emergency dept staffing with paramedics/emts

  1. I am the unit coordinator for an emergency dept which staffs all rn. we see over 42,000 patients yearly and we are working on certification for level 2 trauma center. my administration is interested in staffing with paramedics or emts. can anyone give me any feedback: salaries, experience with emts in eds, licensure, any info?
    •  
  2. 56 Comments

  3. by   ntg
    The use of EMT's and Paramedics in the ED is governed by the state in which you practice. In the state of Michigan they can practice within the facility providing that facility takes on the role of being their physician director. Which means that they do not have a liscense to practice in a facility, but that the facility must provide strict guidlines as to their limitations. The other governing area regarding their practice is the state board of nursing and JACHO. The state of Michigan EMS services Division indicates that the EMT and Paramedic do not have a liscense within the medical facility. They are Pre-Hospital care providers.
    Recently a Department Manager from one of the facilities within the Lansing Michigan area had indicated that there are ways to circumvent the Law as it stands. And utilize EMT's and Paramedics to perform Primary patient care, in this way circumventing the nurse and violating the standards established by JACHO and Michigan Public Health Code.
    Now I ask you would you want someone working on you or your family member with a limited amount of training/education? Again I ask you do Paramedics work as primary care providers in the Critical Care areas? Ofcourse not!! Then why are we allowing this to take place within the ED. Why do the managers in Lansing Michigan believe they can use Paramedics to replace Nurses in the ED.
  4. by   MedicRN
    I think the question that ntg asked is unbeliveable!!! Do you want a paramedic working on your loved one? Well let me remind ntg, if you ever call 911, you will most likely get a paramedic and/or emt. And the day they save you or your loved one's life, maybe you will realize the importance of the paramedic/emt. As a paramedic and a nurse, I know the importance of both education and experience. Because of my background in both fields, I can say that there are both good and bad paramedic's and nurse's. Depending on the competency of the person, that is who I would want taking care of me (not because of the initial's after the person's name)! Nurse's need to stop feeling threatened by the paramedic in the ER, ICU or CCU. I know many doctor's that would rather have me assisting them in the ER (because of my paramedic experience) than any other nurse. I think every nurse who is interested in critical care (ER or floor), should be required to have their paramedic licensure or have prehospital experience!!
  5. by   MollyJ
    This is an old question in one form or another and as hospitals seek to make their ED's leaner, I think we'll see more paramedics in the ED and probably all over the hospital.
    I bow to MedicRN's response. If you have VT, trauma etc or someother problem that has been covered in the paramedic "cookbook", you cannot beat them, however their training DOES not prepare them to do discharge teaching, to advocate for a client who ought not be dismissed, or to deal with problems that I call "complex nursing problems." In my career as an ED nurse I have refused to dismiss a woman from the ED with abdominal pain that the ED doc (new to the ED) had failed to do a pelvic on or tested for pregancy. I received a patient from experienced and generally adequate paramedics termed "code green" (mental patient) who was in DKA. Most paramedics know their code drugs cold, but couldn't do discharge teaching on sick babies, UTI's, or PID patients to save their souls. Standard EMS reply to this is, "Fine well do the codes; you do the UTI's," but the glitch is that trauma stabilization in the ED is a different critter in the ED than in the field and their training has focussed on the field. In fact, the focus of their training is pretty narrow when you consider the broad spectrum of what is seen in the ED. And you know what? I was that weird variety of ED nurse that LOVED it when my patients walked in looking benign and had something cool, subtle or outrageous going on. Post-ED I worked in a public health clinic where a kid presented with a sore throat. Ho-hum another sore throat. BORING, right? Well this one drooled with his sore throat. No thanks, I won't be needing that tongue blade. Referral to ED for treatment of his peri-tonsillar abscess.
    NURSES, we have a knowledge base that makes us THE BEST deal for our clients. Don't forget it.
    So, yes I am sure that paramedics will become even more attractive to hospital administrators and they are useful folks since they tend to think on their feet well, but being able to think on your feet DOES not substitute for an adequate data base of knowledge from which to work. Nurses who work with paramedics--and I did and I admired them and would have only wanted them to care for me or mine in an emergency situation--PLEASE do not forget, deny or deride what it is that you bring to this situation.
  6. by   ntg
    I find the responses very straight forward. I wouldn't expect any thing less. Let me clear up 2 issues. 1. I have been a Paramedic for 20 years and have had a great deal of exposure to various areas not related to emergency medicine. But the education base provided for paramedics in Michigan is very low with varying levels of instruction. Some Paramedics may come from a college based program and others from a Garage based program, all of which are directed to Emergency care. Not having education or background in legal and patient advocation needs provides some trouble areas.
    2. when it comes time to be knee deep in alligators and no one to assist the nurse in the ED can not pick up their equipment and leave the rest to the hospital, they are the hospital.
    I do have a great deal of respect for my primary profession, Paramedic, but have discovered that there is much more needed.
    Something told me by my paramedic instructor while in school in 1974 was:" Paramedics know a lot about a little, while nurses know a little about a lot". It took several years for this to truely sink in, but now that I understand this I find it very disheartening to see administrations looking at the all important DOLLAR and not the reason for their existance, The PATIENT. I truely believe that both disciplines can work together in the same facility and provide each other with complimentary assests.
  7. by   NYMfan
    I'm clearly not as versed in this issue as some of the other responders. However, in the two hospitals i have worked in medics were used in the ER strictly as a "tech". They did phlebotomy, started lines and EKGs. Everything else was done by RNs and the Docs.
  8. by   korn
    I am new to the BB but impressed with the candor being shown. RE: pre-hospital personnel in the ED let me offer the following recommendation. We, as nurses, will not stop the progression of EMS into the ED. Nor should we. The issue is one of how to manage it and maintain top efficiency and provide the best care for our clients, the patients. I previously managed a suburban ED seeing 25K pts. annually. Stimulated from a marketing perspective, we incorporated paramedics and EMTs into our support technical staff with duty restrictions delineated in their job description. This relationship proved to be most effective in enhancing the rapport the ED had with the EMS systems, but also turned into preferential routing of patients, when no destination was determined at the scene of the accident or home. This was the case not with the acute trauma victims that had to be transported by preference to the trauma centers, but the pts. that did not fit that criteria. This relationship blossomed into the mutual respect that produced the development of a regional training program for EMT and Paramedics that extended to more than 1/2 of the state. The clinical relationship strained on occassion but was managed well by open dialogue about role and responsibilities and the peer training roles that developed with ACLS, etc. training programs. FD's make up about 70% of all EMS in the USA. These young people will be the Chiefs and leaders in their cities and townships and the relationships developed will serve the ED well in cooperatively improving the care to the community. We have to look beyond the titles and experiment with different models that work. Equivocal exchange of RN position for Paramedic of EMT is a disastrous decision for any department manager or hospital for the clearly defined reasons listed in previous reponses. The paramedics and EMT's working for me agreed with that fact and never created a problem with it.
  9. by   jen622
    My friends twin brothers are emt's and have recently left the ambulance for work in the ER at a couple of hospitals, the reason being the ambulance co. paid them 6.00-7.00 dollars an hour and the hospital pays them 13.00 dollars an hour. They are very good emt's with many years of experience, why do ambulance companies pay so low when these people save lives????

    ------------------
    jen622
  10. by   level1RN
    RNs and paramedics must work together and appreciate the differences in each other. where i work they do...i don't get much attitude, and don't give much either. at the same time i have paramedic interns under my supervision, and keep a very close eye on them, as the hospital has much that is foriegn to the paramedic...as i do the new MD interns and medical students...and u know what...they keep an eye on me. <<<an note to ntg>>> a pt i'm taking to the unit on a gurney with a transport bag and a zoll, CAN fall into a pit of alligators, leaving me to pull something out of my bag of tricks, just as u would. and i'm not ashamed to say, i'm relived when i get that patient to the unit, with or without a pulse...to somewhere that has the tools i need to see to it that that patient gets the best care...i would expect that u probably have the same sense of relief when u get a really sick one to the hospital....in time.
  11. by   korn
    On a related topic, how do you all feel about the new development by AMR(Americal Medical Response) ambulance company, and their contract with Kaiser Permanente, to handle all their emergency triage calls? The idea is to put a PRE-911 step in place for all Kaiser subscribers to call before making a 911 call. AMR is picking this service up from a location in Wisconsin. AMR dispatchers will triage the call, forward on to either a nurse response center at Kaiser or to the local 911 system for the pt. This is the first major step in ambulance services re-directing patients to stay at home, and they will send someone to their home to provide what previously would have been ED services. (Limited of course)
    Any thoughts on this development?
  12. by   nurse/mom
    korn: I work in a Kaiser facility - recently we had to admit a patient that was initially triaged by AMR. The call was routed from AMR to our psych person in the ER who had the relatives bring in the patient to be medically cleared. The patient turned out to be critically ill and was admitted to the ICU. The triage done by AMR lacked much and did potential harm in delaying this patients care.
  13. by   korn
    nurse/mom

    As you probably know by now, AMR is on the auction block for 1.2 Billion. Seems that their parent company Laidlaw, is ready to get out of the ambulance business. It will be interesting to see what happens with the breakup of the nations largest private ambulance company!!
  14. by   Deb Rn
    Many communities are lucky to have paramedics that are ACLS certified. In my community, we Have EMT's, who are essentially transport personelle, and often can't initiate an IV or do a blood sugar. The skills are varied and we are trying to achieve one standard for them all. Some arrive in terrible condition, and other patients arrive with an IV established cardiac patches on and have had a course of 3 nitro for CP. The way the patient arrive is dependant upon the crew. Very few of the are certified to intubate, so many arrests arrive with only an airway in place. Things are different all over, thought I would share my ER experiences! TY.

close