Paramedic License or EMTP Certification?

ems paramedic questionsThis content is from the Authorized Transmissions newsletter, but I thought it would be great to pull it out and highlight it all on it’s own.

When it comes to being a licensed paramedic or a certified EMTP, opinions vary and it will depend on who you talk to.

Certification: Agency or association grants recognition

Licensure: Governmental agency’s competency standards are met

Now when you think about it, for most states it is one and the same. Even states that require NREMT “certification” still mandate that you take a state exam or meet state standards to be considered competent to practice as a paramedic in that state.

From the NREMT website “…Licensure, .. is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally only by those who are licensed.

As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.”

So, what’s in a name then? Especially if both descriptions are interchangeable and more importantly any state allowing you to work as a paramedic is giving “license” to do it.

Well that is just it. Some states like NY and NJ have been getting petitioned for years to change the identification from certification to license, but for some reason it just has not happened.

What’s the hold up?

Resistance due to education levels? Fears of infringing on other healthcare fields? Perhaps even those EMS insiders who like things just the way they are?

However you look at it. The bottom line in my opinion is that the paramedic profession should be licensed.

States cannot continue to dictate requirements and keep it noted as a certification in order to keep other professions happy.

Nationwide, paramedics should hold licensure and if need be, individual states can set specific requirements for that region in order for that paramedic to work and practice within a set scope or guidelines.

Government agencies need to remove all mention of certification from paramedic programs and gear all education and testing to a licensure format. If that means making exams more difficult, setting higher continuing education requirements and holding individuals to a higher standard overall, then so be it.

I think that this would be a move in the right direction for EMS as a whole and a step that is relatively easy to implement.

Listen, I don’t have the answers to this or know why with a certainty the word license is not the accepted rule.

Maybe we shouldn’t be putting too much energy into this to begin with since in the end it’s just a word.

The reality is that, no matter what the state calls it, a state issued “license” or “certificate” is functionally the same and is a “license”.

The difference to be aware of is that while the terms might be interchangeable for what a state calls it, non-government agencies like the NREMT, are certificates since licenses grant an official privilege (like the ability to drive or practice medicine) whereas a certification is simply a non-government agency saying that you have met their standards (like NREMT, AHA, PHTLS).

What do you think? Does it matter?

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Enough with the buffoonery

You know, a lot of things in EMS just don’t make sense. Spinal immobilization, continued use of Lidocaine, Lasix, Epi the list can go on. I suppose we do these things for a variety of reasons. Following protocols, job security, going along to get along etc.

One thing that has been really buttering my biscuit these days is this whole patient signature thing. This idea that having the patient sign the privacy form, billing form, no fault form etc. clarifies why they are in the ambulance. To me if they are in the ambulance it “implies” they want to be there. If they can’t sign because they are unconscious etc. it still “implies” they want to be there and having me or a nurse sign that they couldn’t sign is ridiculous.

EMS1Shouldn’t our documentation be enough to state why they were transported. How we found them, their complaints, our findings and treatments. Isn’t that all enough to warrant the need for an ambulance? Why do we subject patients to signing unfamiliar forms and computer screens when they are in duress. Chest pain, difficulty breathing, trauma and otherwise. “Oh excuse me sir, I know you are having chest pain and your 12 lead is showing a STEMI but can you allow me stop everything I am doing to save your life and direct your attention to my billing form.”

“Ma’am I know you are immobilized to a flat board with a stiff collar on your neck and although this alone should be enough of unnecessary treatment, can you sign this no fault form while on your back unable to move your head and in a most uncomfortable position”

My personal favorite. The 80-90 year old patient who can barely see, has arthritis and is being asked to use a computer screen and stylus… (what’s a stylus) to sign their name. Now press hard, don’t let your hand rest on the screen, no lets try again, oh wait, that’s good enough, I know it looks nothing like your signature….. “UNCLE!!”

“What” you say, “most patients can sign”? They aren’t in duress or in precarious positions not to sign? Maybe these patients should be going by some other means to the hospital. Perhaps they should be signing before you transport, that in your opinion they don’t require an emergency transport and that they may be required to pay the ambulance bill themselves.

Sure some patients need the ambulance and they most likely can also sign. But why is that part of the deal? Shouldn’t our assessment, care and documentation of it all assure the need for ambulance transport?

Now there are those who will say that it only takes a few minutes to get a signature. Its not a big deal, its part of the job and on and on. While this may be true at the root of it all, requiring these signatures has evolved in EMS from not needing them, to sometimes needing them to needing them is mandatory, patient condition be damned.

To me, the fact that the patient is in the ambulance accepting transport and treatment as I document the same on my report implies they want to be there and agree to being transported. I don’t know about you but I have not seen ambulances driving around snatching people off the street and taking them to emergency rooms against their will. But I guess if they did, as long as they got a signature somehow it would be OK.

My Memorial Day Challenge

Barbeque’s, family time and TV specials. Another Memorial Day weekend. Another Memorial Day of looking at countless comments on Facebook about thanking a veteran, showing your troop support and general well wishes to our troops and families.

For me, it’s another day of remembering. A day of wanting the troop’s home, praying for their safety and wishing their families to be granted the strength and faith to withstand the sacrifices made. It’s a normal day for me.

You see, I have that luxury of simple prayer and reflection. If you know me, you know that every day is Memorial Day for me. I’m too old to be in the military and my time spent in the Army is long over. Still, I want to do so much more than I am. Sometimes I fear I have not done enough to honor the sacrifices being made by our military. Sometimes I am ashamed that I let opportunities pass me by.

I have given to the Wounded Warrior Project, joined in groups putting together care packages and have donated to various military support groups and causes. For some that can be enough. For me I want to do so much more. Yet opportunities pass me by that can make so much more of an impact.

Seeing that soldier, sailor, airmen or marine walking down the street or in the mall should propel me into a personal showering of gratitude upon each of them. But too often I let it pass. Feeling corny, apprehensive of the reaction from them, worried that I may become too emotional and embarrass myself, THINKING too much that the moment passes, gone.

Ashamed and frustrated, I let these opportunities pass by.  I long to have an impact, take action and, without restraint, show all our service members how much I appreciate who they are and all they do. I long to leave them with the feeling that they are truly supported, understood and thought of not just on designated days like Memorial Day but every day.  They must be assured that as I sit in my decorated yard, eating a hotdog, I know they are sitting in a desert eating MRE’s.   They should know that though I am surrounded by the noise and laughter of my family, I pause often to remember that they only have images and memories of those they left behind. I take moments to honor them.  I remind my children of their sacrifice.  I begin to see that the impact I yearn for, the one that carries forward and is so vital to our troops,  are forming In the words I write.  I recognize my inner restraints and can choose to let them go.   The moment -the opportunity – to reach out and say “Thank you” will pass by ONLY if I let it.   I have taken action and can now move forward and hope that I have made a difference; to the soldier I meet, the unit he returns to, the families who worry and perhaps, even the nation they have dedicated their lives to.  My inner battles will not – cannot – prevent me from remembering that their sacrifice may, in fact, be the ultimate one.

I challenge you to do more. Take actions that ensure our service members and their families feel our respect, concern and appreciation.  Do more than post in Facebook or click a like button. If you can donate, do so. Get involved with a local organization to send packages or letters. And if – or should I say when – you get a chance to thank a veteran in person, don’t let that moment pass. It is not easy, but I ask that you stop thinking “should I” or “do they want to be bothered” or “who am I to approach them”. Keep your focus on them and the voice of insecurity will relent. If you are like me, tears may begin to well and words may not come out as planned, but we cannot feel ashamed or embarrassed, for as quickly as those feelings may surface, so will fortitude and inner peace.   Making an impact requires strength; emotions are often the only force that moves us to take action.

We can, and must, do more than post comments from our den or office and as I bring this message to an end to join my family, I think about the most important word within this article – sacrifice. Each moment a service member spends away from home, each march they make or person they help is testament to their daily sacrifice.  Help them know it does not go unnoticed. Reach out.  Take action.  Sacrifice appearances and show your appreciation to the service member in front of you.  They will carry it with them.  Don’t let the moment, the opportunity, pass by; know that offering thanks to those serving is the best way to honor the memory of those, whose sacrifice was their last.

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EMS Video Dedicated To Emergency Professionals

A new video from Farooq Muhammad dedicated to the special men and woman, dedicated to serving the public, in Emergency Medical Services and Fire Suppression all across the globe.

Fire The Mayor And Put The Tooth Fairy In Prison While You’re At It

The past few weeks have left me drained. No audio podcasts this week, since my voice is still shot from my illness. I have been sicker than I have ever been in my life and I feel as if I am starting to have delusional dreams both while I am sleeping and awake.  One is I keep hearing EMS providers in NYC calling for the Mayor to be fired over the snow storm in December.

Now, I understand the frustration and anger over the Mayors handling of the storm emergency and also his finger pointing at EMS implying that they did not do their jobs well enough during the storm. Of course the first head to roll for the lack of response was the EMS Chief himself John Peruggia. We talked a little about this during the last live podcast and many asked why is EMS being punished for any response issues when it was clearly a lack of access to patients and streets from little to no snow removal by the Sanitation department.

EMS being the lowest entity in the cities mind and the easiest to make some type of example of as a knee jerk reaction to the outcry of long EMS response times, patients dying or not being reached in time, is the obvious first line of political attack from above. What the EMS Chief could have done better to get crews to patients in the unplowed streets I just don’t know. But here is my thing.

Making statements that the Mayor and his inner circle should be fired is just ridiculous. This is not going to happen. While it is unfortunate that Peruggia was demoted from his position and others I am sure will follow from other agencies. The Mayor isn’t going anywhere. Setting up Facebook groups and trying to make a case that the Mayor should be fired as if it can actually happen just makes EMS look like children stamping our feet because we are angry that we didn’t get any recognition for our actions during the storm or because EMS is somehow being singled out at the moment as the scape goat for what went wrong.

As providers who where there, you now better and instead of an “Off with his head” mentality you should be offering solutions for future emergencies of a similar nature. I may be a bit delusional right now from my illness, but I am not that bad off where I think the Mayor getting fired will happen any more than I think the Tooth Fairy is going to get thrown in prison for stealing my teeth.

Sometimes these Facebook groups that get started can be great and open up great ideas and keep people informed on a specific topic. We have to be aware though that what we write and how we write our posts there are seen by many. Even those that we may not think read them at all. Such as the general public and even the Mayors Office.

So when statements like this are posted  “….Why hasn’t the Mayor and his Butt Boy Sanit. Commish. been investigated by the D.A.’S office for Crim. Negligent Homicide in any deaths of New Yorkers…”  and “The firing process should start with the mayor, then the sanitation commisioner….” or “….they doing a investigation as to what happen .Ok here is what happen streets not plowed NYPD FDNY and EMS where getting stuck in the snow that what happen…”

They do nothing to help the future or even the present other than venting and while I understand the anger and frustration that may bring on these comments. As EMS professionals we need to take a step back and think about what we post in a public forum that so many can see. Is the mayor going to get fired? No. Are there other solutions that can be looked at for the future? Definitely. So let’s get that thought process going, the next storm is just around the corner. Good luck Abdo.

EMS For Free?

Should 911 EMS services be free? I wonder sometimes that if local government paid for the 911 EMS services provided and we didn’t bill patients, how different the system would be. Would there be more abuse due to people feeling that their taxes are paying for it? Would local government become more aware of the EMS industry and find ways to reduce abuse and offer other solutions like community paramedicine?  Perhaps even giving the ability for EMS crews to decline ambulance transport for patients who don’t require it.

What are your thoughts? Take the quick poll below and feel free to post comments on your views and what you think a solution could be and if free EMS is a good or bad thing.

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Sharing Some Negative Feedback

I have a feature on my other blog Authorized Transmissions that I most likely will be moving here soon called Monday Minutes. These are just some quick audios on calls I had, observations and tips. I recently posted one on some negative feedback I received and thought you might find it interesting to take a listen.

Patients, Protocols and Practice

As someone who always looks for changes in patient care and ways to improve EMS and the treatment we give. It becomes hard to always walk that line between following protocols set by medical control. Trying to look beyond the cookie cutter formulas and think about a clinical picture being presented by a patient.

Each patient is different and needs to be thought of as perhaps needing a slightly different approach to their care and transport. Now of course there are bigger brains than mine out there that sit and create the protocols I am operating under. I don’t advocate working outside your set protocols provided by your medical control, but I do promote approaching patients with a thought process that goes beyond what is printed in your field guide.

Being a good clinician and thinking about the causes of a patients condition, the effects of treatment you give and the outcome upon arrival to the ED and beyond, is what makes good EMS providers at any level.  We are that extension of the ED and the doctor whose license we are working under via the protocols. So, by looking at the big picture with each patient we can practice as true health care providers and not just a ride to a hospital.

Protocols are guidelines that we follow after we can make that determination as to what the patient may or may not need. Sometimes that determination is made with your partner or with a online medical control consult. Our goal as prehospital care providers should be to blend the patient presentation, the protocols provided to us and practice good clinical judgement.

When new treatment comes along we should be advocates to bring that to the field. When protocols we are using are less than desirable for operating in the field, we should be discussing this with our medical directors to have them adjusted for better patient care and outcomes.

We have to take an active role in our education as well as be more vocal for what we need. Knowledge is the key to better patient care, better utilization of protocols and being EMS practitioners.