Q: I'm a paramedic, but not working at that level. Who signs off on my training?

A: Paramedics not working at the paramedic level fall into one of 4 categories:

  1. Dual NR/MA certified paramedic working BLS only: Considered “inactive”; would complete normal CE but then register as inactive with NREMT.  Will still get a current state certification after completing state application.
  2. Dual NR/MA certified paramedic not working ALS or BLS: Considered “inactive”; would complete normal CE but then register as inactive with NREMT.  Will still get a current state certification after completing state application.
  3. MA-only certified paramedic working BLS only: Can affiliate with the BLS service; training officer would complete audit of training records.  No MD sign-off needed for non-NREMT providers.
  4. MA-only certified paramedic not working ALS or BLS: Considered unaffiliated, would recertify with regional EMS office who would perform audit. No MD sign-off.Massachusetts does not yet have the requirement for MD sign-off for paramedics recertifying.  It is only for NREMT paramedics.  As such, the TO will not need to sign off on ALS skills, but only audit/review the training records for the paramedic.


Q: As a paramedic, am I required to hold a PALS card?

A: No; paramedics are only required to maintain current cards in BLS and ACLS.


Q: Am I required to wear identification (e.g., EMT patch) that indicates my level of certification while staffing an ambulance?

A: A service may require their EMTs to wear proper identification, including an EMT patch, as part of their uniform policy.  MA EMS regulation 105 CMR 170.285 (C) requires licensed services to "ensure that EMS personnel carry on their person or in the EMS vehicle on which they are working, identification of their current certification level, current CPR training card, and a valid motor vehicle operator's license"


Q: Our ALS Affiliation Agreement requires that we meet quarterly or as needed and that each paramedic should attend at least 2 M&M Rounds per year. Our service has provided these rounds with our medical control liaison (Affiliate Hospital Medical Director designee) every other month. Most of our paramedics are in compliance, but there are some that have not met the requirement. What should I do?

A: Contact the Affiliate Hospital Medical Director and report it. S/he may want to suspend authorization to practice since s/he’s ultimately responsible for these paramedics.


Q: Can you lose your EMT certification if you are charged with insurance fraud but it is not related to a call you did?

A: It depends on what the final criminal conviction is (regardless if it occurred during your duties as an EMT). MDPH/OEMS handles each on a case by case basis because circumstances vary. A criminal act can lead to an action taken against your certification (suspension or revocation).


Q: Can an EMT work at a private event such as a dance, party, horse show, fair as a private EMT ( not connected with a municipality or private service) or would they be considered a First Responder only?

A: An EMT can work at a private event, but unless they are working on behalf of a licensed ambulance service with immediate access to activate an ambulance, they are not working under EMT certification. They are not even considered a First Responder. First Responder is defined in MA regulation as one who works for a police or fire department, or a life guard. EMTs (of all levels) are limited to the First Responder level when they are employed by one of these agencies (unless, of course, the police or fire department has an ambulance license and they are assigned to operate in that capacity).

EMTs at a private event can provide limited first aid based on their training as an EMT (take vital signs, perform bleeding control, maintain manual C-spine stabilization, or use an AED if available) but they are not authorized to administer oxygen (a controlled substance) or aspirin and epinephrine (EMTs are allowed to administer these drugs with an ambulance service that has a Memorandum of Agreement with a hospital for medical oversight). In fact, MGL Chapter 111C , Section 19 (a)(3) prohibits them from even wearing an EMT patch unless they are working on behalf of the ambulance service. Individuals who agree to provide first aid at a private event should make it clear to the event coordinator ahead of time that they are not working in the capacity of a certified EMT under a licensed ambulance service.  The EMT should also consider issues of personal liability.


Q: What steps should an EMT take to limit liability if s/he agrees to provide first aid at a private event?

A: To limit liability when providing first aid at a private event while NOT on behalf of an ambulance service, an EMT may want to provide written notice to the event coordinator explaining that first aid will be provided based on EMT training, not certification under a licensed ambulance service, and that the first aid will not equal what would be rendered by an EMT staffing an ambulance. One might add that an ambulance will be activated immediately when needed, if that is the case. It may also be wise to consider options for liability insurance, especially if you own a home. Some insurance companies offer an umbrella policy that may protect you in the event you are sued.


Q: Does a paramedic operate under a physician's license?

A: No; the MDPH/OEMS certifies the paramedic and the Affiliate Hospital Medical Director (AHMD) authorizes a paramedic to provide care while working at a licensed ambulance service with which the AHMD and Affiliate Hospital has an ALS Affiliation Agreement.


Q: Is there a liability issue for a paramedic or AEMT working at a level lower than they are trained? (e.g., a paramedic functioning at the BLS level and having to limit care of a cardiac arrest to the BLS level.)

A: A paramedic may only work to the level at which the service is licensed (so a paramedic working at a Basic licensed ambulance service must only work to the BLS level). If an ambulance service is licensed at the ALS level, the paramedic must work at the ALS level in accordance with their certification, as long as there are no limits placed on the paramedic by the service or Affiliate Hospital Medical Director due to any deficiencies. (The same applies to AEMTs with the added stipulation that they are limited to working at the AEMT level only when paired with a paramedic while affiliated with an ALS level service.)


Q: How do I apply for MA EMT certification based on my out-of-state EMT training or certification?

A: Submit the required application and fee to OEMS.


Q: If a paramedic is working for a service licensed at the Basic level; is the paramedic at all responsible for the care of the patient or actions of the other EMT?

A: The care of a patient is the responsibility of BOTH EMTs since they are considered working together as a team. An EMT (no matter what level; paramedic, AEMT, or EMT), may only perform duties to the LICENSURE LEVEL of the service. An EMT (no matter what level) working for a First Responder service (police department or fire department that is NOT licensed as an ambulance service) may only perform duties to the First Responder level.


Q: If a town has decided to change its EMS provider does that town have to continue the previous level of care? For example, if a town has a private ALS service and that town wants to take over the ambulance, does the town have to staff the ambulance at the ALS level or can the town reduce the care being provided by making the service BLS?

A:  A town determines what level of service will be provided within its community (BLS or ALS). A town may choose not to renew their contract with an ALS service, or if provided by a municipal service, not renew their license at the ALS level. This determination should be made after careful consideration of all factors contributing to providing optimal pre-hospital care and examining alternative options such as regionalized ALS.

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