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The following opinion is presented on-line for informational use only and does not replace the official version. (Mich Dept of Attorney General Web Site - www.ag.state.mi.us) STATE OF MICHIGAN FRANK J. KELLEY, ATTORNEY GENERAL Opinion No. 5857 March 3, 1981 EMERGENCY MEDICAL ASSISTANCE: Management of patient at scene of accident Role of advanced emergency medical technician, emergency medical technician and ambulance attendant at scene of accident An advanced emergency medical technician present at the scene of an accident where an emergency medical technician and an ambulance attendant are also in attendance is the most qualified health professional on the scene and has primary authority to manage the patient, including selection of the ambulance to take the patient to the hospital and also to accompany the patient to the hosptial. Honorable Claude A. Trim State Representative The Capitol Lansing, Michigan You have requested my opinion concerning questions under the Public Health Code regarding authority for patient management as among emergency transportation operations, and licensed and unlicensed emergency medical personnel, responding to the same emergency. Your questions are as follows: 1. Where two or more licensed health professionals arrive at the scene of an emergency requiring emergency medical care to a person, which health professional is authorized to manage the patient in the emergency? 2. Does management of a patient in the emergency include the authority to direct an ambulance to take the patient to a hospital, and is the health professional in charge of the patient during the removal to the hospital? The subject of emergency medical services and the scope of authority for patient management is treated in the Public Health Code, 1978 PA 368, Sec. 20301 et seq; MCLA 333.20301 et seq; MSA 14.15(20301) et seq. 1978 PA 368, supra, Sec. 20377, provides as follows: '(1) Authority for the management of a patient in an emergency is vested in the licensed health professional at the scene of the emergency who has the most training specific to the provision of emergency medical care. If a licensed health professional is not available, the authority is vested in the most appropriately trained representative of a public safety agency at the scene of the emergency. '(2) Authority for the management of the scene of an emergency is vested in appropriate public safety agencies. The scene of an emergency shall be managed in a manner that will minimize the risk of death or health impairment to the patient and to other individuals who may be exposed to the risks as a result of the emergency. Priority shall be given to the interests of those individuals exposed to the more serious remediable risks to life and health. Public safety officials shall ordinarily consult emergency medical service personnel or other authoritative health professionals at the scene in the determination of relevant risks.' (Emphasis added.) It must be noted that in accordance with 1978 PA 368, Sec. 20362; MCLA 333.20362; MSA 14.15(20362), the Department of Public Health is authorized to license or approve advanced emergency medical technicians, emergency medical technicians, and ambulance attendants. 1978 PA 368, Sec. 20362, supra, provides: 'The department . . . shall issue a license or approval to: '(a) An advanced emergency medical technician who has completed the course prescribed by this part or rules promulgated under this part and who has passed a written and practical examination prescribed by the department demonstrating the applicant's knowledge and skill as to advanced emergency medical procedures. '(b) An emergency medical technician who has completed a department or public health approved emergency medical technician-ambulance course meeting at a minimum the recommendations and guidelines of the United States department of transportation or an equivalent course approved by the department of public health, and who has passed a written and practical examination prescribed by the department of public health. '(c) An attendant who has completed an advanced first aid and emergency care course conducted by the American red cross or an equivalent course approved by the department.' From a reading of this section, it is clear that the advanced emergency medical technician would require the most complete training in emergency medical care, the emergency medical technician would receive the next most complete training, while an ambulance attendant would have the least training. Thus, in response to your first question, if an advanced emergency medical technician, an emergency medical technician and an ambulance attendant were present on the scene of an accident, primary authority to manage the patient reposes in the individual having the most training in emergency medical care, the advanced emergency medical technician. If no licensed individual responds, the authority is then vested in the most appropriately trained representative of a public safety agency at the scene. Further, the public safety officer in charge of a patient at the scene shall release the patient to one more qualified on the scene at such time as the qualifications of the licensed health professional are made known. It is my opinion, therefore, that management of a patient at the scene of an accident must be turned over to the most qualified licensed health professional on the scene. Turning to your second question, the most qualified licensed health professional at the scene vested with authority for management of the patient may determine which ambulance, if more than one is present, will transport the patient to a hospital. Where the licensed health professional is on the scene, the public safety officer is not authorized to make this decision. In making the requisite decision, the licensed health professional shall be guided by the needs of the patient and the equipment available in the ambulance to respond to those needs so to minimize the risk of death or health impairment to the patient. In the event that a licensed health professional accompanies the patient in the ambulance, the licensed health professional continues to be in charge of the management of the patient until the patient reaches the hospital. It is, therefore, my opinion that the most qualified health professional at the scene of an accident is authorized to determine, based upon the needs of the patient and equipment available in the ambulance, which ambulance will transport the patient to the hospital. Further, it is my opinion, where such licensed health professional accompanies the patient in the ambulance to the hospital, the licensed health professional continues in the management of the patient until the patient reaches the hospital. Frank J. Kelley Attorney General
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