Extrication vs. EMS question

[RMIII]

Here is a question my area agencies have been debating for years. On an accident scene with extrication in the works, what agency should handle the incident command?

Let me explain my situation. I am with a Rescue Squad, where all we do is Extrication. We respond with EMS, that solely does patient care, no extrication. During an extrication we always have a fire department on scene with a charged hose, but the FD's also do no extrication. Theoretically, EMS handles the patient care while Rescue handles the extrication. FD is just there with no responsibility except in case of fire.

I know where I stand, that Rescue should be the group calling the shots on extricating the patient, but EMS disagrees. What do you say, and is there a set standard?

[This message has been edited by RMIII (edited 04-02-2001).]

[fireman_387]

does EMs send enough personell to set up command? Usually they send just enough for the incident. If all EMS are invoilved in patient care they can not manage a scene. However, one thing to remember EMS is responsible for patient care in that they can control some of the scene functions as necessary.

[Carl Avery]

My Humble Opinion, Who ever does the extrication should be the agency in charge. That is not to say that the EMS "sector" Does not have a responsibility to be Pro-active in there advocacy for thier patient. And we need to remember that the patient is the primary reason we are there. Now having said all that, The Extrication Team Has a responsiblity for the OVERALL Safety of the scene and those on the scene including the patient. To say that EMS should have overall control, to me presents an unbalanced scenario. Also, by the very nature of their profession EMS' main focus is the patient. It therefore makes sense to me that they could not adequately assume control for the whole package. Sure EMS has an huge responsibility for the patient and any Scene Comander that does not take their input into full consideration is a fool. Another point in regards to this is the number of personnel available. Typically where I am from EMS consist of a Two or Three personnel per Ambulance in some areas You may also get a "Fly Car" with a supervisor. I present to you for EMS to assume Overall control is a gross misuse of personnel. Command is a task unto itself, The Incident Commander should not be involved in Direct Care, Direct Extrication or Direct Scene Stabilization / hazard Mitigation. The IC's Job is to coordinate these areas so the the patient recieves the ultimate in care while assuring the safety of all parties involved. Again this does not seem to me to be an area where EMS has a prime responsibility. Working together we all achieve more!

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Rescue is the Art & Science of matching your tools, talents and tricks to needs of our customers!
Carl D. Avery

[Nick SBFD 6]

Here the answer is simple, by law the highest ranking fire official is in charge, period.
From the smallest fender bender to the gand daddy of 'em all, the fire department is in charge. Is this the right way? well in my town it is because we do all the extrications. We have a seperate Ambulance squad, and even though we are in charge on a scene, we don't tell them how to treat their patients. (the last thing we need is some fresh out of school medic telling our 15-20 year veterans trying to pull rank because he can put on a band-aid) but anyway, It works for us If there was a third party for tool jobs I could see a potential problem, especially if the departments don't get along.

[FireDan]

The simple answer in most cases would be that the Fire Department should be the incident commander at this type of rescue scenario (the primary role of the fire department is to protect lives and property, which just happens to be our objective). However; we need to be realistic, this is going to be a multijurisdictional response, with each element playing a vital role in the successful handling of the incident. Regardless of the level of training that a fireperson has, they are probably not able to make informed decisions to the proper course of action to be followed by law enforcement community, nor to the EMS community either. Similarly, the EMS folks are equally ill equipped to make fire or law enforcement decisions. And certainly there are very few law enforcement personnel that are trained to make fire and EMS decisions. Therefore the only viable solution is for the members of all the agencies that are apt to be involved to sit down and hammer out a unified command scheme that will best satisfy the demands of your locality. Our first responsibility is to ensure the safety of all response personnel. Once we accomplish that, doing the right job with the right people should almost become second nature to us.

[Ron Shaw]

To be completely honest, I don't think that there is really a simple answer to this thread. I have taught extrication programs in areas that the fire service does not perform vehicle extrication at all. And the firefighters are not allowed to pick up a tool unless so requested by the extrication sector. The fire service may not be on scene and ICS is still used.

For those of you in the Millville, NJ area, this is one example of a well organized ambulance service that does vehicle extrication and county technical rescue. Millville does have a fire department, however the paid private ambulance service, which was once volunteer, is dispatched through the county fire network for mutual aid.

While this may be hard for some of to understand at first, including myself. I can honestly say their professionalism is outstanding and ICS is established by the Millville Rescue (ambulance service) senior person on scene.

On arrival, the ambulance service assumes command of the incident. Millville Rescue (ambulance) has an excellent medium+ rescue truck with well trained extrication specialists. While this may be hard for some of us to realize, it does happen throughout the country in certain areas.

One problem we have in our industry is trying to understand the other departments that don't operate the same way we do.

Some of us may only respond to an incident with minimum manning, while others have more people than tasks. We all have to learn to work with each other and the systems which are used. Even if the accepted way is for the other guy to assume command.

In my area in MA, the fire service would be the first to knock on the door of another agency that performs vehicle extrication. However, there are other agencies such as in Millville that are unique in the fact that they are responsible for performing the task of extrication. The ambulance service is not the only other service to perform vehicle extrication, the special services division of the NYPD vehicle extrication as does the NYFD. Cooperation in this dual role must be considered unique; who has control of a scene if the police are first in, I don't know. But you have to be pretty brave to tell a guy with an automatic weapon to back off your taking over!

I think what really is important here is cooperation and maintaining a proper code of conduct while working with other agencies that may not be operating in a manner which may not be normal to our own way of SOPs.

I was the IC of a heavy truck accident, the MA State Police were on scene there was no who's in charge. When it came to a point of where it was a police matter I just took a back seat a cooperated with the senior trooper. As a fire officer, I was in command for our service.

As far as jurisdication, I think you may find that some states may have a law that will mandate who is in charge. Perhaps someone from NH can clear this up, I was told that the police by law are in charge of an incident.

Personally, cooperation will work a long way instead of coming in like gang busters and taking over or trying to take over. It will also show the other agency that you have respect for them and that may help you in the long run. Unless there is an issue that warrants your action and there by assuming command, try to resolve minor issues after the fact when individuals are a little calmer. This is one of the reasons why we should be practicing post incident analysis after an incident.



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Ron Shaw
http://www.extrication.com

[RMIII]

Thanks for your comments, Ron. I would have to say I completely agree with you that ultimately, cooperation is the key. It really is what keeps our system running here, what with EMS doing the patient care and Rescue doing the extrication. There are times, however, that department "arrogance" gets in the way (with both sides I admit), and then the question arises again, who is ultimately in command. It doesn't help either that Rescue is 100% volunteer and EMS is 100% paid career. I find this competition useless and I do my best to avoid it, because it really comes down to personal pride most of the time and could possibly end up costing in patient care all of the time.

Cooperation and teamwork is essential on any scene and that is something we all need to work on constantly.

[This message has been edited by RMIII (edited 04-04-2001).]

[firefighter26]

From an IC aspect, I guess our department has it pretty well off.

We are the only show in town when it comes to any emergency service.

Ambulance: an average 10-20 minutes away.
RCMP (police): 10 minutes on average.
Our department: 5 minutes to anywhere in the district.

When things are going down we are the first on scene. Our IC controls everything, even the ambulance and police. Of course, they have their own jobs to do, but if our IC tells to do something, they do it. In any case, EHS rarely strays far from their unit anyway. We do all the extrication and patient care. Once they are out, ambulance takes over. As for the PD, they normally get to take over traffic control, or in some cases, start it (our OGs say we are allowed to block the entire highway).

Everyone knows that when it comes to an MVA, we call the shots.

[cfr3504]

In our area, the fire department is in charge of the overall scene. The police are in charge of police matters, but the IC (fire dept) can over ride any decision made by the police (ie letting traffic pass) if it makes the scene unsafe, or hampers rescue or fire suppression efforts. The EMS provider is in charge of Patient care, and which ever agency that handles extrication is incharge of the actual cutting, but not the scene. In my particular department, there isn't any problems, beause we do all fire, ems, and extrication. But I have worked with other agencies before, and the biggest thing is cooperation. Fire department has much greater responsibility than just incase of fire. We are in charge of total scene saftey.

[Litch]

Are there any state laws or regulations that apply to your situation? Some areas have regulations that mandate who is in charge of patient care (and by extension, extrication) at an accident scene.

[CAPTAIN WHO]

As stated in other posts this is a multi jurisdictional function with each group bringing in special skills.

We run a Fire/Rescue Dept. EMS is contracted.
In our zone Fire/Rescue runs the scene. We consult heavily with EMS, We give them access as quick as possible. They then decide who comes out first and complications they see inside.

"We remove the vehicle from the casualty, EMS removes the casualty from the vehicle".

[HYTHE FIRE DEPARTMENT]

We rarely have a problem with who has control at an MVA scene. As far as I am concerned, If there are three agencies on scene (fire, police, EMS) it should be a team effort. Each department has their own concerns that they are trying to look after.

Our department is concerned about scene safety, access to the accident, staging in such a way to protect the crew, patient safety and the extrication process.

The Police are worried about scene preservation for investigation purposes. If we come roaring in and park on the skid marks, and we make a set of our own, they get a little testy. Even though we take care of the traffic control, they have a concern about keeping traffic moving. Now the Police in our area will never step in and say we can’t stop traffic because they say so, but will politely ask us if it would be safe to send a single lane of traffic through. They understand our needs for a safe scene, and if we would prefer not, they leave it at that. Likewise, we understand their needs for evidence preservation, and to keep traffic moving. These are important concerns, as we do not want to destroy evidence that could convict the DUI that caused the accident in the first place. I would hate to have the DUI kill some one, and get off because we ruined the evidence scene

The EMS are worried about patient care and access, and some times may not be tuned to the hazards that are still present. They understand our needs to make sure the scene is safe prior to their access to the action circle, and thus will not enter until we say so. Like wise, when it comes to extrication, the EMS crew usually calls the shots on which exit path to make, and how big to make it. In many cases, the EMS crew will only call for the door to be opened past 90 degrees in order to execute a quick patient removal rather than spend time on removing the whole door. At the same time, we still maintain control by pointing out the dangers of their request (i.e. roof flap on vehicles with side impact curtains), and suggest safer alternatives.

Once the patients have been extricated, control reverts to the Police who will need to investigate the accident. We basically remove ourselves from the scene, and let them do their thing. As we take care of traffic control on most scenes, they will request us to stop traffic at times in order to complete their investigation.

The bottom line is that the Fire Departments in our area still call the shots at the scene, but that does not give us the God given right to ignore the concerns and needs of the other two agencies at the scene. We all work together at the scene making for a smooth operation.


[This message has been edited by HYTHE FIRE DEPARTMENT (edited 04-05-2001).]

[ALSfirefighter]

I agree HYTHE, its called unified command, and believe it or not..it works. It just takes some persons on each side to let go a little ego. Carl, I also understand and agree with some of your points. But who's to say you don't have an EMS I/C, and have an Extrication "sector," for the FD. Just a flip side of that section of your post. RMIII, I don't understand exactly how your trying to get your point across on how "rescue," I just say that because where I'm from we don't always use a rescue for extrication, should be calling the shots on patient extrication. If you mean, how to get the patient out. Yes your right, we are the ones that have the technical training to do that. But EMS will tell you how far you may have to go. You are there to assist EMS, EMS is not there to assist you. Why cut off a roof if all you have to do is pop a door. What if another medic tells me he wants to scoop and go, but I disagree because I feel a full extrication is needed? As a fire service instructor who has taught fire and ems on vehicle extrication/rescue, I have found that the most arguments come from just fire or just EMS personnel and not Fire/EMS. I have never had just a EMS person tell me how to cut/pry a car, just like I've never had just a firefighter tell me how to treat my patient if I'm the Paramedic on-scene. But being that we do both, we have excellent communication and trust each other. Plus our Chief(s) and the BLS ambulance Officer(s) get along well. I also have similar experience as Ron does where the ambulance ran "crash" trucks, this aided in the event that the all vollie FD couldn't get out and extrication was needed. Just thought I'd add to the conversation. Excellent posts everyone!!
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The above is my opinion only, it doesn't reflect that of any dept./agency I work for, deal with, or am a member of. I also do not partake in bashing, nor do I attempt to bash anyone, so if you feel that way, I apologize, but its not intended to be that way.

[Carl Avery]

IMHO, I may have not articulated well, I just think, typically that the Scene often extends beyond the patient, Who ever is responsible for the Scene should be the IC, Now stop, I also say this (as I did before)that any IC in the situation that I propose that did not work closely and take into full account what the EMS Sector input was would be a fool and fully held acountable for their actions. We are there for the patient, that is true, but when we loose sight of the BIG Picture we are asking for trouble

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Rescue is the Art & Science of matching your tools, talents and tricks to needs of our customers!
Carl D. Avery

[RMIII]

Originally posted by ALSfirefighter:
I have never had just a EMS person tell me how to cut/pry a car, just like I've never had just a firefighter tell me how to treat my patient if I'm the Paramedic on-scene

Here's the point. We have had Paramedics attempt to tell us how to cut or pry. In fact, on a couple occasions, we actually had a paramedic try to take over and do the extrication himself. Now, in my opinion, this is a Bozo-No-No. No helmet, no gloves, no turnouts, just simply impatience. A big part of the attitude from EMS is that they are the paid "professionals" and we are just the unpaid volunteers. We then have a tendency to reciprocate a "like" attitude out of sheer defense. While we are unpaid volunteers, we are still professionals trained to do the job. It's offensive when, as a department, we are considered anything less.

This is not the norm around, though. For the most part, EMS and Rescue have worked well together. Both agencies have always been seperate, and at one time a long time ago were both volunteer. Most of the time teamwork is excellent. But isn't it true how one or two bad instances will be remembered more than the good ones?