If you were at your kids football game and there was a major trauma (say one of the kids suffers a major head injury).
You run out to attend the injured (because everyone there expects you to and/or you have a legal obligation). The paramedics are on the scene 3 minutes later.
Who is actually in charge? The off-duty EM physician or the paramedics?
The paramedics are in charge where I practice. I'm the medical director for a very large fire department and another county-based EMS agency. We have "medical professional intervener onscene" protocols that covers PA/NP and MD/DO.
Here is an excerpt from our protocol:
1. EMS should advise the healthcare provider on-scene that a patient-physician relationship has been established with the patient through offline medical direction by the EMS medical director and his physician advisors. EMS should notify the healthcare provider on-scene that they are operating under standard clinical operating guidelines that were developed and are closely supervised by the medical director and his designated physician advisors. Every effort should be made to work
with the healthcare provider on-scene in a collegial environment so long as the care provided by the healthcare provider is not an invasive procedure, administration of medication, reduction of fractures/dislocations, or other medical care that is outside the normal care provided by a medical first responder (i.e., basic life support level care).
2. If the healthcare provider on-scene is a mid-level provider (physician assistant, nurse practitioner, etc.), then EMS may NOT release care to that provider under no circumstances. Doctors of chiropractor (DC), doctors of ophthalmology (OD), doctors of medical dentistry (DMD), doctors of dental surgery (DDS), doctors of naturopathic medicine (ND), or other healthcare providers who are not duly licensed doctors of medicine (MD) or doctors of osteopathy (DO) specifically by the Georgia Composite Board of Medical Examiners do not have the authority to take command of patient care on-scene in the pre-hospital environment.
3. EMS personnel may release patient care responsibility to an on-scene physician only after:
A. The physician has been identified as a Georgia licensed physician and has offered an active non-expired physician license by the Georgia Composite Medical Board along with a valid government-issued photo identification; AND,
B. Obtaining from the physician a commitment to
accompany the patient to the hospital in the vehicle transporting the patient; AND,
C. Having the physician speak directly to the medical director, his designated physician advisors, or the physician responsible for online medical direction (the online medical control physician in the receiving emergency department) and receiving authority to release the patient to physician care to operate outside standard operating protocols/clinical guidelines.
D. In the absence of any of the above factors, the patient may not be released and care will continue as if no physician were on the scene. Law enforcement officers should be contacted in any conflict situation. If the healthcare provider on-scene is desiring to operate outside clinical guidelines, and in the best judgement of the highest trained EMS professional on-scene appears to be not following standard of care, or if the EMS provider on-scene is not comfortable with the care suggested by the healthcare provider on-scene, then law enforcement should be notified immediately and the healthcare provider on-scene should be advised they will be arrested if they do not discontinue their behavior.
E. In the situation where a patient encounter occurs at a private physician’s office who is already under the care of a private physician, reassure him/her that paramedics operate under protocols and standing orders, and the paramedic in charge will be in contact with the emergency department for treatment orders and consultation if outside standard operating guidelines. Only after A through C have been met shall the primary care physician provide treatment, including medication orders, that are outside protocol. This does not exclude the ability of the physician or his/her designated healthcare providers (nurse, medical office assistant, etc.) to have the ability to personally administer medications to the patient from medications supplied by the physician's practice.
3. On-scene medical oversight may be provided by the EMS medical director and/or an EMS physician advisors without securing permission from the direct medical control physician in the emergency department. These individuals are identified by the service director of operations and medical director in advance.
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