# What if you are relieved by an "incompetent"?



## mycrofft (Oct 21, 2008)

Not necessarily a nincompoop, but someone with the (alleged) right letters after their name but no sense.
SCENARIO: You stop at an MVA, there's no fire nor gas down; switch off the cars, post road guards (people or warning devices), and are getting to the victims when the FD rolls up, and the vehicle's chief states officially he is assuming command of the scene and you are relieved. You are wearing jeans, a workshirt, dirty boots and an old sweatshirt on your way back from Home Depot. He does not even deign to look at your paramedic ID, or you left it at home. They are starting to pull a victim out of a car without spinal precautions. Now what, keemosabe?






(from Cape May County herald website)


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## marineman (Oct 21, 2008)

At that point you're not a paramedic you're a bystander and unless you are paged to that scene then it is their scene to command and do as they may. If something like that happened I would hope you're on the phone with everyone along the chain of command up to their medical director to inform them of the lack of spinal precautions.

There was a thread not long ago about stopping if you saw an accident off duty and many people said they wouldn't stop and render care because it's not our scene and we're not paramedics at that point we're simply bystanders. It's also the same if you were called to a scene and there was an RN or even a doc on scene already, guess what it's your scene and taking any advice they give is your choice but you best be following your protocols.


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## stephenrb81 (Oct 21, 2008)

In a lot of areas: If you aren't on-duty (Being paid for your time and service) then you have no more responsibility then a first responder (And in some areas, no more responsibility as a regular bystander) so you really have not authority whatsoever.

Guess it depends on respect for the individual.  If they held alot of respect for the individual, they would allow a bit more........if they had no respect, or didn't know the person from the next person then they would CTA (Cover Their 'Posterior')


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## KEVD18 (Oct 22, 2008)

the argument can be made that you weren't a paramedic to begin with. consider:

you have no equipment(above maybe a bls jump kit)
you have no medical control

are you really a medic? meaning can you practice as one or in this case is it just a title?


back to your original question. while you wouldn't catch me at the scene of an mva off duty to begin with, i'll put that aside. once the appropriate resources have arrived, i would deliver my report and wash my hands of the scene(literally and figuratively). 

you bring up another really good reason why not to stop. let me change the specifics a bit. you show up three minutes ahead of the ambulance/engine/cruiser. you hop out and grab your kit, run up and start delivering care. now you don't do much, a bandage here or there. mainly supportive care and some assessment. fd shows up and takes over. pd takes your information "for the file". fd botches the call and blames it on you. the patient isnt able to provide an accurate description of who did what so it you v. them.

now, in this deep pocket world we live in, the pt is going to go after mcdonalds for selling her the coffee, the car maker for not warning her that accidents can cause injury, the guy who paved the road, you, the fd medics, the cops, everybody. good samaritan protection doesn't prevent you from being sued. it, when applicable, prevents you from being *successfully* sued. your lawyer doesn't care whether or not you win, he still gets paid.


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## firecoins (Oct 22, 2008)

Your not on duty. Why would you retain control? The FD shows up, its their scene. It is not your scene. Your just helping out.


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## medicdan (Oct 22, 2008)

While I agree with you completely about stopping, being a FR, and Good Sam liability, I wonder what happened to patient care being a priority. I understand how litigious this society has become... trust me.

I apologise for changing the direction of this trajectory, but it is about to become another circular argument about stopping for MVAs.

What about if the crew replacing you is incompetent? It is a medic new to the company who hasn't been through orientation or being precepted. You are strapped for crews, and the new guy (who has been a medic for a while, but with unproven skills and knowledge) is placed with a newly minted medic (fresh out of preceptorship). What if the medic new to the company has a reputation for being a poor patient care provider? Making mistakes? 
Would you allow them to "relieve" your duty? What are your thresholds for incompetence?


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## Sapphyre (Oct 22, 2008)

Of the times I've stopped (only when I saw the accident) I've only had my name taken down once, and that time, I performed no direct care.  There was one transport, protocols in that area dictated that the age of the individual (advanced) plus MOI = transport, unless the pt refuses of course.


As to the original question, I've been excused from the scene, I will not be confronting the providers directly. My, I take it I've been able to determine, while turning off the cars, that there's no one that would need an emergent move?  Fire and/or gas are not the only reasons for an emergent move.


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## Hastings (Oct 22, 2008)

This is why you don't stop in the first place.

Anyway, the fire guy is in charge, you have no right to remain on scene, if the patient ends up paralyzed, it's their problem. (Although because you stopped and attempted to render care, they could argue that your care was what caused the injury.)



> What about if the crew replacing you is incompetent? It is a medic new to the company who hasn't been through orientation or being precepted. You are strapped for crews, and the new guy (who has been a medic for a while, but with unproven skills and knowledge) is placed with a newly minted medic (fresh out of preceptorship). What if the medic new to the company has a reputation for being a poor patient care provider? Making mistakes?
> Would you allow them to "relieve" your duty? What are your thresholds for incompetence?



That's a company issue. No respectful company will ever do that, no matter how strapped for crews they are. If that happens, again, it's the company's problem. Not mine.


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## Ridryder911 (Oct 22, 2008)

I would whisper in the Chiefs ear that I will follow up on the victims. If there was any spinal damage, that resulted in paralysis, I will personally contact the family and be glad to testify against him. Have a good day!

R/r 911


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## Anomalous (Oct 22, 2008)

Since you have decided to stop and are seeing something you feel is wrong, how about, "Do you want me to hold c-spine while you get a collar and backboard?"


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## BossyCow (Oct 22, 2008)

It's a difficult situation because as an ordinary bystander trying to speak to a responding official agency about their care, you are not going to get immediate respect and validity. And it shouldn't matter if its a fire department, or private or civic ambulance service, they are there doing a job, you are just a looky loo and will most likely be treated as one. 

I would have to weigh the pros and cons. What is the probability of serious harm to the pt? What is the probability of the responding agency actually listening to what I have to say? Presentation is everything in a situation like this. How you say it will have a huge impact on whether or not its heard.


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## piranah (Oct 23, 2008)

ok...well one thing you have to look at is ABANDONMENT.....say your a paramedic and you relieve a pt to the EMT-I....that is abandonment....you releived a pt to care of someone below you.....plain and simple...if it was a medic....houdy hoo im outta there.....its like having a physician on scene if they are willing to take control of the pt...i will be glad to accept their help/guidence......


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## stephenrb81 (Oct 23, 2008)

piranah said:


> ok...well one thing you have to look at is ABANDONMENT.....say your a paramedic and you relieve a pt to the EMT-I....that is abandonment....you releived a pt to care of someone below you.....plain and simple...if it was a medic....houdy hoo im outta there.....its like having a physician on scene if they are willing to take control of the pt...i will be glad to accept their help/guidence......



Does level-of-care still apply to off-duty Medics?  Since you are off duty, you are not rendering care under any medical direction so you shouldn't have initiated care on the Paramedic level.

In Missouri a paramedic can *assess* a patient and turn patient over to a Basic as long as the paramedic determines that ALS care is not needed AND has not initiated care on the paramedic level (IV, Medications, etc...)


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## Ridryder911 (Oct 23, 2008)

piranah said:


> ok...well one thing you have to look at is ABANDONMENT.....say your a paramedic and you relieve a pt to the EMT-I....that is abandonment....you releived a pt to care of someone below you.....plain and simple...if it was a medic....houdy hoo im outta there.....its like having a physician on scene if they are willing to take control of the pt...i will be glad to accept their help/guidence......




Sorry but ......*NO, NO, NO, NO, !* 

Sorry, you are attempting to assume that person is on duty and hence is *working under protocols *when in reality, when one is off duty you are no more than a first responder. Who's authority are you going to work under? If what you described is true then if you don't perform it.. your negligent and if you do; you are practicing medicine without a license. 

Only licensed personnel such as MD, DO, and in some states NP have independent license to practice medicine. 

R/r 911


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## boingo (Oct 23, 2008)

Its not abandonment to refer care and transport to someone of lower certification, it happens all the time.  ALS units refer patients for transport to BLS crews after an ALS assessment determines it is appropriate to do so, and document accordingly.


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## Ridryder911 (Oct 23, 2008)

boingo said:


> Its not abandonment to refer care and transport to someone of lower certification, it happens all the time.  ALS units refer patients for transport to BLS crews after an ALS assessment determines it is appropriate to do so, and document accordingly.




Unless something happens, then it will be considered abandonment. Technically, it is abandonment. That is why some services refuses to allow anyone transport of lesser level. 


R/r 911


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## boingo (Oct 23, 2008)

Well I'm sure a good lawyer might try to make the case, however in this state, there are criteria that allows refering patients for transport by lower level providers, as long as the reason is documented along with an ALS assessment.


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## firecoins (Oct 23, 2008)

boingo said:


> Well I'm sure a good lawyer might try to make the case, however in this state, there are criteria that allows refering patients for transport by lower level providers, as long as the reason is documented along with an ALS assessment.



As an ALS provider, you are responsible for the patient until they are in the care of a higher care even if you triage it down to BLS transport. If a patient turns for the worst, an ALS assessment triaging it down to a BLS transport would most certainly come under scrutiny.

A medic works under the license of a medical control MD.  If you triage down a patient who craps out, he is going to reconsider whether he wants you working under his license.


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## boingo (Oct 23, 2008)

I assure you I am well aware of the protocols I work under.  If my medical director has an issue with a patient I refer to BLS he knows were to find me.


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## piranah (Oct 23, 2008)

I was pertaining to if the pt needed your level of care...and u terfed it to  a basic...but yes I understand your position about medical direction...


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## mycrofft (Oct 23, 2008)

*boingo , firecoins, don't make me come back there!  (>>>*

"Incompetent" can describe a situation where you do not have the authority to do something or assume responsibility simply because you are not entitled to. It does not necessarily mean you are a meathead, but simply that you or they are not on the list of people who can be allowed to help, by the rules.

How about "ethical" or "moral" responsibility?

What if the fire crew was demonstrating perfect performance?

Here's an anecdote: decades ago, a gas leak caused an explosion in an auditorium attached to a teaching hospital. One account has it that police and FD controlling the scene admitted spontaneous volunteer med students wearing their usual scrubs or lab coats, but excluded volunteer real MD's who were wearing suits or casual clothing.  

I'm enjoying this conversation. 

PS: If I see reds and blues in my rearview mirror, I don't stop for accidents except maybe to contribute to scene safety. I can lay down a mean flare pattern, except it's so dangedly dry out here right now.


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## BossyCow (Oct 24, 2008)

I would think from a legal standpoint, we do not have the authority or responsibility to determine the competence our our fellow workers. If we see evidence of blatant incompetence, we do have a responsibility to act on that knowledge. I would think in a court of law, the presumption of competence would be accepted due to the legitimacy of the responding agency. 

For example, if we are stopped because the wreck happened right in front of us and we were unable to go around it. If we chose to provide some basic first aid in a safe manner, in a way we felt comfortable, if the local-yokels show up and take over care, they are the responding agency. They have a mandate to provide care. They would have more authority on that scene than anyone passing through, be they EMT-B or Trauma Surgeon. Now, if you see something blatantly wrong, dangerous to the pt or monumentally incompetent, that is between you and the pts attorney.

We are not watchdogs of all other agencies. We cannot assume that responsibility. It would be a liability nightmare.


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## mycrofft (Oct 25, 2008)

*Agreed, largely.*

We have to remember that the jeezley pests on scene are often convinced they have a duty to act as they do, rather than follow the rules (which they are probably ignorant about anyway).


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## fma08 (Oct 28, 2008)

So we don't have some sort of even moral obligation to act... yes, may not be "on the clock" but seriously, someone screwing up like that?


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## firecoins (Oct 28, 2008)

fma08 said:


> So we don't have some sort of even moral obligation to act... yes, may not be "on the clock" but seriously, someone screwing up like that?



Yes. We have no moral obligation to act while off duty and on scene. Afterwards you can report it to the state D.O.H.  but you are not to interfere with it.


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## mycrofft (Oct 28, 2008)

*Ah, ummmmmm....*

Morals are personal and derived from one personal values and ususally basd upon your experience and cultural upbringing. There's no legal-ethical imperative (maybe a legal-legal one?), but "moral" is personal. As from the word "mores" ("moh-rays").
"Moral" is what propels you to act despite, if not against, convention. MAny good, and many bad, things have been done on a "moral" basis.
(Usually when someone tells me I have a moral imperative they want my vote or are passing a colection plate)


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## EMTinNEPA (Oct 30, 2008)

Ridryder911 said:


> Unless something happens, then it will be considered abandonment. Technically, it is abandonment. That is why some services refuses to allow anyone transport of lesser level.
> 
> 
> R/r 911



Even if you get released by medical command?


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## mycrofft (Oct 30, 2008)

*EMTinNPEA, I think the issue was...*

...releasing "down" versus "up" the food chain.
Define medical command...another paramedic, a doctor who drives up, a firefighter EMT when his captain takes over the scene?


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## Hazmat91180 (Oct 30, 2008)

IF it were me, and this has happened to me before, when witnessing an accident, I DO feel a moral obligation to make sure everyone is ok. At that point I would take c-spine precautions and hold them there until help arrives. At THAT point when the crew comes, THEY make the decision to honor the precaution or not, and I feel that I did everything I could have.


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## EMTinNEPA (Oct 30, 2008)

mycrofft said:


> ...releasing "down" versus "up" the food chain.
> Define medical command...another paramedic, a doctor who drives up, a firefighter EMT when his captain takes over the scene?



Releasing down.  And by "medical command" I mean online medical direction, i.e. a doctor on the phone.


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