POLICY STATEMENT:

An on-scene physician or nurse does not automatically supersede EMT or Pre-hospital RN authority. Once a System-patient relationship is established, that encounter, written System protocol, and standing orders provide the legal basis for an EMT and/or Pre-hospital RN to function. This authority is considered the delegated practice of the EMS Medical Directors. Patient care cannot be relinquished to another person unless identification and credentials of that individual can be verified and the EMS MD or his/her designee, the on-line Medical Control Physician, agrees with the request.

GOAL/PURPOSE:

To clarify the EMT and/or Pre-hospital RN responsibility to a patient when a physician or nurse appears on the scene and expresses the desire to direct patient care.

POLICY/PROCEDURE:

A. If a Professional Registered Nurse wishes to participate in patient care at a pre-hospital scene, the RN may do so ONLY in a first aid capacity. The RN must have licensure from the Illinois Department of Public Health as a Pre-hospital RN to function as an advanced life support provider. Refer to Policy and Procedure, "Assistance by Non-System Personnel" page 26 of the System Manual for Further information.

B. If a professed, duly licensed medical professional (physician/dentist/DO - hereinafter collectively referred to as physician) wishes to participate in and/or direct patient care on-scene, the EMT/Pre-hospital RN should communicate with Medical Control and inform the on-duty physician/ECRN of the situation.

C. If the on-scene physician (including the patient's private physician) has properly identified himself/herself and wishes to direct total patient care, approval must be given by the on-line Medical Control physician. The on-scene physician must sign the ambulance report form and personally accompany the patient to the hospital, assuming total patient responsibility.

D. Given the preceding circumstances, if a physician gives orders, while on-scene or en route, for procedures or treatments that the EMT/Pre-hospital RN feels unreasonable, medically inaccurate, and/or not within the EMT/Pre-hospital RN skill capabilities, refuse to follow such orders and transfer responsibility for the patient's care back to the base station Medical Control Physician. The EMT/Pre-hospital RN in all circumstances, should avoid any order or procedures emanating form an on-scene physician that would be harmful to the patient.

E. If an on-scene physician has identified himself/herself, is not the patient's private physician, and obstructs efforts of the EMT/Pre-hospital RN to aid a patient for whom they are called, or who insists on rendering patient care inappropriate to System standards for the circumstance and resists all of your efforts to function appropriately to the point where continued intervention will result in obstruction to rendering good and reasonable patient care, the EMT/Pre-hospital RN should:

F. Upon request by any physician to give orders or directions at the scene of an accident or illness, the EMS crew will:

G. If the physician at the scene insists on assuming Medical Control, the EMS crew will:

H. Should, at any time, the physician at the scene gives absolutely contraindicated or inappropriate directions or orders which could adversely effect patient care, or refuse to accompany the EMS crew to the hospital if required by the base station physician, the crew members will:

I. If the on-scene physician is given Medical Control by base station and has produced a valid State of Illinois physician and surgeons license: