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BLS Fire Officer or Paramedic – Who Makes Scene Decisions?

The answer to this is quite simple, really, so long as you are on the 99 of 100 EMS runs being tended to by a BLS Engine (That’s for stopping the clock and bringing an AED to an asthma call) and an ALS ambulance.  In those unrare and remarkably common cases the Paramedic, the highest license there, is responsible for assessment, treatment, reassessment and the decision to transport or seek alternate methods of conclusion.


All too often, as you and I know, the BLS Fire Officer likes to get involved and use their rank at the scene to try to force a conclusion.  This is usually in the case of a patient who the BLS team thinks needs a hospital (They are most notably horrible at this determination) yet the ALS team seems to be leaning towards a referral or refusal.

In the BLS team’s defense, the ALS team is not very good at determining patients who will be ADMITTED to hospital, but as the responsibility of care falls onto the shoulders of the Paramedic at the scene, it should be no surprise when said Paramedic chooses to defend the patient from the BLS Fire Officer.

This is when voices get raised and patient care suffers.


I was asked by an EMT in my system if any patient care scenarios or MCI questions were on the Fire Officer exam in our Department.  After I wiped the tears from my eyes and stopped laughing hysterically, I had to wonder:

If 80% of what they do isn’t even considered a skill to be tested for promotion, where do our priorities lie?

Perhaps that is part of the reason for the rift?  We train our officers to be managers of engine companies, then forget to train them up on EMS runs, I guess assuming that their experience watching Paramedics make decisions will serve well enough.

Well, friends, we all know that sure isn’t happening.

So what’s the solution?  We can’t shout “Third Service” in the living room of Mrs Fishbuscuit when the BLS team is telling her to goto the ER “to get checked out, it could be a stroke” because a scary dream woke her up.

We need to bring these events to the attention of the administration.  Not as a “write up” or “complaint” but as a concern.  If the BLS team makes a mistake and I try to tell the state “But the Fire Officer out ranks me, HE made the decision!” they’ll take my license just as quickly.


Ask the training folks what training officers receive regarding EMS or MCI response.  Ask that they offer a course and, if they hesitate, offer to teach it.  Be part of the solution or get used to dealing with the problem.

And the best way to handle a BLS team not co-operating?  Cancel them on the radio.  While they’re in the room.

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