Who is in charge?

pamedic983 said:
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.
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Why are they removing them?
 
I think the biggest thing is a clash of egos. Sometimes they use the reasoning that we don't have proper PPE on (which can be the case at times) but instead of asking us to please put a full compliment of PPE on, they ask us to leave the scene and remain at our truck until they deliver the pt to us. More often, they simply don't want us involved in "their" scene until they are done playing and they don't allow us access to the pt.
 
I have kicked many ff's off my scene for doing unsafe things that endangered my patient, me and my partner.
 
pamedic983 said:
I think the biggest thing is a clash of egos. Sometimes they use the reasoning that we don't have proper PPE on (which can be the case at times) but instead of asking us to please put a full compliment of PPE on, they ask us to leave the scene and remain at our truck until they deliver the pt to us. More often, they simply don't want us involved in "their" scene until they are done playing and they don't allow us access to the pt.
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There are grants for Globe EMS gear. www.emsgrantshelp.com

Further, your Chief, and the Rescue Chief need to have a pow wow. That is no bueno, and needs to end, forthwith
 
pamedic983 said:
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.
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I think there is an artificial separation of "rescue" and "patient care."

Just as well there is an artifical seperation of managing the scene and caring for the patient.

Is the EMS provider who wants to extricate a patient through an accessible passenger door providing lesser quality rescue than the volunteer fire chief who wants to cut the driver side door open after he cuts down the tree it is against?

Does a rapid extrication with minimal care benefit somebody with a prolonged entrapment? What if freeing the person from said trap will complicate their medical conditions?

Qualified is also a very contentious issue. Is the experienced, professional inner city firefighter serving on a part time EMS unit greater or lesser qualified than the volunteer fire chief? Is the PA, NP or other advanced provider serving in the role of paramedic greater or lesser qualified to make a medical decision in contra to the paramedic supervisor? Is the volunteer firefighter who is also a chemical engineer lesser qualified than the professional fire captain, when he probably has years more work in thermal dynamics?


Better still, who determines who is more qualified? Is it a rank? Could I start a private EMS company get a 911 contract and list my title as Fleet Admiral? Doesn't that out rank "chief?"

Hell I could call myself ensign for that matter and outrank "chief." ;)

You think interagency fighting between fire, police, and ems is rough? Add in ones like a hospital.

Ideas like ICS and NIMS are great on paper. You want to sell me on the idea, get it to work. The federal government can mandate all they like. They can hand out dollars like they are pennies for all the radio equipment and other BS gadgets galore, but until they start funding quality people everywhere, it is all piss and wind, not worth the paper its printed on.
 
I think the powers that be really need to open a dialog on the subject. It sounds like this is more of a symptom of a problem than the problem itself. I have to ask Why? Why would the fire guys remove EMS from a scene with a hurt patient? It's easy to say it's due to ego or jerkdom, but there's more likely another reason. They may not be assured of your abilities or your safety. You stated that you may not have proper PPE. If I'm in the middle of extricating someone from a rig, the last thing I want to do is become personally responsible for the PPE of anyone who wanders onto the scene. I may not have the time or inclination to explain in detail the why's and wherefores involved.

This type of dialog can't be done on a scene. It needs to take place in a meeting, more neutral. And it needs to be discussed maturely in a problem solving vein instead of like a bunch of stray dogs around a fire hydrant (pun intended)

Allowing the topic to go unadressed guarantees that it will come up again and again and each time with more emotion on each side. Because each side is making up their own interpretations and explanations for what has occurred.
 
BossyCow said:
I think the powers that be really need to open a dialog on the subject. It sounds like this is more of a symptom of a problem than the problem itself. I have to ask Why? Why would the fire guys remove EMS from a scene with a hurt patient? It's easy to say it's due to ego or jerkdom, but there's more likely another reason. They may not be assured of your abilities or your safety. You stated that you may not have proper PPE. If I'm in the middle of extricating someone from a rig, the last thing I want to do is become personally responsible for the PPE of anyone who wanders onto the scene. I may not have the time or inclination to explain in detail the why's and wherefores involved.

This type of dialog can't be done on a scene. It needs to take place in a meeting, more neutral. And it needs to be discussed maturely in a problem solving vein instead of like a bunch of stray dogs around a fire hydrant (pun intended)

Allowing the topic to go unadressed guarantees that it will come up again and again and each time with more emotion on each side. Because each side is making up their own interpretations and explanations for what has occurred.
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I think you hit the nail right on the head, great post.

Part of the trouble is if EMS is a seperate agency from fire they rarely have any kind of rescue education or training. The only non fire EMS agency I have seen that provides proper PPE for rescue ops was in NJ. In EMT or medic class we just spout "scene safety" and advise not to go into an unsafe scene. We don't even tell anyone what is safe or not. If you really do have to effect a rescue,(not outrageous in the prehospital environment) an untrained, unprotected person has no business there. But in my not so humble opinion EMS providers need to be part of the team because the whole point of rescue is for the victim, so if you cannot provide care you are quite useless. The least you can do is not interfere. (Of course some of the current fire guys need to realize some of us were fire guys at one time too and we do have a clue)

Any person who is not wearing the proper gear with the education of what is going on and the potential risks and complications should be anywhere near an extrication or any other rescue endevor. Add that to the list of educational requirements not being met by US EMS education.

Most EMS providers understand the danger a 2000 psi O2 cylinder represents but hasn't the perspective of a 6500-10,000 psi (depending on make and model) spreading or cutting tool that you are trying to do damage with.

Private EMS companies think PPE and training are expensive they should figure out what an injury or lawsuit for not providing care costs. If they are not providing care during a rescue, they are not properly serving the patients anyway.

(see I stick up for fire when fire is right) :)
 
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