Question: Can ALS take a pronouncement from the on-scene doctor at a retirement home? I ran the code, since the patient was full code, and got a pronouncement on the phone with the BHP. Once we stopped care, the guy who had been watching us, said that he was her doctor and didn't think we would get her back.

I was wondering if that the on-scene doctor had said something at the beginning of the call, could I just ask him for the pronouncement instead of waiting for the BHP to come to the telephone? We cleared it with management to leave care with that doctor since police didn't come to the scene to call the coroner and take over. Otherwise we would wait for police until we left scene.

 Excellent question. You did the right thing by following your Medical Directives and patching to the Base Hospital Physician (BHP).

Paramedics provide care as an extension of BHP. As such, paramedics orders for care come from Medical Directives (off line medical control) or via direct communication with the BHP (on line medical control). A physician on scene (especially if they are the patient's attending physician) absolutely have the right to assume complete care of the patient however they cannot provide orders to paramedics which contravene or exceed the scope of practice of paramedics as delineated within their medical directives.

In your example, if the physician on scene wished to assume responsibility and care for the patient, then they could intervene and order the resuscitation to cease or they could continue resuscitative efforts as they wish. If the responsibility of the patient were to remain with the paramedics and the EMS system, then paramedics should follow their Medical Directives and patch to the BHP for further direction when indicated.

Cardiac/Circulation,Medical Cardiac Arrest

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