r/Paramedics • u/Ok_Assistance69 • Jun 21 '25
US Overruling captain!
Just getting opinions here. Other night we had a well known psych patient who’s not only know to verbally accost medics/hospital staff, but can get aggressive. Delt with her multiple times where our local PD had her cuffed, hands on a taser. On scene for the THIRD time that week same patient, different captain (not mine, was working OT) and I told this captain “we’re going to need PD” Captain replied back “THIS IS NOT A PD ISSUE” very loud and aggressively I might add. I stated “she can get aggressive” he replied back “SHES NOT AGGRESSIVE”and he denied calling PD. Once she was loaded on the stretcher, she started to become verbally hostile, then and only then did the captain call PD. Then I was instructed to go to my patient. She started getting verbally hostile with me. I was told to get in the engine at this point and the other medics would run the call. PD followed the medic unit to our local ER.
Now, we all learned “BSI/scene safety” right? I always thought it was a medics discretion if it came to safety. KC firefighter died over a psychiatric patient after being stabbed by her. Another psych call, patient flew out the back doors and ended up being killed by a semi truck.
Does anyone think this needs to go up the chain? I feel mine AND my crews safety was compromised by a captain with a superiority complex and this captain has been known for his temper. His behavior was unprofessional, unacceptable and unbecoming an officer.
Opinions???
12
u/splinter4244 Jun 21 '25 edited Jun 21 '25
Haha I’d rather take a write up than to lose my cert and/or life. Love it when fire officers try to intervene during medical calls and unless they’re taking the report, I ignore them and almost always kick them out the rig.
Edit: just to add, yes I would most definitely take it up the chain.
2
u/RJM_50 Paramedic Jun 22 '25
Yes we would toss them out, and they can't stop my radio from calling dispatch.
But there might be some rookie nonsense going on that doesn't need to cause a fuss with the union or downtown. If the OP is a rookie they'll learn how to work with different crews, if the replacement Medic was a rookie they'll learn not to volunteer for this bullshit next time they meet and "chat"
16
u/rycklikesburritos FP-C TP-C Jun 21 '25
If I'm the medic running the call I don't care if chief is on scene, I'm in charge. I would have just called for PD myself. PD isn't only there for aggressive patients. If it's a psych I have them on all my calls. They are the dudes with the body cams that can back me up if I get accused of anything.
4
u/epicfartcloud Jun 21 '25
>I don't care if chief is on scene, I'm in charge.
I feel you, except that's not how it really works in most fire-based EMS systems. Firemedics have to follow their officer's instructions and do what they're told, only exercising independent authority to the extent that the chief allows it (and trusts them to do it, which in fairness, could be a missing part of OP's story). They're only 'practically' in charge, not actually.
6
u/Mediocre_Daikon6935 Jun 21 '25
Then they can ride the call and write the chart.
Their administrative title does supersede his license.
3
u/davethegreatone Jun 22 '25
In my fire department, the medic who takes the call is in charge of the medical scene, even if officers are there or even if other senior medics are there (when we have two medics on a rig, we take turns every other patient).
My patient = my scene (at least as far as purely-medical scenes go. If it's like an MCI or a car wreck that has a medical component of a larger-overall traffic & extrication scene, that's obviously different).
2
u/rycklikesburritos FP-C TP-C Jun 21 '25
Nah. That's only the case if you're scared of a little backlash. I had a captain who thought he was my medical director. I'd tell him he can take the call if he wants, otherwise I'm making the decision in the best interest of the patient. Sometimes he'd complain about "insubordination" and the chief and medical director would remind him that he makes the decisions until I have a patient. Then the medical director is the only one in charge.
2
u/Upstairs-Scholar-275 Jun 22 '25
This isn't true. My chief is a medic. Even he can't tell me what to do when it comes to my patient or my safety or treatment. He isn't over my license. He isn't the one that would take the hit if things went south. Yall need a backbone when you work Fire/EMS. Us backing down so easily is why we are in this mess.
2
u/epicfartcloud Jun 22 '25
This isn't true for you. Most chiefs aren't medics, in many places, unit officers aren't even medics, so you are definitely one of the lucky ones.
Everything you said is 100% true, however, when your chain of command gives an order that is contrary to the duties and requirements of someone's paramedic licensure, training, and professional ethical requirements, a choice has to be made... you either protect your livelihood or you protect your patient.
It's a decision that most physicians end up being faced with during their careers, and the likelihood of this happening in EMS is pretty slim, but it does happen, and it's a watershed moment in the careers of people who experience it. It's a very pure definition of a conflict of interest and, imo, it's the biggest shortcoming of the fire-based ALS model.
2
u/Upstairs-Scholar-275 Jun 22 '25
I work at a Fire based station. Your license is yours and yours only. I'm not going to do anything against the license I went to school and paid for for anyone. I'd be running the issue up the chain if anyone even tried to tell me how to do my job against my license. The problem with EMS is no one seems to have a backbone except when they think it's funny to laugh and joke about the recurring overdoses (something I don't find funny at all). In reality, we shouldn't even be with Fire depts or at least not considered second class to them when EMS runs the biggest portion of the job. But again, no one has a backbone so this is what we get.
1
u/forty-seventhattempt Jun 24 '25
That's how it works in the fire-based system I work in. Unless it's our EMS chief that's there, of course.
2
u/green__1 Primary Care Paramedic Jun 21 '25
in my jurisdiction they are also the only ones who can force someone to get care against their will.
2
u/RJM_50 Paramedic Jun 22 '25
What! That's BS, here PD generally looks to us for that cue they're not allowed to refuse or leave. I'm just waiting for the magic words of an intent to harm, or a suspicion they have a Medical guardian and they're mine. (You can't sign? Then we're walking up these steps!)
But PD gets to force everyone who's been tased, suspiciously drunk, etc to get evaluated for their liability.
2
u/green__1 Primary Care Paramedic Jun 22 '25
here only a doctor or the police can force someone into treatment, doctors won't do it over the phone, and won't come to scene, so that leaves police, and they will only do it if they believe the patient to be suicidal or homicidal.
yes, that leaves a HUGE grey area that I absolutely hate between "competent to refuse care" and "formable"
1
u/RJM_50 Paramedic Jun 22 '25
That sucks, I work in a really good area where we can get a physician to call a patient in the field too. I know many areas that have to work every patient no matter how long they've been stuck to the carpet or how many limbs (and blood) are missing. It's nice for the medical examiner, Law Enforcement investigations, and the family when we can just get a time of death and allow the next steps to proceed, no awkward false hope or messing up a crime scene with all our equipment.
My first intubation was in an area like that. They knew she wasn't coming back, the medical examiner eventually showed up and was confused why I did so much work. They explained I was a rookie and needed practice. Everything was awkward about it, the lady hung herself after getting paid for sex by the homeowner, not sure if she wanted his wife to know, or what her toxicology would show for making bad decisions.🤷🏻♂️
2
u/green__1 Primary Care Paramedic Jun 22 '25
our protocol for codes is pretty good. for anything obvious, we don't need to call a doctor at all. Dispatch just has the medical examiner call us, for anything somewhat expected or were no foul Play is suspected, the family has to call a funeral home, and then we can leave. for anything where there are question marks or it appears suspicious, the medical examiner will come out, and we can leave once the police arrive. for codes that we actually run, we have a protocol for when we can discontinue them, again most of the time we do not require calling a doc. there are a few situations where we are supposed to call, but for the most part no medical consultation required.
7
u/West_Presence_9454 Paramedic Jun 21 '25
This is unacceptable. If you do not feel safe, call PD. We do not have the equipment to properly defend ourselves.
Push it up the chain, yesterday.
11
u/green__1 Primary Care Paramedic Jun 21 '25
don't know the rules in your jurisdiction, but where I live we have the right to refuse unsafe work. And it is not up to them to determine what is unsafe, it is up to you.
I would absolutely take that up the chain.
1
u/RJM_50 Paramedic Jun 22 '25
Maybe not, sounds like we have some rookie shit going on. Might just need to ignore it and move on.
6
u/Belus911 Jun 21 '25
Theres a lot here.
The chain of command doesn't exsist, or you dont care or nots on the hospital (which it absolutely is) is all pretty silly.
What you should do is have an after action with the crew and that captain. You should be doing that on all sorts of types of calls.
Cops following you doesn't help much... the whole argument of a medic got stabbed so the cops should be has no linear or logical progress if the cops are behind following you in a another vehicle.
Also if you aren't searching your patients, you are doing it wrong.
4
u/Fair-Future1047 Jun 21 '25
Spot on for the last part. I would also add, just because the cops are there before you on a psych call, don’t assume they’ve searched the patient. In my area the cops almost never search psych patients before handing them to us
4
u/green__1 Primary Care Paramedic Jun 21 '25
if I call the cops, and I'm transporting the patient, they're riding in the back with me.
2
u/Agreeable-Emu886 Jun 21 '25
It depends where you work a lot of places run 1 man cruisers. The cruiser following behind is pretty common unless they’re that belligerent
1
u/green__1 Primary Care Paramedic Jun 21 '25
I've worked those places. they have to leave their car on scene and go get it later.
1
u/epicfartcloud Jun 21 '25
Then you're lucky to work in an area where they'll do that. Most places I've worked, the only way the officer is in the back is if the patient is in custody (or is going to be once they get discharged from the ER).
2
u/green__1 Primary Care Paramedic Jun 21 '25
if they don't want to go, I legally cannot make them go. only the police can. And that is considered being in custody, which means the police have to accompany.
1
u/epicfartcloud Jun 22 '25
In my area, the police song and dance is that they don't formally take them in to custody until after they're discharged from the ED, because if they get a medical evaluation while in custody, the police agency (city, county, whatever) is on the hook for the bill.
1
u/green__1 Primary Care Paramedic Jun 22 '25
in my jurisdiction there is no billing for hospital, so that's not an issue.
5
u/nsmf219 Jun 21 '25
IDGAF who is on scene, if I need police I’m picking up the radio and calling them. I would have asked the captain to assume care while we rtb. Either file a complaint or don’t work his shift again.
4
u/Fair-Future1047 Jun 21 '25
Just call for PD yourself. As far as taking it up the chain, idk, I think I would be more inclined to just talk to the captain after the call. Tell them what they did was bullshit (obviously not in those words), explain why you wanted PD for a patient that didn’t seem at the time aggressive. If they still seem resistant/dismissive, then take it as far as you think it needs to be taken for the situation to not happen again.
4
u/Fair-Future1047 Jun 21 '25
But…if this guy has a history of trying to flex on calls and is kind of a dick, fuck it, let er rip
3
u/rjb9000 Jun 21 '25
“You’re attending this one? Hop in, boss, I’ll add you to the chart as the lead medic.”
1
u/RJM_50 Paramedic Jun 22 '25
That's exactly what I'd say!
But I suspect they forced some rookie to take over who didn't know better. Somebody needs to talk to this took before they get into a problem, I wouldn't help them document that run. It should start out with an awkward change in patient care, that's when the higher ups will get involved questions about the documentation! I'm not afraid of sabotage to help teach a rook. 🤣
4
u/MarcDealer Jun 21 '25
Captain is a moron for not listening to crew who has experience with the patient. End of story.
3
u/Mediocre_Daikon6935 Jun 21 '25
Captain wants to be lead on the call?
Then it is his patient, and his chart. Full stop. No if’s, ands, or butts.
I’ve run a lot of calls interfacing / intercepting with a with lot of different departments as a paramedic, who obviously have different ways of doing things. Interacted with a lot of Fire and EMS chiefs.
But if it is an als patient and they ain’t a paramedic, then I’m in charge.
3
u/InformalAward2 Jun 21 '25
This is why our department dispatches police and fire for any psychiatric call.
3
u/youy23 Jun 21 '25
Your captain is obviously a pirate captain and was afraid of involving the authorities.
3
u/IslandCyclist Jun 21 '25
I’ve been both the officer on scene and the paramedic. As the officer, my job is overall scene management. Not patient care. My medic wants PD, they get PD.
3
u/Dramatic-Account2602 Jun 21 '25
If you arent on probation, call PD anyway. Not ypur regular captain, so not your regular problem. Behavior will inspire a conversation, and perhaps change. Not all change is positive. In my area, its very typical for dispatch to send PD on any psych.l, especially with a known history. That said, talk to your physician advisor. DuPont had a point with their old slogan "better living through chemistry"! Chemical restraints are both effective in most cases, humane, and enhance safety for all. We have criteria based on the RASS and BROSET scales as to the course to take....
3
u/epicfartcloud Jun 21 '25
Unpopular opinion: this is one of the many downsides of fire-based EMS... when you have to answer to people who aren't in the same profession. Imagine if every fire Lt. was accountable to a police watch commander for every decision they made.
If you want to be able to protect yourself and your crew's safety with your own sound judgement, go work for an independent EMS agency (3rd service, or whatever they call them these days). Otherwise, you do what the good captain tells you, even when it can get you killed.
3
u/RJM_50 Paramedic Jun 22 '25
Ugh, I thought we were past this "old generation" bullshit where they didn't run medical as a rookie. The Medic in charge of that runs patient care runs the show, it's their license. What "Captain Licence" did he have to outrank you in patient care?
Your crew screwed you over taking patient care, they should have all looked around and told the Captain if he wants to change patient care, he's the Medic in change now!😒😂 Are you a rookie or was the replacement Medic a rookie? I wouldn't have played hot potato, especially from the Engine, if you're assigned to the rig that shift he can't move personal unless it's multi victim incident that involves more patients than rigs. Moving on/off the Engine usually has a change in pay or counts towards how many days you've worked in on EMS, depending on your Union contract. Some guys work longer in their career on the Ambulance because it pays more with seniority, and they haven't lost their sanity (yet)!
Generally the few large City Fire Departments that run EMS all have to be trained; AND Paramedic if they want that juicy pay, EMTs are generally flunkies that don't last! So everyone on the Engine and that Captain should know the etiquette rules. Or departments like Detroit have separate Unions and training for Fire & EMS, they can't swap from the Engine like that.
But if you're asking us, then your Union sucks, or you don't have enough friends and/or years of experience at this Department to get the advice you really need.
1
u/Ok_Assistance69 Jun 22 '25
5 years in, just biased admin
1
u/RJM_50 Paramedic Jun 22 '25
Sorry to treat you this way, but I(we) need more information to give correct detailed advice; I've been a Rookie, the Commanding Officer, and Medical Training Officer for Rooks (including working for the local community college Paramedic Academy throughout my career). Please answer the following to the best of your ability without disclosing too much personal information, but don't be vague with the important details! If you want us to we need some important details. Sorry but I'm going to treat this just like I would if I was reviewing this call as the Fire Department Medical Supervisor (I've held that position 😂 ) I need an accurate history of the events:
**1) Was this Captain also a Licenced Paramedic?
2) Is this Captain newly promoted or close to retirement? Or any career change coming soon?
3) Was this Captain dispatched to other medical calls during your shift?
4) Does your department dispatch an Engine with each Ambulance medical call? (Likely because more Engines are available than rigs more likely stuck finishing up at the hospital before being dispatched to the next call). Or is it not common for an engine to go out on medical calls?
5) Are you allowed to Radio dispatch or is that all handled by the superior officer on the Engine?
6) Is there no situation where you can radio dispatch for Leo backup? Without getting approval from the officer on the Engine?
7) How much experience did the replacement Medic have?
8) This is a large(r) metropolitan Fire Department and you're an IAFF Union member, correct?
9) You're not like Detroit Fire and EMS separated; with a different IAFF contract, different chain of Command, and low chance somebody on the Engine is up to date with their Paramedic training and licensure, correct?
10) Did you get back on the Ambulance after this call, back in service for the next call away from this Captain, or stayed on the Engine?
11) Does your Department track EMS days differently than Fire days; for your Union commitment before you can step away from EMS and work on Fire career advancement?
12) How did this psych run get documented? The replacement Medic must have done all the documentation under their name, yes? How much information did you volunteer for them to complete the beginning of this run? How many times did this replacement Medic use your name in the report? Or was this report extremely vague with all of the "drama" redacted (per the Captain's pressure to exclude any & all "drama")?
13) Did you ever speak with the responding LEO at the hospital about the "drama" without anyone looking over your shoulder?
14) Did you ever speak with the replacement Medic about the "drama" at any point after this run? (IMO that's the #1 individual you should be talking to about this!)
15) How is "the Administration biased?"
16) thanks for answering these questions!** 🍻
There are few remaining large City Fire & EMS together, which are better trained because everyone is the same level of Medic (generally). They all have the better medical training, and get days on both sides. And they usually offer an option to exit EMS rotation after X number of years (or actually X days worked per the Union contract), it's not a standard number for all departments or even employees depending on how often the Union contract is negotiated, different groups hired in would be under a revised contract based on when they hired in and seniority. This started in the 1990's for most departments, that ended the days of a Fire Command officer giving orders to EMS with no clue of patient treatment or the severity of the situation, we were just little trucks in their way. But a decade later and all of Fire Dept Officers now had Paramedic Academy training by 2005 all the old Fire only Officers had retired. I retired in 2022 from a Fire & EMS IAFF larger municipality. After the "old guys" retired I never heard of anyone having a situation like this. Only it a Rook was (their opinion) putting the patients like in danger, but then the commanding Officer was a mediocre Paramedic (like myself) and would assume control of patient care and it was documented; so then the Rook would get the appropriate corrective training; and the commanding Officer would be questioned on their rational for those actions. Whomever reviews medical runs should be coming to that: replacement Medic, the Captain in command, and yourself (unless this drama was intentional left out of the run).🤔😒🫤
2
u/Ok_Assistance69 Jun 22 '25
1. NO, not a Paramedic.
2. Has been in the position 2 yrs
3. Yes he was, but he chose not to go on those even though it’s in our response posture. Don’t know why he chose this one.
4. Very VERY small paid dept so yes, they are “supposed” to go on most calls.
5. Yes, we are allowed to radio dispatch at anytime needed as long as it’s articulate to some degree
6. We have no official “policy” on that. My shift captain stated I was in the right and if I feel I need resources it’s not up to him to tell me no.
7. I’ve been there longer than both replacement medics by at least 4 years. Both medics are “baby medics”
8. Yes, IAFF (just a small dept)
9. No we are EMS/Fire integrated
10. No, he told me to “attend to my patient, she started screaming, I told him “SEE” and then he pulled me. I stayed away from him. Called MY captain and then my EMS captain, was told to write a statement. My taking up the chain would be the city/HR if my admin avoids this.
11. Not sure I understand the question
12. I have no idea. I have not been communicated to in regard to this or what the other medics documented. I do know they stated he handled it incorrectly
13. I did not go to the hospital. I was instructed to get on the engine and I would be driven back to the station
14. Only that the whole ordeal was not handled correctly by the captain (his hostility)
15. Good ol boys club. Everyone in current leadership is friends or friends of friends. Hired on/promoted because admin knew them, not because they could perform the job. Honestly they’re all free masons.
16. You’re welcome!
I will say this particular captain has been the talk of many at the dept. Known for his explosive temper and hostility. What I found cowardly is he didn’t even ride in the call since he wanted to make the decision so badly. He made two others do it. He’s honestly one of the worst captains I’ve seen. Sure, is he great on fire, yup! Is he a peoples captain?? NO! He also has a huge distain for women in the field.
One of the medics that took the call is a good guy, but not sure he would document that for fear of retaliation. The other medic is aspiring to be a captain, so either he will play the game to get the job, OR watch everything this guy does to get him out. Not sure though.
Thanks for your time! Let me know what you think
1
u/RJM_50 Paramedic Jun 24 '25
1) Captain wasn't a paramedic!🤯 That's absolutely unacceptable this needs to be escalated to your local Medical Control Authority (MCA)
2) 2 Years is not enough in his position to have
3) Absolutely unacceptable he skipped out on the psych patient after making medical care decisions!
4) What do you consider small, how many Union members? Ambulance on call? Trucks in service? I don't want to assume "Small" and give the wrong advice.
5) Okay, any reason why you didn't just radio dispatch for an Officer to your location? Before this Captain gave bad opinions.
6) Again if you're not obligated by a policy on contacting dispatch; I'm not sure why you didn't just make that (radio) call?
7) I suspected there was some rookie bullshit! You need to talk to that replacement Medic and so they understand a legal patient care transfer, and "Duty to Act" you were already obligated unless replaced by somebody with a higher medical license.
8) I would talk to your regional MCA is likely the most important organization that will stop this Captain from overstepping ever again. They will contact your Fire Department administration about this continual problem.
9) If your department is Fire & EMS integrated; why is this Captain not licensed accordingly?
10) That's why I would contact the MCA, it would avoid the HR/City Hall potential waste of time.
11) This might be why the Captain is no (longer a) Medic... Here once you work ~600 days on the Ambulance or the equivalent of 6 years, we have the option to stop running shifts on the Ambulance, but there is a pay decrease, however that's usually the time when we'd get promoted to a Captain and get that pay increase. Some colleagues decide to keep going for the pay and they enjoy the ambulance. While others are willing to skip the pay for the reduced stress. Does that make sense?
12) That's not acceptable, I'd mention the rookie didn't document the beginning of the call to your MCA. Or they faked that initial documentation?
13) WOW! This sounds like you were officially reprimanded and should ask HR about what happened, not making a complaint at first, just asking why you were sent to "timeout" by a Commanding Officer who doesn't have a Medic license!
14) Depending on how "small" your department is, you should start to speak up to the rookies at this point, it's obvious they don't know how to deal with this Captain and aren't making good medical decisions.
15) Depending on the size of your department and how old this "Good old boys club" is, they might be close to retiring out and then it's over. That happens to us in the late 80s/90s when they didn't understand the importance of the ambulance to the community.
3
u/Upstairs-Scholar-275 Jun 22 '25
Fire/medics do not operate as medics at all. Even the treatment is different. I often advise against doing any medical training with a FD because of it.
1
2
u/goliath1515 EMT-P Jun 21 '25
Oddly enough, my service, NE Ohio, had a similar scenario involving a squad not long ago.
We had a squad staging for safety on an assault call while they waited for police. The captain, our equivalent of a shift manager/supervisor, radioed to the crew and told them to move closer and approach the scene without police established on scene. The squad told them that they were staged for crew safety and the captain basically said “approach, that’s an order!”, and the crew said that they were going to disobey for personal safety. Immediately, the crew got pulled off the call by the captain and was sent to base for a scolding.
Now, per our protocols, the only justification for disobeying an order from a superior is if it knowingly puts you, your partner, or the patient (in that order) in harm’s way. The crew members still work here, as does the captain, so if there was any punitive action taken, it wasn’t severe.
TL;DR: if the order puts people in harm’s way, then you have a right to disobey
1
u/epicfartcloud Jun 22 '25
You always have a right to disobey, and sometimes you have an ethical obligation to do so. The reason behind the decision doesn't save a career, livelihood, and pension, though...
2
u/Flipflapflopper Jun 21 '25
The medics are the highest trained personnel on medical scenes and take charge. It wasn’t his call, it was yours. You run that medical call however you’re comfortable.
2
u/Fibpib Jun 21 '25
The patient wasn’t aggressive at the time and they only got verbally aggressive?
You weren’t spit, hit, kicked or punched?
I agree, it’s your discretion as the lead provider. If you want PD call for PD. Sounds like you had plenty of hands on deck for help though.
2
u/Successful_Jump5531 Jun 22 '25
As a Captain myself, I'm sure you must understand the need to follow orders and the chain of command. Without them there would be chaos. And all the evils in the universe will come crashing down on your head for stepping even a fraction out of that framework....had a good laugh at that I hope
Seriously, I am a shift captain. If my partner feels we need LEO on scene, I say go ahead and call. They may be aware of something I'm not. Actually, if my partner feels we need anything on scene, I let them call for it. ( Im really the one that would be calling in). I may not agree, but I take that up after the call. Example: Where I'm at, for some reason, we have this person is known psychotic, has breakdowns, can actually be fairly combative and have had the PD out several times with us. Most crews still need PD. When it's my turn and show up I tell the cops they can leave. I learned that the cops don't like her so they're already annoyed at having to show up, PT doesn't like cops. Yelling and shouting starts and things get worse. Cops are getting her so upset that if she doesn't go with us, then she'll be arrested. (Most of our crews hate having to deal with her so the animosity continues)Got to the scene once, no cops ( they were tied up on other things) PT got in the truck and we left. Several times I've had to go there, I tell the cops to leave. She calms down and goes with us. She did ask me once why was I the only medic to treat her as person instead of a lowlife scumbag (her words were much more self degrading). Cause she's a person first, a person with problems.
Actually I can't stand her either. But I was raised to treat people as I would want someone to treat my family. Makes my life easier anyway
1
1
u/epicfartcloud Jun 22 '25
I'm sure that a high percentage of aggressive psych patients in the US were raised on 'treat others how you'd want them to treat your family', too... the shortcoming with that strategy of telling PD they can leave (vs asking them to stay out of sight) is that some of these patients want to stab their own families repeatedly in the fucking face, and they tend to look the exact same as the ones who are legit just looking for help and not trying to hurt others.
2
u/gjb1202024 Jun 21 '25
If you don't minimally attempt to communicate with him first, you are part of the problem.
0
u/Ok_Assistance69 Jun 21 '25
That’s apart of the issue, he’s not approachable
1
u/gjb1202024 Jun 22 '25
I would still give that a go and start by saying something like, I would not have asked had I not had the prior experience and let him know you weren't really asking, but that you also understand his reluctance based on the patient's current state. Stop talking and let him speak and you might find you are on the same or similar page. You can judge the reaction and conversation from there and determine next steps if any. Good luck
2
u/Zestyclose_Crew_1530 Jun 21 '25
This is gonna sound harsh, so I apologize, but I think you’re looking at this all wrong. A lot of people are understandably agreeing with you, but I’d venture many of them haven’t worked in a true fire-based EMS system similar to the one you describe.
From what you say, you wanted this captain, who you don’t normally work with, to call PD for a (at that point in time) non-hostile patient. He refused. You stated she “can” get aggressive. She wasn’t at that time. When she did get aggressive, he called for them. He certainly could have done better/been more proactive, but he didn’t do anything that wrong. The scene was safe until it wasn’t, and when it wasn’t, he called PD. His understanding of the run may have been “PD will only aggravate this woman, don’t call unless needed”, and you simply saying, “We’re going to need PD”, isn’t going going to come anywhere close to changing that understanding. He doesn’t know what you know.
If you don’t normally work with this guy, he likely has zero reason to trust your judgement. Respect in the fire service (and this extends to fire based EMS and sometimes even single service) is earned, not simply conferred by a medic patch.
Really it just seems a big misunderstanding. You both clearly have different levels of acceptable risk, and both may have had different levels of previous knowledge of the patient, but his is the judgement that matters in the end, because ultimately, he is responsible for you. You should absolutely not take this up the chain. It’s not a good look to chiefs (who have been in this captain’s position) when a private questions an officer’s judgement. Let alone when the officer is somewhat right, and no one got hurt.
3
u/Ok_Assistance69 Jun 21 '25
The patient was hostile from the moment we arrived to scene, the point was she “CAN” get aggressive. Our EMS captain makes it known that yes, if you feel PD is needed, you get PD. Regardless of what said captain wants, at that point in time my red patch overrides his “bugles” just because you are a captain does not necessarily mean you are correct in ALL instances and negate safety due to being an “in charge” in fact, most captains here will immediately extinguish a possible threat. We work in a high crime area. At the end of the day, this captain put his crew in jeopardy. We have lost captains on less infractions. We are now in 2025, not 2005. Times have changed and this antiquated thought process of being above the policies or being a dictator gets people killed. I’m not willing to die over someone else’s decisions nor am I willing to subject my patch to revocation. No one was “hurt” but it’s best to be proactive, not reactive. The risk was still there.
2
u/Zestyclose_Crew_1530 Jun 21 '25 edited Jun 21 '25
You asked for advice on whether you should take this up the chain. It really just seems like you only want people to validate your opinion. I see why you think you’re right, but I’m telling you the way the vast majority of your superiors will see this situation, along with how the captain will likely explain it, if anything came of your complaint (which probably wouldn’t happen, because nobody got hurt and FDs are notorious for avoiding issues until they’re immediately apparent).
Frankly, you’re dodging the point about communication on the way to the run. It’s unreasonable to expect an officer unfamiliar with you to make a tactical decision on the way to a run based solely on your input (input that’s possibly in contest with the info he has received from dispatch, and input they may have sounded somewhat dismissive of his rank m). You may not like it, but on the way to the run, he’s the one with the radio. That’s the way I see it at least, but I get how others might disagree.
Your only viable courses of action here are to talk to the captain about the misunderstanding, or just get over it. You have stated in other comments you have no interest in the former, so I would suggest the latter.
0
u/Ok_Assistance69 Jun 21 '25
Whatever you say. You must be “one of those” captains yourself with zero regard for your crew members. Nice talking to you though.
1
u/Zestyclose_Crew_1530 Jun 21 '25
I am a private, not a captain. Good luck with this battle. It will probably get you nowhere and earn you a reputation for insubordination you do not want among people whose opinions actually have weight.
Discussing it with him is the right thing to do, but if that is undesirable, try to let it go. It’s the only other way this whole thing won’t likely blow up in your face.
0
u/10pcWings Jun 22 '25
Crazy that OP ASKS for opinions at the end of his post and then responds like this when given an opinion that doesn't align with his own.
OP definitely does not want "opinions", anyone that truly wanted one would be much more open minded.
You're bringing up great points that should be at the minimum reflected on.
1
u/jplff1 Jun 21 '25
If you know she has a history why isn't PD on scene first.
2
u/green__1 Primary Care Paramedic Jun 21 '25
these sorts of patients don't always self identify to dispatch, and they don't always call from the same location.
1
1
1
u/davethegreatone Jun 22 '25
It's your scene and I'd back you on that.
But I think now that it's Monday Morning Quarterback time, it's good to examine the captain's motivations here. Was he trying to protect the patient from known agressive law enforcement (my local PD are great, but we all know "that one department" that has cops who always escalate everything).
Is there a chance you personally have poor de-escalation skills, and another provider could have talked this patient into a calm and normal ride? (Not accusing - just asking. We all know some psyche patients simply can't be talked down because their illness makes them incapable of that).
Tactically, your captain made the wrong call in overruling you. You as the medic made a medical decision based on your knowledge of the patient's pathology, and the captain can't blow in and change your medical calls unless he's taking over the care - and doing THAT is super dicey anyway.
Strategically ... I'm just saying that since I don't know you OR your captain, there's a chance he made the right strategic call, and this should be evaluated just in case.
2
u/Ok_Assistance69 Jun 22 '25
No. I’ve got great de-escalation skills. The captain in question is an aggressive captain with a superiority complex. It’s well known around admin as well, but they just cover for him. It had zero to do with the patient, and the fact I called the shots and not him.
1
u/Stretch5 Jun 23 '25
If you’re the lead medic on the call.. that’s 100% your decision! I don’t work for a fire service and understand you have chain of command and so do I. Whenever my LT comes to assist on the call, that’s exactly what they do, assist unless they absolutely have to take over for the safety of the patient or your crew. I get it if you’re Cpt. is trying to look at the bigger picture and limit extra resources but based on what you said it seemed like he quickly jumped to PD once the patient got mouthy? But other than that you hit the head on the nail, take it to the higher ups. I would talk to him first though and see if he agrees and learns from that experience with you. You were looking after your safety and your crews safety. No room for ego when you’re a first responder.
1
u/Krampus_Valet Jun 23 '25
Very early on as a new medic I allowed an ems captain to talk me out of doing a surgical airway on a patient who definitely needed it. He was probably gonna die anyway, but he definitely died faster. Don't let other people run your scenes, and make it well known that you can go from polite to monstrous douchecanoe at the drop of a hat if some dickbag tries to insert their opinion where it doesn't belong.
1
u/forty-seventhattempt Jun 24 '25
Man, I'm spoiled. where I work, psych calls are PD issue and not an EMS issue. Also, I'm FD based, EMS only, and while our fire officers may be the one talking to dispatch, my partner and I are in charge of what happens on a medical scene.
-14
u/Sudden_Impact7490 RN CFRN CCRN FP-C Jun 21 '25
Speaking as someone who deals with psychs on a near daily basis. Law enforcement presence alone can escalate these situations from tense to hostile.
In the hospital anytime someone calls police or security it immediately goes downhill when they show up. If someone calls for them I will intercept and have them wait out of sight.
If you want them nearby - I get it, but keep in mind the effects they have on the situation when dealing with a psych or mental health issue.
6
u/laeelm Jun 21 '25
This isn’t a hypothetical pt. This specific pt is known to be ‘hostile’ and ‘aggressive’. The question is about this specific pt. He was correct to get LE involved. In the hospital, you are not going down the road in a small metal box with a violent person by yourself. The hospital is a much more controlled environment than a moving vehicle. It’s easy to get away from a psych pt in the hospital. You just walk out of the room and wait for security. You can’t do that in an ambulance.
I think I would have to take this up the chain. At least to understand how to deal with this situation in the future. Because if a medic wants to call for pd but a supervisor says they’re not needed, is the supervisor now going to tech the call or am I going to have to be scared in the back of the truck by myself? Because I won’t do that. A good supervisor won’t tell you to do anything that they wouldn’t do.
0
u/Sudden_Impact7490 RN CFRN CCRN FP-C Jun 21 '25
The hypothetical is going from verbally aggressive already on a cot to an active shooter.
Im aware of the differences between hospital and an ambulance having done both. The problem here is the armchair quarter backing.
As stated it's OPs call and I'm not going to fault him for making it. I'm just giving an alternative perspective having handled 17+ years of them
4
u/Ok_Assistance69 Jun 21 '25
While I understand that logic completely, as a medic we are taught at the Basic level “BSI/scene safety” even if we have the slightest inclination a scene may potentially be an unsafe environment, we have the right to PD presence, or to not go into the scene at all and stage until PD arrives and deems the scene safe for medics. Unfortunately if it escalated the issue, that just means PD should have been there in the first place. At the end of the day, I have a family to go home to and I take ZERO chances.
-11
u/Sudden_Impact7490 RN CFRN CCRN FP-C Jun 21 '25
Sure, but police also aren't trained in mental health. Which is why some places have stopped having them be the initial responder (they tend to shoot/kill these patients demographics)
It's your call. I'm just saying sometimes their presence will escalate violence, not deescalate or prevent it.
On a verbally aggressive person already on a stretcher with plenty of fire/EMS on scene I'm personally not calling. It really depends on the scene, the resources and the overall risk assessment. You have the ability to do far more, safer, for this person than PD can (Ketamine, versed, etc)
Overall, being situationally aware is important but its still a job where you face more risk for injury driving to and from calls than you do interacting with patients.
8
u/splinter4244 Jun 21 '25
We’re not trained for mental health either, not extensively at least. OP cited a legitimate concern due to a recent KC medic that got stabbed and killed. These people are unpredictable wether law enforcement is present or not. I’m absolutely not going to risk my life even if there’s fire/ems on scene and I’m sure as shit requesting PD to at least check for weapons.
2
2
u/Hosedragger5 Jun 21 '25
If the choice is between a violent patient getting shot or me going home at the end of my shift, I know what option I’m choosing. I’m not going to be some hero and risk my life for an unstable person.
2
u/Sudden_Impact7490 RN CFRN CCRN FP-C Jun 21 '25
We're escalating the call type pretty quickly
3
u/Hosedragger5 Jun 21 '25
Yea, well taking it easy didn’t work out for the firefighter in KC.
1
u/Sudden_Impact7490 RN CFRN CCRN FP-C Jun 21 '25 edited Jun 21 '25
How would police have changed the outcome of that call? They wouldn't.. they were on scene and it still happened.
Not every mental health call is a pink slip, so police aren't going to search every patient just because - especially in the days when everyone is hyper aware of unlawful search and seizures.
You can ask, but they can lie. How many CCW owners do you think get transported with nobody ever knowing? More than you'd think.
So absolutely maintain situational awareness and be vigilant, but no matter what sometimes flukes will happen. We have to acknowledge that is extremely far from the norm when viewing it from a macro personality.
Again, if you want to call I'm not saying you shouldn't. I would never judge someone for wanting PD on scene. There are times it's more than appropriate, but there are also times it will make everything much worse and I think this is where the Captain in this scenario was coming from.
1
54
u/Valuable-Wafer-881 Jun 21 '25
Imagine if a nurse wanted security for a psych pt and their"captain" nurse told them no 🙄
This paramilitary stuff holds ems back as a profession so badly