Medical Control

Should a Medical Director be required to practice as an EMT-B or FR?

  • Yes, for both

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  • No, for both

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  • Undecided

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  • Total voters
    1

ffemt8978

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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.

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.


This is for discussion purposes only, so please don't tell my medical director I said this. :ph34r:
 

rescuecpt

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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...
 
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ffemt8978

ffemt8978

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Originally posted by rescuelt@Jul 11 2004, 06:13 AM
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.

What happens if you want to become a paramedic? You have to be an EMT-B first to even apply for the class. And if you live in an area that doesn't have a volunteer agency and the paid agencies aren't hiring, what are you supposed to do?
 

rescuecpt

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Originally posted by ffemt8978@Jul 11 2004, 10:07 AM
What happens if you want to become a paramedic? You have to be an EMT-B first to even apply for the class. And if you live in an area that doesn't have a volunteer agency and the paid agencies aren't hiring, what are you supposed to do?
If the paid agencies are looking for paramedics, I'm sure they'll find a way to get a willing participant through EMT-B so that they can take medic.

BUT, in most places you can pay to take the class, you just can't OPERATE as an EMT-B without being affiliated with either a volunteer or a paid organization. It's like that in my County.
 

SafetyPro2

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In California, the only part of the EMT scope that requires you to be affiliated with an agency or private company is defibrillation (in other words, you can't carry your own AED around). Other than that, you can practice the rest of the EMT scope as a good samaritan if you want to. California's good sam law covers EMTs so long as they're not on-duty at the time of the treatment they provide. In other words: driving around in an ambulance, you're not covered, but if you're driving home from a shift, you are.

Paramedics, on the other hand, have to be part of an agency/company to practice ALS procedures. They can, however, practice BLS procedures like an EMT can without being affiliated.

And as I've mentioned before, First Responders aren't even regulated, so they can pretty much do whatever they want as long as they stay within their training.
 
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ffemt8978

ffemt8978

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Originally posted by rescuelt+Jul 11 2004, 10:41 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuelt @ Jul 11 2004, 10:41 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978@Jul 11 2004, 10:07 AM
What happens if you want to become a paramedic? You have to be an EMT-B first to even apply for the class. And if you live in an area that doesn't have a volunteer agency and the paid agencies aren't hiring, what are you supposed to do?
If the paid agencies are looking for paramedics, I'm sure they'll find a way to get a willing participant through EMT-B so that they can take medic.

BUT, in most places you can pay to take the class, you just can't OPERATE as an EMT-B without being affiliated with either a volunteer or a paid organization. It's like that in my County. [/b][/quote]
A lot of them are requiring that you already be a paramedic to even apply. I understand this as a cost saving measure on their part, but it does make it difficult to get new people into the program.
 

rescuecpt

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Like I mentioned before, you could take your EMT class and go straight to medic school without ever being affiliated... you just can't practice until you get an affiliation. During classes they set up the interships for you if your department isn't busy or if you are not yet affiliated.

I think that's kind of scary to go straight from EMT to medic class - as we've discussed on other boards, I think it is best for the patient and the provider if an EMT waits a few years before taking the medic class... there are some experiences and knowledge that you just can't get from a text book that are only earned through actual riding experience.
 
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ffemt8978

ffemt8978

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I agree, but I'm just playing devil's advocate here.
 

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