Supervision

[Ethan]

Our service has hired EMT basics to be shift supervisors. They also are assigned to ALS trucks

Basic/Medic. Has anyone experienced the same situation and where there any conflicts?

 

[Carlos Danger]

At the first private 911 service I worked for, we had field supervisors who sometimes worked in the office, sometimes on an ambulance, and often in QRV's. One of them was an EMT. This was a long time ago, but I don't remember any specific problems related to him being a basic.

I can definitely think of scenarios where it could at least potentially be an issue. So much of operations in EMS is intertwined with clinical decisions that it could be hard to have a BLS person telling an ALS person what to do. Also, in my experience one of the roles of a field supervisor is being available to back up ambulance crews, and it would certainly be more useful to have a paramedic in that role than a basic.

 

[LACoGurneyjockey]

We had an EMT as one of our divisions field supervisors for an ALS 911 company for quite some time. He was assigned to a truck so responding as backup in a supervisor truck was never an issue. There was some animosity from medics being told how to do their jobs by an EMT, but he tended to leave clinical decision making critique to the other supervisors and QA/QI. I think the biggest inconvenience was supervisors were responsible for restocking narcotics, which he could not do. So narcotic restock had to wait until the other shift came on or come from the other division's supe. Overall he was a fine supervisor and I never had an issue with it, but I know it rubbed some of our more senior medics the wrong way having an EMT as their superior.

 

[STXmedic]

I don't see an issue with an EMT in an administrative role in an ALS department, as long as that role doesn't involve dictating patient care (or even the possibility of it occasionally). If the supervisor starts trying to impose patient care decisions, regardless of how many years experience said supervisor has, I see an issue.

I've personally had EMTs as superiors, but they were dedicated to the office with admin duties. There were also EMT FTOs at that service, but they would only act in that capacity over another EMT.

 

[FiremanMike]

There's a difference between managing the scene and managing the patient. As long as the EMTs in question are mature enough to focus on the big picture and not try to dictate the minutiae of patient care (unless they see something really bad, of course), then this scenario can work.

 

[Tigger]

Where I am the full time staff is expected to take a more supervisory role when the shift captain is gone. It is not uncommon to have a shift of part time people and one (hopefully two) full time people on shift during the summer. We're supposed to keep the operational aspects of things running smoothly (ambulance move ups, mutual aid, things like that) regardless of provider level just because we know how to do that and the part timers may not be as comfortable.

I also worked at a place in MA that used EMTs as the base managers. That led to some issues with ordering and stuff like that.

 

[SeeNoMore]

I have been in this situation several times with no issue. None of the supervisors in question questioned ALS care beyond what might be expected of any other BLS provider if they were on the call. Certainly they did not get involved in QA.

 

[johnrsemt]

Never had a problem as a medic working with a basic supervisor: as long as the supervisor is not questioning what I did or was doing on the scene.

If they asked later, or said "medical director is asking" (usually med director was asking for me to translate my handwriting). I had no issues answering questions.

I did have a supervisor refuse to do something that I asked or told her to do a couple of times; talking to her usually fixed it but not always: had her stop the truck for a few minutes, then asked her to finish transport emergent (20 miles to go) and she refused: she was surprised when she opened the back doors at the hospital and saw I was bagging my newly intubated pt. She wrote me up because I didn't give her enough info for HER to make the decision of how to continue the transport

 

[Akulahawk]

Generally speaking, I'm OK with having an EMT as an administrative supervisor. However I will make a HUGE issue if an EMT tries to butt into clinical care of my patient. In real-world terms, it means I'm OK with an EMT Supervisor telling me to do my job, however they will not tell me how to do my job, including my provision of patient care. If that happens, I will report the EMT to the proper channels, up to and including a formal complaint against their certificate/license. Part of that clinical care decision-making includes mode of transport. If an EMT is my Administrative Supervisor and happens to be driving, and refuses, if I upgrade the mode of transport to Code 3 (RLS), again, that's butting into clinical care. Now I don't care how the Code 3 travel goes, as long as it's safely done because I just want minimal delays, not Warp 3 speeds bordering upon unsafe driving practices as that's failure to drive with due regard for the safety of others.

 

[Ethan]

I had one try to dictate a transport decision for a critical pt. i explained the need for the closest available facility for definitive care. The response I received was it doesn't make a difference. This happened on more than one occasion. I chose to resign and not risk my license. I have no issue with general operations decisions,

 

[DrParasite]

Most supervisors don't do the level of patient care that the ambulance providers do. especially administrative supervisors. the reality is, even if your supervisor is a paramedic, if he or she doesn't get on an ambulance regularly, and regularly see and treat patients, you will probably know your protocols better, be more up to date on latest techniques, and be a better provider than the supervisor, as well as be more in tune with what the best treatment plan is to treat the patient.

EMT supervisors are acceptable as operational supervisors. Akulahawk said it perfectly, "I'm OK with an EMT Supervisor telling me to do my job, however they will not tell me how to do my job." Clinical QA is best reviewed after the call, regardless of if the supervisor is an EMT or paramedic. At the patient side is not the place to argue over what should be done to treat the patient.

If the situation you describe, I would have done what I thought was best, and then had a sit down with administration the next day to discuss what happened. if it still didn't go the way I wanted, than I agree, resigning is the best option.

 

[akflightmedic]

I think the biggest inconvenience was supervisors were responsible for restocking narcotics, which he could not do. So narcotic restock had to wait until the other shift came on or come from the other division's supe.

While the others already gave good responses, I was just personally curious about this statement. He was a supervisor and supervisors stock narcs. Why is he not allowed to restock? He is not giving the drugs...so I am confused.

 

[Akulahawk]

While the others already gave good responses, I was just personally curious about this statement. He was a supervisor and supervisors stock narcs. Why is he not allowed to restock? He is not giving the drugs...so I am confused.

As he is/was an EMT, he probably doesn't have a license that allows him to handle narcotics.

 

[akflightmedic]

In my experience that is irrelevant as it is restocking, not administering. There is no rule which says only a paramedic can restock which is why I was asking for further clarification. He cannot intubate either but can he restock ET tubes? See my point?

There should be adequate security controls in place of course which need to be adhered to, but the restocking should be a non-issue. I will wait to hear from him on why this was.

 

[LACoGurneyjockey]

@akflightmedic, you brought up a valid point and I don't have a good answer. Might have something to do with the company being the source of one of the largest theft of narcs by a former medic in CA, might just be policy that EMTs don't handle narc keys. But I don't know for sure.

 

[Ethan]

The Services I had worked did not allow EMT's to access the narc box. In general it appears trivial but I am sure their is state laws at least here as to why and how.

 

[akflightmedic]

No I do not think there are state laws which pertain to the handling/restocking of narcotics. I do think there are DEA guidelines to follow with regards to security and documentation but ultimately that would be the company's decision on how to handle. Follow the chain of procurement...was a paramedic involved every step of the way? No.

And again this is a matter of restocking a supply or medicine. So it seems more of a company policy than anything.

 

[Ethan]

Sounds like the right idea

 

[usalsfyre]

No state laws in Texas regarding provider levels and the narc box. I ran the narc program at the service I worked for.

 

[WolfmanHarris]

Ironically, most of our Superintendents were Advanced Care Paramedics when they were promoted, but recently because of their extremely limited patient contact and concerns about them getting bogged down in patient care either as back-up or during a major call our Chief required that step their level of practise down to Primary Care Paramedic, essentially asking medical direction to downgrade their certification. Our Captains on the other hand are so far exclusively ACP's.

None of this has prevented supervisory staff from distributing narcotics as the laws in Canada covering controlled substances are entirely separate from anything to do with EMS.