Interacting with EMS Personnel

 There are a number of ways in which a physician may assist in the care of an
acutely ill or injured patient without assuming the care of the patient.
Common to all of these is the fact that medical direction of the case is left
to the physician already in charge of the patient - the EMS medical director.
The bystander physician leaves treatment decisions to the established
protocols and on-line direction of the EMS personnel. Assisting in this way
may be accomplished by:

 1) Evaluating the situation, determining there is no major illness or
injury, and going on. No specific interaction with the patient or the EMS
personnel is necessary. (Example: patient with a twisted ankle on the
sidewalk.)

 2) Stopping to observe the situation, standing by to assist. The physician
may feel that additional help or expertise may be needed in the situation.
(Example: an obese asthmatic patient in severe respiratory distress - may
present a difficult intubation situation.) Informing the EMS providers of
your identity and willingness to help if needed is the best course of action
in these situations.

 3) Assisting EMS providers. After identifying yourself as a physician and
offering to assist, the EMS providers may ask for help with assessment or
care of patients. (Example: an automobile accident with multiple injured
patients, limited EMS personnel.)

 In this situation it is often helpful to relay to the EMS personnel that you
are willing and able to assist them with patients, but intend to allow them
to practice within their usual protocols. Too often (i.e. notoriously) in the
prehospital setting, physicians assume that EMS providers are required to
carry out their orders, much as nurses in the hospital. This is not the case.
The  EMS providers operate under the orders of their physician medical
director.

 In a few cases, the bystander physician may feel that a patient needs
interventions that only a physician can provide, or that the care required is
outside the usual protocols of the EMS providers. In these cases the
bystander physician must assume (medicolegally) care of the patient. The EMS
personnel will need to see reasonable proof of the physician's identity, and
may (depending on their protocols) need to contact their on-line physician by
radio to authorize transfer of patient care responsibility. Only with their
physician's permission will the EMS providers be able to follow the direction
of another physician physically present at the scene. The bystander physician
will need to document his or her orders on the EMS providers' chart. In these
rare situations, the bystander physician will be expected to accompany the
patient to the hospital to transfer care to another (physically present)
physician.

--Bill Bozeman, M.D.