Overruling captain!

[u/Ok_Assistance69]

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???

[u/rycklikesburritos]

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.

[u/epicfartcloud → u/rycklikesburritos]

>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.

[u/Mediocre_Daikon6935 → u/epicfartcloud]

Then they can ride the call and write the chart.

Their administrative title does supersede his license. 

[u/davethegreatone → u/epicfartcloud]

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).

[u/rycklikesburritos → u/epicfartcloud]

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.

[u/Upstairs-Scholar-275 → u/epicfartcloud]

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.

[u/epicfartcloud → u/Upstairs-Scholar-275]

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.

[u/Upstairs-Scholar-275 → u/epicfartcloud]

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.

[u/forty-seventhattempt → u/epicfartcloud]

That's how it works in the fire-based system I work in. Unless it's our EMS chief that's there, of course.