Paramedic triage

two separate roles with different, though equally important, skills, both making a great team. That's how it works in my ER. If there weren't differences, then we would have had the same training and the same national certification.

Hi there,

I work at a level 1 trauma center, average census >300/day and frequently work triage which is staffed with a minimum of 3 RNs, sometimes 5 depending on the census.


Aside from that, I appreciate how medics work and function in the field but there exist fundamental differences between the professions. Medics are taught to follow and function according to protocols. Nurses are able to think outside the protocol.

I would be against this - they are not nurses. They can provide simple information, but as far as ordering and understanding rationale, no. They are not appropriate replacements.

in spotting emergent situations, yes, but placed as initial triage through registration for all ER patients, no.

Paramedics do not get the same training as RN's do. Nurses have at a minimum of 2 years for their degree. Paramedics have, what, a year?? As far as intubation, extrication, and other emergent in the field situations, paramedics are the top choice. Not for triaging - we are trained to see the entire clinical picture, as RN's.

any EMT or paramedic could do a great job, given more training, would then be... an RN!!!!

two separate roles with different, though equally important, skills, both making a great team. That's how it works in my ER. If there weren't differences, then we would have had the same training and the same national certification.

This is something ems has done to itself because of all the different forms ems comes in, volunteer, municipal, fire based and private, this lack of consistency is one of my pet peeves. I believe ems education can and should progress but we are to busy fighting amongst ourselves to advance as nursing has done.
Karl

What a very ignorant and offensive thing to say. Paramedics don't understand rationale? On what do you base this? Please tell me you have some inner, working knowledge of how paramedics are trained. I am not saying all paramedics, but every paramedic I know who went on to nursing school says the same thing: I learned as much or more about patient care as a medic than as a nurse. Every single one. You see paramedics don't study "paramedic theory". We study patient care. We study A/P, patho, pharm, etc. We learn how to think on our feet. We learn how to outreach to the community. And a very big YES: we learn about the rationale behind many things. Do we own the patent on this? Newp. But guess what? Neither does nursing.


Again, that is just plain silly. FYI, paramedics DO triage successfully in many hospitals. I have seen it. I have done it.


You are right. Paramedics don't get the same training. I would say we get better training, but that is just my opinion. But it is opinion based on being both a paramedic and a nurse, and also knowing many paramedics who went on to nursing school. So please tell me: what part of the clinical picture do RNs see that paramedics do not? Please elaborate and be precise.


Or just a better trained paramedic. When I was a paramedic working in the ED, I trained many RNs. So by your logic then at some point before graduation a nursing student knows as much as paramedic? Do you really believe that?


No we wouldn't. Why? Because of nursing political power. While I agree that the roles started out as separate, many paramedics work solely in the hospital setting. Why? Often it is better pay, benefits, schedule, and tuition reimbursement.

A previous poster didn't respond to a point I made earlier, but I think it bears repeating. Not so long ago new grad RNs were either discouraged or prohibited from working in the ER as a first gig. That changed only because of the staffing shortage and not because of some improvement in nursing education. In fact, at least one hospital in my area is not hiring new grad RNs in the ED because of cutbacks. If nurses learn so much in school then why can't they just come out and work as ED nurses? Why an additional 4-6 months of training? Full time. If you want to compare a new grad medic to an RN that has several years of experience then please do. Or...go to an ER that lets paramedics utilize their skills and compare those medics to RNs with a similar amount of time on the job. Tell me what you see then.

Ivan

You seem to want to debate the fact that you believe paramedics are above RN's, and I won't do that with you. Each has their place. If Paramedics were adequate to triage, staff and manage total patient care in the ER, then what is stopping hospitals from hiring them to those positions, may I ask?

"According to ANA’s 1992 Position Statement, "Other regulatory entities have been pressured to lower agency staffing standards, for instance by allowing emergency medical technicians to function in the emergency room without registered nurse supervision or by substituting unlicensed personnel for licensed nurses. These unlicensed persons have not completed nursing education programs, or met other licensing requirements. In many instances, substitution of unlicensed personnel for licensed nurses clearly violates state nurse practice acts. At the very least, it is not in the interest of the health, safety, and welfare of the public".

"According to Mary Jagim, RN, president of the Emergency Nurses Association (ENA), "The use of paramedics in the emergency department would fall under the ENA Position Statement of use of unlicensed personnel in the ED, which is that the registered professional nurse is an essential element in the provision of quality, safe, and cost efficient care whether involved in patient care, or in directing non-RN caregivers."

http://home.earthlink.net/~douglaspage/id77.html
http://www.ena.org/about/position/pdfs/usenon-rn.pdf

Ivan, I respect the fact that you were a paramedic prior to becoming a nurse. RN's, as well as paramedics, are no more ready fresh out of school to work in the ER as paramedics are ready to quickly intubate in the field. I would never suggest a newly graduated RN to start in the ER, even if they feel they are able and ready. They are not."

Having been a RN as well as a Paramedic I have to disagree with that statement. Paramedics have a high level of diverse skill training and experience, much more so than RN students, along with their classroom training and must be able to perform all skills quickly in the field, right after graduation. They hit the ground running, vs new grad RN's that need preceptorship as they do to not have enough high quality clinical time. My first call as a Paramedic was a full code that was worked with just a basic EMT. The pt. was successfully resuscitated and DC from the hospital 9 days later. Working a full code by myself was possible due to the training I received as a medic.

The difference between medic school and RN school is that in medic school, all the BS is cut out and critical thinking and skills are taught in a high pressure, competitive environment which quickly weeds out students that are not up to par.

That being said, while I do feel paramedics can appropriately triage, I do not feel they should as RN's again are being replaced by cheaper staff, jeopardizing our future. With the use of medication aides, and non RN's triaging, pt. care tech's that start IV's and cath., we are eliminating our position and jeopardizing pt. care with semiskilled personnel who can not assess the big picture as an RN can.

You ask the question and then you answer it: What stops hospitals? Nursing political bodies/lobbyists. I find it ironic that you would quote a 17 year old ANA statement. It was wrong then. It is wrong now. Paramedics are not unlicensed. All working paramedics are licensed. They were licensed in 1992. They are licensed now. There is no study, not one, that shows that patient outcomes with hospital based paramedics are less (or more) favorable. That makes me wonder about the motivation behind statements like that. Are they truly about patient safety or is job security the issue? I expect it is somewhere in between. It is wrong for groups like these to lump paramedics in with nursing assistants/patient care techs.

I am not putting paramedics above RNs. So let me be clear about what I am saying. I am saying that with the current state of both nursing and EMT education, that either of these two pools of talent can equally succeed in the hospital setting given the same type of new grad or transition training. Now this is based only on my experience, but I can't find a single reason to think that I am wrong, and no one has been able to demonstrate to me anything other than position statements which do not seem to backed with any study either.