Several months ago I responded as a paramedic intercept to a rollover accident with entrapment requiring extrication. The responding EMS agency was AEMT level, and I was dispatched automatically based on the rollover element of the call.
I arrived on scene relatively quickly, and found the fire department and EMS working quickly to extricate the patient. Standing at the head of the vehicle was an emergency room physician who I knew well, and who was the medical director of the EMS agency doing the extrication (but not MY medical director).
Who was in charge? Well, he is a qualified MD, and by state law he has the right to take over the call and relieve me of command. But, until he does so, it is my license, my liability coverage (and my department's), and my responsibility that is on the line. So I proceeded as I would if he were not there. The incident commander notified me that air medical was 18 minutes away. The nearest hospital--a Level III Trauma Center--was a 12 minute drive. The patient needed Level I, so air transport it was, as far as I was concerned.
I continued to monitor the extrication and assisted by verifying the patient's legs were not entrapped as he was removed. As we walked to the ambulance, the incident commander notified me that the doctor changed to location of the landing zone to the hospital, instead of the scene, something that normally would have been MY decision to make.
As they loaded the patient, I asked the doctor why he did that. He told me he considered the hospital landing pad a more secure landing zone. Well, this plain and simple isn't true. On scene, the fire department places four landing zone guards around the LZ. Traffic is cut off by deputies, and the weather was as perfect as it gets. At the hospital, they post one security guard, usually sitting in his pickup truck, to watch traffic but there is no control over the pad.
In addition to that, he just volunteered me to spend the twelve minutes I had with the patient bouncing down the road, holding on for dear life, as the agitated and panicky driver of the ambulance drove too quickly, turned too quickly, accelerated too quickly, and braked too quickly. Thousands of times I have called forward to one driver or another with my catch phrase, "Smooth is better than fast," but drivers NEVER seem to care enough about what's happening in the back of their rig. They're imagining what amazing responders they are, lights flashing, sirens blazing, and how quickly they got to the hospital.
As I was about to challenge the doctor to either relieve me of command or get out of my way, we received an update that air medical was 12 minutes out, not 18, which meant there was no time advantage to going to the hospital. We had them continue to the scene, and I spent the entire 12 minutes assessing, treating, and stabilizing the patient for transport for what looked very much like a hemothorax, among other injuries.
Later, my own medical director had a heart to heart with the intervening MD, and they made some arrangements on how to handle future incidents.
Here's my problem...and why I'm still so angry:
I'm a full time paid-on-call critical care paramedic with over six thousand transports under my belt (before I stopped counting). I get up at three in the morning for the woman who vomits every time she begins her menstrual cycle and is fully capable of driving herself to the hospital, but insists we come for her. I get up and help the chronic alcoholic who lives his life with his pants lowered around his ankles and then trips and insists we pick him up and put his pants-less body back in his chair. I go to the psych patient who calls every time she thinks someone has poisoned her food, given her Ebola, or changed her medications for something else and knows the key words are "chest pain" to get the dispatchers excited. I go at four in the morning to the elderly woman with a urinary catheter who has no reason to get up in the middle of the night, but does so anyways and always needs help off the floor where she sits down to rest.
I run hundreds of these calls, all in order to get the few calls in which I am truly needed. The actual injury. The actual pain. The actual extrication and hemothorax. And in every one of those hundreds and hundreds of ridiculous, minor, unnecessary calls, I have never once bumped into this medical director. He, of course, only goes to the interesting calls. The fun ones. The calls he wants to tell stories about. These are MY calls. I paid my dues to earn them, and they are mine to run. But he jumps them because he wants "the juice" of running the critical call.
Selfish of me, you think? If he added value to the scene, if he had something to contribute, if he made the right choices, then it would all be about what's right for the patient. But that's not what's happening. He's just looking for "the juice," and he's doing it on our dime.
If he wants a job application to my fire department, I'm sure he could get hired. He's welcome to put his name on the schedule, and begin paying his own dues. I can even give him the addresses of our frequent flyer so he can get ready for the show.