A question posted recently on Quora asked “Who has greater authority on the scene of a medical emergency, EMTs or MDs?” EMT-P Anderson Moorer gave his opinion on the topic. Read his response, and add your own to the comments.
The senior EMT on scene has the responsibility for decision making regarding patient care and has the authority to choose to disregard medical orders from physicians excepting those in their chain of command.
All EMTs are operating under the direction of a physician in every aspect of medical care at all times, either “on-line” via radio and telemetry with physicians in their chain of command or “off line” via pre-established standing orders signed by a medical director.
That EMT may and often will make the decision to accept medical direction from a physician on scene, and must also recognize that a conscious and alert patient may choose to accept care from a physician and/or refuse care from EMS. When a physician on scene wishes to direct medical care, the usual protocol is to contact and gain approval of the current on-line MD or follow existing directions on how to respond which vary depending on the agency.
When an EMT does cede medical control to an on-scene physician they are still bound by their usual scope of practice (they cannot follow orders for treatment which exceed their abilities or training) and they are bound to re-assume control when the on-site physician either leaves or deviates from an appropriate standard of care.
The physician cannot give orders and walk away, or give instructions for care during transport without riding along. They must also provide documentation of care, their credentials, etc.
The EMT has both police on scene and physicians in the ER available to back any decisions in this regard.
In a practical sense, usually the only physicians who will want to get involved are capable critical care providers already known to EMS and able to integrate smoothly with a simple call to the hospital.
On very rare occasions EMS encounters someone who identifies themselves as a physician who is suspect. They may be lying or in a grey area like a medical student, or what have you. Usually, it quickly becomes obvious that they are not capable of a professional level of intervention and if a typical brush off doesn’t work EMS calls in seeking an order to maintain control while catching the eye of the nearest police officer. It happens, but only rarely.
Most paramedics and EMT supervisors are quickly able to establish who should be in control of patient care in an emergency; and they do not cede control unless absolutely certain it is both legal and in the best interest of the patient.
