Who is in charge?

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pamedic983

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This has been an ongoing hot topic in the county where I work. Who is in charge at the scene of a motor vehicle accident in which there is entrapment? Do the rescue personnel from the fire company take precedence over the paramedics or do the paramedics have the authority to take control due to the patient? There are many different viewpoints that people feel very strongly about. In our area, rescue/extrication is handled by the fire companies, some BLS companies are fire based while others are independent, and the ALS providers are separate from everyone.

I think it needs to be a cooperative effort and the personnel in charge of the rescue need to work in conjunction with the medical personnel to make sure the patient gets treated appropriately. Each agency needs to recognize their role and how they can operate alongside the others while not impeding their work.

Does anyone know of any standard or guideline out there for this sort of thing? Does the DOT or NFPA or anyone make such a thing?
 
The laws are 1/2 the problem with this situation. Each department probably has their own policies on the topic, the city/township may have laws, the county, and the state. It's entierly possible none of them agree with each other too.

There was just an article on this very topic in Firehouse magazine (I think thats where it was), although that article mostly illustrated the fight between police and fire, and the arrests of a couple of FFs at incident scenes over the years.

Technically at the federal level, any agency that receives federal money is supposed to follow NIMS and have all their people trained in it. However, when was the last time there was a unified command at a one vehicle MVA? It's not common, at least not where I work. We also have the luxury of having both the state highway patrol and the city/county police on scene if it's on the interstate.

There really is no easy anwser to the problem. People will say the paramedics should be in charge because they are the ones doing patient care, but a lot of paramedics who work for private agencies may not have a great understanding of extricaiton or traffic control. Police often take charge, but they tend to focus on keeping traffic moving, even if what they want to do makes the medics/FFs feel unsafe.

As much as I hate to admit it, Fire is usually probably the best agency to take command. Fire tends to actually use the ICS system on a semi-regular basis, and they are most likely to be able to have the largest number of people respond versus an ambulance company or police department.
 
Luckily in my area this is a non-issue. EMS, fire, and rescue are separate entities with fire and rescue being largely volunteer. So far we have had no problems with the I'm in charge syndrome. We all seem to have the opinion that we are there for the patient not for the glory of the individual or the department. This works well for us normally the fire and law enforcement will take care of traffic crowd and hazards up to the point of shutting down major highways if needed, while rescue will take care of the extrication and EMS will take care of the patient. This does not mean that the different agencies will not take on other roles as needed this is just the usual way things work out. I guess we are fortunate to have this type of cooperation between agencies. I understand that this type of informal arrangement may not work for everybody. I wish you good luck in finding a solution that works to provide the best possible care for your patients.
 
Use ICS.

Problem solved.
 
bstone said:
Use ICS.

Problem solved.
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Yes; or better yet, they all should be up to speed on NIMS. I agree with BStone on this. There should not be an issue as to who "owns" or controls a scene whether its an MVA or a large disaster as long as NIMS is followed.
 
ICS doesn't determine who is the IC if you have 3 people from 3 agencies who all think they are equally qualified to do the job. ICS only solves the problem if people are assigned the roles way before an incident takes place, and they aren't trying to figure it all out on scene. Once you have people in the roles ICS/NIMS works great, but you have to get people in the roles first.
 
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I agree with the fact that ICS should be followed whenever possible, but like it has been said before, it's difficult to follow ICS protocol when you have a small number of people on a one-car MVA. I guess the agencies in our area will have to find a way to work together better.

Does anyone have any recommendations of programs/policies that they know of that ensures different agencies work together well?
 
Have you tried having a meeting with the heads of the various agencies to try to work out an arrangement before it is needed? Taking a little time now could save a lot of time or maybe even a life later.
 
Correct me if I'm wrong, but doesn't ICS stipulate that command is set by the first responding agency, it remains until command is transferred? Are you saying that the later responding agencies do not acknowledge the command structure in place on a scene or that the first responding agency doesn't formally establish command?
 
More often it's not that command isn't established (they all like to say that on the radio!) it's that command isn't enforced. Rescue personnel attempt to keep the EMS personnel out of the scene or visa-versa instead of working together. Usually the fire chief or captain has assumed command, but doesn't actually command the scene. Rescue personnel want to keep the medics on the sideline and deliver the pt when they are done with their extrication and the medics want to be involved with the rescue to assess the pt and monitor their condition and handling.

I think there needs to be a meeting with all the "heads of state" to work out some SOG/SOP's to make the scenes more efficient.
 
ICS does say that, but it also says that command should be turned over to a higher qualified IC when they arrive on scene.

Those tenants all work well when it dealing with something like a wildland fire, where people have very specific levels of training/taskbooks, but it doesn't work so well with multiple agencies with different levels of training and orginizational methods. Someone who may be a capitain in their FD could be a grunt worker under ICS and they don't like that. Or a Cheif may be put in an operations role, or whatever.

I remember doing mass casualty training one time we applied the ICS system (it works well with how most triage programs are set up). I was aissigned as Medical because I was the hightest trained medical provider standing there.

Later during the debreif one of the Captains in my Dept complained I was Medical and not himself becuase her is a Captain and I'm not. Someone had to politely explain to him that agency rank means nothing when it comes to ICS. My guess is that he isn't the only FF out there that doesn't understand that fact.
 
pamedic983 said:
More often it's not that command isn't established (they all like to say that on the radio!) it's that command isn't enforced. Rescue personnel attempt to keep the EMS personnel out of the scene or visa-versa instead of working together. Usually the fire chief or captain has assumed command, but doesn't actually command the scene. Rescue personnel want to keep the medics on the sideline and deliver the pt when they are done with their extrication and the medics want to be involved with the rescue to assess the pt and monitor their condition and handling.

I think there needs to be a meeting with all the "heads of state" to work out some SOG/SOP's to make the scenes more efficient.
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Your commanders need to take command.
 
pamedic983 said:
I agree with the fact that ICS should be followed whenever possible, but like it has been said before, it's difficult to follow ICS protocol when you have a small number of people on a one-car MVA. I guess the agencies in our area will have to find a way to work together better.

Does anyone have any recommendations of programs/policies that they know of that ensures different agencies work together well?
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NIMS is designed for all situations so your little MVA would be just as applicable for NIMS as a large structure fire, MCI, etc.

You folks there need to get on board with this (including law enforcement) and get yourselves properly in compliance with NIMS. State levels were required to be compliant by 2005. You may want to check with your state EMA and see what they have to offer as far as NIMS training.
 
On small scene I am in charge. Once I have my patients loaded then LE can take over.
 
medic417 said:
On small scene I am in charge. Once I have my patients loaded then LE can take over.
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If you are treating the patient, you can not be in a supervisory role.
 
BLSBoy said:
If you are treating the patient, you can not be in a supervisory role.
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Absolutely. You cannot treat and assume command.
 
BossyCow said:
Absolutely. You cannot treat and assume command.
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Not just Command.
ANY ICS position can not be filled if you are being used for "line" work.

For example, a first arriving line fire officer can establish command while iniating the attack with his crew, but he is in "fast attack mode", and must pass command to the next arriving officer.
 
I arrive first in my ambulance. I radio as we pull up on scene telling officers anf fire where I want them when they arrive. I direct my partner as to what we need to do. I am in charge. Often in remote rural areas you already have patients loaded by time other people show up.
 
I didn't intend for this to become an ICS debate, but it is all relevant information.

Does the rescue person in charge have the authority to remove any EMS person from the hot zone or do EMS have the authority to dictate when and how rescue operations are done? That seems do be where most conflict arises. Rescue personnel seem to want EMS to stand aside and not be involved and on the EMS side of things, we tend to want to at least be allowed to assess the pt if not dictate how they are extricated and initiate care if it is going to be a prolonged operation.
 
Ok..........
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