Using other skills

[JJR512]

Suppose someone is a certified EMT-P, LPN or RN, and maybe even a PA too, just for good measure. If such a person is riding the ambulance through his/her local fire department (i.e., acting as an EMT-P), is that person allowed to use any non-paramedic skills or knowledge (things not taught to paramedics) that he/she has learned through his/her other certifications?

 

[MMiz]

It all really depends on the service. Some require the person to act at their level of EMT training, others allow the person to use their experience.

I went to EMT school with a nurse anesthetist. Her hospital required her to go back for EMT training, even though she was highly trained and skilled in the hospital. At the time it was simply a loop that would allow her to make more money. One day she was working in the ER at the local level 1 trauma center during her EMT-B clinical. They had to start an IV on a ped, and no one felt comfortable doing it. This nurse presented her license, they verified it online, and she got the IV on the first try. I'm not sure if it was right, legal, or if the hospital would approve of it, but it happened.

 

[fm_emt]

I'm sure it depends on what your agency says. Many agencies I'm aware of won't let you work outside of the skillset that they hired you for. Liability issue, I presume.

 

[SafetyPro2]

California limits Paramedics to BLS skills if they're working with a non-ALS agency or when acting as a good Samaritan. They can only practice ALS skills when they are with a registered ALS agency.

We currently have that situation right now with our EMS instructor from UCLA who's a Paramedic. On our EMS drill nights, he actually comes to the station at 1 PM to do QC (drill's at 7 PM), and responds with our ambulance on any calls that come in. He's authorized by the department to assist with patient care even though he's not a member, but he's limited to BLS skills only because of the regulations.

We also have one member who recently got licensed as a medic and another who's wrapping up his field rotations. They're in the same boat (or rather, the one is and the one will be when he's licensed).

That being said, they're only limited on the skills they can perform. They can, of course, use the additional knowledge they have and can apply that to BLS skills so long as they don't exceed the scope of practice.

 

[MedicPrincess]

Here in Florida, they can practice within the scope that the service they are riding for is certified as.

Example- a medic is hired with a FD that is not ALS. He/She/It cannot perform any ALS skills, as they are working for a BLS service.

My service doesn't allow third riders for the purpose of observation only. In order to fill that third seat, you have to be either in training with our department, a FF who has been hired into an ALS FD and you are doing the 10 rides our MD requires so they know the protocols, and now since the local college has partnered with the county to begin a Paramedic Course, students will be riding beginning this fall.

But even then, you cannot practice outside what is indicated by the protocols.

 

[Jon]

Here in Florida, they can practice within the scope that the service they are riding for is certified as.

Example- a medic is hired with a FD that is not ALS. He/She/It cannot perform any ALS skills, as they are working for a BLS service.

My service doesn't allow third riders for the purpose of observation only. In order to fill that third seat, you have to be either in training with our department, a FF who has been hired into an ALS FD and you are doing the 10 rides our MD requires so they know the protocols, and now since the local college has partnered with the county to begin a Paramedic Course, students will be riding beginning this fall.

But even then, you cannot practice outside what is indicated by the protocols.

In my county, in PA, medics who HAVE in-county command can assist the primary ALS provider with Command approval. Medics with same-company command don't need approal..

All must be documented on the PCR of the ALS agency.

Part of this is because we usually run single provider, but almost all trucks have 2 full sets of gear - for backup and extra providers.

Jon

 

[TRAUMARN]

You must perform to what you are acting as....If you are not employed by that EMS service and merely doing a ride along, you are legally just an observer. If you are, for example a RN, and are also working as an EMT, then when on the truck you can legally only work as an EMT (unless hired by that company as a RN for transports, etc). Remeber that when we practice medicine, as a prehospital provider, we practice under a MD and as a nurse, we practice under our licsense with the guidence of a MD. However, when the truck you probably can do some things "of off the record" with your partners approval

 

[Jon]

You must perform to what you are acting as....If you are not employed by that EMS service and merely doing a ride along, you are legally just an observer. If you are, for example a RN, and are also working as an EMT, then when on the truck you can legally only work as an EMT (unless hired by that company as a RN for transports, etc). Remeber that when we practice medicine, as a prehospital provider, we practice under a MD and as a nurse, we practice under our licsense with the guidence of a MD. However, when the truck you probably can do some things "of off the record" with your partners approval

Exactly...

My ambulance Co. (BLS) is currently thinking about a Mutual Aid policy where the several paramedics who work for us would have command with the Hospital's ALS service (most already do) - and they would be able to be used as an official resource as secondary ALS providers.... the hospital has 2 single-provider fly cars up 24x7. On "bad" calls both medics go... unles 1 is already tied up on a call. All the cars have 2 sets of gear...

The idea is, that in the event that the second medic is tied up, a medic on the "BLS" truck already has command and has been approved to help, so they can be "drafted" by the ALS provider to assist with a "bad" call - Code, unconscious OD, multi-system trauma - o, in the event of an incident with multiple patients, they can start treating at the ALS level untle the next-due ALS units arrive. This wouldn't replace the next-due units, only assist the single-provider medic for calls.