Who makes the call?

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Squad-6

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I am no longer in public safety. I was a fireighter/emt for 8yrs and am still state licensed, I have a coworker who is a full time firefighter/first responder for the county in which I usually work. If by happenstance we are first on a medical call then who is "in charge" I am not clear as to who is responsible, me as the higher trained or the guy who is officially "suppose" to be there in a way.

I ask because me and this guy do not get along but found ourselves in this situation. A cop who was 2nd on scene(an old friend of a friend) who vouched for me and told this guy to follow my lead. It was awkward. I usually leave it to the "professionals" but when I head the call on my coworker's pager for a child not breathing very close to us I had to run to it.
 
Squad-6 said:
I am no longer in public safety. I was a fireighter/emt for 8yrs and am still state licensed, I have a coworker who is a full time firefighter/first responder for the county in which I usually work. If by happenstance we are first on a medical call then who is "in charge" I am not clear as to who is responsible, me as the higher trained or the guy who is officially "suppose" to be there in a way.

I ask because me and this guy do not get along but found ourselves in this situation. A cop who was 2nd on scene(an old friend of a friend) who vouched for me and told this guy to follow my lead. It was awkward. I usually leave it to the "professionals" but when I head the call on my coworker's pager for a child not breathing very close to us I had to run to it.
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If you aren't with an agency, you are in charge of nothing.

Nevermind running to a call you were not dispatched to. You know you need a medical director to act as an EMT right?
 
Who ever is on duty is in charge regardless if the off duty person has higher training..
 
I think you should worry less about who is in charge, and worry more about patient care.

Is everything getting done that needs to be done? Are they managing the patient appropriately? If so, chill out and figure out what you can do to be helpful - gather name/DOB/PMH/meds/allergies from the parents (and write that info down for the crew who will be transporting), go grab the stretcher and get started setting up extrication, etc.
 
In my first responder class, there was a big explanation on "who's in charge," although I am not fully sure I understand it.

My understanding is:
-- The highest medical qualification is in charge.
-- If medical qualifications are equal, the one with the ambulance is in charge.
 
RedAirplane said:
In my first responder class, there was a big explanation on "who's in charge," although I am not fully sure I understand it.

My understanding is:
-- The highest medical qualification is in charge.
-- If medical qualifications are equal, the one with the ambulance is in charge.
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Its going to change based on where you are at. Some areas fire is always in charge. Others its the ambulance crew. Others it is who ever was on scene first and even others have it where the highest medical authority on scene (regardless if its fire or ambulance) is in charge.
 
If you're not employed in EMS and don't have a medical director, you can't practice. So you're not "in charge".

And why are you listening to your friends pager and responding to calls?

It seems like you're more concerned with exerting your "dominance" then doing what's best for the patient. On scene of a call ( not even your call)is not the place to be comparing stick sizes to see who's bigger.
 
COmedic17 said:
It seems like you're more concerned with exerting your "dominance" then doing what's best for the patient. On scene of a call ( not even your call)is not the place to be comparing stick sizes to see who's bigger.
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Compensating...

In all reality you should let the people on duty be in charge of patient care regardless if they're a higher or lower medical authority than you. If you want to be "in charge" then get hired with an ambulance company or fire dept. Don't be the guy barking orders at other people when you're off duty and they're not, especially when you're no longer in public safety.
 
Just because somebody on location may have a higher practice level does not automatically mean they are "in charge".

Everybody who is present is accountable for what happens both individually and as a team. At an incident where more than one crew are attending, for example a cardiac arrest, somebody does need to take an overall leadership role but it doesn't necessarily have to be the person with the highest practice level, particularly if that person is required to be actively involved in treating the patient. The person leading should ideally, wherever possible, not take an active role in treating the patient, doing so makes it easy for them to become "distracted" and lose sight of the "big picture". There have been a number of cases where patients have experienced clinically significant delays in reaching hospital because the "big picture" was lost, specifically how close the patient was to hospital vs time to get backup.

Ambulance personnel always own the medical aspects of an incident when working with e.g. the fire service or police. The same is true, e.g. when picking somebody up from the GP, the GP is not automatically "in charge" just because they are a Doctor, if they wanted to do something incredibly stupid ambulance personnel have a responsibility to speak up.

There seems to be a little bit of the old notion senior staff are automatically in charge and must not be questioned and junior personnel are to be seen and not heard still around, such a notion is dangerous and unhealthy, it must cease immediately.

At large or complex incidents there should be a formally appointed ambulance manager, but this person is more about liaison and logistics rather than individual clinical decisions.
 
Here is the way I see this. If you go to the scene and are not credentialed with a service and working under the authority of a medical director in that area, you are not in charge once someone who is shows up.

I can understand going to a scene for a PNB if you're closer than the ambulance, or you personally know the patient well, but you are only a bystander and can only preform basic first aid/CPR/AED until they get there and can take over.

You also have to define what you mean by in charge.

In charge of
Patient care? No
Patient extrication? No
Patient Advocate? Everyone is a patient advocate.
Flagging down the ambulance so they don't have to hunt for an address? please
Directing emergency personnel to the patient? Sure
Giving emergency personnel an initial Hx, set if vitals, etc..? If they can be obtained without exceeding your non-existent scope of practice.
Offer a suggestion to the EMT driving on where might be the best place to park for patient access and efficient egress? Sure why not, like maybe "hey they're in the back yard, you might get better access if you go around the side of the block and come up the easement." or "The patient is upstairs down the hall in the last room on the right, the stairs are pretty narrow, you will probably want a stair chair or long board." Though keep in mind they don't have to listen to you.
 
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