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EMS standby at structure fire.
We are a volunteer BLS service in a very small town. We are paged to standby at structure fires, which thankfully, we do not have too many. The fire department is also volunteer and I am also a firefighter.
Our protocols demand we obtain consent prior to initiating treatment (of course) and once we have started our assessment/treatment we expect to transport. The patient has the right to decline treatment/transport at any time. Pretty basic I assume.
My question: Do you do anything different when on standby for a fire? Do you follow all protocols, or can you (for example) give a firefighter a little shot of O2 at their request without doing a full workup and transport? As a firefighter we have O2 on our rescue vehicle for just such occasions. As an EMT I don't think I can give O2 unless doing a full assessment and transport. The black and white answer is of course to follow protocol, but is that the only answer? My thought is to direct the firefighters to the rescue vehicle, there are firefighters capable of running the O2. What is the RIGHT way to handle this?
Our protocols demand we obtain consent prior to initiating treatment (of course) and once we have started our assessment/treatment we expect to transport. The patient has the right to decline treatment/transport at any time. Pretty basic I assume.
My question: Do you do anything different when on standby for a fire? Do you follow all protocols, or can you (for example) give a firefighter a little shot of O2 at their request without doing a full workup and transport? As a firefighter we have O2 on our rescue vehicle for just such occasions. As an EMT I don't think I can give O2 unless doing a full assessment and transport. The black and white answer is of course to follow protocol, but is that the only answer? My thought is to direct the firefighters to the rescue vehicle, there are firefighters capable of running the O2. What is the RIGHT way to handle this?
Replies to This Discussion
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Permalink Reply by Spanner 122 on
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Absolutely. We technically have the right to refuse here, but if the Safety officer deems the need to be checked out further or to be transported (EMS here cannot release after inserting an IV or giving drugs, you must be transported), the Capt will also insist. The firefighter can say no, but will then be given a direct order from either his Capt or Chief. Not a lot you can do about it then.
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Permalink Reply by Jamie on
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I really can't answere this honestly simply because our ems director ( whi is a real a** ) will not respond to any of our fires unless someone in the building/home and got hurt or if one of us goes down. And with that said , what if something really serious happens to any of us and seconds count ?
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Permalink Reply by Art "ChiefReason" Goodrich on
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Without changing your protocol, you are in a word "screwed".
TCSS.
Art
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Permalink Reply by chele on
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Wow Jamie, that sucks. I can't imagine an EMS director being such a butt. EMS goes to all structure fires for standby here and even some grass fires if asked.
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Permalink Reply by O'Kitty on
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Our officers will order (force) us in to rehab. I got in trouble one time because I tried to get out of it. Didn't help that I shouted back at the chief that I wasn't done when he said I was. Oopsie. I must have been affected by the heat that time because I generally am not insubordinate. That's my story and I'm sticking to it! ;-)
I also sorta tried to get out of going to ER last year with a broken foot. Once again the chief demanded that I be seen. I wouldn't have been able to maintain that refusal very long since I couldn't walk on it! lol In that case I pretty much knew I had to go, but hated it. That happened in training.
I can't complain about it. I'm glad our officers are watching out for us like that.
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Permalink Reply by Joey "BigShow" De Piano on
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Not EMS but Fire Fighter and I can tell you from my wife (EMT) and our state laws you can not give anyone more so a fire fighter or police at a scene or event anything without a full name and work up.
I would have to ask my wife but I am almost 100% sure that same SOP falls under the National level which applies to all and every state in the union.
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Permalink Reply by Ben Waller on
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FETC,
I'm not trying to say that EMS is legally obligated to transport a firefighter that is so dehydrdated that IVs are given. What I am saying is that if a firefighter is so dehydrated that he or she can't be orally rehydrated then that firefighter is at tremendous risk for a heat-stress-induced heart attack, heat stroke, or other potentially lethal medical problem. If you treat and release that firefighter without a transport for a physician exam, you are taking a huge risk with that firefighter's health.
The important thing here isn't what your system will let you do - it's about what's in the best interest of the firefighters being rehabbed.
And...maybe EMS can't force the firefighter to be transported, but the fire chief/Incident Commander surely can. Use the Worker's Comp angle if you have to, but if a firefighter is so heat stressed that he/she requires oxygen, IVs, or other treatment that exceeds simple rest, cooling, and oral rehydration, then treat-and-release is rolling the dice with that firefighter's health.
We also need to remember that exhausted, dehydrated, heat stressed firefighters may not have the present mental capacity to legally refuse transport, too. If I were the plaintiff's attorney for the grieving widow, that's the first arguement I'd make when the case went to court.
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If it's about your medical director's trust in your training and judgement, then let me ask you a few more questions.
Does your EMS system have a written protocol or SOG/SOP for firefighter rehab?
Does that standard have mandatory thresholds that require transport for physician exam/treatment vs. treat-and-release?
Does the treat-and-release policy include a further decision on whether the firefighter can return to duty immediately or not?
Are those policies/protocols based on NFPA 1500, NFPA 1582, and NFPA 1584 standards?
Is your EMS system's firefighter rehab protocol designed on evidence-based medicine?
If the answer to any of the above is "no" or "I don't know", then regardless of how trusting and how well-intentioned, your system is taking unnecessary risks with the firefighter's lives.
The fact that it's worked until now just means that the coin flip keeps coming up "heads". Sooner or later, it will come up "tails" and then it will be the lawyers and the jury that have the last word, not the EMS providers, the medical directors, or the fire chief.
I hope your coin keeps coming up "heads" for your firefighters' sake.
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What evidence do you have for your statement "your (sic) doing nothing wrong..."?
Getting away with risky behavior isn't the same thing as doing nothing wrong. Letting an EMS system provid oxygen, IV rehydration, or anything more than simple rest, cooling, and oral rehydration is taking unnecessary risks with the firefighters lives, no matter how much your EMS providers, your medical director, the fire chief, or the firefighters themselves might disagree.
Getting away with taking risks isn't the same thing as doing nothing wrong, regardless of how lucky you've been in the past.
If your system keeps doing this, hopefully you'll keep getting away with it - for the firefighters' sake.
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Permalink Reply by Tom Kilmartin on
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The right way to handle this... hmmm, interesting question. We have a "for profit" medical service called immediately when a structure fire is confirmed. The unit is for us, the firefighters! The crew of that unit is charged by the IC with moitoring all incoming manpower to the rehab area. This entales everything from hydration issues, cooling issues, BP's, Oxygen, and IV's if the Medic thinks it is needed. These folks do an excellent job of "bugging" each man that comes off the fireline to be sure he is feeling fine. They are there also to provide immediate medical attention should the need ever arise. So what is the right way to handle this... treat the patient (firefighter) as if they were any other patient. If your protocols presently do not allow for this type of treatment, change them. Remember... everyone goes home.
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Permalink Reply by anne potter on
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I would have to say since this has been going on giving a little o2 that our medical director does know and well maybe not for everyone to do ,but atleast someplaces do allow it... So why do we continue to beat this up.. I hate to tell you this if a fireman is ready to have a heart attack. He is going to have it... A shot of o2 is not causing it... This is been brewing for awhile.. So lets not all pretend that this guy was just having a heart attack because he was treated with a small amt of o2.... OOOHHHH wait I'm sure his vitals was stable also when the EMt took them before he sent them out.. Probally not... He's got chest pain.. I think by then he has been caught .. You guys such a long stretch to prove your points ....If he having the big one,god for bid... A shot of o2 is not going to mask it.... Soooo for heaven sake stop... Nobody masked anything If he's having the big one odds are he having with or with out help.. Oh yea my guess at that point he's getting alot of o2 and vitals really stink .. Hummmmmm back to scene or hospital.. soooooo stupid...
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Sorry, I can't reply to your post above Anne, too many responses in one line I think. I'll copy and paste what I found "interesting" about your post.
I hate to tell you this if a fireman is ready to have a heart attack. He is going to have it... A shot of o2 is not causing it... This is been brewing for awhile.. So lets not all pretend that this guy was just having a heart attack because he was treated with a small amt of o2....
I don't think one person on here said that treating with O2 is going to CAUSE a heart attack. Honestly, we would all have to be pretty stupid to think oxygen causes heart attacks, don't you think. I believe the point is, you treat a firefighter with O2 or IV's etc and THEN SEND HIM BACK TO WORK, the additional workload after needing to be treated can cause a cardiac event. Some of us actually research and try to prevent health related LODD's for our Health and Safety Committee, hence the reason for the SOP's in the first place.
I believe you can continue to argue this until you are blue in the face, but the reality is, it's dangerous. Tell me again that it's not, if you like, but repeating it over and over doesn't make it true.
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