Road Warriors
On vacation, in church or at the mall, off-duty RNs let their instincts kick in when a medical emergency arises

By Janet Wells
February 4, 2003

In early November, Margery Affleck-Gadd, RN, had a weekend straight out of the television show "ER." It started when the 56-year-old legal nurse consultant was on her way back to her hotel after finishing the Nov. 3 New York City Marathon. Another subway passenger-a middle-aged woman who also had run in the race-fainted on the train. Affleck-Gadd's 21 years as a trauma nurse immediately kicked in; she helped the woman lower her head and sip some leftover Gatorade from the race. The woman was on her feet in time for her stop. Little did Affleck-Gadd know that her role as subway rescue nurse was just a warm-up for a much bigger drama to come.

The next day, Affleck-Gadd was on the runway in St. Louis, a stopover on an American Airlines flight home to Tulsa, Okla.

"I was in seat 17B," Affleck-Gadd said. "Someone several rows up yelled, 'This man is in trouble.' I jumped out of my seat and ran to him, and found a priest having what looked like a seizure, but with no pulse."

Affleck-Gadd directed several passengers to pick up the priest and lay him down in the aisle-"a very narrow aisle, and he was a big man," she said. Affleck-Gadd squeezed in, ripped off the man's shirt and clerical collar, and started CPR.

"It all happened very quickly. I knew I had only about three minutes until he was brain-dead," said Affleck-Gadd, her voice as no-nonsense and precise as her memory of the event. She asked the flight attendants if they had a defibrillator on board. To her surprise, they did and wheeled out a sparkling new crash cart. What they didn't have was the training to use the equipment.

"I slapped the pads on him and went with 360 joules at the first jolt. I didn't mess around. I could see he was in V-Fib, the death rhythm," said Affleck-Gadd, who is certified in advanced cardiac life support. "We defibrillated him only once, and he returned to V-Tach. Then he opened his eyes and tried to talk and we were finally able to understand him, and why he was going to Tulsa."

The priest, a hospital chaplain from California, had already undergone open-heart surgery twice, and was scheduled to receive an implanted pacemaker/defibrillator device in Oklahoma.

"I started an IV on him, and the paramedics came in and carried him out of the plane awake and alive, with much cheering from all the passengers," Affleck-Gadd said.

According to the cardiologist in St. Louis who performed emergency surgery on the priest, he would have died had he not been defibrillated, said Affleck-Gadd, who received an instant upgrade to first class for the rest of her flight, as well as a chunk of frequent-flier miles as a thank-you for her help.

The priest and his rescuer have talked several times on the phone since that day. "She saved my life," said the 68-year-old man, who requested anonymity. "I'm so grateful."

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.

The car had collided with a pickup truck. "We got right to work," recalled Bowen, who said he had quickly noted that nearby residents were arriving on the scene. "The guy in the truck had abrasions and his leg was stuck in the truck. I told the Marines to watch him, and not let some passerby move him," Bowen said.

The other two victims-a mother and her 16-year-old son-had been thrown onto the road's rocky shoulder, their clothing shredded from the impact.

Bowen put the medical pack he had been issued that weekend to good use, intubating the son, putting a C-collar on him, starting IV fluids, dressing an open arm fracture and keeping him still. He stabilized the mother, and kept both warm using Marine-issue sleeping bags, while waiting for paramedics to arrive about 90 minutes later.

While the mother escaped with only a bruised spleen, her son underwent emergency surgery to repair shattered thoracic vertebrae, and has some residual paralysis in his legs, said Bowen, who received a Navy and Marine Corps Achievement Medal for his efforts. "He could have been worse, if he had been moved."

Personal tragedy

Difficult, even tragic outcomes, are not uncommon when dealing with medical emergencies. But some nurses have also faced personal loss.

About nine years ago, Ginger Bergeson, RN, was driving with her three daughters in River Falls, Wis., when a truck smashed into their minivan. Her youngest, 6-year-old Abby, had been in the back of the van. Although her seat belt remained buckled, she had flown through the back window, hitting the pavement.

"She wasn't breathing, she didn't have a heartbeat. I did CPR on her and did get a heartbeat back, but no breathing," said Bergeson, who was an ER nurse at the time.

Abby was flown to the hospital in St. Paul, Minn., where a dazed Bergeson, and her husband, Dale, a physician assistant, learned that their young daughter was brain-dead.

The parents-honoring Abby's wish to "recycle" her organs when she "didn't need them anymore"-donated her kidneys, heart and liver.

Of her ability to treat her injured daughter in such a traumatic crisis, Bergeson said, "It's just so automatic. You think, 'This is what has to be done.' My husband kept saying later, 'I couldn't have done that.' But you're put in that position and you just do it."

After the accident, Bergeson took three weeks away from nursing, then headed back to the ER. "It was good to go back because it gave me something to do," she said. "Work is so busy, it gives you a brief moment to forget."

Clever improvisations

Making do alone, often with little more than quick thinking and improvised resources, is a common thread for many nurses who respond to emergencies.

Karen Taylor, RN, was on vacation in Maui last summer, on her way down from a strenuous day hike to the Iao Needle, when she came upon a traveler in distress.

"She was slumped over her on her knees, in front of her husband, who was desperately trying to hold her up," said Taylor, who lives in Red Oak, Okla.

Taylor, 48, who specializes in psychiatric and mental health nursing, helped the woman to a sitting position on a nearby rock, and immediately did an assessment: "Tall, obese, middle-aged woman, short of breath, pale, cool and clammy. She complained of feeling light-headed and nauseous. Pulse was weak, even and within normal limits," Taylor said.

The woman also, according to her husband, had non-insulin dependent diabetes and hypertension.

Taylor suspected low blood sugar, and obtained snacks and juice from other hikers, along with wet wipes and bottled water to make cool compresses.

With two men assisting her down the mountain, the woman made it back to her car, where she vomited the food and liquids, said Taylor, who advised the woman's husband to take her immediately to the hospital.

"Treating in the field can be challenging when without the tools," Taylor said. "It allows one to use improvisational skills that you don't learn about in nursing school."

When Teresa Shuff's son Marc fell and broke his arm playing basketball at home years ago, she grabbed the handiest item she could find for a splint: a wooden spoon she was using to cook dinner. Then she made a sling out of one of her infant daughter's receiving blankets.

At the ER, Shuff, a 41-year-old RN from North Liberty, Iowa, heard somebody compare her triage efforts to those of a Boy Scout or Girl Scout. "I thought it was a pretty good compliment," Shuff said. "Scouts are prepared and know how to make do."

With nothing else available, Debra Faulk, RN, used her own clothing to help a shooting victim in San Francisco. One evening, years ago, Faulk was in Bible study at New Bethel Community Church in Hunter's Point, one of the city's most crime-ridden neighborhoods.

"We heard a blast, it sounded like a tire had blown out. Then we heard another, then someone screaming, 'Help me, my sister's been shot.' I ran outside," said 46-year-old Faulk, who lives in Richmond, Calif. "I was verbally restrained, told not to go out, but I guess that's the nursing instinct. Someone's screaming for help, how could I just sit there?"

Faulk found a young woman slumped in the front seat of a car, amid shards of broken glass.

"I called for one of my friends to call 911, then took off my lab jacket. I had come [to church] from work," she said, the events still vivid even after 15 years. "The bullet had gone in her neck and out of her head. I applied pressure to both openings with my jacket, and I positioned her head so she could breathe. I asked my friend to hold one side of the victim's head so I could assess her. She had a pulse, very faint, and she was breathing, very shallow.

"I stayed with her, talked to her, told her she was going to make it, that there were people who cared. It was so long ago, but I still get teary," said Faulk, her voice cracking with emotion.

It took paramedics 40 minutes to arrive. Faulk read in the newspaper that the woman died in the hospital several days later.

"An experience like that, you will never forget," she said. "In the hospital, there's a trauma team, you know that the patient will be cared for immediately. Outside, it was me alone. I had to use whatever resources were available. All I had was my clothes."

Out of her hands

Many nurses say that helping someone in an emergency is something that will be with them forever. For some, it even changes their lives.

Take Affleck-Gadd. Seven years ago, she and her first husband, Ken Affleck, were training for a mountain climbing trek by running stairs in an office building where she worked. "We got up 60 stories, it was hot in the stairway, and he suddenly dropped behind me," she said.

Affleck-Gadd ran down a hallway to call 911, then started CPR on her husband. She worked on him for 30 long minutes until paramedics arrived, but he did not respond to resuscitation efforts. Affleck-Gadd later learned that her husband had suffered from blocked coronary arteries and was beyond help.

"He had dropped dead in front of me at the age of 47. I had no one up there, no equipment. After years in the ER, how many codes had I run? Hundreds. But I couldn't save my husband," she said. "I felt so guilty."

While it clearly didn't erase the pain of her husband's death, reviving the priest seven years later allowed Affleck-Gadd "to make some real inroads into the emotional guilt I had been carrying around," she said.

"I resuscitated him successfully in the plane," she said. "Everything was on his side, and mine, that night. He said I renewed his life. But two lives were renewed."

To cap it off, when Affleck-Gadd's plane arrived in Tulsa, a young teenage girl approached her in the baggage claim area. "She said to me, 'You saved that man's life,' " Affleck-Gadd recalled. " 'I'm going to be a nurse.' "

Contact Janet Wells at janetawells@hotmail.com