Passed my AEMT but still want to practice as a Basic?

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Hey, I just passed my A exams, but I now realize that I may be better off practicing as a basic. Advice requested.

I work for a fire department, and the problem is that firefighters outrank everyone on a scene, regardless of EMS level. I've been on scenes where firefighters needlessly interfered in patient care and over-ruled the EMT and AEMTs (when the firefighter has not been doing patient care).

I wonder if it would be better to stay a basic and just defer to everyone than to get my A license an be responsible for patient care that I can't control? The money doesn't matter that much (it's not much of a difference), and I worry that if I lose my AEMT license because some green Basic in turnout gear and Boston Leathers ordered me to do something stupid I would ruin my career and destroy opportunities to do other types of EMS work.

Fyi, 90% of our calls are EMS, not fire.

(By the way, I am not a licensed firefighter, but I participate in all fire and rescue training at work, know how to drive and pump most of our apparatus, and I work for my town's volunteer fire department. I would love to progress to FF1 at work, but I actually worry about the bullying that would result from "threatening" the status quo if I do).

To be clear, the upper levels of the hierarchy, including the chief, have reinforced this weird FF/EMS chain of command thing multiple times, often by SCREAMING at EMS personnel for daring to speak to firefighters on a scene, much less questioning anything regarding patient care. It's a volatile, unpredictable environment where keeping your head down, accepting your non-firefighter inferiority in all situations, and eating occasional platefuls of vindictive **** is expected.

Any input? Should I just stay a basic and look for another job on the DL?
 
Are you an AEMT already? If so, in some places, you'd be held responsible for that standard of care while working in the field, regardless of your preference to step back. I suppose you could "renounce" your AEMT in some way and go back to Basic, but I'm curious: Why did you become an AEMT?
 
I became an A because I love the work and wanted to perform it on a more advanced level. Ultimately I'd like to become a Paramedic. I just don't want to jeopardize my license because of dysfunctional department dynamics. A Basic can over-rule my decisions on-scene because he's a firefighter, but I'm still responsible for the standard of care; that's the problem. I'm looking at options to move away from this department, but I don't want to be hasty or make my resume look spotty. In the meantime, I want to protect my licensure.
 
SallyVT said:
I became an A because I love the work and wanted to perform it on a more advanced level. Ultimately I'd like to become a Paramedic. I just don't want to jeopardize my license because of dysfunctional department dynamics. A Basic can over-rule my decisions on-scene because he's a firefighter, but I'm still responsible for the standard of care; that's the problem. I'm looking at options to move away from this department, but I don't want to be hasty or make my resume look spotty. In the meantime, I want to protect my licensure.
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Based on your first two sentences, I don't think you should give up your A. Don't let a "dysfunctional department" derail your career. There are plenty of other places for an AEMT or paramedic to work.

Basics overruling AEMTs on some non-medical matters doesn't have to be a problem. A lot depends on the attitudes of the people involved. It's not unusual to have operational chains of command involving asymmetric levels of medical certification.
 
If you are able to move, that may be the answer. On a lark, last night, I queried jobs in Montana. (Something I heard on the news about they can't fill jobs) I surprised how many EMS jobs were there. My 2 cents.
 
There are dozens upon dozens of EMS agencies that would kill to have another AEMT. Quit and don’t look back. Where I am in Pennsylvania, you can’t swing a dead cat without hitting an EMS open position. :)

Seriously. EVERYONE is hiring and paying AEMTs better than $20/hour.
 
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the more I read your post, the more confused I get.

first off, are you a career employee of the FD, or a volunteer? Because I do know of combination departments where a career FF is the equivalent of a volunteer Lt. I'm also confused because you say "work for a fire department."

When you say "I've been on scenes where firefighters needlessly interfered in patient care and over-ruled the EMT and AEMTs" are these firefighters also certified as EMTs, AEMTs or paramedics? or just plain hose draggers? If you are functioning as the EMT or AEMT, are you on a suppression unit, or on a transport one?

You say you passed your A exams; do you currently hold a state AEMT credential? I mean, if your job function is EMT, but you are a certified paramedic, you are only supposed to function as an EMT.

Now, if I'm on the engine as an EMT/AEMT/whatever, and the captain of the engine wants to run the show, that's on him. if he or she is going to scream at me for saying something, then I'm going to give him my notice when I get back to the house.

If I'm "some green Basic in turnout gear and Boston Leathers ordered me to do something stupid I would ruin my career and destroy opportunities to do other types of EMS work" then quite simply, I am going to ignore that person's orders. Seriously. that person can file a complaint with whomever, and if they (supervisor/manager) tell me I need to do something stupid because they said so, I would ask for them to put that in writing, take a topic, and then hand them my notice.

If I'm on the ambulance, and the FF are on the engine, once they turn over patient care to me, IDGAF what they say, it's my patient, and it's my decision how patient care proceeds. if they want to maintain patient care and come to the hospital, they can dictate whatever they want, because it's on them. How it should work is the first responders are running the scene, and once the ambulance arrives, the first responders step back and support EMS in any way they want. I'm all for working as a team, but once the handoff takes place, a new team leader calls the shots (and in theory, the most qualified medical person should be the team leader).

I guess my most fundamental question is, if the department is so bad, and the dynamics suck, why are you still there, and why haven't you looked to go elsewhere already?
 
DrParasite said:
If I'm on the ambulance, and the FF are on the engine, once they turn over patient care to me, IDGAF what they say, it's my patient, and it's my decision how patient care proceeds. if they want to maintain patient care and come to the hospital, they can dictate whatever they want, because it's on them. How it should work is the first responders are running the scene, and once the ambulance arrives, the first responders step back and support EMS in any way they want. I'm all for working as a team, but once the handoff takes place, a new team leader calls the shots (and in theory, the most qualified medical person should be the team leader).

I guess my most fundamental question is, if the department is so bad, and the dynamics suck, why are you still there, and why haven't you looked to go elsewhere already?
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Right, that's how things should go, the problem is that's not how it works in this department. I'm on the ambulance, FF-EMT shows up on the engine and then starts periodically interfering with patient care, jumping in the ambulance, making decisions, etc. Yes, I should be able to tell him to F off, but if I do that, he will simply ignore me and then I will be screamed at for insubordination and then fired because "chain of command."

Yes, I'd like to quit, but I don't want my resume to look spotty, so I'm playing a longer game. I have my foot in another door with some part-time work that could lead to something f/t in the future and am keeping a bunch of other feelers out there.

My question here was how best should I protect my licensure in the meantime?
 
SallyVT said:
My question here was how best should I protect my licensure in the meantime?
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Don't offer less than the standard of care you are licensed/certified to provide. Document any person or event that physically prevents you from doing so. Or you could leave your job now, before you have to do the latter.
 
Wow, that sounds like a sucky place to work... I wouldn't last more than a week there.
SallyVT said:
Yes, I'd like to quit, but I don't want my resume to look spotty, so I'm playing a longer game. I have my foot in another door with some part-time work that could lead to something f/t in the future and am keeping a bunch of other feelers out there.

My question here was how best should I protect my licensure in the meantime?
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Apply to other jobs. get your AEMT, and then apply to other FT jobs. the situation you describe sounds hazardous to your mental health, your career, and to your licensure. I mean, maybe it would improve if you get your FF1 and end up on the engine, but damn, I would be looking elsewhere. today. In fact, toxic departments tend to develop a reputation around the area, so it's likely people know why you are looking to leave, esp if you are on the ambulance.

BTW, my first (and only) journey into fire-based EMS (where I was on an ambulance employed by an FD, in a non-suppression role, stationed in a fire station next to the engine), the engine went on all ALS dispatches (and some BLS ones during the daytime), where all FFs were either EMTs or paramedics) and nothing like you describe occurred. We pulled up first and took our bags in, and they were right behind us, usually grabbing the cot or stairchair. The only time the FFs got crankly (other than after midnight calls, but I don't blame them) was when I locked the ambulance on a call (because I'm a city boy and that's what we are trained to do), and they weren't able to open the doors to get the cot out.

What you describe sounds like a recipe for disaster, where the chief needs to be replaced, and an organization that is in need of a major house cleaning and attitude adjustment. I would not stay there any longer than I absolutely needed to.
 
Thanks for the feedback, everyone; it's all helpful perspective. I think things are headed toward me leaving this position sooner rather than later.
 
SallyVT said:
Thanks for the feedback, everyone; it's all helpful perspective. I think things are headed toward me leaving this position sooner rather than later.
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Yeah i would definitely be job hunting and quickly because that place is a lawsuit waiting to happen and you don’t want to be part of it.
 
Just a couple things to consider. If you're actually licensed/certified as an AEMT, you could quite possibly be held to the assessment standards of AEMT even if you're working in an EMT capacity. You basically assess and treat with what you have available, recognizing also the role that you're in. In my instance, even though I'm also a Paramedic and an ED RN, when I'm working as an RN in the ED, I'm NOT allowed to function my capacity as a Paramedic. So, that means I'm not going to insert any advanced airways even if I know that the patient needs one, as an example. It also means that even if I was on shift as a Paramedic (and not hired to also be a CCT-RN if needed), I cannot transport a patient that's on a cardizem drip or on antibiotics, or whatever else isn't in the local Paramedic scope for IFT, even though I routinely hang and titrate those as an ED RN.

Someone else above also touched on an important thing too: document every instance where you were actually prevented from performing patient care by someone. When you do this, make sure you are able to articulate specifics such as exactly what aspects of care you were prevented from doing, what EMS policies/protocols are involved, and the like. Simply alleging an inability to perform care is NOT going to fly. You also must articulate exactly WHEN this occurs, such as prior to, during, or after transfer of care to you. Simply arriving on scene does NOT automatically transfer care to you. Fire and LE do sometimes have overall scene management authority in certain instances and you have to know when those instances are and are NOT an issue.

To go one step beyond this, once you have this documentation that actually shows an actual problem, you must then act on what you've found. You must report the issue to the proper authority. The Fire Department isn't always the appropriate place to report this, sometimes an EMS agency is as they have (usually) disciplinary authority against a person's EMS certificate or license, if not an organization's ability to do EMS. What I'm getting at is knowing / learning when and how to instigate regulatory violence against another entity, but only when that is absolutely necessary and if/when you go down this road, be ready to jump ship to a different entity because you will likely NOT be a favorite around your usual work mates, or at least the FD folks.
 
You will be held accountable to the certification level that you possess. With that said, if you're going to get paid more to be an AEMT you might as well do it. Most of us are in this for money as well as community service.
 
Yep, agree. I naively thought that I could hold off on activating my licensure, but that's not a thing.
Thanks to advice here, I will be documenting heavily and communicating any problems immediately and consistently.
 
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