During transport, who is in charge if L&S should be used. Also can you refuse treatment/transport?

[fiznat]

As others have stated, this is something that should be written in black in white by whatever body controls EMS in your area. Here is a copy of the protocol that governs "lights and sirens" practice for us here in central Connecticut. The relevant passage is towards the bottom under "patient transport."

[crotchitymedic1986]

you answered your own question when you said your volly department had no rules or regulations. GET SOME. It does not matter what they do anywhere else, your organization needs to become professional and set some standards. Otherwise you are all opening yourself up to a huge liability.

[ghurty]

you answered your own question when you said your volly department had no rules or regulations. GET SOME. It does not matter what they do anywhere else, your organization needs to become professional and set some standards. Otherwise you are all opening yourself up to a huge liability.

The problem is, that they are trying to right the rules to allow patient abadonment, as well as driver going with L&S when no need for it. They are being written with out any legal or medical oversight.

[SWA_EMT]

The problem is, that they are trying to right the rules to allow patient abadonment, as well as driver going with L&S when no need for it. They are being written with out any legal or medical oversight.

If this is actually the case, then you have a duty to act. This is your patient. Stop them from putting these rules into effec BEFORE your patient is killed. These people making the rules are going to kill someone. It WILL happen....I guarantee it. That person killed could be you, an actual HUMAN (yes, our patients are still human, no matter our preconceived notions about them), your partner(s), or a member of the unassuming public.

The first step in doing "No Harm".....is making sure our rules are set to protect, not inflict.

[tam]

I am embarrassed to say this, but this is one of the problems with volly squads, that there is no real rules and guidelines.

The other night my (volly)BLS squad (in New Jersey) got into a heated debate of who is in charge during the patient transport. In particular - lights and sirens.

I am of the belief that the EMT treating is in charge, and that if he/she based on the patients status, tells the driver (usually not even an EMT), NOT to go with lights and sirens. Then the driver can NOT use them. And if the driver does, they are opening themselves up to sever liability issues. The problem is, that a lot of drivers love going with lights and sirens.

Other members claim, that the driver is in charge, and it is his decision whether to use lights or sirens. That "if we are transporting then it must be an emergency".

This led to a different discussion whether or not a EMS squad dispatched to a call can refuse treatment/transport if they feel that it is not a "real emergency".

I am of the belief that refusing transport would be considered abandonment, (thus being the reason why we need RMA's). They claimed that even though you arrive on scene and do a quick assessment, it is not considered abandonment until you actually start treating the patient.

So basically, the two questions are:

1) Who is in charge in regards to using lights and sirens during a transport.

2) Can you refuse treatment/transport of a patient if you feel it is not an emergecny.

Remember, we are dealing with BLS here.

It could be that I am wrong regarding both of these. I would love to hear what anyone has to say about this. Also if anyone has links to any legal documents, etc... We are dealing with New Jersey here, but any input would be appreciated.

Thanks

Hi guys.I am new to this forum and this site. I am an EMT from a small town in upstate NY. We have alot of vol. squads here.We have our paid paramedics but everyone else is vol..I was always told that the paramedic or emt is in charge of the patient and as for lights and sirens that would depend on the emergency it-self.If the call is a 1a you don't go lights and sirens. Isn't it illegal if it's not a true emergency? A 1a or 1b is lights at most. Right?

[Richard B the EMT]

The highest medical authority on scene of the ambulance crew is supposed to be in charge, medically, of the patient, per everything I have been taught, and what I recall, off hand, of agency(s), county, and state rules and regs. That person is the one tells the person driving if they are to turn off the L&S and respond to the hospital as a regular vehicle, activate the lights and use the siren when necessary (understandably under discussion in many areas, including several EMT City strings), or running full out "Hot".

In all instances, the person driving has not done their job if the ambulance either is in an accident, or causes one. As always, on that, I refer back to NYS Vehicle and Traffic Law #1104, operate the vehicle with due regard to all other traffic on the road. I tend to believe that all 50 states, and probably all other countries, have some rule or regulation on the books that says something to that effect.

Also, concerning the siren usage, if the EMT or Paramedic in charge of the patient tells the patient that "things are under control", but suddenly the siren blares out, the patient might feel that their condition is worse than it is. This can raise the patient's BP, as "What is this person not telling me about my condition, that they are now using the siren?"

[HERBIE1]

The highest medical authority on scene of the ambulance crew is supposed to be in charge, medically, of the patient, per everything I have been taught, and what I recall, off hand, of agency(s), county, and state rules and regs. That person is the one tells the person driving if they are to turn off the L&S and respond to the hospital as a regular vehicle, activate the lights and use the siren when necessary (understandably under discussion in many areas, including several EMT City strings), or running full out "Hot".

In all instances, the person driving has not done their job if the ambulance either is in an accident, or causes one. As always, on that, I refer back to NYS Vehicle and Traffic Law #1104, operate the vehicle with due regard to all other traffic on the road. I tend to believe that all 50 states, and probably all other countries, have some rule or regulation on the books that says something to that effect.

Also, concerning the siren usage, if the EMT or Paramedic in charge of the patient tells the patient that "things are under control", but suddenly the siren blares out, the patient might feel that their condition is worse than it is. This can raise the patient's BP, as "What is this person not telling me about my condition, that they are now using the siren?"

Agreed, Richard, but I think the original issue was that everyone on scene was the same level of provider, so highest medical authority wouldn't matter.