I got to thinking about this question after it was pointed out to me that in Washington, you can't even become an EMT or FR unless you are affiliated with an EMS agency and have your medical director's approval.
If you are not affiliated with a volunteer or a paid agency, then would you be a renegade EMT? What would you do, buy your own equipment and buff calls? Who ensures that your skills are up to date? In NY, you need the medical director's approval as well, but it's an implied approval that is automatic when your department or sponsoring agency submits your application for class. No one is denied. During or after class, if you start screwing up, that's when the counseling and/or denial occurs.
I then started thinking about how few differences there are between FR and first aid providers, who don't need medical control.
I realize that to push drugs, you need a doctor's approval. But given the limited side effects of the drugs we are allowed to use (most of which can be purchased over the counter), I wonder if it is really necessary for us to operate under a doctor's license as EMT-B or FR.
From a legal standpoint, when you show up in an ambulance or first responder car, you are acting as part of an agency. Good Samaritan laws go out the window, you are now part of the agency's negligence/liability insurance policy.
There is a big difference between giving the air of authority through wearing turnout gear, driving an ambulance, etc, than there is if you give a co-worker two aspirins for a headache or bandage the neighbor's kids scrapes and cuts from tripping in the yard.
The medical director puts their license on the line so that we CAN show up wearing the gear and acting with the same knowledge and skills as the guy of the same level next to us, in the next town over, and in the rest of the County, City, or State.
At such a basic level (FR, and even EMT-B ), we still need protocols and we still give items NOT available over the counter...
For example (just to name a few):
O2 - you need a prescription to have it, and you need to be certified to give it - not just as an EMT, but as a coach, scuba instructor, etc
AED - you need a prescription to get one at home, and except for public places, you need certification to operate one - even in public places there are certified people who typically operate them such as flight attendants, hotel workers, coaches, etc.
Epi - another drug that is not OTC but widely used by CFRs and EMT-Bs.
Nitro - prescription only, again... without protocols, you might give nitro or assist someone in taking their nitro whose bp is too low and they bottom out (a "side effect") or someone who is taking beta blockers will have a synergistic reaction and bottom out...
h34r:
