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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 FETC on
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Jerry, how is this any different when your incident commander is not a hazmat technician and you have a hazardous materials incident?
Resource deployment....
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Permalink Reply by Ben Waller on
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...or it's a technical rescue incident and the incident commander is not a technical rescueer?
Exactly right, FETC.
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Thanks Ben, It is not about a training, certification or outside agency issue, the root of the problem here is all about lack of good quality ICS and communication skills.
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Permalink Reply by Fireyladd - Retired Chief Sharp on
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We dont have this problem at all. We have medics but work with the transporting agency as being in charge of the patient once they arrive on scene.
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How well I know.
Fortunately, it's not a problem in my agency.
The engine is the traffic blocker, staffs the charged hoseline, disconnects the battery, and starts vehicle stabilization.
The medic company does patient assessment, treatment, and packaging.
The truck company completes the stabilization and extricates.
The battalion chief is in command. Since all of our line battalion chiefs completed their paramedic training years ago, there's no problem with the IC being medically qualified here.
It's another advantage of fire service EMS.
Period.
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I agree, Fire Service EMS is much easier as they work for me and I can tell them whatever I want. Not that I don;t do that with others, we invited them to our incident. They will have to function in our established structure.
Our set up is similar except the Commanders are not Paramedics but they don't need to be either. They ask the medic what he needs and handles the incident.
Most of the issues here, like private ambulances, etc. is BS, that same department must have a hard time working with other FD's with M/A incidents too.
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Permalink Reply by Wendy C Helms on
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I have been reading some of the replies to this... and I am wondering if we are answering all of the questions regarding this situation, as they pertain to all the different set ups we have accross the country. For example, we have an MVC with entrapment... PD on scene verify & begin crowd control... FD helps to block the roadway (safety for the respnders)... medics evaluate the patient as long as it is safe for them to REACH the patient.
Now here's where things get tricky... I'm working for a transport company on a critical care ambulance. We find an MVC with entrapment. We contact our dispatch as well as county dispatch for medics (we are EMT-B's & one RN on our ambulance). I have an unresponsive driver, the car seems stable, but we do have white smoke from the hood. Fire extinguisher is pulled along with our EMS supplies (collar, long board, ect...) We begin stabalizing the patient having found a weak pulse & respirations. FD & additional EMS arrive to assist. FD secures the vehicle & pops the hood while preparing to pop the door. (I am not telling FD what needs to be done because MY concern is patient care, which their officer is asking us what we need while they are doing what they need to) Medica arive as we extricate the patient, and have the local squad go ahead with the transport to the hospital (our rig is now blocked in by the rescue & engine, & we really don't care WHO transports, as long as the patient gets to the trauma center fast). So, altho we were in charge of patient care, once the FD arrived the scene became theirs & we worked together to do what is best for the patient. We tell them what we need & they tell us when the scene is safe for us to approach (if they can get there first). As in my area, scene safety is drilled into our heads, so if an MVC scene is not safe for the EMT's or Medics to approach the car, they stand back, ready to move as soon as we get the all clear. Communication & understanding what each person is qualified to do is key in keeping things running smoothly. As an EMT/FF, on the engine my roll is a bit different than when I'm on the ambulance. But I keep all things in mind, and stay within my scope of practice. But that's me...
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Permalink Reply by lutan1 on
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My brain hurts trying to figure out the convoluted ways your guys seem to do things....
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I've read them multiple times, I don't see an issue. Am I missing something?
The medic will dictate how they want the patient out- ie: they want them out the back window to maintain spinal alignment. It's not how it's going to be achieved, but more the outcome.
And I'd agree that the medic is the repsonsible/liable one. Certainly under our systems, that's the go...
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So your convoluted ways is basically the medic who should be doing hands on lifesaving things like advanced airway is also the scene commander?
Wow your brain hurts? Really.... Come on, under the ICS system, you have an Incident Commander, then Operations Officer, Safety Officer, Suppression Crew (Engine Company), Heavy Rescue Crew (Rescue Division) Ambulance with Medic (Medical Division) they all work for the IC.
The medic doesn't order how any of them work directly, he should communicate to the Operations Officer on how he wants the extrication to be done, but the Medic is not supervising other companies.
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You are correct Ben. Altho I sum it up in 2 points... scene safety first, patient care second. We were taught that in EMT school, and through the fire accademy I ended up taking a Safety Officer class as well. Safety must come first. If a responder is injured, then the original patient gets put on hold to treat the injured responder. I for one do NOT intend to ever be that responder. Scene safety... is it safe to enter? Is there someone to keep the bystanders out of harms way? Can we get EMS/Medics close enough/into the vehicle? Do we have to do a rapid extrication to get the patient to a safe distance for treatment? (ie - car on fire) Those who do approach an MVC must be aware of the scene and be properly protected. If the car is on fire, let the firefighters who have the gear on run up to it... not the EMT or Medic wearing regular uniforms that are not fireproof. A dead or injured responder cannot help anyone.
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Permalink Reply by Lee Jones on
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FETC I do agree with you the problem I was Communicating with the Captain what I need to properly extricate the patient based on my medical assessment. I was not ordering his crew or trying to dictate to him. I was just telling him I need the roof off to get the patient off. The problem was he wanted to dictate to me how to treat and remove my patient. That will never happen. I'm liable for the way my patient is treated period. I live and swear by the Incident command system. When I'm in court and i'm going to be asked when was that patient just picked up and yanked out the side door with out being proper stabilized. My answers going to be well the Captain out ranks me so I let him do what he wanted. Guess what I'm doing jail time, paying a lot of money and loosing my License. That's my point.
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