Paramedic registration

[SpecialK]

G'day all,

In Australasia we're working towards Paramedic registration under the applicable national health professional regulation schemes (AHPRA and the HPCAA respectively). This is already used in the UK, Ireland, South Africa, and I understand all of the USA and parts of Canada.

This will be revolutionary. It will transform ambulance personnel into a legislatively recognised health practitioner. Accountability will largely transfer from the employer to an independent authority which will set standards of registration and regulations for conduct, professional development, and discipline.

What this means amongst other things is ambulance personnel will be randomly audited for compliance with professional development requirements, personnel will be individually accountable for their clinical practice and the public can make a complaint and it won't go to the employer necessarily to resolve but can be referred to the regulating authority who can investigate and impose sanctions or cancel registration.

If you read the UK HCPC disciplinary outcomes they are very strict; for example have imposed severe sanctions or cancelled registration for substandard clinical practice or poor ethical or moral behaviour towards patients or colleagues. One of my friends is a nurse who was called before the Nursing Council to undergo a detailed investigation because somebody thought they were looking at inappropriate content on their work computer, they weren't but they still got put through the ringer and too bloody right I reckon as well.

There have been a small number of personnel who are opposed to registration in Australasia because they're not prepared to submit to the level of public and external accountability for professional standards. Many of these personnel are older, were vocationally trained and do not the now required university qualifications and will likely leave or retire rather than be registered.

How have you found it in the USA?

 

[EpiEMS]

How have you found it in the USA?

The National Registry is sort of a strange hybrid. We're licensed (licensed, I know - many of our states call it certification, but it's a licensure) by a state to practice, but certified (in most places that I am aware of) by this private body, the NREMT. Being NREMT certified doesn't let you practice, it's more like a university granting you a degree, if you will, saying that "this person has satisfied X body of knowledge and is capable of doing X".

 

[SpecialK]

I think you have missed the point of what I was asking. I had a look at that link and clearly, what we call registration you call "licensing". Your "licensing" authority appears to undertake the same functions we are preparing to move from a sector-led approach to a legislated, independent authority, for example regulations for conduct, professional development, and discipline.

This is completely new for us in Australasia: the accountability shifting from the employer to the individual. While ambulance personnel have always been individually responsible to a degree, that degree is going to widen significantly. For example; a paramedic does something substandard which results in a negative patient outcome. For now the patient complains to the employer or the Health and Disability Commissioner, and everything is managed "in-house" by the ambulance service away from public scrutiny and without transparency. In the future, the patient can also complain to the regulating authority who can investigate and decide to hold its own process which may result in the paramedic being sanctioned or having their registration cancelled. This can equally apply to non-clinical actions too such as inappropriate conduct. The regulating authority will also, for example, conduct random audits of CPD activity and evidence of practice recency.

So how have you in the USA found it having to work with this system (which again, you seem to call "licensing")?

 

[ExpatMedic0]

The NREMT Paramedic certification is a great thing in my opinion. It sets a minimum standard, requires minimum programs hours and accreditation, ensures we are all at least meeting the minimum standard. Almost every state requires it for initial certification or will accept it for reciprocity for a local license or certification to practice as a paramedic in that state, and it acts as a stand-alone license for the federal government if you work for them on their land in some capacity. Source: https://www.nremt.org/rwd/public/states/state-ems-agencies National Registration has come a long way, but I would love to see it require a degree for entry level certification at the paramedic level. Maybe one day...

However, I will say that although we do you have to answer to the NREMT to an extent, we mostly answer to our local state health authorities and medical director. That states EMS health authority is ultimately and legally how you can work as a paramedic. We are also tied to a medical director. Paramedics aren't allowed to work independently. We have an MD above us, and we work under his or her medical license with standing orders, protocols, and medical control. A good example of how much that can differ is take a look at Seattle Medic 1 and how the medical director runs that system and how those paramedics train and to operate compared to say, some random city in Texas. So we are still tied to the hip to a local medical director and a local regulation body. We have no national guidelines that all states follow, like the UK for example and the NHS using the JRCALC guidelines.We do have national guidelines which in theory lay down the minimum standards, but we don't follow them as local protocol and ultimately it's up to your medical director what you are allowed to do and not do. A lot of us RSI and a lot of us don't, the NREMT has nothing to say about that for example.

 

[EpiEMS]

So how have you in the USA found it having to work with this system (which again, you seem to call "licensing")?

Since we answer primarily to our state (e.g. the state board of EMS) and our medical director, we've always had our own license on the line. Accountability should be on the practitioner - that is how every other medical profession works, EMS should be no different.

 

[NomadicMedic]

Since we answer primarily to our state (e.g. the state board of EMS) and our medical director, we've always had our own license on the line. Accountability should be on the practitioner - that is how every other medical profession works, EMS should be no different.

You have to be accountable for your actions, but you're not an independent practitioner. You still have a supervisory physician that authorized your scope and competence. In the case of discipline, YOUR certification may be in jeopardy, but ultimately a physician makes your practice decisions.

 

[EpiEMS]

You have to be accountable for your actions, but you're not an independent practitioner. You still have a supervisory physician that authorized your scope and competence. In the case of discipline, YOUR certification may be in jeopardy, but ultimately a physician makes your practice decisions.

That is a very important clarification - I shouldn't have glossed over it.
I do wonder if this sort of liability applies to the (obviously much more extensively educated) PAs and (in states where supervision is required) NPs.

(decent resource here: linked PDF).

 

[NomadicMedic]

I think you'll find supervision becomes looser and looser as the supervisory position becomes more comfortable with the subordinate mid-level. However, as soon as there's an incident you can expect that all change. In other words, "everything is fine… Until it isn't."