Fire Department On-Scene Command

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Reynolds One

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When I became an EMT student here in the Phoenix area, one of the things I was interested in was why firefighters always show up for an emergency call, regardless of the circumstances. I quickly found out that, at least here in the Phoenix Metro area (not sure if this is a statewide mandate), all firefighters are required to be, at a minimum, EMT certified. And since the vast majority of calls are not fire or extrication related, they get called out for all medical emergencies (along with an ambulance from a private company - here, AMR pretty much owns all of them). It also means that FD always has on-scene command.

I wonder if this ever presents an issue for paramedics. My instructor (a paramedic) insists that he's never really had a problem, but I've heard stories of situations where the paramedic finds him/herself taking a backseat to fire.

I'm not trying to stir things up or anything like that, I'm just curious what people's feelings are on that. Do other states operate similarly?

This is my first post, by the way. I've read a lot of useful information on here so far!
 
Command is always dictated by local protocol. Where I work fire has overall scene command when they are called out such as a MVC, fire, hazmat situation. However they are only certified at the BLS level so all medical decisions are the paramedic on the ambulance. We run third service attached to a hospital here. Scene command is a tricky thing as involving multiple agencies or departments egos can get in the way and cause issues. That is where protocol and policies for each department come into play. In practice the actual situation will dictate how each scene plays out.
 
It depends where you work, for example in los angeles county . The county has absolute control of the scene and can decide what medical treatments are done and what can the private ambulance paramedic can do ( being the gurney jockey ). Even if the private ambulance were on scene first they must operate at the BLS level regardless if they are ALS and wait for the FD paramedics to dictate. Next door is a different county and the private ambulance like AMR has absolute control during a medical call. It just depends what county you will be working in.
 
For us the agency who has the investigation for the incident is technically in charge. So technically Law Enforcement has command during car accidents but usually it will be the fire department. As far as medical calls here who ever gets on scene first has command. If fire arrives on scene first they are supposed to hand over command of medical calls to us ASAP.
 
I work part time in system similar to you, OP. The fire department by city charter maintains scene control of all non law enforcement type events. This gives them the final say in patient care if they so choose, which is unfortunate. Our AMR operation has higher clinical standards and a greater scope, but a firefighter-paramedic could still kibosh their treatment plan. If the fire company is BLS, they could insist an the ambulance transport. In practice this is a rare occurrence, but it does happen. And of course only the most insufferable and incompetent will cite "city charter," but alas.

Here in the more rural area that is my regular job, we have control over all medical scenes regardless if the co-responding fire departments have paramedics. On traffic accidents we'll usually work together but it's not uncommon to have EMS "in command" as fire resources are often scant and inexperienced.
 
Here you pretty much always get a response from Fire. The Fire Guys take command of the scene but I'm in charge of the patient care.
 
Depends on the scene type. On a structure Fire, obviously it's FD's call and we stage where they'd like us and generally stay out of the way unless there are patients. On an MVC, even one with extrication this is primarily a medical call and we will direct resources. During a technical rescue FD runs the operation but our Special Response Unit Paramedics have the required rope and confined space training to still make patient contact and provide care or if unable to safely enter than to consult to the IC on medical considerations.

Here FD are trained to a First Responder level and only respond to a fairly small segment of our calls (cardiac arrest, unconscious, CP, SOB) and we arrived simultaneously or ahead of FD the majority of the time since we have a pretty aggressive RRU deployment.
 
As most said, it really depends on your area. Around here our FD doesn't do very much so when they actually get on scene they like to try and flex their muscle. Regardless of "who is in charge" we just do the best for the patient. We basically ignore the FD on most scenes where something isnt actually on fire.
 
To the OP. It could have something to do with contract in which AMR has signed with the city/county in which they respond. The Emergency Management office could require an EMS supervisor and there would be no point in hiring separate supervisors if the FD runs all medical calls. For you this means the fire chief is the medical supervisor and assumes all responsibility for what goes on on scene. Like others have said regardless of call type the fire department, in your case, is responsible for scene safety while the paramedics are responsible for care of the patient. I would see it as a good thing as now you no longer have to worry about stopping what you are doing to control other people. I am sure there are case of both no issues and issues with FD taking charge. In the case of the horror stories it could just be a case of the two agencies butting heads.
 
It depends where you are. In the county I live where I do clinicals, fire has a small area they have actual EMS response. Otherwise, they are usually on scene first getting info and stuff and then when we get there they back off and tell us what they know and stick around to help load the pt or work a code and so on. In the city where I work, it depends on which department responds. Some are ALS crews and have control of the scene til they hand off to us. Another is BLS only and we have control of patient care once we get there. Or there is city fire and they take their own calls and we take the overflow they cant respond to. Just depends. They are nice to have around though if you have a good relationship with them.
 
The ambulance service is in charge of the medical aspects of the scene while the fireys are responsible for things like extrication or technical rescue. The individual ambulance personnel treating each patient has responsibility for individual patient decisions while, if appointed, the ambulance incident officer looks after things from an "overall perspective" and is the "go-to person" overall for the fire service OIC.

Take for example a common scenario of a road crash with several patients. The fireys are in charge of extrication and technical scene control (they will often appoint a safety officer who wears a green jerkin and is responsible for safety of the entire scene and all personnel) but they take advice from ambulance personnel about who to extricate first if required and if any special precautions are necessary.

Firefighters have no formal medical training so make no medical decisions.
 
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