USAFmedic.... My post about the license vs. certification isn't strictly talking about the fact that in a legal case THEY WILL come after the person with the license over the provider with a certification.
Does it really matter what they call your state credential? Either way, MIEMSS barely grant you folks the ability to wipe your own butts without asking Dr. Bass' explicit permission. Truth be told, I have so little faith in that state, that I would not be surprised if "dingleberries" would not be a qualifying criterion for a MSP mission. But back to the actual topic at hand....
As someone who works as a "PRN" expert witness for a malpractice attorney, we aren't going to go after the medic or the EMT anymore (assuming they both screwed up equally) unless the medic allowed the EMT to do something that violated a standard of care. This is not to mention that BLS screwups are very difficult to prove in court unless you have it on videotape or one of the providers on scene turns evidence for the plaintiff. The licensed person we are going to go after is the doc overseeing the service since they are the one with the nice fat wallet.
To be frank, if we want to punish an EMS provider for something they did, it's much easier just to have their credentials yanked. Not to mention, it's often much more productive, satisfying and less guilt-inducing.
As far the volunteers who are a RN, MD, RRT, horse doctor, whatever I guess to each their own. I have yet to meet someone who works in healthcare as something other then a EMT/EMT-P who is exceptional at field EMS in a volunteer capacity. Like I said previously I will put a GOOD MEDIC who does it day in and day out as a career up against a ER RN who volunteers and rides a unit any day....And I work with RN's who have ER and ICU background on a critical care transport team as well.
No offense, but that seems to just smack of hubris. In other words, you have have a confirmation bias that doesn't allow anyone to meet your standard. You're telling me that someone with several more years of education, probably more experience (since most EDs, even the slow ones, see more patients in a given time period than even busy ambulance services) and the ability to juggle multiple patients is less qualified than a full-time medic with a minimal education, limited scope of practice, etc? Maybe you guys just have some really crappy ED nurses out there in Maryland nowadays....
Let's use an example I know quite well: the medical director I worked under the longest and his assistants. All of them were EMS providers (the medical director had a state certification in EMS that put him among some of the first classes of ALS EMS providers; most of his assistants were EMT-Bs but a couple were EMT-Is or EMT-Ps) and all were required by policy to ride shifts with us if they wanted to remain able to give medical control orders. That usually amounted to one or two shifts per month for most of them. Are you really going to tell me that, as a general rule, a NREMT-P who works a busy service is a better provider in the field than a MD/DO with a board certification in emergency medicine (or in the case of our medical director: boarded in EM, CCM and IM, not to mention SF combat medic experience in Nam) just because they are volunteers who aren't spending all their working time on the ambulance? I know the field is a different environment than the ED but then again it's not
that different and to be honest, clinical judgment is what matters and in that case the guy or gal with more knowledge and more patients under his belt is probably going to be a better provider.
It's kind of like how I'm willing to bet that I could probably outperform you clinically given that I'm used to working in situations (in and out of hospital; civilian and military) where the scope of practice would make Maryland style ALS look like ARC style first aid. However, that said, I still meet EMS providers of all ilks (BLS, ALS, RN, EMT-P, EMT-B, first responder, etc) who are sharper than I am. Included in this list are several members of this forum (Ridryder to name one).
Hands down the sharpest person I have ever seen clinically was a dairy farmer who never "advanced above" the level of first responder on a volunteer department which ran a whopping 100 or so calls a year. Even when I was his lieutenant, I looked to him for advice because he had been doing it far longer than I had been alive and likely longer than you have been alive. Literally, his state certification number had two digits in it that were not precedent place holding zeros; when he finally "retired" he was the longest active EMS provider
in the state with something like 40 years of service, just counting the years
after EMS was formally organized at the state level. I'd take his word clinically over most EMS providers I know and would even seriously reconsider my take on a case if he said "Hey...something's not right here, LT".
Even our medical director (the one I mentioned before) spoke to him with a respect that was freakishly abnormal for this doc. I found out when Dave (the first responder) retired, he had been one of the doc's EMS mentors
after he came back from Viet Nam. It's an extreme example, but if you want to talk about how frequency of exposure to the back of ambulance being some form of penultimate determinent of prehospital clinical ability, I think a high school dropout who milked cows for a living and saw one hundred or fewer patients a year is a counterpoint to your argument.
I also think anyone who has spent any time isn this field recognises if a life is saved it will take a team of players not just the lead off hitters.
