Health Services Specialty.

[isuhawkeye]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

[BlueLakes1]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

Now if we could scrap the NREMT and get a federal entity to maintain the tests, and issue the licenses/certs (at least to verify core competencies), we'd be a lot better off. I can't stand the NREMT.

[arajca]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

But each state and system sets its own scope of practice, within the DOT EMT practices.

[isuhawkeye]

andrew.  expect to see federal funding tied to the iniative much like nims or the federal highway legislation.

otherwise don't forget nremt is nothing more than a private company.  they hold no special power or authority.  states choose to use them to manage testing.

[SARMedTech]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

Thats an awful lot of maybes, especially in the EMS world. There currently is NO national scope of practice, and to say one is under development is to be overlly optimistic. Even if Iowa came up with a draft that needed no revision, you still have to get 49 other states' Boards of EMS to approve it and enact it. 2013? try 2025. And when talking about the NREMT "planning" anything perhaps we should have an accurate representation of how slowly actual and substantive change occurs in that particular organization. A national protocol, let alone a scope of practice is quite some distance off.

[isuhawkeye]

You clearly haven't reviewed the source material.  This initiative is coming form the federal DOT.  The curriculum for 4 standardized EMS levels will be out in the fall, and the National registry of EMT's will transition to the new tests fall of 2010. 

Im sure all states will NOT adopt this standard, but the goal is to at least create a standard. 

[John Bryan]

On a side note.....the one task that the US Air Force Surgeon General has given CAP to help the AF with , many HSO, Nurses and Medical Officer don't take part.

This "mission" I refer to is DDR..... I wish more of our HSO's, Nurses and Medical Officers would work on getting on to bases and into communities and building this program.

Instead of complaining about what we can't do , why not work in the areas we can. I also think the SG would be more likely to support more AF use of our Health Services folks if he saw us working hard on the project already given to us.

HS folks should be working hand and hand with DDR, safety, CISM and other depts....not trying to creat are own empire.

Just my 2 cents.

[flyerthom]

On a side note.....the one task that the US Air Force Surgeon General has given CAP to help the AF with , many HSO, Nurses and Medical Officer don't take part.

This "mission" I refer to is DDR..... I wish more of our HSO's, Nurses and Medical Officers would work on getting on to bases and into communities and building this program.

Instead of complaining about what we can't do , why not work in the areas we can. I also think the SG would be more likely to support more AF use of our Health Services folks if he saw us working hard on the project already given to us.

HS folks should be working hand and hand with DDR, safety, CISM and other depts....not trying to creat are own empire.

Just my 2 cents.

Inter agency liason is another area. Who better to interface with EMS, Fire and other SAR units then those who work in those fields? We know who to talk too, what they need from US what we need from them.

[SARMedTech]

Not to derail the conversation, but there is a national scope of practice.  Iowa for one is working very hard towards its development.  Under the national scope there will be 4 recognised levels. 

Trainign curriculum, and text books should be out by this fall, and the national registry is *planning* on changing over the tests by 2013
http://www.soundrock.com/sop/pdf/SoP_Final_Draft_4.0.pdf

But each state and system sets its own scope of practice, within the DOT EMT practices.

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will. What they have is protocol. Scopes of practice implies that somehow they can hang out a shingle and set up medical shop on their own, which they cant because the only person with the scope of practice is their medical director, under who license they operate. And this children, is why CAP doesnt have EMT-Bs or paramedics that do anything other than say "that bandaide should be tighter." Heck, as it stands right now, a "CAP EMT" could probably get litigated to death if they put a latex bandaide on a kid with latex allergy.

[isuhawkeye]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

cough er ehem
http://www.idph.state.ia.us/ems/common/pdf/scope_of_practice.pdf

For the record that document is off of the Iowa department of public health bureau of EMS web site.
The scope of practice is a way to designate what skills a medical director can legally include in a protocol.  with out this document medical directors could legally train and allow first responders to intubate, give drugs, or preform other ALS skills.

And now back to your regularly scheduled rant

[BlueLakes1]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

...And currently in the approval process with the NHTSA, http://www.naemse.org/SoP_Final_Draft.pdf .

Incidentally, in EMS here in Kentucky, we commonly speak of things within our scope of practice. Of course, Kentucky paramedics hold licenses rather than certifications, so that might factor into the terminology.

YMMV.

[isuhawkeye]

wow someone else who reads national level documents.  I am impressed

[SARMedTech]

wow someone else who reads national level documents.  I am impressed

REDACTED AND TAKEN TO PM DUE TO POINTLESSNESS OF ARGUMENT AND TOTAL LACK OF RELEVANCE TO CAP.

As an MS student in Emergency Services, my book shelves are full of national level documents. I have not had time to read this 4.0 version of a National Scope, but since you were so kind as to post it, I will do so. However, lest we think we are breaking new ground, the national scope argument has been going on since the late 1960s when ambulances made from converted hearses painted white and stenciled with red crosses roamed the earth. Why, you may ask, is this document in its 4.0 version?  Because, dear reader, the NHSTA has turned it down in its previous forms. As much as I would like to have a national scope/protocol (by the way, I will give you +1/-1 and myself +1/-1 for the argument of protocol vs. scope. If the Oxford English Dictionary is used, these terms mean pretty much the same thing), its not anywhere on the horizon for American EMS in the next 20 years. Its just not going to happen. The closest thing to it is the EMAC (emergency mutual assistance compact) which exists between states and allows DMATs (or whatever your state calls them...does Iowa have a DMAT?  I dont remember that it did last time I checked) to move from state to state offering medical assistance in time of disaster. For example, IMERT works closely with the Missouri DMAT-1. If they need us (or vice versa) their governor calls our governor and the EMAC is enacted by executive order. Then we can go to their state and practice EMS at whatever level we are licensed just as if we were in our own state. Im sorry, but this is about as far as its going to get.

One thing that would have to happen is that all regions within a state would need to align their protocols. For example, here in IL, I am in EMS region 1, which takes in most of the area west of Chicago over to the Mississippi. In my region as a BLS/BTLS provider, I can use a combi-tube, administer epi, etc. Same goes for Chicago which I believe in region 7. However, down in the area of Peoria, students are required to learn this skill and test off on it, however combitube set ups are not carried on BLS rigs. Even within a given city, protocols vary within agency. Until and unless all of this can change, the NREMT, NAEMT and NAEMSA can wish in one hand and spit in the other till the cows come home for a national scope/protocol, it aint nebba gonna happen, GI. One of my professors at AMU sits on a national scope board for NHTSA and what they agree on is that they cant agree on how a national scope would work, but they are for it, so they write these little white papers (notice its called a model and has been submitted to the NHTSA 3 previous times) and keep going through the motions. For the record, I am all for it and lobby for a national scope. But its not going to happen while I can still carry a litter. Ill look over the white paper on the proposed national scope over the next couple of days. Heck I may write an opinion paper on it for school. But lets do the rest of the CAPsters who couldnt give a tinkers [darn] a favor and take it to PM. The only place that this issue has less relevance than in EMS is in CAP which has no EMS. Believe me, I like wearing my little wing and star sewn onto my BBDUs (Im 20 pounds overweight...so shoot me...I still have my camos and will be back in them before summer encampments). But its is meaningless. The only place being an EMT is more meaningless is the USCGAUX but at least there you can get what amounts to an MOU for the duration of an op or op-ex which allows you to function as an EMT with the controlling stations medical officer operating as your medical control.

(Wrestling topic back on track)...seriously, if you want to practice EMS in an austere field environment, do it the right way:shell out alot more of your own cash for khakis and gear and join a DMAT or start your own CERT or join the MRC or something. NHQ has made it plain that there is no place for legitimate use of EMS personnel in CAP and there isnt going to be for the near future, which after all, is what this poor misguided thread started off to be about. ANd if there is an ounce of mercy in the souls of the admins, someone please slap a padlock on this sucker.

[SARMedTech]

Can we please stop saying that EMS personnel have scopes of practice. They dont now, never have and never will.

...And currently in the approval process with the NHTSA, http://www.naemse.org/SoP_Final_Draft.pdf .

Incidentally, in EMS here in Kentucky, we commonly speak of things within our scope of practice. Of course, Kentucky paramedics hold licenses rather than certifications, so that might factor into the terminology.

For my edification, can you please advise what state's responders do not hold licenses but rather only certifications?

[arajca]

Colorado, for one. All levels of EMT (B, I, P) hold certificates, not licenses.

On the protocol issue, Colorado has standardized all systems using the same protocols. As it was explained to me, the reasoning was to avoid legal problems - "ABC system allows their EMT-B's to push D50. The patient suffered needlessly because your EMT-B on scene could not push D50 per your protocols. Why should you not be held responsible for this person's suffering when such a simple thing could have avoided it?" By having the same protocols state-wide, that argument is largely voided.

[brasda91]

I'm an EMT in Kentucky.  I'm from the old-school EMT's (read not National Registry).  I have never called myself licensed.  I am a state-certified EMT.  I think the difference may be a person is "licensed" if they go before a medical board, just the same as PA's, Doctors, Nurses, etc..  Maybe Paramedics have to do that, don't know.  As an EMT renewing my "certification" all I have to do is submit my re-application to the state.  I do not have to be interviewed by a medical board.

[BlueLakes1]

Kentucky EMTs are certified, but Kentucky Paramedics are licensed. When I first became a paramedic, we were also certified, but that changed around 2000 or so, IIRC. Oddly enough, when paramedics in KY were certified, the certification came from the KY Board of Medical Licensure; it changed when we switched to the KY Board of EMS. One benefit for us here was that licensure made it possible for hospitals to hire us to actually work as paramedics in ERs, rather than to just use us as ER Techs.

(Brasda, I'm old school too...37389/1701-P. If you hadn't heard, there's a bill in this session to scrap NREMT and begin state testing again. I hope it passes!)

All levels of EMS providers in Indiana are certified. I know that Texas used to allow paramedics to be either certified or licensed, but I'm not sure what they're doing now. I couldn't find a definitive list on the 'net of which states use certification over licensure, but it seems that licensure (at least for paramedics) is becoming more prevalent.

[Hawk200]

I couldn't find a definitive list on the 'net of which states use certification over licensure, but it seems that licensure (at least for paramedics) is becoming more prevalent.

While I was in Alaska, the state didn't recognize a position of paramedic. I knew a couple of people that went to Washington and took the tests. Don't know if it helped them in any way professionally or not.

It would be interesting to see if they did at present, or will in the future.