On-Scene Interagency Conflict


MARK BOCK, BA, NREMT-P | | Tuesday, June 26, 2007

Ways to keep agency differences from affecting patient careand your public image

Scenario: You're a paramedic working an overtime shift on a Sunday. Your ambulance is assigned to cover an unincorporated area of your county, also served by a county fire department paramedic assessment engine. Mid-morning, you and your partner respond to a "vehicle accident with minor injuries" on the far north side of your coverage area. You're told that police on scene are requesting a Code 2 (non-emergent) response.

As you roll up, you see that the engine has already arrived, with personnel conducting what appears to be an interview of a solo male patient. Next to the patient is a steel mailbox station, which has been uprooted from the concrete base it was bolted into. In front of the mailbox is a pickup truck with moderate damage to the right front bumper. No skid marks are visible.

Your partner parks the ambulance next to the engine, and you make your way toward the patient. The medic from the engine appears relaxed as he allows the patient, who is unsteady on his feet, to ambulate freely. Although there are no obvious signs of trauma, you're immediately alert to the patient's ashen complexion and the glassy look in his eyes. You approach the fire medic and ask what happened. He says the patient apparently lost consciousness while driving and struck the mailbox. Witnesses report that the patient remained unconscious for several seconds following the accident.

You then direct your attention to the patient. A few quick questions reveal that the patient, who is lethargic and slow to respond, is, in fact, altered to date and event. You immediately direct the fire crew to hold manual immobilization of the patient's head and cervical spine. When they fail to do so, you perform the task yourself while asking your partner to retrieve a cervical collar from your ambulance, along with a long backboard and head immobilization device.

At this point, the engineer from the engine approaches the scene, tells you to release manual immobilization and orders you, in no uncertain terms, to step aside to allow his paramedic to run the call, because they were on scene first.

You reply that any patient transported in your ambulance will be cared for according to county protocols, which, with or without obvious trauma, require spinal immobilization of any patient with an altered mental status when that patient has been subjected to any mechanism capable of producing spinal injury.

In response, the engineer gets aggressive, repeating his order that you step aside. You are faced with a dilemma: compromise patient care (and possibly jeopardize your license) or stand your ground and exacerbate a rapidly deteriorating situation.

Your partner, who is testing for a job with this same fire agency, remains silent and gives you a blank stare. The engineer becomes increasingly belligerent, his tone now loud and threatening.

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