Hey y'all! I'll admit, I'm a noob to the firefighter/fire department scene. But I need a little help...

I live out in the woods of southern Mississippi. I joined a VFD about 5 months ago. I'm an EMT but was told I can only do the EMR scope of practice due to not having med control. The fastest an ambulance can get to most of our calls is 15-20 minutes. I really want to be able to use my EMT SOP since I can do more. Plus, I'm the only one in my VFD with this high of a EMS certification.

How can I start fighting for med control? Where do I go? Who do I talk to? Does anyone else's VFD have access to med control?

Thanks to all who can help!

-The medical nerd

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If you are the only one with a higher licensure for your dept, I don't really foresee medical control authorizing an individual to act beyond what the dept is already certified at. With most depts or services, there is a liability coverage etc and assurance of continuing ed being met and so forth. What you are asking is essentially an individual MD to sign you off to operate in such a capacity alone.....IMO, I don't really see it happening. You may be better off getting involved with the EMS service that does do transports etc. You may be able to operate as a satellite responder under their licensure. You may be required to do shifts etc, or may involve getting hired on, but that could be your best option to practice at your level as opposed to trying to get a medical director to sign off on you individually.

Don't go over the Chief's head when it comes to getting things done both within the department and in the county the department serves. So my recommendation is work with the Chief in an attempt to make your wishes become reality. I've had to wait as long as five years a couple of times to get the ball rolling on ideas regarding "improvements" around the department.

The county in which we reside has a First Responder Organization that is led by a physician. The doc is our Medical Director. That's our medical control. He writes our protocols, which all departments in the FRO are required to follow. The treatment protocols are broken down into ALS and BLS levels of treatment.

Thank you for your response. I appreciate all the extra information you've passed on. I've not heard of satellite responder, sounds fun!

Right now, half of the department is just now in EMR school. So technically, I'm the only NREMT and there is only one NREMR. I will continue to look around for ways to use my skills and maybe further down the road if some members decide to become EMTs our chances will improve.

I would talk to the EMS supervisor and see if he/she can put you in touch with their med control doc. If they can, talk to the doc and see if he/she can provide any help or insight.

Kim,

What I mean by "satellite responder" is essentially someone affiliated with the service who may be able to respond in conjunction with the EMS service. Some services have volunteers etc that have their own jump kits etc who can go directly to a scene that the EMS service is responding to. So say you are affiliated with the EMS service which takes 15 to 20 minutes to get to your area and you carry a pager. You would call the service/dispatch and say you are responding direct to the scene and you can start pt care before the ambulance arrives. You become a part of the crew once they do get there. This isn't something always done, but something to look into.

 

As it currently sits, it seems your service is essentially a First Response service and not EMT, but you want to practice as an EMT, correct? That is why if you are affiliated with a service that operates at a higher level, and they are responding, you may be able to operate at the higher level, under that other services licensure. However, say you do get affiliated with that EMS service, and you are in your area and there is a call, but a different EMS service is responding. If you aren't affiliated with that other service, you are only limited to the First Responder skills.

 

 

I really wouldn't push for anything to be honest.  You have 5 months on the job.  You're a rookie and shouldn't have an opinion at this time.  Pay your dues first and learn your job before you try to make changes to the department.

Norm and Tim,

Not sure what level of EMS you guys may be doing, but what I'm reading here is essentially asking to have solo autonomy. When it comes to EMT license and maintaining National Registry, one has to be essentially affiliated with a service that provides that level that one wishes to practice. For the most part this would be a state Health Services type of law and nothing a Medical Director is going to do about it.

 

When it comes to medical control and director, they are essentially signing off on that service to ensure that people are trained and working within their scope of practice. Those services also have their own liability/malpractice insurance etc. What Kim, is essentially asking is for a medical director to give her the OK to practice as an EMT, despite the service she is currently affiliated with as limited to essentially First Responder. That is a HUGE liability for any medical director to sign off on and it puts their MD licensure etc on the line.....something majority of docs wouldn't be willing to do for an individual. My bet is if a doc would sign off on such a thing, Kim would be responsible for having her own malpractrice insurance etc.

 

This is why if she wants to practice as an EMT, it is better to become affiliated with a service that is already at that level. It may mean she may have drive and put in hours elsewhere etc, but would enable her to practice at the level. If she is allowed, and there is a call with her current dept and the EMS agency she is affiliated with responds on the same call, then she may be able to operate at a higher level if she is operating under the scope of the responding EMS agency and not that of the First Responder dept. That means she can't be responding in a dept vehicle, wearing the dept's logo etc if she is operating at a higher level than the rest of the service.

 

There is much more legal aspects involved here than just having a medical director sign off and give her the OK to practice at a higher level than her dept is now. You are talking state involvement for licensure, liability/malpractice issues and so forth.

 

On the malpractice/liability aspect alone, and why I say this goes beyond a simple OK from a doc. Say she would get the OK to practice as an EMT-B, being the only EMT-B on a service that is limited to First Responder. Let's say she is on a call and performs a procedure that as an EMT, she can do, but a First Responder can't. Say she does it wrong and a lawsuit is filed. The onus falls on her because she was performing beyond the scope of practice of the service. The doctor signing off on her could be equally as subject because they gave their OK. In some cases, this has led to jail time for such people, many more times, the loss of license, not to mention financial hardships fighting the matter.

 

 

For me, as a Paramedic, I can't perform ALS skills outside of my service, unless I was affiliated with another ALS service. Even if I'm off duty and come across an accident, etc, in my own services jurisdiction, I can't do paramedic skills unless I was on the clock. If I was asked to help, at that point the dept would put me on OT so I would be covered, yet if I wasn't, I could be held individually liable for any treatments I did prior to the EMS service getting there. 

 

There is a reason you don't really see too many individual EMTs outside of a service, way too much at stake.

Kimberly, I hope you pay close attention to John's reply regarding liability. That's a big deal.

And don't forget, if you push this without the Chief's blessing you may no longer be affiliated with the department.

Thank you so much for taking time to break it down for me. I, of course, would never try to go over my chief's head. I do however like to research things. If I'm told I cannot do something, I just want to know why and the reasons supporting it. 

Thank you for your reply. I do, however, find it to be very rude. All members in this department are fairly new, with the exception of 2. Only one EMR, myself the EMT, and about 10 are in EMR school.

To say I do not have an opinion is rude and closed minded. I agree, I am a rookie. I do not know much about running a volunteer fire department. But I have already made a few changes:

In my 5 months:

I have persuaded the chief into getting all members CPR certified (because they were extremely outdated and some never certified)

We are now working on medical training and getting the medical equipment that was never thought necessary.

To say I should basically keep my mouth shut, is not an option. I'm trying to help my department rise from being on the lower end of the county's VFDs. Not to brag, but I'm off to a pretty good start.

If it's not meant to be for me to practice as an EMT, I will accept this. I only wish to as I want to provide better care for the public in the long transit time for the local ambulance service. I will stay patient, but yet continue to work with my fire chief in changing this. Not above his head, but with him.

Thank you, Mr. Tindell. I will continue to work with my chief and stay patient. Never know what may happen in 5 years with patience and perseverance! 

With perseverance good things will happen and you and your department will continue to meet the needs of the community. Best of luck and stay safe!

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