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CERTIFICATION Certification is a statement or declaration that one has completed a course of study, passed an examination, or otherwise met specified criteria for certification. Certification is not a permission to act, but rather a statement of completion or qualification. Certification is a private matter, issued by a private organization. It does not involve the police power of the state, and is not a state privilege. Certification is based on the premise that there is a right to work. Certification only provides the consumer with more information about a practitioner. It also gives practitioners a way to increase their competency through a course of study and exams. The purpose of certification is mainly to set standards, educate practitioners and inform the public. It may, however, be used to control entry if combined with state laws. See the section below on 'combinations'. LICENSING A license is a permission to do something that otherwise is forbidden. In most cases, a license is required or mandatory for engaging in that activity. For instance, a drivers license is considered mandatory to drive a car on the public roads. An exception is that a house may be built by someone who is not a licensed contractor. A license is given by the government, and is a government privilege. It therefore presumes that the activity in question is a privilege, not a right. The privilege may be bestowed by the federal, state or local government. A license involves the police power of the state. That is, if one violates the licensing law, either by acting without a license, or failing to uphold the rules governing the license privilege, one is subject to prosecution under the civil or criminal laws of the governing body. The purpose of licensing, whether admitted or not, is to restrict entry and control a profession or activity. Nurses are licensed and practice by virtue of that license. Paramedics must, in most states, work under the auspices of a physician's license.

I have put a lot of thought into all of the replies to my initial post on this subject and am impressed with the varying dialogue. One item I haven't seen mentioned is the fact that with few exceptions paramedics in the US aren't licensed. Perhaps this is the reason we have to play these games and continue to suffer a quasi "identity crisis" Over the sixteen years I have been in this business I have seen the profession as it were denigrated to a point that no one enters EMS to remain there anymore. Most simply use EMS as a stepping stone to other disciplines. EMS is a noble profession and I think worthy of folks that want to be there for the long haul. Clearly back injuries, poor pay, exposure to some of the worst sights, sounds and smells imaginable compound the challenges faced by providers. I believe our frustration with the scope of practice often lead the brightest best folks to abandon the profession far too early. Herein lies the core of my sadness with this registry thing. I will of course re-register by whatever means necessary. I simply wish the registry could figure out a way of ensuring continued competency without having to resort to re-testing as I still believe this is a huge step backward in the evolution of EMS.

I figured this would attract some interest. First, I was by no means whining, I passed the State and National Registry Paramedic Exams along with every other exam I have ever taken. Furthermore I attended both Community College and University, am a State Certified Paramedic Level Instructor and a Critical Care Paramedic. I am also an instructor in virtually all of the tertiary certification courses. I take exception to your implication of ineptitude on my part as related my views on this silly exam. I have always had plenty of con-ed hours to re-cert and really believed the Registry would serve as the National EMS credentialing body. In the early days the registry was a prestigious patch to display on one's sleeve. There were very few of us with the NREMTP and we were proud. The emblem served as a doorway to discussion with other healthcare providers and once they understood we were "Registered" it seemed to add a degree of credibility to being a Paramedic. Physicians, Registered Nurses, Registered Respiratory Therapists, Registered Radiology folks etc seemed to understand that there were "registered" prehospital providers instead of "ambulance drivers". As to the assertion that my post was a “conspiracy theory” I suppose time will tell as to the accuracy of my suspicion regarding the registry moving toward “requiring” the exam for re-registration. You might take a moment and visit the registry webpage then follow the link to the NHTSA report on national re-registration before you finalize your opinion. As I have said in the earlier post, this is a matter of respect. We deserve better from the ONLY national entity that was supposed to represent us and our profession. At this point I am not optimistic that this can be headed off due to the hidden influence of nurses and administrators, etc that stand to benefit from keeping the EMS community under their thumb and in check. Consider the difference in pay between registered nurses and LPNs and I think you could easily see a parallel between certified vs registered EMT's and Paramedics. The connotation of being registered carries much more than a shoulder patch folks. If the Registry moves forward with re-testing then to me they become no different that the individual state credentialing process and as such the Registry is no longer necessary. If this is simply an effort to enhance the NREMT bottom line then I would suggest increasing the fees for registration / reregistration and abandon the retesting nonsense. Otherwise I would suggest they change the NREMT acronym to the NCEMT (National Certification of EMT’s) or perhaps the (NLOTTSTBTR) National List of those too stupid to be truly registered.

Has anyone noticed the National Registry is preparing to deliver a huge insult to the EMS community? What I refer to is their veiled attempt to require retesting of registrants. Of course they are slowly introducing this as an option and have said in the newsletter that retesting is "not currently a requirement". It doesn't require much imagination to see where this is headed. I feel this is just another "smackdown" by the very entity we were counting on to validate us as a profession. No other "registry" of healthcare professionals insults their "registrants" by requiring mother may I re-testing including Nursing, Respiratory Therapy, Radiology, Sonography etc. Its time for someone to stand up for EMS and stop selling out to the influences bent on keeping us under their thumb! Oh and by the way I have read the NHTSA crap they will use to try and validate the need for re-testing as a means to ensure competency. To this I would submit that EMS providers are already scrutinized far more than all other disciplines through Physician Medical Directors, QA / QI and tertiary certifications such as PALS, ACLS, BTLS, CPR etc.

What is your employment classification with this agency, Fulltime, Part-time, or PRN? Second,If you are fulltime or even permanent part-time they probably cannot legally just take you off the schedule without cause. Check your state employment laws on this one as you probably are required to work a minimum number of hours per week or risk loosing benefits. Next, what is your agencys written policy regarding A)Education leave B)Your ability to "refuse to go on a call" regardless of personal or school obligations. If you refused to respond to an emergency call and you were the closest unit; you could have a real problem from a legal and ethical perspective, regardless of the reason you refused to respond. Next if the conversation with dispatch is a big deal find out if the phone lines are recorded which will clear up any confusion regarding what was said and by whom. Provided you are working for a government or government contracting agency the phone calls are public record provided they do not pertain to HIPAA info. Finally, how are others in the agency treated in similar situations. IE: Has the agency established a "past practice" with other employees regarding school leave and associated work accommodations to permit attendance? I must agree with an earlier post on this issue in that you must be very careful in pi*&^%g off your supervisors and upper management as they may have more influence with potential future employers than you think.

The first question I would ask is how do you protect yourself from liability if there is a claim of negligence or inappropriate care. Even if you were vindicated of any wrongdoing the cost of litigation alone could bankrupt you. The reason I mention this is a case of negligence against a nearby ski slope which involved a skier that went off the trail and became paralyzed. He and the family sued everyone possible in spite of the fact that the damage was done before the ski patrol, fire and ems arrived. One possible solution to this might be to incorporate a small business or at least form an LLC then simply pay yourself as an employee instead of simply working as an EMT. Of course you would want to insure your LLC for whatever you could afford. Another question is what are the risks of the set environment and what is the "worst case scenario" you should expect. Along with this ask yourself how far from Paramedic backup you will be and what level of care is prudent. With all of this in mind you will need to consult with the local EMS authority to make sure that what you intend to do is within the local laws and by consulting them before the fact you are showing respect which may pay great dividends for you in the future. There is my two cents.................good luck

I agree this is a sensitive issue and suggest it is multi-faceted. I tend to err on the side of caution when allowing someone that I have been summoned to care for to refuse care or to be "transported" by the Police. It is my suggestion that this issue be approached in the following manner and of course your Physician MD must be on board with all decisions regarding care or refusal of care for a human being. First the question that must be asked is: Is there a presence of an impairing substance or distracting injury? Is the patient in any distress physiological, psychological or is there any possibility that the psychosomatic effect of the situation is in ANY MANNER compromising the individuals’ immediate hemodynamic / cardio respiratory stability. Is this individual actually a patient or is the event purely a law enforcement issue? If this is the case, why were you called? Is there any conceivable manner that you can safely care for this individual? To what extent is Law Enforcement willing or allowed to assist? In WNC there is a tremendous aversion among the LE community to "get in the middle" of these kind of situations in absence of a court order. It seems elementary to believe that regardless of your decision regarding transport, if things turn out badly and the patient suffers a serious condition, dies or is found dead in jail the next AM; the first target of criticism will be prominently posted on the EMS crews chest, since they will have been the "medical professionals" who were on-scene. Next, in the presence of an impairing substance and or condition (and I feel a psychiatric emergency is an impairing condition in this context) it is unlikely the patient could make a rational decision therefore their opinion is not valid. Depending on your state laws you may have to obtain a court order to forcibly transport the patient. If all conditions are met and you believe the patient is in need of EMS transport you will likely be forced to consider a variety of restraint options including physical, soft restraints, improvised restraints and finally chemical restraint. Clearly the least invasive and least forceful means necessary to accomplish the task is preferred, bearing in mind the potential for escalation. Ensure that you have adequate personnel and equipment to manage the situation before committing. We actually carry a wide variety of narcotics and benzodiazepine meds along with Haldol and even propofol for anesthesia, not that it would be used for this purpose but who knows? EMS Personnel should never, never, never, never, never in any manner or for any reason accept a patient that is “hobble restrained” or “hog-tied” (Feet and hands cuffed and the patient face down) this is a prescription for disaster and totally inappropriate without exception! There is a phenomenon known as positional asphyxia that is lethal. Patients placed in this position cannot effectively breathe; you cannot effectively manage airway issues if bad things happen. Furthermore it is believed that patients on certain medications, legal and illicit, can suffer from a form of fatal hyperthermia due to the combined effects of the substance along with a reduced ability to dissipate heat through breathing combined with hypoxia. If you are interested in this issue you can find Charly D Miller on the internet, she is arguably the foremost authority on this subject in the national EMS community. Finally, whatever you decision please remember yours and that of your partner’s right to be safe supersede everything else on earth including anything going on with a patient! You have a responsibility to yourself, your family and your colleagues and yes even the EMS profession to take all necessary measures to remain safe. This includes maintaining a high degree of situational awareness and being prepared to retreat from an unsafe situation and always being prepared to defend yourself from harm. Please remain vigilant when dealing with patients as psych patients aren’t the only ones that injure and kill emergency providers.