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Thread: EMR Reports

  1. #1
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    Default EMR Reports

    My department does not fill out reports for EMR (First Responder) level responses. However the chief wants to change that so we can log more calls so we can get more grants (his logic not mine). The question I have is is that ethical/legal because of the fuzzy state of our EMR responders around here. We are in Missouri, a state that does not recognize EMRs so we operate under national guidelines and are supposedly protected under the "Good Samaritan" laws. Also *technically* the "First Responders" are a county wide organization that is entirely separate from the "Fire Department", however all the County First Responders are organized by fire district, all in our district are firefighters because as far as we know the County First Responder organization does not have any kind of insurance or anything so the chief wants his people under the fire department so they have a little more protection (specifically POV response protection). All of the EMR equipment is provided by the County First Responders or is furnished by the individual. The chief of the fire department (who is also the chief of the first responders) is adamant that the two organizations are entirely separate and believes strongly that they should never be combined. My concerns/questions are:
    1. Is this setup even legal?
    2. Do the EMRs need to fill out reports for incidents at all (they don't currently)
    3. If the organizations are truly separate is it okay to count EMR operations as Fire Department operations for incident reporting purposes.
    4. Has anyone else dealt with a chief that does not believe fire based EMS is acceptable? If so what happened?

    Thank you all, hope that made sense.

  2. #2
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    Wow, what a confusing situation to be in. I'm still a little fuzzy about the role of the County First Responders in your area - are they dispatched on calls, or just "up and go" when they hear a nearby EMS call? Is it an organization you have to be a member of, or is the CFR just EMS providers from each of the fire departments?

    To answer your specific questions....

    1. As far as being legal, that would be up to your state-level EMS license agency. It sounds fishy to me, however.

    2. Why in the world wouldn't you have been filling out reports from Day 1?! You're operating as an agency which may or may not being operating legally, under the assumption that the Good Samaritan rule will cover you (which I highly doubt it will), plus you're not documenting the actions that you members are taking? This is a bad, bad idea. Yes, fill the reports out - every time.

    3. I've seen departments handle this both ways - if the FF's are going to a call, then it's counted as a response for the fire department, even if the organization is separate. But, if these are just EMR's going on a first responder call, and they just HAPPEN to be members of the FD as well, you may be stretching it saying that it's a FD response.

    4. I think we've all met FC's who don't want any part of EMS. Rewind my VFD to 1992-1993, and that's the boat we were in. But, we've kept up with the times, and have done well. We're still exclusively a first-responder agency, but have been cleared by the volunteer ambulance company (totally separate) to staff their ambulances on an-as needed basis. Education may be the key here if you all feel that organizing EMS under the FD is the best option for your local area.

    I would REALLY encourage you to seek legal opinion about several things that you pointed out here, especially assuming that the Good Samaritan laws will protect you. Remember that the GS laws are designed to protect bystanders from legal recourse for attempting to help someone in need. Your personnel are trained to provide a specific care, then generally speaking, that exempts you from GS protection. Futhermore, if a citizen decides to sue any of the EMR's, who provides the legal protection and/or insurance? The FD? The County First Responders?

    I see a lot of red flags here....
    Last edited by BoxAlarm187; 01-03-2015 at 01:43 PM.
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  3. #3
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    Well this whole situation sounds like a cluster.

    1. Is this setup even legal? Honestly I am not sure this sounds like a bizarre situation that the county has formed this EMR organization and the state doesn't recognize this level of provider.

    2. Do the EMRs need to fill out reports for incidents at all (they don't currently) MY answer would be yes, if some level of care was provided to a pt that should be documented somewhere.

    3. If the organizations are truly separate is it okay to count EMR operations as Fire Department operations for incident reporting purposes. I would say no, now if the fire department had a EMR program then by all means let those calls count for the department. Its no different than volunteering at two departments the calls that you run at one don't magically appear at the other one and count towards call volume

    4. Has anyone else dealt with a chief that does not believe fire based EMS is acceptable? If so what happened? Yes, he was forced out and retired. Someone more progressive took his place. Is fire based EMS the best thing no, but it does fulfill a need the community has. Most of the time the fire department is in the best position to begin providing that service.

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    WOW !!!

    I'm with Box on this one: WAY too many red flags waving here.

    1. the state doesn't recognize the level of training you have and yet you have an organization providing prehospital emergency medical care, under the auspices of a "countywide" group.

    2. Who is dispatching these calls for the EMR's to respond to?

    3 Who is providing medical direction for this group? ALL EMS providers operate under an MD's/ DO's license.

    4. Who is providing liability insurance & malpractice coverage for your actions?

    5. Who is providing the certified training to make you EMR's if the state doesn't recognize the term by statute?

    6. Has the organization even bothered to check with the county attorney or the state prior to providing unlicensed medical care in the
    street.

    7. Not filing a paperwork trail is probably smart at this point as it would create a trail of documentation for lawyers to follow when suing the organization or it's members. Yes you personally can be sued for your actions acting outside the law in providing medical care.

    8. The chief who wants to start logging these calls as a way of boosting his numbers is delusional. These are EMS calls not fire calls. If he wants to count them in his stats then get your folks trained and licensed by the state as EMT's and provide Prehospital Emergency Medical Care within the state statutes.

    9. To start logging these calls in order to make his department look better in grant writing stats is called fraud and the federal government does not take this lightly.
    they will investigate if they have suspicions.
    They have put well meaning but un-informed chiefs in prison.

    10.The good Samaritan act will NOT cover you in any way shape or form of the imagination.
    You are providing an organized response with "trained " responders [ I use that term loosely as you are not certified/licensed by the state ]
    Last edited by islandfire03; 01-03-2015 at 10:51 AM.

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    Ok to clarify a few points.

    1. The organization is a county-wide organization of EMRs.
    2. In Missouri the state accredits EMR training but not EMRs themselves (stupid I know)
    3. The EMRs work under medical direction and with the full cooperation of the local ambulance service.
    4.EMRs are dispatched by the county dispatch when the ambulance is dispatched, we have a long wait here for ALS ambulance units, I've personally been on wrecks were we waited a hour for the ambulance to arrive.
    5. CEUs are now being offered by both the ambulance service and the County First Responders
    6. I have heard nothing about the County First Responders having any kind of insurance. The Fire Department has insurance but I'm not sure if it has any kind of malpractice insurance.

    In the interest of full disclosure I am not a EMR, I am studying to be a EMT and am not technically a member of the County First Responders. However I am (sadly) the highest trained member of the volly department and have worked with the first responders on a number of incidents. The whole relationship between the fire department and the first responders is a very gray area, especially as our fire chief wants ALL of the EMRs in his fire district to be on the fire department. I am well aware that this entire situation is a powder keg waiting for the spark of one lawsuit to completely bring down the house of cards that is the emergency services around here. I'm moving out of this town in the fall but I want to fix things here if I can. I believe that if we can bring the EMRs under the fire department (in our district at least) officially we may be able to add a level of legitimacy and structure to the organization.

    Another question: About insurance, what kind of insurance would a EMR level EMS organization need? Could someone send me a link? I've searched Google but I guess I'm not using the right words.
    Last edited by firedwight; 01-03-2015 at 12:54 PM.

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    Please don't take my responses as anti Volunteer
    Often times in an effort to provide a service that is desperately needed, some folks may not know what they don't know about providing this type of service



    1. is the county wide organization licensed by the state to provide emergency medical care?
    If not who's statutory authority are they operating under?

    2. I would run this whole scenario by the state EMS office

    3. You have an MD that is risking his license to practice medicine with a county wide group that may/may not be legally operating as EMS service???

    The fact that the local licensed Ambulance service likes having the help arrive prior to them , doesn't affect them or their license. You don't work for them. They can't be sued for your actions prior to their arrival on scene.

    4. the fact that you are being dispatched by the county dispatch leads me to believe that someone in authority at the county level is assuming responsibility for the responders showing up & providing medical care. Whether they are doing this with informed knowledge is unknown.

    5 offering CEU classes for a license level that doesn't exist according to the state, does sound strange.

    6. At a minimum you should be covered by workers comp , liability and medical malpractice insurance coverage.
    You can go to www.VFIS.com for more info on these coverages.
    We have a ten million aggregate liability / malpractice policy for our EMS service in addition to the physical plant & vehicle coverages.
    You may be covered under the towns or counties workers comp as volunteers, but I would want to see the liability / malpractice policy in writing before responding to provide medical care.
    Your mileage may vary , depending on how much of a risk folks are willing to take.

    Yes you are helping your neighbors by providing a free service. That won't stop a lawyer from suing if they think they can get a judgement in court.

    Just spent a few minutes on the Missouri Dept of health EMS website. There is absolutely zero information on EMR 's providing medical care that I could find.

    http://health.mo.gov/safety/ems/

    Edited to add:::
    "
    The whole relationship between the fire department and the first responders is a very gray area, especially as our fire chief wants ALL of the EMRs in his fire district to be on the fire department. I am well aware that this entire situation is a powder keg waiting for the spark of one lawsuit to completely bring down the house of cards that is the emergency services around here. I'm moving out of this town in the fall but I want to fix things here if I can. I believe that if we can bring the EMRs under the fire department (in our district at least) officially we may be able to add a level of legitimacy and structure to the organization."

    That is part of the big picture problem here. You state they don't want to do Transport EMS , yet they want to have all the EMR's be members under control of the fire dept., so the chief can use their responses to count towards his fire run call totals.

    This has been going on since actual structure fires started going down drastically and fire managers figured out that by taking over EMS , they can justify their budgets and staffing levels. Many career departments got into EMS for this very reason , to justify their budgets and continued staffing. Most of those dinosaurs have retired and modern day managers realize that EMS is often up to 80% of a fire departments call volume if they are a transporting agency, so they can show the response numbers are up and ask for more $$$ when it comes to budget time.

    If your chief is successful and brings all the EMR's under the fire dept membership , then his numbers look good and his staffing levels go up. The only problem I see is that EMR doesn't truly exist under the State EMS system.
    Kind of similar to a boy scout troop responding with advanced first aid training.

    Before anyone gets their panties in a bunch:: I get it EMR is all you have and I understand that it's what your populace is happy to have. But don't they deserve better????
    Last edited by islandfire03; 01-03-2015 at 08:59 PM. Reason: added link to state EMS office
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    Thanks for your insight everyone.
    I'll try and do what I can to get things in order here. Fortunately I have people in all the involved organizations and hopefully soon the county emergency contact willing to help legitimize things.

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    Update
    The first responders in my fire district have officially left the county first responders although they will continue to attend their training events. The first responders are now part of the fire department, we are seeing about our insurance (VFIS) and the secretary of the FD and I will be registering us with the state health department. We are going to keep our medical direction through the closest hospital (who also runs the ambulance), they do the MD for the county first responders too, I was mistaken about that. We're going to meet with the medical director soon to make everything officially official and see how he wants runs reported/recorded.

    This is part of a ongoing "stabilization" of our area emergency agencies which continues to go well. Thanks to you all for your suggestions.

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    congrats
    sounds like you have taken the bull by the balls and are attempting to do EMS correctly & legally.


    The folks at VFIS are very helpful and offer many training programs such as infection control , bloodborne pathogens, and OSHA Compliance, emergency vehicle operations, medical run reporting,and a slew of others. Most of these classes meet the mandatory requirements for initial education and annual refreshers.

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