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    Default Estab Cmd on Med Calls

    Historically, our department has established command on ALL calls - long before NIMS. We've had a few mgmt changes and there are some who do not believe we need to do that on EMS calls anymore, so they've stopped. I need to know if there is anything (other than NIMS) that specifically states command should be established on ALL calls including EMS. I don't have a policy to pull from (long story, past chief). Our dept does not provide transport, so we do work with another agency that provides transport. Curious to know how others handle command on EMS response.

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    Quote Originally Posted by dtruelove View Post
    Historically, our department has established command on ALL calls - long before NIMS. We've had a few mgmt changes and there are some who do not believe we need to do that on EMS calls anymore, so they've stopped. I need to know if there is anything (other than NIMS) that specifically states command should be established on ALL calls including EMS. I don't have a policy to pull from (long story, past chief). Our dept does not provide transport, so we do work with another agency that provides transport. Curious to know how others handle command on EMS response.
    Some 30 plus years ago, our department was involved in FIRESCOPE's original version of ICS, from which NIMS was adapted. Since the evolution of ICS, it has always been my department's belief that ICS/NIMS is a tool box; one in which you pull from ONLY when you need those particular tools. We've been providing pre-hopital care at the ALS level since the late 60's/early 70's. We aren't a transporting agency either, so a typical medical response is one BLS engine, one ALS squad with a private ambulance for transport. This yields, typically,up to six firefighters and two private ambulance personnel. As you know, span of control in ICS is 3-7 with an optimum ratio of one commander to 5 resources. So, with the normal manpower on scene being 7-8, there's always an engine captain on scene in charge and no need to announce who's in charge. It's an assumed thing.

    Multi-casualty incidents are obviously different. We treat them different and will announce who's in command over the radio. So I guess we operate procedurally or in the spirit OF ICS, but unless that EMS call overwhelms the initial resources, feel there's no sense setting up a "phantom" organization on a very basic call. Hope that helps???

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    Last edited by Theaxemancometh; 06-25-2010 at 01:15 PM. Reason: add name

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    Perfect.....this is EXACTLY what I was asking for. Thank you!

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    Command announced at all EMS incidents.

    As a rule, initial personnel on-scene are volunteers via POV. If the initial responder is a Captain or Senior Firefighter, they will establish command. if the intial responder is not a Captain or Senior Firefighter, they will wait until one of the 2 arrives.

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    In my volunteer county, we established command on EMS calls simply because we don't have the call load for a lot of the guys to stay completely proficient in ICS. Therefore, if they're doing it for every call, it will come very naturally to them when the "big one" strikes.

    At work, we typically don't establish command for every EMS call, only those that are unusual in nature.
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    Similar to Axeman, we don't establish command over the radio for EMS calls. It is assumed that the EMT on the ambulance is in charge. Even if we have an ambulance and engine for manpower, no real need to call command over the radio.

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    If there is one or two resources on an ems run, I don't think it's needed.

    What I hate MOST is a nearby county establishes COMMAND and then the EMS folks establish EMS COMMAND at the same scene.

    Stupid and will lead to problems.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    Like Axeman, we only establish command when needed (i.e. an MCI), and that's usually due to other circumstances such as rescue or HAZMAT. On a medical call involving difficulty breathing, or even just a minor fall, nothing officially is ever announced. Even on a cardiac arrest when we will have 6-8 FF/EMTs and 1 or 2 FF/Paramedics, we don't officially take command. The first medic on scene is in charge and they'll call the shots (one medic usually manages airway while the other pushes meds and watches the cardiac monitor).

    I believe in NIMS 100 it states that NIMS is a bunch of modules that work together and can be activated if they are needed.

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    Default EMS / Rescue Officer

    At working incidents (fire or rescue) a Fire Officer will establish command. The EMS / Rescue Officer will take the "EMS / Rehab Sector Officer" at fires. On working Rescue Calls the EMS / Rescue Officer takes over "Operations".
    If no EMS Rescue Officer is on the scene, the person in the front right seat of the first arriving ambulance assumes this roll until an officer gets there.

    nc

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    If you want, give Ocean City (NJ) Fire Dept a call.
    I worked with them (they do BLS prehospital treatment and transport, extrication, fire suppression, water rescue and inspections), while I worked for the hospital that provided ALS intercepts.
    On every call that an Engine Co was on, Command was established, and it was VERY organized and well run.

    Their phone # is (609) 525-9182
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    We are an All Hazards Fire/Rescue/EMS agency, and the answer is Yes and No. Examples: "Sick Person" BLS Ambulance alone and "Trouble Breathing" BLS and ALS Ambulances respond. Command is not NORMALLY established. Auto Accident - BLS Ambulance, Engine Company, Maybe a Heavy Rescue also, Command is established..........
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    Thanks for your response, you've helped greatly!

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    Command is only established here when multiple pieces of FIRE equipment is dispatched on a single call.

    Any piece of fire equipment with an ambulance does not get command.

    Any single engine, truck, or rescue dispatch does not establish command.
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    NFPA 1710 6.2.1 - An incident management system shall be provided in accordance with NFPA 1561 to form the basic structure of all emergency operations of the fire department, regardless of the scale of the department or the emergency.

    Do I think NFPA is the bible? No, but in this case it makes good sense.

    We do establish command at every call, even if it is a lift assist or vehicle unlock. It is just a good practice to do, whether for consistency or if the situation escalates and you have to call additional resources.

    Pain in the ***? Nah, it only takes an additional breath on the radio when you arrive and one more sentence in your NFIRS report to be doing the right thing.
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    We establish command on all calls. We started off not establishing command on med calls and then it was noticed that it was being established on MVA's and grass fire. They changed it to all calls so there would be no confusion and no 'I forgot'.

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    Quote Originally Posted by ChiefKN View Post
    If there is one or two resources on an ems run, I don't think it's needed.

    What I hate MOST is a nearby county establishes COMMAND and then the EMS folks establish EMS COMMAND at the same scene.

    Stupid and will lead to problems.
    How's that? If it is an EMS incident, then shouldn't EMS also establish command, as in unified command?

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    Quote Originally Posted by bossteen View Post
    How's that? If it is an EMS incident, then shouldn't EMS also establish command, as in unified command?
    There is ONE incident commander.
    Perhaps you should go back and review ICS.
    EMS is a branch under Operations.
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    Quote Originally Posted by bossteen View Post
    How's that? If it is an EMS incident, then shouldn't EMS also establish command, as in unified command?
    It's not unified command.

    There is "command" and then EMS establishes "EMS command".

    No such animal.

    However, with an EMS incident, there should be unified command as EMS has a very large stake in the operations. This would also depend on how the agencies are structured.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    Quote Originally Posted by ChiefKN View Post
    It's not unified command.

    There is "command" and then EMS establishes "EMS command".

    No such animal.

    However, with an EMS incident, there should be unified command as EMS has a very large stake in the operations. This would also depend on how the agencies are structured.
    Just curious here.

    On a police matter the PD establishes command and directs FD, EMS, and others.

    On a Fire Call the FD establishes command and directs PD, EMS, and others.

    So why wouldn't an EMS establishes command and directs PD, FD, and others as needed?

    Isn't the concept of unified command to mean there is one top commander and all others report to the top commander of the incident.

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    Quote Originally Posted by ScareCrow57 View Post
    Just curious here.

    On a police matter the PD establishes command and directs FD, EMS, and others.

    On a Fire Call the FD establishes command and directs PD, EMS, and others.

    So why wouldn't an EMS establishes command and directs PD, FD, and others as needed?

    Isn't the concept of unified command to mean there is one top commander and all others report to the top commander of the incident.
    Generally, the EMS folks are dedicated to providing, and focusing on, their sole mission: the delivery of medical care. The FD, who typically responds with more people and gets there first, is in a better position to provide command & control while EMS provides patient care.
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    Quote Originally Posted by ScareCrow57 View Post
    Just curious here.

    On a police matter the PD establishes command and directs FD, EMS, and others.

    On a Fire Call the FD establishes command and directs PD, EMS, and others.

    So why wouldn't an EMS establishes command and directs PD, FD, and others as needed?
    There is nothing wrong with that approach. However, there is one "command".

    Isn't the concept of unified command to mean there is one top commander and all others report to the top commander of the incident.
    Unified Command means that representatives from all primary stakeholders are represented at the command post.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    I have, as an EMS provider, established command on incidents such as MVCs. Once the FD arrived, I passed command to the first arriving officer after a brief face to face.
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    Now some of you have piqued my interest. If your agency establishes command of an EMS call, whom takes command? I understand MVA's, specialty rescues, etc. but on medical calls, who takes command the ranking /senior member or the highest licensed EMS provider?

    We do not establish command at medical runs. We do any time a fire apparatus rolls for other than assisting the EMS crew. On cardiac arrests, unconscious pt's or serious trauma runs, an engine or second bus rolls, and either the medic on the first due (primary provider) bus or the lone medic is "command" of patient care. Our officers may have far more command experience, with only two exceptions, the medics are far better suited to run the medical side of these EMS runs.

    Let not NIMS or any other acronym get in the way of always putting the patients interests first.

    Like Chief Ken, our neighbors cannot get along and establish separate commands at all MVA's. The FD is well versed in ICS and NIMS but cannot get the independent EMS provider to fit into the system. The EMS agency contends that they're "command" because it's a patient care issue. Of course they sound like the proverbial monkey/football anytime more than two of their rigs are at the same scene as they have not organization at all.

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    Quote Originally Posted by RFDACM02 View Post
    Now some of you have piqued my interest. If your agency establishes command of an EMS call, whom takes command? I understand MVA's, specialty rescues, etc. but on medical calls, who takes command the ranking /senior member or the highest licensed EMS provider?
    The senior member on scene will take the command and let the EMS folks assume patient care. I'd rather the highest licensed EMS provider be delivering IV's and meds, not directing the next unit where to park.
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    Quote Originally Posted by RFDACM02 View Post
    The EMS agency contends that they're "command" because it's a patient care issue.
    That's a common misconception.

    Command doesn't direct patient care. Command directs resources to accomplish that care.

    Yes, the highest license should have responsibility for the patient care (best accomplished by being with the patient, btw). But does the highest license have to determine how to redirect traffic, how many ambulances are needed, where to land the medevac, what resources are needed to contain the leaking fluids...etc...etc.

    Usually, paramedic resources are limited. So they need to be taking care of patients, not standing at the CP figuring out all the other things.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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