1. #1
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    Default Doctor on Medical Scene

    I would just like some opinions on what has happened.

    We are a volunteer department that runs a full time BLS ambulance. There has been about 5 incidents when one of our local doctors has shown up on our scene. Everything from MVAís to fall patients. The last run was the fall patient. Our ambulance was on scene and had the pt on the cot about to go out the door. This doctor walked into the house made contact with pt. and started to get a history and symptoms with out even acknowledging our EMTís. She contacted our ER and told them what was coming and told us that they were expecting us in ER-1. Since similar things have happened before we asked if the doctor would be riding into the ER with us. She states ďNo, Iím going homeĒ. She continued to put our service down for being BLS in front of the pt. and one of our lieutenants asked her to come outside with him to talk about it. She continued to be very rude to him and our EMTíS in front of the pt. and finally left so we could transport.

    Now I do need to say that we have not had any complaints about pt care from our hospital or any of the surrounding 3 towns we service or 3 hospitals that we go to or 2- ALS services that we transfer to if needed. We have had written complements on our ambulance at least twice that I know of from ALS services. So I donít believe that this is her making sure that we are doing our jobs right or checking up on us. She also is the opposite of helpful, she does not ask if we would like here help she is clear that she is not there to assist us. She acts like we are in her way and our only job is to stand back and let her do what she wants.

    So. I would like to know if or when this has happened to you and what your reactions would be. Also I wanted to know if this could be considered pt abandonment on her part because she clearly assumes pt care then leaves when it is time to transport.

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    I would ask the police to remove them from the scene if they refused to cooperate.

    They are not credentialed by your organization, you cannot take orders from them and they cannot use your equipment. Exactly what purpose are they serving?
    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.

    "The last thing I want to do is hurt you. But it's still on the list."

    "When tempted to fight fire with fire, remember that the Fire Department usually uses water."

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    Wow I gotta say I don't envy your position.

    I should start by saying I don't know the rules of anywhere but my home state, so yours may me different.

    We don't transport but are trained as basic and intermediate EMT's. I have worked scenes with doctors before and had no problems, and was darned thankful in a few. But in these instances the Dr. happened to be near the accident or lived next door. We had one with 3 Dr's witnessing an accident, when the paramedic stated we need to intubate one of the Dr's said but It's been 20 years since I've intubated, paramedic said don't worry I can do it. The moral is that most physicians don't know the scope most prehospital providers have.

    Problems I see with what you describe:
    1.What you have is a civilian chasing your calls, scene safety is not part of medical school as far as I know.
    2. The Dr. could be found negligent by abandoning the patient unless they ride in with the ambulance. From what you describe taking a history may not qualify but much more than may. The Dr's in our area that have been on scene seem to understand this and have ridden in.
    3. Major moral problem, nobody likes being treated with disrespect anytime but especially in front of the patient.
    4. Eventually the Dr. may suggest that you do something against your protocol or outside your scope, obviously this is a problem and sets you up for an argument infront of patient where you will be made to look even less capable.


    What can you do about it, this is the bad part if your officer had a talk with her and it did nothing to help then things may get ugly.

    You need to decide if your problem is that she is there in the first place or how she treats you on scene. (I hate to say this but this is how a few Dr's treat anybody with out a Md.)

    First off this needs to go to the chief level, He needs to have a talk with the doctor he should be prepared to discuss the tiered system and the protocols for BLS and requests for ALS, also he needs to give the Dr channel to give formal complaints. He needs to consider the complaints and respond appropriately or explain why he can't such as funding. This may mean some changes for you guys but if they result in better patient care who cares where they came from.

    If you want her to not respond to the scene unsolicited your chief may need to speak with someone above her at her hospital, if she works in a smaller clinic that may not be possible.

    Last case option because it could get real ugly, at least where I live it is your emergency scene and you have the right to have anyone removed that interfering with you doing your job. I could make the case that she slowed the patient transport in the example you gave I assume you already took a history and have the ability to call the ER yourself. Again I would only do this after I had tried everything else I could think of, and it would have to get worse before I would do it.

    The short of it is if it has only happened 5 times and does not get worse then you may opt to live with it.

    Good luck

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    Quote Originally Posted by ellwood1 View Post
    First off this needs to go to the chief level, He needs to have a talk with the doctor he should be prepared to discuss the tiered system and the protocols for BLS and requests for ALS, also he needs to give the Dr channel to give formal complaints. He needs to consider the complaints and respond appropriately or explain why he can't such as funding. This may mean some changes for you guys but if they result in better patient care who cares where they came from.

    If you want her to not respond to the scene unsolicited your chief may need to speak with someone above her at her hospital, if she works in a smaller clinic that may not be possible.

    Last case option because it could get real ugly, at least where I live it is your emergency scene and you have the right to have anyone removed that interfering with you doing your job. I could make the case that she slowed the patient transport in the example you gave I assume you already took a history and have the ability to call the ER yourself. Again I would only do this after I had tried everything else I could think of, and it would have to get worse before I would do it.

    The short of it is if it has only happened 5 times and does not get worse then you may opt to live with it.

    Good luck
    I haven't run EMS in over 13 years since I became an RN. But I don't think this has changed much.

    You cannot take orders from that physician. Period. You are functioning on YOUR license/certifications, not theirs. You are not obliged to follow their instructions.

    Have you checked their credentials? Have you run them through a credentialing process that verifies their license and their training?

    I have no problems with by-standers helping until I get there, then they need to step to the side and cooperate.
    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.

    "The last thing I want to do is hurt you. But it's still on the list."

    "When tempted to fight fire with fire, remember that the Fire Department usually uses water."

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    Has a representative of your service spoken to this doctor (I'm assuming she's legitimately a doctor licensed to practice in your state -- you shouldn't make that assumption.) about the issues she's creating? That would be my first option.

    If you can't settle on a mutually agreeable solution, your next stop should be your medical control doctor. A call from another doctor might be more effective.

    You can't very well prevent the doctor from entering the patient's home if the patient allows her to be there -- just make it clear that the doctor isn't with you.

    You also don't have much choice in deferring to a doctor for patient care but that doctor is essentially abandoning their patients if they turf them back to an EMT crew instead of accompanying them to the hospital. Got an attorney representing your department? Or an insurance company with an interest in keeping your liabilities down? Sic them on her as a last resort.
    "Nemo Plus Voluptatis Quam Nos Habant"

    The Code is more what you'd call "guidelines" than actual rules.

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    Thank you for your help and opinions you seem to have the same outlook as we do. I just needed an unbiased opinion on it to make sure that we are not missing the big picture. I really think that if the doctor came in with a helping frame of mind that it would be different. We have talked to the LEOís some our on our side some donít understand why we would not want a doctor on scene with us so lean more towards the doctorís side. Mainly if they were to actually have to act on removing her from the scene the only statute they can find is interference with emergency medical personnel. This law does not read clear enough to not classify her as emergency medical personnel not to mention the national headlines that would come from it happening. I believe that our chief has planned a meeting with her superiors at the hospital about the situation. Thanks again for the response.

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    [QUOTE=DeputyMarshal;1261220]Has a representative of your service spoken to this doctor (I'm assuming she's legitimately a doctor licensed to practice in your state -- you shouldn't make that assumption.) about the issues she's creating? That would be my first option.

    She is a "doctor" that works at the same hospital that we are transporting 90% of our pts.

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    Quote Originally Posted by DeputyMarshal View Post
    If you can't settle on a mutually agreeable solution, your next stop should be your medical control doctor. A call from another doctor might be more effective.
    Great suggestion.
    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.

    "The last thing I want to do is hurt you. But it's still on the list."

    "When tempted to fight fire with fire, remember that the Fire Department usually uses water."

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    We actually have a protocol for this. I usually had it to the Doc while we're loading the Pt and then leave while they're reading it.

    http://western.vaems.org/index.php?o...wnload&gid=169

    Page 127

    WESTERN VIRGINIA E.M.S. COUNCIL
    A-16 Verification of On Scene Medical Personnel



    1. EMS personnel will accept an order only from a physician with a license to practice medicine in the Commonwealth of Virginia. Other health care professionals, i.e. nurses, medical technicians, etc. have no role in providing medical control.

    2. EMS personnel may accept written orders from a physician transferring a patient from one medical facility to another if the orders are appropriate and within the scope of these protocols.

    3. When not in a medical facility, and not known by the providers, the individual must provide identification verifying that he/she is a physician and willing to provide medical control to the providers.

    4. The EMS provider will ask the physician to sign the PPCR or patient reporting printout. At the EMS providerís discretion he/she will ask the physician to accompany the patient in the ambulance, to the hospital. If the physician agrees and the orders are within the scope of these protocols, the EMS provider should follow them.

    5. If the on scene physician refuses the procedures outlined in step 4 or orders Supplied are inappropriate, the following steps shall be taken:

    a. Immediately contact Medical Control

    b. Advise the on scene physician that you are operating under the direction of a Medical Control physician and ask him/her to speak with the online physician. If radio communications are not available, contact must be made by phone.

    c. The Medical Control physician may ask the on scene physician to provide an ID proving that he/she is licensed to practice medicine in the Commonwealth of Virginia.

    d. The on scene physician will be granted or denied permission to treat the patient by the Medical Control physician.

    e. The EMS personnel shall continue treating the patient with the assistance of the on scene physician if permission is granted.

    f. If permission is denied, inform the physician that the Online Medical Control physician is assuming the responsibility for patient care.
    Take Care - Stay Safe - God Bless
    Stephen
    FF/Paramedic
    Instructor

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