Also contra to what some have said EMS is somewhat Paramilitary.(a sloppy one)
I suggest that healthcare is not paramilitary. An EMS provider can have any title they want, but aside from an organizational standpoint, it hold little use.
As an example, a paramedic taking care of a patient, who is in charge of that patients care and the responsible party as such, (in other words the person signing their name to the PCR) cannot be order by the grand pubah paramedic of the agency to perform or deviate from standing medical orders. (aka protocols) without assuming care for that patient. (and signing his name to the PCR) You cannot be ordered to abandon a patient.
Now some agencies like to try and create an artificial seperation between the patient and the scene in order to boost their egos a little. A rescue is a about a patient, not a scene. A medical emergency is about a patient, not a scene. Once a victim or patient is removed from a scene, EMS has absolutely no place in it.
Having worked with both FDs and "paramilitary" 3rd services I can tell you that once patient care is initiated the "officer in charge of the scene" becomes a facilitator to the lead medic no matter how many patients are involved. In fact, in all the MCI literature I have seen, and in my first hand experience, it is often the first responding unit that determines how well an incident turns out. In most EMS systems that may mean paramedic joe shmoe who has no rank above field provider for the agency. While others can assume command after, they will never be able to redo the initial management. They cannot stop the incident and regroup, they can only carry on from where they were.
Once the hospital becomes involved or a significant out of hospital response involving prolonged field care, a paramedic of any rank becomes basically a tech. Even if they are the grand pubah. While physicians are "in charge" of patients, nursing operates on an almost seperate but equal term. That is why nursing has the very real ability to bring patient care to a grinding halt.
We like to think of ourselves as healthcare providers and most on this forum want to further EMS in that directions professionally, and I agree but... We are also emergency responders like police and fire.
I think this is a matter of great debate. I have not found a consensus on this matter. I think the future of EMS is as healthcare providers. I think EMS persons are not yet, and the more they become so, the less like police and fire they will be. We'd have to start a new thread to talk about it though. Not enough characters in this one.
We follow orders from medical direction, we have to follow protocols,
Exactly, and the medical director in that respect trumps all LTs, Captains, Chiefs, etc. Especially since said medical director can revoke the right of any of them to function as a medical provider on the spot.
Again, said officers cannot order you to perform above, beneath, or alter the scope of practice or standards of care. Most agencies o not allow the medical director to have input on organizational operation (like hiring and firing) but if you must be an EMT or paramedic to work at a specific FD and the medical director revokes your ability to practice he has essentially fired you.
we have set grooming and uniform standards, we have C-FLOP and FEMA structures in place for large disasters. Many EMS systems that are municipal or fire based use ranks.
So what?
Those FEMA plans are fantasy. Incorperated into them are local control. You think that once a major military response is effected that an Admiral or General (or even a Captain or Colonial) is going to take orders from a mayor or fire chief? That a fire or EMS captain will have authority over even a squad of troops?
The state plans are for issues that will not be getting a federal response. The stated plan when it gets to the federal level is "do your best and try to survive the first 48 hours if you are local." Then an assessment team will be sent. Which means days after before "support" will even show up. If you are lucky it will be stuff that you think you need. More than likely it will be the material and logistics for longterm mitigation, not what keeps the local fire and EMS departments function in non disaster conditions.
IN the absense of the ability to communicate with all providers, or even reach them, how do suppose anyone would have effective command?
How will they coordinate with or resupply them?
Sure the local authorities may get to sit in the command center and give their input, but their operational control is going to be extremely small. Other agencies and providers including physicians and hospitals will fall into support roles to the major effort. Not to mention most healthcare facilities do not have a way to mandate providers during a disaster, they rely on their willful participation and cooperation. Even if they do, the most they could do is fire them after with a poor reference.
FEMA as an organization is a day late and a dollar short. It will continue to be, just by the nature in which it functions.
