Should I keep my EMT certification?

[Emergency!]

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I will be starting medical school in the fall. I am currently certified as an EMT-I in Ohio (my NREMT cert will be expiring). My card will expire in 2007. I am uncertain as to whether or not I should maintain my EMT certification. What would be the advantages of doing so?

I was told by an EMS instructor that if I want to continue working in the field as an EMT, I need to maintain my cert, because even though I will be an MD eventually, I am not allowed to run on a squad without the EMT cert. This doesn't make any sense to me, as this implies that on a squad, I would only be allowed to function as an EMT-I, even though I might be an MD. Yet surely, if I failed to do something that I know how to do as a MD and this resulted in a poor outcome for the patient, I would be sued as a MD and not an EMT.

Thoughts? Comments? Info??

Thanks!

Amy

PS - Congrats to all who matched!!

 

[12R34Y]

I've been a medic for years and I keep mine strictly for nostalgia. I just can't seem to let it expire. it is totally useless currently, but no matter.

I hope to match in EM in about 11 months and 25 days or so and i can honestly say I probably will never run a call as a medic again, but like i said......just can't let it go. kind of pathetic huh?

just keep it. it's no big deal. that way you won't ever say........."man.if I only had my EMT" not that i can imagine that situation.

later

 

[eadysx]

I've been a medic for years and I keep mine strictly for nostalgia. I just can't seem to let it expire. it is totally useless currently, but no matter.

I hope to match in EM in about 11 months and 25 days or so and i can honestly say I probably will never run a call as a medic again, but like i said......just can't let it go. kind of pathetic huh?

just keep it. it's no big deal. that way you won't ever say........."man.if I only had my EMT" not that i can imagine that situation.

later

I am an MS-1, and I can't let mine go either. It was so much a part of my life before med school and even college I can't part with it. I agree that you should keep it.

E-

 

[Doczilla]

Your EMS instructor is only partially correct. If you wanted to continue running with a squad as a medical student, you would have to maintain your EMT-I cert to practice skills, as you have no medical authority until graduation. Once you have your MD and your license, you do not need an EMT certification. Your MD license is sufficient to practice any medical skill you see fit in the prehospital environment. Remember that advanced EMTs (EMT-I, EMT-P) practice as an extension of the physician's authority, i.e., his/her authority to perform the invasive skills such as IVs, intubation, etc. Physicians by definition have the authority to perform these skills already.

Where this gets fuzzy is when you are a resident. An intern has an MD but no medical license until he/she passes step III and applies for a license. Residents usually have a training license under the hospital, which may dictate that residents can only practice within the reach of the clinical faculty. How each training program defines "within reach" varies. Some will say that practicing within the established prehospital protocols would be sufficient as long as online medical control is available. Others may want to have clinical faculty looking over your shoulder before letting you do anything. Some give residents authority to practice advanced skills in the field beyond local protocol (central lines, etc). Regardless, this is only 3-4 years of your training.

Maintaining your certification is your own choice, but will probably bring little benefit outside of running with a rescue squad prior to graduation. You may wish to do so for your teaching credentials. Here's the interesting thing: to teach EMT classes, you have to be an EMT. To teach more advanced EMS classes (paramedic), you only need "special qualifications" to teach the class. (Loosely defined by intention) This is to allow people like nurses, social workers, physicians, and police officers to teach classes relevant to paramedics without having to go through paramedic class themselves. As a medical student, you possess special qualifications and training, and should therefore be able to teach subjects you feel comfortable with.

Like 12R34Y, I kept up my paramedic certification more for nostalgia's sake than any real benefit. I supplemented my income through medical school teaching paramedic classes and alphabet soup (ACLS, PALS, BTLS). Also, for whatever reasons, patients and students seem to feel much more comfortable with me when I say "I'm a paramedic" than "I'm a medical student". Funny that. The short white coat really is the Harry Potter Cloak of Invisibility.


'zilla

 

[Jeff698]

I'm keeping my paramedic because, as someone else pointed out, it is far too big a part of who I am to let it go.

As for whether you need the cert to work on a truck after graduation, the answer is 'it depends'. While there is no argument that your medical license grants you the unrestricted right to practice any/all medicine (credentialing/liability notwithstanding), that is only part of the question.

The other part is the requirements placed on the system by the state regulatory agency. In my former life, I was the Texas EMS Training Coordinator and, good or bad, know all too much about how regulatory agencies work. These vary from state to state so your mileage may vary, but in Texas for a vehicle to be 'in service' it must have two certified people on board. An MD without EMS certification would not qualify. Certainly variances are possible, but in general you need the two certs.

While this may seem like a pretty odd requirement, we need to remember that rules and laws (the current Schiavo case aside) aren't written for rare cases. An MD/DO who wants to work on a truck as a primary medic is pretty damn rare. I'm about as big an EMS guy as you'll likely find and even I won't be doing that except for some unforseen disaster type circumstances. What I will be doing, however, is responding in the field for field training, etc. From a regulatory standpoint, this is a completely different animal all together.

Sorry for the verbosity of my reply. I guess the old regulator in me came out. 🙂

Take care,
Jeff

 

[FoughtFyr]

I kept mine up for two reasons. First, I worked damn hard to get my EMT-P in the first place. There is no reason to give it up as CEUs for MD will count toward EMS. Second, I very often teach EMS units. As it is I list MD, MPH, and EMT-P(IL) after my name on the title page. I think this gives me some credibility with my students. IOW, I have walked a mile in their shoes. I could not see, however, listing "former paramedic" on anything.

- H

 

[Apollyon]

I'm NY EMT-P, but haven't bothered with NC. However, one of our attendings has gotten approval for us to work at EMT-P level while on ride-along. Sounds good, eh?

Except for my colleagues not having had EMS training, so they watch EMS (since they don't know what is involved), who are not passing the laryngoscope to the resident, and the paramedics are better than my colleagues at peripheral IV's (and, for some reason, TLC kits and Cordis's are not carried on ambulances). The one thing they do do is pass the 12 lead over to the resident, and say, "what do you think?".

 

[Emergency!]

Thanks for the replies, guys. In Ohio, you must indeed have two EMT's to transport. I wasn't really planning to work on a truck, per se, but I would like to remain involved in pre-hospital care. My goal is to end up in a rural ED, and hopefully be very involved in medical direction and training for local EMS providers. Having worked under different medical directors, I have seen first hand the difference that the medical director can make in the quality of pre-hospital care in an area.

 

[bartleby]

I am uncertain as to whether or not I should maintain my EMT certification. What would be the advantages of doing so?

I was a tech before I started med school, and it was difficult for me to let my cert lapse. However, unless you plan to work during med school for much-needed income, there is little benefit to maintaining it.

Once you graduate from med school, there is no professional benefit to maintaining your degree. You have the same chops from working as a medic for 5 years before whether or not you've got one less piece of paper in your wallet--no one can ever take that away from you.

Strictly from the time perspective, you are far better off spending the hours you would have been in CME studying for your boards or other physician-level material for your rotations. You already know the "what"... now you've got to figure out the "why".

 

[FoughtFyr]

I was a tech before I started med school, and it was difficult for me to let my cert lapse. However, unless you plan to work during med school for much-needed income, there is little benefit to maintaining it.

Once you graduate from med school, there is no professional benefit to maintaining your degree. You have the same chops from working as a medic for 5 years before whether or not you've got one less piece of paper in your wallet--no one can ever take that away from you.

I disagree wholeheartedly. I give roughly 3-4 talks per month (on average). Some are on EMS topics to EMS groups, others are strictly medical. Being able to list my paramedic license in my credentials gives the audience a good idea of where I come from. I would not want to start every talk with "Hi, I used to be a paramedic". For example, I returned to my medical school to lecture on rape and DV. Now, an intern from Rochester, MN doesn't have a whole lot of experience in this area (especially 4 months after they start), an urban FF/EMT-P does.

BTW - The other "advantage" is in EMS direction. Until EMS fellowships provide a certificate of added qualification, an EMS certification and an employment history go a long way toward EMS director positions - even in residency. Now, I am not looking to start a debate on the need for additional training for EMS directors. I am just pointing out the current model, which does, IMHO, provide a "professional benefit" to maintaining the certifiction/license.

Strictly from the time perspective, you are far better off spending the hours you would have been in CME studying for your boards or other physician-level material for your rotations. You already know the "what"... now you've got to figure out the "why".

I agree, except that most EMS systems (and the NREMT) will accept medical school as EMS CME. So if it "costs nothing" except paperwork time, why let it go?

- H

 

[Jeff698]

I agree completely with FF. In my former life as a paramedic, I can't tell you how many people told me they were 'former' paramedics. I remember thinking that pretty much equated to being an ambulance driver. As in, way back when that's actually what they were when they had no medical training.

Former paramedic is such a nebulous term. If you haven't already, you'll run into doctors or med students who say this. When you actually talk to them about it you find out they were really EMTs. You talk a little more and find out they took an EMT course because they thought it would look good on an application. Not that there's anything wrong with that but, trust me, to a career paramedic, you'd be much better off just keeping your mouth shut.

On the other hand, when I ran into a doc in the ED who had a paramedic pin on his nametag and said "I AM a paramedic" I knew I had a different species of doc. By saying he was a current paramedic and not a former paramedic, I knew what I was dealing with and it made a big difference to me.

There is a similar phenomenon with nurses who 'challenge' the paramedic test. In Texas, our paramedic patch is red. We call these 'paramedics' "pink patches' because we don't consider them real paramedics. Same holds for docs who haven't really "been there/done that".

In short (I know, too late), it really does matter. But then, what do I know, I'm just a paramedic.

Take care,
Jeff

 

[OSUdoc08]

I will be starting medical school in the fall. I am currently certified as an EMT-I in Ohio (my NREMT cert will be expiring). My card will expire in 2007. I am uncertain as to whether or not I should maintain my EMT certification. What would be the advantages of doing so?

I was told by an EMS instructor that if I want to continue working in the field as an EMT, I need to maintain my cert, because even though I will be an MD eventually, I am not allowed to run on a squad without the EMT cert. This doesn't make any sense to me, as this implies that on a squad, I would only be allowed to function as an EMT-I, even though I might be an MD. Yet surely, if I failed to do something that I know how to do as a MD and this resulted in a poor outcome for the patient, I would be sued as a MD and not an EMT.

Thoughts? Comments? Info??

Thanks!

Amy

PS - Congrats to all who matched!!

The next day I work will be as a physician. I retired from EMS the day I entered medical school. My paramedic licensure expires during my 3rd year of medical school, as I will no longer need it.

 

[Emergency!]

Thanks for the comments, all. I will probably keep my cert for at least one more cycle - I had to take the Intermediate transition course, and that counts for most of my CE hours. I will only be maintaining my Ohio cert, anyways. Due to the time involved in taking pre-reqs and no longer working for a place that provides/paid for CE, I didn't get enough hours in to maintain my national registry.

I MIGHT work next summer, but we'll have to see what opportunities come along in med school.

 

[vtach]

Well, I was going to keep my NREMT-P but had such a ruckus with my last renewal 2 years ago that I am going to let it lapse this time. I will keep my Nebraska and Ohio state certifications but not the headache from NREMT. The new national standard almost requires that you take the NREMT-P refresher and with a little vtach on the way I decided to forgo the cost and let it lapse. As noted above, the paramedic certification has more meaning to me than my advance degree. Some thing even as a resident is nice to say, Oh I am a paramedic.

 

[12R34Y]

I totally agree with you guys about keeping your EMT-P. I look forward to the day (soon) when I can be involved in EMS education and have EMT-P behind my name. I think it adds a whole level of credibility with pre-hospital folks. I would have liked some of my former medical directors to have been medics in the past. It makes a difference in your perspective.

later

 

[bartleby]

I disagree wholeheartedly. I give roughly 3-4 talks per month (on average). Some are on EMS topics to EMS groups, others are strictly medical. Being able to list my paramedic license in my credentials gives the audience a good idea of where I come from. I would not want to start every talk with "Hi, I used to be a paramedic". For example, I returned to my medical school to lecture on rape and DV. Now, an intern from Rochester, MN doesn't have a whole lot of experience in this area (especially 4 months after they start), an urban FF/EMT-P does.

If your license expired yesterday, would it make your past experience any less valuable or meaningful?

BTW - The other "advantage" is in EMS direction. Until EMS fellowships provide a certificate of added qualification, an EMS certification and an employment history go a long way toward EMS director positions - even in residency. Now, I am not looking to start a debate on the need for additional training for EMS directors. I am just pointing out the current model, which does, IMHO, provide a "professional benefit" to maintaining the certifiction/license.

I am not disputing the fact that an EMS background is helpful. But you are kidding yourself seriously asserting that a physician who is residency trained, board certified and fellowship trained who was a former medic is less qualified than a person with identical credentials who maintains their license as a paramedic. Particularly from the job market standpoint, I think you will be disappointed in the value placed on this by other physicians.

 

[Jeff698]

I am not disputing the fact that an EMS background is helpful. But you are kidding yourself seriously asserting that a physician who is residency trained, board certified and fellowship trained who was a former medic is less qualified than a person with identical credentials who maintains their license as a paramedic.

For me anyway, your qualifications or ability as medical director aren't really the issue. It is your credibility with street level paramedics that is. This is a perception issue that leads to an acceptance issue (or lack of it).

From that viewpoint, and in my not-limited experience, keeping current DOES matter. Does that credibility disappear the day your cert expires? Of course not. Is it pretty much gone if you go to a new place as an unknown 'former' paramedic? IMHO, yes.

By all means, don't keep your cert if you don't want to. I'm just relaying what my perceptions were as a street medic and administrator long before I had any interest in going to medical school. Most of my collegues had similar views. Did a medical director who wasn't/had never been a paramedic get respect? Of course. They just had to work a bit harder to earn it. For anyone, of course, with or without the patch, credibility is easy to loose if you're a jerk or incompetent.

Take care,
Jeff

 

[FoughtFyr]

If your license expired yesterday, would it make your past experience any less valuable or meaningful?

Nope, it would just make it impossible for me to relay it in a meaningful way.

I am not disputing the fact that an EMS background is helpful. But you are kidding yourself seriously asserting that a physician who is residency trained, board certified and fellowship trained who was a former medic is less qualified than a person with identical credentials who maintains their license as a paramedic. Particularly from the job market standpoint, I think you will be disappointed in the value placed on this by other physicians.

Nope, that is not what I am saying. What I am saying is that the current paramedic has a street level credibility that keeps tham involved in EMS. That involvement quite often leads to EMS directorships without fellowship training. I have a very easy argument that, as a 10 year experienced firefighter/paramedic, who spent 1.5 years working for the USFA and rode with EMS units throughout residency, I am capable of running an EMS system without fellowship training.

But are the units I respond with now going to let me anywhere near their scenes without verification of both my committment and my ability to keep my own a$$ safe on a scene? No way! In short - I don't care what the value placed on this by other physicians is. I care about the value placed on it by other paramedics.

- H

 

[OSUdoc08]

Just say you are a paramedic, or that you worked as a paramedic for years before medical school.

It's not like they ask to see your unexpired paramedic card.

Why do you feel you need to prove yourself to a paramedic anyway? The fact that you are a physician should be enough.

 

[FoughtFyr]

Just say you are a paramedic

But if the cert is expired, one is no longer a paramedic.

or that you worked as a paramedic for years before medical school.

It's not like they ask to see your unexpired paramedic card.

Yep, I could say I worked as a paramedic before medical school. But, in my experience, it is far less akward to list EMT-P on the title page of a talk, or on a business card, or nametag, and let that do the talking for me.

And, in my opinion, if you list it on any of those things after the certification is expired, you commit academic fraud. You can't say you "are" what you in fact "were".

Why do you feel you need to prove yourself to a paramedic anyway? The fact that you are a physician should be enough.

I am glad that your experience with EM physicians has been so positive as to leave you with the impression that being an EP "is enough" to insure EMS knowledge. My experiences have not always been so positive. But, in my days on the street, I almost never questioned the few docs I knew were medics. They had a clue about what I did on a daily basis. I admired them greatly, and am now proud to join their ranks.

- H

 

[OSUdoc08]

But if the cert is expired, one is no longer a paramedic.



Yep, I could say I worked as a paramedic before medical school. But, in my experience, it is far less akward to list EMT-P on the title page of a talk, or on a business card, or nametag, and let that do the talking for me.

And, in my opinion, if you list it on any of those things after the certification is expired, you commit academic fraud. You can't say you "are" what you in fact "were".



I am glad that your experience with EM physicians has been so positive as to leave you with the impression that being an EP "is enough" to insure EMS knowledge. My experiences have not always been so positive. But, in my days on the street, I almost never questioned the few docs I knew were medics. They had a clue about what I did on a daily basis. I admired them greatly, and am now proud to join their ranks.

- H

Bob Suter, DO, FACEP, ACEP President, worked as a paramedic before he was a physician. He was the medical director for my EMS service, and is obviously well-respected in emergency medicine. He is the first former paramedic and the first DO to be president of ACEP.

You will find that he does not advertise himself as a paramedic or former paramedic, as he does not need it. He lets his knowledge speak for itself.

Does a little 2-year degree really mean that much? I can get a paramedic certification and go to med school, but that doesn't mean I have 10 years of experience in EMS.

Perhaps after your title, you should write in how many years of experience you have to make yourself look extra special. I did not learn anything in paramedic school that I have not learned or will learn in medical school or EM residency.

Yes it's not the education, but the experience that counts. However, saying or proving that you are a paramedic does mean that you have it. It only means that you completed a program 2 years short of the bachelor's you likely earned.

 

[FoughtFyr]

Bob Suter, DO, FACEP, ACEP President, worked as a paramedic before he was a physician. He was the medical director for my EMS service, and is obviously well-respected in emergency medicine. He is the first former paramedic and the first DO to be president of ACEP.

You will find that he does not advertise himself as a paramedic or former paramedic, as he does not need it. He lets his knowledge speak for itself.

Absoolutely! But yet you do know his "unadvertised" background...

Does a little 2-year degree really mean that much? I can get a paramedic certification and go to med school, but that doesn't mean I have 10 years of experience in EMS.

Actually an associate's degree means nothing to me, I don't have one. I do have a two year MPH. Should I remove that from my credentials too?

Perhaps after your title, you should write in how many years of experience you have to make yourself look extra special.

Or maybe I could just tell everybody I know you! It is not about looking "extra special". It is about quickly and effectively connecting with the EMS providers I train and work with.

I did not learn anything in paramedic school that I have not learned or will learn in medical school or EM residency.

SWEET! Which medical school or residency is it that teaches scene safety, extrication, HazMat, and situational awareness? I need to see if they have a PGY-2 slot open next year!

Yes it's not the education, but the experience that counts. However, saying or proving that you are a paramedic does mean that you have it. It only means that you completed a program 2 years short of the bachelor's you likely earned.

Well, once again (surprise) we will have to disagree. In my experience (having actually finished medical school and most of my intern year), maintaining my certification quickly and effective "proves" a dedication to EMS in the eyes of many of the field providers I work with.

And BTW - My paramedic program did not count towards any degree I hold.

- H

 

[OSUdoc08]

Absoolutely! But yet you do know his "unadvertised" background...



Actually an associate's degree means nothing to me, I don't have one. I do have a two year MPH. Should I remove that from my credentials too?



Or maybe I could just tell everybody I know you! It is not about looking "extra special". It is about quickly and effectively connecting with the EMS providers I train and work with.



SWEET! Which medical school or residency is it that teaches scene safety, extrication, HazMat, and situational awareness? I need to see if they have a PGY-2 slot open next year!



Well, once again (surprise) we will have to disagree. In my experience (having actually finished medical school and most of my intern year), maintaining my certification quickly and effective "proves" a dedication to EMS in the eyes of many of the field providers I work with.

And BTW - My paramedic program did not count towards any degree I hold.

- H

Mine: We did this in our ER club on weekend seminars. It didn't take paramedic school to teach me this.

 

[12R34Y]

I have to agree with FF and Jeff on this one.....I don't know of a medical school that teaches you ANYTHING about EMS and pre-hospital care (other than OSUDOC's school). Heck, most of my attendings and residents in all departments i've rotated through have no idea what the difference between an EMT and paramedic is. Let alone things like KED boards, LSB's, digital intubations, extrication, Hazmat, mass casualty incidents, riding in the back of an ambulance while performing skills, doing anything outside of a clinic or hospital etc....

your lucky to go to your school osudoc.

later

 

[OSUdoc08]

I have to agree with FF and Jeff on this one.....I don't know of a medical school that teaches you ANYTHING about EMS and pre-hospital care (other than OSUDOC's school). Heck, most of my attendings and residents in all departments i've rotated through have no idea what the difference between an EMT and paramedic is. Let alone things like KED boards, LSB's, digital intubations, extrication, Hazmat, mass casualty incidents, riding in the back of an ambulance while performing skills, doing anything outside of a clinic or hospital etc....

your lucky to go to your school osudoc.

later

Don't most residencies require time spent on the ambulance or helicopter? Many of the residencies require 2 weeks to a month.

 

[Emergency!]

Don't most residencies require time spent on the ambulance or helicopter? Many of the residencies require 2 weeks to a month.

I don't know about "most", but I do know from researching different residencies that in many programs helicopter and/or ambulance time is elective, not mandatory. Personally, I think all EM doctors should have had to spent at least some time on the street (sorry - helicopter time just isn't the same). I realize that not every EM doctor is going to do medical direction or want to spend a lot of time working with EMS, but a lot of your patients are going to come into the ED via ambulance and I would think that having an understanding of what goes on in the streets would be important.

I have run into my fair share of doctors who just don't understand what we do in the streets. Nothing is more frustrating than being criticized for care you did or didn't do by someone who just can't understand that the scene played a very large role in what happened.

I think that it is awesome that your EM club does those kind of things, OSUdoc. It will be great experience for those non-EMTs/medics is your group. What percentage of the people involved in your EM club have prior EMS experience (just curious)?

 

[Doczilla]

Don't most residencies require time spent on the ambulance or helicopter? Many of the residencies require 2 weeks to a month.

EMS is an RRC requirement, but this can be satisfied by doing time in medical director meetings, QA on tripsheets, etc.

It's admirable that your school does weekend seminars on these EMS related topics (I have not yet heard of another one that does), but I would stop short of saying that this conveys understanding. I know plenty of people who went to EMT school just to beef up their resume for med school applications, but would be lost on their own in the back of an ambulance. Reading about incident command in a weekend course is one thing. Successfully managing an MCI is quite another.

In essence both OSUdoc08 and FoughtFyr are both right. It is not necessary to have a paramedic certificate to teach many EMS classes with intelligence and authority, but having the field experience does gain the instructor credibility with EMS students. Adult learners in general have less tolerance for poor instruction, but EMTs can be particularly demanding and critical of teachers who speak only from what they have read and not what they know from experience.

Why do you feel you need to prove yourself to a paramedic anyway? The fact that you are a physician should be enough.

Having taught classes for experienced paramedics as well as SEAL and SF medics, I can tell you that the MD buys you nothing from these guys. They respect only competence, which comes from study (as OSUdoc08 has alluded) AND from experience (which FoughtFyr is referring to). If you were the type that took an EMT class and vollied with the campus squad for a summer, they'll see right through it. They do, however, appreciate tricks of the trade from an instructor who "walks the walk".

As a paramedic now in medical school, have you taken a pharmacology class from a PhD? Do they really know about how to apply the drugs that they're teaching you? ACLS teaches in 2 days more than a basic scientist knows about USING the drugs, no matter how many USMLE questions they've written.

Saying that you ARE a paramedic means that you stay in the game to one extent or another. This means that you read the industry journals (JEMS, EMS Mag, etc), run in the field, take con-ed classes aimed at prehospital providers, and/or stay abreast of changes in the industry and technology that are relevant to EMS. Many of us as field providers have run into medical directors who WERE paramedics "back in the day", but don't have any idea what is going on in the field today and the type of prehospital provider we are now seeing on the street. This makes them particularly damaging as medical directors, as they think they know what they're talking about, but really don't.


'zilla

 

[FoughtFyr]

Don't most residencies require time spent on the ambulance or helicopter? Many of the residencies require 2 weeks to a month.

WOW!! 😱 TWO WHOLE WEEKS! Well shucks, I guess I'm just about out of answers. I mean, those doctor folks iz purty smart. Theyc'n learn my whole 'medic job in juz two weeks. Yep, back to the barn I'll go, 'cuz I know I'm just not that smrt.

Get real. Are you honestly suggesting a few weekend classes or two weeks of ride alongs (stay out of the way Doc and try not to get hurt) is sufficent to give anyone a real sense of EMS, yet alone enough experience to be minimally safe on a scene?!?

Wow, do you have a low regard for EMS as a profession.

- H

 

[Apollyon]

EMS is an RRC requirement, but this can be satisfied by doing time in medical director meetings, QA on tripsheets, etc.

The RRC requirement (well, suggestion) is 4-pronged:
1. EMS education
2. Disaster training
3. Ride-along/field work ("if possible, air ambulance units")
4. On-line medical direction

http://www.acgme.org/acWebsite/downloads/RRC_progReq/110pr105.pdf, page 19

Here is a salient quote from the document, though:

"If residents are required to ride in ground or air ambulance units, they must be notified of this requirement during the resident recruitment process."

Hell, here's the whole thing:

"8. Out-of-Hospital Care Since out-of-hospital care is an integral and vital part of emergency medicine, there must be a formal, structured resident experience. This should include: participation in paramedic base station communications; emergency transportation and care in the field, including ground units and if possible air ambulance units; teaching and oversight of out-of-hospital personnel; and disaster planning and drills. If residents are required to ride in ground or air ambulance units, they must be notified of this requirement during the resident recruitment process."

So, you MUST have an EMS experience, but there are only suggestions as to what it should be.

 

[pushinepi2]

As always, these forums are replete with sarcasm, excellent insight, and valuable opinion....Here is an additional insignificant 0.02....The decision to maintain an active paramedic certification is an entirely personal one. My paramedic cert is active only because I have a difficult time letting it lapse. My former medical director has excellent "in the field credibility" and respect because he listens to his medics AND rides along with them on a regular basis. He's actively involved in QA/QI and will frequently revise protocols based upon input from the field. Its fair to say that an active medic license does not automatically translate into street credibility. Physicians who take their skills and knowledge into the field voluntarily undertake a lot more responsibility and risk. The physician scope of practice is different, as is the standard of care expected of a pre-hospital physician. In reality, physicians are RARELY needed to assist in the pre-hospital arena. Involvement in ambulance or helicopter crews rarely results in improved patient outcome. The issue of whether physicians should keep up EMT or paramedic certification is therefore not a logical one. It is based on such nebulous assumptions like, "I can't bear to let the thing go" or "having an EMT-P after my name gives me more credibility." In my opinion, there's little practical value in maintaining the license. Personally speaking, the "EMT-P" letters remind me of some incredible experiences and rather humble origins. If nothing else, the paramedic certificate is an excellent conversational item. Maybe it helps the a new emergency medicine intern appear a little less green around the gills on July 1st?

-pushinepi2, MS-IV, EMT-P (for now, possibly in the future..no longer EMT-B)

 

[Jeff698]

Why do you feel you need to prove yourself to a paramedic anyway? The fact that you are a physician should be enough.

This question has been knawing on me since you wrote it. At first, I figured I'd take it as the insult it was probably not intended as and leave it alone. Then I figured, despite that fact that you, at one point in your career, were a paramedic, perhaps you really didn't get it.

I feel I need to establish my credibility with 'a paramedic' because I consider them my colleagues. Their trust and respect means a great deal to me because of the respect I have for them.

I mentioned earlier that 'former' paramedic physicians didn't automatically get the same respect from me as did current paramedics. The ones who automatically got much less respect were those who were really were paramedics (as opposed to someone just taking the courses to help get into medical schoo) but seemed to have forgotten where they came from. I have no intention on turning my back on the profession and professionals that have given me so much.

I'm sure you don't mean to come across this way, but implying that you don't care whether paramedics respect you or not certainly gives me that message. Perhaps its just me, though.

The fact that you're a physician matters so little to the respect you're given as their medical director (after all, by definition, anyone in that job will be a physician) that it is shocking you'd say this.

The other thing that bugged me is when you said your EMS career ended the day you entered medical school. That is certainly possible and you are obviously the best person to determine this, but I find that sort of sad.

Being a paramedic is a big part of who I am. I am about to graduate from medical school only because I wanted (and still do) to be an EMS medical director. I have a great deal of respect for those paramedics who will be my colleaques and I look forward to CONTINUING my EMS career after graduation. Granted, I'll wear a different hat, but it will still be the same career. I'm sorry you don't feel the same way.

Take care,
Jeff

 

[OSUdoc08]

This question has been knawing on me since you wrote it. At first, I figured I'd take it as the insult it was probably not intended as and leave it alone. Then I figured, despite that fact that you, at one point in your career, were a paramedic, perhaps you really didn't get it.

I feel I need to establish my credibility with 'a paramedic' because I consider them my colleagues. Their trust and respect means a great deal to me because of the respect I have for them.

I mentioned earlier that 'former' paramedic physicians didn't automatically get the same respect from me as did current paramedics. The ones who automatically got much less respect were those who were really were paramedics (as opposed to someone just taking the courses to help get into medical schoo) but seemed to have forgotten where they came from. I have no intention on turning my back on the profession and professionals that have given me so much.

I'm sure you don't mean to come across this way, but implying that you don't care whether paramedics respect you or not certainly gives me that message. Perhaps its just me, though.

The fact that you're a physician matters so little to the respect you're given as their medical director (after all, by definition, anyone in that job will be a physician) that it is shocking you'd say this.

The other thing that bugged me is when you said your EMS career ended the day you entered medical school. That is certainly possible and you are obviously the best person to determine this, but I find that sort of sad.

Being a paramedic is a big part of who I am. I am about to graduate from medical school only because I wanted (and still do) to be an EMS medical director. I have a great deal of respect for those paramedics who will be my colleaques and I look forward to CONTINUING my EMS career after graduation. Granted, I'll wear a different hat, but it will still be the same career. I'm sorry you don't feel the same way.

Take care,
Jeff

1. Unfortunately, I moved out of state, and am only licensed as a paramedic in Texas. Otherwise, I'd still be in EMS.

2. Most people who work in EMS from my area complain about it, and are forced into it. These people are in their jobs to fight fires, and are being forced to do the "dirty work." Others are on their way to careers as nurses and physicians, and are gaining experience. Still others simply enjoy what they do.

3. I have respect for all EMS professionals, so don't think I don't. Yes, it is important to recieve respect from EMS professionals. However, I don't feel that "flashing your credentials" is the right way to do it. The best way to earn respect is by example. Show people that you are qualified by demonstrating it.

4. Does it really even make a difference if you aren't gonna be an EMS medical director? No.

5. Take a look at what Pushinepi said.

 

[Jeff698]

The decision to maintain an active paramedic certification is an entirely personal one.

I couldn't agree more. What I've tried to describe is how I feel about the issue and why I'll be keeping mine current. Honestly, I really don't care if others let their's lapse or not. And you are also absolutely correct in saying that nothing, including current paramedic cert, buys you automatic credibility. Some of the best medical directors I've ever met were never paramedics.

The only thing that irks me is when physicians who are/were paramedics seem to have lost any respect they had for street folks. I came to realize that it was probably too much to ask that physicians, even EM ones, know or care what paramedics do. I still harbored some hope, however, that those who'd been paramedics would.

BTW, EMS physicians who respond in the field really shouldn't be out there to provide medical care. As you point out, that's what paramedics are for. I'm sure a certain princess, if still alive, would agree with you completely. They should put their medical expertise to use out there doing field training and supervision.

Take care,
Jeff

 

[bcrosspac]

Boy, this thread got the old paramedic juices flowing. I let my Florida paramedic license expire several years ago while I was working as a PA. Now that I am EM resident and wanting to get involved in EMS, I have been trying to find a way to "challenge" either the state (North Carolina) or NREMT-P exam without any luck. I agree that to other paramedics, even though you are an ED physician, the EMT-P credential does mean something to them. I really wish I could find a way to add those silly letters back to my resume. Any ideas????? 😕

 

[pushinepi2]

Boy, this thread got the old paramedic juices flowing. I let my Florida paramedic license expire several years ago while I was working as a PA. Now that I am EM resident and wanting to get involved in EMS, I have been trying to find a way to "challenge" either the state (North Carolina) or NREMT-P exam without any luck. I agree that to other paramedics, even though you are an ED physician, the EMT-P credential does mean something to them. I really wish I could find a way to add those silly letters back to my resume. Any ideas????? 😕

Ah, how nostalgia tugs at the heartstrings! Let this go, B! You've had so many prior professional and pre-hospital careers that there's no more room at the end of your name for more credentials. Like the elderly nursing home patient found down in asystole, this desire must necessarily pass... and why CAN'T you list those "silly letters" back on your resume? Im sure, though, that the EMT-P signature will be slightly eclipsed by your board-eligibility in emergency medicine from Duke University.
If perusing an old Galls cataloge doesn't slow you down some, consider this: EMS has some of the most stringent re-entry policies in the entire country! With over 50 levels of pre-hospital providers, there is much inconsistency. Many state EMS agencies therefore require at least an EMT license and then an active RN, PA, MD, or DO license in order to challenge the paramedic boards. If you are hopelessly inconsolable, you can complete the EMT curriculum in about 4 weeks or less and then challenge the state paramedic boards. The NREMT is a little less accepting of "patch" medics, but has nevertheless been known to award the NREMT-P certification to nurses who have challenged their written and practical paramedic exams (and have a current EMT cert).
A final (and entirely ironic) observation: Here I sit completing a rural EMS elective in Gainesville, Florida with my old fire/rescue service. After teaching ACLS, reviewing protocols, and preparing some new lecture material, I was chided for not "getting back on the box." I was teased about the atrophy of my IV and intubation skills and told how sooo many medical students and physicians "forget their roots." Eager to jump back into that very special chaotic pre-hospital environment, I slipped into an old paramedic jacket and climbed aboard rescue-1. I promptly snatched two patients from the jaws of death: one woman was feeling a little tired and her primary doc requested a "nice and calm" non emergency transfer to the local ED. The next most critical call was from an 83 year old "LOL in NAD" who felt a little more nauseated than her usual. Good thing I was there to lend a helping hand. Gotta love EMS! (And this kick-ass-paramedic/EM thread as well)
🙂

-Not pushing in any epi today,

 

[Doczilla]

Boy, this thread got the old paramedic juices flowing. I let my Florida paramedic license expire several years ago while I was working as a PA. Now that I am EM resident and wanting to get involved in EMS, I have been trying to find a way to "challenge" either the state (North Carolina) or NREMT-P exam without any luck. I agree that to other paramedics, even though you are an ED physician, the EMT-P credential does mean something to them. I really wish I could find a way to add those silly letters back to my resume. Any ideas????? 😕

To recert as a medic, you would probably want to go National Registry, then apply for reciprocity in NC. North Carolina will recognize an active paramedic card from any state or the NREMT-P, which will allow you to sit for the state exam. If it’s been more than 2 years since your initial paramedic training, you will need to go through the whole recert rigmarole. You probably know much of this already, but I'm posting for the benefit of others with the same question.

Go to www.nremt.org and click on "reentry". In a nutshell, this is what you need if you've never held an NREMT-P card:
1) Current CPR, ACLS, and BTLS (or PHTLS) cards (instructor cards count)
2) Verification of paramedic training after 1977 and copy of expired state paramedic certification
3) Letter of support from the NC Office of EMS or whatever state you are applying to (contact them about this. If they give you any sh&t, punt to the medical director for help)
4) Completion of a 48 hour refresher course. In lieu of this, the medical director can sign you off as having completed education "equivalent" to the 48 hour refresher through your medical school/residency program. You may have to break this down by hours (how many hours did we spend on Child with Fever during my peds clerkship?….), which can be a massive pain in the arse, but it's worth not having to go to school for 6 days. There are required hours in specific topics which you need to have completed. You do get credit for teaching classes. ACLS and PALS will only satisfy 16 hours (each) of the required hours. Requirements for OB and Peds training have grown to a total of 16 hours minimum. Distributive education (con-ed articles in magazines like JEMS or EMS Mag) can account for up to 12 hours of your course content. The "required core content" accounts for 24 hours of the requirement, and you have to have a minimum number of hours in each subcategory. The "flexible core content" has minimum requirements in broad categories, but does not require minimums in the subcategories. Tell me this isn't a government operation.
5) Kickback…er… fee to the NREMT

If you HAVE held an NREMT-P card before but it has expired, you need the following:
CPR and ACLS card
Verification of skills from your medical director
48 hour refresher course or equivalent (verified by medical director) as outlined above
24 additional hours of con-ed, similar to above
Smaller kickback

Once you get your national registry card, go to www.ncems.org and contact them to snag the paperwork for “legal recognition”. The website is vague and unhelpful. It would probably be easiest to submit the paperwork through Durham Co. EMS training division or through the helicopter service.


‘zilla

 

[Jeff698]

and why CAN'T you list those "silly letters" back on your resume?

Wow. This seems to be the second suggestion in this thread that we just say/write that we are paramedics without actually being a paramedic. I would have hoped that the reason why one should not do this would be crystal clear from an ethical standpoint. Apparently, I was wrong.

I'll leave the ethical reasons alone, but as a public service, I'll focus instead on the legal reasons this is a bad idea.

While this is, by definition, a state issue and may vary by state, at least in Texas, saying you are a paramedic by either wearing the patch or including letters after your name or on your resume is a clear violation of civil statutes.

Now, just for giggles and to appease my old goverment-type tendencies, I submit for your reading pleasure, the relevant law and rule that substantiates my claim that there is a legal (in addition to the not-apparently-obvious ethical) reason not to falsely advertise oneself as a paramedic.

**First, the authorizing law:

From Texas Health & Safety Code*chapter 773, section 041

Begin quote:

LICENSE OR CERTIFICATE REQUIRED
A person may not operate, conduct, or maintain an emergency medical service, advertise that the person is an emergency medical services provider, or otherwise engage in or profess to be engaged in the provision of emergency medical services unless the person holds a license as an emergency medical services provider issued by the department in accordance with this chapter.

(b) * A person may not practice as any type of emergency medical services personnel unless the person is certified under this chapter and rules adopted under this chapter.

end quote from: http://www.tdh.state.tx.us/hcqs/ems/H&SC773_001_059.htm


What are the potential penalties, both civil and criminal, you ask? Well, as fate would have it, the answer is also available in law in section 063 and 064 of the same chapter (773):

Begin quote:

* CIVIL PENALTY. * (a) * The attorney general, a district attorney, or a county attorney may bring a civil action to compel compliance with this chapter or to enforce a rule adopted under this chapter.

<snip sections about who gets the money you pay in fines after saying you are a paramedic when you're really not>


* CRIMINAL PENALTIES.* (a) * A person commits an offense if the person knowingly practices as, attempts to practice as, or represents himself to be an emergency medical technician-paramedic, emergency medical technician-intermediate, emergency medical technician, emergency care attendant, or licensed paramedic and the person does not hold an appropriate certificate issued by the department under this chapter.* An offense under this subsection is a Class A misdemeanor.

<snip section regarding EMS systems>

End quote

Now, just in case this dead horse hasn't been kicked enough, here is the rule which implements the above law. It lists all the bad things one can do if they want to get in trouble. I've snipped the parts not relevant to the current discussion.

Begin quote:

RULE §157.36
Criteria for Denial and Disciplinary Actions for EMS Personnel and Voluntary Surrender of a Certificate or License

<snip>

(b) Nonemergency suspension, decertification and revocation of a certificant or paramedic licensee. The department may suspend or decertify an EMS certificant or suspend or revoke a licensed paramedic for, but not limited to, the following reasons:

**(1) violating any provision of the Health and Safety Code, Chapter 773, and/or Title 25 of the Texas Administrative Code (TAC), as well as Federal, State, or local laws, rules or regulations affecting, but not limited to, the practice of EMS;

<snip>

**(13) misrepresenting level of any certification or licensure;


End quote. Section available at:

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=157&rl=36


There, I hope that this at least settles the legal question of why one should not say they are a paramedic when they are not. At least in Texas.

I would also hope that this discussion was not necessary because of the obvious ethical problems with doing this.

Take care,
Jeff

PS No, I don't have anything better to do. I'm done with school, I've sold my house, put a contract on a new one and am in between chapters of my first Jimmy Buffet book.

 

[pushinepi2]

"Wow. This seems to be the second suggestion in this thread that we just say/write that we are paramedics without actually being a paramedic. I would have hoped that the reason why one should not do this would be crystal clear from an ethical standpoint. Apparently, I was wrong.

I'll leave the ethical reasons alone, but as a public service, I'll focus instead on the legal reasons this is a bad idea.."

What??? Please, people.. let's not take this issue out of context. When I suggested listing the "silly letters" on a piece of paper, I was referring to Bcrosspac's ability to list his TRAINING and former education as a paramedic on his resume. Ethically and legally, this is an accepted practice. There is no legal reason to prevent someone from indicating their previous life as a prehospital provider on a CV.

-PuSh

 

[pushinepi2]

For those actually interested in obtaining legal transcripts of this thread, here is my unethical suggestion as it originally appeared:

"..and why CAN'T you list those "silly letters" back on your resume?"

R-E-S-U-M-E. I am not in any way asking Bcrosspac to reference anything even remotely ficticious.

 

[Jeff698]

I'm glad to hear that is what you meant. I still think mine was a reasonable interpretation but you are clearly the best person to ask about what you meant.

Take care
Jeff