My rule is never to second-guess the decision making of another provider if I was not on the scene and involved directly with the call, so I will not comment on whom is right or wrong. Each jurisdiction may have a different mechanism for implementing “who is to be in charge”, I can only tell you how, in general things are handled around here. All of our ambulances are BLS and are associated with a Volunteer Fire and/or Rescue Company, staffed either by volunteers or a combination of volunteers and career staff. We do not have a county fire department but do have a Department of Fire/Rescue Services (DFRS), mainly for the direction of career staff. Officers under DFRS do not have any official operational authority, but may serve in that capacity until a line/duty office of one of the first-due companies is on the scene. The Line/Duty Officer may allow the DFRS officer to continue to be IC if they deem the individual has things well in control and the call is proceeding smoothly. However, due to the way the laws are written for the fire service in our area, the Line/Duty Officer actually has the legal authority and responsibly for the call. All of our ALS units are chase vehicles, scattered around the county and are under the direction of the Department of Fire/Rescues Services, we have gone from a 100% volunteer staff of about 20-30 CRT/EMT-I and EMT-Ps to 95 % career staffing. There are many reasons for the shift, which I will not go into here. If the call is dispatched ALS or upgraded to ALS, the on scene 1st due ALS unit medic (can be an CRT/EMT-I or EMT-P) has the authority for patient care directing requests for additional resources through the Line/Duty Officer who has IC. If the incident requires additional medic units, generally an ALS Duty Officer will also respond to direct the call. If I were to show up to a call “off duty”, I would be expected to handle the call until a medic unit arrived on scene, the on duty ALS provider can elect to take over the call or if they feel the call is proceeding smoothly and I have the time and can transport with the patient, allow me to handle the call.

Without second guessing how your call proceeded and they was still some concern of not boarding the patient while standing, due to his size, could you have used a collar with a K.E.D.s device to initially stabilize the neck and back, until the patient was to place onto the stretcher?

Pete