Studies indicate that off-duty emergency physicians (EPs) may be called upon at some point in their lives to provide care as bystanders to accidents and emergencies outside of the hospital. Since EPs have a unique skill set for rapid assessments and stabilization, they are often the most qualified bystanders to act as a “Good Samaritans” by providing such care when it is safe to do so. However, with the exception of Good Samaritan events on airplanes and in schools, little is known about how often or in which locations these events occur.
Several organizations have advised EPs to carry an emergency kit in the event of needing to provide emergency care, but recommendations for the content of these kits are largely based on consensus or expert opinion. Many kits focus mostly on airway protection and hemorrhage control. An inventory of commonly used supplies and medications has yet to be established. “Oftentimes, stories of EPs providing care outside of their official roles are shared among colleagues, but exploring how often and where these events occur may help improve our preparedness and how we handle these situations in the future,” says Taylor Burkholder, MD, MPH.
For a study published in the Western Journal of Emergency Medicine, Dr. Burkholder and Renee King, MD, MPH, emailed a survey to a sample of board-certified and board-eligible EPs and pediatric EPs at five EDs in Colorado, asking eight questions and offering an opportunity to comment and provide anecdotes at the end of the survey. The study sought to describe the frequency and location of out-of-hospital emergencies in which EPs were called upon to provide Good Samaritan care. It also assessed which supplies and medications were most frequently useful to EPs during these acts. The investigators received 90 responses from the 167 invitations that were sent.
“Our study showed that Good Samaritan acts are relatively common, with EPs reporting a median frequency of two such acts per 5 years of practice,” says Dr. Burkholder. During their careers as EPs, 78% reported having provided Good Samaritan care. Several locations were among the most common for providing these acts, most notably at sports and entertainment events, at road traffic accidents, and in wilderness settings (Figure). The majority of EPs who had acted as Good Samaritans—86%—reported that at least one supply would have been useful during the most recent event, and about two-thirds reported at least one medication would have been useful. EPs commonly reported that the most useful supplies in an emergency kit were gloves, dressings, and a stethoscope. They added that the most useful medications during Good Samaritan acts were oxygen, intravenous fluids, and epinephrine.
The study authors noted that the findings were somewhat limited because the results were based on EPs’ ability to recall Good Samaritan events. In addition, respondents who are eager to share their experiences may have been more likely to complete the survey than those who did not have such experiences. Some anecdotal responses also indicated that there may have been over-reporting of Good Samaritan acts. For example, two respondents considered suturing a laceration of a family member at home as such an act.
“There is a need to validate our findings outside the state of Colorado because this region may over-represent events in wilderness settings compared with another area in the U.S.,” says Dr. Burkholder. “It would also be beneficial to explore what supplies would be beneficial to have on hand for physicians who are not EPs and may be called upon to act as a Good Samaritan.”
Preparedness Is Critical
The relatively high frequency of Good Samaritan acts and the reported utility of supplies and medications support the idea that EPs should be prepared in the event that they are bystanders to an accident or emergency, according to Dr. Burkholder. “One strategy to improve preparedness would be to carry a kit with commonly used supplies and medications while in the locations where Good Samaritan events most frequently occur,” he says. Keeping an emergency kit in the car—which is often within reach when EPs come to the scene of road traffic accidents or at sports and entertainment events—may maximize access to useful supplies and medications in times of need.
The study noted that it is important for EPs to think about what supplies should be readily available in their emergency kits. Supplies that are geared toward airway protection, such as airway adjuncts and pocket masks, and those that can control bleeding, like tourniquets, may be used infrequently, but these items can have significant impact on saving lives in some circumstances. Other factors to consider when putting together emergency kits include costs of the items and the potential for the items to perish over time. “Ultimately, EPs should be prepared with emergency kits containing items that are most likely to be used if EPs are called upon as Good Samaritans,” says Dr. Burkholder.