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The Question
by EMS1 Community
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Do EMTs or MDs have greater authority on a medical emergency scene?
Read the response and add your own thoughts in the comments
A question posted recently on Quora asked
"Who has greater authority on the scene of a medical emergency, EMTs or
MDs?" EMT-P Anderson Moorer gave his opinion on the topic. Read his
response, and add your own to the comments.
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The senior EMT on scene has the
responsibility for decision making regarding patient care and has the
authority to choose to disregard medical orders from physicians
excepting those in their chain of command.
All EMTs are operating under the direction of a physician in every
aspect of medical care at all times, either "on-line" via radio and
telemetry with physicians in their chain of command or "off line" via
pre-established standing orders signed by a medical director.
That EMT may and often will make the decision to accept medical
direction from a physician on scene, and must also recognize that a
conscious and alert patient may choose to accept care from a physician
and/or refuse care from EMS. When a physician on scene wishes to direct
medical care, the usual protocol is to contact and gain approval of the
current on-line MD or follow existing directions on how to respond which
vary depending on the agency.
When an EMT does cede medical control to an on-scene physician they are
still bound by their usual scope of practice (they cannot follow orders
for treatment which exceed their abilities or training) and they are
bound to re-assume control when the on-site physician either leaves or
deviates from an appropriate standard of care.
The physician cannot give orders and walk away, or give instructions for
care during transport without riding along. They must also provide
documentation of care, their credentials, etc.
The EMT has both police on scene and physicians in the ER available to back any decisions in this regard.
In a practical sense, usually the only physicians who will want to get
involved are capable critical care providers already known to EMS and
able to integrate smoothly with a simple call to the hospital.
On very rare occasions EMS encounters someone who identifies themselves
as a physician who is suspect. They may be lying or in a grey area like a
medical student, or what have you. Usually, it quickly becomes obvious
that they are not capable of a professional level of intervention and if
a typical brush off doesn’t work EMS calls in seeking an order to
maintain control while catching the eye of the nearest police officer.
It happens, but only rarely.
Most paramedics and EMT supervisors are quickly able to establish who
should be in control of patient care in an emergency; and they do not
cede control unless absolutely certain it is both legal and in the best
interest of the patient.
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