involved off duty. I'm ill equipped, understaffed(remember it takes a minimum of three people to properly log roll a patient. so in the case of your pedi found prone and unresponsive on the sidewalk, there's nothing i can do. if i move him and he's found later to be paralyzed, that will land on me.

good sam protection only prevent you from being successfully sued. you can(and in my area probably will) be sued. you will have to retain and attorney and pay him to prepare your case. chances are your culpability will be dismissed after the first hearing, but how much prep(at $200+/hr) went into that dismissal. all that so i can satiate my desire to save the world 24/7? no thank you sir.

if I'm in a situation, as hasting said, where before i even rise from my chair i can asses that the situation requires nothing more than treatment algorithms found in a basic first aid course(fbao, cardiac arrest, clearing furniture for a seizing etc) and i feel 100% certain that i am in no immediate danger(this rules out anything involving traffic) i will intercede. the very minute i get a feeling that this isn't the case, i keep right on trucking. my certification to practice medicine at the emt level is what pays my bills. i don't intend to put that in jeopardy for some half cocked superman pipe dream. i don't begrudge all of you superemts the right to make that decision for yourselves.

 

[mycrofft]

I respect all your responses.

I think I'm hearing a degree of division between urban and very rural areas.

I have consciously decided in advance there were some poeple I would not stop for, like the guy who passed three cars including a school bus on the right shoulder going about sixty "on" a rural two lane road, but so far have not had to put it to the test. I HAVE been first-on, set the flares, safetied the vehicles, started to take a look at what we had in the way on injuries, then gave a quick verbal to the EMS or LE then walked away without ID'ing myself. ('Course now many of them know me already anyway).

I have not heard anyone bring up the spiritual or religious side.

 

[KEVD18]

i know its my feeling, and i would venture a guess that the brass around here would agree, that religion is such a hot button topic that almost without fail results is an argument that has no known equal that discussion of religious topics would be better suited to private communication or a religious forum. again, just my feeling.

 

[mycrofft]

Then that's why I'm not hearing it. Thanks.

I'm hoping Firecoins doesn't feel I was using our exchange in the other thread for singling-out purposes. Just an example of a respected member of the forum with whom I differed.

 

[BEorP]

I don't know how people can just say "call 9-11 and continue" I mean, this is a poor little kid, who is now motionless. (in this example). How can one, who is suppose to help people when in need just continue on as if nothing is going on?

If we're talking about hypotheticals, what if he is seriously injured and I've stopped to help and the family somehow pins something on me? I can't necessarily risk the job that pays my bills just to stop and "help" (see my next point).

Check on him, do what you need to do. Keep him alive (if it's that serious) until EMS arrives

Other than possibly controlling a severe bleed, what would I be doing to keep him alive until EMS arrives?

But I just don't understand how people can just keep moseying along when someone needs help, and help isn't on scene yet.

In what capacity are you involved in EMS? I have a feeling that if you were deeper in it you may understand. You might still not agree, but you would at least understand.

Go take a 8, or 16 hour first aid course. Have enough training to save a life while off duty, and actually be able to act.

Again other than controlling a bleed, in what ways does first aid save lives?