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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 Capt. Steve Simich on
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Good Question Lee,
Lt.'s, Capt's, and the line medics with authority and responsibility in the incident need to understand that we work as a team.
I recently responded as a rescue officer to a major MVA, where the lead medic had patient care. My first action on the scene was to ask him which patient he needed extricated first. There was no second guessing on my part. Both patients were major trauma's. We did not have a pissing match out there. I have trained our guys, that I will not tolerate pissing matches! We get things done as a team. Yes, the IC is ultimately responsible for things that go well, and things that dont go well. But, we need to build relationships among each of us, including the police, so that we all trust each other, and we can work with each other.
Sometimes, we have to review a call, with all involved and ask the question, what could we have done better or differently, if this same call came in again. This is tough for some. You have to put the issues right out there and honestly review what happened and how could it have been improved. My experience tells me that most issues are not what is done, but how it was done. Line guys that are being direct to the point of ordering to the I/C is probably going to ruffle some feathers.
Ultimately, we all are here for the same reason-to get the job done. But I like your last comment and I was going to suggest the same thing in a different way: The hardest thing you will have to do in any incident to be successful is to keep YOURSELF under control, and not react to the incident! For me, it is to slow my breathing down while responding. It really, really, works. Hope this helps.
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Permalink Reply by John on
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Our dept. follows the idea that the medic in the vehicle taking care of the patient is the one calling the shots as to when it jepordizes the patient, when they say stop they stop, not the incident commander or the officer on the outside. The only way they call theshots is when it comes to crews safety doing the work on the outside.
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Permalink Reply by Pat Showers on
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who ever has the head and neck
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Permalink Reply by 55 TRUCK on
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The Fireman inside with the patient or patients is in charge of patient care. The Officer in command of the extrication sector is in charge of getting the object removed from around the Patient/s.
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Permalink Reply by Paul Montpetit on
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Sure hope to hell the guy inside is EMS trained...if not he?she has no business in there.....
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Here EMT is part of Recruit class..a moderate number including myself opt. to get our Paraidiot too.
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Permalink Reply by Jay Nicholson on
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To sum it up, you have the person who thinks their in charge vs. the person who wants to be in charge. All this before the person who actually is in charge arrives on scene. The nice thing here is that all rescues will have a BC dispatched. He IS in charge. Hopefully, like all good leaders, he will take input from EMS/Fire/Rescue but ultimately it is his butt on the line.
Having been on and trained on vehicle rescues, it's always interesting to see the thought process evolving. Ideas shot back and forth until a game plan is developed.
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Permalink Reply by Ben Waller on
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That will get confusing as soon as there are two or more patients.
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Permalink Reply by Bill Brierton on
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We've haven't had that problem as far as I know of. The EMS folks take care of the patient and we extricate. We work together regardless of rank, career or volunteer, the whole incident revolves around rescuing the patient and getting them to the hospital for better care not who is in charge and who should be doing what.
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Permalink Reply by Kevin Hatfield on
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I really don't believe "if the patient is trapped, it doesn't matter the patient status" why don't we just call them dead then, I believe the "Fire" officer and the "EMS" officer work together, on decisions to do with the vehicle it is the fire side and the patient it is the EMS side, but they have to communicate.
The question at the top of the page is "Extrication, who is in charge of Patient Care?" so it legally is the highest level of Medical trained person, if that happens to be a fire officer then great but most times it is not.
As it works where I am from, EMS says "We need access to the patient now" Fire officer directs his guys to cut the vehicle away from the patient and then EMS is able to remove the patient. They work together ... neither are in-charge of the other.
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Permalink Reply by Brad MacMillan on
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Our biggest problem is arriving on scene, setting up command, only to find the medic is already in the car without clearing the scene first. They assume that the vehicle is stable and there are no hazards. Although they get their asses chewed out, it doesn't seem to make our medics think. They know that when we get on scene we're in charge of safety of that scene and in charge of the extrication. They let us know how they want to get at the pt but in that case, when we have the opportunity to arrive first, we discuss that with them. Most times we'll send a ff into the vehicle after it's stable so we can hold c-spine and cover the pt. But once we're ready to do the move, then usually the medic takes control of the move and we work as a team. But like I said, our biggest problem starts with our dispatch and how they've been known to dispatch medics well in advance of fire to the scene of an MVC.
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Permalink Reply by Just Plain Craig Moyer on
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There was a big discussion about this on Delawarefirefighter about using the helicopter. I always asked the EMT's or paramedics. Its bad to hear an officer call and then cancel an air unit. People don't realize the cost of keeping one of those in the air.
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