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.

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Permalink Reply by jitter man on June 21, 2011 at 9:42pm

I have to agree with you on this one as far as it is here in NC. The fire officer is in charge but then it depends on who is responsible for the extrication. We have county squads or rescue that may be responsible but the local protocols may put them under the EMS director. I argue with this as being in a fire rescue organization I believe the EMS is there for patient care, not patient extrication. I do feel this is not one in the same. Like one of the posts said , when the patient is being extricated they stay out of our way and when the patient hits the backboard we stay out of theirs.
However NY city has the police special operations do their extrications and if you watch youtube not very safely, concerning gear that is.
So across the country it is different but I like it the way we have it as I get to cut up more cars. Have a great day! God Bless and Stay Safe!

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Permalink Reply by Mongo on June 22, 2011 at 10:17am

I couldn't agree more with this statement and the first sentence of Roy's post. Patient care is numero uno at an accident scene. EMS is in charge of what the patient needs medically and how everyone at the scene can mitigate getting that person to help. We as the rescue crew on the fire side of the scene work together with the EMS to find the best way to get him the patient out safely and efficiently.

That being said, I hate it when (and this has happened multiple times in my locals) the EMS crew says we don't need to take the doors/roof and then five minutes later they want the doors and roof taken... The cars a wreck, if the patient isn't in an immediate life or death position where there needs to be rapid extrication, there's no point in not taking the extra few minutes to get the guy out by taking the roof and doors.

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Permalink Reply by Nathan Henderson on December 1, 2011 at 3:19am

The way I have always understood it is the ambulance crew is in charge of patient care and the fd has extrication. If fire gets on scene first then they would provide ems untill the medics arrived to take over pt care.

The biggest thing that matters is that both fire and ems work together for the pt. Ems needs to be able to gain access quickly, assess and stabilize the pt, then monitor them through the extrication process. Fire needs to be able to extricate the pt as quickly as possible using the ems crews assessment of injuries and what damage the vehicle has to do the job quickly.

Both crews need to be able to work together while trying to not hinder the others work. At times extrication may need to stop to let ems stabilize the pt and at times ems may need to step back to let fire take care of extrication.

As long as both fire and ems can work together to take care of the pt and get them out of the vehicle and headed to the hospital asap, then everything should work out fine.

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Permalink Reply by Olivia Jones on December 4, 2011 at 12:46pm

At our FD it is pretty simple, if we have to go into a vehicle for patient care the FD person with most medical training goes in. Where I am at EMS has zero extracation training and we do our level best to keep them out of a car. If there are any questions EMS and FF in car communicate and it seems to work pretty well. That way those doing the cutting are confident that person inside the car knows what they are doing and they arent going to place themselves in the way.

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Permalink Reply by Andrew on December 5, 2011 at 11:27am

My department is pretty good with patient care.

Technically, according to SoP's, I am unsure; I am inclined to say that it is the Medic/EMT who has the most experience or knowledge OR the senior EMS officer OR the Fire Chief/Capt./Lt. thereafter.

My department works pretty well in unison, especially when it comes to EMS. I've never seen anyone throw a powertrip hissy fit or anything.

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Permalink Reply by jitter man on December 5, 2011 at 1:34pm

Here we have the same issues of who is in charge. I have always treated it like this. We use the rescue zones per 1670 and if you don't have you gear on then you don't come in my(extrication officer) hot zone. Don't matter if you are a doctor or not. EMS is patient care and extrication is fire or rescue squads responsibility. If we can work together on prolonged extrications then I try to accommadate EMS but if I know I can do a rapid extrication then I bring them the patient when we free them from the vehicle.

The extrication should be going along with the patient care if they have the right gear and are allowed in my hot zone. If the patient care stops my extrication then that is not acceptable to the operation. If they are truely pinned in then there will not be much room for any good patient care.

Incident Command is in charge and has a lot of determination on how the incident is run due to the liability that the position holds.

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Permalink Reply by Bill Brierton on December 6, 2011 at 8:26pm

I haven't had this issue but the senior EMT worries about patient care and the senior fire fighter worries how to get the patient out of that crunched car. In my 24 years I've never had that problem. Maybe I'm lucky or that it's just an understanding of senior personnel or officers of who is in charge of what.