Transferring Care

[DeadCactus]

As a physician, if you intervene in an out of hospital emergency are you obligated to accompany the patient to the hospital? I seem to recall hearing about being obligated to transfer care to a professional of equal or higher training (ie medics can't transfer the patient to a tech, paramedics can't transfer to an EMT-B).

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[Arcan57]

As a physician, if you intervene in an out of hospital emergency are you obligated to accompany the patient to the hospital? I seem to recall hearing about being obligated to transfer care to a professional of equal or higher training (ie medics can't transfer the patient to a tech, paramedics can't transfer to an EMT-B).

I think most of it is going to depend on whether you want to assume medical command on the scene. If you show up and help someone as a Good Samaritan until EMS arrives, then you're fine letting them take over. If you want to override their protocols or participate in patient care once they arrive, that means taking a trip with them to the ED. This lead to much hilarity when one of our 2nd yr residents helped out at a accident that happened just in front of him and rode with the patient to the ED. Of course he had been at a costume party, and was dressed as Tom Cruise from a certain scene in Risky Business.

Also, if you're going to try and assume medical care make sure that 1) you have proof of licensure in the state and 2) you are not in a position where your sobriety would be in question. For most things, even ED docs are more likely to F%^ things up than be helpful.

 

[DeadCactus]

Got ya. That makes sense. Thank you.

 

[Apollyon]

A seemingly random distribution of states where I've either been EMS or MD (NY, SC, HI) all had laws on the books about an on-scene physician. That makes me think a majority of states, if not all, have it codified.

As for the specifics, Arcan is on point.

 

[Arcan57]

A seemingly random distribution of states where I've either been EMS or MD (NY, SC, HI) all had laws on the books about an on-scene physician. That makes me think a majority of states, if not all, have it codified.

As for the specifics, Arcan is on point.

An interesting sidenote: if you cause the accident that makes the Good Samaritan protection vanish (at least in TX).

 

[EM_Rebuilder]

Something I have wondered..

What if you are an EMS online medical direction physician.. or what if you are their actual medical director/offline medical director?

I was with a bunch of residents at a bar, and was essentially the only than that had zero to drink. We saw a guy get punched and go down for the count.. EMS was called and showed up. For a moment there, I thought the guy might need intubated. I helped EMS load him up and got fluids hooked up and such. EMS knew me well as we provided med control for them (all residents provided med control). I really did not end up alterning any protocols, but if he had needed intubated, I believe I would have done it. I did not go along with him.

Also, I am soon going to be a local associate EMS director and plan on doing some scene stuff... not really a tacticle physician... moreso I will go on scene for a 'major event' (probably once or twice a year.. we are talking huge fire, big standoff... major events only, and only if I happen to be avalible). I have wondered, if I provide care to patients, and maybe even slightly outside of protocol, can I direct and send them on with my medics without going along? This is something I have wondered about and not sure the right anwser....

 

[canjosh]

Something I have wondered..

What if you are an EMS online medical direction physician.. or what if you are their actual medical director/offline medical director?

I was with a bunch of residents at a bar, and was essentially the only than that had zero to drink. We saw a guy get punched and go down for the count.. EMS was called and showed up. For a moment there, I thought the guy might need intubated. I helped EMS load him up and got fluids hooked up and such. EMS knew me well as we provided med control for them (all residents provided med control). I really did not end up alterning any protocols, but if he had needed intubated, I believe I would have done it. I did not go along with him.

Also, I am soon going to be a local associate EMS director and plan on doing some scene stuff... not really a tacticle physician... moreso I will go on scene for a 'major event' (probably once or twice a year.. we are talking huge fire, big standoff... major events only, and only if I happen to be avalible). I have wondered, if I provide care to patients, and maybe even slightly outside of protocol, can I direct and send them on with my medics without going along? This is something I have wondered about and not sure the right anwser....

Former paramedic, current medical student here. The bolded sentence seems to describe online medical control. You're giving verbal orders to medics for whom you already provide medical control.

People often forget that EMS functions under the license of their medical director, so this business about transferring care to a lesser trained individual doesn't really apply. The problem comes when you as the physician decide that you want to direct/provide medical care for a patient when the medics are being 'controlled' by another physician. If you decide to do that, the medics are functioning under your license until you relinquish care.

Obviously, a lot of this stuff involves gray areas and legal stuff for which there may or may not be clear precedence. I think this is why the general advice is to not get too involved, especially considering that in the vast majority of incidents, your actions are not likely to change the outcome.