# What if a layperson is already working the scene?



## mycrofft

(Ths is sort of a reverse of a much earlier thread, about being relieved by an incompetent).

You drive up in your ambulance or fire thingee to a rural highway curve and see a two car accident with people sitting on the curb, one lying down. There are a couple road flares up-traffic, and a young woman (or man, maybe one of each) is moving briskly between the victims. The layperson hustles over to you, speaking rapidly gives a thumbnail sketch of each victim, says the cars have been safetied, and says (s)he's going back for his/her backboard.

Seriously, what are you going to do here?


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## Sapphyre

Oy vey!

No organized volley response agency here, I'm going to ask for eta of PD (and fire, cause I can't even get out of dodge if fire doesn't say so) then thank the bystander for his/her/they're help and ask them to please stand back.


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## Sasha

mycrofft said:


> (Ths is sort of a reverse of a much earlier thread, about being relieved by an incompetent).
> 
> You drive up in your ambulance or fire thingee to a rural highway curve and see a two car accident with people sitting on the curb, one lying down. There are a couple road flares up-traffic, and a young woman (or man, maybe one of each) is moving briskly between the victims. The layperson hustles over to you, speaking rapidly gives a thumbnail sketch of each victim, says the cars have been safetied, and says (s)he's going back for his/her backboard.
> 
> Seriously, what are you going to do here?



I have a question... why does a layperson have a backboard?


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## amberdt03

Sasha said:


> I have a question... why does a layperson have a backboard?



because they are super awesome and are going to save the world by themselves


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## JPINFV

Sasha said:


> I have a question... why does a layperson have a backboard?



Backboard+ 2 chairs=table. Heck, get a sawzall and widen the handles a bit and you have a built in cup holder. Perfect for those tailgate parties.


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## bstone

Are they a trained person? Are they my medical director and his RN wife?


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## reaper

bstone said:


> Are they a trained person? Are they my medical director and his RN wife?



Does it matter?

I would thank them for the help and tell them that we have it from there. Their response after that determines the next step in line!


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## bstone

reaper said:


> Does it matter?
> 
> I would thank them for the help and tell them that we have it from there. Their response after that determines the next step in line!



Of course it matters. If the person is your med director then you work directly under his supervision and his license. If you piss him off then he can say, "you are no longer licensed to work" and POOF you are immediately required to defer to him.

If my med director was on scene then I'd be very happy to have him run it and get his hands dirty.


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## reaper

Maybe the MD, not his wife.

Most good medical directors that come to the scene, will let their personel run the scene and do the treatment. 

I would still tell him thank you and we have it from here.


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## HotelCo

bstone said:


> Are they a trained person? Are they my medical director and his RN wife?



I was always taught that a layperson referred to an individual who had no training or expertise in the area.

Have I been taught wrong?


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## Shishkabob

Layperson = those not trained in our profession, therefore they get thanked and let on their way.


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## amberdt03

HotelCo said:


> I was always taught that a layperson referred to an individual who had no training or expertise in the area.
> 
> Have I been taught wrong?



i think its someone thats has first aid training but really not enough to be of any use.


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## HotelCo

I'm pretty sure it means no training. Best that I can find in the dictionary anyway.


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## VFFforpeople

If there is an RN at sence, do we go under RN? (and will that apply to a medic as well?). Also, like stated thank them, maybe if low on people for some reason have them hold 4x4s on a wound or something. Other than that nope tell them to back away, and not let them hold the head.


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## HotelCo

VFFforpeople said:


> If there is an RN at sence, do we go under RN? (and will that apply to a medic as well?). Also, like stated thank them, maybe if low on people for some reason have them hold 4x4s on a wound or something. Other than that nope tell them to back away, and not let them hold the head.



No. We do not work under an RN unless they are on duty and assigned to that area.


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## mycrofft

*Laypeople on scene. McDonalds' flippers.*

Are you going to use their vital signs, their "diagnoses", accept their dressing without removing them and inspecting?


OK, now, suppose it was YOU first on scene and then the FD shows up....
So much for carrying stuff to help out professional EMS in a non-disaster situation. You can save lives maybe, but if you're helping, don't be disappointed if all your reports and verbals wind up on the floor.


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## Shishkabob

We are under no medical obligation to anyone in the field that is not our medical director or supervisor.

If you're working a pt and a "doctor" says "do this", but they are not your doc, you can say Bye bye to them if you wish.


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## Epi-do

amberdt03 said:


> i think its someone thats has first aid training but really not enough to be of any use.



No, that is an EMT.....    (And, before anyone gets their panties in a wad, I AM JUST KIDDING!!!!)

As for the OP, the bystanders are thanked for their assistance and asked to step back out of the way so we can get to work.  The only MD I am required to listen to onscene is my Medical Director.  If I choose to do so, I may allow another physician to ride in with me, but only if they can produce their lisence and are willing to sign my paperwork.  If they do not wish to do that, then they can step to the side with everyone else.


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## VentMedic

Bystanders can provide some important information and should not be dismissed as just someone to get in the way. If they witnessed the MVC, they can tell if another car was involved, the position of the patients when found and their level of consciousness. These may be questions the patient can not answer. Once you have whatever information, thank them *sincerely without attitude* and they should be referred to the LEOs to see if they need any information from them. 

EMS should embrace the fact that the public gets involved at all. Some in EMS constantly complain people don't care or know what to do in an emergency. States have even had to enact laws trying to get people to assist someone in trouble by at least calling 911. They have passed Good Sam laws to encourage the public to offer assistance. Billions of dollars have been spent on classes and public service announcements telling people how to offer assistance if they see an MVC or someone having a heart attack. We have also had hundreds of threads on the EMS forums laughing and criticizing at people who just wanted to do something. The public just can't seem to win when it comes to EMS. They will be criticized for whatever they do. 

Even those of us who have been in EMS for many years have not so good stories of being told to go away before any pertinent information could be given to the EMS providers. It is a disservice to the patient to not take a few seconds to listen to someone who was there first. It doesn't mean you are inviting them into the back of your truck. Most doctors and other professionals are probably relieved to not have their responsibility go any further than as a first responder. However, they still should be treated with respect. If a nurse or a doctor did just drive by a scene and not stop, I'm sure some would criticize them in several pages of a thread on some EMS forums. 

I guess the AHA should have consulted with EMS before teaching the layperson CPR and AEDs. It seems some in EMS believe they can do it all but don't realize the public is a valuable first link in the chain of survival regardless of the situation. 

Personally I would take a layperson with a couple of AHA or ARC classes who took them thinking they might make a difference over an EMT who watched too much crap EMS TV and just wanted to play with the sirens.


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## amberdt03

Epi-do said:


> No, that is an EMT.....    (And, before anyone gets their panties in a wad, I AM JUST KIDDING!!!!)



texas used to cert something with even less training than an emt called an eca(emergency care attendant) i don't think they do anymore but i could be wrong. thats what ff's used to be certed as back in the day so they wouldn't be required to deal with any medical calls.


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## Shishkabob

amberdt03 said:


> texas used to cert something with even less training than an emt called an eca(emergency care attendant) i don't think they do anymore but i could be wrong. thats what ff's used to be certed as back in the day so they wouldn't be required to deal with any medical calls.



They still do.  Our ECA's are equal in scope to the MFRs, just Texas thought it'd be unique and name them something different.


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## firecoins

a layperson generally refers to someone not trained or lesser training than our own.  An EMT with no EMS experience might as well be a layperson.  My medical director is not a layperson. 

Reguardless of the person on scene and their level of training, I will do my own assessment.  I will thank this person and take any pertinent information they have.  Than I will send them on their way.


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## VFFforpeople

HotelCo said:


> No. We do not work under an RN unless they are on duty and assigned to that area.



Ahh, kk thank you for clarifying for me.


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## VentMedic

firecoins said:


> Than I will send them on their way.


 
Just remember not to chase off bystanders who may be witnesses that can provide useful information to the PD.

Last year a jogger was killed in one of the cities I frequent. He was the victim of a hit and run. Joggers near him got glimpses of the car but when EMS showed up, they told everyone to clear the scene immediately by leaving the area. Thus, the PD was left without any clues as to who hit the man. Fortunately, unlike the EMS providers, the bystanders knew they had important information to give the PD and later contacted them. However, a lot of time was lost when their report could have been made within the first 15 minutes of the hit and run event.


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## firecoins

VentMedic said:


> Just remember not to chase off bystanders who may be witnesses that can provide useful information to the PD.
> .


Good point.  It was merely a poor choice of word on my part.


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## paccookie

VFFforpeople said:


> If there is an RN at sence, do we go under RN? (and will that apply to a medic as well?). Also, like stated thank them, maybe if low on people for some reason have them hold 4x4s on a wound or something. Other than that nope tell them to back away, and not let them hold the head.



Regular RNs are not trained in scene management as EMS people are.  We have had a situation where an ER RN thought she was going to be in charge of the scene at an MVC and called the lead medic a few nasty names and told her she was unprofessional.  The RN was reported and reprimanded when she went back to work, not only for her unprofessional behavior, but also because she was not trained to be in charge of the scene and should have known better.  (The lead medic took the problem to the director, who took it to the RN's supervisor.)


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## LAS46

Noun	1.	layperson - someone who is not a clergyman or a professional person.

Thanks to http://www.thefreedictionary.com/layperson

Antonyms: layperson
Definition: non-expert
Antonyms: expert, professional

A person who is not a member of a given profession, as law or medicine.


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## VentMedic

paccookie said:


> (The lead medic took the problem to the director, who took it to the RN's supervisor.)


 
Was she representing a hospital or another EMS agency?

Some state do have MICNs and PHRNs which could be a very different situation. California, where *VFFforpeople* appears to be from, has MICNs who do Flight, CCT, scence response HEMS and are often liasons for the county EMS systems. 

Sometimes off duty EMT(P)s pull up to a scene wearing their department T-shirt or uniform which some wear 24/7 and are assumed to be representing their agency. However, many employers will make it clear that they will NOT cover you for your actions off duty if your are out of line, injured or cause further injury to the patient. Usually an employer could care less about what an off duty RN or EMT(P) is doing unless they are claiming to represent that agency in any way. Then, they become a liability.


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## paccookie

VentMedic said:


> Was she representing a hospital or another EMS agency?
> 
> Some state do have MICNs and PHRNs which could be a very different situation. California, where *VFFforpeople* appears to be from, has MICNs who do Flight, CCT, scence response HEMS and are often liasons for the county EMS systems.
> 
> Sometimes off duty EMT(P)s pull up to a scene wearing their department T-shirt or uniform which some wear 24/7 and are assumed to be representing their agency. However, many employers will make it clear that they will NOT cover you for your actions off duty if your are out of line, injured or cause further injury to the patient. Usually an employer could care less about what an off duty RN or EMT(P) is doing unless they are claiming to represent that agency in any way. Then, they become a liability.



The medic and the RN are employed by the same hospital.  The RN is just a regular ER nurse, not a pre-hospital RN.  The medic was doing her job, on the job, just as she would if dispatched to any other call.  The nurse happened to roll up on the scene and decided to help.  She also decided that she was in charge of the scene and decided to try to boss the medic around.  It didn't go over well.  My partner and I were the second truck on scene since the first pt was potentially critical and there were two others who refused care (paperwork to do) plus another patient that we transported.  It was on the verge of being an ugly scene.  I've been on MVC scenes where nurses stopped to first respond and you couldn't have asked for better help.  This particular call was more like a battle of egos.


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## usafmedic45

> She also decided that she was in charge of the scene and decided to try to boss the medic around



I very politely remind them we are on a good working basis with the local police/sheriff and it's a felony to interfere with the duties of an EMS provider in our state.  If that doesn't work, I remind them that they can't practice nursing if they are a convicted felon.  If that doesn't work, they find themselves in a squad car.  This has happened twice in roughly 10 years.  One of the cases actually went to court and the nurse lost her license.  The other was released back to continue on her way after we left the scene.  She complained to our medical director about how WE treated HER with no respect because she was a "superior practitioner".  Our MD told her- in my presence- and I quote, "Lady, you're lucky I don't report you to the nursing board for unprofessional conduct. The day you are a truly superior provider in your ability to deliver prehospital care to competent EMS personnel as I have under my authority, hell will freeze over.  Now shut up and get out of my office."  

Even if it's not _per se_ illegal to interfere with EMS where you are, having a cop step in usually makes an arrogant nurse/off duty EMS provider's ego shrink faster than external genitalia in a male hypothermia victim.  No one with supratentorial function will backtalk someone with a tazer, pepper spray, an ASP baton and a pistol.



> I've been on MVC scenes where nurses stopped to first respond and you couldn't have asked for better help



This would be the norm in most areas....I've only had a handful cause problems.


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## firecoins

Only once did I have an RN on scene on an MVA.  She was neither helpful nor harmful.  

I don't use MVC. Personal choice.


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