Needing to Vent
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medicRob
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First Responders are very low level BLS (Oxygen, Bandaging, Splinting, C spine). They do not initiate nor manage IV's or push medications. Some states allow first responder to assist with a patient's epi pen, and some even allow the first responder to assist a patient with NTG, that's about it.
Re: The State Card
So you mean to tell me the state of Texas will penalize you if you are caught working an EMS shift without your card in your wallet even though your uniform, you showing up in the ambulance, your name tag, and your call number all identify you as an EMS provider?
There's a big difference between a state issuing you a card (which they all do) and actually requiring that you carry it at all times. I put mine in my wallet, so it is with me at all times. However, when I arrive on the scene while on shift with my service, I don't have to present that to anyone, my uniform, the helicopter I landed in, and my sexy name tag with the wings pretty much give it away.
DesertMedic66
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Cali we are to carry our cards at all times while on duty. Highway Patrol has came up and asked for our cards while we are posting a couple of times. Along with sups. But off duty we don't have to carry them.
As for helping off duty we have just been told we can do anything within our scope of practice as long as the patient needs it and we have the equipment to do it.
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medicRob
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Well, we carry our state cards with us, but not once in my career have I ever been asked to show my card when arriving. Then again, I don't just stop off on the side of the road while I am not on duty and play EMS at accident scenes. Whenever I am on a scene, I am there in official capacity.
Whenever I renew my licenses, I provide a copy of my card to my employer which is scanned and put on file, same with ACLS, PALS, BLS, etc.
medicRob
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Well, the board of nursing has agreed to let 8jimi8 come work bonnaroo (but that falls under us being a compact licensure state).. that's pretty crazy.
When I spoke of license cards, I was speaking strictly with regard to those who are on shift with an ambulance service or HEMS arriving to a scene they were dispatched too, not off duty EMTs. If you want to stop at a scene when off duty, be prepared to show that card. When you are arriving in the ambulance to the scene you were dispatched too, I see no reason why it would hurt for you to not have your card with you. Most of us carry our cards in our wallets anyways, so they are always with us.
I am part of the TN Disaster Response team, and I honestly don't know how that applies in disaster, I'll have to check up on that.
JPINFV
Gadfly
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How dare you question the almighty Gus!
JPINFV
Gadfly
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All the more reason not to have anything that IDs yourself as an EMT on your car.
I'm pretty sure MA and NY require you to carry them as well.
DrParasite
The fire extinguisher is not just for show
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omg, you have a county T-shirt? I have an FDNY T-shirt, doesn't make me an FDNY Firefighter.
also jump Kits can be purchased galls Galls. If you had told me you were in your work uniform (button down shirt or embroidered uniform shirt with uniform pants), I would give you a little more leeway, but in a county t-shirt? c'mon.
doesn't matter what you think, or what his training was. you are a civilian, he is the professional who is arriving in the AHJ's apparatus. it's still his scene.
interesting.... so if i show up to a building collapse with people trapped, in civilian clothes, because I heard it on the scanner, and I'm a paramedic, I'm in charge if no other paramedics are there? I can boss the fire and rescue crews around, as well as all the BLS crews? cool
who cares, the kid was a douche. it was still his scene, and if he asks you to leave, you should leave.
I don't really buy that, but it might be true. but the more important question, has anyone actually be punished by the DOH for not stopping?
I have heard of NJ DOH doing spot inspections at the hospital as well.
how much ALS equipment do you carry in your POV? I guess if the EMT-I has intubated the patient or started IVs with running fluids or pushed meds they should stay, but I'm pretty sure most 1) are smart enough not to do that 2) would get fired by their medical director for doing that and 3) don't carry enough equipment in their pov to do that. but in theory it could happen.
ehhh, that's a stretched, but other have discussed the whole duty to act thing.
hmmmm, one person climbs off the local fire truck, in gear, while the other is in a non-local county EMS t-shirt claiming to be an EMT....
wow. doesn't the fact that he pulled in a fire truck mean anything? or that he exited in uniform? this can be pretty funny: "officer, i just caught this man trying to rob the store, i'm off duty from the next county over in a t-shirt, before I turn him over to you, despite the fact that you have a police officers uniform and exited a police car, can I see your ID, to prove that you are in fact a police officer in this town"?
btw, if you are EVER in my town, and I get off a fire truck, ambulance, or any department vehicle, in uniform (yes, AHJ's turnout gear counts), and you ask for MY ID, I will respond with quite a few choice words that would be censored here. I don't care if you are a paramedic, cop, doctor, or holy spirit. that's just stupidity that wouldn't be tolerated.
no, the patient belongs to the first responder until the AHJ shows up. once the AHJ's representative shows up, the first responders job is done.
The responder was a douche, this is there is no disagreement. however, once that douche shows up in a department vehicle it's his patient, and if he tells you to get lost, than you better get lost. it's his scene.
I think I see where this thread is going. OP comes for validation that he was right in his actions. Overall community consensus is that he was wrong, and vocally tells him so. OP does not find the validation that he was looking for in that he was right and that the other guy was wrong, so he keeps throwing additional reasons to support the claim that he was right and the other guy was wrong, despite the fact that his underlying logic is faulty. So while he was initially looking for a place to vent, he found a knowledgeable group who is gonna tell him he was in the wrong, and he is gonna deny he was wrong and refuse to admit that he was the one who was not int he right, despite what the majority of the community says. I think this thread has run it's course from the OP's point of view.
reaper
Working Bum
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Just so you understand this. In SC FD has scene control always. Does not matter if they are a first responder or a Medic. The scene is theirs. Most FD's don't interfere with medics. The volly was a ****, but still had right to make you leave. Let your ego heal and learn the laws. Makes things go smoother!
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nwhitney
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What's AHJ?
If EMT's are an extension of the medical director and work under their license and you're in a different county from where you work, stop to help and are doing skills within your scope could you be working without a "license"?:unsure:
If EMT's are an extension of the medical director and work under their license and you're in a different county from where you work, stop to help and are doing skills within your scope could you be working without a "license"?:unsure:
dixie_flatline
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Here in Maryland, county t-shirts ARE our uniform. We do have button-down powder blues, but they are not really meant to be worn while working (ceremonial only). If we're on the bus, it's a t-shirt, ****ies, and boots.
I'm a little torn on this one. Clearly, the kid on the BRT was something of a :censored:, but OP could have handled the situation better perhaps. If I had stopped and the patient seemed to be emergent, I guess I'd be hesitant to hand the scene over to a lone vollie who isn't even a First Responder (according to the OP the kid is still in class for CFR), but there had to be a more diplomatic way (and Cajun clearly had no legal or jurisdictional leg to stand on).
Also, I believe that I was told that I need to have my Maryland cert card on me at all times, but I've never heard of anyone being "carded".
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AHJ = Agency Having Jurisdiction
nwhitney
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Thanks
akflightmedic
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I threw this one in just for fun...I do enjoy how you justify the whacker lights since they 'were just a gift'.
In all my years of running EMS in SC, I never once had DHEC show up to oversee scene control. What I did have was departmental and jurisdictional policies dictating what was acceptable and not.
And you are absolutely wrong. NO off duty officer from another county will ever take command of my scene, never. The legal implications alone are mind boggling.
You are in serious need of an education in what DHEC does and does not do. Especially when you quoted them as saying remember this is an "at will" state because FYI, the majority of US states are "at will" employment states. You sure are giving them a whole lot of power they do not legally have...but this is usually an action of ignorance (typical in fiefdoms and religions). Get educated my friend and then come back without trying to make excuses for every little thing.
If logical and factual discussion to help you see other perspectives, learn from and grow as a provider is not what you wanted to hear from everyone in response to your vent then I can make a few website suggestions where you would be more welcome as you all pat each other on the back and chest thump. (Wow, that's a 3 line sentence!!)
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firetender
Community Leader Emeritus
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Did you read what the OP said?
Look, Folks, if I come across the scene of an MVA and choose to get involved, begin an assessment, determine that my patient may have a fractured cervical spine and THEN I put my hands on him to stabilize him NO ONE IS GOING TO TOUCH THAT PATIENT EXCEPT UNDER MY DIRECTION!
If the person who wants to be in charge cannot see that I'm busy doing something important then that tells me they don't know what they're doing and I'll wait, thank you very much, for someone who does! This is exactly what the OP did.
I don't care if it's the Surgeon General (whoever that is!), unless he gets real close and personal and builds on what I began, I ain't lettin' go, get it?! Under those circumstances, if you know better, then you damn well are gonna prove it to me first.
That is, of course, if I'm absolutely sure I'm on the right track and have covered my bases first. Still, could you picture yourself for one second, once committed to the patient, turning over your support of his neck to NO ONE? I didn't hear the Rescue medic offer ANYTHING.
From what the OP said, his request for the newly arrived Rescue guy to help him in further stabilization was appropriate. I did not hear the Second Responder offer to work in cooperation, rather it was "Get out of here!"
That's not exactly something that would inspire confidence in my patient's future. I would prefer to defend myself against interference rather than have to explain my choice to abandon the patient.
What I heard here was a lot of defense of protocol, without paying heed to what actually was happening. Kind of scary!
Look, Folks, if I come across the scene of an MVA and choose to get involved, begin an assessment, determine that my patient may have a fractured cervical spine and THEN I put my hands on him to stabilize him NO ONE IS GOING TO TOUCH THAT PATIENT EXCEPT UNDER MY DIRECTION!
If the person who wants to be in charge cannot see that I'm busy doing something important then that tells me they don't know what they're doing and I'll wait, thank you very much, for someone who does! This is exactly what the OP did.
I don't care if it's the Surgeon General (whoever that is!), unless he gets real close and personal and builds on what I began, I ain't lettin' go, get it?! Under those circumstances, if you know better, then you damn well are gonna prove it to me first.
That is, of course, if I'm absolutely sure I'm on the right track and have covered my bases first. Still, could you picture yourself for one second, once committed to the patient, turning over your support of his neck to NO ONE? I didn't hear the Rescue medic offer ANYTHING.
From what the OP said, his request for the newly arrived Rescue guy to help him in further stabilization was appropriate. I did not hear the Second Responder offer to work in cooperation, rather it was "Get out of here!"
That's not exactly something that would inspire confidence in my patient's future. I would prefer to defend myself against interference rather than have to explain my choice to abandon the patient.
What I heard here was a lot of defense of protocol, without paying heed to what actually was happening. Kind of scary!
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akflightmedic
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This is why any knowledgeable/experienced provider who finds themselves alone on scene of a patient requiring c-spine will NOT actually take c-spine precautions. **Clarify...your typical MVC, not one where a patient needs active airway assistance maintained by the provision of c-spine precautions.
When alone and waiting for more assistance, it is best to instruct the patient to not move, to remain still in order to keep yourself (the provider) and your hands free to tend to other situations which may arise.
Why on earth would I want to commit myself to holding c-spine when there is no other set of hands around? Why on earth would I crawl into a vehicle and not have eyes on scene safety, MY safety?
By doing either of these, I have placed myself into a potential legal or dangerous situation such as what Firetender has described. See how passionately you insist you will NOT release c-spine once taken. For the record, I have released c-spine on numerous occasions due to lack of foresight and the situation demanded it. None of the patients died or became worse as a result.
If you never take c-spine and provide direction to the patient, you are in a much more defensible position than if you take it and then release it.
Holding c-spine is a default BLS maneuver due to the limitations within that scope.
When alone and waiting for more assistance, it is best to instruct the patient to not move, to remain still in order to keep yourself (the provider) and your hands free to tend to other situations which may arise.
Why on earth would I want to commit myself to holding c-spine when there is no other set of hands around? Why on earth would I crawl into a vehicle and not have eyes on scene safety, MY safety?
By doing either of these, I have placed myself into a potential legal or dangerous situation such as what Firetender has described. See how passionately you insist you will NOT release c-spine once taken. For the record, I have released c-spine on numerous occasions due to lack of foresight and the situation demanded it. None of the patients died or became worse as a result.
If you never take c-spine and provide direction to the patient, you are in a much more defensible position than if you take it and then release it.
Holding c-spine is a default BLS maneuver due to the limitations within that scope.
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firetender
Community Leader Emeritus
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Point well taken.
I projected myself into the situation as described, including making the choice that the OP made, to begin intervention. Though I do not think in terms of liability in such cases, still, committing to a patient is committing to a patient and I would be stuck until a smooth transition is made and someone better equipped takes over.