Physician Assistant

[daedalus]

This may have been asked before but I cannot find it. If one was to become a PA-C, could that person still practice as a medic while off duty as a PA? This is actually not my scenario but one of someone I know that volunteers at a clinic I work at.

 

[johnrsemt]

yes they can, as long as they remember that they are only working as a medic.
my old medical director was a doc for 14 years, and still an active medic for 27 years.

 

[mycrofft]

It's like this:

Got the certificate, hired to do it, greenlight.

Got higher and lower certificates, hired to surpass the lower one, yellow light (are you within company rules and protocols?).

Got the lower certificate but working beyond it ? "Danger, Will Robinson!".Halt.

Got the higher certificate, hired to work the lower certificate, but you want to do the higher level work on the job anyway? Red light, whoa. They get free quality which they may not want and are not paying for. And if you work as the lower level (e.g., a MD wokring as an EMT) if you do not act as a MD to save a pts' life you may be held accountable by the medical board. Might need that EMT after all...

Sometimes on the job you have to stick with your role so the overall structure works. We have deputies who are EMT's in RL (outside the job) and they are the biggest headaches yet. We rely on them to keep us and our clients safe, not dig in and be tied into a medic role.

 

[VentMedic]

A PA in California can also challenge the Paramedic exam.

 

[VentMedic]

We have deputies who are EMT's in RL (outside the job) and they are the biggest headaches yet. We rely on them to keep us and our clients safe, not dig in and be tied into a medic role.

I did a lengthy post on another thread about Correctional Officers holding EMT certs. While it is nice one has EMT training, if one is hired as a C.O. and one's duties are for C.O. and not medical officer, one should not endanger others by trying to fill both roles simultaneously. You let your guard down and someone may get hurt alot worse than the person requiring medical attention. The could include putting the other C.O.s in danger as well as the inmates. That is also why I do not believe the Public safety model of wearing many hats for one job is always in the best interest of the public.

Sorry, slight off track.

As mycrofft stated, when working as a Paramedic you may be working only in that job description.

Some RNs, RRTs, and PAs do take the EMT-P cert to show knowledge or some training as a Paramedic (like other "certs") but work under their RN, RRT or PA license.

 

[JPINFV]

10. How do I become a paramedic if I am currently a MD, RN, MICN, or PA?

In order to apply for a paramedic license, the following documentation must be submitted to the EMS Authority for review:

* copy of current MD, RN, MICN, or PA license;

* documentation that training is equivalent to a U. S. DOT EMT-Paramedic National Standard Curriculum, a copy of which can be accessed at www.ems.gov/index.html then click on Education. A suggested way to provide this documentation is to submit a copy of your transcripts from your MD, RN, MICN or PA training, and it is highly recommended that you have also completed one of the following training courses:

o EMT I Certification
o MICN Course
o EMT-P Refresher Course

* documentation of successful completion of a field internship through an approved paramedic training program which includes 40 ALS patient contacts in a field setting. An ALS contact is the performance of one or more ALS skills, except cardiac monitoring and basic CPR, on a patient (each contact must be documented and signed by a county approved preceptor). Field contacts as a Flight Nurse, EMT II, or other prehospital ALS contacts may apply toward the 40 required contacts;

* in addition, it is highly recommended that training in the following (or equivalent) be completed:
o ACLS - Advanced Cardiac Life Support
o BCLS - Basic Cardiac Life Support
o PHTLS or BTLS - Prehospital Trauma Life Support or Basic Trauma Life
o Support PEPP or PALS – Pediatric Education for Prehospital Personnel or Pediatric Advanced Life Support

The knowledge and skills from these courses will assist you in passing the licensure exam.

Once the EMS Authority has reviewed and approved the above documentation, you will be sent verification to submit with your National Registry of Emergency Medical Technicians (NREMT) Application that you have completed the equivalent training of a paramedic program. In addition, you will be sent a Paramedic License Application – Initial Applicant, and a Statement of Citizenship, Alienage, and Immigration Status for State Paramedic License Application/Renewal (Form IS-01) to complete and return to the EMS Authority with a check or money order made payable to EMS Personnel Fund in the amount of $230.00. Fees include:

Initial Application Fee $100
License Fee $125
State Licensing Match Fee $5

You will also be sent a Request for Live Scan Service Applicant Submission form and instructions for a Department of Justice (DOJ) criminal history check (see instructions on our website for submission of fingerprints).

Once you have submitted the documentation listed above and we have received the results of your criminal history check and NREMT test results you, will be issued a California paramedic license in most cases within 10 to 15 days.

http://www.emsa.ca.gov/paramedic/faq.asp

 

[firecoins]

I believe there have been a few studies of using in the field P.A.s Ill try and find them.

 

[VentMedic]

I believe there have been a few studies of using in the field P.A.s Ill try and find them.

A P.A. would have more effect if they worked as a P.A. with their Physician extender abilities and privileges rather than as a Paramedic in the U.S. EMS system as it is set up now.

 

[firecoins]

A P.A. would have more effect if they worked as a P.A. with their Physician extender abilities and privileges rather than as a Paramedic in the U.S. EMS system as it is set up now.

Its my understanding that is in fact how they were used. This was done to reduce transports of non-emergencies.

 

[VentMedic]

The Physician Assistants are now well organized with many political healthcare issues on their plate. They are also allying with NP to gain strength for some of the issues that involve getting health care to those that need it.

American Academy of Physician Assistants
http://www.aapa.org/

The Society for Emergency Medicine Physician Assistants
http://www.sempa.org/

American Academy of Nurse Practitioners
http://www.aanp.org/AANPCMS2

From reading about extending the practice of Paramedics to decide who gets transport to a hospital and who doesn't, the approach from EMS has been "what will it do for us". The PAs and NPs are coming together with "what can we do better in providing more appropriate care for the people" which gets more support from those that make the policies and provide the funding.

 

[medicdan]

I know it has been discussed in the context of the new EMS scopr of practise, but are these any systems that are successfully using Pre-hospital PAs or NPs? Are there sample SOPs available for them? What are they being used for? What skills do they have? How are they monitored/supervised?

Any current examples?

thanks!
des

 

[firecoins]

I know it has been discussed in the context of the new EMS scopr of practise, but are these any systems that are successfully using Pre-hospital PAs or NPs? Are there sample SOPs available for them? What are they being used for? What skills do they have? How are they monitored/supervised?

Any current examples?

thanks!
des

Currently they are not in use but P.A. responded in fly cars at the request of EMS units to reduce the need to transport. PAs are being used to treat patients whom do not need to visit the E.R. They arn't performing "skills" as we know them. They do what an MD might do, they just provide medical care. Same with NPs.

 

[VentMedic]

The "skills" come with the education and specialty field of the PA. There are general practice PAs, Emergency Medicine PAs, Surgical PAs, Cardiac PAs, Ortho PA etc.
Examples:
http://www.aapa.org/gandp/pro-issues.html

As Physician extenders they can order diagnostics tests and prescribe medications.

Example of "skills" for a PA:
http://www.aapa.org/gandp/issuebrief/emergency.pdf

working in emergency medicine perform
many diagnostic and therapeutic procedures
including, but not limited to, abscess incision
and drainage; administration of medications
and injections; Advanced Cardiac Life Support;
Pediatric Advanced Life Support; analgesia and
sedation; anoscopy; arterial puncture and blood gas
sampling; arthrocentesis; cast and splint application,
removal, and management; central line placement;
dislocation reduction management; debridement
of burns, abrasions, and abscesses; epistaxis
management; extensor tendon repair; foreign body
removal; ears, nose, rectum, soft tissue, throat,
vaginal, and gastric lavage; Heimlich (small gauge)
valve insertion; immobilization (spine, long bone,
soft tissue) and transportation; endotracheal and
nasal intubations; intraosseous needle placement;
simple, intermediate, and complex laceration repair;
diagnostic lumbar puncture; nail trephination
and removal; nasogastric tube placement and
management; ordering and performing initial
interpretations of simple plain x-ray . lms with
second reading by supervising physician (or
radiologist) for collaboration and correlation with
clinical . ndings; ordering and interpreting EKGs
with immediate second reading by supervising
physician; paracentesis; regional block anesthesia
including double cuff method Bier block; rust
ring removal using slit lamp; ocular tonometry;
thoracentesis; thoracostomy tube insertion; urethral
catheter placement and management; venous access
and peripheral cut down; and wound care.​

Their education can range from an Associates degree to doctorate. The Masters degree is the preferred since that is what states normally require for script writing by advanced practitioners.​

Examples of education:
Loma Linda
http://www.llu.edu/llu/sahp/pa/index.html​

George Washington University
http://www.gwumc.edu/healthsci/programs/pa/index.cfm​

Johns Hopkins Emergency Medicine Residency for PAs
http://www.hopkinsbayview.org/emresidency/index.html​