Bledsoe article: The Vanity of EMS

[VentMedic]

Rid, (duplicate post from another forum)

So, if you write CCEMTP behind your name you are considered to be a higher level of care?

The point I am trying to make and I believe Bledsoe was also, although CCEMTP is a trademark, it is being used by anyone and everyone working on these trucks and billing as Critical Care Paramedics with little or no proof of critical care training. It is just a bunch of letters. Many of these trucks still require an RN and/or RRT from the hospital (not an ambulance employee) to accompany them because they are not qualified to take care of the patients on many of the ICU drip or technology.

Some of the hospitals have set up their own CCT teams to get out of that very grey area of legalities.

For the RN, nothing can be added to the original license designated letters. You can stick any and all certs behind it but not attached to those letters.

There have been many controversies in Florida over the use of NREMT-P since that is not the official exam for the state at the Paramedic level. However, some counties were requiring their Paramedics to take the test. The EMT-P is still the official license letters for Florida. The NREMT-P is an extra cert.

Your state statutes should be your guide.

If you use the letters CCEMTP behind your name just for billing but have no proof to back it up, where does that leave you? Is this not a deception to the insurance companies?

Respiratory Therapy has some technical difference in their letters also. CRT and RRT are credentials from the national certification board. Some states, like California, use the term RCP as a catch all in their licensure. Thus, in the signature, it is RCP first for the license and RRT for the cert to follow.

 

[Ridryder911]

I do understand and alike I described I agree with parts, but unfortunately this is one of those areas that is not strictly black & white. As well, I guess I also do not understand since it was not that long ago, we discussed the potential of attempting to have the NREMT to add CC as an additional level to Paramedic.

As you described nothing can be added to the license level is definitely correct, but additional titles (this is where many are getting confused) can be and is definitely encouraged by most Board of Nursing such as RN, MSN or RN, CCRN, CEN, CFRN .. because in the documentation it is adding that person(s) additional or educational and professional status. If one would call a distinguishing identification. Such as examples such M.D., FACEP or M.D., ABOG, RN, CNOR etc.. These are earned titles and degrees that demonstrate past their license level. It does not replace their initial or licensed level, unless there is an advanced level. One does not use RN, ARNP because the ARNP supersedes the RN.

Personally, I have realized for decades the titles addressed is for internal use only. I do recognize the benefit of using the titles is that when reading a study, article or listening to a speaker I recognize that the individual has met or exceeded their professional standards; far more than just the required general education of the entry level.

R/r 911

 

[VentMedic]

I understand the earned titles.

But, what are the legal liabilities when a Paramedic uses the CCEMTP letters because the company is doing "critical care transport", not because the Paramedic took a course and got a certificate. Or, it was the companies PDQ course of here's your protocols.

And, these CCEMTPs must "supplement" their transport with hosptial staff that is not part of a CCT but just a "ride along". The ambulance is billing, the hospital is not in most of those cases. This is the issues we've had for years and was what forced many of the hospitals to get their own CCT staff.

So, again, can someone just as the title CCEMTP behind their name from whatever agency or job just for the benefit of billing?

 

[MSDeltaFlt]

I understand the earned titles.

But, what are the legal liabilities when a Paramedic uses the CCEMTP letters because the company is doing "critical care transport", not because the Paramedic took a course and got a certificate. Or, it was the companies PDQ course of here's your protocols.

And, these CCEMTPs must "supplement" their transport with hosptial staff that is not part of a CCT but just a "ride along". The ambulance is billing, the hospital is not in most of those cases. This is the issues we've had for years and was what forced many of the hospitals to get their own CCT staff.

So, again, can someone just as the title CCEMTP behind their name from whatever agency or job just for the benefit of billing?

No. You have to not only have those credentials behind your name from the credentialing body that your state, county, and service recognizes, but also that you have officially transitioned to that job description and that your medical control will cover you to perform those specialized procedures and protocols under his/her license within said service and job description.

What some people may not realize is that you must use multi-dimensional thought with regards to legalities here. The devil is in the details.

 

[ILemt]

Here is the perspective of a Basic:

As an EMT in IL, I am CERTIFIED. However I am also Nationally REGISTERED.


....


In my mind, I am certified to perform a job the average joe cannot.
I am registered in a database so that I may travel and work in other states.
However I am not licensed; in that I (or my medic partner) cannot operate free of medical control. -- We operate under control of an MD in the ER, whether it be via written protocol or verbal order on the radio.

A license in my mind means that one may operate free of oversight.

....

A bigger discussion would be to decide if an EMT rates a gold badge or
if that "honor" is reserved for Paragods. ... I mean Paramedics

For the record, I don't wear a badge. The one I got when i finished my class was silver.

 

[Ridryder911]

Here is the perspective of a Basic:

As an EMT in IL, I am CERTIFIED. However I am also Nationally REGISTERED.


....


In my mind, I am certified to perform a job the average joe cannot.
I am registered in a database so that I may travel and work in other states.
However I am not licensed; in that I (or my medic partner) cannot operate free of medical control. -- We operate under control of an MD in the ER, whether it be via written protocol or verbal order on the radio.

A license in my mind means that one may operate free of oversight.

....

A bigger discussion would be to decide if an EMT rates a gold badge or
if that "honor" is reserved for Paragods. ... I mean Paramedics

For the record, I don't wear a badge. The one I got when i finished my class was silver.

Unfortunately, since most EMT's are not licensed they do not understand what license even means. In my state in the Basic EMT's are licensed.. yes licensed not certified and NO it does NOT mean the same or even treated the same. NO, license does not mean or implicate that one works "freely" upon their own discretion. License is a regulatory means issued from a governmental body that regulates the control and quality of the person.

Again, for simplistic means .. drivers license, not driver certification. Thus a body regulates and issues license after making sure that those are qualified and adhere to regulations set forth.. and if you don't there is consequences. Certification only means you have met the educational or training requirement and really means nothing. Alike the way people were ACLS, CPR certified ... doodly squat. P.S. badges are for cops... and who cares what color of jewelry one wears on their uniform.... like there should even be any?


This topic opens the debate then.. should only credentialed "speciality teams" make interfacility transfers? As well Bledsoe may have opened a "can of worms. How many states actually require documented additional training and education in vent care, IV medications above the NHTSA curriculum ? Alike several hundred thousands of EMS that routinely transport patients on ventilators, IV medications such as Interglin, sedatives even such as Fentanyl, Diprovan, etc and those with central lines, etc. all of those above the current level of the standardized EMT Paramedic curriculum. Are hospitals in violation of COBRA, since technically it is stated equal or greater .. and according to Medicare and other regulatory agencies the standard Paramedic is not qualified. This opens the door to possible infractions that one should not be operating unless they are qualified to transport such patients. Sure, a service may not bill for it and get by, but then an investigation could be made that technically those Paramedics were never "really" qualified to perform such procedures.

As I described, I am on a task force investigating the standards and regulations in which my state is looking toward for SCT and CCEMT/P. A double edge sword.. it can help and yes could harm many services. Are we prepared to make such regulations that only certified or credentialed transport teams can make such transfers? Or, can we alike in the hospitals have credentialed staff within the team, but not really requiring each to be credentialed above their license level? For example not all ICU's require CCRN but highly promote it.. promoting professionalism, within their scope.

R/r 911

 

[ILemt]

RidRyder911:

There are consequences yes, but by having my drivers license I don't drive with a drivers ed instructor on speed dial. Nor do i drive with a rules of the road booklet in the glove box. But this CERTIFIED emt DOES have the ER on speed dial and I do have the protocol book in the cabinet right next to my partners drug box.



I say again... A License in my mind means you can operate free of oversight. (doesnt mean free of consequences if you screw up)
Free of oversight...
That isnt EMS, as every emt or medic is answerable to medical control.
In my mind being a licensed EMT or medic means that you would never have to ask permission from an ER doc to push a drug, or perform ANY procedure. The license would mean you could do ANYTHING in your scope of practice based solely on training completed prior to the incident.

The ONLY EMS folks I would even come close to saying are truly licensed are Special Forces Medics in the military that can deploy to another country and perform an appendectomy in the field on their own, and turn around and push dozens of drugs on someone else, without once looking at a protocol book or calling a doc. But even they must get CEUs and can contact an MD back at base if they need a consult.

Can you as a LICENSED medic perform surgery in the back of your rig?...
Didnt think so.

 

[reaper]

You thinking does not make sense? An Rn is licensed, but must work under a Dr's orders. (unless they are a RNP, in some states). Almost every discipline in the medical world, that is licensed, answers to someone else.

Civilian EMS is not the military. We are held liable to standards. The Military medic is not. So, you can not compare the two.

As stated already, some states certify and some license. that is the way it is. It does not change the SOP that they work under.

 

[ILemt]

An RN is licensed?
I thought an RN was REGISTERED

I know ... not picking a fight, just saying...

 

[Ridryder911]

An RN is licensed?
I thought an RN was REGISTERED

I know ... not picking a fight, just saying...

I suggest you read and become educated on what the definition of license is in medicine. Yes, I am licensed as a Registered Nurse in 6 states, as well licensed as a Paramedic in 3 so.. again, I highly suggest you expand your knowledge instead of making assumptions or self determinations. My state Board of Nursing as well as State EMS Authority would definitely assure you that I and the other million of R.N, as well as Licensed Practical Nurses are as such!

R/r 911

 

[daedalus]

I suggest you read and become educated on what the definition of license is in medicine. Yes, I am licensed as a Registered Nurse in 6 states, as well licensed as a Paramedic in 3 so.. again, I highly suggest you expand your knowledge instead of making assumptions or self determinations. My state Board of Nursing as well as State EMS Authority would definitely assure you that I and the other million of R.N, as well as Licensed Practical Nurses are as such!

R/r 911

Your opinion as a lay person does not trump the legal opinion of a attorney at law. All EMS personnel legally allowed to operate in their respective jurisdictions, are in fact licensed.

 

[Ridryder911]

Your opinion as a lay person does not trump the legal opinion of a attorney at law. All EMS personnel legally allowed to operate in their respective jurisdictions, are in fact licensed.

WRONG!.. Not all states are licensed! There is a big difference between certification and licensure!.. Did they not teach most of you this in your basic? ..This should had been clarified from day one.. and no, an attorney is not needed just good common sense and reading. But, if you insist here is a letter from the legal counsel of the NREMT.


http://www.nremt.org/about/Legal_Opinion.asp


..."
Mr. William E. Brown, Jr.
Executive Director
The National Registry of Emergency Medical Technicians
Rocco V. Morando Building
6610 Busch Blvd.
P.O. Box 29233
Columbus, OH 43229-1233

Re: Update of Legal Differences Between "Certification" and "Licensure"

Dear Bill:

You have asked that we update our October 22, 1993 letter delineating the differences between “licensure” and “certification.” Although the general public continues to use the terms interchangeably, there are important functional distinctions between the two concepts.

The federal government has defined “certification” as the process by which a non-governmental organization grants recognition to an individual who has met predetermined qualifications specified by that organization.1 Similarly, the National Commission for Certifying Agencies has recently defined certification as “a process, often voluntary, by which individuals who have demonstrated the level of knowledge and skill required in the profession, occupation, role, or skill are identified to the public and other stakeholders.”2

Accordingly, there are three hallmarks of certification (as functionally defined). Certification is a:

(a) voluntary process;

(b) by a private organization;

(c) for the purpose of providing the public information on those individuals who have successfully completed the certification process (usually entailing successful completion of educational and testing requirements) and demonstrated their ability to perform their profession competently.

Nearly every profession certifies its members in some way, but a prime example is medicine. Private certifying boards certify physician specialists. Although certification may assist a physician in obtaining hospital privileges, or participating as a preferred provider within a health insurer’s network, it does not affect his legal authority to practice medicine. For instance, a surgeon can practice medicine in any state in which he is licensed regardless of whether or not he is certified by the American Board of Surgery.

Licensure, on the other hand, is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally performed only by those who are licensed. As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.

Confusion between the terms “certification” and “licensure” arises because many states call their licensure processes “certification,” particularly when they incorporate the standards and requirements of private certifying bodies in their licensing statutes and require that an individual be certified in order to have state authorization to practice. The use of certification by the National Registry by some states as a basis for granting individuals the right to practice as EMTs and calling the authorization granted “certification” is an example of this practice. Nevertheless, certification by the National Registry, by itself, does not give an individual the right to practice.

Regardless of what descriptive title is used by a state agency, if an occupation has a statutorily or regulatorily defined scope of practice and only individuals authorized by the state can perform those functions and activities, the authorized individuals are licensed. It does not matter if the authorization is called something other than a license; the authorization has the legal effect of a license.

In sum, the National Registry is a private certifying organization. The various state offices of EMS or like agencies serve as the state licensing agencies. Certification by the National Registry is a distinct process from licensure; and it serves the important independent purpose of identifying for the public, state licensure agencies and employers, those individuals who have successfully completed the Registry’s educational requirements and demonstrated their skills and abilities in the mandated examinations. Furthermore, the National Registry’s tracking of adverse licensure actions and criminal convictions provides an important source of information which protects the public and aids in the mobility of EMT providers.

I hope this letter is responsive to your request. Please feel free to contact me if you have further questions.

Very truly yours,
Thomas G. Abra...."

 

[teehehe]

WRONG!.. Not all states are licensed! There is a big difference between certification and licensure!.. Did they not teach most of you this in your basic? ..This should had been clarified from day one..
[/i]

Honestly, with how short EMT-B classes are (I believe in Texas, the min. is 140 hours), I don't think they should be wasting time on this type of legalese that doesn't directly effect us. This is something the EMT should be getting clarified when they get certified/licensed with their state.

 

[Fire292Rescue]

Honestly, with how short EMT-B classes are (I believe in Texas, the min. is 140 hours), I don't think they should be wasting time on this type of legalese that doesn't directly effect us. This is something the EMT should be getting clarified when they get certified/licensed with their state.

Personally, when it comes to Ethics/Legal of the EMT-B, it SHOULD be said. A lot of people think "Hey, I'm licensed and certified" to A. Feel Important or B. Don't really know what they are and sometimes even C. Just pick one that sounds "cool" . I'm a State Certified Firefighter here in New Jersey, not a LICENSED. Cause well...yea

People SHOULD know what legalities between terms and why.

 

[JPINFV]

I mentioned that I'm licensed and certified because I have a card that says certificate (Orange County EMT-B Certification. NREMT Cert) and a card that says Licensed (Orange County Ambulance Attendant License). Yes, both are required to for someone to work on an ambulance in Orange County, CA. No, I'm not going to pay an extra $30 to get a card.

So there's a third option as well. D: They are both licensed and certified.

 

[MSDeltaFlt]

Dude, that's your ambulance driver's license. That's an apple. Your EMT is an orange.

 

[JPINFV]

No, that's not the ambulance drivers license. The California Ambulance Driver Certificate is a different piece of paper I had to carry.

Ambulance Attendant License: http://ochealthinfo.com/medical/ems/licensing/licensing.htm#Ambulance

California Ambulance Driver Certification: http://www.dmv.ca.gov/dl/ambu_drvr_cert.htm

The OC ambulance attendant license is issued by Orange County EMS whereas the California Ambulance Driver Certification is issued by the California Department of Motor Vehicles (DMV).

Now, as to the subject, the actual difference between cert and license is very little in terms of local government "certifications." Local EMS certs (not NREMT certs) are issued by a government agency, are required to work at the level the certification is for, and can be revoked or denied for a variety of reasons. In practice, that sounds a lot like a license. Furthermore, assuming that all government EMS certs become licenses, that would not mean an increase in the prestige, scope, education, or pay for prehospital providers. It's simply semantics.

 

[VentMedic]

Dr. Bledsoe has been replying to comments and they are very good reading as well.

http://www.ems1.com/columnists/bryan-bledsoe/articles/421845-The-Vanity-of-EMS

 

[daedalus]

WRONG!.. Not all states are licensed! There is a big difference between certification and licensure!.. Did they not teach most of you this in your basic? ..This should had been clarified from day one.. and no, an attorney is not needed just good common sense and reading. But, if you insist here is a letter from the legal counsel of the NREMT.


http://www.nremt.org/about/Legal_Opinion.asp


"[/i]

Rid! Your own reference is the same article I referenced earlier.

"Regardless of what descriptive title [i.e. certification] is used by a state agency, if an occupation has a statutorily or regulatorily defined scope of practice and only individuals authorized by the state can perform those functions and activities, the authorized individuals are licensed. It does not matter if the authorization is called something other than a license [.e. certification]; the authorization has the legal effect of a license."

The lawyer clearly demonstrated my point.

 

[triemal04]

I don't know why anybody would have a problem with this article; it touches on many of the things that most (sane, or at least reality appreciating) people in EMS know; that the certification standards nationally are a joke, and even that the educational levels are a joke.

The difference between being licensed or certified...honestly, that can wait to be resolved, and really doesn't matter that much. The bigger issue is what Bledsoe talk's about with the CCEMTP certifications; almost anyone can get one, yet many states don't recognize it, and the process for getting it varies widely. Sort of like saying you're a paramedic from LA and saying that you're a paramedic from Seattle; your patch says the same thing, but what you know/can do is a lot different.

Having extra education and training is great, I'm all for that, but unless there is a standard process to go through that is recognized beyond each little local area (because medicine, and EMS extend well beyond a services boundaries, despite what many think) adding a new patch to the uniform, or adding another spray of letters after your name is pointless, since nobody else will know what you are talking about, not care, or more likely, because the course you took was a half-assed one at best and the standards non-existent. (this doesn't mean don't take them if they are worthwhile; just that there isn't a need to shout it to the world, since the world won't give a damn)

Make the standards for EMS nationwide, sort of like they are for most other healthcare professions (the established ones anyway). This would include the extra levels; if you want to be a flight medic, then you need to meet certain requirements that ALL 50 states recognize, same for critica care. Then the alphabet soup will start to matter in situations beyond a resume.

The bottom line in this isn't people calling themselves a CCEMTP when their state doesn't recognize it, or saying they are a licensed provider vs a certified provider; it's the complet lack of standardization in EMS. It's every state having different certifications that mean different things, even if they have the same name. Fix that, and a lot of other problems will be a whole lot easier to take care of.