MCI Question

[TAPSJ 30]

Guys And Gals. I Need Help.

What Is An MCI Level 1?

And What Does It Mean?

Also, How Many Levels Are Thier?

And What Do They Mean?

Thanks In Advance.

Thomas

[pd125 0]

Guys And Gals. I Need Help.

What Is An MCI Level 1?

And What Does It Mean?

Also, How Many Levels Are Thier?

And What Do They Mean?

Thanks In Advance.

Thomas

Depends on the system you work in. The levels in Dutchess show the amount of ambulance responce. Out on the street you count and give that number to the 911 center. The level will reflect the number of patients you called in. They also will bring in the rest of the gang,Rescues, manpower, etc.

[helicopper 1,050]

Depends on the system you work in. The levels in Dutchess show the amount of ambulance responce. Out on the street you count and give that number to the 911 center. The level will reflect the number of patients you called in. They also will bring in the rest of the gang,Rescues, manpower, etc.

OK, so how many levels and how many patients and ambulances for each in the Dutchess system? How many other counties or EMS systems have such designations?

[Bnechis 3,961]

Guys And Gals. I Need Help.

What Is An MCI Level 1?

And What Does It Mean?

Also, How Many Levels Are Thier?

And What Do They Mean?

Thanks In Advance.

Thomas

Section 8. MCI LEVELS Predetermining the response based on number of patients will save time. Requests for EMS resources will be made in Task Force* format. A Task Force consists of three (3) BLS Ambulances, two (2) ALS Ambulances or two (2) additional BLS Ambulances and two (2) ALS equipped paramedics (two fly cars or one double fly car) and two (2) supervisors or senior line officers.

MCI LEVEL NUMBER OF PATIENTS *MOBILIZATION OF

1 Up to 10 one (1) task force

2 11-25 two (2) task forces

3 26-50 four (4) task forces

4 51-75 six (6) task forces

5 76-100 eight (8) task forces

6 100+ ten (10) task forces

(plus additional resources as decided by the IC) *The Task Force concept is intended to address ALS & BLS needs along with the need for assistance in the management positions, interagency liaisons and communications. Clear text should be used for all radio communications. If there are multiple ambulatory patients, a bus or buses should be requested from the municipality or County.

This is from the Westchester EMS Mutual Aid Plan

http://www.westchestergov.com/emergserv/em...lanDec03-v5.pdf

Edited May 6, 2008 by Bnechis

[bil14ga 1]

In Dutchess County the MCI levels are a little different from Weschester. A Level one in most of the local departments will get you an ambulance. Additional levels of MCI will get you 5 ambulances to the scene, two ambulances relocating to different stations for backfill, and two more ambulances on standyby in their quarters. The county CAD is set up for five levels of MCI. After that I am not sure what happens.

[helicopper 1,050]

In Dutchess County the MCI levels are a little different than Weschester. A Level one in most of the local departments will get you an ambulance. Additional levels of MCI will get you 5 ambulances to the scene, two ambulances relocating to different stations for backfill, and two more ambulances on standyby in their quarters. The county CAD is set up for five levels of MCI. After that I am not sure what happens.

[confused] "An" as in one ambulance for a declared MCI? How many victims constitute a level 1 MCI? [confused/]

[Guest alsfirefighter]

Section 8. MCI LEVELS Predetermining the response based on number of patients will save time. Requests for EMS resources will be made in Task Force* format. A Task Force consists of three (3) BLS Ambulances, two (2) ALS Ambulances or two (2) additional BLS Ambulances and two (2) ALS equipped paramedics (two fly cars or one double fly car) and two (2) supervisors or senior line officers.

MCI LEVEL NUMBER OF PATIENTS *MOBILIZATION OF

1 Up to 10 one (1) task force

2 11-25 two (2) task forces

3 26-50 four (4) task forces

4 51-75 six (6) task forces

5 76-100 eight (8) task forces

6 100+ ten (10) task forces

(plus additional resources as decided by the IC) *The Task Force concept is intended to address ALS & BLS needs along with the need for assistance in the management positions, interagency liaisons and communications. Clear text should be used for all radio communications. If there are multiple ambulatory patients, a bus or buses should be requested from the municipality or County.

This is from the Westchester EMS Mutual Aid Plan

http://www.westchestergov.com/emergserv/em...lanDec03-v5.pdf

Barry thanks for sharing that and I have read it before and that's about it.

I doubt most fire and/or EMS providers/commanders/supreme allied commanders don't know anything about that.

I haven't had a chance to look over the red binder thingy's the county made and issued being I don't think they've been made available where I operate but is it in that information? If not perhaps the "leadership" or management of county agencies can begin to work with DES to get that in the next order or have a equipment/mutual aid book made up similiar to what Rockland is (was?) doing listing all available resources.

[Bnechis 3,961]

Barry thanks for sharing that and I have read it before and that's about it.

I doubt most fire and/or EMS providers/commanders/supreme allied commanders don't know anything about that.

Funny...Never considered we would be doing MCI's on the west coast of France.

I haven't had a chance to look over the red binder thingy's the county made and issued being I don't think they've been made available where I operate but is it in that information? If not perhaps the "leadership" or management of county agencies can begin to work with DES to get that in the next order or have a equipment/mutual aid book made up similiar to what Rockland is (was?) doing listing all available resources.

Its not in there

[PC_420 28]

Funny...Never considered we would be doing MCI's on the west coast of France.

Its not in there

Haha. That was just so funny! I just started laughing so hard.

When I get to work I'll give you a line up for Putnam how it works.

Of course by the time I am done writing it up, it will cause us to have to have to use it. I hate karma.

Edited May 6, 2008 by PC_420

[Danger 160]

In Dutchess County the MCI levels are a little different than Weschester. A Level one in most of the local departments will get you an ambulance. Additional levels of MCI will get you 5 ambulances to the scene, two ambulances relocating to different stations for backfill, and two more ambulances on standyby in their quarters. The county CAD is set up for five levels of MCI. After that I am not sure what happens.

Really? We called a Level One last week and got 5 ambulances, with two on standby in our stations. Unless they upgraded to a two and it wasn't in the CAD.

[Goose 188]

Really? We called a Level One last week and got 5 ambulances, with two on standby in our stations. Unless they upgraded to a two and it wasn't in the CAD.

Arlington's 3 + 2 outside?

[Guest]

Any number of patients more than ONE is by definition an MCI. Calling a Level 1 MCI for 2 patients is a bit crazy, but one may choose to do so.

[Guest alsfirefighter]

Vacguy I've actually never have heard it that way or have seen it in any curriculums if you can PM me and pass that on to me I'd appreciate it in the event its updated info so I current.

I've always been taught, have read and have used in teaching and the field that generally around the 5 patient area is a "MCI" or any number of patients that taxes your resources to its limits. 2 patients isn't really uncommon I would say for most of us and shouldn't tax our systems...if it does you have personnel staffing issues. The 3 or 4 range depending on number of vehicles shouldn't be that overall taxing either...double up vehicle occupants.

One thing that I often see is that you get a fair amount of patients and the mad dash is on to get them all off scene and to the hospital immediately. Triage triage triage...and make a decision on what order your patients will go. If a person with minor complaints has to wait for 10 minutes to get off scene then you do what you have to do. When I have multiple patients the first thing I do is get a count and by visual try to figure out how many buses I will need and request them, then I assess each one and then formulate their needs in my head by injury Often its of no circumstance and they are all BLS or just 1 is ALS. In the cases that are multiple ALS then I make the decision based on patient condition/status. I assess, take care of an immediate threat to life if need be, and/or assign a BLS provider(s) to stay with the patient to contiune care and start the process to get that patient moving and I move on the next. By then additional ALS providers will arrive or I focus on the most critical/needy patient.

Barry I always have liked that dry wit, lol.

[Guest]

Vacguy I've actually never have heard it that way or have seen it in any curriculums if you can PM me and pass that on to me I'd appreciate it in the event its updated info so I current.

sure thing

[Danger 160]

Arlington's 3 + 2 outside?

Yeah, IIRC we had 3 BLS w/4 or 5 medics, Lagrange 47-72, PV 56-79 to the scene. PV rerouted to standby at HQ. Alamo and Transcare on standby.

[Medibart 55]

The textbook definitions I've seen is that an MCI occurs anytime the number of patients are too great for your current resources. If you have 2 ALS patients and only one medic, technically you can consider that an MCI.

I think sometimes we put so much weight on the term MCI. We think of an MCI as a huge incident with multiple sectors and officers and vests and command posts. Think of the last time you had a 3 patient minor accident that required 2 ambulances. Someone probably triaged the 3 patients, directed people to immobolize them and decided which patients were going to go where and in which ambulance. Without a major declaration someone was incident command, triage officer, treatment officer and transportation officer and it was probably all the same person. Therefore, again without a declaration, an MCI occurred and was, even if subconsciously, handled with standard MCI management techniques.

Vacguy I've actually never have heard it that way or have seen it in any curriculums if you can PM me and pass that on to me I'd appreciate it in the event its updated info so I current.

I've always been taught, have read and have used in teaching and the field that generally around the 5 patient area is a "MCI" or any number of patients that taxes your resources to its limits. 2 patients isn't really uncommon I would say for most of us and shouldn't tax our systems...if it does you have personnel staffing issues. The 3 or 4 range depending on number of vehicles shouldn't be that overall taxing either...double up vehicle occupants.

One thing that I often see is that you get a fair amount of patients and the mad dash is on to get them all off scene and to the hospital immediately. Triage triage triage...and make a decision on what order your patients will go. If a person with minor complaints has to wait for 10 minutes to get off scene then you do what you have to do. When I have multiple patients the first thing I do is get a count and by visual try to figure out how many buses I will need and request them, then I assess each one and then formulate their needs in my head by injury Often its of no circumstance and they are all BLS or just 1 is ALS. In the cases that are multiple ALS then I make the decision based on patient condition/status. I assess, take care of an immediate threat to life if need be, and/or assign a BLS provider(s) to stay with the patient to contiune care and start the process to get that patient moving and I move on the next. By then additional ALS providers will arrive or I focus on the most critical/needy patient.

Barry I always have liked that dry wit, lol.

[helicopper 1,050]

Any number of patients more than ONE is by definition an MCI. Calling a Level 1 MCI for 2 patients is a bit crazy, but one may choose to do so.

Not really... By definition, a mass casualty incident is going to be more than two! I've heard the term "multiple" casualty incident used as well but never for just two patients. Five has always been the rule of thumb that I've been told.

The textbook definitions I've seen is that an MCI occurs anytime the number of patients are too great for your current resources. If you have 2 ALS patients and only one medic, technically you can consider that an MCI.

I think sometimes we put so much weight on the term MCI. We think of an MCI as a huge incident with multiple sectors and officers and vests and command posts. Think of the last time you had a 3 patient minor accident that required 2 ambulances. Someone probably triaged the 3 patients, directed people to immobolize them and decided which patients were going to go where and in which ambulance. Without a major declaration someone was incident command, triage officer, treatment officer and transportation officer and it was probably all the same person. Therefore, again without a declaration, an MCI occurred and was, even if subconsciously, handled with standard MCI management techniques.

True but I don't think "declared MCI levels" start until a minimum threshold is reached. The point about doing all the MCI management techniques is a good one and we should pay attention to those basics so when the MCI is really a mass one, the techniques are not foreign!

[INIT915 1,119]

The textbook definitions I've seen is that an MCI occurs anytime the number of patients are too great for your current resources. If you have 2 ALS patients and only one medic, technically you can consider that an MCI.

I think your exactly right.

[meat441 43]

Maybe the first question asked should be, WHAT DOES M.C.I. MEAN?

M.C.I.

MASS CASUALTY INCIDENT= Large amount of patients sick or injured.

MULTIPLE CASUALTY INCIDENT= Incident involving more than one patient sick or injured. But limited in amounts.

MAJOR CASUALTY INCIDENT= Incident which can create a number of sick or injured patients. I.E. Fire, Hazmat, High-rise fire, Transportation, Stand-by event which could include hundreds to thousands attending.

How can we utilize a (specific number)? 1-100 patients LEVEL#1, 101-200 patients LEVEL #2? Numbers aren't the answer.

Why not look at the available resources current or required.

Lets take a small town that has 3 BLS unit's available from it's EMS system. 10:00 a.m. on a Wednesday morning. Maybe that town can provide only 1 BLS unit for that time period.

Lets take that same town at 8:00 P.M. Wednesday evening. I bet that same town could provide all 3 BLS unit's will full crews?

1 BLS unit Wednesday morning at 10:00 a.m. handling an MVA with 7 Green tag patients. This type of patient count would tax their available (LOCAL RESOURCES). Correct?

3 BLS unit's Wednesday evening at 8:00 p.m. handling an MVA with the same 7 Green tag patients. Would this incident now tax the (LOCAL RESOURCES).

Maybe what needs to be identified is (time of day). Available resources from Local, County or State.

GREAT DISCUSSION! A LOT TO DISCUSS?

LETS KEEP IT GOING. I would like to hear what others think when it comes to MCI's

[ny10570 745]

I thought Medibart covered it pretty well. Anytime the number of patients exceeds your capacity. One medic with a complicated L&D you potentially have an MCI. 5 stable patients complaining of headaches because of Diesel fumes not an MCI because I had 5 seats available (and they say there's no room to work without a super mod). It also doesn't mean you have to bang out the MCI task force.

[Medibart 55]

I wouldn't think of it as local resources, more on scene resources. If you need 10 ambulances and you are in a large city that has 10 ambulances (like NYC) you may not have taxed the local resources but it's still an MCI.

As far as the different classifications - that's up to local policy. As stated before, Westchester County has a mutual aid plan that defines the various MCI levels. This will vary from region to region.

Maybe the first question asked should be, WHAT DOES M.C.I. MEAN?

M.C.I.

MASS CASUALTY INCIDENT= Large amount of patients sick or injured.

MULTIPLE CASUALTY INCIDENT= Incident involving more than one patient sick or injured. But limited in amounts.

MAJOR CASUALTY INCIDENT= Incident which can create a number of sick or injured patients. I.E. Fire, Hazmat, High-rise fire, Transportation, Stand-by event which could include hundreds to thousands attending.

How can we utilize a (specific number)? 1-100 patients LEVEL#1, 101-200 patients LEVEL #2? Numbers aren't the answer.

Why not look at the available resources current or required.

Lets take a small town that has 3 BLS unit's available from it's EMS system. 10:00 a.m. on a Wednesday morning. Maybe that town can provide only 1 BLS unit for that time period.

Lets take that same town at 8:00 P.M. Wednesday evening. I bet that same town could provide all 3 BLS unit's will full crews?

1 BLS unit Wednesday morning at 10:00 a.m. handling an MVA with 7 Green tag patients. This type of patient count would tax their available (LOCAL RESOURCES). Correct?

3 BLS unit's Wednesday evening at 8:00 p.m. handling an MVA with the same 7 Green tag patients. Would this incident now tax the (LOCAL RESOURCES).

Maybe what needs to be identified is (time of day). Available resources from Local, County or State.

GREAT DISCUSSION! A LOT TO DISCUSS?

LETS KEEP IT GOING. I would like to hear what others think when it comes to MCI's

[Guest]

ALS, i cannot find that info u asked for. by chance Meat posted more or less what i know about the definition(s) of MCI.

Medibart, i think your on target. all agecies are different, so having the agencies create their own policies on MCI's is beneficial. I think the problem lies at the general membership for not knowing their SOP's for MCI. When i train for MCI's i always see the same people at the drills. Another problem is their are dozens and hundreds of others who do not attend the drills and do not know the MCI SOP's...this is a problem. I still know people who don't even know what the hell a trunking radio is...

how does anyone in the emergency services in westchester county NOT know about these radios? God forbid they're on the day an MCI happens.

[TAPSJ 30]

Thanks Guys This Is A Big Help. Does Anyone Know The Dutchess County Protocall For An MCI???

Thomas

[bil14ga 1]

I posted the MCI response as I sat at the watch desk the other night and typed the response for the MCI as I looked right at it. I believe when the MCI level 1 was called the other day, the dispatcher understood that the IC needed the next level and therfore dispatched it. It could be different for the other departments in the county, but the assignment i put up earlier is Fairviews. Hope this answers the questions.

Chris

[pd125 0]

Thanks Guys This Is A Big Help. Does Anyone Know The Dutchess County Protocall For An MCI???

Thomas

The Dutchess plan is tailored to the fire distriict,City, that the incident is in. The first alarm assignment then fill in of ambulance-fire/rescue that is needed. The plan is sent to Chiefs and EMS operations for changes and updates. Fire/EMS gets on scene gives a patient count that gets the ball rolling.

[Guest emtb23]

In my opinion, MCIs are a huge weakness of the EMS system that we have in northern westchester. I've never had to deal with a large incident, and although we have periodic drills and whatnot, I really hope the day never comes.

The problem is that we don't need a plane crash at the airport to overtax our system. Here's an example:

Imagine a 3 car MVA with 6 patients on one of the highways in Northern Westchester. Let's say 3 of them are ALS. I get on scene with my BLS ambulance and medic intercept. I'm already in trouble for the following reasons:

1) Chances are, due to MOI, all of these patients could be considered "major trauma" and should be taken to the medical center by ALS. We can fit two patients in a rig, but each medic only has one set of ALS gear (monitor, etc., as far as I know), so a case can be made that I need to call and ask for 5 more ambulances and 5 more medics. I have no idea where these ambulances and medics would be coming from, but given the location, I think that the 5th patient could easily be waiting 30-45 minutes.

2) Let's say I approach the scene from an MCI mentality and start the whole green/yellow/red business. I call for more ambulances and ALS units. Given response times in the area, it might be 15 minutes before the most critical patient gets transported. A more likely manifestation of this problem is the following, and I have had this happen: 2 car MVA with 4 patients, big SUV vs. little honda. The two SUV patients are RMAs, the two in the little honda need to get to WCMC ASAP. I call for another ambulance mutual aid, but I can get the two little honda patients packaged and ready to go 10 minutes before someone shows up to RMA my SUV pts. In an ideal world there'd be a bunch of EMTs on scene to RMA the SUV guys while I'm packaging the hondas, but that never happens. Now I'm sitting on scene with 2 possibly critical patients who are waiting for me to either RMA the other two or for another rig to show up and do it. I've mentioned this scenario before and people have thrown around the idea of leaving an EMT on scene if there's an extra with some equipment, but I'd be awful uncomfortable doing this.

3) The recently-posted stat-flight dispatch protocol says that a helicopter should be called when an MCI threatens to overload local resources. It also says to notify dispatch if I'm going to need more than one. Getting back to the original scenario, according to that protocol, how am I supposed to know if I should call none or one or two birds? Theoretically, and this seems unrealistic, I would know how long it will take each of the next 5 (most likely VAC) rigs to show up, and if the times are high enough I'd call for the helicopter. Is that realistic, though?

[ny10570 745]

emtb23, everything you have here is exactly what makes EMS so tough and so much fun. There are extremely few hard and fast answers. Just a lot of guidelines to get you headed in the right direction. This where clinical discretion comes into play and it allows you to break just about any rule or guideline (so long as you don't try and operate above your training) if you are doing it to better care for your patient and you can justify why you did it.

1. You do not need ALS for a mechanism based trauma transport. There are three reasons to take ASL with you; underlying medical condition that is actively causing harm to the patient, an unmanageable airway, or hypovolemic shock. Since these are mechanism of injury based trauma calls unless they are complaining of something medical roll on out, their airway should be intact, and they shouldn't be bleeding too severely.

2. You have two critical pts on scene packaged and ready to go and two RMA's standing around get your giddyup on. No medical director on earth will hang you for leaving two non patients so you can treat people with life threatening injuries. If the pts are not critical, the call becomes tougher. Do you wait till they start to circle the drain and get your RMA's or do you take off. So long as you asses your RMA's, properly inform them of their decision and have them sign, who says you can't fill out the paperwork after the job. I've been called to jobs just to get RMA's and as much as it sucks if the crew had a good reason to spilt its completely understood.

3. Its extremely unlikely you'll be able to get lifenet anywhere faster than the local VAC or ALS flycars. While they can be an excellent resource at MCI's they aren't going to be any use that early in an incident.

[Guest emtb23]

I don't disagree with you, ny. The problem is that the decisions made when things are interesting and challenging are the ones that leave us open to litigation.

1) Why don't you think there are times when MOI-based ALS request is appropriate? I was under the impression that that was the whole point of that part of the major trauma protocol. Granted, it also says not to delay txp. to hospital (like any other ALS-request, we don't wait on scene for them), but my point originally was that if you had all of the resources in the world, these patients could fall under ALS-appropriate care due to a prolonged extrication, rollover, etc.

2) I also don't disagree that the most reasonable-sounding thing to do is to leave the two RMAs on scene and get going with the two criticals. But isn't that textbook abandonment? In the unlikely event that one of them decides to code 2 minutes after you leave, you're screwed, right?

3) Stat flight says call them when ground txp. > 30 minutes and the helicopter could do the whole job faster than an ambulance could. I also agree with you that conventional, reasonable thinking wouldn't dictate calling a helicopter in this sort of situation, but if all of those patients really required ALS care, don't you think txp (and even VAC response by the 5th due rig) > 30, and stat flight would be far faster?

Edited June 13, 2008 by emtb23

[helicopper 1,050]

I don't disagree with you, ny. The problem is that the decisions made when things are interesting and challenging are the ones that leave us open to litigation.

1) Why don't you think there are times when MOI-based ALS request is appropriate? I was under the impression that that was the whole point of that part of the major trauma protocol. Granted, it also says not to delay txp. to hospital (like any other ALS-request, we don't wait on scene for them), but my point originally was that if you had all of the resources in the world, these patients could fall under ALS-appropriate care due to a prolonged extrication, rollover, etc.

2) I also don't disagree that the most reasonable-sounding thing to do is to leave the two RMAs on scene and get going with the two criticals. But isn't that textbook abandonment? In the unlikely event that one of them decides to code 2 minutes after you leave, you're screwed, right?

3) Stat flight says call them when ground txp. > 30 minutes and the helicopter could do the whole job faster than an ambulance could. I also agree with you that conventional, reasonable thinking wouldn't dictate calling a helicopter in this sort of situation, but if all of those patients really required ALS care, don't you think txp (and even VAC response by the 5th due rig) > 30, and stat flight would be far faster?

You can't work in this business (any emergency service) with the mindset that this will "leave me open to litigation" or "will I get sued if I do this - or don't do that?". If you do your job within your training and protocols without biases or discrimination you have nothing to worry about. If you or your ageny do get sued, so what? There's no basis for a judgement against you.

As for your comments,

1. Assessing the mechanism of injury is a valid component of a patient assessment but it should not be used by itself! A rollover does not an ALS patient make. I've seen prolonged extrications for patients with ankle injuries so the extrication alone is not a determinant that ALS is required. Start with the PATIENT then factor in all the environmental considerations to confirm or support your findings. If you consider the environment first there's a good chance you'll miss stuff with the patient.

2. If PD or FD is on the scene, leave the RMA's with them and transport the criticals. If not, have them sign the refusal and go. Don't delay transport of critical patients to babysit refusals. In the event that a patient crashes after you leave any other RMA would you be screwed? Of course not! If you have an extra EMT and want to leave him with the RMA's until other EMS arrives, do that if it will make you feel better.

3. If you have six patients you don't necessarily need six ambulances. Double up the patients - with the monster rigs around now that's not an issue - and transport. Now you only need three. Given Life-Net/STAT-Flight's response time, treatment time, and transport time, it's going to be at least 30 minutes. Can you use them? Sure. Should you? That's a judgement call. Every situation is different and there may be compelling reasons not to use them today and equally compelling reasons to use them tomorrow. You can't lock yourself into a single decision now.

EMS requires good judgement and decision making skills - that's why we have QI/QA programs, to understand what happened and why people did what they did. Good decisions get highlighted as what to do and bad decisions are learned from so we eventually stop making the same mistakes! Get involved in your agency's program and develop these skills and you'll ultimately be a better EMT.

[Guest emtb23]

1. Assessing the mechanism of injury is a valid component of a patient assessment but it should not be used by itself! A rollover does not an ALS patient make. I've seen prolonged extrications for patients with ankle injuries so the extrication alone is not a determinant that ALS is required. Start with the PATIENT then factor in all the environmental considerations to confirm or support your findings. If you consider the environment first there's a good chance you'll miss stuff with the patient.

I may be wrong, so maybe someone can clarify: I was under the impression that MOI can be used without any other information to qualify a patient as a major trauma (under the Adult/Peds major trauma protocol), thus qualifying the patient for ALS response and transport to a trauma center. The reason for this, I assumed, was that internal injuries don't always manifest themselves in predictable ways and in the field it may be impossible to determine the extent of someone's injuries. So if someone falls 20', for example, even if they have what I think is just a broken bone, I still call ALS and take them to the med center (not the closest hospital).

edit: the adult major trauma protocol that EMSJunkie posts below is what I've been referring to.

2. If PD or FD is on the scene, leave the RMA's with them and transport the criticals. If not, have them sign the refusal and go. Don't delay transport of critical patients to babysit refusals. In the event that a patient crashes after you leave any other RMA would you be screwed? Of course not! If you have an extra EMT and want to leave him with the RMA's until other EMS arrives, do that if it will make you feel better.

If the PD/FD is a licensed first response agency, then I don't see a problem with leaving patients on scene with them and taking the (more) criticals. But if they're not, how is this different from abandonment (provided you don't RMA)?

Edited June 13, 2008 by emtb23