Who's in charge of a scene?

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MedicDelta

MedicDelta

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It's not so black & white. If I had a patient that needed a cric and I, the off-duty medic did one, I would expect that two things would happen if it was done 100% correctly:
  1. I would expect to not be prosecuted thanks to Good Sam laws. Depending upon the state involved, I might also expect to not be sued successfully for the same reason.
  2. I would also expect to lose my local accreditation if I'm not explicitly authorized ALS skills off duty, and possibly my License as well, if I'm not authorized to do ALS "stuff" off duty.
There are 3 different processes in play: Criminal, Civil, and Regulatory. Good Sam laws cover the first two... Knowing what you're authorized to do while off-duty will help keep you from having problems with the third.
It must be different in Canada. I heard a story of an Advanced Care Paramedic who performed ET intubation on someone when he was working volunteer with St John Ambulance(volunteer first aid).
 
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MedicDelta

MedicDelta

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This topic comes up on the interwebz with surprising frequency, considering how uncommonly it actually happens.

In 15 years I've had two physicians on scene. The first, I was a new-ish paramedic responding to a call in a public place (I don't even remember what the call was for or where exactly it was), and when I got there, someone who happened to be a doctor was trying to make the patient comfortable while they waited for us. He identified himself and told us that if there was anything he could do to help, to please let him know, and then he stepped away. Second one was a serious multi-car MVC with numerous patients in a small, rural town that we responded to with 3 helicopters. When we landed on scene, an anesthesiologist from the nearby small hospital was wearing bloody scrubs just doing whatever he could to help EMS. The ED had sent him there to help when EMS called in telling OLMD that they had several patient who needed airway management. He intubated 2 patients, possibly saving their lives because they were pretty sick. He too, offered us any help he could before simply stepping away and letting us do our thing.

My point is not to rehash war stories, but just to illustrate how on-scene physicians usually work. In the real world, I've never even heard of an on-scene physician making things difficult and refusing to turn over care to EMS. I'm sure it happens occasionally, but it's a truly rare occurrence.
Thank you for your personal stories I appreciate it. I'm learning a lot already.
 

JPINFV

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I think you're more likely to have an green and anxious first responder or EMT show up on a scene vs an MD.

Pretty much this. I've been on scene once since starting medical school... and that was a roll over incident in the middle of nowhere (about an hour from anyplace) on the freeway that runs between LA and Vegas. There ended up being 1 person with no training, an off duty paramedic, an EMR, and myself (2nd year medical student at the time) there for a good 15 minutes before EMS arrived.

Anyone want to guess which of the 4 of us was freaking out and trying to call for a helicopter?
 

DesertMedic66

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Pretty much this. I've been on scene once since starting medical school... and that was a roll over incident in the middle of nowhere (about an hour from anyplace) on the freeway that runs between LA and Vegas. There ended up being 1 person with no training, an off duty paramedic, an EMR, and myself (2nd year medical student at the time) there for a good 15 minutes before EMS arrived.

Anyone want to guess which of the 4 of us was freaking out and trying to call for a helicopter?
Gonna make a wild guess and say it wasn't you or the off duty medic
 
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MedicDelta

MedicDelta

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Pretty much this. I've been on scene once since starting medical school... and that was a roll over incident in the middle of nowhere (about an hour from anyplace) on the freeway that runs between LA and Vegas. There ended up being 1 person with no training, an off duty paramedic, an EMR, and myself (2nd year medical student at the time) there for a good 15 minutes before EMS arrived.

Anyone want to guess which of the 4 of us was freaking out and trying to call for a helicopter?
I'm one of the athletic trainers for my high school football team and a couple weeks ago we had an opposing player go flying in the air and was complaining of severe pain in his lumbar spine and my first thought was "holy crap I gotta hold c spine on this guy and get a collar on". The other AT(who is less qualified than me with emergency care, but with plenty of experience as an AT) assured me that there was no need to do any of that but in my gut I still felt that we needed to. I've come to realize that things taught in training are not the way it works in real life. I am a newly certified EMR though and I'm sure I felt the same was as that EMR in your story. We're nervous and want to take every precaution possible because that's the way we're trained. If I was there alone on that day I probably would have been holding c spine waiting for the ambulance. I'm learning everyday though, from you guys, from the other AT on the team and from my dad who was a Canadian Forces Search And Rescue Technician and paramedic for 12 or so years. I don't know if I'd be calling for a helicopter though lol, on the football team it's a team effort and we make decisions together because we compliment each other with our certifications. We also had a paramedic sitting right there in the crowd who I knew and asked to help us out.
 

JPINFV

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Nothing wrong with holding c-spine. It was the entire, "OMG, WE NEED A HELICOPTER AND FLY THE PATIENT BACK TO VEGAS!"

I think one of the hardest lessons to learn in medical care is that when dealing with emergencies, either you control the scene or the scene will control you. Regardless of how much poop is hitting the fan, you can never let the scene control you.
 
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MedicDelta

MedicDelta

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Nothing wrong with holding c-spine. It was the entire, "OMG, WE NEED A HELICOPTER AND FLY THE PATIENT BACK TO VEGAS!"

I think one of the hardest lessons to learn in medical care is that when dealing with emergencies, either you control the scene or the scene will control you. Regardless of how much poop is hitting the fan, you can never let the scene control you.
I like that, thanks. I will keep that in mind.
 
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