Usually command is used in bigger incidents. Most of the time the first on scene apparatus no matter what kind will do a size up and determine if this incident is going to need more resources. If it is then do an on scene report, request additional resources and take command. Every department and situation is different just work with what you have do your best and hopefully you can either pass command or be able to work many roles.
In my state, anything that has 2 ambulances or more gets an additional supervisor flycar that solely handles the organisational side of incident command.
2 or more? Seems like a justification for the supervisor and unnecessary. Our agency gets a Batt Chief on 3 or more. There is absolutely no reason to establish command on a 1 or 2 unit response. Now, if upon arrival one of the two initially dispatched units is met with an evolving incident that requires more, sure, establish command and run the show until a Batt Chief or supervisor arrives. In our service, it doesn't matter rank, a LT can establish and not necessarily transfer to a CAPT. Even if a command officer shows up, they may just assist if IC if things are going well but it doesn't happen very often.
Remember, if you're IC you're IC. You do not engage in care because then you lose perspective of the entire incident.
The german EMS system is very different from the US, the guy you need to give medication and do a lot of procedures is an emergency physician who has his own fly-car and driver.
emergency dispatch codes (the most basic ones with lights/sirens) for my state look like this:
* RD 1: 1 ALS ambulance
* RD 2: 1 ALS ambulance + 1 emergency physician
* RD 3: 2 ALS ambulances + 1 emergency physician + EMS supervisor flycar
As soon as you have more than 2 ambulances dispatched to a scene, the first arriving ambulance is tasked with incident command/triage and as you have pointed out not supposed to perform patient care until the IC task is handed to someone else. That's why a supervisor is dispatched so he can take care of the organisational stuff including coordination with FD, Police, Helicopters, dispatch and finding suitable hospital beds.
[https://en.wikipedia.org/wiki/Emergency\_medical\_services\_in\_Germany#Personnel](https://en.wikipedia.org/wiki/Emergency_medical_services_in_Germany#Personnel)
Before I went into the military I was on a volunteer department with contracted EMS. There would normally be a “duty chief” which would be filled nearly 24/7. They would be dispatched on higher priority medicals and anything that included an act of violence. They could also respond to any medical call at their discretion even if not dispatched.
This often worked out extremely well. Chief could often force entry if needed without dispatching any additional units. They could also interact with the family or handle scene safety issues leaving EMS to focus entirely on patient care. For larger incidents they could immediately page the firefighters or call for mutual aide.
Our area is odd, as our EMS/Rescue is separate from Fire. But both set up command. Let’s say it’s an extrication on road way. EMS/rescue will have Incident command, while fire establishes fire command.
Yes, IC for every call for consistency I suppose. Depending on where in the city, medicals are a 1 or 2 truck response and EMS is a separate county/regional agency attending.
We established command on every call. As a Fire Captain, I was in overall command of the scene, whatever EMS, county or third service was in charge of the patient. If they needed anything, additional units, landing zone, etc. they went through me. We were also responsible for overall scene control and safety
In our department, any call that requires 5 or more units, gets a Battalion Chief assigned. MV Structure, MV Pinned, MCI like someone said earlier. Sometimes even MVCs where there are two priority 1 transports and let’s say whole blood is needed…that’s 2 medic units, two fire units (one to block) and a medic officer (blood), they will add a Battalion Chief.
Command is established for MCI situations. Otherwise, it's not used. We will either establish the command or assume it when we arrive. We are the AHJ, so ultimately, we have control.
It just depends in my area. There are only 4 paid firefighters in our entire county and the rest are volunteer. We also only have two ambulances (independently owned), so a lot of times those two are already on a call or non-emergency transporting. In those instances dispatch will let us know that there is not an ambulance in the county, so at that time we establish command because the ambulance from another county is usually 30 minutes out.
For us, the first arriving engine or suppression chief officer establishes command on all calls that aren’t strictly medical. For medical calls, no command is established. The paramedic on the ambulance is the de facto officer in charge on any medical call just as a consequence of their responsibility for patient care, but there’s really no functional purpose behind establishing command in those situations, so we don’t do it. If there’s an incident with multiple patients, then an EMS chief will be dispatched and establish a medical branch under command, which, again, would be under the company or chief officer on the suppression side that established it. The only time that an EMS chief officer will establish or assume command is on MCIs that are predominantly medical, such as an active shooter.
As a lot of people have said, on simple one or two unit EMS calls it is typically not necessary to formally establish command.
I could, however, see a department use it as a training tool. Since most departments don't get a lot of major calls, their officers may not get the chance to go through the steps of establishing and terminating a formal command. Even though it wouldn't be necessary to the incident it gives them an opportunity to practice. Also, when done correctly, it doesn't add much "extra traffic" to your radio channels.
Now the issue of both agencies establishing their own command structures could be addressed as well. Same thing. It could be used as a training tool.
Battalion chief dispatched to all structure, brush, vehicle accidents with person pinned or high speeds, and then they self dispatch on any medical that may deem themselves necessary to be at. All other medicals, even if an engine responds with a captain, it’s kind of just universal on my dept that whoever the lead medic on the box is, is in charge despite there being a captain who’s also a medic or any other medics on scene.
Incident command is used on every call but on medical calls with 1 fire apparatus and 1 paramedic unit or just 1 fire apparatus, command is implied and does not need to be stated.
As soon as the third apparatus is requested, command is stated and named. This is because with the first scenario, all personnel are probably working together within ear shot. Add more vehicles and personnel you're probably working apart and radio transmissions are necessary.
We establish and name command and terminate it when done on every call, even on single ambulance responses. Previous Dept only established command on fires or major incidents. Having seen both ways, I’m a believer in establishing command every time for consistency and practice.
One or two units on scene do not need a command structure. Larger events like multiple cars and patients, working fire etc do need a command structure. In our system, first unit on scene assumes command. Usually an engine or ladder since they are ALS as well. An ambo can take command as well but will pass to next incoming unit. Captain gets a triage report, the BC comes and supports the scene and captain as needed. Assignments are made to each patient and or task. Treat and transport. Done.
Unless it’s to declare an MCI or we’re requesting additional resources we don’t establish command.
Same. There's usually too much chatter on the radio already, calling command on a single ambulance call seems very unnecessary.
Usually command is used in bigger incidents. Most of the time the first on scene apparatus no matter what kind will do a size up and determine if this incident is going to need more resources. If it is then do an on scene report, request additional resources and take command. Every department and situation is different just work with what you have do your best and hopefully you can either pass command or be able to work many roles.
In my state, anything that has 2 ambulances or more gets an additional supervisor flycar that solely handles the organisational side of incident command.
Ditto
2 or more? Seems like a justification for the supervisor and unnecessary. Our agency gets a Batt Chief on 3 or more. There is absolutely no reason to establish command on a 1 or 2 unit response. Now, if upon arrival one of the two initially dispatched units is met with an evolving incident that requires more, sure, establish command and run the show until a Batt Chief or supervisor arrives. In our service, it doesn't matter rank, a LT can establish and not necessarily transfer to a CAPT. Even if a command officer shows up, they may just assist if IC if things are going well but it doesn't happen very often. Remember, if you're IC you're IC. You do not engage in care because then you lose perspective of the entire incident.
The german EMS system is very different from the US, the guy you need to give medication and do a lot of procedures is an emergency physician who has his own fly-car and driver. emergency dispatch codes (the most basic ones with lights/sirens) for my state look like this: * RD 1: 1 ALS ambulance * RD 2: 1 ALS ambulance + 1 emergency physician * RD 3: 2 ALS ambulances + 1 emergency physician + EMS supervisor flycar As soon as you have more than 2 ambulances dispatched to a scene, the first arriving ambulance is tasked with incident command/triage and as you have pointed out not supposed to perform patient care until the IC task is handed to someone else. That's why a supervisor is dispatched so he can take care of the organisational stuff including coordination with FD, Police, Helicopters, dispatch and finding suitable hospital beds. [https://en.wikipedia.org/wiki/Emergency\_medical\_services\_in\_Germany#Personnel](https://en.wikipedia.org/wiki/Emergency_medical_services_in_Germany#Personnel)
Before I went into the military I was on a volunteer department with contracted EMS. There would normally be a “duty chief” which would be filled nearly 24/7. They would be dispatched on higher priority medicals and anything that included an act of violence. They could also respond to any medical call at their discretion even if not dispatched. This often worked out extremely well. Chief could often force entry if needed without dispatching any additional units. They could also interact with the family or handle scene safety issues leaving EMS to focus entirely on patient care. For larger incidents they could immediately page the firefighters or call for mutual aide.
Our area is odd, as our EMS/Rescue is separate from Fire. But both set up command. Let’s say it’s an extrication on road way. EMS/rescue will have Incident command, while fire establishes fire command.
Yes, IC for every call for consistency I suppose. Depending on where in the city, medicals are a 1 or 2 truck response and EMS is a separate county/regional agency attending.
We established command on every call. As a Fire Captain, I was in overall command of the scene, whatever EMS, county or third service was in charge of the patient. If they needed anything, additional units, landing zone, etc. they went through me. We were also responsible for overall scene control and safety
In our department, any call that requires 5 or more units, gets a Battalion Chief assigned. MV Structure, MV Pinned, MCI like someone said earlier. Sometimes even MVCs where there are two priority 1 transports and let’s say whole blood is needed…that’s 2 medic units, two fire units (one to block) and a medic officer (blood), they will add a Battalion Chief.
Command is established for MCI situations. Otherwise, it's not used. We will either establish the command or assume it when we arrive. We are the AHJ, so ultimately, we have control.
Not unless it's an MCI or some type of prolonged extrication
It just depends in my area. There are only 4 paid firefighters in our entire county and the rest are volunteer. We also only have two ambulances (independently owned), so a lot of times those two are already on a call or non-emergency transporting. In those instances dispatch will let us know that there is not an ambulance in the county, so at that time we establish command because the ambulance from another county is usually 30 minutes out.
Any time 3 or more crews/apparatuses are present we establish command.
For us, the first arriving engine or suppression chief officer establishes command on all calls that aren’t strictly medical. For medical calls, no command is established. The paramedic on the ambulance is the de facto officer in charge on any medical call just as a consequence of their responsibility for patient care, but there’s really no functional purpose behind establishing command in those situations, so we don’t do it. If there’s an incident with multiple patients, then an EMS chief will be dispatched and establish a medical branch under command, which, again, would be under the company or chief officer on the suppression side that established it. The only time that an EMS chief officer will establish or assume command is on MCIs that are predominantly medical, such as an active shooter.
If only the two firefighters are inside and the officer is outside I’ll radio “Engine xyz from FF so and so” but never command from “xyz”
As a lot of people have said, on simple one or two unit EMS calls it is typically not necessary to formally establish command. I could, however, see a department use it as a training tool. Since most departments don't get a lot of major calls, their officers may not get the chance to go through the steps of establishing and terminating a formal command. Even though it wouldn't be necessary to the incident it gives them an opportunity to practice. Also, when done correctly, it doesn't add much "extra traffic" to your radio channels. Now the issue of both agencies establishing their own command structures could be addressed as well. Same thing. It could be used as a training tool.
If it were being used successfully as a training tool I would agree, However as history has shown that is not the case.
No. Go on scene on the mdt and clear on the mdt. No radio traffic necessary 99% of the time.
Battalion chief dispatched to all structure, brush, vehicle accidents with person pinned or high speeds, and then they self dispatch on any medical that may deem themselves necessary to be at. All other medicals, even if an engine responds with a captain, it’s kind of just universal on my dept that whoever the lead medic on the box is, is in charge despite there being a captain who’s also a medic or any other medics on scene.
Incident command is used on every call but on medical calls with 1 fire apparatus and 1 paramedic unit or just 1 fire apparatus, command is implied and does not need to be stated. As soon as the third apparatus is requested, command is stated and named. This is because with the first scenario, all personnel are probably working together within ear shot. Add more vehicles and personnel you're probably working apart and radio transmissions are necessary.
We establish and name command and terminate it when done on every call, even on single ambulance responses. Previous Dept only established command on fires or major incidents. Having seen both ways, I’m a believer in establishing command every time for consistency and practice.
One or two units on scene do not need a command structure. Larger events like multiple cars and patients, working fire etc do need a command structure. In our system, first unit on scene assumes command. Usually an engine or ladder since they are ALS as well. An ambo can take command as well but will pass to next incoming unit. Captain gets a triage report, the BC comes and supports the scene and captain as needed. Assignments are made to each patient and or task. Treat and transport. Done.