IC commad at MVC's

[10-75k]

What qualifies an officer to be either the IC or Ops officer at MVC? This question stems from a call I was on the other day. A one vehcile MVC into a gruad rail with 5 Pt ranging in age from 40yrs to 10 months (2A,3C). There was no entrapment all persons were out upon fire dept. arrival. The first due rescue had no EMTS and the second due had one. The incoming enigne company I believe had at least 3 EMTS. Most serious injury was a broken arm. The IC who was a mutual aid chief with at least 10 yrs. of experience was the first on location and took command. Now ready for the math there are 5 pt going to the hospital they all get collar and long board it takes 4 FF to properly long board some one and 1 EMT for 5 pt. The IC told the engine crew to stage at the overpass and not to enter the highway. (By the way I was the one EMT and the IC is not.) Now I'm not the smartest person in the world but I think it is pretty tough for one EMT to handle 5 pts, and for things to get done right.

I feel that unless the IC has some kind of medical training that he/she should not be in charge. And I also feel they should be at least an EMT.

[MetalMedic]

Traffic crashes here in Ohio can get tricky when legally, the Fire Chief or the most senior Fire Officer is in charge of the "emergency" scene. However, legally, the highest trained medical person on the scene is responsible for the nature of patient care. Most of the time these are two different people and that is where the urination contest often begins. With that said, in the situation you describe, one EMT for five patients is not reasonable and whoever was the "senior" EMT on that scene should have been pleading his/her case to the Incident Commander to get more EMTs for the patients.

Now, not knowing what politics are involved behind the scene in this case, I am not sure how you could fix your particular problem. As for the IC needing medical training, around here that has not been a big problem as long as the IC respects the decisions of those who do have such training and accept their advise on the scene.

[ 12-28-2001: Message edited by: rmoore ]</p>

[res7cue]

Amen Metal on the volly/ career crap.

The PA laws are very similar to yours, ie;

The Fire Chief, Senior Officer, Duty OFficer is in charge of the overall incident as the IC, while the highest trained EMS officer/ personnel are in charge of PATIENT CARE. Everyone in our county knows that and works very well together for the most part.

[10-75k]

MetalMedic:

You seem like an intelligent person. I don't want to get into the paid/volunteer debate on this subject (I'll fight that battle some other time.) The subject matter on this topic it that the IC should have EMS training on MVC's. If it wasn't for EMS there would be no need for the fire dept. on MVC's. The person could just climb out the window. The thing that I guess I'm getting at is that the IC needs EMS training to understand pt care and what other resources might be needed. On this incident I told the IC what I needed and he looked at me with this blank stare.

[ 12-28-2001: Message edited by: rmoore ]</p>

[ALSfirefighter]

10-75, I agree with you that the engine company should have been there with you to help you with packaging. Regardless of whether or not it was 5 transports or 5 RMA's. We also have the privilidge here of clearing c-spine so that may have aided in the amount of time on the highway. But even still then I would have had the extra personnel there with me. Did you ask the IC to have the engine company come in? I've been in your shoes, and more times than not even your chief won't say something to the other chief, so the problem doesn't get rectified. We have senior officer postions filled by non-medically trained people. However law does say the highest officer on scene from the FD is in overall command of the scene. However, most have an idea of what it entails or if they don't will ask us if we need any additional resources. Plus with most of us being either FF/EMT's or FF/Medics those not actively involved in patient care will chime up about any extra resources that may be needed.

Hey dragon, how come you haven't reposted. Oh yeah I forgot you opened your mouth before you had the facts. I have that same problem with some vollies where I work. And ya know what, they were the same way when I was vollie also and I told them that. And you know what, I'm my time off I volunteer to build low-incoming housing, and I also feed and play with dogs at the local shelter. <br />I apologize to the regulars who know me and know I do not normally engage in such personal retoric, however his post hit me the wrong way today.<br />-----------------------------------------------<br />The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of. <img src="biggrin.gif" border="0">

[Lewiston2FF]

IMHO the senior fire officer on scene should be in command of the MVA scene, I would hope that the IC would have some medical knowledge, but if not they should have enough sence to accept the judgement of whoever is providing pt care. A closed mind has no place at any scene. <br /> My personal experience is that if I need more manpower to tend to patients, I request it through my chief and he trusts my judgement. My chief has minimal medical experience/training, and he would prefer to keep it that way. I dont mind that until he stops listening to those with medical experience on scenes that involve medical decisions.

[SFDchief]

In my opinion, I, as a medically trained individual and dept. chief, find it hard to run a mva and worry about patient care at the same time. Isn't that what the Incident Command System is for?.

While patient care is an essential part of an mva the IC should also be concerned with overall scene safety, including but not limited to extrication (if needed), staging, traffic control, hazardious materials (fluid containment). Maybe it's more appropriate calling the incident commander, the incident coordinator.

I would get any information needed about patient condition from ems command. Even though, as previously stated, I am medically trained, I would never second guess the condition of the patient when there is another emt treating the patient. I've seen too many chief officers, both medically trained as well as non-medicaly trained, sizing up a patient from several feet away when there is someone already in direct contact of the patient. Second guessing is a good way of getting yourself into trouble.

Just my 2 cents

[ 12-27-2001: Message edited by: SFDchief ]</p>

[firefighter26]

I can't expain everything everwhere else, but I can tell you how things work at my department.

In order to even be considered to be an officer you need to have medical training. My thoughts are, how else are you going to be able to command something you have no experience with? Here, I know that each and every one of my officers have done the tour and know their stuff. It makes a big difference at these kind of calls because they can automatically see what needs to be done and make sure we have the what we need to do it.

I do agree that officers should be subjected to some type of medical training, even if it is just basic. Besides, you never know when it might be needed anyway, not just for command desicions.

[dmsmith]

1 EMT, 5 Patients.....

Why not call for some mutual aid ambulances?

[Knighthawk]

The mutual aid buses sound like a good idea. Now this will be a hypo. situation. The mutual aid bus get toned 3 times and no response. This isnt't going to be slam on the Vol. service just to promote the paid service so PLEASE DO NOT TAKE IT THAT WAY! You know you have a paid bus from two separate Vol. organizations. The first is 1 town south and the other is 2 towns north. You can't just call for the paid buses because the mutual aid plan between the bus squads doesn't have them listed until the fourth or fifth alarm.<br />Thats 3 tones for your bus squad and they make out on the 3rd tone, 3 tones for mutual aid bus squad for which the co. you run the call with and your 1 EMT has to complete the crew, 3 tones for the bus squad of the town that's on your immediate border (Just down the road say maybe a mile) no response. By the time you get to the paid bus squad you could very well be within the 30-45 min. mark. The wrecker has come to remove the car now. Where do you put the three other patients to keep them out of the elements? Like I said this is just a hypo. situation.<br /> Now as far as the IC with medical training again this would be a good thing. Wouldn't he have a duty to act since he is the only highest medically training person on scene at the time? Would that be abuse, neglect or abandedment on or of the patient? I guess he could pass command to the officer or highest senior member of the first due in rescue co. If I am wrong please let me know and don't just blast me.

[firenresq77]

I think SFDchief said it best. EMS isn't the only thing to worry about at an MVC. That is why there is an Incident Command SYSTEM. THe IC is there to run the whole scene, and must rely on the medically trained people to provide patient care and to advise what other resources they need.

And yes, I am an EMT......

[SFDchief]

[quote] Now as far as the IC with medical training again this would be a good thing. Wouldn't he have a duty to act since he is the only highest medically training person on scene at the time? Would that be abuse, neglect or abandedment on or of the patient? I guess he could pass command to the officer or highest senior member of the first due in rescue co. <hr></blockquote>

Knighthawk, just to clarify, if I'm the IC of a job and there is a medic there although I'm the highest ranking officer I am not the highest medically trained person. A medic has more medical training as an emt. The highest medically trained person should be involved with patient care. If there's an officer that's an emt and a firefighter/emt they both have the same level of medical training regardless of their rank. As I stated before, a non-medically trained officer should not made medical desicions with out consulting ems command. Let me correct myself, NO INCIDENT COMMANDER should make medical desisions without first cnsulting ems command.

If I am the first on the scene of an mva I will size up the scene as a whole and then if nothing else assess the patient(s) injuries as the state says I must do as an emt. If another emt (or medic) arrives I will then pass patient care over to them. Until the arrival of another emt (or medic) the next highest ranking officer (or senior firefighter) will be IC.

In my opinion the IC does not neccesarally have to be the highest ranking officer.

[ALSfirefighter]

SFD, excellent points. The EMS sector of incident command is often overlooked. What's even rarer, but seems to be growing, is the concept of unified command. There a lot of ego's that need to be overcome to accomplish that form of IC. However, in larger incidents it can be very successful. Many larger cities utilize this form of command. As far as requiring medical training to be an officer, hey, I never say no to more training. However, I don't feel that it is as necessary as firefighter26 states. Again, that is what sectors are for. Anything less in my opinion is micromanagement. <br />------------------------------------------------<br />The above is my opinion only and doesn't reflect that of any dept/agency I work for,deal with, or am a member of. <img src="biggrin.gif" border="0">

[lutan1]

Let's see if I've got this correct....

According to some people who have posted, I shouldn't be/can't be an IC at a rescue because I'm not medically trained? Or that I'm a vollie and not paid?

CRAP! CRAP! CRAP!

Over in Oz, we do it a little different- not to say we're correct and you're not, but....

My dept. is a rescue dept and nothing more. We don't fight fires, we don't respond to medical incidents, etc. We rescue.

We work along side ambulance depats. (All paid) and combination vollie and paid fire fighters. They do medical and fire related stuff respectively.

At an MVA, each service/dept on scene has a dept. commander. The Police are the Incident Controllers. They have the final say on the scene itself. The fire dept look after all fire and safety related issues and the ambo's look after all medical/patient related stuff. We, as a rescue dept. perform the rescue. We perform that rescue after close consultation with the ambos, and in consultation with the firey's.

We do it, we do it well. We're trained to do it.<br />We don't tell them how to treat a patient or how to fight a fire, and they don't tell us how to do our tasks.

It all comes down to communication- with no communication, how can anyone perform a rescue of any sort. Regardless of what dept they are from and whether they are paid or volunteer. <img src="rolleyes.gif" border="0">

And to really add fuel to the argument about paid vs volunteer- some could say that vols do it because they want to, paid staff do it because they have to.... <img src="biggrin.gif" border="0">

[MetalMedic]

[quote]Originally posted by 10-75k:<br /><strong>MetalMedic:

You seem like an intelligent person. I don't want to get into the paid/volunteer debate on this subject (I'll fight that battle some other time.) The subject matter on this topic it that the IC should have EMS training on MVC's. If it wasn't for EMS there would be no need for the fire dept. on MVC's. The person could just climb out the window. The thing that I guess I'm getting at is that the IC needs EMS training to understand pt care and what other resources might be needed. On this incident I told the IC what I needed and he looked at me with this blank stare.

[ 12-28-2001: Message edited by: rmoore ]</strong><hr></blockquote>

Intelligent person!!! <img src="biggrin.gif" border="0"> I am nothing special, just spent a lot of time the past 21 years observing how things are done by various agencies.

I guess I cannot give you a better answer than I have. I was once involved with a town that would send EMS to MVAs and not send the Fire Dept. unless requested by EMS. I believe they still do this to this day on accidents that happen inside their city limits. I am not sure of that is a better answer than having an non-medically trained Fire Officer in charge of the scene.

My guess is that if you wanted to require the OIC to be medically trained, it would take a change in your State's laws, and that would be impractical. So, that only leaves you with trying to develop a better working relationship with this person in the interest of better patient care. It won't happen overnight, but you won't get very far being confrontational with the "OIC" on the scene,,, the time to deal with such problems is before they happen.

Good luck!