Guest guest Posted June 7, 2006 Report Share Posted June 7, 2006 FD is in command of the scene. EMS is in charge of Pt care. This keeps the paramedic focused on the most important reason we are there. FD if not working on scene safety are the strong backs for the medic and the go for's. You can not transfer command to a medic and think that the medic can focus on Patient care and scene safety at the same time.. Tidwell wrote: Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2006 Report Share Posted June 7, 2006 , The way it works for us, is that ultimately the entire scene is controlled by the FD and patient care is given to the responding EMS agency, in our case it is one of two services. If it is a large scale incident, there will be a liasion from the responding agency incorporated into the ICS structure. We are fortunate to have a good working relationship between FD and the two private services who respond in our city. As far as air transport is concerned, sometimes FD will arrive first, triage the patient and call for medical helo even before EMS arrives. Sometimes that is good and sometimes not, because some of the time the patient doesn't need air transport, since once EMS arrives patient care is their responsibility. Hope this helps you. Troy Firefighter/Tactical Paramedic Port Arthur Fire Department. Who is in charge? Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2006 Report Share Posted June 7, 2006 Hello, Incident command is the unified system for scene management, traditionally fire has command. While this is the tradition, it is not the stead fast rule. It sounds like your company and the first responders need to sit down and work out an agreement. The thing to remember is the overall incident command does not mean medical command. Medical command will usually fall to the senior medical personell on scene. The other things is that at large medically related scene, i.e. MCI or MVA, letting fire take command allows EMS to focus on the patients. The launching of air medical is another matter. I happen to work for a flight program and we will launch on the request of law enforcement, fire, EMS or hospital. We do respond to areas where the EMS is the only entity that can request air medical. Again, this is a matter that may be best solved by sitting down and working out an agreement with the first responders and you department. Hope this helps, Mike S. > > Ok I have a question for everyone here and would like your opinion. I live > in a town of about 19,000 people. I work for the local EMS company here > that covers the entire county of about 85,000 people. We have a total of 6 > first responder organizations. Now to my question. Does fire have any > Incident Command over EMS calls? I was just wondering because it seems that > they think that they do. My understanding is that they have Incident > Command over fire calls and EMS until a company representative of the EMS > service shows up. Once that person shows up then it is immediately > transferred to the medic-in-charge which would be the personnel from the EMS > service. Now if I am wrong please let me know. If I am not please let me > know and where can you find something law wise saying that? FIRE OR EMS > over medical or trauma calls? > > > > Also it is my understanding that EMS also launch the air med > unit not the fire departments. Unless the fire department is EMS as well? > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2006 Report Share Posted June 7, 2006 Generally fire dept. should have command over operations such as extrication, fire suppression, traffic control (if no P.D. is onscene), landing zone opps. and safety of personnel, However, in-charge EMS personnel are in charge of ALL pt. care decisions including care practices, helicopter utilization, transport and treatment strategies. EMS should be in " command " of medical scenes in almost all instances. F.D. and EMS whether they are within the same dept. or two different services should work together and not fight over who is in-charge it`s not good for safety of responders and it`s not good for pt. care if you can`t agree. Ideally on large or intricate scene EMS command and Fire command work side by side to make over all decisions however there needs to be ONE overall scene commander cause you gotta think whoever is in command takes overall responsibility over the incident which means if something goes wrong that person is the one who has to explain the situation. That's my two cents on the subject hope it helps and hope it`s not a misinterpretation on my part. Tidwell wrote: Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2006 Report Share Posted June 7, 2006 Generally fire dept. should have command over operations such as extrication, fire suppression, traffic control (if no P.D. is onscene), landing zone opps. and safety of personnel, However, in-charge EMS personnel are in charge of ALL pt. care decisions including care practices, helicopter utilization, transport and treatment strategies. EMS should be in " command " of medical scenes in almost all instances. F.D. and EMS whether they are within the same dept. or two different services should work together and not fight over who is in-charge it`s not good for safety of responders and it`s not good for pt. care if you can`t agree. Ideally on large or intricate scene EMS command and Fire command work side by side to make over all decisions however there needs to be ONE overall scene commander cause you gotta think whoever is in command takes overall responsibility over the incident which means if something goes wrong that person is the one who has to explain the situation. That's my two cents on the subject hope it helps and hope it`s not a misinterpretation on my part. Tidwell wrote: Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 One thing about the ICS (and the NIMS supports this) is pre-event communication and coordination. A Memorandum of Understanding, as a supplement to the FRO agreement, should delineate in broad concept who is in charge. For example: when you are doing standby or rehab at a fire scene, EMS comes under Logistics / Medical. If it is a response to a HAZMAT incident and you have multiple casualties, you have units that operate under a Unified Command, in Operations with Triage / Treatment / Transport (Fire would be in the Red Zone, comingled in the Yellow (Decon), and EMS in charge on the Green side of the line) AND you still have a need for the Rehab / Scene medical (Logistics /Medical) for the 'glow worms' (g). Same idea in an extrication. Fire is in charge in the Red Zone, but once the patient is clear of the wreckage (Green Zone), then the EMS organization is in charge. Complicated? Not if you consider that the patient(s) is/are really running the show, not necessarily the Fire Folks or the Medics. The patient(s) is/are the one you are eventually accountable to. Larry RN LP Houston Texas _,_._,___ " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 #### One thing about the ICS (and the NIMS supports this) is pre-event communication and coordination. A Memorandum of Understanding, as a supplement to the FRO agreement, should delineate in broad concept who is in charge. Totally agree. This is a " check your ego at the door " understanding that should be under a Unified Command structure (which is also a NIMS concept). This has to be done pre-event at a table, where people can come to an agreement and understanding. There should be a written First Responder Organization (FRO) agreement and this understanding needs to be a part of that agreement. #### For example: when you are doing standby or rehab at a fire scene, EMS comes under Logistics / Medical. If it is a response to a HAZMAT incident and you have multiple casualties, you have units that operate under a Unified Command, in Operations with Triage / Treatment / Transport (Fire would be in the Red Zone, comingled in the Yellow (Decon), and EMS in charge on the Green side of the line) AND you still have a need for the Rehab / Scene medical (Logistics /Medical) for the 'glow worms' (g). I also agree with this with some clarifications. In the first scenario of a fire scene with EMS there for rehab, Fire has the command, but the EMS team should be in their back pocket acting as a medical safety officer and giving the commander input on medical safety. In you second example, there should be a unified command, but I do not believe you should delineate that fire is in " charge " of the red zone and the yellow zone and EMS is in " charge " of the green zone. That is a very broad statement and is dependant upon the standard operating procedures of the emergency entities involved. Usually, fire is in 'charge " of haz-mat operations if they have that training and EMS is in charge of patient care, not zones. BTW, if you are on the roadway in Texas at a haz-mat scene, DPS will quickly tell you who is in charge. #### Same idea in an extrication. Fire is in charge in the Red Zone, but once the patient is clear of the wreckage (Green Zone), then the EMS organization is in charge. Why are we delineating out different emergency entities are in " charge " of different zones. This should be a unified command with fire having responsibility over the extrication and usually overall scene safety and EMS having responsibility over patient care. If it is safe for them, you will find EMS guys all over the red zone starting patient care long before the FD gets the patient to the " green zone. " Both FD and EMS working in harmony to achieve the overall objective. Ron A. Derrick LP NREMT-P Safety and Emergency Preparedness Coordinator Sid Memorial Hospital Kerrville, Texas ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of Larry Sent: Thursday, June 08, 2006 3:37 AM To: texasems-l Subject: Re: Who is in charge? Complicated? Not if you consider that the patient(s) is/are really running the show, not necessarily the Fire Folks or the Medics. The patient(s) is/are the one you are eventually accountable to. Larry RN LP Houston Texas _,_._,___ " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 Okay - I have to ask who is in charge of the patient or who is in charge of the scene? Are we figuring out who is in charge of the scene on a single patient MI? I can tell you according to DSHS, whoever is mostly highly trained is going to be responsible for the patient BUT is this a peeing match? Let me pose a question for you with all the Al-Zarqawi news and I teach this part of NIMS/ICS as part of an MCI program.plane into the Pentagon minutes after two planes into the World Trade Center.who is in charge? 1. Arlington County Fire Department?.plane into the building, fire, patients, plus they're on scene within three minutes and they did establish " Command " within five. 2. Metro Washington Airports Authority?.they have responsibility for plane crashes within five miles of a metro Washington airport. 3. The FBI? .at the time it wasn't confirmed, just very, very likely to be terrorist.and they have national statute responsibility for terrorism investigations. 4. What about NTSB? .plane into a building.doesn't have to be terrorist.they have federal statutory authority over aircraft accidents. 5. Special situation.the Pentagon is part of the Military District of Washington (MDW) whose commanding officer runs MDW and reports only to SecDef. He has his own fire service, security force, etc. Is it his show? Honestly, they all have a say in what could and should be happening? What DID happen though? It worked, everybody worked together and people didn't fight for their turf but to fix a giant problem in each of their backyards. Personally, when you consider how everything came together, I think one person in particular needs credit. One, is Combs, a FBI special agent who had previous fire experience, I think in Boston, and who worked as a liaison to local fire departments. Because local fire departments knew who he was and they had worked together previously . no peeing match. Word is he showed up and said " what do you need? " not I'm in charge. If anybody was going to take over, you might think it was FBI, but instead they said ACFD.you're handling it, keep it up, and at the right time command will get transferred to us so that we can do the investigation and then we'll transfer command to the military so they can clean up, which is what happened. No bi & ching and moaning.FBI didn't run in with guns drawn and say " mine " but offered technical help on evidence preservation. Washington airports said let's help like most other jurisdictions in the area. NTSB deferred to the FBI and the military said, we have a lot of resources and a lot of hands.how can we help? Again, does that mean the FBI didn't have suggestions of don't touch this, please don't take pictures inside the building with papers blowing around stamped " TOP SECRET " , etc.? Ha.but the ICS was used as a tool to facilitate management of a scene, not be IN CHARGE! ICS shouldn't be about who is in charge, but how is the job going to get done. That being the case, what kind of scenes are you guys having trouble with.MVCs, single patient MIs, what? It seems to me that in station and on scenes you don't have to be " command " to be the one who is getting things done on scene. Honestly, who cares if fire is in charge of the scene.ultimately you are still responsible for how you provide care for your individual patient? If non medical personnel start suggesting how much adenosine I draw up, then I'm interested in helping them find another job than critiquing my skills, but otherwise, hey, I've got a job to do, you have a job to do, what's going on? That is a convo that shouldn't happen on scene, though, but, ahead of time like Combs and local fire departments in DC well before the plane hit the Pentagon. Know what I mean? Who is in charge? Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 My understanding is they are in charge at any fire scene and MVC where rescue is involved. They are only in charge of the rescue, however, as a paramedic youare in charge of patient care. However, if you see that during the rescue the patient is being or will be further injured, you have the authority to tell them to stop and they have to find another way. Now do not forget that you work with these people everyday and every effort should be made to ease your relations with any FD you normally work with. Salvador Capuchino Jr EMT-Paramedic AMR --- Tidwell wrote: > Ok I have a question for everyone here and would > like your opinion. I live > in a town of about 19,000 people. I work for the > local EMS company here > that covers the entire county of about 85,000 > people. We have a total of 6 > first responder organizations. Now to my question. > Does fire have any > Incident Command over EMS calls? I was just > wondering because it seems that > they think that they do. My understanding is that > they have Incident > Command over fire calls and EMS until a company > representative of the EMS > service shows up. Once that person shows up then it > is immediately > transferred to the medic-in-charge which would be > the personnel from the EMS > service. Now if I am wrong please let me know. If > I am not please let me > know and where can you find something law wise > saying that? FIRE OR EMS > over medical or trauma calls? > > > > Also it is my understanding that EMS > also launch the air med > unit not the fire departments. Unless the fire > department is EMS as well? > > > > [Non-text portions of this message have been > removed] > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 In a message dated 6/8/2006 3:24:23 P.M. Central Daylight Time, barry.sharp@... writes: Again, this is aimed at disaster emergency management not just the run of the mill nursing home call. Ah but any student of NIMS and the use of any IMS/ICS system will tell you that no way will ICS just " work " at a large scale incident if it's not practiced in the daily real world environment. I've seen reams of wittings on the topic in the time since 9/11 while doing the research for the book that just came out from Wiley with my name on it end of shameless plug) and I can assure you that in no place where ICS " works " like say California is it not practiced on the run of the mill calls as well as the " big ones " . I've even heard one FD use terms like " Ambulance 1 is on scene at XXX main Street assuming command " on a 2 piece response, sounds ridiculous at times but if you do it day in and day out you get use to it so that when buildings are falling and planes crashing you use it my nature and reaction as opposed to thought where you must " think " about how the system works. As for the question of the original poster, I doubt you will ever loose the " I'm here, I'm in charge " mind set that some seemingly carry on all calls they are sent to but the only way I know to move to that end is to sit and talk this stuff out BEFORE the calls come in and you need to do it in a non confrontational atmosphere which is half the problem as most of the times it's some clash of the titans that has brought the heads of the agencies involved to the table to " discuss " the " problems " by then feelings are hurt, egos bruised and folks are generally hot under the collar and are well less than rational at times and they tend to play more cards in political circles at that point trying to show who ash the bigger " thing " . That's a lose/lose situation in the making for sure hence the better approach is to get to the table BEFORE the titian's clash! Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) (Home Phone) (IFW/TFW/FSS Office) (IFW/TFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 In a message dated 6/8/2006 4:26:16 P.M. Central Daylight Time, csuprun@... writes: This is the way other than the unfunded mandate. At least here they tell you what to do and then pay you something to do it. Good line! After all NIMS and ICS training are readily availed to us all from the various points of government. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) (Home Phone) (IFW/TFW/FSS Office) (IFW/TFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 Gene, There is some legal (?) directive for using ICS/NIMS. President Bush, through executive order, mandated that all disaster and emergency responses use the NIMS (National Incident Management System) which does include ICS. Governor also ordered that all state responses (and agencies that are funded for emergency management responses through the state) use NIMS. While it may not be statutory, my understanding is that executive orders have the force of law. Again, this is aimed at disaster emergency management not just the run of the mill nursing home call. Just a couple of extra thoughts for the discussion. Barry Sharp -------------------------- Sent from my Wireless Handheld Re: Re: Who is in charge? Incident Command is not a legal concept. It is a practical concept that is put into effect by policy mutually agreed upon, which varies from place to place. So there's no legal basis for Incident Command in Texas. As for who can launch a helicopter response, that's also up to local protocol. As the previous writer stated, folks need to get together and agree on a policy. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 The order is if you want federal dollars, you have to be " NIMS compliant. " It is the primary way the federal government influences state and local governments.you want federal dollars, you have to play by federal rules. This is the way other than the unfunded mandate. At least here they tell you what to do and then pay you something to do it. Re: Re: Who is in charge? Incident Command is not a legal concept. It is a practical concept that is put into effect by policy mutually agreed upon, which varies from place to place. So there's no legal basis for Incident Command in Texas. As for who can launch a helicopter response, that's also up to local protocol. As the previous writer stated, folks need to get together and agree on a policy. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 I can just picture the usage of full ICS/NIMS for a nursing home call. " Medical Sector to Operations: We need a monitor, medical bag, and stretcher to Room 215. " " Operations to IC: Medical sector needs a monitor, medical bag, and stretcher to Room 215. " " IC to Logistics: I need a monitor, medical bag, and stretcher to Room 215. " " Logistics received. " In reality, the medical sector was 2 paramedics. Everyone else was the four firefighters on the engine company... <GRIN> -Wes Re: Re: Who is in charge? Incident Command is not a legal concept. It is a practical concept that is put into effect by policy mutually agreed upon, which varies from place to place. So there's no legal basis for Incident Command in Texas. As for who can launch a helicopter response, that's also up to local protocol. As the previous writer stated, folks need to get together and agree on a policy. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 I agree that you must " walk the walk " of ICS on every call in order to be proficient on the big calls. I just didn't want to over extend the intent of Bush/ orders. Barry -------------------------- Sent from my Wireless Handheld Re: Re: Who is in charge? In a message dated 6/8/2006 3:24:23 P.M. Central Daylight Time, barry.sharp@ <mailto:barry.sharp%40dshs.state.tx.us> dshs.state.tx.us writes: Again, this is aimed at disaster emergency management not just the run of the mill nursing home call. Ah but any student of NIMS and the use of any IMS/ICS system will tell you that no way will ICS just " work " at a large scale incident if it's not practiced in the daily real world environment. I've seen reams of wittings on the topic in the time since 9/11 while doing the research for the book that just came out from Wiley with my name on it end of shameless plug) and I can assure you that in no place where ICS " works " like say California is it not practiced on the run of the mill calls as well as the " big ones " . I've even heard one FD use terms like " Ambulance 1 is on scene at XXX main Street assuming command " on a 2 piece response, sounds ridiculous at times but if you do it day in and day out you get use to it so that when buildings are falling and planes crashing you use it my nature and reaction as opposed to thought where you must " think " about how the system works. As for the question of the original poster, I doubt you will ever loose the " I'm here, I'm in charge " mind set that some seemingly carry on all calls they are sent to but the only way I know to move to that end is to sit and talk this stuff out BEFORE the calls come in and you need to do it in a non confrontational atmosphere which is half the problem as most of the times it's some clash of the titans that has brought the heads of the agencies involved to the table to " discuss " the " problems " by then feelings are hurt, egos bruised and folks are generally hot under the collar and are well less than rational at times and they tend to play more cards in political circles at that point trying to show who ash the bigger " thing " . That's a lose/lose situation in the making for sure hence the better approach is to get to the table BEFORE the titian's clash! Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino (AT) aol (DOT) <mailto:LNMolino%40aol.com> com (Cell Phone) (Home Phone) (IFW/TFW/FSS Office) (IFW/TFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2006 Report Share Posted June 8, 2006 It sounds like to me that when the EMS & Fire are different providers there seems to be a pi$$ing match. I am a FF/medic and we don't have that kind of problem. On incidents where we request mutual aid or receive it, everyone is very professional. I work in a city with approx. 65,000 people and a very small community borders our city. They only have a vol. Fire Dept. We gave them mutual aid on a large fire once. There were also other paid fire departments there. The incident commander was the volunteer chief. No one tried to " take away " command. Everyone was able to work together as a team to get the job done. As far as using command on small incidents like just an engine and ambulance, that is not really practice. You won't have divisons and units in staging. The best way to practice is training. > > I agree that you must " walk the walk " of ICS on every call in order to be > proficient on the big calls. I just didn't want to over extend the intent of > Bush/ orders. > > Barry > -------------------------- > Sent from my Wireless Handheld > > > Re: Re: Who is in charge? > > > > In a message dated 6/8/2006 3:24:23 P.M. Central Daylight Time, > barry.sharp@ <mailto:barry.sharp%40dshs.state.tx.us> dshs.state.tx.us > writes: > > Again, this is aimed at disaster emergency management not just the run of > the mill nursing home call. > > Ah but any student of NIMS and the use of any IMS/ICS system will tell you > that no way will ICS just " work " at a large scale incident if it's not > practiced in the daily real world environment. > > I've seen reams of wittings on the topic in the time since 9/11 while doing > the research for the book that just came out from Wiley with my name on it > end > of shameless plug) and I can assure you that in no place where ICS " works " > like say California is it not practiced on the run of the mill calls as well > > as the " big ones " . I've even heard one FD use terms like " Ambulance 1 is on > scene at XXX main Street assuming command " on a 2 piece response, sounds > ridiculous at times but if you do it day in and day out you get use to it so > that > when buildings are falling and planes crashing you use it my nature and > reaction as opposed to thought where you must " think " about how the system > works. > > As for the question of the original poster, I doubt you will ever loose the > " I'm here, I'm in charge " mind set that some seemingly carry on all calls > they > are sent to but the only way I know to move to that end is to sit and talk > this stuff out BEFORE the calls come in and you need to do it in a non > confrontational atmosphere which is half the problem as most of the times > it's some > clash of the titans that has brought the heads of the agencies involved to > the table to " discuss " the " problems " by then feelings are hurt, egos > bruised > and folks are generally hot under the collar and are well less than rational > > at times and they tend to play more cards in political circles at that point > > trying to show who ash the bigger " thing " . That's a lose/lose situation in > the > making for sure hence the better approach is to get to the table BEFORE the > titian's clash! > > Louis N. Molino, Sr., CET > FF/NREMT-B/FSI/EMSI > Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant > > LNMolino (AT) aol (DOT) <mailto:LNMolino%40aol.com> com > > (Cell Phone) > (Home Phone) > (IFW/TFW/FSS Office) > (IFW/TFW/FSS Fax) > > " A Texan with a Jersey Attitude " > > " Great minds discuss ideas; Average minds discuss events; Small minds > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) > > The comments contained in this E-mail are the opinions of the author and the > > author alone. I in no way ever intend to speak for any person or > organization that I am in any way whatsoever involved or associated with > unless I > specifically state that I am doing so. Further this E-mail is intended only > for its > stated recipient and may contain private and or confidential materials > retransmission is strictly prohibited unless placed in the public domain by > the > original author. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2006 Report Share Posted June 9, 2006 Good points all, thanks for improving and clarifying Ron Derrick wrote: #### One thing about the ICS (and the NIMS supports this) is pre-event communication and coordination. A Memorandum of Understanding, as a supplement to the FRO agreement, should delineate in broad concept who is in charge. Totally agree. This is a " check your ego at the door " understanding that should be under a Unified Command structure (which is also a NIMS concept). This has to be done pre-event at a table, where people can come to an agreement and understanding. There should be a written First Responder Organization (FRO) agreement and this understanding needs to be a part of that agreement. #### For example: when you are doing standby or rehab at a fire scene, EMS comes under Logistics / Medical. If it is a response to a HAZMAT incident and you have multiple casualties, you have units that operate under a Unified Command, in Operations with Triage / Treatment / Transport (Fire would be in the Red Zone, comingled in the Yellow (Decon), and EMS in charge on the Green side of the line) AND you still have a need for the Rehab / Scene medical (Logistics /Medical) for the 'glow worms' (g). I also agree with this with some clarifications. In the first scenario of a fire scene with EMS there for rehab, Fire has the command, but the EMS team should be in their back pocket acting as a medical safety officer and giving the commander input on medical safety. In you second example, there should be a unified command, but I do not believe you should delineate that fire is in " charge " of the red zone and the yellow zone and EMS is in " charge " of the green zone. That is a very broad statement and is dependant upon the standard operating procedures of the emergency entities involved. Usually, fire is in 'charge " of haz-mat operations if they have that training and EMS is in charge of patient care, not zones. BTW, if you are on the roadway in Texas at a haz-mat scene, DPS will quickly tell you who is in charge. #### Same idea in an extrication. Fire is in charge in the Red Zone, but once the patient is clear of the wreckage (Green Zone), then the EMS organization is in charge. Why are we delineating out different emergency entities are in " charge " of different zones. This should be a unified command with fire having responsibility over the extrication and usually overall scene safety and EMS having responsibility over patient care. If it is safe for them, you will find EMS guys all over the red zone starting patient care long before the FD gets the patient to the " green zone. " Both FD and EMS working in harmony to achieve the overall objective. Ron A. Derrick LP NREMT-P Safety and Emergency Preparedness Coordinator Sid Memorial Hospital Kerrville, Texas ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of Larry Sent: Thursday, June 08, 2006 3:37 AM To: texasems-l Subject: Re: Who is in charge? Complicated? Not if you consider that the patient(s) is/are really running the show, not necessarily the Fire Folks or the Medics. The patient(s) is/are the one you are eventually accountable to. Larry RN LP Houston Texas _,_._,___ " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2006 Report Share Posted June 11, 2006 Thank you Troy I am the medical officer for the fire department that I am in and also I work for the EMS service here. The thing that I was telling my Fire Chief was that I do not have a problem that fire is IC. That is part of NIMS. What the problem I have is that I respond in my personal vehicle requested by my EMS dispatch and when I arrived on scene the IC which in this case was another Fire Chief argued with me that I should not be on that scene. Now, the unit was responding from about 14 min away and I was close. So I responded with the authorization of the service supervisor. That means that I automatically receive pay and fall under their protocols. I told him who I was with and that I am taking over command of the patient. The Fire chief already had the helicopter in the air (by our protocols the FD does not call the helicopter and that is written in the agreement between the EMS service and the FRO). Don't get me wrong if there is a serious pt with obvious injuries where it warrants helo transport, by all means get them en route. That is fine that the fire department has command but when I arrive on scene and the fire department has already established a safe zone then myself or any other EMS that works for us will take over care for that pt. I do not go out and tell the fire department how to run their job and in my opinion they should not tell me how to run my job. If anyone has anymore on this please come forward. J. Tidwell Re: Who is in charge? , The way it works for us, is that ultimately the entire scene is controlled by the FD and patient care is given to the responding EMS agency, in our case it is one of two services. If it is a large scale incident, there will be a liasion from the responding agency incorporated into the ICS structure. We are fortunate to have a good working relationship between FD and the two private services who respond in our city. As far as air transport is concerned, sometimes FD will arrive first, triage the patient and call for medical helo even before EMS arrives. Sometimes that is good and sometimes not, because some of the time the patient doesn't need air transport, since once EMS arrives patient care is their responsibility. Hope this helps you. Troy Firefighter/Tactical Paramedic Port Arthur Fire Department. Who is in charge? Ok I have a question for everyone here and would like your opinion. I live in a town of about 19,000 people. I work for the local EMS company here that covers the entire county of about 85,000 people. We have a total of 6 first responder organizations. Now to my question. Does fire have any Incident Command over EMS calls? I was just wondering because it seems that they think that they do. My understanding is that they have Incident Command over fire calls and EMS until a company representative of the EMS service shows up. Once that person shows up then it is immediately transferred to the medic-in-charge which would be the personnel from the EMS service. Now if I am wrong please let me know. If I am not please let me know and where can you find something law wise saying that? FIRE OR EMS over medical or trauma calls? Also it is my understanding that EMS also launch the air med unit not the fire departments. Unless the fire department is EMS as well? Quote Link to comment Share on other sites More sharing options...
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