EMT or Athletic Trainer

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dbitt54

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I am a football coach with emt-b cert. I have another coach who is a emt-p. We were just discussing different scenarios and this one came up. Say one of our players gets hurt on the field and needs assistance. Does the athletic trainer have more say so than the emts present? I know athletic trainers are trained specifically on sports injuries and emts are more trauma/medical, but where is the line. I guess all in all, how does the pecking order go?
 
Who ever is going to be taking over all care of the patient is the one incharge. You can make suggestions but they dont have to listen.
 
dbitt54 said:
I am a football coach with emt-b cert. I have another coach who is a emt-p. We were just discussing different scenarios and this one came up. Say one of our players gets hurt on the field and needs assistance. Does the athletic trainer have more say so than the emts present? I know athletic trainers are trained specifically on sports injuries and emts are more trauma/medical, but where is the line. I guess all in all, how does the pecking order go?
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Athletic Trainers are going to be far better educated in caring for sports injuries than even a medic. On top of that, chances are your team physician is the doc your ATC works with and under. In essence, you have a closed medical system. Your ATC will be the one calling the shots unless your team doc says different OR turns the player over to EMS. You coaches are "off duty" as far as your EMT/EMT-P certs are concerned anyway. Also, chances are quite good that your ATC could pass the EMT-B, and possibly EMT-P exams, without breaking much of a sweat. Put one through ACLS/PALS/PHTLS and I'd say the odds of passing EMT-P written would be extremely high. Becoming an ATC takes at minimum, a 4 year degree. The curriculum and internship experiences will be very similar in any program nation-wide. So says the NATA-BOC.

When it comes to evaluating exactly what broke, your ATC will be a LOT more specific about what broke, how bad it broke, how to rehab it, and who to refer to than a medic. Trust me on this. Knee or Leg pain can be determined to be something MUCH more specific... I've had all the education that an ATC gets. I know.

Don't get me wrong: There are things that an ATC doesn't learn in the normal course of their education that a medic does. Without further education in the Pre-Hospital stuff, an ATC can't replace a good medic.
 
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To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete.


firefite said:
Who ever is going to be taking over all care of the patient is the one incharge. You can make suggestions but they dont have to listen.
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Who ever is in charge is making patient care decisions and until the trainers turn over care to the paramedics, or God forbid EMTs (I'd love to see some EMTs claim that they are a "higher level of care" than the trainers), my opinion is that they are in charge and can decide to initiate any treatments that they deem fit.

Oh, and if you want to take that statement literally, the ED physician is "in charge" since they will ultimately receive care
 
JPINFV said:
To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete.





Who ever is in charge is making patient care decisions and until the trainers turn over care to the paramedics, or God forbid EMTs (I'd love to see some EMTs claim that they are a "higher level of care" than the trainers), my opinion is that they are in charge and can decide to initiate any treatments that they deem fit.

Oh, and if you want to take that statement literally, the ED physician is "in charge" since they will ultimately receive care
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Yes the trainers can initiate any care they want as long as the patient is under their care. But once the patient is handed over then it's different (at least for me. If someone is going to be doing anything to my patient while under my care they have to get it cleared by me first.)

And as for me if I'm going to be transporting then the patient is going to be under my care and not the trainers. If there is a doctor on the team and he wants to take over all care of the patient then that's fine by me as long as I get it cleared from my sup and the receiving facility (so basically unless they are a well known doctor then that's not very likely).

By in charge of patient care I mean at that time. Yes the physician will ultimately take over patient care but that is done at the hospital and not out in the field.
 
firefite said:
Yes the trainers can initiate any care they want as long as the patient is under their care. But once the patient is handed over then it's different (at least for me. If someone is going to be doing anything to my patient while under my care they have to get it cleared by me first.)

And as for me if I'm going to be transporting then the patient is going to be under my care and not the trainers. If there is a doctor on the team and he wants to take over all care of the patient then that's fine by me as long as I get it cleared from my sup and the receiving facility (so basically unless they are a well known doctor then that's not very likely).

By in charge of patient care I mean at that time. Yes the physician will ultimately take over patient care but that is done at the hospital and not out in the field.
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The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.


Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'
 
JPINFV said:
The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.


Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'
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That is what I said. "who ever is taking over care" means who ever is going to be taking over care for the patient. The trainers took over control when the injury happened. When EMS arrives/transfer of care is done then the EMS crew will be taking over control of the patient. And this will happen again at the hospital.

I'm sorry that I didn't describe it the exact way you were looking were and use the exact words that you would have used.
 
JPINFV said:
To the OP, get together with the senior staff at your local EMS agency and hammer out a plan ahead of time. We're dealing with two different providers who are going to have a very different idea of what is appropriate and different ways of approaching an injured athlete.





Who ever is in charge is making patient care decisions and until the trainers turn over care to the paramedics, or God forbid EMTs (I'd love to see some EMTs claim that they are a "higher level of care" than the trainers), my opinion is that they are in charge and can decide to initiate any treatments that they deem fit.

Oh, and if you want to take that statement literally, the ED physician is "in charge" since they will ultimately receive care
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What needs to be done is a sit-down with Coaches, Trainers, EMS/ED folks, and perhaps the Team's Designated Surgeon(s) to hammer out a plan of when and where an injured athlete gets transported. This should include not just emergent situations but also those situations where a delay in care by a physician or surgeon needs to be minimal.

This should also include agreements with ED's to accept ill/injured athletes as an IFT type of transfer so that they're never closed to you and so that they'll accept reports directly from the ATC about the athlete as well as from the Paramedic because the ATC will have a VERY good idea what happened, and likely has a VERY good idea what the injury is.

On days where an ambulance stand-by has been arranged, a meeting with the ambulance staff and team medical staff should also happen.

For the OP: If you have an ATC on staff, you should turn over medical clearance/care to the Trainer. You, as an EMT-B and the other Coach who is a Paramedic, do not possess the requisite knowledge to adequately care for sports injuries, even if you did take a "Care and Prevention of Athletic Injuries" course as part of your Coaching Credential. Think of your ATC as a "Medical Coach" who has the authority to keep athletes from practice and or competition. ATC's in general want to keep athletes doing what they do best, and will work hard to keep or return those athletes back to competition. Don't override their decisions.

JP: Very different ideas about what's appropriate and how to care for an injured athlete doesn't do the differences proper justice. Much severe friction can develop because of those differences.
 
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As noted above, make sure these issues get worked out before the season starts. Everyone involved in injury management needs to be on the same page. At every hockey game, our program has an ATC, 2 student-trainer/EMTs, 2 paramedics, a GP, Ortho, and Dentist. The visiting team as an ATC and sometimes a doc as well. They all know their roles during injury management, and we've yet to have a situation with serious headbutting with the EMS side (the Doctors can be a bit different since there are many of them and they are not working in their usual environment).

At our program, the trainer is "in-charge" at all times, unless the injured player, coach, or official has sustained a life threatening injury. We are lucky in that we have the same paramedic crew (or at least one of them) at every game, so we do not have to hash it out with a new crew weekend.

The paramedics are an essential part of our medical team. They help us with our c-spine protocol on the ice, provide supplies and equipment that we don't generally have access too, and manage the life threatening injuries that our Sports Medicine staff don't have experience dealing with. It's also great to have someone able to start a line and give zofran to a player that's been battling illness and is dehydrated and nauseous before the game.
 
And whatever plan you have decided on, make sure it's in writing.
 
I have not read all the replies to the OP. If an injury happens to an athlete that requires the athlete to be transported to the hospital, the EMS agency assumes medical control over the patient once they arrive on scene.

To the OP: First are both of you Licensed in the state to practice at your current level? also, are you allowed to "practice" while you are "Off-Duty." I am unsure on your state laws, I do know in Idaho, We are limited on what we can do when we are not working on an Ambulance/Engine/Rescue ext. More towards your question, I would have to say Yes and No. Depending on the injury.. and even than as I think back to my ATEP program, there truly isnt any difference in handling a sports injury. Fractures you are going to stabilize. Concussions you are just going to assess mental status. Sprains and Strains: RICE. it truly comes down to is the injury Life Threatening or not. Also, as an Off Duty Paramedic or EMT, you wont have the Medical Equipment to preform any procedures, and the equipment that your AT has, he or she is already trained on how to use that equipment effectively.

I guess I am truly not seeing the type of injury that would require you as a First Responded to assume Medical Control over? Can you give me an example of an injury...
 
JPINFV said:
The problem is that this isn't what you said. You said that it was "who ever is taking over care." The problem is that until the trainer transfers care, the trainer is in charge, not the EMS team, regardless of if the EMS team is transporting. The trainer is similarly free to make any treatment decisions he sees fit, regardless of anything the EMS team suggests.


Regardless, though, this sort of brinksmanship is silly. How about collaboration between two different fields that overlap with the current patient? Providing appropriate care is more important than 'who's on first.'
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I have to disagree with this, Once the EMS crew has arrived on scene it is there patient. the Athletic Trainer has already determined by calling 911 or calling over the EMS Standby Crew that this injury needs further care than what he or she can provide. Therefor the EMS crew assumes Medical Control as soon as they arrive. Just like when ems crew gets called to a nursing home, when EMS arrives they are in charge. there is no difference.
 
EMT11KDL said:
I have to disagree with this, Once the EMS crew has arrived on scene it is there patient. the Athletic Trainer has already determined by calling 911 or calling over the EMS Standby Crew that this injury needs further care than what he or she can provide. Therefor the EMS crew assumes Medical Control as soon as they arrive. Just like when ems crew gets called to a nursing home, when EMS arrives they are in charge. there is no difference.
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So on an emergency IFT, once the crew arrives at the hospital the crew is now has medical control?
 
JPINFV said:
So on an emergency IFT, once the crew arrives at the hospital the crew is now has medical control?
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You are taking that patient to another facility correct? Using your Rig? You have to assess the patient correct? you have to confirm that all procedures that are currently in place are done correctly.. because if something is not done correctly who's A** is on the chopping block. YOURS not the staff that had the patient before... and if something is done incorrectly you have to document it. therefor when you arrive to "receive" that patient, than its your patient.

Lets put it this way, you are transporting a patient to the ER. You go into the ER with the patient, are you allowed to tell the ER techs or RN or Doctors what procedures they can do while you are in the room? NO, its there patient now. by you bringing that patient there, you have involuntarily gave that patient to them and they assume medical control.
 
The problem is that you don't assume care or relinquish care until report is given. Just because you show up at the ED to transport a patient doesn't mean that you are immediately in charge of that patient's care. Similarly, just because you walk through the doors of the ED doesn't mean you relinquish care. That occurs after you properly transfer care to the ED. Similarly, a patient under the care of a trainer is the trainer's patient until they transfer care to you, which doesn't occur just because you show up.
 
JPINFV said:
The problem is that you don't assume care or relinquish care until report is given. Just because you show up at the ED to transport a patient doesn't mean that you are immediately in charge of that patient's care. Similarly, just because you walk through the doors of the ED doesn't mean you relinquish care. That occurs after you properly transfer care to the ED. Similarly, a patient under the care of a trainer is the trainer's patient until they transfer care to you, which doesn't occur just because you show up.
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I agree but disagree at the same time. If you have shown up and are with the Patient than care is being relinquished. We are going to play a quick what if situation. I do know that this WHAT IF will NEVER HAPPEN. and if it does, you are a freaking idiot.

So if I am transporting my patient to the ED and I go through the doors and stop in the hall way, I can tell the Doctors, Nurses and Techs or anyone else to NOT touch/treat the patient? and get away with it...

yes I know this sounds stupid, but I cant think of another situation to describe it...
 
EMT11KDL said:
So if I am transporting my patient to the ED and I go through the doors and stop in the hall way, I can tell the Doctors, Nurses and Techs or anyone else to NOT touch/treat the patient? and get away with it...
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...if you're holding the wall? Sure. Similarly, if you're holding the wall with the patient and decide to mentally check out, if something bad happens the hospital is going to say, "Well, we never accepted care over that patient." Once you transfer care, however, all bets are off. Otherwise, it's like a crew arriving at a dialysis clinic and demanding that their patient is immediately removed from the dialysis machine for no better reason than the fact that the crew is there.

Similarly, let's go back to the emergency transfer. If you have assumed care as soon as you arrive, then you should be able to just start disconnecting lines and immediately preparing the patient for transport, even before report is given?

That last scenario actually gets to the heart of the situation. Collaborating between the transferring and receiving team is more important than either team arguing that their proverbial penis is larger than the other team.
 
For me as soon as I make patient contact then I am in control of all care. If I show up to the ER to do an IFT and the nurses are not ready to give a report and have me take control of the patient I do not make patient contact.

As soon as the report is given then I make patient contact and the patient is now under my care.

And then as soon as I give my report to the receiving facility about the patient, that ends my care of the patient.
 
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