# EMT scope of practice?



## beaucait (Mar 24, 2016)

I have a friend who was a camp counselor..... Long story short the camp she used to work at was looking for "a medic" to administer medication to children at a summer camp. I know I'm not a medic, but she seemed adamant that I would be able to do the job, you know, being a "boo-boo bandit". 

My question is, would an EMT be able to give out prescribed medication to children or would that not be in the scope of practice? 
I don't want to say yes and have my license revoked because I gave hyper Harry his ADHD medication one day at summer camp.


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## STXmedic (Mar 24, 2016)

It would partly depend on your state and your medical director. You'd have to have a medical director approve you to be able to hand out those meds, and the state would have to be able to allow him to make that approval. Some states have a state scope that a medical director can't go beyond. Without a medical director, you'd only be able to provide basic first aid under your cert.


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## beaucait (Mar 24, 2016)

STXmedic said:


> Without a medical director, you'd only be able to provide basic first aid under your cert.


That was my assumption, was that if I had permission from "med control" that I would be able to help administer medication. Just like if a patient has Albuterol as a prescription, I am allowed to help administer, but not actually determine for myself how many puffs etc.


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## conemt (Mar 24, 2016)

Side question, but aren't EMTs supposed to contact medical control before administering/assisting with anything?


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## TransportJockey (Mar 24, 2016)

conemt said:


> Side question, but aren't EMTs supposed to contact medical control before administering/assisting with anything?


No. In nm and tx emts have a list of meds they can administer under standing orders. Its state and medical director dependent


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## beaucait (Mar 24, 2016)

TransportJockey said:


> No.


I can do aspirin, oxygen, and oral glucose by myself basically that's it....


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## conemt (Mar 24, 2016)

What state are you in Caitlin?


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## beaucait (Mar 24, 2016)

Maine. I can do a few other drugs but for most of them I have to call for med control.


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## johnrsemt (Mar 25, 2016)

Where I used to work I spent 2 summers working as the Health Director at a Boy Scout Camp, with 1000+ Scouts/leaders and 150+ staff members.
The Council had a medical director, and he authorized us to give the participants there medications (they turned Prescription meds into us, and got them as needed, and we kept a log of it)  Royal pain, but it gave us a tracking system to protect us and the Scouts. 
OTC meds, we had authorization to give out about 30-40 medications:  and a few prescription meds:  O2, Albuterol (Xoponex), Epi 1:1,000, etc.

I checked with my medical director of where I worked before I took the summer leave of absence to work at camp, he thought it was a great idea, and told me as long as the medical director for the council was cool with it, the state didn't care, and neither did he; since I wouldn't be working for him.   He let me shadow him in the ED for a couple days a week for a few weeks, mainly to learn to judge who needs sutures, who doesn't; and to evaluate better who has fractures and who has sprains.  (Camp was 45 minutes to a hospital, and 35 minutes from a transporting ambulance and 40 minutes from an Urgent care).

It will be different if you work in a State, where it is State wide protocols,  but check with your medical directors.  They are the best source of info for these questions.

If anyone goes to work in a camp like this (Boy or Girl Scouts, YMCA, Church Camps):  check with the local (closest) Urgent/Immediate Care and find out what they do and don't do there.   No reason to send a Scout who needs 15 sutures in their head, if the Urgent Care won't do head sutures.  Send them direct to the ED.
Also remember very few patients from camps need an ambulance.


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## BassoonEMT (Mar 26, 2016)

It's best to find out some details from the administrators of the camp. I've done a few different camps and have never had any legal issues. I'm sure they've had some sort of medical personnel in the past so they may have these issues sorted already. They may say that you're the "medic" (medic or emt, either way it's a different than normal scope), but on paper, legally, you may be "medical staff", "health officer" or some other title. Being an EMT may have given you experience needed and base qualifications for the job, but you may not be part of a traditional agency with a medical director, so you're not functioning as an EMT.

It all varies by state. An established camp or association should know what the requirements are for them in terms of treatments and medications allowed. Assisting in kids taking their own prescribed medications, or giving OTC meds (usually needs written approval from parents). It could be that, as an EMT you're trained in administering/assisting PO medications, and with that you're able to distribute/manage these other meds. If a kid gives himself insulin injections, you would be responsible for storing and "guarding" the medication, but it's self administered. Whether or not you're "assisting" with the administration is another story.

Again, all depends on the state and the camp, but I highly doubt that unless you do anything horribly invasive that you would have any issues with your card. 

Find out from the camp, they should be used to this.


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## beaucait (Mar 27, 2016)

So basically it's up to the medical director of the summer camp? That makes more sense


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## DesertMedic66 (Mar 27, 2016)

Unless it is a very large summer camp I highly doubt they will have a medical director (an actual Doctor)


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## BassoonEMT (Mar 27, 2016)

Right, they probably wont have a medical director. At least not in the EMS sense of the term. 

You can probably look up online the laws about camps and medicine for your state. There's a whole specific set of laws usually just for camps and that should answer everything in addition to whoever is your boss. 

But EMTs at camps is not a new concept, so you shouldn't have anything to worry about.


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## NomadicMedic (Mar 27, 2016)

BassoonEMT said:


> But EMTs at camps is not a new concept, so you shouldn't have anything to worry about.



I drive over the speed limit all time time, and I've NEVER gotten a ticket, so you shouldn't have anything to worry about if you speed. 

Your logical fallacy is anecdotal.


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## BassoonEMT (Mar 27, 2016)

DEmedic said:


> I drive over the speed limit all time time, and I've NEVER gotten a ticket, so you shouldn't have anything to worry about if you speed.
> 
> Your logical fallacy is anecdotal.



Except to make your analogy actually make sense, it should read
 "I always drive 65 in a 65, so you shouldn't have anything to worry about if you go 65 in a 65"
"Except there's no speed limit sign so I'm not sure"
"So ask the sheriff, he'll tell you what the speed limit is"


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## beaucait (Mar 27, 2016)

My main concern is having my license revoked if I don't do all my research, and doing something wrong. Considering I just got my license that would be terrible, and being so new to EMS I dont really know all the rules and how lenient the state is.


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## Inspir (Apr 1, 2016)

We have the ability of to 'delegate' our scope to a lower level registered EMS provider. For example, a AEMT could delegate a EMTB to start an IV or insert a King LT, etc. Or a Paramedic could delegate a AEMT to administer narcotics or insert a chest tube, etc. This is under the complete discretion of the higher scope EMS provider and must be under DIRECT supervision and guidance. You can only delegate to a person one level lower than you. For example a Paramedic could delegate to a AEMT but not to a EMTB.

Some will do it some will not. It depends on your working relationship with your partner and if you prove you can perform and know your stuff. Afterall, it will also be their license on the line if you screw it up.


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## TransportJockey (Apr 1, 2016)

Inspir said:


> We have the ability of to 'delegate' our scope to a lower level registered EMS provider. For example, a AEMT could delegate a EMTB to start an IV or insert a King LT, etc. Or a Paramedic could delegate a AEMT to administer narcotics or insert a chest tube, etc. This is under the complete discretion of the higher scope EMS provider and must be under DIRECT supervision and guidance. You can only delegate to a person one level lower than you. For example a Paramedic could delegate to a AEMT but not to a EMTB.
> 
> Some will do it some will not. It depends on your working relationship with your partner and if you prove you can perform and know your stuff. Afterall, it will also be their license on the line if you screw it up.


What?  I'm not entirely sure that's how it works.  What state are you in?


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## ERDoc (Apr 1, 2016)

Agreed, that seems weird or misunderstood.  So an AEMT can delegate to an EMT but a paramedic can't?  That seems bass ackwards to me.  If an EMT has not been taught how to start an IV or put in a King tube and someone is telling them to, that is some scary stuff.  What medical director in their right mind would develop those protocols?  I can see the medic/AEMT thing, "Hey Bob, while I get the airway can you push meds?"


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## Tony Ippolito (Apr 1, 2016)

I worked in a alcohol/drug detox. It's technically a loophole they are using. The trick is that you don't open or touch the medication or bottle, and just hand it to them. You never actually Adminster the medication, you just observe it being taken.


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## Gurby (Apr 1, 2016)

Inspir said:


> We have the ability of to 'delegate' our scope to a lower level registered EMS provider. For example, a AEMT could delegate a EMTB to start an IV or insert a King LT, etc. Or a Paramedic could delegate a AEMT to administer narcotics or insert a chest tube, etc. This is under the complete discretion of the higher scope EMS provider and must be under DIRECT supervision and guidance. You can only delegate to a person one level lower than you. For example a Paramedic could delegate to a AEMT but not to a EMTB.
> 
> Some will do it some will not. It depends on your working relationship with your partner and if you prove you can perform and know your stuff. Afterall, it will also be their license on the line if you screw it up.


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## Inspir (Apr 2, 2016)

Maybe delegate is a poor choice of words. It more like a AEMT or Paramedic with an instructor endorsement can teach you hands on in a field setting.


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## TransportJockey (Apr 2, 2016)

Inspir said:


> Maybe delegate is a poor choice of words. It more like a AEMT or Paramedic with an instructor endorsement can teach you hands on in a field setting.


In most states, unless the lower level provider is a student on an internship rideout, that is not true either.


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## DesertMedic66 (Apr 3, 2016)

"Alright EMT partner, you remember that YouTube video I showed you on how to insert a chest tube this morning? Well go ahead and place one on this critical patient". No thanks


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## ERDoc (Apr 3, 2016)

DesertMedic66 said:


> "Alright EMT partner, you remember that YouTube video I showed you on how to insert a chest tube this morning? Well go ahead and place one on this critical patient". No thanks



Don't laugh, but YouTube is a great place to review a procedure you haven't done in a long time (?ever) and you need to do it now.



Inspir said:


> Maybe delegate is a poor choice of words. It more like a AEMT or Paramedic with an instructor endorsement can teach you hands on in a field setting.



But why wouldn't a medic be able to "teach" an EMT?


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## ExpatMedic0 (Apr 3, 2016)

From my experience, in the states I have worked, some of these camps are registered in the state data base as an EMS agency. They are often found along with other random non-transporting agencies such as on site occupational health EMT's and paramedics at construction sites or expo centers, ect. I worked on site at an Expo center and at a race track directly for them, not as a contractor for a transporting agency. Each of them had a numerical code which corresponded in the state data base as an official EMS agency. We also had uniforms with our own "agency" patches. Each place had their own protocols from the medical director in that county, and they often included dispensing many oral medications not found on an ambulance. If your not official (speaking from the states I have worked) you can not represent yourself or be employed as an EMT as far as I know. If in doubt you could try finding out who the medical director for the county the summer camp is in. Otherwise, there is a grey area where you could work as a camp counselor or possibly a first-aid person with out using your EMT certification, skills or identifying yourself in anyway as an EMT. However, I would look into the legalities of that in your state and its limitations.


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