Can EMT set up IC?

[BearGrizzly]

hi, so let’s just say ambulance arrived first on scene of a MCI. After checking the Scene Safety, can you set up Incident Command? or would that only apply to the firefighter side of things.

 

[DesertMedic66]

Yes an EMT can

 

[DrParasite]

yes.

however, many EMTs are not comfortable running an incident, and many EMS systems don't have the command structure to run a large incident (and still handle patient care), so many/most will gladly let the FD be the incident commander. But there are some decent sized and decently trained agencies that will set up and operate their own incident command system.

 

[Jim37F]

Sure an EMT can initiate IC. They can maintain IC throughout the incident, hand it over to a more experienced Paramedic or Field Supervisor... or even the Captain of the fire company that arrives a fee minutes later.

As long as you can recognize that it's going to be an incident bigger than a typical response that's gonna require an IC, if you're first on, or the most experienced on scene, you can always initiate/take over Command.

Call in extra resources is probably the most important in the very beginning, you can always cancel unneeded units, and heck, just establishing an IC initially can let any coresponders (say an engine enroute to what they so far assume is a regular call with you) that something bigger is up.

Like say the auto accident you're going to is a fuel tanker leaking diesel all over thoe freeway, never to early to let Hazmat know... or you have a dozen people in the minivan that got hit, and you're going to need 3 more ambulances...

Even if you're in a fire based area (LA for example), the least you could do is call them over the tac channel and say "hey, we have a 3 car collision, drivers in two cars are going to require extrication, and we have 6 other patients in the third vehicle, let's call more units", that's still a down and dirty form of IC, is a lot better than standing around and not telling anybody anything.

 

[Bishop2047]

I think this totally depends on the individual. Plenty of EMT-Bs, AEMTS, Medics, CCP, FFs or Doctors what would have no business running a scene. You want whoever has the best knowledge of local resources and the right temperament running a scene.

Rank/Education level do not always mirror these qualities (though often they do). I will always defer to he/she who is better suited for that position gladely.

I work casually all over the map so I am rarely in the place where I should be the IC, but I am typically the most "educated".

 

[CANMAN]

Incident command for a larger scale incident needs to be established by the first arriving unit, or second arriving unit if units are arriving together. If this is a fire unit then you should let them setup the command and you as the first arriving EMS unit can focus on triage. Incoming units need to be given direction on a large scale incident, even if that's reporting to/identifying a staging unit for apparatus, but without an initial incident command things can go from controlled to hectic on a large scale incident. That being said just because you initiated the command, doesn't mean you SHOULD maintain it. As soon as someone more qualified arrives you can PASS the command to a new incident commander. This happens frequently on the fire side all the time.

Examples: You are first arriving ambulance and unit on a school bus accident. You can take/setup the initial command, identify and call for additional resources, and establish a staging area if needed so incoming units know what you have going on and where they're supposed to report. Once Fireman Frank, or Captain Chuck arrives on other apparatus to assist you can pass the command to them.

On a house fire incident at 123 Make Believe Way, if I'm the officer on the wagon it would go something like: "Engine 131 is on location side Alpha of a single story, single family dwelling with heavy fire from side Bravo/Charlie. We have a hydrant in the yard and will be setting up for interior attack. First arriving ladder company come to side Alpha, you will be primary search, I do not have an all clear. Second arriving engine pickup our hydrant. Lt. from E131 will be establishing the Make Believe Way command, stand by for a 360 report and all clear confirmation."

This example has allowed all units to know what you have, and has assigned from time sensitive tasks to the first incoming units. As soon as Captain whoever, or Battalion Chief xxx shows up I'm going to pass command to them which then allows me to focus on putting the fire out with my crew.

Hope those examples help.

 

[CANMAN]

I think this totally depends on the individual. Plenty of EMT-Bs, AEMTS, Medics, CCP, FFs or Doctors what would have no business running a scene. You want whoever has the best knowledge of local resources and the right temperament running a scene.

Rank/Education level do not always mirror these qualities (though often they do). I will always defer to he/she who is better suited for that position gladely.

I work casually all over the map so I am rarely in the place where I should be the IC, but I am typically the most "educated".

Hopefully by "educated" you mean one of the most trained and experienced people on the incident? Formal education has little to nothing to do with who should/being an effective incident commander. If I have a Captain (no formal college degree) who has taken classes such as Fire Officer I, II, etc at a fire academy and has 15 years experience vs. someone who has a Master's in Fire Science from a University, but has only ever achieved the rank of volunteer firefighter during their tenure that Master's degree means jack squat to me...

 

[DrParasite]

If this is a fire unit then you should let them setup the command and you as the first arriving EMS unit can focus on triage.

Orrrrrr, the EMS unit can establish command, and assign the fire unit to perform triage and report back the results......

Examples: You are first arriving ambulance and unit on a school bus accident. You can take/setup the initial command, identify and call for additional resources, and establish a staging area if needed so incoming units know what you have going on and where they're supposed to report. Once Fireman Frank, or Captain Chuck arrives on other apparatus to assist you can pass the command to them.

Again, why??? you take command, you give both fireman frank and captain chuck directions on what needs to be done. it's not exactly rocket science.

There are a couple things about command that people seem to forget:
1) According to NIMS, you CANNOT assume command, or take over command. So if that EMS unit is first on scene at a house fire, the person in charge is well within their rights to give orders to the fire crews (stretch a line here, do it, etc). The fire chief can't assume command, the IC needs to transfer it. Of course, at a fire, it's better to have the more experienced person be running the scene, because if something does happen, they are responsible (and this doesn't take into consideration, AHJ rules, local operating SOPs, and political BS).

2) Most FDs are better off when it comes to available staffing, at least compared to EMS agencies. Take FDNY: 4 FFs and an officer on every engine, 5 FFs and an officer on every truck, compared to two people on every ambulances.... While FDNYs is to known to be well staffed, having 3 or 4 people on fire apparatus is pretty common place, with one being a supervisor or acting supervisor; that's still compared to 2 people on the ambulance, with a supervisor in a separate vehicle. However, that doesn't mean EMS cannot and should not be able to run a scene on their own, using the manpower they have assigned to them.

3) Also remember, ICS can be used for big or small incidents, and on large incidents, the IC might not even be a public safety person. That's why you have operations sections chiefs, branches and divisions, who handle the actual work, while being supervised by managers who direct the strategic goals, leaving the technical stuff to the boots on the ground staff.

But as for to the original question, yes, EMS can establish command, assign tasks to incoming units, request additional resources, request specialized resources, direct additional units to set up a LZ, etc. In a real world situation, one EMS person is in the IC, while the second is the triage officer. once triage is complete, additional resources should have arrived to fill out additional positions within the ICS chart.

 

[CANMAN]

Orrrrrr, the EMS unit can establish command, and assign the fire unit to perform triage and report back the results......Again, why??? you take command, you give both fireman frank and captain chuck directions on what needs to be done. it's not exactly rocket science.

There are a couple things about command that people seem to forget:
1) According to NIMS, you CANNOT assume command, or take over command. So if that EMS unit is first on scene at a house fire, the person in charge is well within their rights to give orders to the fire crews (stretch a line here, do it, etc). The fire chief can't assume command, the IC needs to transfer it. Of course, at a fire, it's better to have the more experienced person be running the scene, because if something does happen, they are responsible (and this doesn't take into consideration, AHJ rules, local operating SOPs, and political BS).

2) Most FDs are better off when it comes to available staffing, at least compared to EMS agencies. Take FDNY: 4 FFs and an officer on every engine, 5 FFs and an officer on every truck, compared to two people on every ambulances.... While FDNYs is to known to be well staffed, having 3 or 4 people on fire apparatus is pretty common place, with one being a supervisor or acting supervisor; that's still compared to 2 people on the ambulance, with a supervisor in a separate vehicle. However, that doesn't mean EMS cannot and should not be able to run a scene on their own, using the manpower they have assigned to them.

3) Also remember, ICS can be used for big or small incidents, and on large incidents, the IC might not even be a public safety person. That's why you have operations sections chiefs, branches and divisions, who handle the actual work, while being supervised by managers who direct the strategic goals, leaving the technical stuff to the boots on the ground staff.

But as for to the original question, yes, EMS can establish command, assign tasks to incoming units, request additional resources, request specialized resources, direct additional units to set up a LZ, etc. In a real world situation, one EMS person is in the IC, while the second is the triage officer. once triage is complete, additional resources should have arrived to fill out additional positions within the ICS chart.

I may get flamed for this reply, and if so that's fine because my reply is strictly based off experience. The WHY is because Captain Chuck, who has LIKELY (not always) had more training due to his rank and likely more experience with commanding incidents that's why. Can "the ink is still wet on my card" EMT take command upon arrival and dish out some non "rocket science" task to incoming units sure, is that person the most qualified and/or person who should be responsible if something goes sideways, prob not. We don't see tech's running codes in the hospitals over PA's, MD's, NP's, CRNA's etc. do we? There's a reason for that, experience and training..... The union mason at a construction site doesn't delegate to the foreman on where XYZ is installed do they? This is palpable and understood in almost every other industry, but for some reason we have a power struggle between EMS and Fire when really we should just be working together, allowing the most qualified person to call the shots, and doing what's right for the patient and what needs to be done to keep people safe.

According to NIMS..... I didn't say anything about assuming command, I said you can PASS command, which indeed is something you can do under "NIMS". 99.5% of incidents are handled under departmental SOP's and guidelines, and never make it to a full on NIMS type structure level of ICS. That being said if you work for a department where you have taken IC as a EMS provider on an ambulance that arrives on a house fire, and don't pass the command to a Lt., Captain, B.C, Chief, etc upon their arrival and someone "assumes" the command from you, I want to be there to watch that go down when you make the point of "NIMS says". This isn't a power struggle of who's in charge, or trying to prove that as a Paramedic or EMT on a EMS unit you know how to run an incident, it's who is the BEST person to run an incident. Frankly if I am an officer on the first arriving piece and someone above me wants to "assume" command I couldn't be happier, and I'm not gonna give them static because NIMS says...... It allows me to go handle other things that need to be done. NFPA says alot too but tons of departments pick and choose what they want to follow because they're guidelines.

I was merely giving a few examples, and frankly if you feel appropriate taking the command as you roll up simultaneously with a fire unit on a rescue or fire type response you go ahead and do that. These type of issues that come up will vary widely based off so many factors such as paid, volunteer, paid fire but different paid ems, paid fire w/private ambo as paid EMS, different departments and counties working together, and the list goes on. We can't perfect a spot on response to every question asked because we are all from different areas. With that being said I will close with the EMS units around my way typically do not take command, or if they do will PASS the command to a higher ranking, likely more qualified, OFFICER, who likely arrives via a fire unit, upon their arrival, on most fire incidents and rescues as they have more experienced with the ICS around my way. Your departments may vary....

 

[gotbeerz001]

As a medic unit at scene, you have more important things to do than insist on running the show after a Company Officer or BC has arrived. It makes sense for the first due ambulance to run treatment and transport while the firefighters work triage and the officer takes over as IC.

I would also like to watch as an EMT on a transport unit refuses to pass IC to a Battalion Chief. #legendary

 

[DrParasite]

it appears many people here are answering questions that weren't asked. let me refresh your memories:

hi, so let’s just say ambulance arrived first on scene of a MCI. After checking the Scene Safety, can you set up Incident Command? or would that only apply to the firefighter side of things.

The answer to that is yes, you can. There is no requirement that you be a firefighter to use or set up incident command. All of the other statements and added fluff that people have added don't really answer the original question.

There are advantages to having the FD do it, particularly if they have the extra resources available (FD's are historically better staffed than EMS). But if you show up to an MVA, with a single engine company, 4 ambulances, 2 EMS supervisors, it would be entirely appropriate for the first arriving unit to establish command, and then transfer it to the first arriving EMS supervisor. It has nothing to do with getting into a pissing match, but an MVA is a generally a medical call (taking the rescue aspect out of it), as are many MCIs, once the cause is identified as not being a fire or LEO issue, so having the most qualified medical person calling the shots makes a lot of sense.

But that also would require EMS to be able to function independently of the FD, have staffing levels on part with the FD, and practice using the incident command system on a regular basis, so they are proficient in it. Unfortunately, very few agencies are able to do that, but that doesn't prevent those agencies that am from running a full ICS system without the FD to tell them what to do.