Decison making on scene

[SeeNoMore]

If I am on scene with a providor with a higher level of cert, I assume I must follow their lead and medcial decisions? For example whether a PT gets a collar, 02 etc.

I have ran into this a few times, and I am trying to decide how to handle it. I want to make sure I am fullfilling my duties as a providor, but also respecting the chain of command and not appearing arrogant.

 

[Hastings]

If I am on scene with a providor with a higher level of cert, I assume I must follow their lead and medcial decisions? For example whether a PT gets a collar, 02 etc.

I have ran into this a few times, and I am trying to decide how to handle it. I want to make sure I am fullfilling my duties as a providor, but also respecting the chain of command and not appearing arrogant.

Do those things.

If a higher level provider tells you to stop, or not to do it, then simply stop and don't do it.

 

[lafmedic1]

I have had a "Mds"show up on scene sometimes with an obscure non emergency related cert. If they direct you to do something harmful make sure you repeat it to them what they asked you to do and if you transport the patient have them attend the patient as they are a higher level than you and can not leave as it would constitue abandonment in some areas.Usually as soon as you mention that they WILL be riding to direct treatment all the way they back off. Drs can also be a big help so dont discount them right away .

 

[SeeNoMore]

"Do those things.

If a higher level provider tells you to stop, or not to do it, then simply stop and don't do it."

That's what I have been doing. Thanks for the imput.

 

[PapaBear434]

There are certain things that need to be done at a BLS level despite the call. Vitals, obviously. Boarding someone or putting a collar on, possibly.

You will get to the point, especially if you work with the same folks enough, that you will know what you're gonna do because you know what they are gonna do. It's a rhythm you'll get.

But in answer, yeah, the highest level cert usually will run the call. If it's a BLS patient, a lot of time higher level providers will let the Basic be the Attendant in Charge and run the call, but some won't as a matter of principal. Just have to figure out who you're working with.

 

[VentMedic]

If it's a BLS patient, a lot of time higher level providers will let the Basic be the Attendant in Charge and run the call, but some won't as a matter of principal. Just have to figure out who you're working with.

Yes they may do that but with the knowledge that if anything happens they still will be held as the person with the higher license and the responsibility falls directly on their shoulders.

 

[marineman]

It depends what you mean by higher level of cert. If the person has a duty to respond to that scene and has a duty to provide patient care then yes you go with their decision. If they don't have a duty to act then no they don't have a say (anyone that's not EMS like a doc or nurse regardless of their specialty unless they would like to take full responsibility for all patient care all the way in)

 

[VentMedic]

It depends what you mean by higher level of cert.

Unfortunately in EMS, a higher level of cert could mean any of the EMT-A-B-C-D-E-F-G alphabet.

I have often wondered if in Washington state, does an EMT-Airway trump an EMT-IV? Does the EMT-ILS trump an EMT-IV/Airway?

 

[PapaBear434]

Yes they may do that but with the knowledge that if anything happens they still will be held as the person with the higher license and the responsibility falls directly on their shoulders.

Depends with us, actually. If it's ruled a BLS patient, and the BLS attendant did something stupid, it's solely on him unless the ALS provider did nothing to correct it or stop him. Whoever is ruled AIC for that case.

 

[VFFforpeople]

I do y training, I know BLS and that is what I am going to do. Like stated if the Medic says hey you stop..I am going to keep doing my duty and call it a day.

 

[Sasha]

I do y training, I know BLS and that is what I am going to do. Like stated if the Medic says hey you stop..I am going to keep doing my duty and call it a day.

You're going to ignore a medic?

 

[Shishkabob]

O what you know what to do, that is in your protocols, until told otherwise.

 

[SeeNoMore]

Thanks for all the input folks. I probably am suffering from newbie enthusiasm but it seems better to me to be err on caution if time is not wasted. I guess all I can do is act as I have been trained and like said, stop or modify if directed.

 

[reaper]

I do y training, I know BLS and that is what I am going to do. Like stated if the Medic says hey you stop..I am going to keep doing my duty and call it a day.

Nice way to lose your cert!

 

[WuLabsWuTecH]

Almost always listen to someone with a higher level of cert. If you really feel uncomfortable doing it, ask them to help you with it or to do it for you.

Usually its not a big deal. Just the other day the In charge medic told me to put a lady on 15 lpm by NRB. The other medic told me not to and to keep it on 10. What do I do? Put it on 15 until they sorted it out between themselves.

 

[PapaBear434]

Nice way to lose your cert!

I'd say that depends. Obviously if the medic is doing something medic related, the basic probably shouldn't stop or correct him. But if there is a fall victim that fell from six feet off a ladder and lost consciousness and the medic says "You don't have to worry about putting a collar on him or boarding him, let's just roll," I'd say you have every right to tell him no and do it anyway.

BLS level stuff is both basic's and medic's responsibilities, and the basic shouldn't be afraid to correct the medic if he's doing something stupid in that regard.

 

[VentMedic]

Depends with us, actually. If it's ruled a BLS patient, and the BLS attendant did something stupid, it's solely on him unless the ALS provider did nothing to correct it or stop him. Whoever is ruled AIC for that case.

That will not fly in any court room if that ALS provider is still present.

 

[silver]

I have had a "Mds"show up on scene sometimes with an obscure non emergency related cert. If they direct you to do something harmful make sure you repeat it to them what they asked you to do

Wait if you acknowledge that this is dangerous you would still follow his orders?

That does not seem right, and if you acknowledge it isn't right you will get your license pulled too.

If you dont feel comfortable with anything a higher credentialed person say, you can always say no. If a paramedic asks a basic to do something that is wrong you can always say I do not feel that is right and will not participate. I am going to report this instance when we get back.

 

[PapaBear434]

Wait if you acknowledge that this is dangerous you would still follow his orders?

That does not seem right, and if you acknowledge it isn't right you will get your license pulled too.

If you dont feel comfortable with anything a higher credentialed person say, you can always say no. If a paramedic asks a basic to do something that is wrong you can always say I do not feel that is right and will not participate. I am going to report this instance when we get back.

Also have to keep in mind that you practice under your Medical Director's medical license, not some random Doc that walks up. You do what YOUR Doc says.

 

[marineman]

Also have to keep in mind that you practice under your Medical Director's medical license, not some random Doc that walks up. You do what YOUR Doc says.

Exactly what I was trying to convey in my previous post. If the "higher trained" person giving you the order is your partner or another EMS provider that has a duty to act at that scene then yes follow the order. If it's a doctor, nurse, rrt, or god himself thank them and continue following your protocol. Nothing against those other professionals but just because they have a higher level of education doesn't mean that they're in charge of me or my scene.