My Call! I'm In Charge!

One night, long long ago, I was attending when my bus was assigned to an auto-ped. We were a little bit away from it, so it took us five or seven minutes to get there. On the way, about halfway through our response, dispatch advised that an ambulance from a private EMS service was on the scene. Let’s call the private company “XYZ” for the sake of storytelling.

Good, I thought. I won’t have to work. Let them handle it and I can go back to eating.

My partner and I got on scene and strolled over to see how things were going for the private crew. Three important things need to be mentioned here. First, I am fully down with someone else doing a good job on a call. Knock your bad selves out. I don’t need to steal good calls. Second, I like to help if I can help. Sometimes you need an additional pair of hands.  Finally, it is my city. My agency is responsible for EMS in the jurisdiction. I have a responsibility to make sure care is being performed reasonably well, at a standard consistent with the expectations we have in the city. So I walked up and asked how things were going.

“This is my call! I’m in charge!” The XYZ medic wanted to make sure I knew who was in the leadership position.

“Great. Need a hand?” I offered.

“I’m running this call!” He shouted. He would have done better to give me a task.

One great piece of advice I received in paramedic school was that if you feel the need to announce that you’re in charge, you’re not. Someone in charge should be directing the scene, making decisions, delegating tasks, and otherwise generally being in charge without feeling an overwhelming need to loudly declare the fact.

I looked around and absorbed the scene. The patient was an adult male with a visible open tib-fib fracture on the right leg. He looked to be awake, but upset and hurting. Dude looked a little pale to me, but that may have been due to a pain response resulting from his leg. He was fully clothed, except for his right pant leg being cut from the cuff to knee level.  He wore a cervical collar. There was an XYZ EMT at the patient’s feet, putting a SAM splint on the busted leg. A backboard was on the ground next to the patient. (What with the backboard and C-collar, you can tell this was a long time ago…)

Considering the patient’s pallor and the fact he was hit by a car, I wondered about his vital signs. I was hoping he wasn’t hypotensive. I asked about the blood pressure and was informed they hadn’t checked it yet. Okay, maybe they were prioritizing packaging and scene departure. I asked about the patient’s heart rate. They told me they hadn’t checked that yet, either. I asked about verbalized complaints. Hadn’t asked. I inquired about the rest of the secondary exam. Nope. They hadn’t gotten around to it yet.

I silently wondered what they had accomplished and lifted the patient’s shirt. There I found a tire track across dude’s belly.

The XYZ crew was splinting the leg and hadn’t found the tire track yet.

At that point, I announced that I was taking the call over and getting the hell out of there. I asked my partner to pull our wheels and “set me up.” He would know that I was looking for two blood pumps to be hung and for a couple of 14s to be tossed onto the bench seat. I directed the firefighters to logroll the patient onto the backboard, and then onto the bed. I told the police we would be leaving the scene in two minutes and they should go to the trauma center for a victim statement. Everyone looked relieved that decisions were being made.

Everyone but the XYZ medic, that is. He plum lost his mind. He literally jumped up and down. Spit flew when he screamed about it being his call. His hands were balled into fists and he was quivering with rage. I asked him to step back. He loudly declined by issuing a string of profanities, so I asked a nearby police officer to help him step back. The police officer smiled and took the apoplectic medic by the arm and led him over to the sidewalk, away from the scene, yelling the whole time about the arrogance of the city medics. The XYZ EMT helped roll the patient onto the backboard and then stepped back, too.

Transporting to the hospital, the call was fairly straightforward. The patient was maintaining his own airway, tachy but normotensive, and complaining of pain in his abdomen, pelvis, and lower leg. I got him naked, finished the physical exam, popped a couple of IVs into him, and set up the hospital.* We arrived and I gave the big room report.

The ED attending doctor was one that I throughly respected (and kinda feared, if I am being honest). He was a phenomenal doctor who was very perceptive and had high expectations for the performance of everyone around him. He was definitely not afraid to call out a bad job, even a little bit. It made him intimidating to me, especially as a new medic. “Who put that splint on?” he asked me irritably, glaring at me and pointing to the SAM splint on the patient’s ankle.

“XYZ” I gave him the private ambulance company’s name. I didn't put the splint on, but I still felt guilty. That was the affect this attending had on me.

“XYZ?” he confirmed with one eyebrow raised.

“XYZ,” I repeated with my hands palm-forward in front of my chest. “I wouldn’t have wasted time with it.” At best, I would have splinted the leg using the other leg, the backboard, towels, and some tape. But only after everything else was done. It is certainly possible to die from abdominal tire tracks, but not as often from broken lower legs.

“Look at this,” he directed with a disgusted tone in his voice. He showed me the patient’s lower leg. The splint ended about four inches below the fracture. It wasn’t even high enough to immobilize the break, let alone the joints above and below.

I have never been so glad to not be the one to put on a splint.

*This was back when we were stingier with pain meds. I would give him some opiate analgesia nowadays.