# EMT without medical direction



## FFmed (Feb 22, 2021)

I’m posting in ALS hoping someone has some experience with this. Any help greatly appreciated..I’m considering a job that was offered but not clear on the legalities. They have referenced OSHA first-aid (vs medical treatment) as an exclusion to need any medical supervision but also have generic handbooks that outline misc. treatments that seem to be more than “first-aid”. It’s a warehouse in the auto industry who hires EMTs as the only medical staff available. My concern is the super relaxed handout of OTC meds (ASA, ibuprofen etc.) without obtaining any medical history or assessment. Not even vitals. I’m having a hard time getting answers from the staff and didn’t wanna seem like a prick by criticizing the practices. Advice?


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## akflightmedic (Feb 22, 2021)

Elaborate on these misc. treatments.


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## mgr22 (Feb 22, 2021)

FFmed said:


> I’m posting in ALS hoping someone has some experience with this. Any help greatly appreciated..I’m considering a job that was offered but not clear on the legalities. They have referenced OSHA first-aid (vs medical treatment) as an exclusion to need any medical supervision but also have generic handbooks that outline misc. treatments that seem to be more than “first-aid”. It’s a warehouse in the auto industry who hires EMTs as the only medical staff available. My concern is the super relaxed handout of OTC meds (ASA, ibuprofen etc.) without obtaining any medical history or assessment. Not even vitals. I’m having a hard time getting answers from the staff and didn’t wanna seem like a prick by criticizing the practices. Advice?


I spent a few years working part-time as a medic in the entertainment industry. It was similar to what you describe, in that OTC meds were sometimes distributed by coworkers without medical training. I tried to put a stop to that after the first suspected allergic reaction to a topical antibiotic, but I wasn't high enough on the food chain. The best I could do was try to educate employees about risks. It was frustrating and occasionally entertaining, like whenever a mild painkiller/diuretic for menstrual cramps was given to men for musculoskeletal pain.

You are right to be concerned, especially if you have no medical direction (I did). Maybe there's a middle ground where you can politely highlight your concerns to your prospective employer before accepting the offer. Be specific. Give examples. If you don't get the job, at least you tried to behave as a professional.


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## FFmed (Feb 22, 2021)

akflightmedic said:


> Elaborate on these misc. treatments.


Obtaining blood glucose, Sp02, assessing lung sounds, breathing into paper bag for panic attack. There are others..those are just some of the ones I remember.


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## CCCSD (Feb 22, 2021)

SPO2, BCGs, lung sounds aren’t advanced nor requiring medical direction/consult. As long as the LEMSA says it can be done, it’s a basic skill.


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## akflightmedic (Feb 22, 2021)

Exactly. Not advanced treatments at all.


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## FFmed (Feb 22, 2021)

mgr22 said:


> I spent a few years working part-time as a medic in the entertainment industry. It was similar to what you describe, in that OTC meds were sometimes distributed by coworkers without medical training. I tried to put a stop to that after the first suspected allergic reaction to a topical antibiotic, but I wasn't high enough on the food chain. The best I could do was try to educate employees about risks. It was frustrating and occasionally entertaining, like whenever a mild painkiller/diuretic for menstrual cramps was given to men for musculoskeletal pain.
> 
> You are right to be concerned, especially if you have no medical direction (I did). Maybe there's a middle ground where you can politely highlight your concerns to your prospective employer before accepting the offer. Be specific. Give examples. If you don't get the job, at least you tried to behave as a professional.


Thanks for the feedback!  I know I’m probably overthinking this but my gut tells me that it’s just not good practice to hand out meds without properly assessing my patients. The menstrual meds made me laugh I needed that😊 The aspirin apparently is used for “bad headaches” during the work day.  Needless to say I’m petrified already!


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## FFmed (Feb 22, 2021)

CCCSD said:


> SPO2, BCGs, lung sounds aren’t advanced nor requiring medical direction/consult. As long as the LEMSA says it can be done, it’s a basic skill.


Correct but technically considered “medical treatment” per OSHA standards since the “first aid only” guidelines are used by this company. That’s where the confusion comes in. They aren’t licensed with any state agency to provide even BLS skills, strictly first aid only. If there isn’t a doc somewhere in the picture providing protocols couldn’t you be seen as practicing without a license even though you’re just using diagnostic tools pulse ox, BG readings etc..?


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## ffemt8978 (Feb 23, 2021)

FFmed said:


> Obtaining blood glucose, Sp02, assessing lung sounds, breathing into paper bag for panic attack. There are others..those are just some of the ones I remember.


They're still allowing breathing into a paper bag for a panic attack?  🤔


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## FFmed (Feb 23, 2021)

ffemt8978 said:


> They're still allowing breathing into a paper bag for a panic attack?  🤔


Right. “that’s how we’ve always done it” type of system. Sadly, the needed changes will probably only come after the “panic attack” is actually an asthmatic one who ends up unconscious after a few breaths of this lol😔


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## E tank (Feb 23, 2021)

ffemt8978 said:


> They're still allowing breathing into a paper bag for a panic attack?  🤔


He did say there's no medical direction....


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## NomadicMedic (Feb 23, 2021)

Don’t take that job. Walk away. Don’t look back.


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## ffemt8978 (Feb 23, 2021)

NomadicMedic said:


> Don’t take that job. Run away. Don’t look back.


FTFY


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## NomadicMedic (Feb 23, 2021)

Stay calm. No need to run.


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## akflightmedic (Feb 25, 2021)

I don't know, I really do not see an issue with the job. You are basically a "First Responder" to meet OSHA's on site First Aid requirements. I was an HSE specialist for many years as a dual role I had for an overseas federal contractor. Now being the ONLY paramedic on a remote FOB and being the HSE Coordinator, that was a direct conflict of interest. LOL And if you know OSHA rules and what constitutes a recordable versus a non-recordable and how those labels impact companies on existing and future contracts, your actions or inactions can literally cost millions. 

As for this role, how you have described it thus far, I do not have any alarm bells going on myself. I am sure they are ringing for you or others who have possibly not done many industrial OSHA type jobs or are relying on the lawsuit/liability mantras which are hammered so hard through school. I mean it is a real thing, not dismissing that, however it seems to be more of a boogeyman than what it truly is.

As for the meds, these are all OTC meds. If these people were at home, what would they do? They get a headache, they go to their medicine cabinet and they chug some pills. They are adults and at work. They get a headache, oops they do not regularly carry tylenol, and they do not want to go home. They just want a pill and to keep working. Give them a dang pill. They do not need physical exam, vitals, etc. They are not "patients" in the context we normally see patients in. They ate a sausage biscuit from a questionable gas station on the way in to wok, now they got the poops...give them some Imodium. Back to work. One standby company I worked for many moons ago (for anyone who wants to argue the above about this being "prescribing meds"), we simply had a large tackle box filled with OTC meds. We pointed at the box, said help yourself and left it at that. You know, treat people like adults. 

I am on the fence, if the pay, the hours, and the benefits work for you...give it a go. IN time you may be able to effect some change. Right now, run with how it is and make the best of it. If the pay, hours or benes are not that good and you cannot sleep at night anguishing over this...then bail.


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## NomadicMedic (Feb 25, 2021)

akflightmedic said:


> I don't know, I really do not see an issue with the job. You are basically a "First Responder" to meet OSHA's on site First Aid requirements. I was an HSE specialist for many years as a dual role I had for an overseas federal contractor. Now being the ONLY paramedic on a remote FOB and being the HSE Coordinator, that was a direct conflict of interest. LOL And if you know OSHA rules and what constitutes a recordable versus a non-recordable and how those labels impact companies on existing and future contracts, your actions or inactions can literally cost millions.
> 
> As for this role, how you have described it thus far, I do not have any alarm bells going on myself. I am sure they are ringing for you or others who have possibly not done many industrial OSHA type jobs or are relying on the lawsuit/liability mantras which are hammered so hard through school. I mean it is a real thing, not dismissing that, however it seems to be more of a boogeyman than what it truly is.
> 
> ...



I see your point in all of this, but the OP is obviously having issues coming to grips with the fact that he doesn’t need to take vital signs before giving somebody an aspirin for a headache. That’s not gonna make him a great occupational health style provider. It’s probably the wrong fit, and he just doesn’t realize it. Or maybe he does, and came to post here to validate his thought.

frankly, if you have to come to a message board to ask questions about right or wrong, that should be your first indication that it’s not a good fit.


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## FFmed (Feb 26, 2021)

NomadicMedic said:


> I see your point in all of this, but the OP is obviously having issues coming to grips with the fact that he doesn’t need to take vital signs before giving somebody an aspirin for a headache. That’s not gonna make him a great occupational health style provider. It’s probably the wrong fit, and he just doesn’t realize it. Or maybe he does, and came to post here to validate his thought.
> 
> frankly, if you have to come to a message board to ask questions about right or wrong, that should be your first indication that it’s not a good fit.


I just used the headache scenario as an example, and I should have also clarified that “right or wrong” isn’t really the issue here. Right vs wrong is about the same as normal vs abnormal and ultimately depends on which book you read and whose opinion your going on..The issue at hand is whether or not the “first aid” treatment that’s being provided (or not provided) in these situations can be seen as “medical treatment” and subject to the same laws/guidelines that your state has in place for EMS personnel. Having an established set of protocols (MD) doesn’t exempt you from lawsuits but it will definitely stand up better in front of a judge/jury should a disgruntled employee decide to pursue a case against you (not the company). I get it, it’s uncool to be too cautious and bust out a set of vitals every time someone has eyelash pain. I don’t plan on being “that guy” believe me. But handing out OTC meds to everyone everyday will eventually backfire. Someone’s gonna have a bleed somewhere, an allergic reaction or drug interaction and as low as risk it is, it’s still a risk. God help you when that day comes.  Maybe with time I could get comfortable with a gig like this but I would have to make some changes for sure and at least have some liability waivers in place signed by all employees if they choose to use the on-site  first aid clinic. You can’t depend on the company or anyone else to protect you. Again, not a case of right or wrong, I just wanted some feedback from other EMTs who have worked these types of gigs and the changes (if any) that they initiated to improve better outcomes for everyone involved. Thanks for the input🙏


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## NomadicMedic (Feb 27, 2021)

I get your position on this, and it's not really wrong. You're concerned because you're an EMT and if you took this job you might be put in a position where you'd be asked to perforrm outside your scope. 

When I said that this would make you a poor occupational health provider, I wasn't dissing you. It's more a dig at the company that's trying to fill the position of an occupational health spot with an EMT. You haven't been trained for that job and expecting an EMT to fill it is just the company betting that nothing bad will happen. And if you're a gambling man, you might feel comfortable with it. "How bad can it be. I'll hang out, give out some aspirin and immodum and bandage the occasional laceration. Easy peasy." 

Right up until it's not. 

As an example, I was offered a job as an occupational health paramedic with a large company that provided these services to warehouses. It paid well and the scope of practice was very clearly defined. There was a medical director and lots of occ health training provided to the staff. I didn't take the job because I was offered a 911 job and it was more in line with what I wanted to do. However, I had no concerns about that job. They explained that they knew I wasn't a trained occupational health guy, but they were going to train me. They did not want me working outside off my scope, and had standing orders from a physician that allowed me latitude in what I could do. It was similar to working as a MA in an urgent care. 

Conversely, this job you cited sounds like a company that is trying to fill a spot because they were told they needed somebody there and they have no real idea how an EMT functions, that a medical director is needed and that putting you in charge of dispensing OTC meds puts you in a difficult position. 

As far as you taking the job and "trying to change things"... That's usually an exercise in futility. Especially when you're an EMT in a manufacturing or warehouse facility. They probably just won't care what you have to say and if you rock the boat, they'll get someone to fill that spot that will just shut up and hand out the ibuprofen. 

So, you do what feels right to you... But I believe that putting an EMT in a situation where you have no legal authority to act as an EMT is a non starter.


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## Martyn (Mar 1, 2021)

Quote 'LOL And if you know OSHA rules and what constitutes a recordable versus a non-recordable and how those labels impact companies on existing and future contracts, your actions or inactions can literally cost millions.'

Stupid OSHA rule (for example): someone presents with a splinter in their finger, you remove said splinter using METAL tweezers - it then becomes a recordable incident as you used metal tweezers which OSHA class as a medical instrument.

Someone presents with a splinter in their finger, you remove said splinter with PLASTIC tweezers - this is NOT a recordable incident as plastic tweezers are NOT classed as medical instruments.

It's a nightmare with all the rules.

FYI, I am an EMT and trained as a HSMT (Health and Safety Medical Technician).


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## akflightmedic (Mar 2, 2021)

You got it! Just like if I give you 800mg of ibuprofen it is a recordable, but if I give you 400mg and tell you to take 1 pill every 4 hours, it is a non-recordable. 

And the "other duties as assigned" allows me to have you sit at a desk and stack papers or twiddle pens instead of getting a "lost time" on record. 

If I sutured someone, recordable. If I used butterfly strips, non recordable. If I used dermabond, recordable. If I instruct patient how to use dermabond on their own, non-recordable. All the rules exist for one reason or another, yet every single one of them has a complete workaround.


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## FFmed (Mar 2, 2021)

akflightmedic said:


> You got it! Just like if I give you 800mg of ibuprofen it is a recordable, but if I give you 400mg and tell you to take 1 pill every 4 hours, it is a non-recordable.
> 
> And the "other duties as assigned" allows me to have you sit at a desk and stack papers or twiddle pens instead of getting a "lost time" on record.
> 
> If I sutured someone, recordable. If I used butterfly strips, non recordable. If I used dermabond, recordable. If I instruct patient how to use dermabond on their own, non-recordable. All the rules exist for one reason or another, yet every single one of them has a complete workaround.


Geez..did you go straight from EMS into this job? How long did it take to really settle in and become comfortable? Did you ever have to provide more than first aid?


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## akflightmedic (Mar 3, 2021)

I was a govt contractor for many years, prior to my own medical business. I deployed as a medic, then took all the OSHA classes through the employer, then transitioned into a newly created "Safety Medic" role which meant they now rolled up two high paying jobs into one and gave me a fractional increase in wages that while ok at the time, in hindsight was an insult. Especially once deployed to remote FOBs and being the only medic/safety guy on site, and being expected to control recordables with the care I give or do not give....and also to turn a blind eye to many of the very unsafe operations taking place under the Camp Manager's direction who is responding to the US Gov daily demands and pressures.

'Twas a huge conflict of interest all the time...so I stuck to working out and being a hermit in my clinic/living container. Required inspections were announced way in advance at the morning meeting for all to plan for. See me walking, you best be doing the right thing.


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## BillEMTP (Mar 22, 2022)

I worked for a nationwide company that did mostly clinics at job sites. We were in a convention center doing first responder type calls. We also handed out OTC meds. 

I got nervous about doing this with no medical direction. Their protocols were geared for clinics and didn't address the type of calls we were running. I asked the manager about needing a first responder permit. I was told it wasn't necessary. Needless to say I don't work there anymore.


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## HardKnocks (Apr 4, 2022)

CCCSD said:


> As long as the LEMSA says it can be done, it’s a basic skill.



Some of us practice in Multi-State Jurisdictions. 

EMS Rules under the following State(s), (TX, FL, ID, AZ.), made no references made to the term LEMSA.

You have to remember that there are a large number of visitors to the forums that are just beginning in this career.


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## DrParasite (Apr 4, 2022)

akflightmedic said:


> As for the meds, these are all OTC meds. If these people were at home, what would they do? They get a headache, they go to their medicine cabinet and they chug some pills. They are adults and at work. They get a headache, oops they do not regularly carry tylenol, and they do not want to go home. They just want a pill and to keep working. Give them a dang pill. They do not need physical exam, vitals, etc. They are not "patients" in the context we normally see patients in. They ate a sausage biscuit from a questionable gas station on the way in to wok, now they got the poops...give them some Imodium. Back to work. One standby company I worked for many moons ago (for anyone who wants to argue the above about this being "prescribing meds"), we simply had a large tackle box filled with OTC meds. We pointed at the box, said help yourself and left it at that. You know, treat people like adults.


The problem is, OTC meds are still meds that need approval, at least from the prehospital guidelines.  Your standby company did what we used to do:  we won't give them the meds, but if they want to get it from the cabinet, they can get what they want.  it's stupid, that some places don't let EMTs give benedryl for an allergic rxn, or tylenol for a headache, but mom and dad could give it to their kids or each other with no issues. 

As for the original question, I interviewed for a job as an OMT (occupational medical technician), which sounds like what OP is describing.  they required you to have an EMT cert to get hired, but once hired, you followed the employers SOPs (which, in theory, were signed off on by a doctor, somewhere in the US).  Some of the procedures were beyond the scope of your basic EMT, but, as it was explained to me, you weren't functioning as an EMT, so you had a wider scope of what you can do.  The whole idea was the prevent recordable incidents, and to prevent 911 and OSHA from seeing any elevated numbers.  Suffice it to say, I said thanks but no thanks.


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