Taking/Relinquishing Scene Control

[Nate]

I have to agree with the two above posters.

[RiderRob89]

As a BLS provider, I feel it is essential that ALS and BLS work together for the best possible outcome for the patient. On calls where the patient's condition is critical, I would hope and expect that ALS would take the lead, at least clinically. The exception to this would be where the ALS provider is new, or inexperienced, in which case I would expect that they would perform ALS interventions and let an (experienced) BLS provider deal with everything else. When push comes to shove, however, the public and our patients often will not make a distinction between ALS and BLS, so it therefore becomes essential that we work as a team and present a unified front to the public. Leave the politics, egos and infighting in the station, because they have no place on an emergency scene.

[medic001918]

As a BLS provider, I feel it is essential that ALS and BLS work together for the best possible outcome for the patient. On calls where the patient's condition is critical, I would hope and expect that ALS would take the lead, at least clinically. The exception to this would be where the ALS provider is new, or inexperienced, in which case I would expect that they would perform ALS interventions and let an (experienced) BLS provider deal with everything else. When push comes to shove, however, the public and our patients often will not make a distinction between ALS and BLS, so it therefore becomes essential that we work as a team and present a unified front to the public. Leave the politics, egos and infighting in the station, because they have no place on an emergency scene.

I'm afraid I have to disagree with letting a BLS provider deal with everything else if there's a new medic on scene. A paramedic should not be on their own if they're not a solid BLS provider and fully capable of managing a scene. Just because someone is a new medic, does not give them any less of a reason to maintain control of their scene. After all, part of being a paramedic is having the ability to make the decisions that need to be made. This does not just apply to medical and clinical decisions. As scene control can adversely affect patient outcome if done poorly, or improve patient outcome when done properly since a paramedic is technically responsible for the scene, it doesn't make much sense to let someone else assume the role that you're going to be responsible for unless that provider is equal in training and certification. My feelings on the subject are not based on an ego or even being a paragod. They are based on liability and legality. If I'm going to be held responsible for something, I'd prefer to be the one who has made the decisions so that I can fully explain the rationale behind them to someone if the need arises. While the public might not make a distinction regarding BLS vs. ALS, the legal system will. I think it all comes back to training standards and requirements. If you're not capable of managing a scene, maybe you shouldn't be a lead medic?

Shane

NREMT-P

[Rescue0ne]

...On calls where the patient's condition is critical, I would hope and expect that ALS would take the lead, at least clinically. The exception to this would be where the ALS provider is new, or inexperienced, in which case I would expect that they would perform ALS interventions and let an (experienced) BLS provider deal with everything else.

When I was a new ALS provider, I already had 6 busy years as a BLS provider under my belt. There's no justification for me to automatically hand patient care over to the BLS provider and me only handling ALS intervention. (I know it's sounding like I'm contradicting what I said earlier in this thread, but I'm really not.) No matter if I'm allowing the BLS provider to handle most of the hands on pt. care...that patient is ultimately my responsibility, until I hand him/her off to an ER MD. If ALS intervention IS necessary, I'm taking the hands-on role anyway, the BLS provider is then my "assistant", for lack of a better word. I'd not let them take the lead, if I was performing ALS care...they wouldn't normally have a clue as to what I was looking for in re: vitals, scores, etc. What's the BLS provider really able to do for the patient while I'm performing ALS intervention, unless it's helping w/ 2-person CPR, or taking notes from me for the patients chart?

...When push comes to shove, however, the public and our patients often will not make a distinction between ALS and BLS, so it therefore becomes essential that we work as a team and present a unified front to the public. Leave the politics, egos and infighting in the station, because they have no place on an emergency scene.

Politics, egos, and infighting have no business ANYWHERE, let alone in the station...but of course, you're correct in that respect. Your EMS agency should already have, in place, an IC setup for major situations, etc. It really comes down to professionalism. Either you have it or you don't.

[RiderRob89]

[cfaulknor]

Correct me if I'm wrong, but it shouldn't be abandonment unless the ALS provider makes patient contact or does something out of the BLS Scope of Practice.

[medic001918]

If an ALS provider is assigned to the call, they have an obligation to perform an assessment on the patient as part of their duties. If you're present and do not do an assessment, you are being negligent in your care. An ALS assessment is supposed to go into more depth than that of a BLS provider, if for no other reason then the training and understanding of anatomy, physiology and pathophysiology.

Shane

NREMT-P

[Rescue0ne]

I know this topic has been talked to death, but I found a copy of my Regional EMS Council's Guidlines, and thought I'd share it with you.

Scene Authority For Patient Care

Scene authority and transition of patient care may occur on several levels within our system. With these protocols, each OMD has agreed to, and assigned each provider with a specific patient care level (CCEMT-P, EMT-P, EMT-CT, EMT-I, EMT-ST, EMT-J, EMT). Based on their proven medical knowledge and mastery of practical skills, the senior level patient care provider may assume responsibility of prehospital care. In the event of a multi-agency response (1st Responder agency, transport agency, etc.), the agency assigned with the task of transport shall obtain and maintain the senior level of provider care responding to the incident. If there are concerns regarding the care of the patient, Medical Control shall be consulted.

Patient Care Transfer:

1. The 1st Responder responsible for patient care will provide a verbal report to the

assuming transport provider. Once the report is received, the transport provider

assumes patient care responsibilities. The transfer of care shall be noted on the call

report and/or by radio communications.

2. The transport provider may request the assistance from the 1st Responder agency for manpower for those calls that are resource intensive (cardiac arrests, major illness/injury, etc).

3. Should disagreements arise between the 1st Responder responsible for initial patient

care and the receiving transport provider, they should be resolved in a quiet,

professional manner prior to transport. If a resolution cannot be reached prior to

transport, either Medical Control may be contacted for further resolution or the 1st

Responder responsible for initial patient care may be requested to accompany the

patient to the receiving facility. Each agency's OMD (or designee) shall be notified of

the incident within twenty-four (24) hours.

4. Once ALS level of care has been initiated (IV therapy, EKG monitoring, medication

administration, etc), that same level of care must be maintained until transfer of care

to the appropriate receiving facility. (This STILL means if an ALS provider has administered BLS care, that ALS provider has to accompany the BLS provider & patient to the hospital. This is that hazy area I mentioned in a previous post. Bottom line, you accompany the patient, no matter what.)

[chazmedic]

In the great and mighty state of Arkansas, it is LAW that the "highest level of certification on the responding ambulance" once on scene, takes responsibility and care of the patient. You cannot downgrade from ALS to BLS. The ALS provider has to have direct patient care. Note I said from the responding ambulance. This is to prevent the "I'm a doctor/nurse/vet" syndrome from occuring. A EMT basic cannot legally remain the "primary" caregiver once the paramedic arrives on scene. This has been historically more a problem with BLS first responders refusing to "turn over" the patient to the BLS ambulance. In these cases, the EMT first responder usually feels they are equal to the ambulance EMT, therefore, doesn't have to turn over the patient. However, it doesn't matter, as the law clearly states the "responding ambulance" has the primary care.

The only exception is the introduction of ALS first responders with BLS transport ambulances. Law has provision that the BLS ambulance must allow the ALS provider maintain primary caregiver. Remember, no downgrading from ALS to BLS, even if the call is truly a BLS call.

Now, as to the original intent of the thread, how to turn over care from the BLS to ALS level. I prefer the patient report presented with a nice hot cup of coffee, creamer, and a sugar or two. I also prefer the coffee to be in a nice stoneware cup. Bowing in not necessary, however, if you wish, feel free. Liberal use of "Sir" is considered flattery and will be looked upon favorably. Carry my bags to and from the ambulance and cry when I leave.

[1aCe3]

"In these cases, the EMT first responder usually feels they are equal to the ambulance EMT, therefore, doesn't have to turn over the patient."

So whats the genius going to try do? Transport the pt in his pov? :shock: