Are You Licensed or Certified?

[paramedicmike]

I don't know of any school that certifies it's students. From an EMS perspective, NREMT certified me when I passed their exam. Not my school. The state in which I currently live has issued me a certification, not a license.

USALSFYRE's thoughts aren't necessarily incorrect. The idea, however, of a school certifying its graduates is just blantantly false.

edit: typo

Edited June 26, 2011 by paramedicmike

[Lone Star]

I don't know of any school that certifies it's students. From an EMS perspective, NREMT certified me when I passed their exam. Not my school. The state in which I currently live has issued me a certification, not a license.

USALSFYRE's thoughts aren't necessarily incorrect. The idea, however, of a school certifying its graduates is just blantantly false.

edit: typo

The NREMT, registers emergency medical services providers from across the nation. It is a not-for-profit, non-governmental, free-standing agency.

REGISTRATION: The process of entering one's name and essential infomation within a particular record. In EMS, this allows the state ot verify the provider's initial certification and to monitor recertification.

By your assertion, it would be logical to conclude that once an EMT lets their NREMT lapse, they are no longer 'certified' and therefore ineligible to maintain the necessary criteria for licensure.

[paramedicmike]

If that is the basis for state certification then yes. That assertion is true. It does not, as you're going to attempt to argue, apply in every jurisdiction. Overall, however, the point is not invalid in that schools do not certify individuals. Certification is awarded either by NREMT or the State. The costs, time and effort involved in developing a legally defensible certification exam would be prohibitive.

NREMT is not limited strictly to registering providers. They develop and administer certification exams as well. NREMT mandates successful completion of their certification exam as a necessary requirement of registration at the relevant provider level. It even says as much on the certificate they send out with notice of having passed the exam.

[Bernhard]

In Germany the "Rettungsassistent" is a protected healthcare profession, protected means no one may call himself "Rettungsassistent" if he has not passed the 2 year education (= certification) and given the acknowledgment (= license) from the state's authorities (most states: ministry for medical issues, some states: ministry for the interior). The license then is valid for all states of Germany, independent from the state you're gaining it - and for lifetime: once you are "Rettungsassistent", you are always.

To continue practising, in some states or from some organizations/services there is an annual training required (differs, mostly around 30 hour per year), but it's simply a matter of attending the hours, not an exam. In some organizations the training of resuscitation algorithms including defibrillation has to be repeated annually, this counts as part of the annual training above.

In reality, this annual training requirement is not controlled very strictly, not by state nor by the organizations/services - however, I think that most personnel meet the requirement (especially, since the employer has to pay for it).

From the state there is no required course or additional cert level system to be allowed something special. As "Rettungsassistent" you're allowed virtually anything in emergency medicine as long as you have the ability to do it (beeing teached in EMS school/clinical internship or somewhere else) and - in case something went wrong - can successfully explain it to a judge (this statement simplifies the legal aspect a bit, but maybe you get the point). There may be organizational/service internal standards restricting this or setting special requirements, though.

[Kiwiology]

From the state there is no required course or additional cert level system to be allowed something special. As "Rettungsassistent" you're allowed virtually anything in emergency medicine as long as you have the ability to do it (beeing teached in EMS school/clinical internship or somewhere else) and - in case something went wrong - can successfully explain it to a judge (this statement simplifies the legal aspect a bit, but maybe you get the point). There may be organizational/service internal standards restricting this or setting special requirements, though.

Is this the same in all of Germany? Brown thought Germany had EMS Doctors (Notarzt-Einsatz-Fahrzeug) and that they were the only ones authorised to do invasive procedures?

Oh, das Germany gut ja

[Bernhard]

Is this the same in all of Germany? Brown thought Germany had EMS Doctors (Notarzt-Einsatz-Fahrzeug) and that they were the only ones authorised to do invasive procedures?

Yes, a concept often misunderstood...

The system includes emergency physicians on scene, yes. And yes the primary intended role of a "Rettungsassistent" is to assist a doctor (hence, the term "-assistent" in the title).

But only in specific cases (described in a standard operations procedure) dispatch will send an emergency doctor along with us. And often enough even then we're the first on scene for several minutes. So, a "Rettungsassistent" is capable, allowed and even required to do a lot of the invasive stuff as well. Our education includes (beside the anatomy and pathophysiological knowledge) several invasive procedures, and we do it regularly. It may depend a bit of local circumstances (actual density of emergency physicians), but usually it is common to do a lot without a doctor initially available.

The only real restriction by law is, that we have to hand the patient over to a doctor and we're not allowed to finally "heal" a patient (this is clearly restricted to doctors and licensed alternative practioners). So in the german system we additionally have the option to call an emergency doctor to scene (if not already dispatched), call a general practioner (they still make house calls here!) or transport into a hospital or a doctors office. Until handed over, the life supporting is our responsibility to all extends.

Our common invasive procedures (beside the usual BLS/ALS things) are defibrillation, i.v. access, e.t. intubation, medication (analgetics, epinephrine, glucose, beta2-sympathomimetics, benzodiazepine for anticonvulsive therapy, nitro). Not so standard would be other medications, i.o. access, thorax tubing or tracheotomy. Those are not covered in EMS school but may be trained in additional courses (for example, i.o. access and Monaldi thorax tubing are common meanwhile). If the provider knows how to do it and it's the only thing to help the patient, he even has to if needed...(and exactly those would be the points someone has to explain to a judge, if lucky he can show some recent training certifications to proof his ability, but it's not legally required in the first place).

Only medications we're strictly not allowed to give by own decision are some specific opiate derivates listed in narcotic substances law (morphine and fentanyl are some of them). But even this could be argumented, if there would be no other way to help the patient until a doctor is on scene.

Problem is, this broad range of possibilities often is not understood by the public or even by some EMS practioners, mostly those older ones who still have in mind that there was a time before the profession of "Rettungssassistent" came to effect in 1989. And naturally, the doctor's professional association more and more wants to regulate the allowed procedures of non-academic healthcare workers, but they have no legal effect (only public relation power - far more than the shabby EMS-workers associations, I'm very sad to say).

So, in reality we're relatively free to do what is needed, even invasive procedures. Sure, we then have to take full responsibility (and that's a critical point for some, since the profession is far too underpaid if taken this into account). But additionally in the german EMS system, we're able to have an emergency doctor in our team directly on scene, thus giving a much broader range of medical possibilities.

Hope this short reply helps, a more intense description of specialities, procedures and such of our system would be something for an own thread or personal communication. Feel free to ask.

Edited June 27, 2011 by Bernhard

[Bieber]

Certification here, but that certification requires an Associate's degree, so I'm not complaining (too much). From what I've read about the licensure versus certification debate, it doesn't sound like a license is doing anything more for paramedics in other parts of the country than it is for those of us holding certifications.

[Richard B the EMT]

I keep hearing how mixed up California is supposed to be, and I must admit I don't know if it is true. If what I heard is correct, a Paramedic "certified" in Los Angeles would need to be recertified to work in San Francisco.

Here in New York State, the NYS DoH "certifies" Paramedics, but local ReMACs, or Regional Medical Advisory Committees authorize the Paramedics to work in specific localities. EMT-Bs like myself don't usually fall under ReMAC review and advisement, at least as I have experienced, career-wise. NYS DoH also certifies EMT-Bs.

If a service or individual EMT-B or EMT-P messes up, action against them would first be at REMSCo, or Regional Emergency Medical Service Council, level, who then passes their recomendations to SEMSCo (State EMS Council), and then to the DoH.

(Edited for a clarification point.

Edited June 28, 2011 by Richard B the EMT

[xselerate]

I remember an almost identical thread a few years ago...

[EMS Solutions]

Thanks guys for the great input. Yet it still seems like EMS can't come to an agreement on which should be which and why or why not. I am actually doing a live EMS podcast tomorrow night on the NJ Redesign Bill which is proposing amoung other things having EMT's and paramedics in NJ licensed. I would like to invite you to join me during the show. You can listen or chat live, or even call in with your opinions if you like, toll free. It's on Wed 6/29 at 7PM EST.

I am posting the link for the show below. Hope to see some of the EMTCity clan there.

NJ Redesign Bill