We had 2 extrication calls this past monday and this past wednesday on both of thse scenes the ems crews keep trying to act like extrications gods. the accident on wednesday we had another fd respond mutual aid with us and we pretty much had the pt out except just finishing up on the dash roll. well the paramedics start running around telling this other dept to go cut the roof of the truck off when there was absolutely no need to. this dept is a county dept and is full of unexperienced guys who just want to do something so they just do wat neone will tell them.. but we got control of the situation before things got out of hnd and people started cutting things they shouldnt of...but neway does neone else have this problem???

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We don't, but then we run an integrated Fire/EMS Department. We do our own extrication and patient transport. We run regular extrication drills to hone the degree of teamwork necessary to treat, extricate and transport patient(s) involved in crashes, without the infighting or disorganization you describe.

Basically, when we have someone trapped in a vehicle we generally take the roof off. It's fast, it's easy (when you have enough help), it makes a lot more room for the EMS crew to access and treat the patient, and - above all else - facilitates the extrication of the patient(s).

Vehicles from which people have to be extricated with hydraulic tools are no more than scrap metal. Cutting the roof, or not cutting it, is not going to change the value of the vehicle.

Turf wars - they are bad enough in private but in the public eye they are inexcusible. Maybe your department can plan a drill with the EMS agencies involved, to see where they are coming from and perhaps foster teamwork?
EMS must call the shots if there's a clinical reason for them wanting a particular technique done.

ie: if they want the roof off, is that so they can slide the patient up a spineboard and over the rear parcel shelf to maintain spinal alignment? That's their call, not the rescue crews.

on both of thse scenes the ems crews keep trying to act like extrications gods.
To be the devil's advocate here (I've been a rescuer for many years and taught rescue to the Ambulance Service for many yeras also, so I've seen both sides), who says you guys are the rescue gods you think you are?


Road Rescue must be a team effort- EMS manage the injuries and the clinical side of the extrication. Ideally, they should be coming to the rescue crew saying we need to extricate the patient this way (ie: in line, immobilised, etc) and the rescue crew should then give them the options with realistic timeframes to complete. (ie: remove roof, half roof flap, full roof flap, remove doors, etc)

Many rescue crews waste valuable time attempting techniques for all the wrong reasons. Roof flaps are good example- with changing technology, this technique still has its place, but is getting harder and harder to do with SRS systems, etc. We need to be open to new ideas, new techniques, etc as each scene dictates.

Below is a link to a book in which I was a contributing author, "Vehicle Extraction Techniques" http://emergencytechnologies.com.au/vet.htm
The aim of the book is not to teach extrication, but correct extraction, with a focus on spinal injury management. Have a read of it, try some of the techniques, and let me know your thoughts....
We've never really had such a problem at my F.D. Although we do both Fire & EMS. Did your F.D. have an incident commander at the above incident? It sounds like some training with the EMS crews as to the Incident Command System and chain of command.
Perhaps they saw something that you didn't see and had a better idea that would be beneficial to patient care. If they are paramedics I am sure it isn't their first rodeo and they have most likely participated in more extrications than yourself. As other posters have indicated it sounds like you did not have an incident commander as if you did then this shouldn't have occurred. Additionally if the other department is called in as your mutual aid then they are under the control of the host department.

It sounds like you need to have some joint training with all parties involved.

Emergency incidents are managed using the Incident Command System where typically, the first on scene Engine Company Fire Captain is the Incident Commander until relieved by a responding Battalion Chief.

OK, let me get this right... you are on the scene of an accident and you have medics dictating how the patients are going to be extricated? Excuse me, but the last time I looked, there was a Fire Captain on scene at the incident who upon arrival, assumed command for the incident and coordinated resources.

The medics job is to take care of the patient, possibly while the patient is still trapped, but typically when we can get the patient out of the revine or from over the side or from within an upside down vehicle. In no way is it appropriate for a paramedic from an ems provider to tell the incident commander what he or she is going to do.

For appropriate resource usage issues, I assign a rescue group or extrication group, depending on the type of incident. Someone has to be in charge to keep things running efficiently. If the EMS folks have something to offer or suggest, they need to to talk to the IC and not bother the firefighters doing what the IC told them to do. It doesn't work that way. There is something called 'Chain of Command".

If this is two separate fire departments having a turf war, then I would sit both Captain's down and ask them what they don't understand about unified command and how long it has been since they trained together...

There is no "I" in team...

TCSS, Mike
Mike, I think you're twisiting this around, unless I'm misreading the original post.

This is not a question about unified command or someone telling an IC how to do their job.

I go back to my reply- if there's a clinical reason for them to want to extricate a certain way, then it has to be their call. They are the clinical and patient care experts.

In 12 yeras of extrication, as the OIC of the rescue crew, I always consulted with and took advice from the paramedic on their preferred extrication technique. Our job was to facilitate and make that extricaiton happen.
EMS role is to take care of the patient and only tell the extrication team when to stop cutting when it affects the patient, but they shouldn't be telling crews with expirence what to do. fortunatelt our dept. doesn't have those problems.
Our EMS service knows we've got the scene tell we give them the ok to go in.
My department runs the same as Joe's. We are Fire/EMS. We don't have that problem and we talk to each other to know what may or may not work.

Now in my day job I have to deal with different fire departments and when I have had to deal with extrication I let the fire department handle it and I just wait for them to be ready for the patient to be handed off to me and my partner. I am on my departments extrication team and so it can get pretty tough not to make a suggestion about what they can do for the extrication. In my day job the city fire department don't want to hear from the ems crew about extrication. So I just get ready for the patient hand off.
Around here where I work, folks who work on the ambulance are trying to get hired by the fire department full time. By the time they do get hired, they typically have a few years of experience under their belts. Many of us Captain's and above have spent time working as a paramedic and then up through the ranks. Having someone with minimal experience, even though they are the medical personnel, isn't going to happen. It's not that we don't talk to the medics, but having more than one person calling the shots isn't a good way to do things. When this happens then you have issues as was reflected in the original post. The fire department runs the calls, and the EMS contract provider provides the EMS and transport. I should also note that the majority of our firefighters are paramedics. So there is simply a handoff from one of our medics to the private ambulance company medic who will provide transport. As mentioned in my earlier post, I typically create a rescue group, usually including one our fire medics to make the determinations as to how to extricate patients and initiate pre-hospital care.
I'm guessing it's just the difference from one side of the world to the other!

Remembering that all our agencies are state based and Police are the overall Control agency for every incident. (Command changes depending on whether it's a fire, MVA, etc, but Police have overall Control)
We are probably not far from working these incidents the same as you. For California, if the incident is on the highway, the California Highway Patrol has authority as the incident commander. If it's not on the highway then there is a good chance that we (the fire department) will have jurisdictional authority. It all depends where the incident occurs. Regardless, private ambulance service providers do not have the authority to do much but take care of patient care. The rest is up to the fire and law enforcement personnel on scene.

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