EMT/Paramedic Insignia

[JCW0312]

^ So is a First Responder called an EMT and an EMT called an EMT Specialist? 

[isuhawkeye]

I don't make this stuff up

This problem is exactly why the proposed national scope of practice document is in the works.  If it goes through we will have 4 levels of EMS provider as a standard across the entire country.

holding breath

Iowa scope of practice model
http://www.idph.state.ia.us/ems/common/pdf/scope_of_practice.pdf

Proposed National scope of practice model
http://www.nasemsd.org/documents/FINALEMSSept2006_PMS314.pdf

[JCW0312]

I don't make this stuff up

I didn't figure you did. You'd have to be smoking something good to come up with that. 

[isuhawkeye]

^^ True, but the National scope of practice concept is very exciting. 

sorry to be so far off topic. 

Back to the badge/patch issue

[Duke Dillio]

Not quite right, sargrunt. EMT-Bs are quite licensed to practice pre-hospital emergency medicine, just like paramedics as we both operate on the license of the state or regional medical director. At least, thats what the IL DOPH EMT license in my wallet says. Here in IL, while on duty, EMTs give about a half dozen meds, assess patients, treat shock and trauma, perform airway treatments (IE albuterol nebulizer) and even intubate patients with combitubes. Im also "licensed" to deliver babies in the field, stabilize fractures, eviscerations, lacerations and abdominal wounds. The meds I can give are aspirin for possible MI, nitro for chest pain, O2 (which is considered a drug so any CAP member carrying a cylinder since CAP has not medical direction is doing so illegally) glucose, glucagon, epinephrine and albuterol. EMT-Is can give about 3 times that many drugs including morphine and can also needle decompress a pneumothorax and perform and emergency surgical field airway (cricho-thyroid stab/tracheostomy).

I was simply saying that in California, the idea here is a little different than what I have seen in the past.  I worked as an EMT in Colorado and things were a whole lot different than they are here.  We had the half dozen meds (charcoal, O2, Nitro assistance, MDI assistance, glucose, and epi assistance).  They were talking about letting us use combi tubes but that sort of fell to the wayside.  The issue I had there was that I worked in a hospital which had a habit of coming up with things that we weren't authorized to do because we only had a "field license."  I worked as a tech in an emergency room and I was basically a glorified phlebotomist.  CA does not recognize the I level for EMT's that I know of, of course this may be different in different areas but in Stockton, there is B and P and that's it.  EMT's in CA are extremely limited in their scope.  I assume that this is due to the amount of lawsuits that are filed each year by the huge number of lawyers that we have in this pretty little state.  I generally go with the old, "When in doubt, ask someone else," meaning I get on the phone with a doctor for anything higher than general first aid.

[afgeo4]

I have a new member in my unit and being the PDO, I have to figure out this question...

She was a paramedic whose cert lapsed. She is currently a NYS Certified EMT.

Which EMT/Paramedic badge, according to regs, can she wear?

I see NO guidance on this at all. Which regulation talks about authorization of specialty badges? Technically, if there is nothing that dictates who is allowed to wear this badge, then no one is.

[Eclipse]

The authorization for the badges was done in an interim change letter in 2005.

One of my CC's has a copy and I will get it posted as soon as he sends it to me.

Suzy Parker mentions them in her Nov 2005 presentation "Looking sharp today in a CAP uniform"   http://level2.cap.gov/documents/Uniform_ppt.ppt", slide #20, but beyond the Basic, Intermediate, Paramedic, mentioned in the slide and the ICL, there is no regulatory definition of what is required, specifically, for each badge.

Basically you need to align your states EMT ratings to he badge and get as close as you can  (assuming they don't have just Basic, Inter, Para).

[SAR-EMT1]

I have a new member in my unit and being the PDO, I have to figure out this question...

She was a paramedic whose cert lapsed. She is currently a NYS Certified EMT.

Which EMT/Paramedic badge, according to regs, can she wear?

I see NO guidance on this at all. Which regulation talks about authorization of specialty badges? Technically, if there is nothing that dictates who is allowed to wear this badge, then no one is.

Simple answer: Expired certs dont count for anything.
If she is CURRENTLY certified at the BASIC level, then she gets the BASIC badge.  If she is CURRENTLY a PARAMEDIC then she gets MASTER, anything in between gets you the SENIOR badge.

[sarmed1]

Now if I can just get HMRS to stop calling its graduates medics...

there is always hope.....

I wrote a draft document to the  Ranger Supplement on Health Services and eliminated the title medic, and upgraded it to medical specialist (ie as in just like in the USAR world, the medical pro that is assigned to support a team is a medical specialist regardless of their level of base certification)

we'll see where it goes form there....

mk

[Eclipse]

Simple answer: Expired certs dont count for anything.
If she is CURRENTLY certified at the BASIC level, then she gets the BASIC badge.  If she is CURRENTLY a PARAMEDIC then she gets MASTER, anything in between gets you the SENIOR badge.

Ditto - still waiting the copy of the ICL, but it doesn't have that guidance anyway. He tells me he discussed this with a staffer at NHQ charged with making these decisions, and the B-I-P designation is a national definiation and you get the badge based on your certification.

And yes, the certification needs to be current at the time of application for the badge.  This is extrapolation from my personally having professional promotion requests bounced because the cert was expired.

[afgeo4]

Ok... I know you guys are applying logic as to what these badges are authorized for, but... what are they actually authorized for and where does it state that?

The regs don't even say one has to be an EMT to wear this badge, so then technically everyone can wear it. As it stands in black and white currently, members may wear the EMT/Paramedic badge. That's all, right? No specific qualifications required to wear the badge in the regs?

How many of you think that's absolutely ridiculous? That someone took the time to create these badges, under guidance, and someone took the time to write the badges' existence, under guidance, and yet no one took the time to say who may wear them.

[CadetProgramGuy]

Well.....CAPM 39-1, 5-1 says.....

5-1. Wear of Awards and Decorations. Awards and decorations prescribed by CAPR 39-3, Award of CAP Medals, Ribbons, and Certificates, will be worn only by CAP members for whom they have been authorized and only on those uniforms outlined below.

CAP knowledgebase says.......

1. Any cloth patch displaying the blue six-sided cross referred to as the "Star of Life" awarded by a certifying/licensing agency upon satisfactory completion of a US DOT EMT/Paramedic Training Course or approved equivalent. Patch will be removed when no longer current or when certifications are withdrawn.

CAPM39-3 Says nothing.....

[Eclipse]

^ Further to this, wear of the badge requires commander's approval, so the onus on checking is there.

Still waiting on the ICL, but I'm told EMT-B, I & P are national standards and the badge you wear is based on what your current certification is at the time of the award.

[SARMedTech]

Ok... I know you guys are applying logic as to what these badges are authorized for, but... what are they actually authorized for and where does it state that?

The regs don't even say one has to be an EMT to wear this badge, so then technically everyone can wear it. As it stands in black and white currently, members may wear the EMT/Paramedic badge. That's all, right? No specific qualifications required to wear the badge in the regs?

How many of you think that's absolutely ridiculous? That someone took the time to create these badges, under guidance, and someone took the time to write the badges' existence, under guidance, and yet no one took the time to say who may wear them.

The really ridiculous part would be that in many states (IL and NM among them) it is illegal to "wear or otherwise publicly display" the star of life emblem if you are not licensed as an EMS provider as the SOL is the international symbol for EMS services, providers, etc. I guess the folks that would wear it without licensure would also wear military, CAP ribbons, insignia, etc that they are not entitled to. I take the wear of that insignia very seriously and have reported a couple of non-CAP members to the IL DOPH for wearing it when not authorized to do so. I dont go around wearing the FMRB that Im not entitled to wear (though i will be in about 18 months).

[chiles]

The really ridiculous part would be that in many states (IL and NM among them) it is illegal to "wear or otherwise publicly display" the star of life emblem if you are not licensed as an EMS provider as the SOL is the international symbol for EMS services, providers, etc. I guess the folks that would wear it without licensure would also wear military, CAP ribbons, insignia, etc that they are not entitled to. I take the wear of that insignia very seriously and have reported a couple of non-CAP members to the IL DOPH for wearing it when not authorized to do so. I dont go around wearing the FMRB that Im not entitled to wear (though i will be in about 18 months).

Totally agree here. I was an EMT-B in MD and I wore the badge. My license expired and I'm not a fully licensed nurse, so I wear the RN Caduceus. If something goes down at an activity and someone shows up sporting an EMT badge, I assume you're a licensed EMT. I think I'm going to stop assuming.

[afgeo4]

Well.....CAPM 39-1, 5-1 says.....

5-1. Wear of Awards and Decorations. Awards and decorations prescribed by CAPR 39-3, Award of CAP Medals, Ribbons, and Certificates, will be worn only by CAP members for whom they have been authorized and only on those uniforms outlined below.

CAP knowledgebase says.......

1. Any cloth patch displaying the blue six-sided cross referred to as the "Star of Life" awarded by a certifying/licensing agency upon satisfactory completion of a US DOT EMT/Paramedic Training Course or approved equivalent. Patch will be removed when no longer current or when certifications are withdrawn.

CAPM39-3 Says nothing.....

1. Correct... 39-1 says they should be worn by those authorized... WHO is authorized? WHERE is the authorization? Don't guess. This is a black/white issue.

2. Knowledgebase... although a great guidance tool, is not a regulation and does not authorize anyone for anything.

3. Cloth patches aren't special badges.


Anyone here a CAP health professional and would like to pass this on to our health officers up at NHQ?

[chiles]

I'm a health professional and it's all part of the discussion and attempt to get a development program for us medical types. IIRC, this is one of the issues we were discussing awhile back on the health services mailer. If Col Greenstone is on here, he'd be able to help. If this issue got kicked up to me as the wing NO (we don't have a Wing Medical Officer), I'd say that only those certified could wear it. I'm not sure if this is something within my sphere of influence, but I will find out.

[Eclipse]

So it tuns out not to be an ICL, but an action by the NEC, below is the relevant passage.  The rest of the information came from one of my unit CC's who discussed the below in detail with a staffer at NHQ who is in charge of plans and programs implementation. (see attached for the full minutes)

As told to him/me, the grade of the badge matches the valid certification level of the member against the national definition of EMT-Basic, -Intermediate, -Paramedic.

CAPM 39-1 was last revised just before this meeting (MAR 2005), and beyond the Powerpoints referenced in previous messages, there appears to be no further clarification on the issue, with the assumption being that the next rev of 39-1 will clarify.

3. Modification to EMT/Paramedic Badge.
COL ROBINSON/RMR MOVED and COL GLASGOW/NCR seconded the committee
recommendation that the National Board approve the 3-level EMT/Paramedic
badges and eliminate the wear of an EMT patch on the left BDU pocket.
March 2005 National Board
1 6
MOTION CARRIED WITH NO DISSENTING VOTES.
FOLLOW-ON ACTION: Implementation of policy, notification to the field, and change to
regulation. There was agreement that the phase-in date would be set by National
Headquarters.
NOTE: There was clarification that members would wear these badges according to
their individual state licensure levels as an EMT.

[SARMedTech]

So it tuns out not to be an ICL, but an action by the NEC, below is the relevant passage.  The rest of the information came from one of my unit CC's who discussed the below in detail with a staffer at NHQ who is in charge of plans and programs implementation. (see attached for the full minutes)

As told to him/me, the grade of the badge matches the valid certification level of the member against the national definition of EMT-Basic, -Intermediate, -Paramedic.

CAPM 39-1 was last revised just before this meeting (MAR 2005), and beyond the Powerpoints referenced in previous messages, there appears to be no further clarification on the issue, with the assumption being that the next rev of 39-1 will clarify.

3. Modification to EMT/Paramedic Badge.
COL ROBINSON/RMR MOVED and COL GLASGOW/NCR seconded the committee
recommendation that the National Board approve the 3-level EMT/Paramedic
badges and eliminate the wear of an EMT patch on the left BDU pocket.
March 2005 National Board
1 6
MOTION CARRIED WITH NO DISSENTING VOTES.
FOLLOW-ON ACTION: Implementation of policy, notification to the field, and change to
regulation. There was agreement that the phase-in date would be set by National
Headquarters.
NOTE: There was clarification that members would wear these badges according to
their individual state licensure levels as an EMT.

I guess Im in violation because I still have the cloth insignia on my BDUs. I recently asked my squadron command if I should remove it and was told no. We also have members wearing their NREMT patch on their BDUs which I do not do and am fairly certain is not allowed, but I learned long ago not to get into spitting matches over uniform wear. Its not my area of concern.

[flyerthom]

Now if I can just get HMRS to stop calling its graduates medics...

there is always hope.....

I wrote a draft document to the  Ranger Supplement on Health Services and eliminated the title medic, and upgraded it to medical specialist (ie as in just like in the USAR world, the medical pro that is assigned to support a team is a medical specialist regardless of their level of base certification)

we'll see where it goes form there....

mk

To throw a further curve ball, several states have bridge course for RNs to work in the field with an EMT-P scope of practice.
They are doing EMS - can they use the badge? <somewhat retorical, keep reading>

To further confuse things - in PA my certification as prehospital RN is under the Bureau of EMS. In NV my EMS RN license is under the state board of nursing. In CA the MICN certiification is further different. My original training in PA is NREMT-P test eligible.
At this point i just use the Nurse insignia and do not wear the EMT badge. But I am working in EMS so I wonder if I could wear the EMS badge. If I was nationaly registered there would be less of a question. At this point it's best not to wear it.