Input please on outsiders helping on scene

[dougd]

My dilema is this: on numerous occassions, someone has identified themselves as a medic/nurse, and have expected to take control of the scene. Some have been upset when I've politely explained that while I appreciate their offer, I have to ask them to step aside... Am I wrong for expecting someone claiming to be a medic/nurse relinquish the scene once I'm there, or refusing their assistance?

Nope, you're not wrong - it is your scene. Anyone who has any field experience or street time is going to understand that and offer to be an extra set of hands for you, but isn't going to be offended if you decline.

Your protocols may already address this. The guideline protocols by the Ohio Regional Physicians Advisory Board include the following: (Obviously, these don't apply where you are at, but I would suspect that the state of Nevada has something similar. )

ON SCENE EMT INTERVENER

On a EMS run where an unknown EMT from outside the responding EMS agency wishes to intervene in the care of patients, the following steps should be initiated:

1. Ideally, if no further assistance is needed, the offer should be declined.

2. If the intervener's assistance is needed or may contribute to the care of the patient:

a. An attempt should be made to obtain proper identification of a valid Ohio EMT card. Acceptance of borderline states' EMT cards are at the discretion of individual EMS services. Notation of intervener name, address and certification numbers must be documented on the run report.

3. Significant involvement with patient care or variance from protocols will require the intervener to accompany the patient to the hospital.

PHYSICIAN AT THE SCENE

GOOD SAMARITAN PHYSICIAN

This is a physician with no previous relationship to the patient, who is not the patient's private physician, but is offering assistance in caring for the patient. The following criteria must be met for this physician to assume any responsibility for the care of the patient:

1. Medical Control must be informed and give approval.

2. The physician must have proof they are a physician. They should be able to show you their medical license. Notation of physician name, address and certification numbers must be documented on the run report.

3. The physician must be willing to assume responsibility for the patient until relieved by another physician, usually at the emergency department.

4. The physician must not require the EMT to perform any procedures or institute any treatment that would vary from protocol and/or procedure.

If the physician is not willing or able to comply with all of the above requirements, his assistance must be courteously declined.

PHYSICIAN IN HIS/HER OFFICE, OR URGENT CARE CENTER

1. EMS should perform its duties as usual under the supervision of Medical Control or by protocol.

2. The physician may elect to treat the patient in the office.

3. The EMT should not provide any treatment under the physician's direction that varies from protocol. If asked, the EMT should decline until contact is made with Medical Control.

4. Once the patient has been transferred into the squad, the patient's care comes under Medical Control.

http://www.ems.ohio.gov/policies/EMS_Guide...rocedures07.pdf

[letmesleep]

Ruffems, As I stated, you were the first one there, you turned over care, and waited to pass c-spine appropriately.....your absolutely right she treated you like crap and that is uncalled for. a simple thanks for your help and c-spine maintained, and you would have stepped back as a professional. She pushed you by being an ass, and you should have gotten an apology for that. If I'm wrong let me know, but the original poster described people showing up to help after they were on scene.....my question is why? can't these "professionals" see that help has arrived, and go back to dropping their quarters in the slots? Really,Why?

mshow00, Really, I see it as a professional maintaining MY scene. again as I stated, If I needed the help and you offered, you would be put to work....step on my toes and your gone. I do believe that is the topic of disscusion here. Helping is one thing, but sticking your nose in, and trying to take over is, oh so different. With that said if I don't need any more help, you will get a polite thank you unlike what happened in Ruffems story. Burnout? I think not, what if the tables were turned on you, and I showed up then started pushing you around on YOUR scene? Is that cool with you? help is one thing, being polite is another, but pushing me around is harmful to the Pt....agree or disagree?

[Just Plain Ruff]

to the OP, if they show up and offer to help then by all means if I'm overwhelmed with a critical patient and it's just me then darn it I'll take theirh elp till EMS gets there.

If I don't need their help then I'll say thanks.

The minute that they try to take over scene is when we have a issue.

Letmesleep, here is one other experience I had.

drove up on a bad rollover. One firetruck was on scene. No ambulance in sight.

5 patients, 3 ejected and one pinned in. The side of the firetruck said "ALS Rescue Truck"

I got out of my car. Walked up, said I was a medic from Clintom MO, and asked if the 2 firemen needed help. I was told "No, the ambulance will be here in about 10 minutes." WTF?????? I said "you have 5 patients here and 2 of you" He repeated "we don't need any help" I said "this is your scene but can you really handle all 5 patients with just two of you" He said, "You can leave, we have it under control" Well, I just don't take No for an answer and I told him unless he is a medic then I'm going to help these people. I assessed them and said "you are gonna need 2 more ambulances and at least one helicopter" At that time the fire cheif arrived on scene.

He asked me who I was and I told him. I also told him that his crew told me to leave. He about blew a gasket. We started to treat the patients and started packaging three of them. The chief also ordered 2 additional ambulances and one helicopter. After all the patients had a ambulance crew to take care of them I went back to my car.

The chief came up and asked me more about what the fireman said to me and I told him. As I looked in my rearview mirror I could see the chief having an animated discussion with that fireman.

So the question is this, there was fire already on the scene. 5 injured patients and not a EMS unit in sight. Did I do the right thing by refusing to leave and starting to assess the patients or should I have left? I feel I did the right thing. who knows.

[letmesleep]

Good one, You made a choice to stay and help for sure. I would have to say that the 2 to 5 ratio is a little overwhelming for anyone. I would have to say that I agree with your decision here, but let me do my own back tracking for a second. You pulled up, did a quick size up, and decided to get out and help. There was NO real emergency medical help on scene ie: ambulance(s). even an ALS rescue truck can be a little under stocked for what you threw out on the table. I would be curious as to what the FF's were getting chewed for....would it be for not putting you to work, or for their attitudes? Maybe I didn't make my opinion clear.....Anyone of us who offers help, and then tries to take control is the whacker!

With that all said, how did you handle things after EMS started to arrive, did you maintain control of the scene or turn it over? Again, if it was you showing up, and someone "off-duty" was there.....how would YOU expect them to handle themselves? It doesn't sound like we are on the 2 opposite ends of this discusion, and I'm sure we can go back and forth with "what if's", but it seems to me that with all that has been said so far the question in play is.....Where/ when have you (generic) crossed that line of professionalism? How about this question, and simply stated......Duty to act?

[ERDoc]

To the OP, since you are the one that is responsible, you are the one in charge. As others have said, be gracious and accept the assistance but tell them what to do. I'm sure you already know this, but besides not being able to confirm their title you also can't confirm their blood alcohol level. There is no need to be rude (I'm not saying you were). Just be courteous and if their help is not needed just say, "Thanks for the offer but we're good."

Ruff, both of those stories suck. Good for you for sticking up for yourself and not letting inept providers get away with it. Those FFs obviously missed the class on sizing up a scene. Are you changing the stories though? Is it any cooincidence that you, "roll up" on these things? I'm betting you are a whacker with a scanner in your car and run to them when you hear them dispatched.

[letmesleep]

oh, oh, and Ruffems....my answer to your question is YES, I might have done the same thing. As long as you slept well that night knowing that you did the right thing, then yes.

[firedoc5]

It's your job, your "house", your scene. If it's something that you may need a little assistance with let them help. But by all means, do not them take control of the scene or control of the patient from you. Personally I would thank them for the offer. If they storm off, that's their problem. If they hang around you may ask for their assistance, which would be your call. But they don't need to take over and actually treat as if they were at their own job. How would they like it if you went to their place of employment and ask if you could take control of their patient(s)?

And I don't know how many times I've had the same thing. So many of those times it was someone claiming to be what they aren't. Or even if they were, how much had they had to drink while in the casino? I wouldn't place the life of my patient, or my job in jeopardy with someone who might be a little "tipsy". One thing you might ask them is if they would be willing to go to the hospital, and later on to court if it came to that. You'd probably see the dust fly from them taking off.

[dougd]

I tend to get sucked in to providing support for bike tours, fund raisers, runs and the like - character flaw, I'm sure. Inevitably, I end up in the middle of someone else's turf and try to remain cognizant of that fact. For example, just last month I was down at a state park supporting a 100-mile ultra run. (For the record, anyone who willfully participates in a 30-hours, 100 mile foot race is probably a good candidate for a 72-hour evaluation, but I digress... ). We received a call on the radio about a female patient, witnessed syncopal episode with about 2 minutes LOC. I asked for a squad to be dispatched and my partner and I headed over and assessed the pt. Once the local VFD showed up, I turned the patient over to the paramedic on the squad, gave the crew a patient report and told them, "Ok, I'll be standing over there if you need anything else."

[letmesleep]

ok, I'm going to throw this out there. don't know if it's the right way to handle this or not, and credit to DAHLIO for posting this on the " GREAT PSA" thread......agin my apology if I didn't do this politically correct, but check out this link:

http://youtube.com/watch?v=6ZafgFvHTTo

just thought it fit!

[firedoc5]

ok, I'm going to throw this out there. don't know if it's the right way to handle this or not, and credit to DAHLIO for posting this on the " GREAT PSA" thread......agin my apology if I didn't do this politically correct, but check out this link:

http://youtube.com/watch?v=6ZafgFvHTTo

just thought it fit!

You mean we can't play crochette(sp?) anymore?