Who has the most authority at an EMS scene?


Forum Probie
I am a paramedic at a volunteer fire department that runs an ALS ambulance. Our chiefs first respond in a take-home squad. A chief of mine and myself butt heads sometimes while on calls. Who is ultimately in charge and calls the shots? The paramedic, or a chief officer on strictly a medical call?


Forum Deputy Chief
What does your SOP/SOG/By-Laws state?

Yes, ultimately you are the highest level provider and in charge of PATIENT CARE, however I have seen some whacky shyte come out of a few VFDs over the years.


Forum Asst. Chief
As far as I'm concerned, the person signing the chart is responsible for all patient care decisions. If you as a senior officer who is also medically qualified at an equal or higher level than I want something done differently, I am more than happy to allow you to take over patient care and attend to this patient. If you are not my equal in terms of certification, or you do not want to take over patient care, then I'm happy to take into account your opinions, but the decisions are mine to make. You can write me up tomorrow, but today I'm in charge of this patient.

There may be policies and procedures that contradict the above at this agency or that, but that is how I practice. I absolutely under no circumstances will allow somebody with little or no personal liability to dictate what I do or don't do on a call. Either take to case or stand aside. You don't get to make my medical decisions and then leave me to explain them.


Forum Deputy Chief
They can call the shots if they want to completely take over patient care for the remainder of the call. If not, they aren't running things. Not that suggestions aren't welcome if we're in a tougher situation or they spot something important that needs to be noted, but final say is mine to make if my name is on that report.


Forum Troll
Going to depend on protocols and state laws. For instance, where I am at if we respond to a TC/MVC then LEO/PD is technically in charge of the scene.


Forum Asst. Chief
Anybody you want can be in charge of the scene(logistics, staging, operations etc); but patient care is mine until relived by an equal or higher authority, or appropriately triaged to bls.

The only person who dictates my patient care is med control(either by standing order or OLMC).


Family Guy
How, and why is this even a thread topic? The "ruler" should never be pulled out on scene of a call regardless of the departments status (paid, or volunteer). I do not envy your situation OP, nor would I work--let alone volunteer my time--for such an outfit. We're a team, and all team members should understand their designated roles, respectively, on each and every call (fire, medical, traffic collisions, etc.). If you're having issues with someone high enough to call themselves a chief, then yeah...red flags.


Forum Captain
Unless I'm the only unit of the scene, I'll gladly let the Fire guys take scene command and control while I take care of my patient. That's pretty much how it's been everywhere I've worked.


The fire extinguisher is not just for show
Who is ultimately in charge and calls the shots? The paramedic, or a chief officer on strictly a medical call?
The answer is, of course, it depends. State laws, agency policies, local medical direction can all influence stuff.

As a general rule, there are two ways to be "in charge," operationally, and clinically. Clinically, it is usually the provider with the highest level of medical training (medical director, paramedic, RN, etc). Operational, it is the provider with the highest rank (chief, captain, supervisor, etc). So the question of "who is in charge" doesn't have a clear cut answer.

Many years ago, I was on a fire department, that provided ALS first response. the Captain on the shift was an AEMT, and his driver and firefighter were both paramedics. who was in charge? Well, the captain wrote the paperwork, and the FFs did the patient care. you can argue that one as to who was in charge of the situation.

Also keep in mind, if the chief in question says "you will assess this patient, and run a 12 lead," that's a fair directive to give you, and TBH, it's probably easier to follow his orders instead of butting heads. Now if he says :"you will give the patient medication x, y and z" and you don't think they are indicated, then say (respectfully!!!!) that you don't think it's necessary, and file a clinical complaint with the appropriate person at your department. And if he pushes you to, then give him all the equipment and let him do it, and follow up with the appropriate person afterwards.

The real question is why are you butting heads with a chief? especially on a scene? if you have an issue, it should be brought up through the chain of command, during a prescheduled meeting, with the Chief of the department if needed. If he tells you the ranking operations office is in charge, then have him show you the SOP (ie, put it in writing), and that's that. if he says the highest medically trained person is, well, that's what, have him show you the SOP.

Asking random people on the web might get you the answer you want to hear, but if that's not how it works at your department, than it's irrelevant to the situation.


Forum Captain
You raise a very valid point.

Nobody should technically be "in charge", that is dangerous thinking and there is very good evidence patient harm comes from this kind of mantra; both in and out of the ambulance context. One person should be tasked with "overall oversight" ideally in a hands-off context where they "oversee" things to make sure nothing gets missed, but this subtly but very importantly different from that person being the "do-as-I-say-and-only-as-I-say" person.

It would be perfectly appropriate for that person to say to, for example the person ventilating somebody who has been intubated for traumatic brain injury, "please make sure you ventilate a a low rate" but it would not be appropriate for that person to say "you will do this because I told you to".

Other personnel also need to be aware they can, and indeed should or must, speak up and keep doing it if they feel something is wrong or not being done properly or could harm the patient.

I remember years ago somebody refused to acknowledge I existed because I disagreed with them. Those days are long gone. And that's a good thing.