Yesterday I was taking a break from studying. I just passed my state paramedic examination and I'm preparing for nyc remac exam. I took my girl out to the movies and on the way thre minivan in front of me flipped and rolled on the highway. By the time I got out of my car and run up 2 females crowled out of the wreck and stood up. I run up, yell at everyone to move back, clear the scene and check for additional victims. I got to 2 ambulatory victims that are surrounded by bystanders. I asked who called 911 and many people say they did. I instruct two bystanders to hold manual stabilization of the head and never let go. So guy comes out of nowhere and asks patients to sit down. I turn around and look at him like he is a retard and tell him that pts while standing up with no movement in the c-spine, heads are being held in line and when ambulance comes they just do rapid takedown. He starts yelling that he is a paramedic. Well so am I. So the vicxtims stand becasue I asked him where he works and he just said mumbled something under his nose. Off duty cop shows up and wants to be in charge. He tell the patients to sit down. I asked him about his level of medical training. He tells me he is a cop. In the meantime paramedic who was watching two victims tells bystanders to let go of the head anf cspine stabiliazation. I got really angry, called 911, made a report my way which I knew was being recorded, walked up to the paramedic asked him if he is in charge which he acknowledged, walked up to the cop who just gave me a dirty look, got in my car and went to the zoo becasue movie was sold out. How much of the ratard you have to be to issue "sit down" orders without cspine mobilization to a person who was just involved in rollover in car going 50 mph?

I haven't been an emt for a long time (2-3) years and my ink on my paramedic card hasn't dried out yet. But this was a basic call that anyone with some common sense would handle the right way.

I left. I followed the rules and had the smae level of medical training on the scene with off duty pd taking over. I just pray the god that if something like that happens to my friends somebody with common sense would be the first on the scene not two morons who probably never did a mva.

I'm not a lawyer, and I don't play one on TV. But as I understand it, good samaritan laws don't apply to people who have applicable training. I would think that would be covered by your training too, if not it should be. By trying to help, you are taking on a potential liability. I would think you should take any opportunity you can to hand off liability^h^h^h^h^h^h^h^h responsibility to someone else. You did the right thing by getting it on the record that someone else was taking charge.

I would have taken the cops badge number and broadcast it to the 911 operator if the cop did not want to be recorded and I would have asked the other paramedic to identify himself to the 911 operator with his license number (I am assuming the state has licensing provisions for accredited paramedics.) and then stood by to give facts to the first responders on the scene.

Not being and EMT or paramedic, I would not have been able to help to the extent you did, but I have a strong aversion to people who claim false or exaggerated credentials.

Bountyhunter

good samaritan laws protect you only to the point... if there is gross negligence (like in this case) than out the window goes any immunity you had...

I asked for shields but all I got back was: I'm a cop don't worry about it guy.

I can't really do much on the scene like that without proper equipment except manually stabiling the patients which was thrown out of the window by those two morans.

I never second-guess the actions of another EMS provider if I was not on the scene, or if I lack 1st hand knowledge of a particular patient. There are exceptions, where it is clear the actions or lack of action by an EMS provider clearly violated the standard of care.

I will say, that here in Maryland we do have a protocol for field clearance of possible C-spine injuries, which I have used, but with the greatest of caution. However, if there is/was any doubt, it is always better to be conservative and treat the patient as though they did have C-pine injuries.

I have, when 1st on the scene and without an EMS unit coming anytime soon, performed a quick neurological exam and in the absence of any indicators (pain, deformity, numbness, weakness, neuro-deficit) allowed the patient to assume a position of comfort, which might be sitting or laying down, especially to treat potential shock.

On a more positive note - Matt, congratulations on passing your exam.

Pete

In the absence of a clear authority figure, most PHRASECENSOREDPOSTERSHOULDKNOWBETTER. will follow whoever yells
the loudest, looks the toughest, acts the most confident, etc.

It doesn't sound like any of you had a uniform on, or other signs of your profession. So maybe
to the victims and bystanders, you were equal, and since you knew what you were doing and
were trying to be reasonable, you didn't seem as alpha as the other two.

Maybe in the future, could you carry a jacket with an official looking logo on it? A bag with
cool looking paramedic stuff? A big brick of a walkie-talkie couldn't hurt. Perception
is reality. Just a black jacket that said PARAMEDIC and a toolchest full of medical stuff would
have put you way ahead of two plain clothes morons, wouldn't it?

I know, there isn't always time for that, or room for that, but...

I have all that stuff in my car (I'm forbiden to wear my paramedic identifing gear on the date since I was "stuck" for two hours in the ice rink with amputated finger. not that my date is insensitive but I get stopped and ask questions all the time")... Just when you see a car doing matrix scene in front of you wearing cool gear aint the priority. Whenever I enter the scene I identify my self and hang my badge on my neck.

But I see how would that make a point.

I'm not a lawyer, a cop, or a paramedic, just a First Aid instructor, and this is all 20-20 hindsight anyway. However, as I understand it, neither you nor the other paramedic were in uniform or on duty; the police officer was both. Therefore, he is officially in charge. Rather than getting into a machismo contest with him, I think you should have introduced yourself as a qualified paramedic or whatever your qualifications are, and stated "My recommendation is [whatever your recommendation is, e.g. "these patients should remain standing until the ambulance arrives"]" If he chooses to override/ignore your advice, or chooses to believe the other off-duty paramedic, that's his prerogative. (fwiw, before reading this thread, I think I would also have tried to get the two patients to lie down.) Look at it from the cop's point of view - he's probably attended hundreds of accident scenes, he's trained in first aid, at a minimum, he's the only guy there in uniform and he's trying to do his job, and some civilian comes over and tries to make him look bad in front of everyone. How would you react if it were you? Especially when there's another off-duty EMS provider who openly disagrees with you?

Did the other EMS provider have actual work experience? Did he have the same qualifications as you? Did he or the police officer know that you had only just completed your training? (Am I correct in assuming that, if you'd just passed the paramedic's exams, you must have several years of work experience as an EMR or EMT?) If I were in the cop's shoes and I were confronted with conflicting opinions from two equally qualified providers, one of whom worked in the field and the other who had "only just graduated", I know which one I'd be more likely to listen to. (So emphasize your work experience as well as your level of training; e.g. "I'm a paramedic with [name of employer] for the past [n] years." rather than "I just completed my paramedic training this afternoon and you're doing it wrong." which doesn't get across the message "I have 5-10 years of work experience as an EMT".)

Technically, as you were the first on the scene, you are in charge until you voluntarily relinquish control to another equally- or better-qualified bystander, or EMS takes over. From your level of training, you almost certainly know the legalities better than I do. However, the other off-duty EMS (a) may have had more experience than you, (b) may have seen something you missed, or (c) may not have known there was another off-duty paramedic on the scene.

Maybe it would have been better if you'd gone up to him and said "Hi, my name is ...., I'm a paramedic with [name of employer], I'm glad you're here. I have these two patients stabilised, but there are people trapped inside, I could use your help over here." or something like that. I know, I know, easy enough for me to say while I'm sitting here goofing off at work, not so easy when it's dark, cold and wet and there's six injured passengers and two off-duty paramedics who don't know each other, but that's why you asked the question, right? <img src="/images/graemlins/wink.gif" alt="" />

He was trying to help, you were trying to help, the cop was trying to help. If I interpreted your post correctly, it's a shame that you ended up getting into a shouting match in public.

With multiple casualties, I would not have left the scene until the ambulance showed up, I would have made my report to the on-duty paramedics when they showed up, then I would have gone to the zoo. This may be very unfair, but your post makes it sound like you took your ball and went home in a pout because the other kiddies wouldn't play by your rules. I'm sure you were far more concerned about the patients' safety than you were in proving you were right, but that didn't come across clearly in your post.

I feel sorry for the victims. If I'm injured and scared, the last thing I want to see is the first responders argueing about my treatment. If I was about to go in to shock then that would certainly make matters worse. Remember why you chose this profession. I'm sure it wasn't for the lucrative pay. The question you asked in your post was "what would you do". I supposed my answer is that I would have stayed on the scene to help as best I could have and refrained from any confrontation with anyone else that might make matters worse for the victims. I also would have reported it to the on-duty personel when they arrived if in fact this did not take valuable treatment time away from the victims. I suppose in a nutshell, I would have put the victims' best interest above all else.

Now, having said that... I realize that this is one of those "easier said than done" type of situations and I don't think you should be discouraged that I (or anyone else) dont agree completely with your decisions. Right or wrong, you're human and will make mistakes. Furthermore you are to be commended not only for stopping to help to begin with but also for chosing a profession in which you selflessly give yourself to helping others in need!

No shouthing match in public had taken place. I learned long time ago that shouting leads to panic and confusion. I was very calm thru the entire event.

Now the cop was off duty and not in uniform... First aid trainging for police officers in NYC doesn;t really consits of much since EMS units are never more than 5-10 min out or even faster if they get shot. Scene should be controlled by the highest medical authority until unfiromed unit arrives.

This wasn't a Paramedic call. It was a basic EMT call which I am for a while. Paramedic status would matter if somebody needed to take charge and it happened to be that two paramedics were on the scene.

Now I do understand your point about taking my toys and going to play in my sandbox since other kids don't want to play by my rules. The thing is that when I see gross negligence and breaking of the rules it is time to repeat clear directions one more time and since I'm not an advocator of shouting and screaming it is time to go. I can't stand besides somebody who is hurting a patient since now my cartification is on the line because of somebodys else actions.

For some people especially in NYC EMS is a afternoon hobby since they are protected by Good s. laws by volunteering which there is nothing wrong with that since I started that way but it doesn't give you much experience in the field. For some it is a profession and gateway to other stuff such as PA or Medical school. For others it's a full time job. And I honestly belive that second paramedic was a member of volunteer organization and not much experienced.

I value your word guys that's why I posted it here so I can get some opinions regardless of them being negative or positive.

Based upon what Matt has given us in terms of how the event unfolded, I will say that Matt was the highest medical authority on the scene.

Unless the other medic was on duty or since both were off duty, Matt was outside his jurisdiction and the other medic was within his jurisdiction, Matt had, by his action assumed responsibility and authority of patient care. His initiation of treatment (c-spine stabilization) was in keeping with the standard of care, his treatment should have continued until the EMS units dispatched arrived and assumed patient care.

The LEO, unless he was also a paramedic should have concerned himself with control of the accident scene and not patient care, since Matt identified himself as a paramedic.

An accident scene can be utter chaos, it is up to the highest ranking EMS or Fire official to assume control of the scene, until relived by a superior or higher trained individual. In Maryland, by state law, fire line-officers, not EMS officers are responsible for incident command of the accident scene; EMS personnel are responsible for patient care.

Pete

Sorry, I just re-read your post and realized the cop was off-duty too. My understanding of Canadian law is that all of you were legally considered to be first aiders (I could be wrong) and that, as the first on the scene, you were in charge until you chose to hand the scene over to (a) another first-aider, (b) EMS (on-duty), or (c) qualified medical personnel (e.g. a doctor or nurse).

If you were the highest qualified person on scene, you did not have to relinquish the scene to either of the other two. If they ignored your advice and risked injury to the casualties, knowing that you were a paramedic with several years experience, I think they should both have been reported to their respective superiors. The police officer probably would/should have been subject to disciplinary action, the other paramedic could have his certification pulled. If he didn't have any certification, he might well have been subject to legal action.

I don't see how your certification would have been in danger if you stayed, as long as you had clearly stated your qualifications and that you were in charge in front of witnesses. Any subsequent investigation would reveal that any mistakes made were made in spite of your actions, not because of them.

My biggest concern would be that the police officer and the other paramedic will probably not have their behaviour corrected unless someone makes a formal complaint. By leaving, you legally seem to have agreed that the casualties were in competent hands.

Again, this is based on what little I know of Canadian law; your laws may well be completely different. However, having gotten another paramedic to state, for the record, that he was now in charge, was technically the correct thing to do but may not have been in the best interests of the casualties.

Sadly, some professions with legal or social authority are prone to overwhelming common sense with the fearfull 3 letter word EGO. During our liferaft testing, Doug assembled no less than the senior Coast Guard PJ, a crew of survivalmen from Luke AF base and numerous active,reserve and former service and civilian emergency professionals. I had humorous visions of my own obit in all this " former coastguardsman drowns in Arizona wavepool. Stomach cramps from eating to much food blamed. " Who WAS in charge? The certified, designated and employed lifeguard who was still a teenager. Perhaps you should take this experience, distastefull as it is and bring it up in various EMT journals and public venues.

You also have to realize you are dealing with a NYC cop (off duty or not) - you know they walk on water, their poop doesn't stink, and the demand that you listen to them, or they will have you arrested when the motor unit shows on scene

Matt congrats you passed the test. You have worked hard for it.

Burak

Several members of this forum are police officers in their real lives, so I'm not about to get into an "I hate cops" debate. <img src="/images/graemlins/wink.gif" alt="" />

But regardless of the personality of this particular off-duty peace officer, if he knowingly overrode the medical instructions of a qualified, off-duty paramedic and thereby caused injury to any of the casualties, he opened himself and possibly his department up to a lawsuit.

At this point, if I were in Matt's position, I would probably go to my governing/licensing body and seek clarification. I find it ridiculous that he would jeopardize his professional certification by staying to help, but not by abandoning a casualty to the care of someone who was clearly incompetent. If that is, indeed, the case, then perhaps it's a situation that needs to be amended. If it's not the case, then perhaps the licensing body would be willing to issue a clarification in writing, as it's unlikely Matt would be the only one who'd have trouble knowing what to do in these circumstances.

Although I think it's a great compliment to the members of this forum to be asked for their opinion on something like this, it's really a question best answered by the ethics committee of the official certification body.

To me the most stupid and at the same time most amusing thing that was told to me while doing my last first aid course was: If you have to deal with an emergency, the beter trained you are the more likely you are to be faced with a lawsuit. Basically the way the law works (at least in my country) if you are someone operating in an unoficial capacity (say a paramedic / doctor / nurse off duty at the time) and you assist in a situation as you would if you were a lay-person then chances are you will end up facing a law suit at the end of it, because of potential mishaps. If your are a totally untrained person (i.e. without qualifications) then you will not receave such lawsuits as you are not expected to know beter. The result ofwhich is that the law encourages people who have zero medical training to help out in an emergency situation, and punishes people who do have medical training by allowing them to be subject to lawsuits that would otherwise not effect them if they had not receaved such training (which is probably the on ething that gives them the ability to actually help in such a situation). One of my friends is a registered nurse and she has been told specifically by a superior that if an incedent occurs while she is off duty, she should ignore it, because she would end up being filed against if she attempted to help in anyway. I'm sorry but I find this sort of situation ludicrous.

Aparently the only solution is to get trained but refuse any form of qualification, that way you have the knowledge to help out, but without any qualifications you don't run the risk of a law suit

An off duty EMS provider, whether career or volunteer is generally covered by Good Samaritan Laws in most of the US. The law does not prevent anyone from being sued, but unless there is merit to the lawsuit, the suit it generally dismissed or found in favor of the defendant. Even an on duty EMS provider is generally covered by Good Samaritan Laws, since they are not receiving direct compensation, i.e. “fee for service”. This would still be true in jurisdictions where the EMS service charges for their services, since again the EMS provider is not receiving direct “fee for service” compensation.

There are several legal obligations that an EMS provider must abide by, to be covered by Good Samaritan Laws.

1st: There must be a “duty to perform”, most states require certified or licensed EMS providers to act whether they are no duty or not. To fail to stop and render aid, if it was found out that the EMS provider did not render aid, could be grounds for legal and possibly criminal litigation. On the other side of the equation, a medical procedure (i.e. emergency C-section) that is beyond the scope of the EMS provider’s training insulates the provider from a “duty to perform”.

2nd: The provider cannot cause harm through causative action or inaction. An EMS provider, who causes injury or harm through their action or inaction, can be held responsible. Basically – “Do No Harm”

3rd:They must provide the “Standard of Care” to which their level of training dictates. Generally, each level of EMS provider is responsible for the care provided at their current level of training as well as those below. An on scene paramedic is not only responsible for ALS care, but ensuring all BLS care is appropriate and compliant with the “Standard of Care”.

There are a number of other factors that need to be considered as well as the above, when determining whether an EMS provider is covered by Good Samaritan Laws. Some of the hard fast “laws/conditions” may be softened in times of catastrophe or a Mass Casualty Incident (MCI).

Pete

Do these laws apply to non-EMS people also? Let me try a hypothetical: let's say I observe a person who has been shot in the leg and their femoral artery is severed. They are already unconcious. If I do nothing they will bleed to death in minutes and there is no one else around. Drawing on my 30 year old Boy Scout training I apply a tourniquet which I leave on until the ambulance arrives. But because I never loosened the tourniquet they lose their leg above the knee.

Am I liable even though, had I done nothing, they would have died? If so, I can understand why people don't get involved.

Vince

There is probably no fast hard answer to that scenario. You can be sued for your actions, good or bad, if you have a sympathetic jury and/or a good lawyer, most likely the principal of “life over limb” will prevail and no monetary judgment will be made against you.

However, if it can be shown that your Boy Scout training (Standard of Care) indicated that the tourniquet should be tighten only to stem the bleeding or that it was to be loosened every 30 minutes and you yanked down on that tourniquet beyond reason or you failed to release the tourniquet periodically based upon your training you might be found responsible. You might also run into trouble if the current Standard of Care was significantly different from your aged training.

As part of our biannual training we are required to have modules on medical-legal responsibilities and requirements. One of the most important lessons we are given is the importance of bedside manner or patient courtesy. Studies have shown that Paramedics who are perceived by the patient to be courteous, caring and compassionate, regardless of the quality of care provided, receive fewer complaints and are sued less frequently, then ones who provide high quality care but are rude or uncaring.

Pete

Individuals with specific training or duties can be criminally liable for "depraved indifference." I was literally one hour out of basic training and standing on Hyde Street in San Francisco. 98 y/o Tilly Zimmerman was in the crosswalk and struck by a speeding Cable Car ( tough to do, but possible.) I provided first aid until the paramedics and this huge irish SFPD sargent arrived. The car operator stood there smoking a cigarette. The cop hopped on and gave him a thorough tongue lashing which included threats of the USCG impounding his vessel pending a maritime board of inquiry. But then he was a Cavanagh <img src="/images/graemlins/grin.gif" alt="" /> When I was later reassigned to the Bay area, those cablecarmen sort of took a deep breath when a coastie was in the crowd <img src="/images/graemlins/tongue.gif" alt="" />

I guess it comes down to whether a person would rather live with the fear of a lawsuit or the guilt over not helping out. I'd probably choose the former.

Thanks for the info.

Regards, Vince

"Aparently the only solution is to get trained but refuse any form of qualification, that way you have the knowledge to help out, but without any qualifications you don't run the risk of a law suit."

Sad but apparently true, I'm afraid.

Vince

The vics exited the vee-hicle under their own power.

Someone else wants to be in charge - good leave.

They can't sue me. They have no ideal who the hell I am.

The only exception to this is when the other "folks" on the scene are obviously not up to it.

My training level (now quite out of date) dosen't really have a suitable civilian equivilent. I was a 8404 Corpsman,(HM2) and had done a big hunk of my time doing medevacs in the field, boats/ships and water. I also did a lot of ER time, along with ortho, lab, x-ray, etc.

While a civilian photojournalist, I responded to numerous scanner calls - I've pulled line on brush trucks at fires while the full time firefighters were waiting for all the volunteers to catch up. I also responded to one that was a fall from the roof of a three story apt. building under construction.. Sadly, even with rescue one and the ambulance there, I was still the most experienced, so I put down my camera bag...

The arguement I have most often - REFUSING to let ANYONE move a vic until EMS takes over...

I (another corpsman and myself) did pull 2 cute early 20's girles outta a flipped pickup truck.

As soon as I saw the fuel spreading, I sent bystanders back over a 100 meters to block the road and he and I cut 'em outta their belts...

This is the ONE time (out of literally dozens) I moved a vic when I wasn't the EMS on the scene...

It is not quite that easy. If you were to administer some type of aid and later on the individual decided to sue you for whatever reason, the lack of the certification, etc. could be more problematic then having the certification. The certification tells the world that you have met some type of standard, i.e., you have been trained, tested and found to meet the at least the minimum standard for the organization or agency that is issuing the certificate. Examples are Red Cross- CPR, First Aid, Life Guard, AHA- CPR, and FEMA- CERT. Depending upon state law such “certified” individual may or may not have certain “rights and privileges” and responsibilities under the law.

However, even the “certification” is not always looked at legally with equal status as being licensed. The problem is many of the organizations that issue “certifications”, really do not have a legal standing per say. They are generally recognized as legitimate organizations, but the issuance of “certification” has often led to the erroneous notion that the individual has some “rights and privileges” associated with the certification. Some of these include “Wilderness First Aid/EMT, Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS),

Many organizations are no longer “issuing” a certificate of competency, but are issuing a certificate of completion or attendance to avoid the impression that the individual can now perform some type of medical intervention. An example would be endotracheal intubation as offered under the ACLS program. Physicians, nurses and paramedics all take the same identical class, however (this may vary by state) only physicians and paramedics may intubate. That is why on an ALS transport of an ICU patient both a nurse and a paramedic must accompany the patient.

A license can only be issued by a government agency, local, state or federal. The license does denote certain “rights and privileges” and responsibilities under the law. The confusion arises in that a government agency can also issue a certification with certain “rights and privileges” and responsibilities under the law, and an organization can issue a “certification” that does not conferee certain “rights and privileges” and responsibilities.

Pete