# Medic working BLS only.



## Amber2313 (Dec 5, 2010)

I asked this question within a thread once directly, but that person didn't respond, so I guess I'll ask a broader audience.
Back home (I'm in college hours away) I work for a private BLS service doing emergent and non-emergent transport. We also have a mutual-aid contract with the county, so we pick up a good number of their transports as well. My company's entire staff is made up of basics and drivers -and one medic. 
The company I work for is contracted (for several years now) to work at a local dirt track. When cars flip, we go out. When people in the stands get too drunk, we go out. We have 2 of our trucks out there and a local volunteer fd brings a truck, too. If there isn't at least one truck on standby, races don't happen. When called down, one rig goes out and the other hangs back unless it is obviously more than one truck should handle or the first truck calls back for assistance.
That medic is one of those guys that only wants to go out on "good" calls. Usually we go, check someone out, and get a refusal, but on those times that we do transport, out medic likes to prod. Obviously if it's more than a BLS call, we're calling for intercept, but he steps on toes and knows it. 

So here's my question: If we do have to transport, and the medic begins to poke, should we let him take over just because he's a medic, even if it is a BLS service and he can only use the same skills we can?


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## firecoins (Dec 5, 2010)

ems.amber911 said:


> So here's my question: If we do have to transport, and the medic begins to poke, should we let him take over just because he's a medic, even if it is a BLS service and he can only use the same skills we can?



Yes. He is in charge.  Even if he can't use ALS skills, he has still been trained to a higher level. He still will be held to that level if the it hits the fan.  So what if he "steps on your toes"  bite your ego and let him run it.  If you were a patient on a BLS truck would you want a Medic with 12 to 18 months of training working on you or an EMT-B with 150 hours of training working on you?


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## EMT11KDL (Dec 5, 2010)

ems.amber911 said:


> I asked this question within a thread once directly, but that person didn't respond, so I guess I'll ask a broader audience.
> Back home (I'm in college hours away) I work for a private BLS service doing emergent and non-emergent transport. We also have a mutual-aid contract with the county, so we pick up a good number of their transports as well. My company's entire staff is made up of basics and drivers -and one medic.
> The company I work for is contracted (for several years now) to work at a local dirt track. When cars flip, we go out. When people in the stands get too drunk, we go out. We have 2 of our trucks out there and a local volunteer fd brings a truck, too. If there isn't at least one truck on standby, races don't happen. When called down, one rig goes out and the other hangs back unless it is obviously more than one truck should handle or the first truck calls back for assistance.
> That medic is one of those guys that only wants to go out on "good" calls. Usually we go, check someone out, and get a refusal, but on those times that we do transport, out medic likes to prod. Obviously if it's more than a BLS call, we're calling for intercept, but he steps on toes and knows it.
> ...



I am not sure about your state laws for EMS.  But in the State of Idaho, If Said person is a Paramedic, but they are working on a BLS rig, there scope of practice is BLS.  So If he is working on the BLS rig, than NO he should not be doing anything more than the scope allowed for that agency/rig.  

Personally, what ever he does, DOCUMENT IT! and I am not saying document to get him in trouble, document to keep yourself out of trouble.  Document EVERYTHING!!!!!


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## firecoins (Dec 5, 2010)

EMT11KDL said:


> I am not sure about your state laws for EMS.  But in the State of Idaho, If Said person is a Paramedic, but they are working on a BLS rig, there scope of practice is BLS.  So If he is working on the BLS rig, than NO he should not be doing anything more than the scope allowed for that agency/rig.
> 
> Personally, what ever he does, DOCUMENT IT! and I am not saying document to get him in trouble, document to keep yourself out of trouble.  Document EVERYTHING!!!!!



He isn't saying the medic is working out of his scope.


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## Amber2313 (Dec 5, 2010)

EMT11KDL said:


> I am not sure about your state laws for EMS.  But in the State of Idaho, If Said person is a Paramedic, but they are working on a BLS rig, there scope of practice is BLS.



Same.


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## Amber2313 (Dec 5, 2010)

firecoins said:


> Yes. He is in charge.  Even if he can't use ALS skills, he has still been trained to a higher level. He still will be held to that level if the it hits the fan.  So what if he "steps on your toes"  bite your ego and let him run it.  If you were a patient on a BLS truck would you want a Medic with 12 to 18 months of training working on you or an EMT-B with 150 hours of training working on you?



See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.


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## Shishkabob (Dec 5, 2010)

ems.amber911 said:


> See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.



Who cares if it's a BLS call?  Doesn't make the EMT any more qualified at running it.  Most of the calls we run in EMS are pretty much BLS.


The medic is in charge of patient care, no questions asked, regardless of what he's working as at the moment.  As has been stated, in a court of law you are held to your highest certification. He still carries the patch and the responsibilities that go with it.


I'll admit it, I've stepped on toes.  Every medic has.  Tends to happen when you put your patients wellbeing above that of another providers feelings.


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## Shishkabob (Dec 5, 2010)

ems.amber911 said:


> See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.



Who cares if it's a BLS call?  Doesn't make the EMT any more qualified at running it.  The patient should still get the assessment done by the most educated provider, regardless of their initial complaint.  The interventions afterward should correlate with what needs to be done.


The medic is in charge of patient care, no questions asked, regardless of what he's working as at the moment.  As has been stated, in a court of law you are held to your highest certification. He still carries the patch and the responsibilities that go with it.  That is why I absolutely refuse to work on a BLS truck.  


I'll admit it, I've stepped on toes.  Every medic has.  Tends to happen when you put your patients wellbeing above that of another providers feelings.  I try to avoid it, but it happens.  However we also do not know to what level he's "stepped on toes" as the OP doesn't really explain that part...


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## Veneficus (Dec 5, 2010)

ems.amber911 said:


> See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.



I don't think that is the case. If I showed up on a BLS ambulance, the assessment I could perform and the decisions I could make from it could easily exceed that of "BLS skills."

A paramedic is not a higher level of care provider because of a handful of psychomotor skills. They are so because of the knowledge base they can call upon to more accurately decide what treatments are indicated.

Having said that though, it doesn't give anyone the right to be a jerk with their coworkers.

I think many EMS people have a slightly skewed view of higher level providers. They often see what they do as not trusting/capable, showing off, or something similar. It is not that personal, really.


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## firecoins (Dec 5, 2010)

ems.amber911 said:


> See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.



he is responsible for your actions whether your doing something wrong or not.  He is in charge whether he takes it or not.

as mentioned, your boiling it down to psychomotor skills.


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## EMT11KDL (Dec 5, 2010)

firecoins said:


> He isn't saying the medic is working out of his scope.



i might have misread what was wrote,  The op said "poke" so I was assuming poke as in IV.


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## Amber2313 (Dec 5, 2010)

Let me add an additional tidbit of info.
Management has reprimanded him for acting as he has and says since we're BLS, so is he, and he should only take the calls in order. There is no system of "he's a medic, he's on top" because that's not how management sees it (though I think that's more of a personal issue than an education one).
The way the track is supposed to run with two trucks is that truck 1, which is closest to the gate to get on the track, is supposed to go down when called, goes first and calls truck 2 if they need assistance. On rare occasions, both go down at once because of multiple car pileups. 
He will call over radio and ask us to stop and trade places so me, the EMT, stays at the race track so races can still run and he can take pt in. (Hypothetically. I've never had to deal with him for more reasons than I want to explain. 
Anyway... back to taking calls in order.. the plan is that if truck 1 transports, truck 2 becomes truck 1 so that races can still run. If truck 2 transports too, which I've never seen, then races are done until a rig gets back or they're just postponed. 
There is no hierarchy because of education there as management stands. That's why things are set that way.

Without all the detail before, I'm asking what's right.
Management or .. everything else.

Trust me, I've considered all this before, but opinions are always a good thing as long as they're p o l i t e.


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## Amber2313 (Dec 5, 2010)

EMT11KDL said:


> i might have misread what was wrote,  The op said "poke" so I was assuming poke as in IV.



My bad. No IVs here.


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## Veneficus (Dec 5, 2010)

ems.amber911 said:


> Let me add an additional tidbit of info.
> Management has reprimanded him for acting as he has and says since we're BLS, so is he, and he should only take the calls in order. There is no system of "he's a medic, he's on top" because that's not how management sees it (though I think that's more of a personal issue than an education one).
> The way the track is supposed to run with two trucks is that truck 1, which is closest to the gate to get on the track, is supposed to go down when called, goes first and calls truck 2 if they need assistance. On rare occasions, both go down at once because of multiple car pileups.
> He will call over radio and ask us to stop and trade places so me, the EMT, stays at the race track so races can still run and he can take pt in. (Hypothetically. I've never had to deal with him for more reasons than I want to explain.
> ...



I think management in this case is making a mistake and that they are not properly utilizing their resources to the best benefit of all involved.

In order to make best use of resources, this "medic" if the only one at that level should see all patients. He should then disposition them to be transported, sign refusal, whatever. Since he has nothing to function past that of anyone else, he should remain at the track unless he is part of the last unit to transport before none are available.


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## brentoli (Dec 5, 2010)

In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
Of course a medic would have greater knowledge, but a restricted skill set. 
I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.


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## Amber2313 (Dec 5, 2010)

brentoli said:


> In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
> Of course a medic would have greater knowledge, but a restricted skill set.
> I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
> I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.



Originally Winamac, currently Bloomington (Give ya one guess. Ha)
I understand that completely. That's why I can see either side of this being viable. One one hand, no matter the restriction on their skills, medics have more experience. But on the other, he can only use the same skills as me and if I'm not 100% with those skills as he should be too, then I shouldn't be out their teching as a basic.


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## Veneficus (Dec 5, 2010)

brentoli said:


> In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
> Of course a medic would have greater knowledge, but a restricted skill set.
> I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
> I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.



I am not talking about interventions.

I am saying that the knowledge of a medic makes him better suited to disposition patients no matter what skills he is using. Just like a physician who showed up and had no equipment would be able to make more educated decisions.


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## STXmedic (Dec 5, 2010)

Even if he's not cleared to do ALS interventions, he's still got a much higher knowledge base than an EMT-B. As has been said, a paramedic's assessment skills are one of the major distinctions between an EMT-B. And you need no special clearance to do a patient assessment. He may see a mechanism that raises a high index of suspicion for an internal injury, that may have been looked over by a basic (no fault of the basic, just a lack of training). He may also see a potential for the patient to deteriorate rapidly 2/2 said injury. Also, I don't know how things work where you are, but where I work if you call the hospital and speak to the attending physician, he can clear you for interventions above what you may be cleared through by your service to do (to an extent, they aren't going to recommend a chest tube in the field, especially without proper training). Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.


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## Amber2313 (Dec 5, 2010)

Veneficus said:


> I am not talking about interventions.
> 
> I am saying that the knowledge of a medic makes him better suited to disposition patients no matter what skills he is using. Just like a physician who showed up and had no equipment would be able to make more educated decisions.



But for a patient that's cut his arm reaching over the fan of a motor? That's a lot of what we see. If you think Mr.Medic should oversee all patients, this is one where I think that's wrong. 
For a patient that was in a fight (hickheaven + mini-nascar...) and was injured either by getting hit with fists, beer bottles, car parts, or otherwise... was cut with any of those.
Or for a patient that rolled his car, is bruised from the seatbelt, and whose wife is worried and insists he be taken into ER just in case...

If it's something more than what I completely understand and can take care of, I'm calling ALS in the first place. In the meantime, sure, why not grab the medic? But there's nothing he can do that I can't in those rigs regarding patient care, education and experience or not. If it's something I know how to handle, I do as he would. Same skills. If not, he couldn't do anything about it anyway. ....right?

And I know what you're saying... he knows about outside things I may not recognize. Yes, he may, but I know and understand every skill I was taught as a basic. If I'm dealing with anything outside of that, ALS it is.


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## Amber2313 (Dec 5, 2010)

PoeticInjustice said:


> Even if he's not cleared to do ALS interventions, he's still got a much higher knowledge base than an EMT-B. As has been said, a paramedic's assessment skills are one of the major distinctions between an EMT-B. And you need no special clearance to do a patient assessment. He may see a mechanism that raises a high index of suspicion for an internal injury, that may have been looked over by a basic (no fault of the basic, just a lack of training). He may also see a potential for the patient to deteriorate rapidly 2/2 said injury. Also, I don't know how things work where you are, but where I work if you call the hospital and speak to the attending physician, he can clear you for interventions above what you may be cleared through by your service to do (to an extent, they aren't going to recommend a chest tube in the field, especially without proper training). Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.



He can do NOTHING ALS on our rigs because we're BLS. It's not him; it's the company. 

I agree with you that sometimes throwing him in is a good idea, but not every transport, which is his thinking because he's a medic he says and management has battled.

There are a lot of individual and personal issues involved that play into this more than I realized before talking to people here.


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## STXmedic (Dec 5, 2010)

ems.amber911 said:


> * he knows about outside things I may not recognize*. Yes, he may, but I know and understand every skill I was taught as a basic. *If I'm dealing with anything outside of that, ALS it is*.



Exactly my point. What if you DONT recognize it.


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## Veneficus (Dec 5, 2010)

Veneficus said:


> I think management in this case is making a mistake and that they are not properly utilizing their resources to the best benefit of all involved.
> 
> In order to make best use of resources, this "medic" if the only one at that level should *see all patients*. He should *then disposition them *to be transported, sign refusal, whatever. *Since he has nothing to function past that of anyone else, he should remain at the track unless he is part of the last unit to transport before none are available*.




I do not think he should ride a call, there is absolutely nothing he can do that a Basic Can't in a rig with only BLS equipment on it.

A medic is not somehow automatically superior at basic psychomotor skills. In the situation you described, I stand by my bolded statement.


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## Amber2313 (Dec 5, 2010)

PoeticInjustice said:


> Exactly my point. What if you DONT recognize it.



So what if it were a night that that medic wasn't working the races? 2 basics / 2 drivers. If something goes wrong or I suspect it will I call ALS.
If there's something that could potentially be more than I see, I'm pulling Mr. Medic in, absolutely, but I don't see needing that in the situations I presented. I'm asking about EVERY transport, not the more difficult ones (which honestly are nearly 1 in a million out there, which is why none of this is a big deal, just wanted opinions)


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## brentoli (Dec 5, 2010)

PoeticInjustice said:


> . Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.



Can't carry equipment outside of the services scope of practice without a waiver in IN.


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## brentoli (Dec 5, 2010)

While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.

Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.


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## Shishkabob (Dec 5, 2010)

brentoli said:


> While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.



Except said mechanic can recognize a catestrophic event coming and tell you not to attempt to start the car and call for a tow truck.


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## Chimpie (Dec 5, 2010)

Our department (industrial facility) was providing a service to the First Responder level only.  We had EMTs and Medics working with us but they were limited to the MFR scope just like the rest of the us.  

When on calls, we all were the same level.  Whether the responder was a MFR, Basic or 'Medic, no one had seniority of the call unless they were a senior ranking officer (Lt, Capt., Chief).


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## Amber2313 (Dec 5, 2010)

brentoli said:


> Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.



I don't understand. We're not ALS, nor do we try to be. That's the point? Unless you mean outside of this case.


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## Amber2313 (Dec 5, 2010)

Chimpie said:


> Our department (industrial facility) was providing a service to the First Responder level only.  We had EMTs and Medics working with us but they were limited to the MFR scope just like the rest of the us.
> 
> When on calls, we all were the same level.  Whether the responder was a MFR, Basic or 'Medic, no one had seniority of the call unless they were a senior ranking officer (Lt, Capt., Chief).



So did the medics (or EMTs in your case, too) ever try to act outside of that as if they had seniority like my Mr. Medic does? And if not, how would you handle one if they did? 

Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...


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## Veneficus (Dec 5, 2010)

brentoli said:


> While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.



It is not exactly that simple. 

With some basic things like a stethoscope I can find a myriad of things. From the neck to the abdomen. A BP cuff can give me an ankle brachial index. My understanding and knowledge of pathology allows  me to find a myriad of things, as well as monitor a patient clinically over time. 

Bt I am not unique to this, the more education and experience a person has the better at it they are.

Just by the numbers at 120 for basic, 750 for medic, that is 6.25 times the education. 



brentoli said:


> Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.



Cost?
Availabillity?

ALS isn't a need, it is a want.


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## Chimpie (Dec 5, 2010)

ems.amber911 said:


> So did the medics (or EMTs in your case, too) ever try to act outside of that as if they had seniority like my Mr. Medic does? And if not, how would you handle one if they did?
> 
> Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...



No, no one acted with seniority unless they seniority.  We had too much respect for each other.  If someone did (sometimes we had bad days) we were all open enough with each other to be able to talk it out.

If the behavior continued I'm sure we would have worked it up the chain.  

If you've done this and there are still problems, start documenting dates/times the 'bullying' occurred and the dates/times you talked to your supervisors about it.

Maybe everyone needs to sit together to try and work it out.


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## Amber2313 (Dec 5, 2010)

Chimpie said:


> No, no one acted with seniority unless they seniority.  We had too much respect for each other.  If someone did (sometimes we had bad days) we were all open enough with each other to be able to talk it out.
> 
> If the behavior continued I'm sure we would have worked it up the chain.
> 
> ...



That company has a lot of interpersonal issues. It's a well-known fact. That's why this seems so troubling, I think. It's full of drama, but it's very flexible with me living 4 hours away in college, so it's still worth it. I just wanted some opinions outside my own on this. 
Thank you.


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## Shishkabob (Dec 5, 2010)

ems.amber911 said:


> Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...





I don't care if someone is my captain, chief, or the President of the United States.  If I am the highest credentialed medical professional, any and every patient care decision is up to me.  If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards.   Guess I'm a jerky medic.


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## brentoli (Dec 5, 2010)

Veneficus said:


> It is not exactly that simple.
> 
> With some basic things like a stethoscope I can find a myriad of things. From the neck to the abdomen. A BP cuff can give me an ankle brachial index. My understanding and knowledge of pathology allows  me to find a myriad of things, as well as monitor a patient clinically over time.



Aside from a more detailed report how can you develop any course of treatment? No one disputes you can perform a better assessment.


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## Amber2313 (Dec 5, 2010)

Linuss said:


> I don't care if someone is my captain, chief, or the President of the United States.  If I am the highest credentialed medical professional, any and every patient care decision is up to me.  If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards.   Guess I'm a jerky medic.



I agree if there's something wrong with the care they're getting from the lower certified techs, but if not, what's the harm?


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## brentoli (Dec 5, 2010)

ems.amber911 said:


> I don't understand. We're not ALS, nor do we try to be. That's the point? Unless you mean outside of this case.



I got on a tangent sorry.


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## Veneficus (Dec 5, 2010)

brentoli said:


> Aside from a more detailed report how can you develop any course of treatment? No one disputes you can perform a better assessment.



A better assessment decides if an ALS unit needs to be involved or not.

It decides how much effort needs to be put into to talking people into being evaluated at a hospital when they don't want to be.

It identifies occult injuries that maybe completely unknown to a more junior provider. 

It decides who needs to be transported, how urgently, and in what order.

What to watch for if the person refuses treatment or transport to determine if they are worsening before they crash.

It determines who is at great risk of having complications with treatment available, and adjusting for that or seeking permission to.


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## CAOX3 (Dec 5, 2010)

Linuss said:


> I don't care if someone is my captain, chief, or the President of the United States.  If I am the highest credentialed medical professional, any and every patient care decision is up to me.  If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards.   Guess I'm a jerky medic.



Here is the issue, no one operates at the als level in my service unless given the green light by our medical director.  Just because you passed the bare minimum test offered by the state means little in my service and to my medical director. 

Your an emt unless he tells you otherwise.  You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.

Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.


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## JPINFV (Dec 5, 2010)

CAOX3 said:


> Here is the issue, no one operates at the als level in my service unless given the green light by our medical director.  Just because you passed the bare minimum test offered by the state means little in my service and to my medical director.
> 
> Your an emt unless he tells you otherwise.  You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.
> 
> Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.



Here's the problem with this. Just because someone is limited to EMT interventions and EMT diagnostic tools (however, being in California, I could play word games with how the scope of practice is written in terms of diagnostics. "Evaluate the ill and injured" and "obtain vital signs including, but not limited to" are broad), doesn't mean that the assessment is necessarily limited to an EMT level assessment or EMT level clinical reasoning. If I went back to work on the ambulance tomorrow, even though I would be an EMT, that doesn't preclude me from using techniques such as percussion or considering the medications that the patient is on, even though I didn't learn it in EMT class.


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## Akulahawk (Dec 5, 2010)

CAOX3 said:


> Here is the issue, no one operates at the als level in my service unless given the green light by our medical director.  Just because you passed the bare minimum test offered by the state means little in my service and to my medical director.
> 
> Your an emt unless he tells you otherwise.  You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.
> 
> Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.





JPINFV said:


> Here's the problem with this. Just because someone is limited to EMT interventions and EMT diagnostic tools (however, being in California, I could play word games with how the scope of practice is written in terms of diagnostics. "Evaluate the ill and injured" and "obtain vital signs including, but not limited to" are broad), doesn't mean that the assessment is necessarily limited to an EMT level assessment or EMT level clinical reasoning. If I went back to work on the ambulance tomorrow, even though I would be an EMT, that doesn't preclude me from using techniques such as percussion or considering the medications that the patient is on, even though I didn't learn it in EMT class.


While I'm not in DO school as JP is... I also have a MUCH more advanced education than a Paramedic does. I just also happen to be a Paramedic. While working BLS, I'd be "stuck" with BLS tools. That doesn't mean that I can't evaluate the patient at the higher level limited by equipment at hand... However, the problem is that if I were to do the full scope of what I _can_ do, that could be considered "Practicing Medicine without a License" depending upon the exact circumstances. 

I have worked BLS as a Medic before. Normally, I'd switch off calls with my BLS partner. However, I'm also responsible for my partner's actions as I'm far more educated. If the SHTF... _I'm_ the one that's going to be held responsible because I'm the most medically qualified.

My take on educational hours
EMT=150 hours
Paramedic=1275 hours
ATC = appx 3500 hours (I ended up doing something like 5500+ due to being in two internship programs, one at a JC and other while at a 4 year, + claswork)
Doc = Ungodly numbers of hours...


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## CAOX3 (Dec 5, 2010)

JPINFV said:


> Here's the problem with this. Just because someone is limited to EMT interventions and EMT diagnostic tools (however, being in California, I could play word games with how the scope of practice is written in terms of diagnostics. "Evaluate the ill and injured" and "obtain vital signs including, but not limited to" are broad), doesn't mean that the assessment is necessarily limited to an EMT level assessment or EMT level clinical reasoning. If I went back to work on the ambulance tomorrow, even though I would be an EMT, that doesn't preclude me from using techniques such as percussion or considering the medications that the patient is on, even though I didn't learn it in EMT class.



Absolutely, I'm not saying your not allowed to use your training and education to our advantage and patient benefit but all this screaming I'm in charge, I'm in charge because I'm a medic isn't going to get you very far in my service unless your
approved, promoted and operating as one.


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## Mzcr (Dec 5, 2010)

Patient care should take a back seat to egos. The medic, with or without equipment, should be better able to evaluate a patient and determine best available treatment and when/if to call for appropriate assistance. Getting your feelings hurt isn't helping the patient.


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## Akulahawk (Dec 5, 2010)

CAOX3 said:


> Absolutely, I'm not saying your not allowed to use your training and education to our advantage and patient benefit but all this screaming I'm in charge, I'm in charge because I'm a medic isn't going to get you very far in my service unless your
> approved, promoted and operating as one.


That's fine, but if your partner does something wrong, YOU are also responsible because YOU still have the higher license. Does your service also indemnify you for this? Last time I checked, a local agency doesn't and can't override a state agency or state law... Chances are, while it could happen, it probably relatively rarely does. But they could just leave your butt hanging out to dry over something you were present for.


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## CAOX3 (Dec 5, 2010)

Akulahawk said:


> I have worked BLS as a Medic before. Normally, I'd switch off calls with my BLS partner. However, I'm also responsible for my partner's actions as I'm far more educated. If the SHTF... _I'm_ the one that's going to be held responsible because I'm the most medically qualified.



I understand what your saying here a medic working as an emt isn't held any more responsible then an emt working as an emt.

For example if we re transporting a sob patient and your driving and I decide to give an albuterol treatment the patient flashes  and the :censored::censored::censored::censored: his the fan, in my service your not going to be held responsible for my actions if we are both only approved to work at the bls level even if your a medic. 

My medical director is the only one who can grant you permission to operate at your level of training, if he says you can only operate at the emt level, then that's what level you operate at.  You may feel more responsible since your training level is greater then mine, but you wouldn't be held any more responsible then I would.  I should know the aspects of my job and if I make a decision detrimental to the patient then its my responsibility and I take the heat.


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## firecoins (Dec 5, 2010)

CAOX3 said:


> Absolutely, I'm not saying your not allowed to use your training and education to our advantage and patient benefit but all this screaming I'm in charge, I'm in charge because I'm a medic isn't going to get you very far in my service unless your
> approved, promoted and operating as one.



A medic working on BLS truck should know more and act in accordance.  
Even if your medical director does not approve said medic to work as a medic, the medic will be held at a higher standard when working in the capacity of EMT-B.  Why?  He is certfied by the state as a higher level than an EMT and his credentials are at risk if he does something unbecoming.  

If a medic working on a BLS truck fails to catch something or his EMT-B does and fails to call ALS or makes some other improper transport decision, it could still come back to the medic, theoretically.


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## Amber2313 (Dec 5, 2010)

Mzcr said:


> Patient care should take a back seat to egos. The medic, with or without equipment, should be better able to evaluate a patient and determine best available treatment and when/if to call for appropriate assistance. Getting your feelings hurt isn't helping the patient.



It's not an ego issue. If it's a call something worthy of him looking it over, by all means, go for it. However, when my patient cuts himself reaching across a motor fan or gets punched in a fight, I don't see the need for Mr. Medic to jump in. Why, in the case, is his treatment better than any other tech out there? Every one of us can handle a band-aid and a bruise. Nothing hidden is going to jump out at me and take my patient due to those injuries and I know it. Stop assuming it's about feelings. It's about all this annoying, unnecessary shuffling of patient and a paragod.


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## Amber2313 (Dec 5, 2010)

firecoins said:


> A medic working on BLS truck should know more and act in accordance.
> Even if your medical director does not approve said medic to work as a medic, the medic will be held at a higher standard when working in the capacity of EMT-B.  Why?  He is certfied by the state as a higher level than an EMT and his credentials are at risk if he does something unbecoming.
> 
> If a medic working on a BLS truck fails to catch something or his EMT-B does and fails to call ALS or makes some other improper transport decision, it could still come back to the medic, theoretically.



In terms of a mistake, possibly. In terms of having your hands tied behind your back and not being allowed to do what you're trained to because of the company you work for, I think if the state tried to pull his cert for that he'd have fair ground to fight it. 
I'm not expert in that company, but I assume that's how it would go down should SHTF.


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## Shishkabob (Dec 5, 2010)

ems.amber911 said:


> In terms of a mistake, possibly. In terms of having your hands tied behind your back and not being allowed to do what you're trained to because of the company you work for, I think if the state tried to pull his cert for that he'd have fair ground to fight it.
> I'm not expert in that company, but I assume that's how it would go down should SHTF.



That's the thing, it's a no win situation for the Paramedic and is the reason why I, and many other medics I know, refuse to work in the capacity of a BLS responder. 

In every agency I've ever seen, the Paramedic is deemed in charge of patient care, seniority of lower providers is irrelevant.  Granted I've never seen what the guidelines of BLS only departments say, but then again I don't care as I wont be in that position of being handicapped.



This isn't a red patch vs blue patch thing, so don't go thinking the Paramedics (or Intermediates in the same position) in here are egotistical because we say we're in charge.  This is protecting the patient as much as it is protecting ourselves and our way of life.  Amber... you're in medic school, you'll see soon enough the amount of burden put on you solely due to your patch.


You'll find we're a bit protective about our certification.


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## firecoins (Dec 5, 2010)

ems.amber911 said:


> *In terms of a mistake, possibly*. In terms of having your hands tied behind your back and not being allowed to do what you're trained to because of the company you work for, I think if the state tried to pull his cert for that he'd have fair ground to fight it.
> I'm not expert in that company, but I assume that's how it would go down should SHTF.



Yes in terms of mistake made by himself or by his EMT-B partner.  The medic is responsible even if he is not "in charge" of his partner.  

A medic is not required to do ALS interventions unless the medical director allows him to do so.  Its also hard to do ALS interventions without ALS equipment which can not be found on a BLS truck.  

I myself pick up BLS shifts.  I do not have access to ALS equipment and am expected to perform BLS only.  I do not order my EMT partners around but I make sure everything is being done by the book.  I make sure we have medics if we need them and they are available.  I make sure we go to the correct facilities which is usually not a problem but has become an issue on occassion.


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## CAOX3 (Dec 5, 2010)

firecoins said:


> A medic working on BLS truck should know more and act in accordance.
> Even if your medical director does not approve said medic to work as a medic, the medic will be held at a higher standard when working in the capacity of EMT-B.  Why?  He is certfied by the state as a higher level than an EMT and his credentials are at risk if he does something unbecoming.
> 
> If a medic working on a BLS truck fails to catch something or his EMT-B does and fails to call ALS or makes some other improper transport decision, it could still come back to the medic, theoretically.



The state gives you the ability, medical control gives you the authority.  

Scenario:

If your medical control removes intubation and acls from you r protocols, the state isn't going to hold you responsible if you don't intubate or follow acls protocols right? Even though that's what you were taught.

What I'm saying is the state doesn't supersede med control.  If he says your an emt then your an emt.  You operate under his lic. and he has the ability to limit or expand your scope of practice as he sees fit.


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## Mzcr (Dec 5, 2010)

ems.amber911 said:


> It's not an ego issue. If it's a call something worthy of him looking it over, by all means, go for it. However, when my patient cuts himself reaching across a motor fan or gets punched in a fight, I don't see the need for Mr. Medic to jump in. Why, in the case, is his treatment better than any other tech out there? Every one of us can handle a band-aid and a bruise. Nothing hidden is going to jump out at me and take my patient due to those injuries and I know it. Stop assuming it's about feelings. It's about all this annoying, unnecessary shuffling of patient and a paragod.



You don't seem to see any point in him looking anyone over. 

Bottom line is you can't change other people. He's a medic. He has a much greater level of training and therefore responsibility for patients than you do. If he's a jerk, he's a jerk. You can't change that. You can either refuse to get upset about it, address it with the company, or find a new job.


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## firecoins (Dec 5, 2010)

CAOX3 said:


> What I'm saying is the state doesn't supersede med control.  If he says your an emt then your an emt.  You operate under his lic. and he has the ability to limit or expand your scope of practice as he sees fit.



I agree but he can not give you something out of the scope of your training but he can limit or expand your abilities within that scope.


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## Shishkabob (Dec 5, 2010)

firecoins said:


> I agree but he can not give you something out of the scope of your training but he can limit or expand your abilities within that scope.



Don't speak for Texas ^_^


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## Amber2313 (Dec 5, 2010)

Mzcr said:


> You don't seem to see any point in him looking anyone over.
> 
> Bottom line is you can't change other people. He's a medic. He has a much greater level of training and therefore responsibility for patients than you do. If he's a jerk, he's a jerk. You can't change that. You can either refuse to get upset about it, address it with the company, or find a new job.



Have you read my posts? Obviously not. I suggest trying that before you go being impolite. I don't see any point in him looking over patients that obviously don't need it. No. If there's reason or suspicion, like I said before, he can have at it.


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## firecoins (Dec 5, 2010)

Linuss said:


> Don't speak for Texas ^_^



I won't speak for Texas if you don't speak for NY.


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## Akulahawk (Dec 5, 2010)

CAOX3 said:


> The state gives you the ability, medical control gives you the authority.
> 
> Scenario:
> 
> ...


The State giveth your ability. It also giveth the responsibility. The Medical Director giveth you the authority to perform at a certain level within the system the Medical Director haveth responsibility over. Medical Director can not removeth you from responsibility the state giveth to you. B)

In other words, your medical control removes intubation and acls from your protocols, that's fine. However, it does NOT remove you from the responsibility from recognizing that your patient will shortly need those interventions and you or your partner FAIL to bring the patient or deliver the patient to where those interventions may be done because your education and experience tell you that must happen where an EMT-B may not have a sufficient education or experience to recognize the impending problem.


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## Mzcr (Dec 5, 2010)

Actually, I read all your posts and have said nothing impolite. Why do you insist on taking offense?


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## Amber2313 (Dec 5, 2010)

Mzcr said:


> Actually, I read all your posts and have said nothing impolite. Why do you insist on taking offense?



Lol. Okay, I'm done. You said what you wanted to. I semi-agree. All I wanted was opinions and it's not a big deal anyway. Have a nice life. I'll probably see you around the forum sometime I'm sure.


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## CAOX3 (Dec 6, 2010)

Akulahawk said:


> The State giveth your ability. It also giveth the responsibility. The Medical Director giveth you the authority to perform at a certain level within the system the Medical Director haveth responsibility over. Medical Director can not removeth you from responsibility the state giveth to you. B)
> 
> In other words, your medical control removes intubation and acls from your protocols, that's fine. However, it does NOT remove you from the responsibility from recognizing that your patient will shortly need those interventions and you or your partner FAIL to bring the patient or deliver the patient to where those interventions may be done because your education and experience tell you that must happen where an EMT-B may not have a sufficient education or experience to recognize the impending problem.



I see what your saying, I just don't believe a medic should be held responsible if the powers that be only allow him to operate at the emt level.  

Handcuff ing the medic and  then punishing him for something I do seems ridiculous to me.  Even if we were operating in a pb system and I do something in my scope that I shouldn't and it determined to be detrimental to the patient I should bear the brunt not the medic. 

 I'm  a certified provider and have the ability to operate on my own by the state, the medic shouldn't be held responsible for my actions, just as a doctor shouldn't if a nurse makes a wrong treatment decision.  We are all providers and allowed to make decisions, if I make the wrong one I should be the one punished regardless of who else is there.

Very good topic and discussion.


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## Akulahawk (Dec 6, 2010)

CAOX3 said:


> I see what your saying, I just don't believe a medic should be held responsible if the powers that be only allow him to operate at the emt level.
> 
> Handcuff ing the medic and  then punishing him for something I do seems ridiculous to me.  Even if we were operating in a pb system and I do something in my scope that I shouldn't and it determined to be detrimental to the patient I should bear the brunt not the medic.
> 
> ...


If the medic is aware of what you're doing and fails to stop you from doing it, then yes, that medic is responsible. Same with the Doc. If the Doc is aware that the RN is making a mistake and fails to correct it, the Doc is also responsible. The person who made the mistake is also held responsible. 

When I worked as a Basic while licensed as a Medic, there were reasons why I'd do the things I did... sometimes it might have been perceived as rude or whatever at the time but remember that I'm going to protect my license. I won't let you do something to harm the patient because of that. I may be functioning as a Basic at the time, but I have some liability because I have a higher license and therefore, I should "know better" about patient care stuff, even if you're the one providing care.


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## Veneficus (Dec 6, 2010)

CAOX3 said:


> I see what your saying, I just don't believe a medic should be held responsible if the powers that be only allow him to operate at the emt level.
> 
> Handcuff ing the medic and  then punishing him for something I do seems ridiculous to me.  Even if we were operating in a pb system and I do something in my scope that I shouldn't and it determined to be detrimental to the patient I should bear the brunt not the medic.
> 
> ...




I agree with your points.

But life isn't fair. 

Something I think everyone keeps forgetting is the financial and emotional strain of having to defend yourself in the legal process even if you are not at fault. 

In my home state any request for compensation over $20k has to be heard by a jury.

I would feel quite comfortable in front of a jury of my peers or even a judge, but look at the type of people who are commonly jurors.


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## Trauma Chaser (Dec 9, 2010)

WOW even though he is a medic he is working under BLS protocals. And if it is a BLS rig you do not carry advance medications and supplies. I cant beleive someone hasnt at your company hasnt said something,


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## Mzcr (Dec 9, 2010)

I disagree. Working BLS, the medic only has the equipment and authorization to treat at a BLS level. But you cannot remove their ability to make better field diagnoses.


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## DrParasite (Dec 9, 2010)

ems.amber911 said:


> However, when my patient cuts himself reaching across a motor fan or gets punched in a fight, I don't see the need for Mr. Medic to jump in.


I disgree.  he should do it all.  he should assess him.  he should write the chart.  he should provide all documentation.  If he wants to be in charge, let him.  he can perform his ALS assessment, and do whatever makes him happy, and he can fill out all the legal documentation, and let him hang for it if there is a problem

I am not going to lose sleep over it and neither should you.

question: if a doctor decides to volunteer as an EMT or work at a standby event as an EMT (he has the cert and everything, or was an EMT before med school) just for fun, should he be in charge of all patient care, or should the paramedic?  after all, the EMT is working for a BLS service, but has additional training far surpassing the paramedic, but he isn't operating as a MD in this situation.  Just something to ponder, and yes, I do know one doctor who works per diem as a medic (just for fun) and another doctor who volunteers as an EMT


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## Amber2313 (Dec 9, 2010)

DrParasite said:


> I disgree.  he should do it all.  he should assess him.  he should write the chart.  he should provide all documentation.  If he wants to be in charge, let him.  he can perform his ALS assessment, and do whatever makes him happy, and he can fill out all the legal documentation, and let him hang for it if there is a problem
> 
> I am not going to lose sleep over it and neither should you.
> 
> question: if a doctor decides to volunteer as an EMT or work at a standby event as an EMT (he has the cert and everything, or was an EMT before med school) just for fun, should he be in charge of all patient care, or should the paramedic?  after all, the EMT is working for a BLS service, but has additional training far surpassing the paramedic, but he isn't operating as a MD in this situation.  Just something to ponder, and yes, I do know one doctor who works per diem as a medic (just for fun) and another doctor who volunteers as an EMT



I have long since posting this realized there are far more inside pieces to that story than I care to explain, than anyone could understand, or than anyone would care to listen to. 
...but I do find the advice you gave me humorous with the signature that followed.
Probably just me, but I was amused nonetheless.


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## DrParasite (Dec 9, 2010)

ems.amber911 said:


> I have long since posting this realized there are far more inside pieces to that story than I care to explain, than anyone could understand, or than anyone would care to listen to.
> ...but I do find the advice you gave me humorous with the signature that followed.
> Probably just me, but I was amused nonetheless.


I'm not sure if that was a dig at me or a cheap shot at my signature.

Either way, if you want to fight it, go for it, and don't let the fact that everyone on here disagrees with you change your mind.  

Personally, I don't think that just because he is a medic he should be in charge of anything, especially if you are all working for a BLS agency.  But that is just my opinion, and I also don't think every call requires a paramedic (I know that's an argument for another thread), and I also think that there are bigger issues in EMS to worry about, and as long as he is going to write the chart, and hang in case there is a problem, let him be in charge.  but again, that's just my opinion

I won't lose sleep over it, and I don't think you should either.


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## Amber2313 (Dec 10, 2010)

DrParasite said:


> I'm not sure if that was a dig at me or a cheap shot at my signature.
> 
> Either way, if you want to fight it, go for it, and don't let the fact that everyone on here disagrees with you change your mind.
> 
> ...



Sorry. Wasn't really meant to be either. Should've clarified 'cause I knew it sounded like it. My bad. Just that post and that signature together. One said yield, the other said, "you move". Lol. I got a chuckle, tiny as it may be. 
I'm not worried about it. Never really was, but asking it here, to both everyone else and to me made it seem like a forefront. Because it's all everyone here knows about it all, it seems like more of an issue, and without all the pieces of the puzzle. And I put too much focus here, never outside of here, for a million and two reasons I don't care to explain. 
Never a big deal at all. 
I'll do my thing and he can do him. It's winter anyway. No racetrack for us


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## JPINFV (Dec 10, 2010)

DrParasite said:


> question: if a doctor decides to volunteer as an EMT or work at a standby event as an EMT (he has the cert and everything, or was an EMT before med school) just for fun, should he be in charge of all patient care, or should the paramedic?  after all, the EMT is working for a BLS service, but has additional training far surpassing the paramedic, but he isn't operating as a MD in this situation.  Just something to ponder, and yes, I do know one doctor who works per diem as a medic (just for fun) and another doctor who volunteers as an EMT




Using physicians are a terrible foil since, unlike RNs, EMTs, and paramedics, a physician doesn't lose the privileges granted by his medical license like the others do when they clock out. If the physician wants to write a perscription during a standby, it is perfectly legal to do so. In contrast, a paramedic working an event as an EMT can only operate as an EMT because of how the system is set up. 

Additionally, there's a question of how supervision is performed. The higher provider doesn't have to be the primary provider to ensure that a proper assessment and treatment is performed, and provided everything that is supposed to be done, is done, I would question the need for the higher level provider to step in in the first place.


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## jjesusfreak01 (Dec 10, 2010)

DrParasite said:


> Question: if a doctor decides to volunteer as an EMT or work at a standby event as an EMT (he has the cert and everything, or was an EMT before med school) just for fun, should he be in charge of all patient care, or should the paramedic?  after all, the EMT is working for a BLS service, but has additional training far surpassing the paramedic, but he isn't operating as a MD in this situation.  Just something to ponder, and yes, I do know one doctor who works per diem as a medic (just for fun) and another doctor who volunteers as an EMT



This is somewhat silly. So long as they are licensed as an MD (or DO) in the state, they can't lower their level of licensure. They have an unrestricted license to practice medicine that encompasses the scopes of every nurse, paramedic, and emt on scene. Technically though, the paramedic would be in charge of patient care unless the local statutes allow a doctor on scene to take over patient care, in which case they could do so. This would probably never happen though, since you really shouldn't have doctors with EMT certs (or paramedic certs, though there are a few exceptions). There are few reasons to keep up a lower certification when you have the unrestricted license. 

That said, i'm trying to get into med school for next fall, and am going to attempt to get enough CE to renew my EMT cert before I head off to medical school (for no particularly good reason). Since I just got the cert, and it has a 4 year period before expiration, its entirely possible I could be near the end of my residency before it actually runs out.


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## JPINFV (Dec 10, 2010)

jjesusfreak01 said:


> That said, i'm trying to get into med school for next fall, and am going to attempt to get enough CE to renew my EMT cert before I head off to medical school (for no particularly good reason). Since I just got the cert, and it has a 4 year period before expiration, its entirely possible I could be near the end of my residency before it actually runs out.



Er, what now? In 4 years, you'd just be about starting residency, not finishing it.


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## Trauma Chaser (Dec 10, 2010)

ok on our vol fd we back up the county ems on every bls and als call. they have three stations throughout the county with 2-3 rigs at each station. so we usualy get there within 5 minutes of each other. we have paramedics like myself on the vol FD along with emt's, and first responders. do i act as a paramedic???? yes, because i have the knowledge, training, and certifications...duh - but do we have advanced equipment out on the  rig?????? nope alllllll bls equipment so other then telling the als unit whats happening and packiging the patient for when they arrive. then when the rquipment gets there and its ok with the paramedic in charge of the rig, ill jump in and help. so if you have the equipment use it if not open a first aid bag, open the o2, and drive that cart lol.


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## Veneficus (Dec 10, 2010)

jjesusfreak01 said:


> This would probably never happen though, since you really shouldn't have doctors with EMT certs (or paramedic certs, though there are a few exceptions). There are few reasons to keep up a lower certification when you have the unrestricted license..



Actually I know several physicians who keep their medic certs. One who keeps his EMT cert. (Sorry JP not referring to you yet  )

Many do so as a form of street cred. For some strange reason doctors who interact with EMS are given considerably more weight to thier opinions when they are not thought of as "school boys who hide in the hospital and wouldn't know what to do without the safety of it." (I don't advocate that philosophy but I know it exists. Look at what some of the people on this forum say about physicians who are not EM specialists.)

Another reason is teaching. At least 2 states I know of will allow a physician to be an EMS instructor by virtue of an unrestricted medical license. However they must obtain the proper credentials on paper and that includes being an EMS provider.

Some maintain the certification as a demonstration to other physicians that EMS providers can be smart people. Most of the physiicans I have encountered everywhere think extremely poorly of EMS. Particularly in the US. Actually I would say the only physicians who have any appreciation for EMS are the ones that deal with it all the time. But not all of them.    

I was once told that "once you become a doctor, you will never be anything less."

For the same reason a physician cannot pretend to have lesser knowledge when specialized equipment is not available, neither can a medic. Though the treatment options are limited.

I can see doctors who are also EMS providers calling themselves medics or whatever in order to disguise the fact they are also physicians. But I think it is absoltely impossible for a doctor to "act like" and EMT or medic, the knowledge and thought process has been absolutely made part of you. Only with mind altering substances could you seperate yourself from it.


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## firecoins (Dec 10, 2010)

Veneficus said:


> Only with mind altering substances could you seperate yourself from it.



which ones do you suggest?


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## JPINFV (Dec 10, 2010)

Veneficus said:


> Actually I know several physicians who keep their medic certs. One who keeps his EMT cert.



I can see anther reason, if they still spend time on an ambulance for what ever reason, is legal reasons. If it takes two EMTs or paramedics to staff an ambulance, then an MD won't cut it. An MD/EMT or MD/paramedic, however, will count for staffing. Of course this makes things interesting when a physician acts as a physician while also counting as a member of an ambulance crew.


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## Veneficus (Dec 10, 2010)

firecoins said:


> which ones do you suggest?



alcohol seems the favorite.


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## STXmedic (Dec 10, 2010)

JPINFV said:


> I can see anther reason, if they still spend time on an ambulance for what ever reason, is legal reasons. If it takes two EMTs or paramedics to staff an ambulance, then an MD won't cut it. An MD/EMT or MD/paramedic, however, will count for staffing. Of course this makes things interesting when a physician acts as a physician while also counting as a member of an ambulance crew.



How would transfer of care work in that situation? Multiple casualty incidents? "Why did the doctor ride with that person and not MY family member?!" Could be an interesting set-up for a lawsuit.


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## jjesusfreak01 (Dec 10, 2010)

JPINFV said:


> Er, what now? In 4 years, you'd just be about starting residency, not finishing it.



Right, but my current cert doesn't expire for 4 years, so if I get enough CE in the next year to re-cert, i'll have 3 years + 4 for the renewed cert.



Veneficus said:


> Actually I know several physicians who keep their medic certs. One who keeps his EMT cert. (Sorry JP not referring to you yet  )
> 
> Many do so as a form of street cred. For some strange reason doctors who interact with EMS are given considerably more weight to thier opinions when they are not thought of as "school boys who hide in the hospital and wouldn't know what to do without the safety of it." (I don't advocate that philosophy but I know it exists. Look at what some of the people on this forum say about physicians who are not EM specialists.)



You hit the nail on the head there. Those were the "few exceptions" I was referring to. Our medical director has a paramedic cert for some of those reasons. He also spends time in the field assisting on calls in a QRS vehicle.


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## Trauma Chaser (Dec 12, 2010)

when physicians work ems they work as medical direction or as a paramedic. even when they need some one to do an amputation, a physician can't do it, they have to call a surgeon. great respect to doctors who wrok the street though.


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## JPINFV (Dec 12, 2010)

Trauma Chaser said:


> when physicians work ems they work as medical direction or as a paramedic. even when they need some one to do an amputation, a physician can't do it, they have to call a surgeon. great respect to doctors who wrok the street though.




If a case is so severe that you need to do a field amputation, then the emergency physician is going to be able to amputate. The scope of practice for physicians does not work like the scope of practice for EMTs and paramedics.


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## JPINFV (Dec 12, 2010)

PoeticInjustice said:


> How would transfer of care work in that situation? Multiple casualty incidents? "Why did the doctor ride with that person and not MY family member?!" Could be an interesting set-up for a lawsuit.



If a MCI was occurring, I'd be questioning why the physician was transporting instead of leading the medical branch on scene.


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## Trauma Chaser (Dec 12, 2010)

im starting to like the state where i work......good god if i have to have my family doctor cut my arm off.....oh man. he would probably just be like here is a Z - pack, 1 a day for 5 days and see me in a week.


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## JPINFV (Dec 12, 2010)

I don't believe you understand what is meant by the practice of medicine. 



> IC 25-22.5-1-1.1 Definitions
> Sec. 1.1. As used in this article:
> (a) "Practice of medicine or osteopathic medicine" means any one
> (1) or a combination of the following:
> ...


Emphasis added
http://www.in.gov/pla/files/MLBI.2009_EDITION.pdf

A physician and a surgeon hold the same unrestricted license to practice medicine. If your family physician chooses to, even in Indiana, he can perform amputations. It might not be prudent. The physician's malpractice insurance probably won't cover it if anything goes wrong, and if done in the hospital, the physician will probably lose his privaliges in that hospital, but there's nothing illegal in the sense of a scope of practice issue.


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## Veneficus (Dec 12, 2010)

I typed out a big long reply, but then figured all I did was waste my time.

paramedics and emergency physicians are the be all end all of medicine, sooner or later I will capitulate to that.


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## 18G (Dec 12, 2010)

Speaking for the state I am in (PA), a Paramedic working as an EMT is not allowed to portray themselves as a Paramedic since they are not able to provide the higher level of care. That means we are not permitted to identify as a Paramedic or display insignia that indicates the ability to provide ALS care when working as an EMT. This makes sense to me. 

Granted, a Paramedic when working as an EMT will be able to better assess and in certain circumstances make better decisions, but overall a Paramedic without their authorization, equipment, and drug box isn't much better than the EMT. 

I guess it's more of a state level thing and what the statutes indicated. Regardless, any attorney will argue anything for their client but doesn't mean it will be upheld.


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## Trauma Chaser (Dec 13, 2010)

it is what it is.....everyone is right in forums and nobody cares what is right.


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