Protocol For Resonding to EMS Calls

[Guest]

I was just wondering what other departments SOP's were for people resonding to EMS calls in their POV's if they are CFR or higher. My department has a paid city engine which responds on all calls and volunteers are able to either respond to the fire house or the scene depending on the call. Our new SOP is to respond to the firehouse for every EMS call regardless if its your neighbors house or you are driving by the scene. They brass wants the paid city engine to take the EMS call and the volunteers to respond the the firehouse for station coverage. I think this is kind of a foolish SOP becuase we are all certified MRT (CT's version of CFR) or EMTS. I was scolded today by the Captain for responding to the scene of a stroke whenI was literally a block away. I was just wondering what other departments do in terms of responding to EMS calls. This SOP was just put into effect.

[danb 10]

This is a very iffy subject.

In my FD we run medicals and although we permit POV response, its getting better as in the sense of people are comming to the firehouse more!

Generaly an EMT will respond to the call via POV park out of the way with the keys in the car still in case it has to be moved. I think its important to have an EMT at the scene as soon as possible, but i am a firm believer that everyone else should go to the firehouse ( except for your officers).

The big problem i see is you get people who respond POV who arent certified and in the end just stand there with their thumbs up you know where.

I think ( at least in my department) there can be some improvements to the whole EMT POV situation ( its not really bad even) by issuing EMT's radio's. I mean if i live 2 miles from the firehouse, and a mile and a half from the scene and i dont hear an EMT responding to the scene thats closer than me why should i jeporidze the patient by going to get the rescue ( and hopefully then you have a driver also)

I think if your department thinks it all out, and explains a procedure to all EMT's and forbid non EMT's to go to the scene and there is some way of knowing that you have an EMT on scene, and the others can go get the rescue to assist for prolonged operations ( up here sometimes its tough for VAC to get out ) and FD might be there for a while with the patient

[Guest]

In my town in Connecticut , here is the deal. A volunteer crew staffs the ambulance at HQ 24/7. If a call comes in, they respond and if someone lives close to the location of the call, they can respond and initiate care ahead of PD and EMS. For backup calls, usually one person goes to grab the rig while another person close to the call responds in their personal vehicle. Essentially, any member can respond to any call in their personal vehicle. However, the main thing we are taught is to put our vehicle in a location htat will not hinder emergency vehicles as they arrive on scene.

[ny10570 745]

For most medical emergencies what can you do for the pt by arriving in your POV. Assuming you have your own equipment, unless its an arrest or an injury what can you do for the person? Now if you have an emergency that you can make a difference with who's to say while you were driving down the street you weren't flagged down when they saw you driving by.

[Amato122 0]

what is this hatzollah? Unless you are a medic with a full compliment of drugs and intubation kit you have no business being on scene before the ambulance. Even if you are a "super buff" with your own BLS bag and 02, what are you gonna do "air and stare, while you wait for the bus from 3 towns over(because this is how it always seems to go down)"? You're just gonna sit there and piss the family off, because you are not rapidly transporting their loved one to the hospital.

Instead respond to your FD or VAC with a driver and get to your patient and commence with the glorified taxi service that is basic life support EMS. The only time you should respond directly to the scene is maybe for an arrest, and only if you know your volly outfit will definitely get a crew out, and it is down the street from your house. I know there are a lot of guys (and gals) out there who get their rocks off rushing into someones house and announcing they are an EMT, but these people need to realize this is not a game or hobby for the people actually calling 911. It is a cruel world out there and it is very easy for one to get sued or get their a__ kicked. Stay safe people and get those buses out.

[AFS1970 504]

If the reason for not responding to a scene is because all you can do is "Air & Stare" then we really shouldn't be sending Fire units at all. My district is surrounded by 3 or our city's 4 EMS stations. Even on serious calls it is rare that I get a long time on scene before a Paramedic Ambulance arrives. We work very well together here between Fire & EMS, but most of the calls in the EMS system are "Air & Stare" type calls. (by the way, I like that term, I've never heard it before).

But supposing it is a call that doesn't require Oxygen. If a certified & qualified home responder is able to get to the scene safely and quickly and determine that the entire Engine crew is not needed and can free the apparatus up and wait for EMS then I can't see how that is a bad thing. Having someone who is not bringing an appropriate level of care to the scene is useless however. Adding extra MRT's to a scene full of EMT's is (most of the time) going to be one of these cases.

SOP's are written for a variety of reasons, but are usually in the best interest of the department. If a station often gets multiple simultaneous calls, then station coverage during EMS calls is paramount. If this is not the case, then the last thing you want to do is create a boy who cried wolf mentality among your volunteers, and have them get used to not responding because they are never put to good use. Encouraging non-response is one way to injur of kill a volunteer system.

[Guest]

what is this hatzollah? Unless you are a medic with a full compliment of drugs and intubation kit you have no business being on scene before the ambulance. Even if you are a "super buff" with your own BLS bag and 02, what are you gonna do "air and stare, while you wait for the bus from 3 towns over(because this is how it always seems to go down)"? You're just gonna sit there and piss the family off, because you are not rapidly transporting their loved one to the hospital.

Instead respond to your FD or VAC with a driver and get to your patient and commence with the glorified taxi service that is basic life support EMS. The only time you should respond directly to the scene is maybe for an arrest, and only if you know your volly outfit will definitely get a crew out, and it is down the street from your house. I know there are a lot of guys (and gals) out there who get their rocks off rushing into someones house and announcing they are an EMT, but these people need to realize this is not a game or hobby for the people actually calling 911. It is a cruel world out there and it is very easy for one to get sued or get their a__ kicked. Stay safe people and get those buses out.

←

Couldn't agree more (except for the whole BLS EMS comment....). The less people O/S the better if you ask me. Its difficult to work in an environment where everyone wants to be the hero and your just trying to do your job.

Edited October 30, 2006 by 66Alpha1

[Amato122 0]

I apologize If I offended anyone with my BLS taxi service comment. I posted at 5am right before leaving for my job as an EMT in the city where I often feel "like a glorified taxi service" Sorry.

-Amato122

[RWC130 594]

If YOU are one of the following:

A: New York State Paramedic

B: New York State Emergency Medical Technician

C: New York State Certified First Responder

AND

YOU have BLS Equipment in your POV I see no problem in responding to a scene to begin BLS patient care. I've done it in the past numerous times.

Maybe you live close and the Ambulance is responding with a delay

or Mutual Aide is coming in.

You can do a little more than "Air and Stare"

FOLLOW YOUR SOP'S OR SOG'S ON THIS MATTER!

Just my two cents!

[Skooter92 7]

IMHO:

If your organization is going to allow first response, then create some rules like:

1) EMT 1st responders should have AEDs, O2 and enough stuff to make it a good idea to have them go in the first place. Only letting those folks with a clue do this sort of thing....that too. Test and educate them on a regular basis. Less embarassment that way.

2) Law enforcement gets there first, hopefully. If not, then stage away. depending on the call nature....because I have seen too many morons charge into calls for EDP's, injuries due to assaults or domestics, or overdoses. Run towards the cliff, ya lemmings....I'll be posted over here, with my Caffeine Free Diet Pepsi.

3) Limit how many show up on a scene. 66Alpha hit the proverbial nail on the head. 14 first responders is a bit much. OK, too fluckin' much.

[Guest alsfirefighter]

Amato...we all have bad days brother...but damn think before you speak/type.

Based on your analogy we should scrap all BLSFR, which is the national standard of care and has proven to increase survival rates. The point is someone should get there to start some form of care. Even if its 'air and stare' which could turn to the family staring at a person as they decompensate into respiratory then cardiac arrest. Also, there isn't much difference between a BLS glorified taxi service or an ALS glorified taxi for those borderline calls where its just protcol numero uno: Routine Medical Care: Oxygen, EKG, IV Access and that is all. Under the wonderful phrase "any condition which ALS intervention may be needed at any time until the patient arrives at the facility.

The only issue that I have dealt with and still occassionally see is when a person whom is just a driver responds to the scene to meet an ambulance on the scene when the bus is enroute with an emt/driver. A driver should not be making patient contact and should not be close to that scene unless the ambulance or another certified person is. This also goes with drivers cancelling an ALS unit. Even if the EMT on the scene says so it should be their voice on the radio doing it. I've even heard the comment numerous times "I can do what you do, you know. I just don't have the time to take the class." Well okay then, if you're so sure...take the class, take the test and show me your card and then we'll talk.

[res6cue 67]

This also goes with drivers cancelling an ALS unit.  Even if the EMT on the scene says so it should be their voice on the radio doing it.

←

That's being a little picky. Considering many agencies use point to point simplex portables, I can think of many occasions where the EMT would be inside the house attending to the patient and would direct the driver to "go cancel ALS" using the mobile radio. Nothing wrong with that scenario at all.

[Guest]

A driver or attendant has no authority to make any decisions relating to the care of the patient. Only a certified individual should be calling the shots, and part of that is requesting or canceling additional resources. I'll give you a for instance. I work in an area where radio coverage is rather shoddy, and portable coverage is even worse (its gotten better now that the ALS units have repeaters in them). Anyhow, because my portable is essentially worthless in any type of structure, you'll never catch me telling a volunteer attendant or driver to go out to the rig and call for or cancel resources. I'll call the 911 center's taped line on my cell phone, identify myself and make the request. After all, its my patient and my career at stake im not about to put either of those in a third party's hands.

Edited October 31, 2006 by 66Alpha1

[res6cue 67]

A driver or attendant has no authority to make any decisions relating to the care of the patient. Only a certified individual should be calling the shots, and part of that is requesting or canceling additional resources.

They're NOT making the decision, YOU are. They're simply the ones calling over the air to relay your message. By your reasoning, an Incident Commander should never let an aide, an apparatus driver or a subordinate call for or cancel additional resources at a fire scene, nor should anyone but that IC be the voice on the radio. Clearly that's not how it works, however.

a volunteer attendant or driver

Interesting that you would include the word "volunteer" here. Perhaps that more than anything else has to do with your reasoning? What if driving the rig was that person's career, not "hobby"?

[Guest]

I'm not talking about a larger incident where you have tiered leadership/accountability etc. I'm talking simply about a routine EMS call (i'm not a firefighter and have only a limited knowledge of how they operate). During a larger incident, incident commanders and the subordinate staffers are each trained (and likely cross-trained). The key, as i see it, is the fact that these individuals are trained. The instance I'm discussing is where you have an untrained individual acting as an intermediary - this doesn't sit well with me and i just don't agree with or practice (again i see this aspect of patient care as my responsibility not a third party's...so paid, volunteer, certified or not, i would be making the call) this. Anyone else can do as they see fit.

I used the word volunteer only because attendants and drivers are not employed as EMS professionals, they only exist under the volunteer system. Even if i were to be o/s with 100 paid guys, it wouldn't matter, i would still make the call. It's my patient, my treatment decisions, and my responsibility. Being paid or volunteer is irrelevant to me.

Edited October 31, 2006 by 66Alpha1

[Guest alsfirefighter]

Res6cue, its not a problem until it becomes a problem and I've had such an issue arise. The "driver" thought the EMT answered him a 'head nod' when asked if he wanted him to cancel ALS. The EMT was tied up in the moment and delivering care and asked out loud, "I wonder what is taking ALS so long" when the driver answered I cancelled them. The patient was significantly ill and became critical while they then had ALS turn around and intercept. We also do not have simplex radios so comm isn't a problem for us.

Have a situation occur where there is a detrimental outcome to a patient and watch the finger pointing occur. You may call it picky, it may sound picky, but often the things that are "picky" are small issues that can become large.

Let's not also mix apples and oranges, an aide calling or cancelling additional resources over the air is a bit different then talking about patient care issues. Also most dispatchers if an FD has aides will know their voice also. Any police dispatcher worth their salt would question any unit whose voice is different from what they know.

This isn't a career or volunteer issue, however I understand what Alpah is talking about. If I'm in a bus of a paid service, no matter it be FD based, 3rd party, private etc., the person in the seat next to me is certified. It is often on the volunteer EMS side of the house that uncertified persons drive and/or ride as an 'attendant.'

[WAS967 97]

I'm with ALS on his initial reply to Amato. Saved me a lot of typing in fact.

If all you do on a scene is "Air and Stare" you might as well get out of the business. I understand Amato's frustration with extended responses from agencies who have a hard time getting a rig out. But in cases where the rig isn't that far out, there is PLENTY you can do to aide the patient AND the crew that is enroute beyond just sitting there with your oxygen going and twiddling your thumbs. Vitals, History, Pyschological First Aid, Actual First Aid, gathering medications from the 4 corners of the house into a bag to accompany the patient to the hospital, taking care of the patients needs before they go (getting thier keys, purse, etc....making sure pets are taken care of, talking to concerned family over the phone, etc).

Our jobs sometimes go beyond patient care. If your not up to the extra stuff "because it's not your job" you need to rethink your career choices.

[INIT915 1,119]

If the EMT and Driver cannot communicate face-to-face regarding making very simple radio transmissions, maybe some agencies should consider integrating that into their training programs.

We all have those partners who we don't look forward to working with, but I would think if there is such a barrier as outlined in this thread, some significant changes are needed.