Are You a Practicing EMT? Maybe Not

IndependantAction

By Brian Sebastian, Northwest EMS Program Coordinator

[The Northwest EMS Program is a Bureau of Land Management and U.S. Forest Service interagency group in Oregon and Washington that provides medical direction to 35 employees who are trained and certified as EMTs.]

As an IC or a DIVS, it’s great to know how many EMTs you’ve got on your fire or division.Northwest EMS Program Logo

But when you inquire “Are you an EMT?” do you really know what you’re asking for?

On the flip side, as an Emergency Medical Technician (EMT), it feels great to put your hand up in response to that question—or maybe it doesn’t. It’s actually a complicated issue that can’t really be answered with a simple hand-raise.

Did you know that our trained medical responders may not be legally covered or obligated to provide care on an incident? For instance, they might actually be an expired EMT, an EMT without reciprocity for the state in which their current incident is located, or they’re an “off-duty” EMT.

Our Northwest EMS Program has come up with an alternative way for supervisors or project leaders to ask: “Are you an EMT?” First of all, we recommend asking: “Are you a practicing EMT?”

We have developed five elemental questions to determine if someone is an authentic, lawfully practicing EMT. Individuals who aren’t in alignment with these five elements may be taking on undue personal liability by acting as an EMT.

Northwest EMS Program photo

Medical aid being rendered on the fireline.

The Appropriate Recognition of EMTs on Incidents

At the Northwest EMS Program’s 2019 annual protocol review, our key discussion topic was the appropriate recognition of EMTs on incidents. The following two bullets come from this annual review:

  • EMTs employed by the federal government routinely provide care though rarely meet all of the five elements. Some EMTs may be hired as Administratively Determined (AD) employees or under contract to specifically perform emergency medical care which means they have a duty to act. However, many government employees who happen to be EMTs have an unofficial expectation to provide medical care.
  • More specifically, seasonal hires are often selected because of their EMT training and given medical gear, thereby creating an implied expectation of duty to provide medical care. It’s subtle, but this expectation is inappropriate because it adds undue liability to our newest, least experienced, and therefore most vulnerable employees.

Training, Certification, Authorization, Equipment, and a Duty to Act

Here are the aforementioned five elements that EMTs and Paramedics must have to legally provide care:

  1. Trained: EMT completed accredited training to apply for certification and/or licensure.
  2. Certified: EMT received certification or licensure from the state they are working in, showing they have met the standard of competence and approved to practice medicine within that state.
  3. Authorized: EMT authorized by a local physician (medical director) to perform interventions under their direction according to the state’s scope of practice.
  4. Equipped: EMT has the necessary tools and gear to perform the skills of an EMT.
  5. Duty to Act: EMT is officially employed and on duty as an emergency care provider.

If people don’t meet these five elements—can’t answer “Yes” to all five—they may assume personal liability for providing medical care.

Supervisors, Burn Bosses, Incident Commanders and Project Managers should ask: “Is anyone a practicing EMT?” instead of simply: “Who’s an EMT?” This clarifies if a care provider is present and meets the five elements. Or they may identify themselves without meeting all five elements and voluntarily accept the ensuing liability.

Medical Provider Definitions

The Northwest EMS Program also provides the following definitions:

  • Wilderness First Responder (WFR): Requires 70-80 hours of coursework focusing on remote treatments.
  • Emergency Medical Technician (EMT): A common emergency medical qualification. It requires 150+ hours of classroom and clinical time focusing on patient assessment, stabilization and transportation.
  • Paramedic: Requires about 2 years of classroom and clinical time.

If you have any questions, dialogue with your medically trained coworkers or contact me, Brian Sebastian, Northwest EMS Program Coordinator, at brian_sebastian@firenet.gov.

14 thoughts on “Are You a Practicing EMT? Maybe Not

  1. Thank you for this article Brian. As a MEDL it can be frustrating when overhead personnel report a number of EMT’s on an engine or division that were not screened by the medical unit for these very components you’ve discussed.

    • Agency Administrators/Line Officers/EMS Program Coordinators must provide these folks with a national reciprocity, standardization, and medical direction so that they are not put in the position of deciding between unknown liability and saving a friend/coworkers life by exercising their abilities as a medically trained emergency responder. By the way, this is not a “follow that up at the local level” situation. Seeking medical direction from a physician and establishing protocols is so far above a seasonal forestry technician – EMT’s capacity and level of compensation it is hilarious! I’d like to see Albuquerque run a desk audit on that. The National EMS system was not designed with Federal- Interagency resources in mind. These folks, medically trained or not, do not operate on a local level. State lines, jurisdictional boundaries, medical service coverage areas do not exist for many of our personnel. Nor does the wildland fire or all risk environment provide the luxury of time needed in order to check in with the MEDL (assuming that one is even in place at the time) and sign reciprocity agreements and such. When there is fire on the hill or in someone’s backyard we don’t have time to stop and get 4-8 crew EMT’s squared away at the med tent. Remember… most of us are here as forestry technicians or at the most FIREFIGHTERS. I have no doubt that the selfless caregivers in our ranks will comply when a support system designed for where and how we operate is finally put into place. Maybe Washington will get it in their head when a “non-practicing” EMT actually refuses to render UN-OBLIGATED aid in fear of the liability this article has identified and some poor soul is lost. The SA has been gathered… anchor in already.

    • So true. I have been told many times you (me as the MEDL) don’t need to order any emts or paramedics because we have plenty with the crews. We don’t know what their skill level is, what crews they’re on or if they have reciprocity to work in the state we’re in.

    • That’s a great question. Personally, I think the answer is a function of an individual’s drive. If you’re a wildland firefighter interested in EMS with the funds, time and energy to pursue an EMT or WEMT…go for it! Just know it can be a significant effort to understand the policies, complete the continuing education requirements and maintain proficiency, but you’ll be a valuable resource in a variety of industries.
      If an EMT seems like a lot but you want to learn some extra medical skills, I think an EMR or a WFR are valuable skill sets for every firefighter.
      And, if you just like to fight fire and EMS isn’t your thing, get good at the Medical Incident Report (8-line) and know how to get your people out.
      Thanks for the question!

  2. overhead should be actively working with local EMS to provide EMT”s and other rescue services and medical services.

  3. Your a Certified EMT with equipment at hand or your not. Must engines have a min. Required level. If not check their engine type requirements before Operation send that team out on the line. Just like you would any line type assignment. That is the way of the past and worked very good. Why try to reinvent the wheel.
    Work smarter not harder.

  4. Great, concise post Brian. Thank you. I’ve worked as a dedicated fireline EMT for 8 years and I always end up in just this conversation with any number of EMTs out on fires from crews, engines, operational overhead, etc. Your recommendation to ask “Is anyone a practicing EMT?” gets to the heart of the conversation much more quickly. The only other major part of the conversation that I like to have is really how I would interpret that question of “practicing”–that is, actually performing emergency medicine on any sort of routine or regular basis and not just in training. Generally this ends up only really being those individuals who are part of emergency services like ambulance services or fire departments that do EMS. I like to know this before I mentally commit resources in my mind for potential incidents. Just a final thought. Thanks again!

  5. I see 2 issues, one setting up a large fire response and accounting for EMS in a specific county or state when the agency does not provide EMS care. And as you stated people with training that are current National registered EMS provider but not covered by a provider.

    I am fortunate that the agency and location I work as a clinic with medical director. Our EMT trained employees can take a provider protocol test and be covered by the medical provider (white Carded). We do run into issues with outside EMS providers and getting them covered when we initiate large fires, mostly delays. Our provider does not recognize first responder level. They are considered good samaritan.

    • “Agency leadership is committed to working quickly to establish the program in ahead of the 2018 field and fire season” (https://www.fs.usda.gov/inside-fs/delivering-mission/excel/emergency-medical-services-policy-works)

      3 years ago, what happened? Too costly, more complicated then anticipated, USFS way of reinventing a wheel that DOI has had implace for years?

      Side bar conversation, how is the USFS short-haul program operating legally with dedicated EMTs, possible local or regional med. control? When they leave their local unit for national response how’s that working out

      “Transfer of risk and liability to the employee, most often 1039 employees?”

      “110 years of tradition unimpeded by progress”

  6. Another key follow up question I have learned to ask: “Do you have the necessary equipment/meds to act in this capacity?”. Don’t assume this – be sure to ask and fully understand their capabilities so you don’t waste valuable time when it counts.

  7. This is a good discussion starter – I’ve thought about this and long been concerned with how integrated (or not) wildland fire is with national, agency and local EMS. You’ve laid out a good framework but it is far more complicated. I don’t think “practicing” is a sufficient additional term, as someone could be/consider themselves (or be considered by others) as “practicing” without meeting any the 5 elements you list. It has a different widespread connotation than is your specific desired meaning and that is extremely difficult to change. The national EMS system (which is under the authority of NHTSA, see ems.gov) doesn’t start with EMT-level, EMR should be included. The national EMS system does not include Wilderness medicine, because there is no standard curriculum set by NHTSA (any random person can put on a WFR class and “certify” them), so WFA and WFR are not part of that system unless they also have EMR or EMT. I think it is important to include the role of the National Registry with states on certification, and state-to-state reciprocity. You allude to it but it should be specified that EMS duties are either in or not in your official job/position description (federal PD). That may preclude or require some of your 5 elements and is critical for liability reasons to you and the agency as to whether you are operating “within the scope of your duty” (meaning can/will the agency take on your personal liability or leave you hanging). Most of the places you say “state” should be clarified to include “or agency as applicable”. The National Park Service, is formally recognized as the equivalent of a “state” by the federal government to authorize EMS providers and determine standards of care – we operate separate from whatever physical state we’re located in, subject to “scope of duty”, MOU, land ownership and other specifics. Military branches are similar. The Forest Service may get to that point as well, as they continue moving towards the NPS model – there is now a single combined NPS/USFS Medical Director, but USFS, BLM, & USFWS are more complicated because they have no Congressional authorization or requirement to provide EMS services to the public on their lands (with local counties retaining that), whereas the NPS does on their land. Beyond that is the problem of mutual aid incident response, across state lines and multiple agencies, with some large fires now having their own medical control, or reliant on local ones that have different standards of care than those of agency responders from elsewhere that are temporarily operating on those lands on an incident. MOU and incident delegation language and land-ownership status becomes very important. I’m not familiar with Fire-specific ones, but I’d suggest they should specifically include EMS and whether that is for incident responders only or also for the public that may be encountered during the incident. Completely separate is widely varying state requirements on “duty to respond” and Good Samaritan laws – it is vital to be aware of them for the state(s) you work in and how they may or may not apply on and off duty. It is simply not the case that as #5 indicates – only if you are “officially employed and on duty as an emergency care provider” is there a legal duty to act (for personal liability purposes). Lots to think about, thank you for raising the profile of it.

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