1. #1
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    Default Transporting in a "non-transport" Vehicle

    DAVE HANEY
    Copley News Service

    A split-second decision to take an injured firefighter to the hospital may cost the fire chief his emergency medical technician's license and censure of the department where he's volunteered for 30 years.

    Chief John Doering says he was just using common sense when he ordered the firefighter put in the back of his department's rescue truck and transported to a nearby hospital: There was no ambulance nearby.

    The Peoria-Area Emergency Medical System, however, says Doering's decision violated state law. Dunlap is not a licensed transport provider.

    The mess evolved from a cardiac emergency call the all-volunteer squad got more than three months ago. Eleven members of the Dunlap Fire Protection District, including Doering, arrived. As the crew wheeled the patient out to a waiting ambulance, one of the firefighters collapsed.

    Doering called over the radio to ask whether another ambulance was nearby. When he was told "no," Doering ordered two of his EMT-trained firefighters to take their fellow firefighter, who by then had regained consciousness, to the hospital.

    Part of what's at issue: At what point does a firefighter or other emergency personnel become a patient?

    "This is about making a common-sense decision," Doering said. "If we would've thrown this firefighter in a pickup and taken him in, no one would've said anything, but because he was put into a district-owned vehicle and given a higher level of care they claim we violated (procedure)."

    Doering says the situation is rare, happening "maybe once every four or five years," adding that the decision follows his department's policy and feels it's akin to any employer taking a hurt employee to the hospital in a company vehicle.

    "You are talking about people who give up their personal time for nothing but to help make a difference in their community," Doering said of his volunteer department. "I would not hesitate to do it again if the situation merited it."

    The Dunlap firefighter was later released after receiving tests at Methodist Medical Center.

    Dr. Matthew Jackson, director for PAEMS, declined to comment on the issue Thursday, but in a letter penned last month to fire chiefs throughout Peoria County said he doesn't disagree with the need to take the individual to the hospital, nor in a non-transport vehicle.

    "This incident is clearly different than merely giving an injured employee a ride to the hospital as emergency medical care was rendered to the patient prior to and during transport," Jackson wrote.

    PAEMS, a local arm of the Illinois Department of Public Health, advises and regulates emergency medical services, EMT training and licensing as well as insuring quality pre-hospital care is provided.

    "The crew, under Chief Doering's order, used their rescue truck as an ambulance, a practice for which neither the vehicle nor the agency is licensed for," Jackson continued.

    He adds that Doering made the problem worse: "This whole incident could have been averted if he would have merely given us his assurances that he would either not transport pre-hospital patients in the future, or seek the appropriate licensure and waivers necessary to transport patients in the future."

    Both men said Thursday they hope the dispute comes to an amicable conclusion soon. Both sides have attorneys discussing the issue.

    "They (PAEMS) have rules they want to enforce," Doering said. "We just want to make sure that a firefighter gets the care he needs."


    Tough call, I could be swayed in eiher direction depending on what the true facts really were, we all know that news reports are seldom exactly what happened.

    Larry

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    absolutely ridiculous. this is a prime example of micro managing to the most extreme levels, and too many people that are probably paid too well with too much time on their hands. too stupid. Hope the Chief walks away from this the same way he walked in.

    FTM
    The good thing about this job is that we have done so much, with so little, for so long that we can do everything with nothing...... which is what is wrong with this job.
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    Very tough call. And one I will bring to my next EMT class on Sunday. However speaking as a First Aid Instructor for the military and specifically from British Columbia, under BC law it is not recommended to use a private vehicle of any kind for pt transport. The rationale is that if a current injury should become aggravated by or additonal injury be caused by the driver or the vehicle, the only recourse the pt has for medical insurance coverage is to sue the owner/driver of said vehicle.

    This regulation transcends friendship as well as kinship and family. That one is a tough pill to swallow.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

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    Welcome to the world of EMS! In his situation, with "no ambulance nearby", I like to think I would've done the same thing. He/she goes to the hospital ASAP, worry about the bureaucrats later.
    In Arduis Fidelis
    Faithful in Adversity

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    Been there, and done that.

    Suffered from a bit of heat exhaustion on a scene one day. Had the option of waiting for an ambulance (10-15 minutes), or going via POV with an EMT in the back with me.

    Screw the ambulance. It got me there earlier then waiting, and I had the same level of care.

    Un-freakin-believable.
    Quote Originally Posted by ThNozzleMan
    Why? Because we are firemen. We are decent human beings. We would be compelled by the overwhelming impulse to save an innocent child from a tragic, painful death because in the end, we are MEN.

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    Our regulations allow us to take firemen to the hospital. If there is no ambulance available to do so and the situation warrants.

    I can't remember where it is written but I do remember reading it somewhere.

    This is absurd that this guys job is in hack over this? Obviously some coward civilian behind a desk is the one calling the shots.

    Do the right thing and get the brother to the hospital...no matter how it needs to be done.

    FTM-PTB

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    Quote Originally Posted by FFFRED
    Our regulations allow us to take firemen to the hospital. If there is no ambulance available to do so and the situation warrants.

    I can't remember where it is written but I do remember reading it somewhere.

    This is absurd that this guys job is in hack over this? Obviously some coward civilian behind a desk is the one calling the shots.

    Do the right thing and get the brother to the hospital...no matter how it needs to be done.

    FTM-PTB
    Absolutely right!
    I am a complacent liability to the fire service

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    Wait for how long for an ambulance? Longer than you could get your crewmember to the hospital by your emergency vehicle.... Use the agrument that transporting someone in a "non-transport" emergency vehicle with an EMT is a higher risk than a POV with Johnny Not-a-clue???????????????? Somebody has put their brain, you know that thing in your head you are suppose to use, in neutral or reverse!!!

    We all look at risk vs. reward. If we don't then your in the wrong business. In most situations the "right" thing to do is to get the person, whomever it is, to the highest level of care needed as soon as possible. If you can do it without causing more harm than waiting than it is a calculated risk in the risk vs. reward equation.

    This is like saying the Police or Fire Dept when they see a situation that EMS is needed at can't request them but the cellphone caller driving on the Interstate can!!!! Hello, is anybody home?????

    Every organization has rules to follow but they don't always fit every situation confronted. You have to let your troops do the "right thing" safely and get everyone home in one piece.

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    Quote Originally Posted by TCFire
    He/she goes to the hospital ASAP, worry about the bureaucrats later.
    Protect Life and property period. Let the bureaucrats fight it out later. I wonder how they would of handled it if the ff would of died. Then they would be blaming the chief for not doing something. Granted the ambo would have been the best bet however when you don't have that option ava. right away. I would have and would do the same thing. Good job Chief
    Training does not make perfect. Training makes permanent!

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    Default Priorities

    1) Save yourself
    2) Save your brothers
    3) Save civilians
    4) Save property

    99) Follow Bureaurocratic rules

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    Quote Originally Posted by MalahatTwo7
    Very tough call. And one I will bring to my next EMT class on Sunday. However speaking as a First Aid Instructor for the military and specifically from British Columbia, under BC law it is not recommended to use a private vehicle of any kind for pt transport.
    But Rick, that was a FD rescue vehicle, not a private vehicle.

    Under the BC WCB regs, the first choice in that scenario is actually the company or dept ETV. Since the FD did not have an ETV, the rescue was the next available company vehicle. He was in fact an injured employee at that point, so in BC there would be no "requirement" to use an ambulance. I suspect the local regs for that dept are different, which is what led to the problem.

    I too would encourage the ambulance as the first option, and we do here at work, but when the ambulance is too far away, we transport our own with the company ETV (a 2005 Chev Tahoe) or one of our helicopters if it is that serious. In either case, the environment is nowhere near as cushy and ideal as an ambulance, but it does more than meet the provincial requirements for an injured worker.
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    Anybody that thinks the Chief made the wrong call, is just another MUTT. He did what was in the best interest of his member. He made a decision to help his guys and stuck with it, something that many officers need to learn. I dont give a damn if he put the guy in a ric-shaw (sp?), he got the guy to the hospital is the least amout of time. Thats what counts, that should be the end of the story. Somebody needs to kick that pencil pusher in the gonads.
    Just another one of the 99%ers looking up.

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    Maybe the medical director would prefer that the brother FF be shoved into the bed of Bubba's pick-up and driven at warp speed to the hospital kinda like you see in the aftermath of a tornado or hurricane. Or maybe he'd prefer the ever popular "drive-by dumping" at the ER door that is ever so popular in the ghetto areas (I've hauled a few GSW's off the street who were dumped off by their "buddies" - you know, the ones who just happen to hightail it outta there as soon as he hits the stretcher/pavement, whichever is closer).

    If one of us gets hurt & needs help, I wouldn't care if it took a mule (the 4 legged kind, not the 4 wheeled kind), a rickshaw or a front end loader, as long as our people (who are there in the 1st place to help everyone else) need help, they will get it...PERIOD. Anybody ever go to a scene where both a perp AND a PO were injured either in a MVA/MVC (whatever you call it) or during a chase? Remember who got treated first and foremost? That's right - the public safety provider (FTM...they're like Doritos...crunch all you want, they'll make more)!!!

    Sounds like this pencil pushing, stethoscope wearing EMS director has no understanding of what goes on in "the real world"...sometimes you gotta adapt to the situation at hand. Remember, if we're there, it means something ain't right, the situation obviously didn't go according to plan (no one calls 911 'cause they're having a good day) so we need to improvise, adapt and overcome to get the job done, especially it involves the safety of one of our own. It's not like they provided ALS in the back of a '76 Vega with a teardrop on the roof...they used a bonafide emergency vehicle that was able to do the job (and safely it appears...not like they were doing CPR in the hosebed or anything). From what I read, the chief did what he had to do at that particular moment at that particular call...doesn't sound he like wants to make a habit of this but the medical director wants him to sign a policy stating he won't do it again. Just sounds like the medical director is ****ed someone thought outside the box and is trying to flex his muscle...let's see how much he flexs when he's on the witness stand attesting to this policy when a FF dies 'cause a chief was afraid to violate a ridiculous policy.

    Just my 2 cents...Stay Safe...and hey if you're gonna collapse on the fireground, be kind to your chief & make sure there's an ambulance onscene so he doesn't catch any flack for getting you the help you needed, ok...

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    I only want to make clear that I make no judgement call on what transpired, or what might in the future transpire. I only comment on how the laws within BC are stated. I am not familiar with the WCB code on this particular instance, however I am quite familiar with what the insurance law is as this came direct from a lawyer who runs medical cases.

    As I stated earlier, for a patient to be eligible for medical insurance coverage, and who's injuries are either aggrevated or additionally caused (ie MVA event because of the transport vehicle) the only recourse for that patient to receive his medical insurance is to sue the driver of that vehicle, because care at the base level does not provide for transport beyond the immediate injury site, based on immediate danger to life etc. In other words, the only time a pt may be moved from the immediate location to which he/she is found is in time of imminent danger. Fire, flood etc. Which of course we are all familiar with.

    I've never been faced with making that decision, and as such, am not going Monday morning quarterback the original story. I can only say I hope it works out in a good way for all concerned.

    As I think about it, the only persons that I think might be covered for an emergency transport like that are OFA 3's who are employed in remote areas such as logging camps or mining areas. And only because it is commiserate with their duties as the on-site emergency care provider. I do know that my First Responder 3 licence does not cover overground transport.
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    If those stinkin' beiracrats have nothing better to do than crap like that, NY is in very sad shape!
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    Sounds to me someone is salty because their wallet won't be getting any fatter off the lack of this transport.
    FF/NREMT-B

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    Thumbs up

    it appears this was the correct decsion................I mean it wasnt like he shirked the ambulance for the Chief's car.......I think this was the right call and cant believe the chief is gettign grief about it.
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    Another option: double load in the waiting ambulance.
    NREMT-P\ Reserve Volunteer Firefighter\Reserve Police Officer
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    Quote Originally Posted by RyanEMVFD
    Another option: double load in the waiting ambulance.
    But then you'll have the patient bitching too.
    Quote Originally Posted by ThNozzleMan
    Why? Because we are firemen. We are decent human beings. We would be compelled by the overwhelming impulse to save an innocent child from a tragic, painful death because in the end, we are MEN.

    I A C O J
    FTM-PTB


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    In my eyes he was taking care of family. I would have done the same and delt with anybody who thought different later. It rubs me the wrong way to think people wouldn't do the same if put in that position.

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    Quote Originally Posted by Res343cue
    But then you'll have the patient bitching too.
    Not to mention a huge HIPPAA violation if PT's are not related.
    FF/NREMT-B

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    Quote Originally Posted by pfd4life
    Not to mention a huge HIPPAA violation if PT's are not related.
    Ambos here take two all the time. Even three if they are not really hurt. I've never heard anyone say we can't do it due to hippaa. That said, if I'm hurt I either want my own ambo or the chief to take me. I refuse to ride with some mutt from the scene, although here ambos are no problem and there wouldn't be any wait. This chief absolutely did the right thing and should not hesitate to do it again.
    I am a complacent liability to the fire service

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    Patient care trumps HIPAA. If there isn't a reasonable alternative and you're capable of properly treating both patients during transport (without impairing the care of the other), do it.

    ===========================

    Since as it is I think 50% of the patients we transport in our ambulance should've gone by POV anyway, I have no problem what so ever with the Fire Department transporting their own here. In my area, unless you win the Paramedic Lotto and they happen to be in your district being returned to their intercept car, at the very best you'll receive ALS just as quick as you could've been driven POV to the hospital proceeding with traffic and begun care in the ER. Call 911, and we have to follow rigid protocols.

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    This CHIEF made the right decision to take care of his own firefighter. The FF was transported with 2 EMS personnel with him so he had adequate care. WHY wait for an ambulance with a down and unconscious FF when you have medical personnel on scene and a more rapid way top transport than waiting for an ambulance.

    I would have done exactly as this Chief did. Whether it cost me my job or not I know I did the right thing for my guy.

    FyredUp

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    The problem is... the suits in the OEMS offices have no fracking clue as to what happens in the "real world" we deal with on a daily basis. They are so far removed from the street, they would need GPS just to find it!

    The Chief made the correct decision here...
    ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
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