Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Liability for EMS Licensing

There is a good article in JEMS looking at the medical director’s liability for the actions of EMS.

Relationship Status
The relationship between the EMS medical director and the EMT is a supervisory relationship, and not one of agency. What’s the difference? You are an agent—a representative—of the EMS service you’re employed with or volunteer for, and whose uniform you wear. That agency — not your medical director—is vicariously liable for your actions.[1]

The only comment is suggesting that the author (a real lawyer) doesn’t understand law. However, the lack of action against medical directors for the many cases of EMS mistreatment or malpractice, including the many irresponsible absentee medical directors, does suggest that medical directors are not accountable for the actions of EMS.

Adding to the confusion is the fact that many states use the term “certification” rather than “licensure” to describe the legal status of EMS practice. For some reason, states have been hesitant to call a license a license when it comes to EMTs, even though we’re required to take an examination and undergo a process similar to that of other healthcare providers.[1]

For some reason, states have been hesitant to call a license a license when it comes to EMTs

Few people really understand what it is that EMS does, so we should not be surprised at their attempts to limit anything that EMS does.

So despite erroneously calling it “certification,” if you’re granted permission to practice as an EMT by a state or local authority, you actually hold a license.[1]


It’s important for all EMS personnel to know the specifics of the licensing/certification schemes in their home states because they widely differ. However, the basic legal framework of the relationship between the EMT and the medical director generally isn’t what we may have been taught. As EMS continues to develop and move forward, this important distinction will become even more crucial for EMTs to understand.[1]

It has nothing to do with whether we have completed a short course or a multi-year university degree. The completion certificate/diploma/degree does not confer any scope of practice. The state license, even when called a certification by the state, is what does confer a scope of practice.

The National Registry of EMTs has a page devoted to a legal opinion on this.

Licensure, on the other hand, is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice. Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally performed only by those who are licensed. As such, licensure prohibits anyone from practicing the profession who is not licensed, regardless of whether or not the individual has been certified by a private organization.[2]

Maybe we should be trying to get the government to be honest in their terminology.


[1] Liability for EMS Licensing
W. Ann Maggiore, JD, NREMT-P
Wednesday, February 2, 2011

[2] The Legal Differences Between Certification and Licensure
National Registry of EMTs
Legal opinion



  1. Could you explain more about why the distinction between licensure and certification is important to EMS? I’ve certainly heard the arguments about what it is and am prepared to agree that we are or should be licensed in as much as that is the status by which other healthcare professionals are regulated, but (pardon my ignorance) what’s the big deal? If it is called certification, how does that negatively affect the profession? Does this have something to do with the technician/clinician argument? Protocols versus critical thinking?

  2. I stopped caring about the distinction between “certification” and “licensure” when it comes to states and local authorities when I found out that California uses the term interchangeable when discussing physicians.

    “2040. The terms “license” and “certificate” as used in this chapter
    are deemed to be synonomous.”


  3. Matt, It’s a distinction without a difference. No matter what we call it, it does not allow independent practice. We must be employed by an EMS (or sometimes other) entity and we must have a medical director. Our scope of practice is limited to what the medical director , or in some cases the county or state, allows us to do. Licensed plumbers can work without direct supervision and without a written set of protocols. The building codes tells a plumber what the standard to with which is work must comply, but it does not tell him how to get to that standard. My son is licensed first class fireman (not firefighter) and can run large commercial boilers without an engineer writing out protocols for him.

    You can call it a license if you wish, but the truth is that it’s a certification that allows us to work in the EMS industry, but only within the established protocols and under the supervision (direct or indirect) of the medical director.

    The late James O. Page wrote and article in JEMS more than 20 years ago trying to dispel the myth that we work “under the medical director’s license”, but most people in EMS, including many people who should know better persist in telling us that the medical director can be sued for what we do.

    Here is the relevant MA law. Chapter 111c Section 20,
    Section 20. No physician duly registered under section 2, 2A, or 9 of chapter 112, and no nurse duly registered under section 74 or section 76 of said chapter 112, and no hospital shall be liable in a suit for damages as a result of acts or omissions related to advice, consultation or orders given in good faith to emergency medical services personnel who are qualified under section 9 and are acting on behalf of a service duly licensed under section 6, by radio, telephone or other remote means of communication and prior to arrival of the patient at the hospital or other health care facility from which the emergency communication to the EMS personnel is made, nor shall any such EMS personnel be liable in a suit for damages as a result of their acts or omissions based upon such advice, consultation or orders by remote communication, if the such acts or omissions were made in good faith, nor shall any physician be liable in a suit for damages as a result of acts or omissions relating to the discharge of duties under this chapter, including, without limitation, duties as a medical director at the state or regional level, if such acts or omissions were made in good faith.


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