"Is There a Doctor in the House?” Addressing Bystander Physician Involvement on Scene

The dispatcher comes across the radio: “Medic 8, motor vehicle crash, thruway northbound, reported serious. Be advised that PD and FD are also responding.” You confirm the transmission and make it to the scene to find one patient, entrapped and critically injured, following a single-vehicle accident. As you begin to assess and treat the patient and the fire department sets up for extrication, a car pulls up and a man jumps out. “I’m a doctor,” he says to no one in particular. You and your partner exchange glances that seem to say, “Oh, no—not again.”

Most EMS providers will face a scenario like this at some point in their careers. There are many well-intentioned physicians who are more than willing to lend their hands and training at emergency scenes. Unfortunately, even if they have a working knowledge of emergency medicine, these doctors may not always be cognizant of the formal hierarchy of medical oversight controlling EMS operations in the field. This ignorance can often lead to confusion in regard to responsibility for out-of-hospital patient care, overall adherence to EMS system protocols and online medical authority. Sometimes the difference between appropriately utilizing these physicians and alienating them lies in your approach to handling these interactions, as well as their understanding of your system policies.

This article will deal with commonly identified issues surrounding the presence of a bystander physician on an EMS scene, discuss the inherent legal issues and illustrate examples of strategies EMS systems have employed to mitigate this common and potentially contentious situation.

Perspectives

Medical organizations such as the National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP) and the American Medical Association (AMA) have all addressed this subject in publications and position statements. The consensus is that the direction of prehospital care at the scene of a medical emergency should be the responsibility of the individual in attendance who is most appropriately trained in providing prehospital emergency care and transport.1 ACEP offers that an “intervener physician is a physician who provides evidence of medical licensure, has not established a prior physician/patient relationship, wishes to take charge of a medical emergency and is willing to accompany the patient to the hospital when so requested.”1 The AMA outlines guidelines to be applied in instances where a physician happens upon an emergency scene and desires to take medical and legal responsibility for the patient. It recognizes that prehospital EMS systems operate under the authority and direction of a licensed physician who has both medical and legal responsibility for the system.2

But even with these official assertions, the realities of these situations still place EMS providers squarely in the middle, forcing them to handle the question of whom to listen to while still addressing their primary responsibility of providing patient care.

Legal Issues

In general, the matter of the bystander physician is full of legal landmines of which EMS providers should be aware. Concerns include questions of medical authority, possible deviations from accepted local, regional or statewide protocols, and overall liability.

There are some essential steps that should be taken as soon as someone presents himself as a physician to EMS providers at an emergency scene. First, an attempt should be made to ascertain what sort of medical discipline the purported doctor practices and the extent of his knowledge of emergency procedures. Do not be afraid to ask for identification. Some states’ medical boards and regional medical advisory committees offer identification cards to doctors for just such situations.

Second, impress upon the physician that online medical control must be willing to transfer responsibility for directing patient care. Many areas require the intervening doctor to accompany the patient to the hospital. There is no point in going through the time and trouble of this process if the doctor does not understand this necessity.