It goes both ways for sure. If someone is hysterical they are not getting in my ambulance, be it a parent, caregiver or fellow EMS provider.
I know my company's policies are that riders are allowed up front at the discresion of the crew. Riders are not allowed in the back unless there is a medically justifiable reason, or the patient needs an interpreter. This is because our insurance does not cover riders in the back unless it was medically necessary for them to be there. If we have a rider in the back it has to be documented, and exactly why it was necessary for them to be there has to be documented.
Per our Operations supervisor a ventilator is not a qualifying reason because according to our management the patient can be ventilated via BVM. This is not my personal opinion, this is simply what our orders are from management.
Vent you made a comment earlier about allowing a BLS provider in the back with a patient who has a PICC line or another vascular access device if the parent is in the back. State law where I am states that no, they can not. The parent is not legally recognized as a medical provider, and according to the state the BLS provider won't know what to do if a vascular access device (of any kind) becomes dislodged.
Wow - now, first up - I am in Canada, so I'll be the first to admit things are different. Brigid's first transport was at 3 months old - for that one, and every subsequent one, I have been in the back. It has never been a point of debate... although my qualifications might help there. I don't announce it, but it's one of those things that you notice (while the situation may make me uneasy, I can find my way around the back of a truck).
As for the parent not legally recognized as the medical provider... hang on to your hats. Pediatric TPN is NOT a community mandated therapeutic modality - which means "here is your kids and their TPN, here is a VERY brief review on how to run it and care for the lines, we'll send a home nurse out once or twice to see how you are doing, but you're on your own". Voila - instant "parent as a medical provider".
The vent/BVM thing boggles me. A patient has a vent that has been specifically programmed for them at set pressures, volumes, rates etc and is their "best" respiratory status. You service actually wants you to disconnect their vent and bag them for the duration of the trip (an admittedly far less accurate science) instead of allowing the parent who knows the ins and outs of the equipment to ride with? How about the equipment? Are you allowed to transport the actual vent? Is there "we won't fix it" liability tagged on to it?
For Brigid's last transport, O/A she was connected to her home O2, TPN, jejunal feed, drainage bag from her gastrostomy and her home monitor. She was not "stable" but there was really not much that could be done in the field for her - we were concerned she would deteriorate further en route in our POV. HR 240, RR 50, Temp 43*C (110ish - the dysautonomia causes some very odd presentations), BP 63/26. Based on your protocols, how would a 4 year old child like her be transported? This question is open for all posters to respond, not just Aidey. I'm really curious to see how things differ from place to place.