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  • #16
    Oh, should I even dare to comment. OK, I talked myself into it. Some of my previous posts may have hit on this subject, but I will continue. Unified ICS will work in this situation, only if all of the parties involved know what unified command is. There are some areas of our county that have EMS "Rescue Squads", and it even works for them, sometimes. In my opinion, unless you have at least Fire and EMS "officers" as part of Unified Command, you may as well let the EMT in the rear holding C-spine have command. You need to have both the technical end and the medical end to have a safe and careful "rescue" not recovery or additionl "rescues". I have taken shots at hot shot medics in the past, but that was personal on selected few. I believe in our County EMS has command at "rescues". Bob, if I am wrong, please correct me. We have a generally OK working relationship with the "away" squads, and are lucky enough to have a good one in our local. We are primary fire and rescue for our local, but assist in three other townships as rescue only. If your state or county says who the Authority Having Jurisdiction is, well if you are unhappy, sorry. Be safe. Also, Carl, excellent post.

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    • #17
      FIRST OFF, FOR ALL YOU OLD TIMERS IN THE FIRE SERVICE, STEP AWAY FROM THE DINOSAUR YOU FELL OFF OF AND RELIZE THAT IT'S NOT ONLY THE FIRE SERVICE THAT'S DOING RESCUE OF ANY SORT ( INCLUDING VEHICLE EXTRICATION ). REMEBER THAT SAYING OF LIFE BEFORE PROPERTY ? WELL WHO BETTER TO MAKE THE DECISIONS ON PATIENT REMOVAL AND PACKAGING THAN THE HIGHEST TRAINED PERSONNEL ON SCENE ( EMS ). A LITTLE SCENARIO FOR YOU. A PERSON IS STUCK UNDER A VEHICLE OR A PIECE OF MACHINARY ( COMPARTMENT SYNDROME ). WHO WILL MAKE SURE THE PT SURVIVES THIS SCENARIO (. EMS ). THE MEDIC WILL BE ABLE TO ANSWER ANY QUESTIONS YOU OLD TIMERS HAVE TO THESE MEDICAL PROBLEMS. OLD TIMERS OUTCOME OF SCENARIO ( PTS DEAD BUT WE WERE ABLE TO LIFT THAT HEAVEY VEHICLE ). THAT'S NICE GUYS. AND FOR THAT GENTLEMANS STATEMENT THAT THE MEDICS WILL BE ABLE TO PUT BAND AIDS ON PEOPLE, GET BACK ON THAT DINOSAUR AND LET THE NEW PROFESSIONALS DO THE JOB THE WAY IT'S SUPPOSE TO BE DONE.

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      • #18
        Things may be different up here in Canada, but if you want to play the scenario game, here is one.

        We get called to an MVA on the highway. A T-bone. Our luck was with us, and it wasn't a high speed collision.

        Our FRs have already put a hard collar on the passanger and there is more then enough access to bring her out with spinal control. EHS comes along, practically pulls our head responder (also a captain) off the PT and procedes to take the hard collar off and moves the head and neck in an attempt to see if it is broken!!!! Then EHS puts the hard collar back on and lets her get out without and spinal!!!!

        Our department trains specifically for PT care at MVAs. Once they are out of the vehcile, EHS can take over.

        I respect that things are different everywhere, but when it comes down to the dirty work, let the guys with the right tools and training do the job. It doesn't matter who it is, as long as it gets done right.

        [This message has been edited by firefighter26 (edited 04-14-2001).]

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        • #19
          Look at what was started, them vs. us. well I hate to break this tailboard chat up but I take exception to what WASIE205 said. I am not a dinosaur, as you may have put it, nor am I a "new professional", but I am a person who has learned alot from "those dinosaurs". Just remember who opened the doors (no pun intended) to the way extrication is done today. It is a combo of both old school (open up and get em out) with new school (where to open em up and get em out without getting hurt). This forum is for training and new ideas of "OUR Profession", not a target range. Most of the "old school" people are learning more and more about EMS issues and procedures. So if you want to take shots at people, do so in your mind and not on the keyboard. Sit back and enjoy this web site and the people who post, you may learn something. just ny two cents. Nothing more. Have a great day! Be safe.

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          • #20
            I was involved one time with a boat into a pier crash with 3 injured. The location of the crash fell into a grey area that put this call in any one of 3 fire districts, 3 EMS districts, and 4 LE districts and the US Coast Guard. All possible districts were dispatched on this too. Technically speaking, b/c this incident occured on the water, the USCG was ultimately incharge. What ended up happening that night was that the CG took control of stabilizing the vessel that had crashed and any fluid spills on the water, and provided an officer for the command post. EMS took control of coordinating which rig took what pts in and sectored off the EMS staging area and the actual scene (they couldnt get a rig down to the actual scene) as well as provide a medic for the command post. Fire mitigated any fire hazards with the land based units and used my depts rescue boat as a ferry to get pts from the scene to the staging area while the CG had our other boat in use to help them as well. The EMTs on the actual scene were from my dept, the USCG and the other land based fire depts that were dispatched. EMS had a person down there to coordinate with the ambulances as far as when the pt left the scene on a boat and what kind of injuries they were looking at. LE did a whole lot on this incident. Access into the staging area was very limited so they blocked off traffic into the area with one agency, the marine units provided a second transport boat, and secured the scene on both sides of the pier with their other avail. units and the other units on scene provided crowd control and investigation functions. All were represented in the command post.

            Each specialty was left to do their thing but everything had to be highly coordinated. This is why ICS works..9 agencies were on that call..and not one questioned who was in charge of what. Everyone talked and worked out a plan of action that worked for all and everyone got their job done quickly and efficiently.

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            • #21
              Originally posted by WASIE205:
              FIRST OFF, FOR ALL YOU OLD TIMERS IN THE FIRE SERVICE,...WELL WHO BETTER TO MAKE THE DECISIONS ON PATIENT REMOVAL AND PACKAGING THAN THE HIGHEST TRAINED PERSONNEL ON SCENE ( EMS ). ... THE MEDIC WILL BE ABLE TO ANSWER ANY QUESTIONS YOU OLD TIMERS HAVE TO THESE MEDICAL PROBLEMS. .
              I read this post and once again see further reinforcement for the Extricators being in overall charge of the "SCENE". WHY, cause EMS needs to be FOCUSED on the PATIENT. This is a LIFE & DEATH SITUATION! I know this is going to go on and on. But somehow it is only Logical that the people who are trained and designed to manage a complex scene
              should be the one in "overall charge". It is also Logical to me that EMS Direct and inform us as to there needs. If EMS was to be responsible for the overall Scene, valuable and well trained resourses to me would be squandered on things that can and should be handled by those trained to provide those services to the EMSers. We need to serve our Customers, amongst them are the EMS sector. Just because in my view they are not in Overall Charge does in no way Lesson their importance. To me on the contrary. Since our focus is Serving the EMS team and their patient there by enabling them to devote their skill and expertise to helping thier patient!


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

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              • #22
                In my little area of the world, the first aid squads handle extrication. Our first aid covers 3 towns, of which each has their own fire department. If it ever came down to who needed to make the final decision, the Fire Departments are the actual IC's, but for the most part the first aid officers handle the patient care and extrication decisions. Mostly this is for one simple fact: there is a first aid member inside the vehicle with the patient or patients who knows what the current status of the patient is. They make the call as to what level of extrication may be needed. The Fire officers will generally standby ready to offer assistance (as requested) and manage any hazards that may be happening (leaking fluids, helicopter landings, etc.) Police on the scene are gathering information for their reports, handling traffic, and controlling bystanders. In our area, this works well and knock on wood, we have not had reason to change any of this process. Unfortunately for the first aid squads, membership is getting lower while the fire departments are getting higher. In light of this, we have begun teaching the fire fighters how to do extrication so there are more bodies at a scene able to assist. Again, not trying to take over for the first aid, but just offer assistance. Isn't that what we are all doing this for?

                And yes, all the fire departments and first aid's around here are volunteer organizations. And yes, I am one of those "old dinosaurs" who manages to keep up on these topics and skills. I even manage to be able to teach these young kids some things every now and then.

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                • #23
                  I agree with ALSfirefighter and Hythe that unified command is the way to go. I too am a FF/EMT-I with an agency that provides fire-rescue and EMS. In our primary response area the hihest ranking officer from my FD is in charge. Typically that is the chief. The chief designates an EMS officer a Extrication officer and manages the fire crew. The chief also does a good job of listening to the officers that he has designated. EMS decides the best way to get the pt. out and extrication makes it happen the safest way possible.
                  Now, we have an advantage in that the majority of our people are cross trained to some degree. Everybody tends to know what is going on with every aspect of the extrication even though they are focusing on the extrication today.
                  Now to answer the question. Rescue should establish command. If paramedics are attempting to perform extrications they should be removed from the scene. They are not only endangering the pt. but are also not being very professional. Our common goal should be removing the pt from the vehicle in the safest manner possible for both the responders and the pt without inflicting any more harm.



                  ------------------
                  Shawn M. Cecula
                  Captain
                  Lewiston Fire Co. No. 2

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                  • #24
                    My experience as far as the role of the FD doing the extrication and the squad is that it is a fire call until the patient is removed.....the fire department was called for the extrication and has the specialties and so should be achieving their goal of PT extrication. Once the PT is removed, then the squad can complete their goal of PT care and the call becomes their authority.

                    ------------------
                    -------------------
                    William McCorkle
                    Firefighter/EMT-D
                    CHFD / CHEMS
                    MLFD / RUEMS
                    -------------------

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                    • #25
                      I am from another neck of the woods where the FD does the extrication. We are separate from rescue and all they do is Pt care.

                      I agree with Carl, medics need to worry about pt care and pt care only. Tell the ones doing the cutting how you want the pt to be brought out and get out of the way. having EMS in charge of the scene would never work in my area, they have a hard enough time keeping themselves organized. I am not knocking EMS everywhere, but that is how it is around here.

                      My reasoning for having the FD in charge is simple. Does EMS set up IC when going to Joe Blow's house on a heartattack? No. FD's always have some sort of IC set up and there is no confusion as to how orders are placed, scene secured, etc. Things work smoothly when EMS states their needs and gets back to work on the pt. It seems a waste of valuable resoureces when the FD directs traffic and two guys stand there with a charged line.

                      I am not claiming to be right or wrong. We do things this way here and it works very well. As stated by someone earlier, other methods work well in other areas. The key is, no matter how you do it, do it well and with the ones we are trying to help first on the agenda, not who calls the shots or who gets their name on the news (probably noone, HA!).

                      Anyway, no matter how you do it, be safe doin' it!!

                      My $.02 worth!!

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                      • #26
                        MY 2 cents worth. I can see a good way to avoid all this hassle of who is in charge by putting all agencies in your area who may respond together for a auto extrication training scenario . give each seperate entity thier own time frame to explain the way they do it and why. Get all input sit down and put together an agreed upon SOG for accidents in your respective areas. Just an idea hope it works it certainly does for us.

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