# Who Makes the Call?



## MedicPrincess (Nov 1, 2006)

An infant is in respiratory distress. EMS lauches life flight based on dispatch information (common for our area) so the infant can be taken directly to the childrens hospital that is 35-40 minutes by ground. ALS fire on scene determines the infant is stable and cancels life flight. The EMS Medic says No, keep that helo coming until she can evaluate the patient.

Now this particular FD and EMS have a long history of tension, created by FD, enhanced by Rural Metros providers less than stellar performance (theres no way in hell they will transport my daughter again. I'll drive her myself).

So read here...

http://www.pensacolanewsjournal.com/apps/pbcs.dll/article?AID=/20061101/NEWS01/611010350/1006


Emergency officials vow cooperation
*Amy Sowder*

Confusion between emergency-response agencies led to a meeting Tuesday about who has the ultimate authority to say how a patient should be taken to the hospital.

The dispute arose Sunday night between the Rural/Metro and Midway fire districts over the response to a Midway-area baby.

.....

Although the meeting was closed, Sheryl Bracewell, Santa Rosa County's emergency management director, and Midway Fire District Chief Stephen Demeter confirmed that the time lapse did not cause the baby's death. Both attended the meeting.

Demeter said the incident has been blown out of proportion.

"It's definitely an attempt to make us look bad," Demeter said. "The family is satisfied with our service."

Bracewell disagreed.

"Nothing said in the meeting convinced me," Bracewell said. "LifeFlight should have landed. If we err, we want to err on the side of the patient."
.....
The confusion began when Midway Fire and Rural Metro both had a paramedic, said Karen Smith, spokeswoman for Baptist Hospital.

"Usually, the fire department's job is to stabilize the patient until ambulance arrives, and then patient care falls on their shoulders," Smith said. "Our protocol says the decision is made by the paramedic with the ground ambulance."

http://www.pensacolanewsjournal.com/apps/pbcs.dll/article?AID=/20061101/NEWS01/611010350/1006


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## Flight-LP (Nov 1, 2006)

Sounds like some people need to stop being afraid of treating pediatric patients. Was this a special needs child that necessitated a critical care transport team, or was a child that had respiratory distress that should be capable of managing by any proficient ALS provider? Also, there was no ER any closer that could have handled this patient? Again, special needs is a different story, but to think that an ER cannot provide basic resuscitation and stabilization really bothers me.......................


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## Summit (Nov 2, 2006)

He who is on scene has the best understanding.

If Fire-ALS is on scene and they say they don't need a bird, then that is what goes unless there is something blatantly obvious they are missing.

This does sound like mistrust on the part of EMS-ALS and a pissing match between EMS-ALS and Fire-ALS


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## wolfwyndd (Nov 2, 2006)

Yeah, based on the information provided, it sounds like a pissing contest to me.  

In regards to you driving your own daughter, Princess, I'm with you.  Some of the EMT's that our jurisdiction has hired I wouldn't want treating my DOG much less one of my family members.  Short of a family member being pulsless and apneic I wouldn't call my local jurisdiction for squat, and the ONLY reason I'd call them then is because the ambulance has all the tubes and the AED.


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## Jon (Nov 2, 2006)

Rural/Metro? As in "Big, Nasty, Rural/Metro"???

Are they only EMS, or Fire, too?


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## Ridryder911 (Nov 2, 2006)

There are times when "flying" a patient is appropriate and when it is not. More and more research is demonstrating that there is no significant outcome change in communities with an ETA < 30 45 minutes. 

As a former flight nurse, I am a proponent of Air Services but when used appropriately. We have installed a mentality that all critical patients need to be flown, which is not correct. Even more so of those that are in an arrest situation, in fact many will not even consider flying such patients. 

I agree, there should be more emphasis in education on ground EMS and that the only difference should be the "mode" of transportation only. 

R/r 911


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## trauma1534 (Nov 22, 2006)

I had this like situation at my agancy about a month or so ago.  We had a wreck where there was intrapment, with head injury.  Flight was requested by FD on scene command.  All well and good.  As I was hearing the radio traffic and what I had going on with my patient, I agreed that the patient should fly.  Just as we were pulling up at the scene, I was advized by dispatch that Flight had been cancelled by the first responder at the scene.  I was IRATE!!  I am a firm believer that anyone can activate a chopper, however, it should be up to the AIC of the responding transporting unit to disregard them.  The rest of my story?  I had a patient with head injuries with classic signs of such injuries who was flown to a level one trauma center no more than an hour upon arival at the local ER.  I was also questioned as to why I didn't fly this guy out.


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## jeepmedic (Nov 22, 2006)

Aint my money Fly 'em


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## yowzer (Nov 23, 2006)

These sort of pissing matches can easily be avoided by only having one agency providing ALS services, and making them the only ones who can call or cancel airlift. 

When that's not the case, LISTEN TO THE MEDIC LOOKING AT THE PATIENT. There's no such thing as ESP.


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## FFEMT1764 (Nov 24, 2006)

Flight-LP said:


> Also, there was no ER any closer that could have handled this patient? Again, special needs is a different story, but to think that an ER cannot provide basic resuscitation and stabilization really bothers me.......................


 

I have an ER near me that will divert a cardiac arrest to a hospital 30 minutes further away just so they dont have to do any work...so I can understand wanting to fly the child to a specialty center...esp. if the service doesnt have RSI, like us.


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## FFEMT1764 (Nov 24, 2006)

Here is a simple solution, if you dont have an ambulance to transport someone in you shouldnt be launching or cancelling helicopters...we have trouble here with that from the VFD's...the get on scene and want the bird in the air for things that can go to the local bandaid station...and they like to cancel the bird when we could really use them. Thats why its now countywide policy that the FD can only put a bird on standby, the EMS transport unit or QRV can then ask the EMS supervisor to launch or stand down the bird...and around here the bird will auto launch for the lower half of the county, and they dont mind it if we do cancel them...all for the best care of the patient.


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## Mercy4Angels (Dec 16, 2006)

thank god our town doesnt have EMS/FIRE. we are two seperate companies. Firefighter handle fires thats their job. do you see medics with a hose in their hands on their off time ? lol....medics come out of the hospitals, emts come out of the town service, fire comes from town fire. medics have the final say.


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## possum (Jan 6, 2007)

1st of all I have a problem with Frist Responder Fire Dept. I don't like to take over pt. care. If they did something wrong It your *** in troulbe not the Fire Dept.


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## jeepmedic (Jan 6, 2007)

Mercy4Angels said:


> thank god our town doesnt have EMS/FIRE. we are two seperate companies. Firefighter handle fires thats their job. do you see medics with a hose in their hands on their off time ? lol....medics come out of the hospitals, emts come out of the town service, fire comes from town fire. medics have the final say.



I do both. We have Fire and EMS. No problem. Its all in how you start.


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## jeepmedic (Jan 6, 2007)

possum said:


> 1st of all I have a problem with Frist Responder Fire Dept. I don't like to take over pt. care. If they did something wrong It your *** in troulbe not the Fire Dept.



In Virginia if the First Responder does something wrong you report it to your Regional Council or OEMS rep. and if you do not like taking over care then you need to be a First Responder.


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## Jon (Jan 6, 2007)

jeepmedic said:


> In Virginia if the First Responder does something wrong you report it to your Regional Council or OEMS rep. and if you do not like taking over care then you need to be a First Responder.


I'm sorry... do you not want your patient to get the BEST care possible? FD's doing first response means someone gets there QUICKER to help the patient. In theroy, it means the patient is assessed quicker and the CORRECT rescourses are sent to the patient... if the patient is absoultly stable and still wants/needs transport... they can dowgrade it to BLS... if patient is critical, ALS can be added, and so on. It also means that the patient gets treated earlier than if they had to wait for the ambulance to arrive.

First-Response fire is overkill in some places, espicially when fire arrives at the same time or after the Ambulance.


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## possum (Jan 7, 2007)

What Is a First  Responder Unit.. Can a First Responder Unit transport ??/ NO

So with out EMS a (AMBULANCE ) a First Responder unit is NOTHING!!!




jeepmedic said:


> In Virginia if the First Responder does something wrong you report it to your Regional Council or OEMS rep. and if you do not like taking over care then you need to be a First Responder.


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## jeepmedic (Jan 7, 2007)

possum said:


> What Is a First  Responder Unit.. Can a First Responder Unit transport ??/ NO
> 
> So with out EMS a (AMBULANCE ) a First Responder unit is NOTHING!!!



First Responders can help alot. They can have a pt. ready for transport before the ambulance gets there. They can do BLS CPR and AED. In trauma they can have the Pt. boarded for you when you arrive on scene. Which would give you an onscene time of less than 10 min. Now if I am not mistaken and if I am correct me. But Bristol is the closest Level 1 trauma center around and Kingsport would have the next largest ED in your area. Right? Then your on scene time would need to be cut down as much as possable. (I don't think you would want to go to Lee Co. band-aid station.)


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## Chimpie (Jan 7, 2007)

possum said:


> What Is a First Responder Unit.. Can a First Responder Unit transport ??/ NO
> 
> So with out EMS a (AMBULANCE ) a First Responder unit is NOTHING!!!


Tell that to three people I've treated in the past couple of weeks for some major lacerations they had. 

Take into consideration reacting to the scene, going to a phone, calling 911, waiting for dispatch, waiting for arrival, waiting for unload of medics and supplies, you're probably looking at around 10 - 12 minutes before patient contact is made, let alone treatment.

Instead, I was notified of an injury at work, I was there within two minutes, made patient contact. And within another two I was treating.

Did they need to be seen by a doctor for further evaluation? Two of the three for sure. Did they need the BRT and ambulance? Nope.



possum said:


> a First Responder unit is NOTHING!!!


 
I don't think so.


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## Jon (Jan 7, 2007)

possum said:


> What Is a First  Responder Unit.. Can a First Responder Unit transport ??/ NO
> 
> So with out EMS a (AMBULANCE ) a First Responder unit is NOTHING!!!


First... when acting as First Responders, even the Fire Department is functioning as part of the Emergency Medical Services of your area... collectivly referred to as EMS (I keep on having to correct myself) You are correct, First Responders / QRS units can't transport... but they can initaite patient care FASTER than the ambulance crew can, and perhaps even obtain a refusal and recall the ambulance crew.

I agree that taking a fire engine on EVERY ambulance call doesn't make sense, but if the FD can beat the ambulance to the scene, they SHOULD be going. It also helps to justify a paid FD staff... because (anecdotaly) we've done a real good job at public education, and there are less fires, and less major fires than there were years ago.

Jon


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## jeepmedic (Jan 7, 2007)

Jon said:


> First... when acting as First Responders, even the Fire Department is functioning as part of the Emergency Medical Services of your area... collectivly referred to as EMS (I keep on having to correct myself) You are correct, First Responders / QRS units can't transport... but they can initaite patient care FASTER than the ambulance crew can, and perhaps even obtain a refusal and recall the ambulance crew.
> 
> I agree that taking a fire engine on EVERY ambulance call doesn't make sense, but if the FD can beat the ambulance to the scene, they SHOULD be going. It also helps to justify a paid FD staff... because (anecdotaly) we've done a real good job at public education, and there are less fires, and less major fires than there were years ago.
> 
> Jon



Very well said.


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## Mercy4Angels (Jan 7, 2007)

guess it depends on your town. here its the police (first responders), us (bls), medics (als), lifeflight (doctor or medic depending)


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## TedDM4605 (Jan 13, 2007)

Around here anyone First Resp, Police, Fire, etc can request air transport, but the final determination is made by the ambulance if they continue or get disregarded.  The reasoning is fairly simple.  The transporting medic is the one that will end up with the responsibility of transport and managing the pt during that time so they have the final say.  Some other factors is we are notified (most of the time) which hospitals can and will accept various types of patients (diversion).


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## 94accord (Jan 25, 2007)

Summit said:


> He who is on scene has the best understanding.
> 
> If Fire-ALS is on scene and they say they don't need a bird, then that is what goes unless there is something blatantly obvious they are missing.
> 
> This does sound like mistrust on the part of EMS-ALS and a pissing match between EMS-ALS and Fire-ALS



While I would agree that it may seem a little like a pissing match, one can not ignore that fact that fire trucks do NOT transport people... end of story. If the fire medic is there and is the ONLY one there, cool, let him/her make the call. However, I can not see any good reason for cancelling the birn in flight when the possibility just MIGHT exist that you may need that thing. As someone else said, always err on the side of helping the patient. Ultimatly, it should have been the ground medic that had the final say, and I am VERY surprised that a fire medic would have cancelled ANY additional equipment... last i checked, they like all the gear and help they can get. I have had a few run-in's with other private ems teams on the same accident, and its sad, but some people see it as a competition, and that is truly pathetic. Our job, our goal, and my personal desire, is to help the people that I can... that can not and will not get done if i am busy second guessing another tech on scene. 


Just my 2cents.


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