Those Pesky Civilian Helpers

Physicians and Nurses Offering Help Can Challenge Emergency Responders





GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He is chair of the EMS Section for the International Association of Fire Chiefs (IAFC), was appointed to the National EMS Advisory Council by the U.S. Secretary of Transportation and is a member of the International Association of Fire Fighters (IAFF) EMS Standing Committee. Ludwig has a master’s degree in business and management and is a licensed paramedic. He can be reached at



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What to do when unsolicited physicians, nurses or other medically qualified people show up and offer their services.




I cannot tell you how many times during my career I have had a civilian come up to a scene and declare, “I am a (fill in the blank). Is there anything I can do to help?” Usually when they do this, you are in the middle of dealing with a critical patient, have both hands tied up, and you may be even cradling a phone or radio to your ear.

Some of those who have come up to my scenes have been memorable. During a mock-disaster exercise in St. Louis, a car screeched into the scene, a man got out of the car and announced he was a physician from the American Red Cross and that he was in charge. Neither the incident commander nor I had ever seen this man before and certainly he had not attended any of the planning meetings. He was completely unknown to us, dressed in civilian clothes and driving his personal vehicle. After a brief conversation, he tried to tell us that during a disaster, when the American Red Cross is mobilized, it is in charge. Sorry! In a polite way, he was told he was not in charge and we are certainly not turning over all our personnel and assets to a stranger.

In another scenario, I had a person shot in the abdomen in a bar in south St. Louis and a physician who was driving by saw all the commotion and decided to stop and see whether he could help. He declared himself a physician to the police officers outside and they let him through the doors into the scene. Once inside, he identified himself as a physician and began issuing orders to the paramedics on the scene for the critical patient. I asked the man to show up some identification that he was a physician. He could not and became somewhat indignant that he was even being questioned. The conversation went downhill from there and I asked the police officers to remove him from the scene when he became even more incensed about being questioned regarding who he was.

Civilian bystanders who show up on scenes are a challenge to many firefighters and EMS responders. Do this job long enough, and eventually someone is going to stop, declare who they are and offer to help. Sometimes, they may be already on the scene when you arrive. This is especially true in large-scale disasters when unsolicited help or self-dispatched physicians, nurses or other medically qualified people will show up and offer their services.

These doctors and nurses are well-intentioned and more than willing to provide their expertise to help a patient. The problem is that even though physicians and nurses may have additional medical education and training, they are not trained nor do they typically have experience working within the medical or fire command structure of an emergency incident.

This lack of knowledge can often lead to confusion in regard to responsibility for out-of-hospital patient care, overall observance to your EMS system protocols and online medical authority. In many cases, the difference between appropriately using these good Samaritans and pushing them away them depends on your approach to handling these situations.

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