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Extrication. Who Is In Charge of Patient Care?
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.
Replies to This Discussion
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Permalink Reply by John Dobson on
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Are Helicopters want us to call them quick. They tell tell us at every inservice "call if were not to needed we will go back and not be upset at all". They even told us if we need them to help with a code they will land and help work the patient. They will not transport a patient without a pulse. But sometimes I don't think we call them enough maybe to conservative. I am the only one to ever call from are department. We are going to work with are local Lifeflight to set up preplaned LZs over are township very soon.
We get upset with the local EMS because they will load a patient haul them 10 to 20 miles to the local hospital, Unload the patient at the helo pad to send them back over the top of where we loaded them to start with. Seems like a waste of time to us to call the helicopter send it to that hospital when we have a good lz not a 1/4 mile from the about any scene.
We had a young child who had a stroke,EMS called for lifeflight we were first on scene. We met the family on a county road next to a small private airfield ( I meen 10 feet away) they sent the helicopter 15 miles away to the hospital to meet them at the pad. As we loaded the patient in the ambulance the helicopter went right over head. We all know the guy who owns the airstrip he would have help anyway he could have. (We helped him when he crashed his helicopter).
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Permalink Reply by Wendy C Helms on
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In my experience, both as an EMT and a FF on scene of an MVC, it comes down to first, scene safety, of which the IC (usually on the firematic side) has control over. The EMT or Medic has an initial concern of the care of the patient (once the scene is safe), and ultimately the patient care is in their hands to decide. (it's the EMT/Medic certification that is on the line, not the FF cert) That being said, it is imperitive that the medical person and the firematic person communicate and work together. While the patient belongs to the EMT/Medic, the scene belongs to the FF. The problem comes in with the human factor (pride, for example). A good officer will take charge of the scene to provide for everyones safety, while looking to the medical side as to what they need to care for the patient, once the patient can be reached. If it comes to a court issue, the last thing any department wants or needs is to show a lack of communication and cooperation. As one of the few EMT's who ride the engine, when we are first on scene, the officer usually looks to me for direction on patient care, while I look to him for direction on firematic issues. IMHO it comes down to good communications skills and the ability and willingness to work together (you know, cooperate). But that's just my take on it.
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Permalink Reply by Brad MacMillan on
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I completely agree Ralph. One of the situations I was talking about was we responded to a 2 vehicle MVC. When we got there Vehicle A was on it's side and Vehicle B was on it's wheels, but angled on a horrible slant into a steep, but shallow ditch (it was only about 4' deep but a pretty steep grade down). When we got there, there was a medic in Vehicle B, and another medic had already pulled the single occupant out of Vehicle A, who was unconscious. That doesn't sound like great patient care or life safety practices to me. I would have had no problems with us stabilizing the vehicles, gaining access, then getting the medics in there. But that wasn't the case here. That's just ONE of the incidents. But I do agree with the fact that if it's like a rear-end or head-on and everything is still pretty stable, and the patient needs immediate care, then why not right?
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Permalink Reply by kirk elliott on
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i am a fireman & in training for first responder. patient is first priority.
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Permalink Reply by Christian Prado on
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The highest level of EMT is incharge when It comes to the patient...well thats how we do it..
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ems & fire must work together for the good of the patient,if you don`t its like we were not there.
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Permalink Reply by FETC on
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I don't understand why this is so hard to overcome. The Medic is in charge of patient care, the fire department is in charge of extrication. Last I checked that bus didn't carry rescue tools. The issue is far bigger than your title though.
Sorry but your Pride comment is just wrong Lee. You are not using ICS at an auto accident. At least around here where i work, the fire department is in charge of the scene per RSA (State Law)
Now I am not a paramedic, nor do I wish to ever be one. I am an NREMT-Intermediate but have been the incident commander of many scenes to include every paramedic on my group, (4 of them).
In the scope of the situation, using ICS, it doesn't matter who is certified at what, it all comes down to the Incident Commander or if a Rescue Operations Branch or Division Officer has been assigned, it comes down to good size-up, resource deployment and good communications.
Asking the medic what is his medical assessment and needs are is key. The medic is not the Rescue Operations officer, (could be) but usually a single resource assigned directly to manage the patient. Paramedics shouldn't be telling others what is needed to be done, they should be advising the Rescue Operations Officer of his concerns. Paramedics don't call for the helicopter or additional medical resources here, I do. They are one resource, for which I manage on the scene.
The problem with this scenario is the medic is used to being in charge and telling his partner or another bus, what to do on the regular EMS call. (majority of their work) But as much as everyone feels the firefighters are pulling rank, power struggle or fire service pride, in this environment the medic is not in charge of the overall scene.
In our interview process for new hires, candidates that are "firefighter-paramedics", I tend to ask if we were at an MVA and you were involved in patient care and your Lieutenant says get out of the car now, what would be his reply?
The correct answer is... yes Sir. Because the medic is working within the ICS, and the officer is his direct supervisor and they may see a situation that has become dangerous that he medic-boy hasn't, like a gas leak, fire, potential explosion or worse a secondary accident about to occur.
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Permalink Reply by Ben Waller on
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Actually, the patient is the third priority.
The first priority is the safety of the responders. If one of the responders is injured, that removes two responders from the rescue - the injured one and a second rescuer to care for the injured one.
The second priority is the safety of uninjured bystanders. If we let them get involved, they can be injured, which will require pulling at least one responder off of the original problem to care for the injured bystander.
The third priority is the patient, even though the patient is the reason we're there in the first place.
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Permalink Reply by lutan1 on
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The title of this discussion is, "Who Is In Charge of Patient Care?"
It specifies patient care, not extrication, not the scene, not anything else.
Patient care is about clinical decisions. Clinical decisions lay with the senior medic.
Simple. Discussion closed.
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Actually, Luke, it's not that simple in places the practice the Incident Command System.
If there's a Medical Group established, those decisions may rest with the Medical Group Supervisor, who may or may not be the senior medic.
Further, if the senior medic isn't trained or protected to be in the hazard zone, then the I.C. can deny entry to that medic, leaving the patient care to someone else who is trained and protected adequately against the hazards.
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Permalink Reply by JERRY SALINAS on
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With regard to this question .... is difficult when the incident commander has no medical training. Here in my fire department, there is no Senior EMT of patient management is provided by EMTs from other institutions. It is a shame.
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