Thread: Medical Calls on vol. fire dept.
01-09-2000, 01:40 PM #1LEES CHIEFFirehouse.com Guest
Medical Calls on vol. fire dept.
When a paramedic or emt are on scene it offends the first responder when they come in and take over a scene the first responder is in control of. This is usually on a minor call, that the first responder is totally qualified to handle the call. The emt or paramedic rechecks vitals that the first responder has taken, this offends the first responder and now have very few comming on call. We only have one paramedic and a few emts. We need the first responder as the paramedic and emts are not always available. We need suggestions on keeping everyone happy. Maybe some new policies and procedures.
01-09-2000, 02:55 PM #2BChewFirehouse.com Guest
As a Paramedic that started out as a first responder, I can understand the feelings of your first responders.
However, you must remember, that regardless of being a career or volunteer EMS provider, there are laws that govern who is responsible for the patient, utlimately the one with the highest certification. So, as a medic I am always cautious about whom I work with, and will recheck there work until I am comfortable with them.
I assume you EMS is an independant service from the FD, this makes mutual training difficult. But that is the only way to resolve this problem. The medics will need to work / train with the first responders to get more comfortable with them.
Bruce Chew, FF/EMT-P
01-09-2000, 07:12 PM #3F02Firehouse.com Guest
Leave the attitudes and ego's at the door.EMT,Medic,FR or whatever.Your all there to help the patient not have a turf battle.If somebody wants to recheck vitals Iv'e taken Fine,no offence taken.If they want to push me out of the way or ignore me I might get a little disturbed.I won't say anything at the time but I will talk to them calmly later.If this does'nt work I'll talk to their superior.A lot of times its not whats being done but the attitude its being done with.
01-09-2000, 09:33 PM #4HarrisonJRFirehouse.com Guest
We had the same problem happening on our department some of the first responders were getting upset if an emt started to push their weight around but I agree with FO2 that you have to leave the egos at the door and that the patient is #1. Our solution was if it became to bad our cheif would talk to their medical director and things did ease up but only when it could compromise the patients care otherwise once they had arrived on the scene they then assumed responsiblty so why not double check everything it's their butt in the sling! I can't believe people wouldn't show up for a call even if you may get stepped on a little what do you do the job for to help people or to puff up your ego? New policy could be to have a discussion with the offenders and just let them know your feelings but continue to give the patient the best care until other help arrives. HarrisonJR/Firefighter-First Responder
01-09-2000, 10:02 PM #5LEES CHIEFFirehouse.com Guest
The paramedic and emt are members of our fire department, same as the first responders
There is no problem when the EMS arrives for THEIR crew to recheck the vital our fire department members have taken. The problem occur with the ego of the emt,paramedic and first responders WITHIN the department.
01-10-2000, 01:41 PM #6BURNSEMSFirehouse.com Guest
Hello, I would Talk to the persons involved and advise them of the Problem, In your System can the A.L.S. Personell provide that Level care, if so then they should provide the Level of care required and allow all others to continue on with the Job at Hand, in our Dept we have BLS and ALS providers and each does there job with no arguments, Now if something just Dont Jive then yes I will check my self to be sure, after all as a Paramedic I am ultimatly responsible for Pt Care, but we allow our BLS folks to do all Skills at that Level and if No ALS is required then we help with what ever needs to be Done, after all we are ther for the Patient, do you have a EMS Chief if not elect one or appoint one to take care of just such problems.
Here today for a Safer Tomorrow
01-11-2000, 07:19 PM #7Medic019Firehouse.com Guest
I know the feeling the first responders feel. However, now being a paramedic I know why they recheck vitals - especially when giving meds.
However, I personally don't recheck vitals on a patient that is stable until I get them in the rig for transport - Mind you this is on stable patients. Now, If I have to get another set of vitals prior to a med I will ask the First Responders or EMT's if they mind me taking another set of vitals due to having to give a medication.
Explaining your actions professionally to fellow caregivers and respecting their training is the only way to prevent sour feelings between different levels of caregivers.
Have you tried joint training session with all levels of EMS providers...This gives a chance for each level to show off your skills. It is also a great learning experience for all involved.
Firefighter/Paramedic in Northwest Pennsylvania... Stay Safe
01-11-2000, 08:45 PM #8Pamela BaberFirehouse.com Guest
Our volunteer department has First Responders, EMTs and Paramedics. Because we respond to calls by pager any and all persons could be at the call. We have a policy that the first person on scene is accountable until the person with the highest level of pre-hospital training arrives. As a medic, the first words out of my mouth are "tell me what you've got".
The EMTs and FRs on our unit understand that the first set of vital signs are taken to establish a baseline. Vitals beyond that are for purposes of trending and may be taken by a person of a higher level of training than themselves, especially in critical situations or pre- medication administration. We also have a policy that vitals are taken every 3-5 minutes on unstable patients until the ambulance arrives, usually 15-20 minutes later.
We do include and empower our FRs and EMTs
to play an active part in patient care and have post-run discussions to answer any questions they may have as well as to receive their input. Many of our FRs have gone on to become EMTs. If there is no involvement and respect for those who have taken their time to acquire their certification, loss of interest will result as LEES CHIEF pointed out. They will also never achieve a comfort level in providing competent patient care unless given an opportunity to utilize their skills in the field. Individuals who behave in this manner do these members and the patient no service at all. Someday that FR or EMT may be the only person at a call or with persons of same training level. I gaurantee you, that same people who lack understanding of this issue, would be the first to complain if something goes wrong.
01-11-2000, 09:34 PM #9Lieutenant GonzoFirehouse.com Guest
I am trained as an EMT-D. If my crew and I are on a medical call and request an ALS response, I have no problem with them rechecking vital signs and asking the patient the same questions as I did on our arrival. We compare the patient's responses and vital signs to determine changes in the patient's level of consciousness, pain response, etc. They have a much higher level of training than we do, and they would be remiss in their duties if they didn't. The personnel with the highest level of certification will ultimately be responsible if anything goes wrong. We are fortunate to have an excellent working relationship with our ambulance provider and the paramedics. If there is a problem, you have to communicate with each other to come up with a workable plan. It doesn't matter whether the Department is career or volunteer, the same issue pertains to both.
Take care and be safe...Lt. Gonzo
01-12-2000, 10:39 PM #10LMRCap1Firehouse.com Guest
We had the same problem within our department. When the call was over everything was taken back to the station and discussed. I am a EMT specialist here in MI since we first respond as a basic unit. I usually stand back and make sure what needs to be done is getting done. If I make a suggestion I do it as so. The guys in our department apprreciate the respect. If it is a bad call then I will jump in and do what I have to do but continue with the FR's assisting in what they can do. As stated though it needs to be dealt with at the station. I can still ask questions of the patient and get further into what is going on than the FR's but we use it as a learning tool for them and next time I can just listen to the questions I need. It also helps them on calls that a Specialist or Paramedic is not on the call with them which sometimes happens. Its all in the communicationand remembering we are there for the patient not to boost our egos
Captain, LMR VFD
01-17-2000, 06:14 PM #11R5Firehouse.com Guest
Has anyone else noticed the huge egos which some in the fire service hold? First, as a fire officer, EMT and medical first responder instructor, when on scene I check vitals behind most anyone if the patient ain't doin' too hot. Sometimes, I may ask the first responder to recheck the vitals for me (saves me time and gives the fellas something to do). Also, when I train first responders, I tell them this may happen and not to get offended.
Do your first responders give the arriving ALS crews a report of findings or happenings since the first responders arrived on scene? I teach my students to give the crew a complete report about conditions found, complaints, and treatment given when the EMS crew comes in the door. You may want to incorporate something like this into your program.
Hope this helps.
01-18-2000, 02:26 AM #12Ohiofiremed57Firehouse.com Guest
I thing that your all on the right track here...
Sounds like an ego problem which ultimately becomes a pt. care issue. Here, as in most all places, the highest trained EMS provider on scene in IN CHARGE....no matter what. Reguardless if the FR believes this pt.is a BLS run or not. What we all have to remember is that we are there to provide the highest level of pt.care available.
As FR's you have to realize that you are the low man(woman)on the poll (no offence). Your pt. assesment may not reveal the underlying cause of the illness, and as such your "diagnosis" may differ from that of a higher trained person. This ultimately will deturmine if the pt. is to be BLS or ALS.
I understand your frustration. And you should get together with the medics and basics to resolve this lack of "bed-side manors".
KEEP UP THE GOOD WORK! we need ya.
"Paramedics save lives, EMT's save paramedics" * and FR's save us all!!!
[This message has been edited by Ohiofiremed57 (edited January 31, 2000).]
[This message has been edited by Ohiofiremed57 (edited April 23, 2000).]
01-21-2000, 09:59 AM #13chf jstanoFirehouse.com Guest
Our dept is planning a coffee/donut get together for the responding ems agencies in the town. Sometimes it's just a matter of getting to know each other a little bit and openly discuss any gripes or problems that may arise.People come and go and we are not always familiar with others who respond to the same scene. Getting to know those you may be working with (in a relaxed situation)will make things go easier in a time of crisis and stress. It can be used as a time for each agency to understand what to expect from the other in both capabilities and on scene proceedures. I would certainly hope that egos can be set aside and we all can remember that we are in this business to serve the public.
01-30-2000, 09:44 PM #14STATION2Firehouse.com Guest
If I may throw in a few comments. I also am with a volunteer department on the SW side of Houston, Texas. We run a first responder program with our County ALS Service. We have three (3) types of 1st responders. We have ECA (Emerg. Care Attendant), EMT and Paramedic. We have the same medical director as our ALS Service does. That means that we only provide BLS pt care. I don't agree with it, but thats the way it goes for now. That makes our situation a little easier because no matter what level FR arrives, none can do more than the other. The key is for all your personnel to have respect for each others capabilities, strengths and weaknesses. If your people can't respect each other, how can they respect a patient from a different socio-economic situation than theirs. The old saying of "There is no 'I' in the word TEAM" comes to mind. If your EMT is providing pt care and your paramedic arrives, they should get an update as soon as they can get one if not by them listening in. The EMT shouldn't get their feathers ruffled over a status report. At the same time, the Paramedic shouldn't go barging in with a superman attitude and ignore the EMT. As an officer you have got to handle these situations, but be careful. What you perseve as a problem between your EMT and Paramedic on a scene may not be. Unless its obvious, let the slighted one come to you (Or whoever in their respective chain of command)and express their grievance if necessary. They may work it out on their own. If you jump in at every sign of friction, no matter how slight, you could actually cause the slighted one to lose even more credibility with their coworkers and cause them to appear to be a "whiner". You as the supervisor could also have your credibility damaged and appear to be a micromanager. There are times to say something and times to let it lie until and/or if its brought to your attention officially. Under no cicumstances should tensions be allowed to vent onscene. I mean in front of the patient, family members, fire personnel, law enforcement, EMS or whoever. That you should mandate. The effectiveness of your agency will be judged by the public then and there, there are no second chances for a first impression. Be safe.
02-03-2000, 06:33 PM #15NFPD206Firehouse.com Guest
I agree with FO2. Our purpose is to provide the best service to our community. How ever with out knowing the whole story I can say that will work. Often higher trained personnel have a tendency to belittle those not as qualified. You must speak with all personnel involved and get them to understand we must all work together. Our department is applying for our ALS license and soon will be running non-transport EMS. I currently have around 30 volunteer firefighters and 11 full-time personnel. Out of those I have 3 paramedics that are full time and am working on getting part time paramedics. If a call does not require ALS then ask your medic to work with the first-responders and teach them as much as they can. But your first responders must understand that the level of training for medics is much higher and sometimes they donít have time to explain the in and outs and why they are doing what they are doing. Do they question the Chief when he arrives on the scene of a fire. I doubt it. It all comes down to what is best for the people of your community. If your people are so self minded that they are worried about who is in charge of the call instead of what is best for the patient then may be they need to evaluate why they are working for the fire department. Just food for thought, good luck
Captain Jeremy Whitehill
Nixa Fire Protection District
02-15-2000, 03:40 PM #16Wabash ExpressFirehouse.com Guest
As a paramedic, I have encountered this type of problem several times. First, it is important for the paramedic to realize that the first responder already on the scene is a big asset. The paramedic needs to get report from the first responder on the scene before asking the family questions, or asking the patient questions. Often times the first responder on the scene can offer the medics a quick thorough briefing as to what is going on. On the flip side, the medics must have faith and confidence in the first responder's skills. That means that the medics must know that the first responders are receiving quality training from their department. The first responder's fire department must also have a QA/QI system in place in order to monitor their first responder's skills. As a first responding firefighter/paramedic on an engine company, it ****es me off when the transport medics don't ask me for an update and stand their and ask the family and the patients the exact same questions that I just asked them. Soooo...I know both sides of the story.
Good luck to all.
City of Durham (NC) Fire Department
02-17-2000, 05:46 PM #17BriTHFDFirehouse.com Guest
In our State we (Firefighters) have a nice little statute that we can lean on for support. That statute states that if the Fire Deparment is called to ANY emergency, the highest ranking officer of that department is in charge of the scene.
If we go to an MVA, the fire department runs the scene and instructs the police, ambulance, etc. on what tasks they need to perform.
We run First Reponder medical, but, our town has mandated that we become EMT's. Our paramedic service comes from the local hospital in town and is run from their firehouse. Conflict only developes between either the paramedics and the private ambulance crew, or between the ambulance crew and us.
03-16-2000, 11:44 AM #18jedge168Firehouse.com Guest
I can understand the situation. Like so many that have already responded I am a paramedic that started as a first responder, and I still work with a great many first responders still to this day (the area we cover is about 60% rural). I can appreciate the feelings of the first responders. They feel like they're useless as they sit there and watch the medics repeat everything they've just done, but like was stated earlier, that medic is responsible. It actually boils down to turst and tact. If the medic trusts the first responder, then he shouldn't be as likely to repeat stuff right then unless the vitals or whatever had been a while. Tact comes in at getting the patient loaded BEFORE repeating any of this stuff. I know some of this may sound mean or uncareing, but sometimes it has to be done. I've also found that it helps matters a great deal to tell the first responders, no matter what their level of cert is, that the medic tells them each time that they appreciate the help. Whether the medic likes it or not, sometimes his job would be alot harder without those first responders.
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