Duty to act?

[Thoe713]

Does a person who is licensed as a paramedic in a state (Nevada in this case) is employed by an ALS/transport providing fire department, but who is not compensated at the paramedic level (by choice) have a duty to provide ALS level care on the scene while on duty?

Thoughts?

 

[trevor1189]

Does a person who is licensed as a paramedic in a state (Nevada in this case) is employed by an ALS/transport providing fire department, but who is not compensated at the paramedic level (by choice) have a duty to provide ALS level care on the scene while on duty?

Thoughts?

Are you saying that you are a paramedic that is paid as an EMT? In that case no you are an EMT. Our dept has paramedics, but we are BLS only, so when they ride the trucks they act in the capacity of an EMT.

I hope that makes sense, I didn't really understand your question.

 

[Shishkabob]

Ask your supervisor.

 

[Lifeguards For Life]

you are allowed to perform procedures to the level you are being emplyed to work at. for example once i get my paramedic license, on the ambulance I wil function at the paramedic level. But if i keep working with public protection on the beach, i will function as an EMT while working with them, because they are a BLS service. now thats not to say i can not take a more detailed pt. hx or perform a better pt assessment while working on the beach. ask your sup for clarification

 

[8jimi8]

Does a person who is licensed as a paramedic in a state (Nevada in this case) is employed by an ALS/transport providing fire department, but who is not compensated at the paramedic level (by choice) have a duty to provide ALS level care on the scene while on duty?

Thoughts?

What do you mean by not compensated at that level by choice?

are you volunteering?

explain a little more please.

 

[Flight-LP]

Why on earth any Paramedic would voluntarily be associated with an agency that limits his / her ability to care for a patient and open themselves up to the unlimited civil liability is beyond me.

Regardless of the level of your service / agency / company, your level of certification and expertise will be brought onto the playing field should litigation ever be brought against you. Use caution.........

 

[Thoe713]

duty to act

Wow, thanks for the replies, that was quick. OK, here is the scenario. I'm a 20 year paramedic and a fire captain for an ALS providing FD. Some of us have maintained our PM license "out of grade" as it's called, to help the department with staffing, i.e use us as the ALS providers on our ALS engines in lieu of having to put a FF/PM on the rig in times when they cannot get a FF/PM to work. Some of us (there are a few) are concerned that having to split the duties of possibly having to provide ALS on a scene ( like an MVA) along with our duties of captains/ scene management etc... creates a safety issue. All of us are on the same page with making our guys safety the #1 priority So......if I ask the department to not compensate me as an "out of grade paramedic", but as an EMT-II, does that remove my duty to act as an ALS provider because I'm not getting paid, or does the fact that I am a licensed PM in the state supercede.

Does that help?

 

[Flight-LP]

Wow, thanks for the replies, that was quick. OK, here is the scenario. I'm a 20 year paramedic and a fire captain for an ALS providing FD. Some of us have maintained our PM license "out of grade" as it's called, to help the department with staffing, i.e use us as the ALS providers on our ALS engines in lieu of having to put a FF/PM on the rig in times when they cannot get a FF/PM to work. Some of us (there are a few) are concerned that having to split the duties of possibly having to provide ALS on a scene ( like an MVA) along with our duties of captains/ scene management etc... creates a safety issue. All of us are on the same page with making our guys safety the #1 priority So......if I ask the department to not compensate me as an "out of grade paramedic", but as an EMT-II, does that remove my duty to act as an ALS provider because I'm not getting paid, or does the fact that I am a licensed PM in the state supercede.

Does that help?

Actually that does help paint a very clear picture.................

Your department is an ALS providing agency, correct??

You are a paid employee of the agency and are also a certified Paramedic, correct??

If both are yes, then you have a perceived duty to act.

My suggestion would be to have your department get the manpower they need and not try to cut the corners to get it done. This is one reason fire based EMS gets a bad rap. Another idea would be to get clearly defined job descriptions and SOP's in place to protect emplyees against any of these staffing types of issues.

 

[8jimi8]

It sounds to me that if you don't provide needed treatments because you are wearing a "different hat" you open yourself up to abandoment.

You say that your service is an ALS service and that you are a firefighter captain, am i reading this correctly? Sounds to me like you should delegate the saftey officer position to someone who does not have ALS training.

 

[Akulahawk]

Wow, thanks for the replies, that was quick. OK, here is the scenario. I'm a 20 year paramedic and a fire captain for an ALS providing FD. Some of us have maintained our PM license "out of grade" as it's called, to help the department with staffing, i.e use us as the ALS providers on our ALS engines in lieu of having to put a FF/PM on the rig in times when they cannot get a FF/PM to work. Some of us (there are a few) are concerned that having to split the duties of possibly having to provide ALS on a scene ( like an MVA) along with our duties of captains/ scene management etc... creates a safety issue. All of us are on the same page with making our guys safety the #1 priority So......if I ask the department to not compensate me as an "out of grade paramedic", but as an EMT-II, does that remove my duty to act as an ALS provider because I'm not getting paid, or does the fact that I am a licensed PM in the state supercede.

Does that help?

The fact that your agency doesn't compensate your as a Paramedic but as an EMT-II likely won't reduce your liability. Your agency is an ALS provider as are you. About the only way that I can see this happening won't likely fly as it goes to cross purposes with your agency's needs. They downgrade ALL Captain positions to non-medical positions and therefore not consider ANY unit staffed w/ Paramedic Captains to be ALS. They'd also have to remove all ALS equipment from those apparatus. Your agency would have to remove that capability from everyone.

How you are compensated has nothing to do with your capability. It's more in what you're employed as by your agency. If I'm a Paramedic, working for an ALS company in a BLS ONLY position... I function in that authorized role of BLS, but nothing prevents me from doing everything except interventions at the ALS level.

 

[VentMedic]

Does a person who is licensed as a paramedic in a state (Nevada in this case) is employed by an ALS/transport providing fire department, but who is not compensated at the paramedic level (by choice) have a duty to provide ALS level care on the scene while on duty?

Thoughts?

Since this is also happening in my home state of Florida, I am in agreement that not everyone holding a Paramedic patch should function as a Paramedic as many FFs just get the cert to beef up the resume. Just being a certified Paramedic does not necessarily make you qualified to function as one. I also believe the FDs should stopped handing out money for a patch to which some have no desire to function as and especially as you have stated "by choice". I also believe the medical director should have the ability to declare you to work at whatever level he/she sees you are qualified for regardless of holding Paramedic patch even if that means just as an EMT.

If you are also not maintaining (by choice) any of the department's competency requirements as a Paramedic or participating in the training sessions, then no you should not be functioning at a Paramedic level or being paid as one either.

There are a couple of fire departments in Florida that have over 1000 - 2000 FFs with 90% of them being Paramedics. Some are now just going through the motions of maintaining a cert with the state because of the xtra money as they have a comfy engine or desk job. They have no interest in being a Paramedic nor would they be capable of functioning as a Paramedic. Thus, there would be more liability to have someone who is not participating as Paramedic regularly to all of a sudden decide they could intubate or run a code after being away from it for a few years.

If the FDs are serious about doing EMS, they should forget about requiring everyone to be a Paramedic (cert or no cert) and only have those who truly have a desire to function in a medical aspect of the job allowed to wear the patch of Paramedic and be compensated. This is the way it was done many years ago and EMS was highly respected in the FDs.

Now if you have met the requirements of being a Paramedic by your medical director and function as one, you should take the pay level and title instead of the by choice.

 

[VentMedic]

The fact that your agency doesn't compensate your as a Paramedic but as an EMT-II likely won't reduce your liability. Your agency is an ALS provider as are you.

That depends. Take the mess in Collier County, FL as an example. The Medical Director clearly stated he will not allow 25 patch holding Paramedics to function at that level even if they are on an ALS engine. They will function purely as an EMT while qualified Paramedics provide the ALS. He does NOT want to be liable for what they will do as a Paramedic.

Even for RNs, if there is some question about qualifications or competency, the RN may have to function as a CNA and will only be held accountable as a CNA until clarification or remedial training is finished. We have even had RNs from other states who failed to complete their licensure paperwork with our state working as CNAs until they do so. In no way will they be held to a higher level of licensure. If a Flight RN who is also a Paramedic relocates to our state and gets their Paramedic license first, they can only function at the Paramedic level until they get their RN. They will not be accountable for any RN skills/knowledge but may be severly counseled if they overstep their bounds and try to function as an RN.

 

[46Young]

That depends. Take the mess in Collier County, FL as an example. The Medical Director clearly stated he will not allow 25 patch holding Paramedics to function at that level even if they are on an ALS engine. They will function purely as an EMT while qualified Paramedics provide the ALS. He does NOT want to be liable for what they will do as a Paramedic.

Even for RNs, if there is some question about qualifications or competency, the RN may have to function as a CNA and will only be held accountable as a CNA until clarification or remedial training is finished. We have even had RNs from other states who failed to complete their licensure paperwork with our state working as CNAs until they do so. In no way will they be held to a higher level of licensure. If a Flight RN who is also a Paramedic relocates to our state and gets their Paramedic license first, they can only function at the Paramedic level until they get their RN. They will not be accountable for any RN skills/knowledge but may be severly counseled if they overstep their bounds and try to function as an RN.

Similar situations in my experience. My understanding is that you're only able to function to the EMT-P level if so authorized by the OMD. If you're on a BLS rig, you're restricted to BLS only. If you're off duty, you're restricted to BLS only. If you're working a designated medic position, you're required to act at that level, and nothing less. If you have a medication error, or a pt care error, the OMD can restict you to BLS pending investigation/remediation. This temporary restriction may not apply to any other agency that you happen to be working for at the same time, unless the restriction is placed by the state.

Bottom line, if your agency is using you to fill a medic slot, you're a medic 100%. If you're not assigned to a medic slot, being authorized to operate ALS is up to the OMD. Otherwise, if you're assigned to a BLS spot, you're restricted to BLS only.

Here at FCFRD, medics can operate as medics at any time while on duty, provided the necessary equipment is on hand (it always is). If you're dual hatting, you're still as responsible for pt care as any other medic onscene.

A Capt at 20 y/o? It takes at least 7 years here to get to that level (suppression, EMS, or all hazards), if you're lucky. Years of experience are needed before earning the responsibility of commanding your own company. I hope that you're on your game, lest you get your crew killed due to inexperience.

How exactly does your promotional system work?

 

[Akulahawk]

Similar situations in my experience. My understanding is that you're only able to function to the EMT-P level if so authorized by the OMD. If you're on a BLS rig, you're restricted to BLS only. If you're off duty, you're restricted to BLS only. If you're working a designated medic position, you're required to act at that level, and nothing less. If you have a medication error, or a pt care error, the OMD can restict you to BLS pending investigation/remediation. This temporary restriction may not apply to any other agency that you happen to be working for at the same time, unless the restriction is placed by the state.

Bottom line, if your agency is using you to fill a medic slot, you're a medic 100%. If you're not assigned to a medic slot, being authorized to operate ALS is up to the OMD. Otherwise, if you're assigned to a BLS spot, you're restricted to BLS only.

Here at FCFRD, medics can operate as medics at any time while on duty, provided the necessary equipment is on hand (it always is). If you're dual hatting, you're still as responsible for pt care as any other medic onscene.

A Capt at 20 y/o? It takes at least 7 years here to get to that level (suppression, EMS, or all hazards), if you're lucky. Years of experience are needed before earning the priveledge of commanding your own company. I hope that you're on your game, lest you get your crew killed due to inexperience.

How exactly does your promotional system work?

The way I read his post is that he's been a FF for 20 years and is a Captain... not that he's a 20 year old...

 

[46Young]

Oops, my bad. Disregard. It makes a lot more sense now.

 

[emtbill]

http://www.emtlife.com/showthread.php?t=5825

 

[rescue99]

Does a person who is licensed as a paramedic in a state (Nevada in this case) is employed by an ALS/transport providing fire department, but who is not compensated at the paramedic level (by choice) have a duty to provide ALS level care on the scene while on duty?

Thoughts?

The answer is..it's a sticky situation. A jury will probably conclude that if you are on duty with an ALS department, the tools are present and you chose not to use them, resulting in injury or death then yeah, you have a problem.
If you receive a dime of compensation for maintaining a Medic license, you may have a duty to act.

 

[audreyj]

I'm in IL and we were told by our EMS coordinator that once we are licensed as paramedics our EMT-B licenses become void, we're still allowed to do both BLS and ALS calls however we cannot be employed as an EMT-B. The EMS coordinator of your resource hospital should be able to answer your question as it pertains to your situation.

 

[rescue99]

I'm in IL and we were told by our EMS coordinator that once we are licensed as paramedics our EMT-B licenses become void, we're still allowed to do both BLS and ALS calls however we cannot be employed as an EMT-B. The EMS coordinator of your resource hospital should be able to answer your question as it pertains to your situation.

You can check but, I thought Ill. was another state one could purchase any license level up to the level of training... after successfully passing of course. Here in MI, I can apply for and purchase MFR, EMTB, EMTI and EMTP if I so choose as long as I meet recertification qualifications for relicense. There are FD's will require a member to be licensed (physical license) at the level in which they respond even if that is a lower level. Consistency, insurance, who knows the reasoning?

 

[VentMedic]

The answer is..it's a sticky situation. A jury will probably conclude that if you are on duty with an ALS department, the tools are present and you chose not to use them, resulting in injury or death then yeah, you have a problem.
If you receive a dime of compensation for maintaining a Medic license, you may have a duty to act.

Functioning as a Paramedic is a privilege that is granted by the medical director whose license you are working under. You can hold a Paramedic license but you may not be able to function as one even on an ALS truck if your medical director believes you do not meet the requirements or you have failed/chosen to maintain the requirements. Believe it or not we have many Paramedics working at Burger King, while waiting to join a FD, who maintain the minimum state requirements for CEUs.

There would also be extensive liability for an ambulance or FD that allowed someone just maintaining a Paramedic patch to function at an ALS level if there were not records of current competency on file. We still have FFs maintaining a Paramedic cert but haven't pushed a med or intubated since 1988. They are in no way able to function as a Paramedic, even though they are collecting the Paramedic differential pay (which I do not agree with), and would not be held accountable for anything but BLS. The rationale for the pay (per the union) is that they could be moved to working as a Paramedic if needed provided they met the training and competency requirements (per the FD).

I'm in IL and we were told by our EMS coordinator that once we are licensed as paramedics our EMT-B licenses become void, we're still allowed to do both BLS and ALS calls however we cannot be employed as an EMT-B. The EMS coordinator of your resource hospital should be able to answer your question as it pertains to your situation.

No you can not claim to hold a certification that you do not have current. However, you can still work at a less capacity with a higher cert.

In Florida, we also have the option to allow a Paramedic who is losing their certification for some violation or incompetency to test for the EMT (NREMT) provided they meet the requirements and provided their offense does not exclude them. At least they can then still function on an ambulance to be employable.

Another example: Paramedics working in some hospital EDs under the title of ER Tech, regardless of their Paramedic cert, they may not be allowed to intubate or push certain or any meds. They will only be held accountable for the job description given.

People who hold dual licenses also run into this problem. Just because I can manage an IABP or VAD as an RRT does not mean I can do so as a Paramedic on an ALS truck if it is not in my job description. Thus, a nurse or RRT would ride along. Also, a flight nurse moonlighting in an ICU may not be able to intubate or put in a central line (except PICC) in a unit that he/she is not authorized to do so.