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EMS Trying to get involved in extrication.
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???
Replies to This Discussion
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Permalink Reply by Oldman on
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That is one answer, not necessarily the answer. I have been around many third services which work extremely well with their fire and law enforcement counterparts. I can think of 5 here in Harris County. No, not everything is smooth sailing, but when issues arise, they sit down and come to a common consensus. I would hope that these are not the exception.
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Permalink Reply by FETC on
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OldMan, whos in charge at a serious MVC while operating with entrapment, is it the FD Officer or the Paramedic?
Does your third party agreement spell that out with verbage? In my Fire Based agency, if I as the Incident Commander tell my Paramedic to work on a specific patient (or) leave the scene due to a serious threat or hazard to the responders, he obeys the order as I am his commanding officer, he moves regardless if he he is higher trained than me in EMS.
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Permalink Reply by Medicine Man on
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Yes Mike but there is an I in extrication. 2 actually!!
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Seriously though, we do not have this problem here as we do it all ourselves. However, when I worked the township years ago, everybody wanted to work the tools even if they did not have much experience. Since I was EMS Captain then I coordinated what we needed to the IC and we got it done. Hell I even worked the tool now and then! Now since I am in the city we have our own rescue truck that does all the work, but it still works the same we tell them what we need, work together to provide the best result and away we go or they go depending on whos on the medic for that call.
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FETC
Following the principles of Incident Management, the Incident Commander is in control of the overall scene. The Paramedic would be part of the EMS sector for managing the patient (s), and working in unison with the IC. There is no reason these parameters could not be spelled out in the interlocal agreements. Again, communication is essential for any multi-agency response. If there is good communication by agencies before an incident occurs, it stands to reason there will be good communication during the incident.
As far as patient care goes, by law in Texas, the highest EMS certification on the scene is legally responsible for patient care, and this legal responsibility does include how and when a patient is removed from the vehicle. It is the EMS personnel who will be held accountable for something untoward occurring to the patient, not the IC.
If I am the IC, I'm going to use my resources to the patient (s) advantage. I might do a quick triage to develop an operations plan of how many potential patients I have, and what other resources I might need. I will work with the EMS sector to accommodate their tactical needs, and not try to dictate how or which patient to work on. I will coordinate the tactical objectives of EMS with the tactical objectives of the extrication sector for the common objective... the patient (s), and lets not forget we have a third tactical objective of getting the roadway opened up as quickly as possible. And it matters not if it is an FD based EMS system such as mine, or a third service system not 5 miles from me. My point is, and will continue to be, effective communication and mutual understanding will go a lot further than all the chest beating.
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First off thanks for the ICS lesson... though I am pretty sure I already understand the principles of the incident command system, management system or NIMS.
Works the same here, the IC is in charge. Paramedics are a resource for me as well but they don't run the scene. I have made brand new "I know everything" paramedic go sit in his rig when he started to tell everyone he should be in-charge and this is what is going to happen, etc.
But as for your third tactical objective, I disagree as I could care less as to how quickly I re-open up the roadway. Rescuer Roadway Safety is the only priority up until we clear any dangerous and active roadway.
Cops close roadways for hours when they need to do accident reconstruction... never seen a cop measure skid marks or collect evidence while cars are whizzing by but I have seen too many fire-rescue extrication operations on a still dangerous and active roadways.
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Permalink Reply by Kenneth Holley on
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Well we seem to have a variety of ways to run a scene. With some of us the fire department is in charge of extrication operations and in others ems is in charge. Some of us use incident command (which by rule we have to use to get grant money) and some of us do not. In my area we use incident command. When we are called out on an extrication by ems it is usually because their truck is on the other side of the county. But when we are called they let us call the shots because we have some of the best trained people on our tools. We only let the people on our department use our tool because we understand its operations better than anyone else. But i digress. It would seem that geting the pt out of the vehicle as safetly and as quickly as possible should be the priority. If someone has a better idea of how to remove a pt the least you can do is take a second and think about it. Their idea might just work.
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Permalink Reply by Dustin on
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see are department runs first responder with the hospital we run through it pretty much like being a emt basic just without transporting. we also have paramedics on our department. and they said there was no reason in taking the roof off on this particular call. we had the iv started and had the dash rolled and were in the process off moving the pt. on the backboard. since we dont transport the ambulance service that was transports for us arrived on scene and didnt ask for a update or a report of what was in process this one paramedic just had it in his head how he wanted things done and he had this figured out before he even seen the pt. Their other paramedic was 100% ok with our process. and just for the record the ambulance crews that transport for us have no extrication experience. And i never said we were rescue gods but not saying that are guys arent good at what they do because we do run a lot of extrication on our interstate.
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see are department runs first responder with the hospital we run through it pretty much like being a emt basic just without transporting. we also have paramedics on our department. and they said there was no reason in taking the roof off on this particular call. we had the iv started and had the dash rolled and were in the process off moving the pt. on the backboard. since we dont transport the ambulance service that was transports for us arrived on scene and didnt ask for a update or a report of what was in process this one paramedic just had it in his head how he wanted things done and he had this figured out before he even seen the pt. Their other paramedic was 100% ok with our process. and just for the record the ambulance crews that transport for us have no extrication experience. And i never said we were rescue gods but not saying that are guys arent good at what they do because we do run a lot of extrication on our interstate.
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Permalink Reply by Angie Taylor on
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WELL...yes and no. I've been on both sides of this discussion, as a paramedic and a firefighter. I've even picked up rescue tools as a flight nurse. Sometimes more hands are better. And sometimes, you need the input of EMS providers as to what the patient requires in order to survive the extrication.
There has been an ongoing argument as long as I can remember about exactly who that is inside the wreck. Is it the rescue company's "victim" or is it the EMS company's "patient"? The answer is YES. You're extricating my patient, and I'll be receiving your victim. There absolutely HAS to be a coordination between services. HOWEVER...as a firefighter, I tend to ignore screaming rookie medics who have NO extrication experience. I can usually manage that situation with little or no effort simply by grabbing him and saying "CHILL OUT...we got this." In my previous departments, everyone present knew what I am and what my experience level is. I rarely had to engage in this discussion at all.
One way to start fixing this problem is to do joint extrication training scenarios with local EMS departments. Painful, I know. But once they see your proficiency they might just back off. Sometimes you just need to remind EMS that 4 hrs of extrication training in EMT class does NOT qualify them to direct extrication efforts.
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