Just wondering how many part-time, poc, and or volunteer departments struggle with this. Understanding in the fire service for years we have always had rank. You listen and report to your company officer, battalion chief etc. When your dealing with a combined department that both delivers ems and fire services do you run into problem where you have officer that are not medically trained trying to dictate operations concerning a ems incident. 

Now when you are dealing with a extrication your sir medic-emt is in charge of your patient care. Your sir medic should be telling your sr firefighter in charge of extrication what he needs to best remove his patient. 

I wonder how many other departments struggle with officers thinking they are in charge of everything and trying to dictate patient care to a medic. Last time I checked the medic in charge of the patient is the one liable for how that patient is treated, not the firefighter. 

This has been a struggle I have seen since I have started the fire service. I think it's more of a pride issue then anything. Letting someone with no rank tell you the big Captain what he needs done. 


Any thoughts. 


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Hello Mike

In case of a scenario with multi victims ...
At the time of the call to the central 112 (Europe, n º of emergency), screening is done, and if a multi victim accident, the INEM (National Institute for Medical Emergency), sends to the scene, a car VIC (Vehicle Incident and Disaster), with elements to mount a campaign hospital and the like, and yes we used the system START - Simple triage rapid treatment.

Thanks for the question.
Fire has command, EMS is in charge of patient care nothing else. EMS may dictate this or that which fire should oblige but always remember this, the only thing worse than no plan....is 2 plans.
Here in NHC, fire does extrication. If we arrive and ems is on scene, then we have one of them suit up and go in the car for patient care. If ems is not on scene (we all are emt-b), then one of us go in and establish patient care. Even though I'm an officer in the fire service, I might not be the one going in the car. I better serve to patient by getting them out. I have had command from in the car while doing patient care. The question you ask (along with many more on this site), depends on how your services are set up, SOGs'/SOPs', and/or AHJ. The thing I like about this site is being able to gather ideas of how other people operate and see if that can help your station.
let me ask one thing
In Portugal the extrication team is composed of six elements, and in US ?
For us, the Police are the Incident Controller.

Each agency present (fire, rescue, ambulance, etc) will have an agency Commander.

So overall, the Police are in charge of the incident, but as each phase unfolds (patient care vs fire for example) the relevant agency calls the shots.

The patient care side will always remain with the Paramedics. No one can over ride them when it's a CLINICAL decision.
Our medical folks are in charge of the patient care but they fall under the IC.Just as the engine crew and the extrication crew,if extrication is needed.But the IC is THE MAN(or woman,depending on who is in charge at that particular call)
In our area, all of the Fire Officers are Paramedics as well and therfore as knowledgable in patient care as the firefighter/paramedics that arrive with the squad(ALS transport).
The way that it is established around here is that the senior medic on the squad is in charge of patient care while the Senior Fire Officer/OIC is in charge of the overall scene(extrication, pt access, vehicle stabilization, etc...). Even when that squad crew determines that the patient may need a helicopter, they must run this past the OIC/Senior Fire Officer and he/she will determine the transport options. It has been established this way for so long, that it seesm to work without a hitch.
I agree integrated departments are a bit of a special circumstance, but the average Fire Cpt around here is barely an EMR or First Aid'r. I know in my EMS training there was an area that involved extrication. Like I said at the bottom of my last reply .... EMS is incharge of the Pt and if there is no time to cut the car apart then other means must be taken, EMS is in care of the Pt and the Fire side is in charge of extrication ... but they have to work together and either are in charge of the other ... (Unless I am on scene with a PT that is a RED and the EMR Capt of a surrounding Department is trying to tell me that we have the extra time to take the car apart ..
Exactly, same on my integrated department ..... On an EMS call bars dont matter ... it is the highest trained Medical person
If the patient is trapped, it doesn't matter the patient status, you still have to take the car apart. If the patient isn't trapped, why would you take the car apart?
The issue I faced was that we didn't have EMS at our station until recently. We worked well with the Ambulance crews but had hard times with the medics. As an officer I have overall command of the scene. I just ask that if they needed additional equipment, i.e. another ambulance, air transport, whatever to let know and I would call so I would keep track of resources. Nothing like missing someone else calling for equipment then you call and dispatch asking "is that 2 additional BLS" Our job is to stablize the vehicle and assist with lifting when asked.

I had one medic who I had to call on the carpet because she was very disrespectful. If something happens they look at the IC and no one else. Now that being said I'll sit back all day and let them do thier job.
We are told we are responsible for all life safety on that scene. If EMS is not trained or does not have proper PPE they should not be in harms way. Now with that said if we can use them in a safe manner we do. We have loaned them a turnout gear, safety glasses, helmet to work with.
Indiana is a OSHA state. If OSHA says firefighters can't do things they are not trained to do, Why can EMS?

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