Physicians in Pre-Hospital Setting

[Aurora013]

As far as docs riding...I know two of the docs at the ER ride with local volunteer agencies as medics. Both started out as paramedics, and keep doing it because they love the job. One of them does it sporadically, but the other has a weekly duty night. As far as what their level of care is, they can only practice up to paramedic standards when they are in charge (one of them got his wrist slapped by the hospital for assuming he had standing orders for more MSO4 than state protocols said he did as a medic). However, if they are not providing any patient care, as in are the driver or a second medic on scene but won't be riding it in to the hospital, they can act as a ER doc in the capacity of being able to give orders to the medics (so instead of calling the ER for an order for more MSO4, they just ask the guy who's standing next to him). But if they provide any care enroute to the hospital, they still need to call the ER to get a "second opinion." And at no point in time are they allowed to perform any treatments that go beyond the state/local protocols for paramedic.

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[146233]

In Illinois, it's muddy. We have physicians that come with us all the time on transports -- technically, they are considered part of a "transport team" and thus an extension of the hospital, so they still have full-scope rights. However, inside our ambulance, the paramedic still has final say over what happens and what does not (although I have yet to see a medic overrule a doc).

As for working as medics, I'll have to do some research and find out. I know there are a couple that do it. I'll ask them what their scope is out on the street. I suspect if they're practiciing as physicians, then they have their own malpractice; their hospital would surely have a seizure otherwise.

 

[MavsFan08]

As far as docs riding...I know two of the docs at the ER ride with local volunteer agencies as medics. Both started out as paramedics, and keep doing it because they love the job. One of them does it sporadically, but the other has a weekly duty night. As far as what their level of care is, they can only practice up to paramedic standards when they are in charge (one of them got his wrist slapped by the hospital for assuming he had standing orders for more MSO4 than state protocols said he did as a medic). However, if they are not providing any patient care, as in are the driver or a second medic on scene but won't be riding it in to the hospital, they can act as a ER doc in the capacity of being able to give orders to the medics (so instead of calling the ER for an order for more MSO4, they just ask the guy who's standing next to him). But if they provide any care enroute to the hospital, they still need to call the ER to get a "second opinion." And at no point in time are they allowed to perform any treatments that go beyond the state/local protocols for paramedic.

The residency I am interested in requires a rotation with an EMS agency, where you ride with them. I'm not sure of the rules on this.

I am interested in riding on ambulances as an ER resident outside of this rotation, but my paramedic license has expired last year. I'm not sure of how that works.

 

[pmdc222]

As far as docs riding...I know two of the docs at the ER ride with local volunteer agencies as medics. Both started out as paramedics, and keep doing it because they love the job. One of them does it sporadically, but the other has a weekly duty night. As far as what their level of care is, they can only practice up to paramedic standards when they are in charge (one of them got his wrist slapped by the hospital for assuming he had standing orders for more MSO4 than state protocols said he did as a medic). However, if they are not providing any patient care, as in are the driver or a second medic on scene but won't be riding it in to the hospital, they can act as a ER doc in the capacity of being able to give orders to the medics (so instead of calling the ER for an order for more MSO4, they just ask the guy who's standing next to him). But if they provide any care enroute to the hospital, they still need to call the ER to get a "second opinion." And at no point in time are they allowed to perform any treatments that go beyond the state/local protocols for paramedic.

This seems like such a strange rule. I'm assuming these doctors work for the same hospital that gives medical control to the service?

Its very weird that they would not be able to do med control options themselves without calling but then if their partner wants to, they can become medical control. I would assume it would be one way or the other in both circumstances. Both people on scene are responsible for patient care and accountable the legal sense, not just the person in the back of the ambulance.

If they do work for the same hospital and are frequently on the other end of the phone when they give medical control, aren't they in essence working under their own license? I would think they should be able to do everything in the protocols incluidng med control options but nothing more.

I guess there's no clear-cut rule about this and as zipmedic said, I guess they have their own malpractice? What if it is hospital-based -- is their hospital malpractice extended prehospitally?

 

[pmdc222]

I am interested in riding on ambulances as an ER resident outside of this rotation, but my paramedic license has expired last year. I'm not sure of how that works.

An EM resident who used to work for us said he was going to take shifts. He took one or two apparently but never really had time otherwise. He still had his paramedic cert though. I'm not sure there is a way to do it otherwise. The only thing I could think of is if the state would allow you to challenge the test to get it back.

 

[polygonal]

I'm very skeptical about some of issues brought up here. Physicians practice under their own, independent medical license. The scope of practice issues are nothing like those of the EMS world. I am not aware of any "laws" in any state that prohibit their practice (or scope of practice) to inside the hospital. A physician that has their unrestricted medical license (i.e., has finished enough post graduate training and has taking the required board exams) has the legal authority to practice medicine to the fullest extent. This also includes the legal ability to prescribe and administer almost all medications (with a very few caveats) and perform surgery (there are many more issues about credentialing but that’s a different topic).

Now, there are some very real issues regarding abandonment and malpractice. Generally, if a physician on scene initiates any therapy above the scope of practice of an EMT/Paramedic or assumes medical direction there are issues about abandonment by turning care back over to the EMT rather than riding in and turning care over to another doc. Malpractice for physicians in pre-hospital settings is another murky area. Just because a physician CAN do something doesn't mean his malpractice carrier will allow it or whether it's prudent from a medicolegal perspective.

 

[FoughtFyr]

In Illinois, it's muddy. We have physicians that come with us all the time on transports -- technically, they are considered part of a "transport team" and thus an extension of the hospital, so they still have full-scope rights. However, inside our ambulance, the paramedic still has final say over what happens and what does not (although I have yet to see a medic overrule a doc).

As for working as medics, I'll have to do some research and find out. I know there are a couple that do it. I'll ask them what their scope is out on the street. I suspect if they're practiciing as physicians, then they have their own malpractice; their hospital would surely have a seizure otherwise.

Not to resurrect a dead thread, but I can't let this go. The laws in Illinois (and every other state) are NOT muddy. They are very clear. A paramedic is certified / licensed / authorized (depending on the state) to perform activities traditionally legally defined as the practice of medicine within a specific setting (an EMS system). NOTHING IN ANY STATE'S EMS ACT PROHIBITS ACTIVITIES BY A LICENSED PHYSICIAN. A physician can practice medicine where ever they want (within the state issuing their license). Now, your EMS system can, and usually does, limit the degree to which you (as an EMS provider) can work with, assist, or lend material assistance to a physician on the scene. But that is almost always a local regulation, not a state one. Do not fool yourself into believing that you, as a paramedic, have any "greater right" or authorization to patient care than a physician does. The EMS Act enables you to act "as a physician" by extension of your project medical director's license. That extension is a limited vehicle. The physician's license is not.

As for physicians who respond with EMS units (and are not the medical directors of that unit) there are two general models. First, some states have legislated "field surgeons" which allow physicians to act "under" another physician's license as a device to limit liability. This is rare. More often, the physician acts under their own license, but using either the shield of the municipality's sovereign immunity, or an extension of the municipality's liability insurance to cover their malpractice. Even in tort happy Illinois, the sovereign immunity shield is fairly tough. Believe it or not, the concern with physicians working in the field is not their malpractice liability but rather the insurance against their being injured on the job. A physician's disability simply costs more than an EMT-P's.

- H

 

[viostorm]

I don't know where aurora got their information.

After 1 year of internship and passing step 1,2,3 physicains have an "unrestricted medical license" in that anyone can do anything. A family practice doctor can do heart surgery if they want.

Whether they get compensated, are allowed by the hospital, or can defend themself if there are any complications is the difference.

Your physicians provided they have a license can do anything they want.

 

[leviathan]

I was confused with the initial comments made by some members here...thanks for clearing it up FoughtFyr.

A paramedic is granted a medical standing order from a physician to perform SOME of the same acts that are normally exclusive to physicians. A physician, well, IS a physican, so they can do everything they are normally permitted to do irrespective of location from a legal point of view. The only thing holding a physician back would be malpractice insurance not covering him/her to perform procedures outside of his normal area of practice, although that might be exclusive to Canada.

 

[146233]

Not to resurrect a dead thread, but I can't let this go.

Yes, thank you for clarifying. I stand corrected.

 

[kylek044]

As far as docs riding...I know two of the docs at the ER ride with local volunteer agencies as medics. Both started out as paramedics, and keep doing it because they love the job. One of them does it sporadically, but the other has a weekly duty night. As far as what their level of care is, they can only practice up to paramedic standards when they are in charge (one of them got his wrist slapped by the hospital for assuming he had standing orders for more MSO4 than state protocols said he did as a medic). However, if they are not providing any patient care, as in are the driver or a second medic on scene but won't be riding it in to the hospital, they can act as a ER doc in the capacity of being able to give orders to the medics (so instead of calling the ER for an order for more MSO4, they just ask the guy who's standing next to him). But if they provide any care enroute to the hospital, they still need to call the ER to get a "second opinion." And at no point in time are they allowed to perform any treatments that go beyond the state/local protocols for paramedic.

They might to that just to appease formalities and avoid pissing off anyone in the pre-hospital community (medics and emts tend to have big heads). There are actually EMS fellowships for physicians that involve them riding along on ALS units, so anyone who tells you that physicians can't practice out of a clinical setting is misinformed.

 

[Autopulse]

I can answer this from both sides. I am a board certified emergency physician with fellowship training in EMS, and a paramedic. I work in the ED as well as I am the medical director for the EMS agency. When I am functioning as the Medical Director, I have sov. immunity. If I were to pull a shift in a rig as minimum staffing, I would be silly to think I am functioning as a medic. No, I would just be a wierd Medical Director, that still has his Medic cert.......I would not have to call for extra morphine or ativan. I would be operating under my licence, so I can authorize myself to load them up!....just like every other responder in my county. As such, I would be held to a much higher standard.
If I were to operate in another jurisdiction (say as a volunteer Medic), I could do 2 things...follow the rules and protocols or go above protocols. At that time I will be Dr. XYXZ, friendly citizen and the agency would be absolved of my doings.
That said, resident training programs muddy the h2o a little bit.

If you have any questions, PM me.

I'm out!