# "Dr" on scene



## OnceAnEMT (Apr 20, 2014)

Hello! I've been reading these forums for the past few weeks now just enjoying the stories and challenging myself with the scenarios, and figured I would go ahead and register to ask about a scene that happened today.

Before I get into this, I just want to mention I am a state licensed EMT-B and am only a few months new to the profession.

I was at Easter Brunch with family at the nearby golf club when a waitress I knew came up to me asking me to come help with an injured worker. Upon approaching the scene, there are 4 men surrounding a young female on a sidewalk with a beverage-carrying golf cart (basically the size of a ground's keepers cart, but loaded high with drinks) next to her. Broken glass all around. MOI was never made clear to me, but it was either the cart tipped and she fell out, or the cart tipped, she fell out, and it fell on her. I see people with phones out and asked if EMS was notified and they said yes. I get there and see a man properly holding C-spine. Excellent. I ask the men if any of them were EMTs, Fire, anything, and one older gentleman on her side announces that he is a doctor. I acknowledge the spinal precautions and ask if he has done an assessment, and he says yes she is "good". I mention I am an EMT and ask if there is anything I can do to help, and he says he's got it. Following that he announces her jaw is fractured and puts a towel filled with ice on it. I hear a fire engine en route so I just head back inside. 

I was not there first, so it wasn't my scene as I approached. If it were just citizens, of course I would have ran the call, using them to help. However, a man declaring he is a Dr. kind of puts me at the bottom of the totem pole. Did I do the right thing here, by going OK and stepping back? They weren't doing anything wrong, and since I didn't know how long it has been I could not say for certain whether they have or have not done an assessment, let alone a primary. 

I guess this is more of a "What would YOU do?" type of question. I was not in uniform and had no weight to be in control of the scene, so I didn't attempt to challenge the doctor. As an EMT, is this the right way to think about it?

Thanks for the help!


----------



## UnkiEMT (Apr 20, 2014)

That's really a fairly complicated question to answer, I'm pretty sure I'm only going to be able to scratch the surface of giving you a good answer.

First, given the scenario you laid out, I think you did exactly right. The patient was receiving appropriate care, there was basically nothing you could do to improve the care, so not attempting to take control was the right choice.

Second, when you're off duty, unless someone is messing up pt care and likely to injure the pt (in which case you do what you gotta do), don't attempt to seize control from another caregiver, be it another EMT, a RN, a MD, what have you. You have no right to the scene, it just causes a big fight and interferes with pt care. (To a lesser extent, this holds true even if the person who currently has the scene is a layperson...When you're off duty all you're really doing is first aid, anyhow, cover the life threats and wait for the rig.)

Second (b), When you're on duty, it's a different story (And one that depends on your local protocols, some places I've worked I can tell an MD to go shove it, others an MD can take complete control, and still others it's an uncomfortable mix wherein they can tell me what to do as long as they ride in with the pt, but I have ultimate veto.)

That being said, sometimes you'll walk on a scene, announce yourself, and people will gladly turn the scene over to you. I worked a two month long stand-by once, and every day we had a family practice MD on scene (A different one every day.), even though under the rules I had, if they wanted the scene it was theirs (along with all our equipment), any time we had a pt who was in my wheelhouse, the MD was more likely to turn it over to me. I am positive that the MDs learned more about trauma/MIs/whatever than I did, but we actually treat those pts more often than a FP MD does. This is less likely to be true at the EMT level than at the medic level, but it's not a completely invalid statement even still.

Yeah, that's just the brief overview, and is, of course, just my opinion, I'm sure others people have other opinions.


----------



## FLdoc2011 (Apr 20, 2014)

I agree, being off duty and and coming up to a scene where others are already "in control" you just see if you're needed and if not then just offer assistance if needed and stand by.   

On duty is a different story,  and frankly unless the physician is trying to live out some adrenaline rush I don't know many docs that would willingly want to jump in and take over a scene where on-duty medics are already on scene and managing it, just not worth the time and liability.  And frankly outside of their hospital/clinic/OR  with the proper clinic they probably wouldn't add much to the mix besides knowledge.


----------



## OnceAnEMT (Apr 20, 2014)

Thank you for the response and opinion! Really what I was looking for out of this was a "you weren't completely wrong", which you provided. I know things get gray when it comes to off-duty service. 

That said, I cannot agree more about the importance of steering clear of causing any sort of argument, especially in this case. There were no apparent life threats, and like I said, they weren't doing anything that waved even a yellow flag to me. No reason to raise a fuss and scare the Pt. 

But as you both pointed out, when not on-duty it seems its only troublesome to attempt to commandeer an already managed scene. Thanks for the confirmation, I appreciate the help!


----------



## Akulahawk (Apr 20, 2014)

It all really just depends upon whether or not you're on-duty or not. The rules are very different... Off hand, I'd say that you did exactly what you should have done, given your off-duty status and the fact that everything appeared to be well-managed for the time being. 

Now if you were on-duty as an EMT, you don't take _anyone's_ word that they're some kind of medical/healthcare provider, unless you know them. That's not the scenario here.


----------



## JPINFV (Apr 20, 2014)

My personal philosophy when I get voluntold to go to a scene when not working is that I have 2 priorities. 

1. Make sure the patient isn't dying (99.99% of the time they aren't).
2. Make sure no one else is making the situation worse (no, putting the cool moist towel on the forehead of the syncope isn't going to do... well... anything, so... sure, go ahead). 

Battles. Pick and choose them wisely.


----------



## OnceAnEMT (Apr 20, 2014)

JPINFV said:


> Battles. Pick and choose them wisely.



Exactly the takeaway I was thinking when I was headed back inside.


----------



## JPINFV (Apr 20, 2014)

[youtube]http://www.youtube.com/watch?v=kn481KcjvMo&feature=kp[/youtube]


----------



## mycrofft (Apr 21, 2014)

Off-duty means on-Good Samaritan.

Maybe not in this case, but...Was the pt conscious and alert? :huh: (We tend to charge in and forget to ask for consent).

If you are not going to be running the scene (and being off the clock means also protocols may not pertain/protect you unless you are contracted as government worker; sometime not even then), you could always help the pt by keeping records to hand off to responders. Include names, times, measures, any pt observations. Increases potential liability I suppose ("Can the defendant explain why (s)he stood by scribbling while the plaintiff was laying there being abused by that ALLEGED doctor…") but as everyone has observed, it can't always be risk free .


----------



## OnceAnEMT (Apr 21, 2014)

mycrofft said:


> Off-duty means on-Good Samaritan.
> 
> Maybe not in this case, but...Was the pt conscious and alert? :huh: (We tend to charge in and forget to ask for consent).
> 
> If you are not going to be running the scene (and being off the clock means also protocols may not pertain/protect you unless you are contracted as government worker; sometime not even then), you could always help the pt by keeping records to hand off to responders. Include names, times, measures, any pt observations. Increases potential liability I suppose ("Can the defendant explain why (s)he stood by scribbling while the plaintiff was laying there being abused by that ALLEGED doctor…") but as everyone has observed, it can't always be risk free .



I'd hope consent was given, as she was conscious and had her c-spine in someone's hands. Couldn't tell you if she was fully AnOx4 or not, but she was fully responsive. Like I said, I really didn't talk to her or confront her, just with the alleged Dr. Thinking back, I feel that perhaps I should have confirmed with her whether or not she wanted my help as an EMT. But then I fear that could lead to an increase in anxiety on any Pt's part, given the circumstances. Just as well, any layman would say without thinking that "Dr > EMT", so I feel even she would say she's fine. 

I think that unfortunately cases like this don't follow much algorithm, primarily because it is acting as a good samaritan. Just lots of gray area that changes per scene.


----------



## mycrofft (Apr 21, 2014)

Grimes said:


> I'd hope consent was given, as she was conscious and had her c-spine in someone's hands. Couldn't tell you if she was fully AnOx4 or not, but she was fully responsive. Like I said, I really didn't talk to her or confront her, just with the alleged Dr. Thinking back, I feel that perhaps I should have confirmed with her whether or not she wanted my help as an EMT. But then I fear that could lead to an increase in anxiety on any Pt's part, given the circumstances. Just as well, any layman would say without thinking that "Dr > EMT", so I feel even she would say she's fine.
> 
> I think that unfortunately cases like this don't follow much algorithm, primarily because it is acting as a good samaritan. Just lots of gray area that changes per scene.



Did good and I agree.


----------



## Handsome Robb (Apr 21, 2014)

I'd ask if they needed help or someone to call 911. If theres lots of people already let them do what they're doing unless its harmful or dangerous. No point to jam myself past them. Definitely wouldn't identify myself. If they needed some guidance I might maybe step in but still wouldn't ID myself.


----------



## Summit (Apr 21, 2014)

If you are off-duty and come up to a scene with good samaritans and decide to help, after your scene/primary survey, here is your flow chart:

Introduce yourself and ask have they called 911? ->No: call if needed
Yes
Are they hurting the patient by doing something? -> Yes: Get them to stop
No
Are they hurting the patient by not doing something? -> Yes: Do the thing
No
Have they neglected to do key secondary assessments? -> Assess
No
"How can I help?"

And don't refer to bystanders as "just _citizens_" if they don't have some certification card. It makes you sound pompous.


----------



## Handsome Robb (Apr 21, 2014)

Summit said:


> And don't refer to bystanders as "just _citizens_" if they don't have some certification card. It makes you sound pompous.



Agreed. Especially as an EMT-B without much if any experience. You never know what kind of company you're in. Makes you look like a real :censored::censored::censored::censored::censored::censored::censored: when you mouth off to a bystander and it turns out they're an EMS professional with more experience and/or a higher level of certification, a trauma surgeon, ERP or something else along those lines and just hadn't identified themselves.


----------



## OnceAnEMT (Apr 21, 2014)

Robb said:


> Agreed. Especially as an EMT-B without much if any experience. You never know what kind of company you're in. Makes you look like a real :censored::censored::censored::censored::censored::censored::censored: when you mouth off to a bystander and it turns out they're an EMS professional with more experience and/or a higher level of certification, a trauma surgeon, ERP or something else along those lines and just hadn't identified themselves.



Citizen was the first word that came to mind while writing it out, didn't consider bystander. And I certainly didn't call them "citizens" on scene or even after, was just the only word I could think of while posting here. But, thank you for correcting me.

Just to be clear, I never "mouthed off" to anyone. That's kind of the point of this thread, me wanting to make sure I didn't not do enough.


----------



## Handsome Robb (Apr 21, 2014)

Grimes said:


> Citizen was the first word that came to mind while writing it out, didn't consider bystander. And I certainly didn't call them "citizens" on scene or even after, was just the only word I could think of while posting here. But, thank you for correcting me.
> 
> Just to be clear, I never "mouthed off" to anyone. That's kind of the point of this thread, me wanting to make sure I didn't not do enough.



Sorry, that came off condescending and it wasn't meant to be. More of a generalized statement. Only reason I say it is because I've had some random brand new EMT-B blast me when I was off duty for not holding C-Spine on a GLF when some older lady bopped her face on the concrete at the dog park. As soon as fire rolled up he started *****ing to them about me being an idiot then they all walked up and greeted me and were all "not playing paramedic on the box today and you still catch calls!"  He shut up real quick after that.


----------



## OnceAnEMT (Apr 21, 2014)

Robb said:


> Sorry, that came off condescending and it wasn't meant to be. More of a generalized statement. Only reason I say it is because I've had some random brand new EMT-B blast me when I was off duty for not holding C-Spine on a GLF when some older lady bopped her face on the concrete at the dog park. As soon as fire rolled up he started *****ing to them about me being an idiot then they all walked up and greeted me and were all "not playing paramedic on the box today and you still catch calls!"  He shut up real quick after that.



All good. Now that is funny though. Trust me, I have no intention in winding up in a silly situation like that.

Common sense is inherited, not taught in EMT school, right?


----------



## rmabrey (Apr 21, 2014)

Had this happen at a restaraunt job after I had finished EMT class. 

Older male passed out while waiting for a table. My boss grabbed me and introduced me as an EMT (I had passed skills but hadnt taken the written). A man by the patients side introduced himself as a doctor. I went back to work.


----------



## JPINFV (Apr 21, 2014)

mycrofft said:


> Off-duty means on-Good Samaritan.
> 
> Maybe not in this case, but...Was the pt conscious and alert? :huh: (We tend to charge in and forget to ask for consent).
> 
> If you are not going to be running the scene (and being off the clock means also protocols may not pertain/protect you unless you are contracted as government worker; sometime not even then), you could always help the pt by keeping records to hand off to responders. Include names, times, measures, any pt observations. Increases potential liability I suppose ("Can the defendant explain why (s)he stood by scribbling while the plaintiff was laying there being abused by that ALLEGED doctor…") but as everyone has observed, it can't always be risk free .



Alleged doctor vs alleged EMT...


----------



## JPINFV (Apr 21, 2014)

Grimes said:


> I think that unfortunately cases like this don't follow much algorithm, primarily because it is acting as a good samaritan. Just lots of gray area that changes per scene.


Welcome to medicine.


----------



## STXmedic (Apr 21, 2014)

JPINFV said:


> Alleged doctor vs alleged EMT...



Exactly what I thought....


----------



## mycrofft (Apr 21, 2014)

Had a podiatrist intro self as MD at an accent scene, he had one subject lie down curled up in the back seat of her 66 Mustang, from which we ended up extricating her (without damaging the car) because she started complaining of neck pain.


----------

