Re: Re: Police refuse to allow medics gain patient refusals

[Guest guest]

An interesting question comes to mind: If you choose to first respond, not

as a recognized FRO but as a general member of the public, but you hold an

EMS certification of some sort, must you get an informed refusal from

patients who refuse treatment and do so before you leave their side or

transfer treatment to another person or agency?

It is true that there's no blanket duty to respond, but once you do, you're

bound to render care to the extent of your training and expertise, given the

situation. Now, " the situation " is a loaded phrase, and takes into

consideration lack of medical direction, tools, and all sorts of other stuff.

But, If I happen upon a wreck while returning to my area from a transfer, and

I decide to help, it is generally conceded that the only things I can do are

basic things that any member of the public could do, such as CPR, basic

airway maintenance, hemorrhage control, protecting the patient from extremes

of heat and cold, and so forth.

If I am trying to do those things but am interfered with by an officer of the

law, where do I stand? Where does s/he stand? If I have begun care, even to

the extent of placing a 4x4 on a lac to the forehead on a patient who has hit

the windshield and made a spiderweb, the patient, who can't remember what

happened, wants to refuse further treatment, the local EMS is not on scene,

and a cop says get yer a** out of here, what does one do?

What's magic about being a bona fide FRO if there is somebody hurting who

needs care? Are we saying that if one holds an EMS certificate of some level

that s/he is on a lower status than a member of the public with no

credentials would be?

Further, what rules do law enforcement officers have to respect with regard

to EMS personnel who are giving care on the scene of an incident, whether it

be an MVC or otherwise?

I suggest that, at least in Texas, there is no rule of law that speaks to

this. Do we need such a rule? Is this purely an item that ought to be

addressed by education of LE officers and touchy-feely meetings with EMS? Or

should LE officers be bound to defer to EMS personnel when treatment

considerations arise?

Who knows? Who cares? Write your thoughts on this subject. And please

don't flame me for asking these questions. I'm just the instigator.

gg

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

Well, yeah, if I picked a fight, it won't be for the first time. Let's see

some other dogs in this fight. What's the relationship between LE and EMS?

What should it be? What rules govern? Let's hear it.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

Gene - As usual, you have written an excellent

thought provoking letter. Here's my twice

pennies worth, sprinkled through your letter:

--- wegandy@... wrote:

> An interesting question comes to mind: If you

> choose to first respond, not

> as a recognized FRO but as a general member of

> the public, but you hold an

> EMS certification of some sort, must you get an

> informed refusal from

> patients who refuse treatment and do so before

> you leave their side or

> transfer treatment to another person or agency?

> It is true that there's no blanket duty to

> respond, but once you do, you're

> bound to render care to the extent of your

> training and expertise, given the

> situation. Now, " the situation " is a loaded

> phrase, and takes into

> consideration lack of medical direction, tools,

> and all sorts of other stuff.

I would say that " lack of...tools... " includes

the lack of appropriate paperwork to document the

informed refusal. The best course of action,

assuming you (1) chose to get involved in patient

care, and (2) got kicked off the scene by an

officer, might be to hang around ***away from the

scene*** but close enough to catch the attention

of the EMS unit when it arrives so you can

explain your side of the story to them

(specifically any pertinent medical information).

After all, if you think the patient needs EMS and

you got rousted by the cops, you should at least

go somewhere and call EMS, agreed? In my

experience, a wise officer will make sure you

have some sort of ID that proves you're certified

(and we ALL carry our certification cards,

right?) and then let you do what you can. I

think we can safely assume that if cops wanted to

be medics, they would be medics, not cops.

They're generally content to let medics do the

medic thing, as long as the bystander/medic looks

and acts like s/he knows what he's doing.

Furthermore, if you've shown your ID to the

officer, expressed your concern that the patient

needs medical attention, and you're attempting to

provide it, most cops (not all, mind you, but

most) will call an ambulance for you.

It's simply the wisest course of action for the

cop, who probably understands the liability of

refusing to call an ambulance for somebody who

requests one, especially when there is an

identified card-carrying EMS provider on scene to

confirm the patient's (read: plaintiff's) side of

the story.

As far as getting in any kind of " anatomy "

contest with the officer, you and the patient

both lose immediately. You go to jail and the

patient doesn't get the treatment s/he needs.

The way I see this scenario unfolding, the cop

doesn't think the patient (plaintiff?) needs EMS

assistance, therefore s/he's kicking you out and

probably NOT calling EMS. Consequently, since

the patient isn't getting medical treatment

anyway, you might as well avoid a trip to jail.

No reason for both you and the patient to suffer.

It sounds ugly on the page, but it's the truth.

> But, If I happen upon a wreck while returning

> to my area from a transfer, and

> I decide to help, it is generally conceded that

> the only things I can do are

> basic things that any member of the public

> could do, such as CPR, basic

> airway maintenance, hemorrhage control,

> protecting the patient from extremes

> of heat and cold, and so forth.

>

> If I am trying to do those things but am

> interfered with by an officer of the

> law, where do I stand? Where does s/he stand?

> If I have begun care, even to

> the extent of placing a 4x4 on a lac to the

> forehead on a patient who has hit

> the windshield and made a spiderweb, the

> patient, who can't remember what

> happened, wants to refuse further treatment,

> the local EMS is not on scene,

> and a cop says get yer a** out of here, what

> does one do?

Now you're in a situation in which you're driving

past a collision in a ***marked ambulance***, and

this changes the rules of the game entirely. How

many people at the scene of the collision are

going to write down all the license plates of the

people who failed to stop and render aid?

Exactly zero. How many of those people will

remember your ambulance company's name,

conveniently marked in 47-foot tall, Scotchlite

retroreflective lettering on the billboard-sized

side of your ambulance, if you don't stop?

Exactly nine million, and all of them are

plaintiff's attorneys on the way home from a

convention. You're pretty much obligated to

stop, if for no other reason than you can at

least honestly testify that you stopped.

> What's magic about being a bona fide FRO if

> there is somebody hurting who

> needs care?

There is no magic in being a " bona fide FRO " in

my opinion; the magic is in being willing and

able to help another person who needs your help.

That's not a common quality. I'm not willing to

go to jail to prove my point on this, but I'm

also not willing to let somebody die or suffer

needlessly out of sheer fear or laziness, either.

> I suggest that, at least in Texas, there is no

> rule of law that speaks to

> this. Do we need such a rule? Is this purely

> an item that ought to be

> addressed by education of LE officers and

> touchy-feely meetings with EMS? Or

> should LE officers be bound to defer to EMS

> personnel when treatment

> considerations arise?

A police officer, by AG opinion (and maybe State

law now), is a police officer 24/7/365. They

have a legal obligation to act whether on- or

off-duty, even if only as a reliable witness to

the incident. Do we as EMS providers carry the

same obligation? Legally, I don't think we do.

Ethically and morally, yes; legally no. Am I

correct Gene?

> Who knows? Who cares? Write your thoughts on

> this subject. And please

> don't flame me for asking these questions. I'm

> just the instigator.

" Instigator " ? You picked a fight, now you don't

want to get hit? I see how you are...lol

> gg

A. Reynolds Jr. DAD, HUSB, EMT-P

Stretcher Fetcher Grunt Instructor

School of Hard Knocks

__________________________________________________

[Guest guest]

<Does EMS want to be called out for every single

fender bender that occurs?>>>>

If you are generating refusals in my provider district and you are not a FRO of

record with my agency...yes I want to be notified of each and every call you

make in my district...for ONE simple reason:

Something happens later (patient complaint, PD Officer complaint, bad pt.

outcome, ER complaint, auto insurance litigation needing a copy of the refusal,

etc)then you had better summon me out to the scene in my city/coverage area

because I believe/feel/understand that as the licensed EMS provider of that area

I will be the one held to task for the EMS activities the occur there...as a

result, you owe it to me via professional courtesy to notify me of the call and

have me respond. Also, you owe me a copy of the refusal within 5 days of the

call in case anyone comes looking for it.

After incidents occur, people are not going to remember who the first responder

was. They are going to go to the phone book and call the EMS service of that

area to gather whatever info they need....trust me...in my district we are the

EMS provider in 9 cities and areas of 2 unincorporated counties with 8 separate

FRO's.

Yes...if you are not one of the 8 FRO's...I want you to call me on every little

incident...otherwise I will never know it occurred>>>'s Law of EMS states

that you will have first responded on the wife of the mayor of the city I am

having the most political issues with at the time and I will not have any idea

it ever occurred.

Sorry for the long reply , but I needed to expound on this one. Thanks.

Dudley

[Guest guest]

First of all he was probably mad because EMS got involved in the accident

investigation by having the people move there cars. In County if you

are involved in a non-injury accident, the vehicles do not need to be towed

and no one is under the influence of drugs or alcohol the parties can just

exchange info and fill out a blue form at the court house within 24 hours.

I know almost all the traffic deputies and they all say the same, we do not

do your job so do not do ours. If you told them to move the cars and then

called for an investigation I understand why he is upset. They know we have

a job to do and know we need to conduct our proper business. To file a

complaint will make the GAP between LE and EMS even bigger. Remember you may

need them to come to a scene that turns violent and I want to know they will

be there quickly and will help.

Best thing, let it go and chalk it up to experience. And remember they have

a job to do also.

Chuck

Hermann Life Flight

>

>Reply-To:

>To: < >

>Subject: Re: Re: Police refuse to allow medics gain patient

>refusals

>Date: Wed, 29 Aug 2001 07:11:41 -0500

>

>Perhaps we are overexpanding this incident. There is no doubt that

>bonafide

>EMS personnel have an ethical, if not legal under given circumstances, duty

>to act when they witness an accident. However, unless those particular EMS

>personnel are covered by medical protocol in the area they are in

>( " legitimized " might be an appropriate term), whatever they do is limited

>to

>those interventions that any reasonable person would do, and that are not

>required to have medical oversight. Right?

>

>The problem here is not that these STATTSAR folks went to the cars and

>checked on the people involved. That is perfectly understandable. In

>fact,

>I'm sure it happened well before the deputy arrived on the scene.

>Apparently, the STATTSAR people felt an ambulance was not warranted since

>they did not call one immediately (remember, they had 2-way radio

>communication to a dispatch center - the same dispatch center for the

> " legitimate " EMS service in that area). The deputy on arrival sees a group

>of orange-shirted bystanders attempting to get the participants in his

>crime

>scene to sign these documents. The deputy doesnt know who they are, but he

>sure knows who they are not. Perhaps a little more tact could have been

>used; perhaps it was, initially. The problem is that these bystander

>medics

>had assumed the function of the legitimate EMS provider by gaining patient

>refusals.

>

>Read the entire thread. It is apparent that McBarron and STATTSAR are

>determined to function as an EMS Provider or FRO without proper

>credentialing and oversight. Using his logic, people should be able to

>begin practicing immediately after they take the state test since they

>MIGHT

>be getting their certificate in the mail any day now. There are rules

>regarding this activity, designed to ensure medical oversight AND

>cooperation between recognized FRO's and the EMS providers of their areas.

>STATTSAR ignores these, and THAT's the problem. Organizations like this

>one, and incidents like this, are pillar examples of what EMS has to

>overcome to reach the legitimacy and standing we deserve.

>

> Petty, EMT-P, EMSI

>

> Re: Re: Police refuse to allow medics gain patient

>refusals

>

>

> > Well, yeah, if I picked a fight, it won't be for the first time. Let's

>see

> > some other dogs in this fight. What's the relationship between LE and

>EMS?

> > What should it be? What rules govern? Let's hear it.

> >

> > GG

> >

> > E. Gandy, JD, LP

> > EMS Professions Program

> > Tyler Junior College

> > Tyler, TX

> >

> >

> >

[Guest guest]

,

You are SO WRONG about " Read the entire thread. It is apparent that

McBarron and STATTSAR are determined to function as an EMS Provider or FRO

without proper credentialing and oversight. " We had marked personnel and

units on location of this incident. We were acting as good samaritans

keeping in mind that people do not know that we cannot provide care as a FRO

(or Provider for that matter) even though our vehicle says " Search and

Rescue " on it. Do they even know the difference? Not likely. Gaining the

refusal may have been being too litigiously cautious, but what if our FRO

license arrived yesterday. The persons in those vehicles could have filed a

lawsuit against STATTSAR as a legitimate FRO (per the date on the FRO

license issued by TDH).

An mabulance was not requested by us because everybody was ambulatory (not

saying you are not injured by being ambulatory), denying an ambulance, with

no VISUAL signs of injury. Does EMS want to be called out for every single

fender bender that occurs?

Our administration including our Medical Director have reviewed the incident

and all details pertaining to this incident and have concluded that when the

deputy told us to leave (which we did) the deputy assumed all liability of

patient care and outcome.

Additionally, is incorrect when he stated " Using his logic, people

should be able to begin practicing immediately after they take the state

test since they MIGHT

be getting their certificate in the mail any day now. " This is

preposterous. There is a difference when you have certified/licensed

personnel in uniform on location of an incident who have a duty to act

(whether legal or moral) and a non-certified/licensed person on location.

Had we been on location out of uniform with no identifying marks would we

have responded? most likely. Would we have garnered refusals and identified

ourselves as STATTSAR (NOT medics)... no.

And oh, we do not ignore the rules regarding FROs and Providers.

C. McBarron

Chief

South Texas Advanced Tactical Team Search & Rescue

http://www.stattsar.org

[Guest guest]

Okay, I'll step into this one. I don't have a position, but I've read every

post on this... so let me ask a few questions (for which there are likely

legitimate answers...). Inline below...

Mike

RE: Re: Police refuse to allow medics gain patient

refusals

,

You are SO WRONG about " Read the entire thread. It is apparent that

McBarron and STATTSAR are determined to function as an EMS Provider or FRO

without proper credentialing and oversight. " We had marked personnel and

units on location of this incident. We were acting as good samaritans

keeping in mind that people do not know that we cannot provide care as a FRO

(or Provider for that matter) even though our vehicle says " Search and

Rescue " on it. Do they even know the difference? Not likely.

M> I have to agree with here. Having a marked " Search and Rescue "

unit and crews in orange jump suits seems to make them at least visible.

While there is no legal duty to act (we'll get to that later), I can't see

anyone having a problem with their initial approach, assessment and triage.

Gaining the

refusal may have been being too litigiously cautious, but what if our FRO

license arrived yesterday.

M> Doesn't matter. Until you have actual notice (have received, read and

understood the notice), I don't believe it applies (of course, I'm not an

attorney). Just like my provider card - until I get it in the mail, it matters

not what the CertQuery says, or so says TDH, who can fine me for not carrying it

while I practice. And gaining a refusal is providing care and treatment -

that's what a refusal form says. Essentially, it says " We offered to care for

you, treat you and transport you [note: or obtain transport for you] and you

don't want it, and we have evaluated you enough to determine that you're okay

enough to refuse these services. " You provided enough evaluation and care to

determine that they were either injured or had significant mechanism, determined

that they needed treatment and/or transport, determined that they didn't want it

and determined that they could, should and would refuse care, treatment and

transport. You stepped from a " duty to act " in response to assuming the duties

of a fully-qualified (state qualification, NOT a reflection on the medical

capability of any personnel in your unit, of whom I know none personally) EMS

agency. Potentially a mis-step, but I'm not with TDH, not an attorney and don't

know. I think that's what most here are arguing, though...

The persons in those vehicles could have filed a

lawsuit against STATTSAR as a legitimate FRO (per the date on the FRO

license issued by TDH).

M> Maybe, maybe not. You're not an FRO for that particular area. Though

most attorneys would probably include you since you provided care.

An mabulance was not requested by us because everybody was ambulatory (not

saying you are not injured by being ambulatory), denying an ambulance, with

no VISUAL signs of injury. Does EMS want to be called out for every single

fender bender that occurs?

M> If you're providing care and obtaining refusals? Look at it this way

- say a patient comes back and requests a report from EMS on this incident at

that location. The EMS service doesn't have a *clue* what they're talking

about, because they never made the scene...

Our administration including our Medical Director have reviewed the incident

and all details pertaining to this incident and have concluded that when the

deputy told us to leave (which we did) the deputy assumed all liability of

patient care and outcome.

M> Except that the deputy doesn't have the necessary medical training to

legally understand or accept such responsibility. And, you didn't have the

standing to challenge him, because it wasn't " your turf " , you weren't an actual

" EMS Provider " and were not authorized to provide care at that scene. Bad deal

all around - you can't argue your way to jail (unless you really *want* to <g>),

and you can't ignore him, but it's a liability to " just leave " as well...

Additionally, is incorrect when he stated " Using his logic, people

should be able to begin practicing immediately after they take the state

test since they MIGHT

be getting their certificate in the mail any day now. " This is

preposterous. There is a difference when you have certified/licensed

personnel in uniform on location of an incident who have a duty to act

(whether legal or moral) and a non-certified/licensed person on location.

M> No, there's not. Certified/Licensed personnel on location may walk up

as individuals who happen to be a member of your organization. Your

organization was not accredited to provide care or assume the duties of an FRO.

's logic was dead-on.

Had we been on location out of uniform with no identifying marks would we

have responded? most likely. Would we have garnered refusals and identified

ourselves as STATTSAR (NOT medics)... no.

M> So a simple change of clothing affects your standard of care? A

refusal is an item of care in the aresnal of an EMS provider. It's " care " is

that it requires a thorough evaluation of the patient, their mental status,

mechanism of injury and their confidence in you as a provider. If I first

respond with my fire department, and I'm in street clothes, I can obtain a

refusal on a patient. But, I'm required to document it the same way I would

were I in uniform, on the ambulance, and do the same assessment(s). My uniform

makes no difference. My status as a responder does. If I'm driving through

someone else's territory - my refusal isn't worth squat. If they have injuries

or mechanism (the definition of a patient), I need that locale's EMS service to

make the decision on obtaining a refusal.

Bottom line? Your actions turned the participants from the wreck into

" patients " in an EMS sense. Your obtaining refusals was at least implicitly

practicing outside your scope as a provider, and most likely would have fallen

outside that scope even with an FRO notice in hand, as you had no established

relationship (reportedly) with the EMS system in that area, and did not

adequately turn over the call to them, even for refusals.

I do applaud your approach to the accident. I do applaud your groups

willingness to help, and their concern over their actual duties. I apologize

for any personal tone this has taken on the list... and look forward to seeing

how you do in the field.

And oh, we do not ignore the rules regarding FROs and Providers.

C. McBarron

Chief

South Texas Advanced Tactical Team Search & Rescue

http://www.stattsar.org

[Guest guest]

I must say, the Dudman is right on the money, you come to my County and

start " playing EMS " you better call EMS just the same as any of my 20 +

FRO's would do.

RE: Re: Police refuse to allow medics gain patient

refusals

> <Does EMS want to be called out for every single

> fender bender that occurs?>>>>

>

> If you are generating refusals in my provider district and you are not a

FRO of record with my agency...yes I want to be notified of each and every

call you make in my district...for ONE simple reason:

>

> Something happens later (patient complaint, PD Officer complaint, bad pt.

outcome, ER complaint, auto insurance litigation needing a copy of the

refusal, etc)then you had better summon me out to the scene in my

city/coverage area because I believe/feel/understand that as the licensed

EMS provider of that area I will be the one held to task for the EMS

activities the occur there...as a result, you owe it to me via professional

courtesy to notify me of the call and have me respond. Also, you owe me a

copy of the refusal within 5 days of the call in case anyone comes looking

for it.

>

> After incidents occur, people are not going to remember who the first

responder was. They are going to go to the phone book and call the EMS

service of that area to gather whatever info they need....trust me...in my

district we are the EMS provider in 9 cities and areas of 2 unincorporated

counties with 8 separate FRO's.

>

> Yes...if you are not one of the 8 FRO's...I want you to call me on every

little incident...otherwise I will never know it occurred>>>'s Law of

EMS states that you will have first responded on the wife of the mayor of

the city I am having the most political issues with at the time and I will

not have any idea it ever occurred.

>

> Sorry for the long reply , but I needed to expound on this one.

Thanks.

>

> Dudley

>

>

>

>

>

[Guest guest]

and another great post from the King Of Stretcher Fetchers.....Phil..

bryan

Re: Re: Police refuse to allow medics gain patient

refusals

> Gene - As usual, you have written an excellent

> thought provoking letter. Here's my twice

> pennies worth, sprinkled through your letter:

>

> --- wegandy@... wrote:

> > An interesting question comes to mind: If you

> > choose to first respond, not

> > as a recognized FRO but as a general member of

> > the public, but you hold an

> > EMS certification of some sort, must you get an

> > informed refusal from

> > patients who refuse treatment and do so before

> > you leave their side or

> > transfer treatment to another person or agency?

>

> > It is true that there's no blanket duty to

> > respond, but once you do, you're

> > bound to render care to the extent of your

> > training and expertise, given the

> > situation. Now, " the situation " is a loaded

> > phrase, and takes into

> > consideration lack of medical direction, tools,

> > and all sorts of other stuff.

>

> I would say that " lack of...tools... " includes

> the lack of appropriate paperwork to document the

> informed refusal. The best course of action,

> assuming you (1) chose to get involved in patient

> care, and (2) got kicked off the scene by an

> officer, might be to hang around ***away from the

> scene*** but close enough to catch the attention

> of the EMS unit when it arrives so you can

> explain your side of the story to them

> (specifically any pertinent medical information).

>

>

> After all, if you think the patient needs EMS and

> you got rousted by the cops, you should at least

> go somewhere and call EMS, agreed? In my

> experience, a wise officer will make sure you

> have some sort of ID that proves you're certified

> (and we ALL carry our certification cards,

> right?) and then let you do what you can. I

> think we can safely assume that if cops wanted to

> be medics, they would be medics, not cops.

> They're generally content to let medics do the

> medic thing, as long as the bystander/medic looks

> and acts like s/he knows what he's doing.

> Furthermore, if you've shown your ID to the

> officer, expressed your concern that the patient

> needs medical attention, and you're attempting to

> provide it, most cops (not all, mind you, but

> most) will call an ambulance for you.

>

> It's simply the wisest course of action for the

> cop, who probably understands the liability of

> refusing to call an ambulance for somebody who

> requests one, especially when there is an

> identified card-carrying EMS provider on scene to

> confirm the patient's (read: plaintiff's) side of

> the story.

>

> As far as getting in any kind of " anatomy "

> contest with the officer, you and the patient

> both lose immediately. You go to jail and the

> patient doesn't get the treatment s/he needs.

> The way I see this scenario unfolding, the cop

> doesn't think the patient (plaintiff?) needs EMS

> assistance, therefore s/he's kicking you out and

> probably NOT calling EMS. Consequently, since

> the patient isn't getting medical treatment

> anyway, you might as well avoid a trip to jail.

> No reason for both you and the patient to suffer.

> It sounds ugly on the page, but it's the truth.

>

> > But, If I happen upon a wreck while returning

> > to my area from a transfer, and

> > I decide to help, it is generally conceded that

> > the only things I can do are

> > basic things that any member of the public

> > could do, such as CPR, basic

> > airway maintenance, hemorrhage control,

> > protecting the patient from extremes

> > of heat and cold, and so forth.

> >

> > If I am trying to do those things but am

> > interfered with by an officer of the

> > law, where do I stand? Where does s/he stand?

> > If I have begun care, even to

> > the extent of placing a 4x4 on a lac to the

> > forehead on a patient who has hit

> > the windshield and made a spiderweb, the

> > patient, who can't remember what

> > happened, wants to refuse further treatment,

> > the local EMS is not on scene,

> > and a cop says get yer a** out of here, what

> > does one do?

>

> Now you're in a situation in which you're driving

> past a collision in a ***marked ambulance***, and

> this changes the rules of the game entirely. How

> many people at the scene of the collision are

> going to write down all the license plates of the

> people who failed to stop and render aid?

> Exactly zero. How many of those people will

> remember your ambulance company's name,

> conveniently marked in 47-foot tall, Scotchlite

> retroreflective lettering on the billboard-sized

> side of your ambulance, if you don't stop?

> Exactly nine million, and all of them are

> plaintiff's attorneys on the way home from a

> convention. You're pretty much obligated to

> stop, if for no other reason than you can at

> least honestly testify that you stopped.

>

> > What's magic about being a bona fide FRO if

> > there is somebody hurting who

> > needs care?

>

> There is no magic in being a " bona fide FRO " in

> my opinion; the magic is in being willing and

> able to help another person who needs your help.

> That's not a common quality. I'm not willing to

> go to jail to prove my point on this, but I'm

> also not willing to let somebody die or suffer

> needlessly out of sheer fear or laziness, either.

>

> > I suggest that, at least in Texas, there is no

> > rule of law that speaks to

> > this. Do we need such a rule? Is this purely

> > an item that ought to be

> > addressed by education of LE officers and

> > touchy-feely meetings with EMS? Or

> > should LE officers be bound to defer to EMS

> > personnel when treatment

> > considerations arise?

>

> A police officer, by AG opinion (and maybe State

> law now), is a police officer 24/7/365. They

> have a legal obligation to act whether on- or

> off-duty, even if only as a reliable witness to

> the incident. Do we as EMS providers carry the

> same obligation? Legally, I don't think we do.

> Ethically and morally, yes; legally no. Am I

> correct Gene?

>

> > Who knows? Who cares? Write your thoughts on

> > this subject. And please

> > don't flame me for asking these questions. I'm

> > just the instigator.

>

>

> " Instigator " ? You picked a fight, now you don't

> want to get hit? I see how you are...lol

>

> > gg

>

> A. Reynolds Jr. DAD, HUSB, EMT-P

> Stretcher Fetcher Grunt Instructor

> School of Hard Knocks

>

>

> __________________________________________________

>

[Guest guest]

There's no " general legal obligation " for a certified/licensed EMS person to

render aid. In other words, no " general duty. " Moral, ethical? That's up

to you.

The " Failure to Stop and Render Aid " law applies only to those involved in

the accident. " Failure to Stop and Render Aid " is also commonly known as

" hit and run. " Unless you have the legal duty to render aid (such as being

on duty in your territory, being dispatched) there is no duty now obligation.

Stop to think what would happen if every certified or licensed medical

professional had to stop at every accident they pass! There would be traffic

jams lasting for hours.

Gene G.

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

Didn't the person posting the original message invite

an in-depth conversation by naming the deputy and

providing a badge number? The person that wrote the

original message did not provide all the information

needed to give proper advice. By simply reading the

original post, one may be led to believe that this

deputy was completely in the wrong by asking people

that had a responsibility to be on the scene to leave.

By only providing the information that he did, the

person posting the original information was only

providing enough information to lead readers to

believe that the deputy was completely in the wrong,

and his group was doing nothing wrong. Let's say you

live in Houston. You are traveling to Dallas with a

group of friends from your agency. You witness a minor

accident, but stop to make sure that everyone is okay.

Would you then pull out refusal forms? Essentially,

this man and the other people with him were a group of

people that work together driving through somebody

else's territory. They weren't on duty with an agency

that operates in a near-by town. By simply reading the

original post, you have no way of knowing if this

group originally tried to work with the deputy or if

they immediately clashed. Why give advice to somebody

when you don't know the complete story? You would

really feel good about yourself when you gave somebody

bad advice? In my opinion, which I admit does not mean

much, advising somebody to file a complaint against a

person for doing their job is not the best of advice.

Bach

--- clfrpratheart@... wrote:

> I want to jump in and ask this in response to your

> question

> Christy.... Why would one need to know that kind of

> in-depth

> information to that extent just to answer a question

> for advise.

> Would you need to know that information from any and

> everyone that

> posts to the list before you give any kind of advise

> to them. All I

> would want to know is what they were wanting advise

> on and I would

> help anyway I could.....

>

> Jeff Fox EMT-I

__________________________________________________

[Guest guest]

,

VERY WELL PUT!!! I would hazard a guess that if we looked at 99% of the issues

we face as EMS providers they boil down to communications.

We cannot have good on-scene relationships with other agencies unless we

communicate regularly and on a variety of issues. It certainly helps when I go

to our police chief with an issue now that we are " friends " in the workplace and

have regular communications on a variety of topics...from the city picnic to his

pet llamas.

The same goes for EMS agencies...and I must truly say, since returning to Texas

I have been most impressed with our RAC. Say what you will but it has been a

tremendous help going to two RAC meetings in the 2.5 months I have been here and

meeting and talking with our fellow EMS agencies. I understand them and they

understand us. When we interact either in the field or on administrative

issues, we have a basis of a relationship to work from...communication is only

better after that.

As is evident from this topic as well as many others on the list, we can get

much better results through communication and education. Thanks for

bringing it back to the basics.

Dudley

[Guest guest]

Probably because the question was asked in the context of an FRO and

" jurisdiction " for EMS scenes. Thus, it helps to know which agency/agencies are

involved, and in the context of an FRO, whether or not they have medical

direction, and through whom.

And it's spelled adviCe, with a " c. "

Mike

Re: Police refuse to allow medics gain

patient

> > refusals

> >

> >

> > I would be curious to know which EMS agency you were

representing. Per

> > the

> > most current lists on the TDH website, your organization is

neither a

> > Provider nor a First Responder organization. Who IS your

medical

> > director?

> > And who was obtaining the refusals? You indicate " we, " but you

do not

> > have

> > a TDH certification per the TDH CertQuery.

> >

> > This is not the first time STATTSAR members have been " asked "

to leave a

> > scene of an MVA. Perhaps Deputy Zepeda had good cause...

> >

> > Christy Petty, EMT-P

> >

> >

> >

> >

[Guest guest]

I am sorry if I didn't post enough information for all of you, it was never

my intention to exclude information you might need, as demonstrated by my

many persoanl replies and post-wide replies. It was also not my intent to

" vilify " any one person, agency or department, simply to state what happened

and what we can do to prevent it from occuring in the future and what if any

action(s) should be taken due to the incident. By providing the deputy's

name, I was simply trying to provide all of the information I believed you

(the readers) needed. As usual with humans, the amount of information

provided in the post was biased because I knew / provided information which

I presumed you did or did not need to know. I apologize to the list for

this. For the record, the deputy never gave us a chance to identify

ourselves or attempted to get a run down from us, and we were not " playing

EMS " as checking whether someone is injured is not a game or any place else

other than for the serious.

STATTSAR has decided not to file a formal complaint against this deputy but

to rather promote awareness of who we are and to encourage the local EMS

organizations/committees to educate traffic officers on EMS issues,

specifically patient refusal and right to care issues. STATTSAR is not in

the business of destroying vital EMS-LEA relationships but to bolster these

and we believe such a complaint would be contrary to that mission.

If SLHEMS feels we have infringed upon their right or duty in any way than

on behalf of STATTSAR I truly and sincerely apologize. We have already

mailed a copy of our report and refusal forms as of Monday to SLHEMS so that

if something did come up they have complete documentation as to our actions

and who was on scene. I truly hope this doesn't impact the relationship we

made with SLHEMS during Tropical Storm assisting them with reaching

patients in high water under the direction of thier Executive Director.

Our Operations Committee will be reviewing a new policy this Thursday that

if ANY STATTSAR medic is on location with a potentially injured/ill person,

the EMS Provider for that area will be contacted, whether or not the patient

requests EMS or not. Additionally, a procedure will be developed to be

followed if a similar instance were to ever occur again, however I do not

foresee such.

I believe several excellent points and issues have been raised, some of

which I intend to discuss with TDH. Perhaps some more rules need to be

established for FROs to better define the " grey " spots.

C. McBarron

Chief

South Texas Advanced Tactical Team Search & Rescue

http://www.stattsar.org

[Guest guest]

Ooh, I see you have a touch of an attitude. I'm sorry

if I have offended you, sir. I'm also sorry if I have

confused you. I was attempting to get my point across

that it was a very valid thing to do to question the

original post. The original post did not give all the

pertinent information and the person that questioned

the writer about their medical direction and whether

or not they are certified was only bringing out

additional information. That person NEVER stated in

the original message that he was not certified by TDH.

What business does a bystander with no certification

have obtaining patient refusals?

--- clfrpratheart@... wrote:

> Just to say, I was speaking of the fact that it was

> requested what

> agency someone was representing, who their Medical

> Director was, and

> whether or not the person posting has or had a

> current cert with TDH

> or if there was a FRO in place. That was my question

> was for the

> second post to the original, not whether there was a

> request for in-

> depth coversation in the first post. Sorry if I

> confused you any

> .

>

> Jeff Fox EMT-I

>

>

> > > I want to jump in and ask this in response to

> your

> > > question

> > > Christy.... Why would one need to know that kind

> of

> > > in-depth

> > > information to that extent just to answer a

> question

> > > for advise.

> > > Would you need to know that information from any

> and

> > > everyone that

> > > posts to the list before you give any kind of

> advise

> > > to them. All I

> > > would want to know is what they were wanting

> advise

> > > on and I would

> > > help anyway I could.....

> > >

> > > Jeff Fox EMT-I

> >

> > __________________________________________________

> >

[Guest guest]

,

I do not have an attitude, simply apologizing for not originally providing

all of the information you and others desired. And no, you didn't offend me.

Nor did you confuse me. I was doing the paperwork and our medic was

obtaining the refusals. I have a previous TDH certification which has

expired and I really don't see what difference it makes since I was not

assessing the people in the car, just filling in the blanks with the answers

the person was providing from the medics questions.

C. McBarron

Chief

South Texas Advanced Tactical Team Search & Rescue

http://www.stattsar.org

[Guest guest]

Sorry dude, that last message I wrote wasn't aimed

towards you. It was supposed to be directed towards

that guy with heart somewhere in his email address.

Sorry!

--- McBarron wrote:

> ,

>

> I do not have an attitude, simply apologizing for

> not originally providing

> all of the information you and others desired. And

> no, you didn't offend me.

> Nor did you confuse me. I was doing the paperwork

> and our medic was

> obtaining the refusals. I have a previous TDH

> certification which has

> expired and I really don't see what difference it

> makes since I was not

> assessing the people in the car, just filling in the

> blanks with the answers

> the person was providing from the medics questions.

>

> C. McBarron

> Chief

> South Texas Advanced Tactical Team Search & Rescue

> http://www.stattsar.org

>

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

[Guest guest]

Gene,

We have tried the " educate " the law enforcement, and it worked. The one problem

we have is that the turnover rate of DPS Troopers in our area requires us to

" break in " a new Trooper on a very regular basis. We see the same problem with

City officers as well. While it is a time consuming task to go to law

enforcement

and educate them about our system, we have found the working relationship to be

a

much stronger one. We have benefited a great deal once the line of communication

has been established. I do not suggest that this approach will always work, but

failure is certain if it is never tried.

With the overwhelming number of rules, laws and mandates that public safety

personnel are expected to abide by, I don't think that a rule that demands that

law enforcement " play nice with us " will receive much attention. A mutual

respect

that is earned by both parties will result in a more efficient system.

We have had a number of instances where we have come upon accidents while

returning from a transfer. It always seems that we are out of our service area

when finding these. The appropriate agency for the service area is notified and

then we provide treatment. Because we can access medical direction via radio or

cell phone, we will advise of the situation and initiate advanced care if

needed.

This works in our situation because we utilize a regional medical director. Once

the responding agency is on scene, we will give a report and turn care to them

provided the appropriate level of care is available.

Cases involving our first responders require that the appropriate agency be

contacted to respond for transport or secure refusals. Our location and the

structure of our RAC have made interaction between services much easier.

Less than two years ago while transporting two patients to a Lubbock Hospital, I

witnessed a head-on collision. In the time it took for us to cover the mile

between us and the scene, the divided hiway " closed " . The East lanes blocked by

the accident, the West blocked by traffic. Our patients were stable, so one

medic

stayed with them while I approached the scene. A 80 y/o male and a 39 y/o female

were DOS. A 11 y/o female was alive and able to be extricated. As I had

approached the scene, I had placed a call for Aeromedical and ground units from

Lubbock to respond (13 miles away). By the time extrication was complete and the

patient packaged a helicopter was on the scene, ground units and law enforcement

followed in a short time. Another EMS unit from a community 30 miles South of

our

City was returning home from a transfer and stopped to assist as well. Within 20

minutes we were on our way with our patients, the survivor was on the way to a

level I facility and the scene was secure and controlled. All of this was

accomplished with four agencies, three out of district, working together for a

common good. No turf war, no ego, no problem. All of this is possible because

EMS

providers in the region have worked to build some level of cooperation with each

other.

Once again, it has worked for us, may not work for everybody, just sharing my

thoughts.

, Director

Seminole EMS

wegandy@... wrote:

> An interesting question comes to mind: If you choose to first respond, not

> as a recognized FRO but as a general member of the public, but you hold an

> EMS certification of some sort, must you get an informed refusal from

> patients who refuse treatment and do so before you leave their side or

> transfer treatment to another person or agency?

>

> It is true that there's no blanket duty to respond, but once you do, you're

> bound to render care to the extent of your training and expertise, given the

> situation. Now, " the situation " is a loaded phrase, and takes into

> consideration lack of medical direction, tools, and all sorts of other stuff.

>

>

> But, If I happen upon a wreck while returning to my area from a transfer, and

> I decide to help, it is generally conceded that the only things I can do are

> basic things that any member of the public could do, such as CPR, basic

> airway maintenance, hemorrhage control, protecting the patient from extremes

> of heat and cold, and so forth.

>

> If I am trying to do those things but am interfered with by an officer of the

> law, where do I stand? Where does s/he stand? If I have begun care, even to

> the extent of placing a 4x4 on a lac to the forehead on a patient who has hit

> the windshield and made a spiderweb, the patient, who can't remember what

> happened, wants to refuse further treatment, the local EMS is not on scene,

> and a cop says get yer a** out of here, what does one do?

>

> What's magic about being a bona fide FRO if there is somebody hurting who

> needs care? Are we saying that if one holds an EMS certificate of some level

> that s/he is on a lower status than a member of the public with no

> credentials would be?

>

> Further, what rules do law enforcement officers have to respect with regard

> to EMS personnel who are giving care on the scene of an incident, whether it

> be an MVC or otherwise?

>

> I suggest that, at least in Texas, there is no rule of law that speaks to

> this. Do we need such a rule? Is this purely an item that ought to be

> addressed by education of LE officers and touchy-feely meetings with EMS? Or

> should LE officers be bound to defer to EMS personnel when treatment

> considerations arise?

>

> Who knows? Who cares? Write your thoughts on this subject. And please

> don't flame me for asking these questions. I'm just the instigator.

>

> gg

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

[Guest guest]

Just remember folks...stattsar is not a EMS agency........

[Guest guest]

AMEN....ANDREW......

[Guest guest]

--- wegandy@... wrote:

> There's no " general legal obligation " for a

> certified/licensed EMS person to

> render aid. In other words, no " general duty. "

> Moral, ethical? That's up

> to you.

As in almost any situation, whether I stop to

help depends on the circumstances. Is there help

on scene already? Do I have my kids with me (No,

I'm not leaving them unattended in the car on the

side of the road)? Does it appear that my

assistance, with no tools, supplies, radio

communication, etc. would make any significant

difference? I'm sure I'm preaching to the choir,

but that's my opinion on the subject.

> Stop to think what would happen if every

> certified or licensed medical

> professional had to stop at every accident they

> pass! There would be traffic

> jams lasting for hours.

My God! Run for your lives! Bands of marauding

off-duty EMS providers are roaming about in

search of injured parties! Oh, the humanity! I

get your point. lol

> Gene G.

>

Stay safe - phil

__________________________________________________

[Guest guest]

Perhaps we are overexpanding this incident. There is no doubt that bonafide

EMS personnel have an ethical, if not legal under given circumstances, duty

to act when they witness an accident. However, unless those particular EMS

personnel are covered by medical protocol in the area they are in

( " legitimized " might be an appropriate term), whatever they do is limited to

those interventions that any reasonable person would do, and that are not

required to have medical oversight. Right?

The problem here is not that these STATTSAR folks went to the cars and

checked on the people involved. That is perfectly understandable. In fact,

I'm sure it happened well before the deputy arrived on the scene.

Apparently, the STATTSAR people felt an ambulance was not warranted since

they did not call one immediately (remember, they had 2-way radio

communication to a dispatch center - the same dispatch center for the

" legitimate " EMS service in that area). The deputy on arrival sees a group

of orange-shirted bystanders attempting to get the participants in his crime

scene to sign these documents. The deputy doesnt know who they are, but he

sure knows who they are not. Perhaps a little more tact could have been

used; perhaps it was, initially. The problem is that these bystander medics

had assumed the function of the legitimate EMS provider by gaining patient

refusals.

Read the entire thread. It is apparent that McBarron and STATTSAR are

determined to function as an EMS Provider or FRO without proper

credentialing and oversight. Using his logic, people should be able to

begin practicing immediately after they take the state test since they MIGHT

be getting their certificate in the mail any day now. There are rules

regarding this activity, designed to ensure medical oversight AND

cooperation between recognized FRO's and the EMS providers of their areas.

STATTSAR ignores these, and THAT's the problem. Organizations like this

one, and incidents like this, are pillar examples of what EMS has to

overcome to reach the legitimacy and standing we deserve.

Petty, EMT-P, EMSI

Re: Re: Police refuse to allow medics gain patient

refusals

> Well, yeah, if I picked a fight, it won't be for the first time. Let's

see

> some other dogs in this fight. What's the relationship between LE and

EMS?

> What should it be? What rules govern? Let's hear it.

>

> GG

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

>

[Guest guest]

Why am I not surprised?

Re: Re: Police refuse to allow medics gain patient

> refusals

>

>

> > AMEN....ANDREW......

> >

> >

> >

> >

> >

[Guest guest]

Wow, how bizzare...sounds like they had other things

to worry about besides patient refusals...

Connie

--- Christy Petty wrote:

> Well, I guess as a final chapter to this saga,

> McBarron, Krieg

> and another member of STATTSAR were arrested today

> by FBI agents and are

> currently in jail on federal conspiracy and child

> pornography charges.

>

> You can see the story at www.click2houston.com.

>

> 'Nuff said.

>

> Petty, EMT-P

> Re: Re: Police refuse to allow

> medics gain patient

> refusals

>

>

> > AMEN....ANDREW......

> >

> >

> >

> >

> >

[Guest guest]

Can you say NO EMS certification for these guys? Wonder if they are worried

about them patient refusal forms now? At least they have got these suspects in

custody- and if the evidence is suffice, I hope they fry their you know what....

Nothing worse than child pornography.

Just my 2 cents

Jay

Re: Re: Police refuse to allow medics gain patient

refusals

> AMEN....ANDREW......

>

>

>

>

>