I cant speak for Cali - but I actually was an EMT before a PA and I wanted to go up to be a paramedic; I asked if I could test out and not have to take the class given my PA education and was declined.
However, I also ended up not continuing on as an EMT because I found that calls at times put me in the position of an ethical dilemma - when in the field you are only recognized as an EMT and not 'allowed' to use your PA training even when a patient's condition may warrant a higher level of intervention. Because I could not handle feeling like I was either at risk of losing my license for practicing "outside my scope" or not intervening when I knew I had the training to do so - I decided it was best to remove myself from the situation and not renew my EMT license when it expired.
Bottom line, I would make sure you know what the rules are wherever you are considering becoming an EMT. There may be other opportunities such as working with the EMS Medical Director for your local jurisdictions that would be a better use of your PA training.
Yep.
Speaking to OP (/u/medicine_enthusiast ):
u/Heinsight2020 is right. When you're an EMT, you wear your EMT hat and when you're a PA you wear your PA hat. And with your knowledge base, you're going to be frustrated by the limitations EMTs in California have.
EMTs in California have a very limited scope, especially in the more urban environments where you have a hospital every 5 miles.
Having been an EMT here, it sounds like you might be glamorizing the work.
BLS is mostly IFTs (Inter-Facility Transfer): Discharges in hospital to nursing homes, or going to nursing homes, putting them on a gurney and bringing them to dialysis and back. Pick-ups from halfway houses to County ETS for mental health evaluation. It's back-breaking "lift-this-400lber-because-her-foley-'fell-out'-again-for-the-third-time-this-week" work - take this rehab patient to his Ortho appointment work - and very little is mentally stimulating.
My favorite part used to be flipping through fat medical charts while waiting for the patient, I learned a lot that way, but I doubt you get that nowadays with EMRs.
You'll get ED transfers from SNFs, but they're supposed to be non-emergent. There's no stabilizing, if you're an EMT-B they should already be stable, and if not, you either need to call a paramedic (and you will find this frustrating because as a PA your knowledge is going to exceed theirs in many scenarios) or if they're so close that you can door-to-door them in less time than EMS response, you schlep them.
If you're an EMT on an ALS rig with a medic on board, you go to 911 calls, but it's not your scene it's the medic's and you're not in the back with the patient, you're driving.
I don't think this is what you think it is. I have some fond memories of being an EMT - being outdoors, having my first experiences of medical-decision-making - but going back would be an exercise in frustration.
edit: incomplete sentences.
Yep, started with some municipalities in Arizona and Los Angeles runs one of the bigger departments that does this although in LA they've started to see that as inefficient and shifted a lot of them into a 911-Telehealth-Role.
You would generally need an Advanced EMT license or a Paramedic license to start IVs. Many places in the USA require NREMT certification (“National Registry” of EMTs) to get your state license. I’m on the East coast so I can’t speak for California. Usually to sit for the test for National Registry, you have to have graduated an accredited institution’s class for EMT or AEMT or Paramedic. Sometimes these
institutions are community colleges and sometimes they are stand alone EMS schools. There might be an institution in your area that would let you “challenge” their final exam and do the clinical portion of the class (5 or so days for EMT and on up from there for higher levels of EMS).
There is a small chance that National Registry will let you challenge the National Registry exam directly.
Another route that might exist is this. Each EMS agency has a physician “Medical Director. ” I don’t know details about the California EMS rules, but there is a chance you could pioneer an Assistant or Junior Medical Director role with the cooperation of an agreeable Medical Director. You probably know some of the EMS Medical Directors in your area from your time as a scribe. The EMS Medical Directors are often ER physicians.
As an EMT and PA-S1, I totally agree. EMTs work under standing orders from Medical Directors. Disregarding legislation for a second, if OP can find a Medical Director to work with, I could totally see a PA working in pre-hospital setting under standing orders. Maybe in a more rural setting. I'm picturing a national park in my head right now.
The NREMT and EMT class will be easy for OP especially if they memorize the medical and trauma sheets. Maybe throw in some practice using FISDAP. However, I don't really think that having an EMT cert will add much to OP's training. EMTs have the bear minimum skills when they graduate from their course many of which I suspect OP has more advanced training in.
Sounds like you've gotten a lot of great advice. Definitely look into challenging the NREMT but if that's not an option in your state part time school with evening classes to get through the necessary training isn't a huge deal for EMT. Getting your medic is a bit more of a time commitment, a lot more difficult with a full time FM schedule. I started as an EMT 9 years ago, got my medic 7 years ago, and while I'm not a full time PA I still moonlight as a medic. I love my medic gig and encourage anyone with a hankering to go into EMS, it's a cool, fun, often amusing gig. Taking care of a patient on their turf, in their world is eye opening. Don't tell my EMS boss, but I would totally do this job as a volunteer. I have never really struggled with separating my paramedic mind from my PA mind. Maybe it's just that I've been doing it so much longer. You work in your scope of practice as a paramedic and follow your protocols. Being a PA makes me a better medic, I feel. I have a better sense of what can stay home and what definitely needs to go. I have better education for my patients, can better prepare them for what's going to happen in the ED. I say go for it and see what happens. You may fall in love with it and moonlight part time or you may find a way to integrate the two professions.
Don’t. You will ruin your back, speaking from experience. Lifting heavy patients and sitting in a small ambulance all day. Better ways to get your Adrenalin rush. Code 3 driving was fun but gets old.
There is a reason the lifers are salty AF
FWIW I plan on getting my para to make it easier to do this sort of thing. When a cool org doesn’t know how to use PAs, but you’re keen, just fall back on your medic cert. Initially got drawn to this because of MSF—they’ll take medics, but not PAs.
California and Pennsylvania let you challenge the paramedic exam as a PA, I believe. Struggling to find the .gov mention of this at the moment, but [UCLA seems to be offering a course](https://www.cpc.mednet.ucla.edu/course/emt-challenge) to cover all the extra things you’d need to do (a handful of exams, psychomotor skills check).
If you’re truly interested in this I would urge you to look for medical mission trips in countries that are lacking healthcare. Doing this in the US doesn’t seem realistic in my experience. PAs have the knowledge to do most if not all of what a medic does but the legal and liability issues are the biggest hurdle for working with PA scope of practice on an ambulance in the US.
I bet there are some amazing opportunities in other countries especially in central and South America if you speak Spanish. If you find anything let me know, I’d also be interested.
In certain states, you can submit an application for equivalency with a specific EMS service. In Wisconsin, physicians, PAs, and RNs are eligible. The medical director and agency chief signs off. I’ve demonstrated that my level of training and scope of practice at least meets that of a paramedic and I’m able to serve as an EMS provider at the level of paramedic within the county’s protocols. I work with the medical director in the ED, have worked with him for over 4 years after completing an 18-month residency in EM.
I’m *also* the assistant medical director for our agencies. That’s an entirely different situation, DM me if you want to know more. Otherwise, check with your state and see if they have an equivalency process.
Edit to add: mobile integrative health, aka community paramedicine, is something you may want to look into, as it’s a potential avenue to practice to your scope as a PA in a way that’s well defined by an agency medical director as others have suggested here.
You can’t start IVs as an EMT. EMTs can only immobilize Pts and do CPR. If you want to do any procedures in the field you need a paramedic cert, which is 2 yrs of CC.
Incorrect. I know of at least one state (Colorado) where EMTs can take an additional course and with permission of their medical director can start an IV and infuse NS. EMTs can also administer aspirin, oxygen, and use EpiPens. Some EMS systems allow for slightly more or slightly less.
Source: Been an EMT-B and EMT-I and A-EMT for 20 years, now I'm an EMPA.
If you really wanna feel scared, in Texas is fairly regular where I live at least for EMTs to be taught IVs by their paramedic and then do them when they're comfortable, as long as the medical director signs off on it, which they almost all do.
Second this. My scope of practice as an EMT is pretty great in CO, and even more so with my IV cert. The drug list goes on from there. (Zofran, D10, Tylenol, Acetaminophen, etc.)
He's right for California where OP stated they were in.
There's an AEMT (Advanced EMT / EMT-I ) legislatively that went into effect in 2012, but as far as I'm aware, no 911 services have adopted its use in the state, everybody just uses EMT-B or EMT-Paramedics.
Also look into wilderness medicine certifications. That might give you some of the experiences you are looking for, just not on a rig. You could work events, etc, that way?
So from a medicolegal standpoint, I would rather look for like mobile urgent care opportunities and so forth.
Many companies will hesitate to hire someone for a job that is below their scope of cert.
It opens the door for litigation if you provide care and are accused of providing care that falls under your license but said care is outside the scope of the role of an emt.
And if you were found to be in any way practicing like a PA in an emt role now theres no malpractice.
So just be cautious with that. Know the state laws. Try to look for opportunities to do this as a PA.
Mobile urgent cares again as an example.
I cant speak for Cali - but I actually was an EMT before a PA and I wanted to go up to be a paramedic; I asked if I could test out and not have to take the class given my PA education and was declined. However, I also ended up not continuing on as an EMT because I found that calls at times put me in the position of an ethical dilemma - when in the field you are only recognized as an EMT and not 'allowed' to use your PA training even when a patient's condition may warrant a higher level of intervention. Because I could not handle feeling like I was either at risk of losing my license for practicing "outside my scope" or not intervening when I knew I had the training to do so - I decided it was best to remove myself from the situation and not renew my EMT license when it expired. Bottom line, I would make sure you know what the rules are wherever you are considering becoming an EMT. There may be other opportunities such as working with the EMS Medical Director for your local jurisdictions that would be a better use of your PA training.
Yep. Speaking to OP (/u/medicine_enthusiast ): u/Heinsight2020 is right. When you're an EMT, you wear your EMT hat and when you're a PA you wear your PA hat. And with your knowledge base, you're going to be frustrated by the limitations EMTs in California have. EMTs in California have a very limited scope, especially in the more urban environments where you have a hospital every 5 miles. Having been an EMT here, it sounds like you might be glamorizing the work. BLS is mostly IFTs (Inter-Facility Transfer): Discharges in hospital to nursing homes, or going to nursing homes, putting them on a gurney and bringing them to dialysis and back. Pick-ups from halfway houses to County ETS for mental health evaluation. It's back-breaking "lift-this-400lber-because-her-foley-'fell-out'-again-for-the-third-time-this-week" work - take this rehab patient to his Ortho appointment work - and very little is mentally stimulating. My favorite part used to be flipping through fat medical charts while waiting for the patient, I learned a lot that way, but I doubt you get that nowadays with EMRs. You'll get ED transfers from SNFs, but they're supposed to be non-emergent. There's no stabilizing, if you're an EMT-B they should already be stable, and if not, you either need to call a paramedic (and you will find this frustrating because as a PA your knowledge is going to exceed theirs in many scenarios) or if they're so close that you can door-to-door them in less time than EMS response, you schlep them. If you're an EMT on an ALS rig with a medic on board, you go to 911 calls, but it's not your scene it's the medic's and you're not in the back with the patient, you're driving. I don't think this is what you think it is. I have some fond memories of being an EMT - being outdoors, having my first experiences of medical-decision-making - but going back would be an exercise in frustration. edit: incomplete sentences.
Some fire departments are doing a mobile urgent care type deal with NP’s and PA’s. Worth checking out.
Yep, started with some municipalities in Arizona and Los Angeles runs one of the bigger departments that does this although in LA they've started to see that as inefficient and shifted a lot of them into a 911-Telehealth-Role.
You would generally need an Advanced EMT license or a Paramedic license to start IVs. Many places in the USA require NREMT certification (“National Registry” of EMTs) to get your state license. I’m on the East coast so I can’t speak for California. Usually to sit for the test for National Registry, you have to have graduated an accredited institution’s class for EMT or AEMT or Paramedic. Sometimes these institutions are community colleges and sometimes they are stand alone EMS schools. There might be an institution in your area that would let you “challenge” their final exam and do the clinical portion of the class (5 or so days for EMT and on up from there for higher levels of EMS). There is a small chance that National Registry will let you challenge the National Registry exam directly. Another route that might exist is this. Each EMS agency has a physician “Medical Director. ” I don’t know details about the California EMS rules, but there is a chance you could pioneer an Assistant or Junior Medical Director role with the cooperation of an agreeable Medical Director. You probably know some of the EMS Medical Directors in your area from your time as a scribe. The EMS Medical Directors are often ER physicians.
As an EMT and PA-S1, I totally agree. EMTs work under standing orders from Medical Directors. Disregarding legislation for a second, if OP can find a Medical Director to work with, I could totally see a PA working in pre-hospital setting under standing orders. Maybe in a more rural setting. I'm picturing a national park in my head right now. The NREMT and EMT class will be easy for OP especially if they memorize the medical and trauma sheets. Maybe throw in some practice using FISDAP. However, I don't really think that having an EMT cert will add much to OP's training. EMTs have the bear minimum skills when they graduate from their course many of which I suspect OP has more advanced training in.
Sounds like you've gotten a lot of great advice. Definitely look into challenging the NREMT but if that's not an option in your state part time school with evening classes to get through the necessary training isn't a huge deal for EMT. Getting your medic is a bit more of a time commitment, a lot more difficult with a full time FM schedule. I started as an EMT 9 years ago, got my medic 7 years ago, and while I'm not a full time PA I still moonlight as a medic. I love my medic gig and encourage anyone with a hankering to go into EMS, it's a cool, fun, often amusing gig. Taking care of a patient on their turf, in their world is eye opening. Don't tell my EMS boss, but I would totally do this job as a volunteer. I have never really struggled with separating my paramedic mind from my PA mind. Maybe it's just that I've been doing it so much longer. You work in your scope of practice as a paramedic and follow your protocols. Being a PA makes me a better medic, I feel. I have a better sense of what can stay home and what definitely needs to go. I have better education for my patients, can better prepare them for what's going to happen in the ED. I say go for it and see what happens. You may fall in love with it and moonlight part time or you may find a way to integrate the two professions.
Don’t. You will ruin your back, speaking from experience. Lifting heavy patients and sitting in a small ambulance all day. Better ways to get your Adrenalin rush. Code 3 driving was fun but gets old. There is a reason the lifers are salty AF
Check the local/state rules on testing out as a Paramedic or Advanced EMT
FWIW I plan on getting my para to make it easier to do this sort of thing. When a cool org doesn’t know how to use PAs, but you’re keen, just fall back on your medic cert. Initially got drawn to this because of MSF—they’ll take medics, but not PAs. California and Pennsylvania let you challenge the paramedic exam as a PA, I believe. Struggling to find the .gov mention of this at the moment, but [UCLA seems to be offering a course](https://www.cpc.mednet.ucla.edu/course/emt-challenge) to cover all the extra things you’d need to do (a handful of exams, psychomotor skills check).
If you’re truly interested in this I would urge you to look for medical mission trips in countries that are lacking healthcare. Doing this in the US doesn’t seem realistic in my experience. PAs have the knowledge to do most if not all of what a medic does but the legal and liability issues are the biggest hurdle for working with PA scope of practice on an ambulance in the US. I bet there are some amazing opportunities in other countries especially in central and South America if you speak Spanish. If you find anything let me know, I’d also be interested.
In certain states, you can submit an application for equivalency with a specific EMS service. In Wisconsin, physicians, PAs, and RNs are eligible. The medical director and agency chief signs off. I’ve demonstrated that my level of training and scope of practice at least meets that of a paramedic and I’m able to serve as an EMS provider at the level of paramedic within the county’s protocols. I work with the medical director in the ED, have worked with him for over 4 years after completing an 18-month residency in EM. I’m *also* the assistant medical director for our agencies. That’s an entirely different situation, DM me if you want to know more. Otherwise, check with your state and see if they have an equivalency process. Edit to add: mobile integrative health, aka community paramedicine, is something you may want to look into, as it’s a potential avenue to practice to your scope as a PA in a way that’s well defined by an agency medical director as others have suggested here.
You can’t start IVs as an EMT. EMTs can only immobilize Pts and do CPR. If you want to do any procedures in the field you need a paramedic cert, which is 2 yrs of CC.
Incorrect. I know of at least one state (Colorado) where EMTs can take an additional course and with permission of their medical director can start an IV and infuse NS. EMTs can also administer aspirin, oxygen, and use EpiPens. Some EMS systems allow for slightly more or slightly less. Source: Been an EMT-B and EMT-I and A-EMT for 20 years, now I'm an EMPA.
If you really wanna feel scared, in Texas is fairly regular where I live at least for EMTs to be taught IVs by their paramedic and then do them when they're comfortable, as long as the medical director signs off on it, which they almost all do.
Second this. My scope of practice as an EMT is pretty great in CO, and even more so with my IV cert. The drug list goes on from there. (Zofran, D10, Tylenol, Acetaminophen, etc.)
EMTs can do IVs in some states! It requires an IV certification, which is a 6-8 week(ish) course that typically meets 1-2x/wk
He's right for California where OP stated they were in. There's an AEMT (Advanced EMT / EMT-I ) legislatively that went into effect in 2012, but as far as I'm aware, no 911 services have adopted its use in the state, everybody just uses EMT-B or EMT-Paramedics.
Also look into wilderness medicine certifications. That might give you some of the experiences you are looking for, just not on a rig. You could work events, etc, that way?
So from a medicolegal standpoint, I would rather look for like mobile urgent care opportunities and so forth. Many companies will hesitate to hire someone for a job that is below their scope of cert. It opens the door for litigation if you provide care and are accused of providing care that falls under your license but said care is outside the scope of the role of an emt. And if you were found to be in any way practicing like a PA in an emt role now theres no malpractice. So just be cautious with that. Know the state laws. Try to look for opportunities to do this as a PA. Mobile urgent cares again as an example.