Understanding Governor Abbott’s “Qualified But Not Certified” EMS Waiver

Governor Greg Abbott created concern yesterday, when he released a list of waivers in support of an expanded Texas EMS workforce.

The greatest controversy stemmed from the allowance of, “qualified, but not formally certified”, personnel to work at an advanced level with medical director approval.

Advocates are praising the decision for being proactive while critics are concerned with its potential risk.

Both arguments are worth examining.

The Issue of Certification Vs. Credentialing

The biggest concern of critics is the waiving of certification to allow advanced practice. This issue deals with the difference between certification vs. credentialing.

In Texas, certification does not provide the right to practice as an EMT or Paramedic. It’s evidence that a professional standard has been achieved.

The privilege to practice is provided by the EMS medical director credentialing personnel to practice under their license by meeting their approved standards.

The professional standards for credentialing vary across the state.

The waiver does not change the gateway to field practice. All field providers still require medical director credentialing to practice.

It does, however, increase the importance of medical director oversight.

This is the core of medical directors deeming personnel to be qualified but not formally certified.

The Issue of Reality vs. Hypothetical

Supporters praise the waiver’s proactive approach to reinforcing the Texas EMS workforce.

The measure allows for semi-responsible credentialing prior to emergent circumstances. It also creates a pathway for near-certified EMS students to contribute their skills during pandemic operations.

Critics of the waiver are concerned about minimally trained personnel practicing as paramedics. Hypothetical situations exist in which the waiver could be abused.

The reality is that medical directors are responsible for those who practice under their license.

The most likely use of the waiver will involve paramedic students approaching graduation or those who have recently graduated but have not tested.

Departments with internal paramedic programs near completion, employed EMTs with few remaining clinical requirements, and graduates who are distant from an open testing center are top candidates.

The other reality is that medical directors can limit advanced practice procedures while still providing an advanced scope of practice.

It may be beneficial for rural EMS systems, if needed, to utilize an advanced credentialed EMT to interpret 12 lead EKGs or administer a dextrose solution while being restricted from pharmaceutical assisted intubation.

The potential for abuse, however, should not be dismissed.

Texas EMS does not have a set standard for credentialing EMS personnel.

Progressive EMS agencies have active medical directors with impressive training standards. Less engaged agencies are known to have disinterested medical directors with minimal training standards.

Experience with the latter is what gives some EMS personnel pause about supporting the waiver.

The reality is that EMS staffing shortages may occur during COVID-19 operations. Although hypothetical situations exist, the state is entrusting medical directors to be responsible with their assigned duties.

General Summary

Overall, the waiver provides a proactive option for medical directors to support their EMS systems if pandemic related staffing shortages occur.

It is a tool that can be used or left alone at the medical director’s discretion.

This article only touched on the most discussed portion of the waiver. There are still conversations about non-certified EMT students being credentialed, the issue of advance credentialed EMTs and pay increases, the professional risk facing advanced credentialed EMTs, the issue of paramedic students who are not currently employed, and the use of advanced credentialed time in lieu of clinical hours.

ATEMSP is active in these conversations and committed to representing the individual EMS provider.

If you are not a member, please consider joining here. If you have additional questions regarding the waiver or would like to discuss EMS issues with ATEMSP leadership, contact us here: info@atemsp.org

The Association of Texas EMS Professionals (ATEMSP) represents the individual Texas EMS professional. ATEMSP is active in state and federal public policy.