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Physician on scene

Patient Care Policy: Physician on scene

The issue of non-EMS system physicians on scene or in clinics and offices is a complex one. Conflicts with physicians (and other health care providers) at scenes come in many varieties. Many physicians are not well informed of the law or regulations regarding the State EMS system and often of the abilities and skills of EMT's of all levels. Do Not get into an argument with a physician at a scene. Keep in mind that your job is to care for the patient. If the situation allows, provide the physician with information regarding "Physicians On Scene".

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PROCEDURE

Physician caring for their patient, who subsequently calls for EMS transport.

If the physician wishes to stay with the patient during transport they may do so. However, advise the physician on Notification of Responsibility, and make sure they are clear on guidelines that apply:

• The EMT may assist in patient care only if your participation is within your Scope of Practice, and based on Joint EMS Protocols.
• If any conflict over the patient's care arises it will be addressed through on-line medical control.
• The highest level EMT/Paramedic will always ride in the back with the physician, and be in position to provide patient care and monitoring.
• Document the attending physician and their understanding of Patient Responsibility on the PCR and complete On-Scene Physician Form.

If the physician releases the patient to you and chooses not to accompany them during transport, the following guidelines apply: (doctors office or clinic)

In essence the physician has transferred the physician-patient relationship to the EMS Physician Medical Director temporarily. You act as the physician delegate in this regard, as you do in all patient care.
If the physician has specific orders to be carried out during transport as a matter of professional courtesy.

They should be followed if:

• The orders are consistent with your Scope of Practice.
• They seem reasonable and medically prudent for the patient.
• There is no change in the patient's condition that would warrant a deviation from the orders.

If you have any concerns, expedite transport and contact on-line medical control for guidance.

Scenario: An unknown physician or similar health care provider appears at a scene and offers their help.

• You have no authority or responsibility to allow another health care provider to participate in patient care.
• They should be courteously thanked and denied access to the patient.
• Do not hesitate to ask law enforcement assistance to remove such an individual from the scene if they become aggressive or insistent on assuming care of the patient.

Scenario: A known physician or similar health care provider appears at a scene and offers their help the following guidelines apply:

• You have no authority or responsibility to allow another health care provider to participate in patient care. However, if this provider is a physician, is known to you, and in the unusual situation could provide a service not otherwise available (i.e., an anesthesiologist appears when you are unable to intubate), you may allow them to participate in the patient's care.

• Provide them with the formal On-Scene Physician Policy.
• The physician must accompany the patient to the hospital.
• If the physician does not agree to accompany the patient to the hospital, they should be courteously thanked and denied access to the patient.

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SPECIAL CONSIDERATIONS/NOTES/PRECAUTIONS:

Contact medical control by phone or radio, if need be, and have the physician discuss his/her concerns with the physician in the emergency department.

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