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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 M.J. 6821 on
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Your right that the Sr medic is in charge however, the sr. medic and sr.ff have to work together.The medic has to tell the ff how he wants to move the pt out of the car and the ff has to figure out how to do it the best way poss. On our dept. at all MVAs we have EMS ops officer thats in charge of extrication and pt care.
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Permalink Reply by Roy Walker on
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There is no place for an ego at the scene ,we are all trained first responders and will assume pt .care until an emt arrives and takes over, he can tell us how rapidly he needs to access the patient and patient care requirements but we are in charge of extrication . We have respect for each other and are open to suggestions but final decisions on extrication are ours and decisions on patient care go to the paramedic in charge. Once pt. is extricated all decisions are his.
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Permalink Reply by Lee Jones on
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I know how It should be, but doesn't always go like that. Just thought it would be interesting too see if people still have this problem. I could care less about rank it's all about doing whats best for our patient. Sometimes you just need to slow down and take a breath.
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Permalink Reply by Ben Waller on
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In most states, the senior fire officer present is the legal incident commander. That means that if there is a disagreement between the Medical Group and the Rescue Group, the IC will be the one making the final decision, since he/she has the legal authority to do so.
Good Incident Commanders don't micromanage tactics, let alone task-level work unless the people doing the tactical and task-level work are completely screwing things up.
If the Incident Command system isn't being used by everyone on the scene, you have a more basic problem than a medic and a fire officer disagreeing with each other.
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Permalink Reply by Kevin Hatfield on
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On an MVC The Officer on the fire side is in-charge of operations for his crew and extrication, only after the Medical staff have discussed how they want the patient to be removed. Ultimately it is the Medical side that is in-charge, cause the patient is more important then the car they are in. Departments do get into "Cock Matches" and all it does is cause a delay in the help to the Pt. I work on an integrated department and we don't run into problems like that, the person who is attending to the Pt is in charge of what needs to be done ... the officer is in charge of getting it done.
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Kevin, that may be how it's done in your neck of the woods, but that's not how it's supposed to work.
In many places, the EMS folks don't have the qualifications to determine the best extrication route for the patient compared to the firefighters or rescue squaddies. There are actually places where fire/rescue has their own patient care folks and they do all of the patient care until the extrication is complete. Once the patient is freed and packaged, the fire/rescue people hand the patient off to a transport EMS unit that may be from another agency. If the EMS agency crews don't have the training, protective clothing, and interoperability to enter the Hot Zone around the car, then they're not going to be in a position to touch the car or the patient, let alone particpate in patient care.
The car is part of the scene; the IC is in charge of the scene at the strategic level; EMS generally operates only at the tactical level on single-patient extrications, which means that they don't make decisions outside their scope.
i work for an integrated department, too, and our ICs have all had at least EMT-B and most have completed paramedic certification. Our rescue people are all EMTs or paramedics. That takes the "non-medically trained" IC issue nonexistant.
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Permalink Reply by Matt Moore on
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At my department, medics stay out of our way while we extricate, but when the patient hits the back board, we stay out of the medics way...
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Permalink Reply by Bekks on
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I guess I was spoiled during my EMS days.
On scene, the FD Captain always said "what do you need from us" and they made it happen.
No problems ever.
But we don't have many blended Fire/EMS services either.
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Permalink Reply by Paul Montpetit on
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Senior EMS person on scene is in charge of the patient...Fire personnel take care of the extrication......IC is in charge of everyone on scene.....
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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Depends on the scenario...
• Paramedic Engine Company: pretty much excludes the private AMR medics from doing much more than providing transportation, but only if ground transportation is used. Often times, our more extreme medical emergencies get to use helicopter medivac from the scene, and this includes only Fire Department paramedics. There is also the thing about transferring patient care from a FD medic to the private ambulance medic. We don't do that. The original treating medic stays with the patient from the scene to the hospital, and this includes riding on the ambulance with the engine company or BC picking up the medic at the hospital.
BLS Engine Company: This type of engine company, which for us is not the rule makes use of private ambulance medics, and this would include using them as the primary care providers for the patient. However, the on scene Fire Captain, who is the IC oversees patient care generally speaking, and the firefighters performing the extrication are actually more in touch with providing primary patient care until the patient has been removed and transferred to the awaiting AMR medics. I found this situation quite often, not always having a paramedic assigned to my station. Many times, I would facilitate the AMR medic, if safe to do so, to evaluate the patient and possibly start some intervention such as an IV. Firefighters handle the basics, but from experience, I can't tell you how cool it is having your own medic that is also a firefighter. This makes the Captain's life a very simple exisitence. Why? They do the EMS paperwork... :D
CBz
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Permalink Reply by Márcio Teixeira on
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Hi there
In Portugal the extrication team is composed of six elements
No. 1 - Team leader
No. 2 - Element Tool
No. 3 - Element Tool
No. 4 - Element of Security
No. 5 - Rescuer
No. 6 - Assistant General
About the question ...
Rescuer (5) - be responsible for providing pre-hospital care
until the arrival of their team, acting as a point of
reference to the victims and helping the team out of hospital.
After a comprehensive assessment of the status of victims, should:
- Inform the team leader of the priorities;
- Establish contact with victims, as early
possible;
- Carry out the examination of victims;
- Stabilize the victims;
- Proceed with the extraction, according to the responsible team
prehospital.
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do you employ the use of "START" triage, including the medical triage tags?
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