Response to Medical runs

[Fire 160]

Do any of you out there have SOP's regarding fire dept. response to medical runs? Our FD is being dispatched to runs w/o an ambulance (ex. an elderly person fell out of bed and needs help up). Our concern is what made the person fall in the first place? Don't get me wrong, we don't have any problem assisting the public in this situation but who is going to be in the hot seat if the person codes later in the evening???

Just looking for ideas.

[SilverCity4]

...Paging Dr. Law...Paging Dr. Law...

Can I assume that your firefighters are medically trained and would recognize a potentially life-threatened condition if they were presented with such?

If in doubt about a victims condition, call the bus and have them sign a refusal form.

I'd consult an attorney and see if you could draw up your own form that's sort of a "refusal to call an ambulance" or something to that effect, for when it's pretty darn obvious that they don't need an ambulance.

Here's a thought: are you any more liable in this situation than you would be if you went to a "smell of smoke call" and found nothing, yet the house burned down six hours later? I hadn't really thought about it in those terms before.

[weir33]

There are some things to consider here. Are you going because EMS can't go or won't go. If its becauce they won't go I would be doing a text book primary/secondary survey and focus on good vitals and history,pass the info to EMS and let them make the call,get the name, unit# or some id of the person your talking to. Also document every action down to the color of the pen used to right the report. Another good idea is errors and ommisions insurance. There are examples of refusal forms in the back of the brady prehosp. care text books Good luck....

[Weruj1]

where I work we screen all EMS calls for assistance .......if there is any indication they might be hurt vs. needing assitance then the right amount of help is sent .......very rarely do we send someone on an Assitin(service)call and they need an ambulance for a NON-LIFE threating situation. EMD's get done for US ........

[ 01-22-2002: Message edited by: Josh Drouard ]

[POC1813]

My department requires the ambulance be dispatched if someone calls for assistance. We looked long and hard at this situation, and decided that was the best way to cover ourselves.

[BFD196]

In our district, if there`s a medical call, we go with the ambulance. Most other districts just run life threatening. If a person is continually falling out of bed or something, we`ll usually cancel the medics upon arrival, if they aren`t hurt.

[EMT135864]

It is in the best interest of all involved, especially the patient, to have an ambulance dispatched as well. The engine can get there, assess, assist, and cancel the ambulance if it is unwarranted. This is, of course, assuming that the fire personnel responding on the run are medically certified. If they're not, then how can the pt refuse treatment without being properly assessed? It is in the better interest of the patient to have the ambulance dispatched with the engine and then cancel it, instead of not having it dispatched and needing it, then you have to wait even longer. EMD is a wonderful thing most of the time, but it doesn't work if the FD isn't medically certified.

[ALSfirefighter]

In my dept. the ambulance usually gets dispatched for assists mentioned in the first post. We run EMS and would get sent to the above if there is no ambulance immediately available. Or if dispatch can assertain if forcible entry may be required. For us only our BLS engines would respond. So they have the ability to assess and RMA if warranted. Or contact medical control for assistance or an RMA AMA. We also provide ALS flycar service which obviously does the same.
Fire160 you have a dispatching problem. If you are being sent to medical runs w/o an ambulance you need to change it. If you are running as a first response provider, then follow your training and protocols regarding RMA's. I agree with you being in the public eye. EMS is one of the greatest PR tools for the fire service. Direct hands on interaction person to person. Not stomping through a house breaking things and not explaining why you are. However, this is not a normal assitance call. And your dispatch needs to realize that and make a change.

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The above is my opinin only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of.

[firecat1524]

We run the "I'VE FALLEN AND I CAN'T GET UP" calls withour EMS if our dispatcher has determined from the caller that there is no need for emergency medical response. When we arrive on the scene, if there does appear to be a need for EMS, we initiate patient care and call for a transport unit. We have only had maybe one or two calls where we needed EMS to respond...so I don't see where this is much of a problem. To respond an EMS unit on every one of these type calls is a misallocation of resources in my humble opinion.

[bfcf623]

Fire 160, I can understand your situation. My department does not have SOP's for this in particular. Thats left to our dispatchers and the medical priority dispatching. Speaking personally sometimes I have cancelled an ambulance after arriving on scene and checking the patient and determining there is no need for a transport. Some people loose their footing and fall, some black out and fall, some people get injured when they fall and some don't, the combinations are endless. We all understand there's an ethical and moral obligation to do whats in the best intrest of the patient. If that means holding there hand telling them do not be embarrassed about tripping on the carpet and helping them back in a chair or bed then so be it. I always tell people "Never be ashamed of calling for help, I am happy everything turned out okay and if you need us again don't hesitate to call". During your assessment if you find more to it than that or have a "gut feeling" (even during the dispatch) do what your trained for and make sure appropriate help is sent to assist you. Providing good medical care is your best defence and whether an ambulance is sent or not document everything. Hope this helps.

[CollegeBuff]

A "floor to bed" type call used to get an ambulance by itself. Nowadays I've been noticing a trend towards sending an engine (all personnel EMT-C certified) by itself- especially if it's during a rush and most of the ambulances are on runs. That's just in my city. Next one over sends a solo engine everytime no matter what.