The average EMT or paramedic can’t buy an ambulance, stock it however they’d like, operate it without medical direction, and go into business for themselves answering emergency calls. Yet, in many states and many settings, “event medics” are doing just that.
In several states, medical standby services are completely unregulated by the state EMS authority.
For example, in Texas, event medical services are not considered an EMS provider (i.e. an EMS service) because they don’t transport—nor are they considered a first responder organization under Texas law, since event medicine doesn’t “routinely respond to medical emergency situations.”
Some places, such as the Georgia Institute of Technology, actually require an EMT at “any event that has the potential for participant injury or harm, or one at which 250 or more guests are present.”1
In short, in many locales, event medicine operates without any legal authority or regulation while other places have sophisticated requirements and legal frameworks.
This article will explore the legal ramifications of EMS personnel attempting to “freelance” by providing services at athletic events, car races, concerts, movie sets, mountain bike competitions and other events where they are not part of a recognized EMS service, and have no physician supervision.
These positions are attractive for the potential extra income and the opportunity to do something different than the average EMS shift. However, “freelancing” can expose licensed or certified EMTs and paramedics to significant liability in a situation where they’re unlikely to be covered by any insurance.
Different States, Different Legal Frameworks
A look at how different states view event medicine is instructive. For example, Nevada has both statutes and regulations addressing event medical coverage.2 These laws are comprehensive in nature and clearly address the way in which coverage of special events by EMS should be handled, outlining the responsibilities of the host organization as well as the EMS agency. In addition, Nevada’s EMS regulations state that “No person may independently perform the activities authorized pursuant to these regulations.”3
In New Mexico, Department of Health regulations establish a minimum standard for special event EMS, noting that only certified entities may provide this coverage.4 As for “freelancing” for event coverage, EMS Bureau Chief Kyle Thornton notes “There is really nothing in the rule that precludes that, as long as the venue – and the caregiver – realize that the caregiver must have medical direction to provide the majority of their scope of practice’s designated level of care.”
Thornton went on to say that the agency, when asked discourages informal “standby” arrangements. If an event venue is asking, they encourage them to utilize their local EMS agencies. In addition, the UNM School of Medicine, through the Department of Emergency Medicine, also has a structured event medical provider called Medicine Bow, that hires out to provide care at events such as the State Fair, concerts and other large events. The group has a dedicated medical director.
Pennsylvania devotes an entire chapter in its legal EMS framework to “Special Event EMS.”5 The various sections outline requirements for planning, administration, management and medical direction, as well as communications system requirements, and how attendees at the events are to be notified of access to EMS. Event planners are required to have their plan approved by the Department of Health through a regional EMS council, and to submit a report after the event.
A brief Google search revealed significant blogging about event medical services, as well as advertising for positions as a “Special Event EMT” or “Event Medic” at salaries of $14-$20/hour. Not one of the advertisements we reviewed mentioned how medical supervision will be provided, or how the need for liability insurance will be handled. One site even advocated for event promoters to “contact a friend who is an off-duty doctor, EMT or other medical professional to volunteer at your event.”
This solution to providing EMS at events, in general, may be a great idea for the event promoter, but is usually a bad idea for the EMT. These sites often paint a romantic picture of EMS personnel providing coverage on movie sets as an “EMT to the stars,” ready to jump into action if a stunt goes wrong or someone becomes ill or is injured on the set.
What isn’t addressed on these websites is what level of care can be expected, how medical direction is provided, whether there are protocols, and, should the EMS provider be sued over the care rendered, who’s providing insurance coverage.
Although they may advertise having paramedics on site, a paramedic isn’t a paramedic without medical control, protocols and a hefty stock of EMS gear. That’s the foundation of our practice. Event promoters often don’t want to spend the money to hire a local EMS agency for standby with a fully stocked unit and immediate transport capability.
Many nonprofit organizations also claim a need for volunteer EMT coverage for special events. These events may be risky as well for the same reasons. Some of these events, such as athletic events and events involving special populations, may present even more need for EMS personnel to use their skills.
At the very minimum, EMS providers should do their best to determine the framework they are operating under and whether there’s insurance to cover potential claims against them.
With so many different legal frameworks across the country, it’s clear that there’s no singular answer to the question of how event EMS should be handled. However, in states that lack oversight of this growing EMS function, it’s clear from the legal perspective that freelancing is a dangerous practice that leaves EMS personnel exposed to liability for practicing without oversight.
It’s important for any EMT who’s considering working as an event provider to find out what requirements—if any—exist in their home state. Even without a state-mandated framework, should a lawsuit occur, the EMT may well find that they’re without any kind of insurance coverage, leaving them personally exposed.
Furthermore, in the states where the law provides for legal protection or immunity for EMS personnel, it’s worth finding out whether these legal protections extend to event EMS coverage. Otherwise, you may be out on a limb.
1 Police and EMT. (n.d.) Gerorgia Tech. Retrieved Wednesday April 18, 2018, from www.specialevents.gatech.edu/resources/safety/police-emt.
2 NRS §450-B-650 to 450-B-700, Emergency Medical Services Regulations §1150
3 Emergency Medical Services Regulations §500.022 V (Basic); §500-024 V (Intermediate); §500.026 IV (Paramedic)
4 NMAC §188.8.131.52
5 Chapter 1033.1 to 1033.7