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Red alert

Affleck-Gadd is far from alone in using her nursing skills while off duty. In 2001, according to the CDC, more than 4.5 million nonfatal injuries were reported due to car accidents in America, 3.5 million cases of overexertion, 369,000 injuries due to dog bites and 63,000 injuries from gunshot wounds. More than 45,000 people nearly choked or suffocated and 5,800 nearly drowned. A whopping 7.8 million people sustained an injury due to a fall. And more than 15 million Americans suffer from heart disease-the nation's No.1 cause of death.

With Americans ill and injured every minute of every day, it's no surprise then that many nurses find themselves running a trauma code while they are on vacation, shopping for groceries, on their way home or even at church.

"Nurses will respond when they see a need and they have the ability to deal with the need. That's why they went into the profession," said Barbara Zittel, Ph.D., RN, executive secretary of the New York State Board of Nursing.

In the summer of 2001, Zittel was having dinner at a fancy New York inn when she noticed another restaurant patron in distress.

"It was an elderly man who looked like he was having a heart attack. I had him put on the floor and started CPR and mouth-to-mouth [resuscitation]," she said. A physician-while flatly refusing to do mouth-to-mouth-offered assistance, and started performing chest compressions alongside her. Their efforts were not enough, however, to save the man.

"Afterward, for a quick instant I wondered if I should have responded as I did," she said. "If I had to do it over again, I would, and I would come to the rescue of others. That's what nurses are about."

Many nurses, like Zittel, seem to jump into the fray with barely a second thought.

But if there's a little voice inside your head telling you not to get involved, listen to it, said Kathleen Lambert, JD, a clinical supervisor and lawyer in Tucson, Ariz. Some accident scenes are unsafe. Some nurses don't have the training or stomach to respond to a trauma situation. And there can be an issue of liability.

All states now have good Samaritan laws that protect medical and nonmedical personnel who volunteer to help those in need of emergency medical treatment, even when something goes wrong. Each state's Nursing Practice Act has a section outlining protection specifically for nurses who respond to emergencies outside of their workplace.

But the laws differ from state to state-and may be affected by the new federal Homeland Security Act, which, according to Lambert, likely will offer more protection for medical practitioners responding in emergency situations.

"There are a great deal of changes coming related to emergent care and what is supposed to be done," she said. "If you limit health care professionals so much that they don't want to practice, you will be hurting society as a whole."

In general, Lambert advised, the laws and codes will not cover practitioners who step outside the boundaries of their licensed skills. In addition, she cautioned, nurses are not covered by their employers' malpractice insurance when they are off duty.

Responding to an accident or treating someone who is ill is "very much a personal choice," Lambert said. "You need to consider so many things: 'Is this something I can handle? Are there dangerous things about the situation?' You need to weigh and balance."

"I'm not saying don't give aid," Lambert continued. "But do look at what your skills are and where you would be most useful. It may be using your phone and calling 911, or saying, 'Don't move this patient right now, it looks like a neck injury.' "

On the road

Standing guard is exactly what Richard Bowen, RN, did early one foggy morning on a rural stretch of highway near the Arkansas-Missouri border. The 36-year-old OR nurse and Desert Storm veteran was on a bus with 40 U.S. Marines on their way home to Springfield, Mo., from a reservist's training weekend in April 2000. Almost everyone on the bus was asleep, camouflage paint still covering their faces, Bowen said.

About 1:30 a.m., the bus driver pulled to a stop, and Bowen awoke to someone calling for his help outside.

"I thought we were back at the reserve center and maybe someone had sprained their ankle getting out of the bus. I got out and found a car tipped over. It was shocking," he said.