RE: Certification Vs. Registery

June 1, 2003

,

I was speaking, mainly, of the defining differences between licensure

and certification. Also, in the part about licensure involving the

police powers of the State, it states that punishment can be provided

for working in said occupation without a license. One cannot be

punished for performing (or, practicing) unlicensed or uncertified in an

occupation if that occupation requires no licensure. At the point that

the State requires such, it becomes licensure.

Schadone, NREMT-Paramedic

City of Austin

Austin/ County EMS

Medic 12 / Medic 24

@...

Certification Vs. Registery

Mike,

Your description of Registery Vs. Certification is a little fuzzy. In

reading the definitions it makes it seem like you only violate a law

when working with out a license. The readers need to know that their

is punishment from the state if you work without a TDH Certification

at which ever level you are working at. For instance if you work as

an EMT-B but either your cert has expired or you never actually

certified at that level the state can prosecute you with punishment

of being jailed in a state jail for up to 2 years. Falls under

Impersonating a Public Servant. Just thought I would pass thjat a long

Turnbow, EMT-I

BRMC EMS

June 3, 2003

We are NOT licensed to practice Emergency Medical services. We are

certified (or licensed, as you and others have pointed out there is no

occupational difference) as having completed a training regimen

successfully that should have given us a level of skills. The LICENSED

Physician relies on that certification to grant us the benefit of their

license in certain circumstances.

If we were truly licensed, we would not need a physicians orders or

protocols or whatever to do what we do.

And, if a Physician wanted to grant his plumber the delegated practice

to start IVs and push drugs, I suppose that would be ok.

The whole thing is that it is the Physician's license, so it's always

their decision. We can't decide to just be a Paramedic, true. But all

our professional practice is at the mercy of the physician pulling the

strings. We be the puppet.

=Steve=

Mike Schadone wrote:

>I think that we are seeing the same thing at different angles (so to

>speak). A physician is licensed to practice medicine. We are licensed

>to practice Emergency Medical Services. There is an extension of the

>physician's license that allows us to practice medicine (it is his or

>practice, not ours). But, no one can just decide to be a paramedic and

>jump on an ambulance and start responding to calls and treating

>patients. They must have permission from the State to perform this

>occupation. That is the definition of licensure.

>

>If I were able to perform the occupation without any documentation, and

>you decided that you wanted to perform within the same occupation, but

>finished a course where they gave you a piece of paper and status

>stating that you have met a standard, then it would be certification

>(CNA's are certified within the nursing occupation). Also, the National

>Registry amounts to a certifying agency, but you still cannot practice

>unless you fulfill the requirement for licensure.

>

> Schadone, NREMT-Paramedic

>City of Austin

>Austin/ County EMS

>Medic 12 / Medic 24

> @...

>

> Certification Vs. Registery

>>

>>Mike,

>>

>>Your description of Registery Vs. Certification is a little fuzzy. In

>>reading the definitions it makes it seem like you only violate a law

>>when working with out a license. The readers need to know that their

>>is punishment from the state if you work without a TDH Certification

>>at which ever level you are working at. For instance if you work as

>>an EMT-B but either your cert has expired or you never actually

>>certified at that level the state can prosecute you with punishment

>>of being jailed in a state jail for up to 2 years. Falls under

>>Impersonating a Public Servant. Just thought I would pass thjat a long

>>

>> Turnbow, EMT-I

>>BRMC EMS

>>

June 3, 2003

I'd think we're getting back into the " reasonable standards " issue. Look how

many medical directors differ in their delegation. Austin EMS doesn't allow

field medics (except for STAR Flight) to do RSI, but other systems do. Does

that mean Ed Racht is negligent? I highly doubt it.

Look at the variances in EMS systems' protocols. There's a mishmash. About

the only thing I haven't seen delegated is brain surgery.

We're back to dueling experts. What's the answer? Truthfully, no one will

know, except for the 12 jurors chosen.

-Wes Ogilvie, attorney at law

June 3, 2003

Here's a new twist on this subject, so we get off the well-beaten path!

What are the limitations of a Physician's Delegations? Since we

work under the delegated practice of a physician, and so the physician

is the one responsible for what we do, what can they delagate and

to whom? There have to be limits.

Interestingly, the Texas State Board of Medical Examiners has a rule

on Delegation. It's long, so here's the web site reference:

http://www.tsbme.state.tx.us/rules/rules/193.htm

But, it doesn't mention EMS at ALL! So where does that leave us?

=Steve=

June 3, 2003

Steve-

This section is one of the most clearly written of the entire " Act " :

193.4. Scope of Standing Delegation Orders.

Providing the authorizing physician is satisfied as to the ability and

competence of those for whom the physician is assuming responsibility, and with

due regard for the safety of the patient and in keeping with sound medical

practice, standing delegation orders may be authorized for the performance of

acts and duties which do not require the exercise of independent medical

judgment.

It appears that if the Physician chooses to delegate his authority to a layman,

he may do so. In actuality, look at some of the advanced therapeutic modalities

that are now provided in home settings by trained laypersons.

It is left to the Physician's judgment and at his/her risk.

TD EMTP

RE: Certification Vs. Registery

Here's a new twist on this subject, so we get off the well-beaten path!

What are the limitations of a Physician's Delegations? Since we

work under the delegated practice of a physician, and so the physician

is the one responsible for what we do, what can they delagate and

to whom? There have to be limits.

Interestingly, the Texas State Board of Medical Examiners has a rule

on Delegation. It's long, so here's the web site reference:

http://www.tsbme.state.tx.us/rules/rules/193.htm

But, it doesn't mention EMS at ALL! So where does that leave us?

=Steve=

June 4, 2003

A related question is this. As you mention (and it does drive us crazy

trying to teach CE across different systems), different medical

directors are comfortable delegating different things to EMS folks.

That's confusing enough. But where does it say anything about

delegating to EMS folks? There is some vague language about " training "

in there. But, can a physician delegate tasks to non-EMS folks? It's

mostly a moot point, but if I've discovered anything in life it's that

if it CAN happen, it WILL somewhere! So, what is so special, from the

physician's point of view (or more appropriate from the legal point of

view concerning delegated practice) about EMS certs/licensed

individuals? Can the physician just as easily (and legally) delegate

tasks to lay persons? And if so, does that mean we in EMS have ZERO

legal standing in the medical community? Sort of goes back to the

license vs cert thing.

=Steve=

ExLngHrn@... wrote:

>I'd think we're getting back into the " reasonable standards " issue. Look how

>many medical directors differ in their delegation. Austin EMS doesn't allow

>field medics (except for STAR Flight) to do RSI, but other systems do. Does

>that mean Ed Racht is negligent? I highly doubt it.

>

>Look at the variances in EMS systems' protocols. There's a mishmash. About

>the only thing I haven't seen delegated is brain surgery.

>

>We're back to dueling experts. What's the answer? Truthfully, no one will

>know, except for the 12 jurors chosen.

>

>-Wes Ogilvie, attorney at law

>

June 4, 2003

Physicians can delegate lots of stuff to lay people. They do it all the time

with their office help. They have them drawing blood, doing labs, taking

x-rays, giving shots, all without any special training. They can do it so

long as they're willing to be responsible for it. However, what they can do

with lay people is mostly within their office. They can, however, have somebody

that goes around with them to assist them, and some of them have people of

dubious training that have been with them for years who have learned how to

assist them.

GG

In a message dated 6/4/2003 11:50:29 AM Central Daylight Time,

paramedic1@... writes:

> Subj: Re: Certification Vs. Registery

> Date: 6/4/2003 11:50:29 AM Central Daylight Time

> From: <A HREF= " mailto:paramedic1@... " >paramedic1@...</A>

> Reply-to: <A

HREF= " mailto: " > </A>

> To: <A

HREF= " mailto: " > </A>

> Sent from the Internet

>

> A related question is this. As you mention (and it does drive us crazy

> trying to teach CE across different systems), different medical

> directors are comfortable delegating different things to EMS folks.

> That's confusing enough. But where does it say anything about

> delegating to EMS folks? There is some vague language about " training "

> in there. But, can a physician delegate tasks to non-EMS folks? It's

> mostly a moot point, but if I've discovered anything in life it's that

> if it CAN happen, it WILL somewhere! So, what is so special, from the

> physician's point of view (or more appropriate from the legal point of

> view concerning delegated practice) about EMS certs/licensed

> individuals? Can the physician just as easily (and legally) delegate

> tasks to lay persons? And if so, does that mean we in EMS have ZERO

> legal standing in the medical community? Sort of goes back to the

> license vs cert thing.

>

> =Steve=

>

> ExLngHrn@... wrote:

>

> >I'd think we're getting back into the " reasonable standards " issue. Look

> how

> >many medical directors differ in their delegation. Austin EMS doesn't

> allow

> >field medics (except for STAR Flight) to do RSI, but other systems do.

> Does

> >that mean Ed Racht is negligent? I highly doubt it.

> >

> >Look at the variances in EMS systems' protocols. There's a mishmash. About

> >the only thing I haven't seen delegated is brain surgery.

> >

> >We're back to dueling experts. What's the answer? Truthfully, no one will

>

> >know, except for the 12 jurors chosen.

> >

> >-Wes Ogilvie, attorney at law

> >

June 4, 2003

Steve,

A physician can delegate to non-EMS people. We had several people that were

hired in our office and cross-trained to work in the back. I believe it is

covered under the medical practice act somewhere. (I'm just too busy to look it

up right now)

For what it's worth,

Neil

Re: Certification Vs. Registery