Paramedic triage

I recall starting in the ER and was freaked out with the thought of starting a line on a patient quickly. I think back and wonder why I was so intimidated. On the floor, most patients have lines in place and if you do need a restart, you can usually page the IV nurse. I did work on a floor that was mainly dialysis, sickle cell and cancer patients, so I learned some tricks with the most "difficult" population. Again, I think it goes back to training and experience. Not every patient will have those gusher veins that we all love. Those difficult veins were great practice for starting lines on peds. I can see your rationale for moving on from Paramedic, after what you were put through - what about flight nursing as an option to have the best of both worlds? That's my goal - would be great fun, I think.

I know you weren't asking me, but I have a big mouth. I am still a paramedic, as well as an ER RN. I volunteer prehospital, and get paid in hospital. Put simply, the pay for RNs is much better. But I love being on both sides of that ER door! I feel that being a paramedic has made me a better ER nurse, and vice-versa. The roles are different, but there is overlap.

I love being a paramedic. I have always been volunteer, never paid. I volunteer weekly with the same partner I've had for nearly 7 years (since I was an EMT-B, before becoming an EMT-Paramedic), and I don't see myself giving it up anytime soon. My partner and I joke that this is the longest relationship either of us has ever had.

My medic program was great -- my instructor was sooooo passionate about A&P, pathophysiology, etc. ... we had a great mix of classroom and clinical. My clinical preceptor was a trauma nurse, and she was the first person who put the idea of becoming a nurse into my head -- during my last semester of clinicals, she told me I'd make a great nurse. I hope to prove her right.

No, flight nursing is not an option (but heck! Them choppers don't need snow chains!) as I don't work in nursing anymore...read my post Husband Died of Medical Incident and you will see why. Nursing and working in the medical field will always be in my blood, and posting on allnurses lets me stay involved but at a distance. http://allnurses.com/california-nurs...ng-224330.html

I also was a full time volunteer medic for my community except when I worked as a paid medic for a rural ambulance company that covered a hugh area--it would take up up to 2 hr to get to some of our calls and those fancy helicopters don't fly when it's snowing or icy!

And had some GREAT partners!!!! And lots of fun times!!!

I have flown to many hospitals around my area that use medics for the RN role. I always saw them in the more rural areas, never in more populated places. Even in Aeromedical you have RN and Medic switch off who is primary on every other flight.
I know there will forever be a Rn vs. Medic debate here, for many reasons, but we can't forget where nursing started, where it is now and best of all, where it is going. You now have Docs worried about nurses taking their jobs and I don't think it will be too long before Medics unite/come together and start challenging some of the nursing positions. It all comes down to education and competency.

I have to disagree with this. My first week as a paramedic I did an rsi in the field with the assistance of my emt-b partner and the fire department. I was prepared for this in school where I competed 10 intubations in the or with crna's and 5 in the field. The fact is that medic school prepares a new medic to operate 100% within their scope of practice day one.

I too agree that I learned more in paramedic school in regards to a&p, pharmocology , and management of medical problems and trauma than I did in nursing school. I found that nursing school pretty much explained theories and gave you a basic understanding of nursing. I learned how to be a nurse during my orientation program at my hospital, not in nursing school.

I don't work in the ER but my friend is a CNA in a peds. ER and she said that the triage system goes something like this...

A patient comes in the ER and they first see the CNA who takes their name, some quick basic information and their chief complaint. Next they move to a CNA/RN triage team where the CNA will take vital signs while the RN begins the assessment. If an EKG or blood work is needed ASAP then the CNA can do that while the RN continues the assessment. The patient is then prioritized and either goes into the ER or back to the waiting room (to fill out any forms or registration if necessary.) I think that you have some EMTs working in the ER as techs. but they basically do the same things CNAs do which is assist the nurses or physicians.

!Chris

This is similar to my experience as well. In paramedic school during my "putting it all together" ride time, I participated in many codes/intubations (this is prior to graduation). Obviously we studied trauma and emergencies, but we also extensively studied medical complaints and non emergencies. Diabetes, cardiopulmonary/vascular, GI, oncology, mental health/psych, and neuro were some of the topics covered in as much depth or more as nursing school. We also covered OB as well. I have delivered several times (Some prior to graduation). In short paramedics deal with anything from the minor (cough/cold) to the dire (traumatic arrest, MIs, etc). I do feel that I learned more about OB and mental health in nursing school, but that is really about it.

Paramedics are hammered in critical thinking, patient assessment, documentation, medicolegal, pharm, etc. I can't even recall how many IVs I started, EKGs I read, manual blood pressures taken, lung fields auscultated or medications given (IM, SQ, PO, IV, SL, PR, Inhaled) during my medic training. Paramedics learn surgical crichs, needle thoracentesis, splinting, how to move/lift patients. Of course this list is not complete, but it is more than the hands on training that nursing students receive that I am aware of. Even if there are nursing students that get to do this they are the exception. For paramedics it is the rule. Not only do we learn how to do all of this, we learn why/when we do all of this or said in another way: we learn the rationale behind all of this and more. Paramedics learn sick vs. not sick (good for triage eh?). As a paramedic I was trained by paramedics, doctors, and yes, RNs. In fact, the co-instructor of my program at the Chicago Fire Academy was an ER nurse.

Paramedics learn how to talk to patients/families in times of duress. Again, this is all before graduation. Please don't forget this: 99.9 percent of paramedics started out as EMT basics. Many paramedic programs (but not all) require a certain amount of time as an EMT basic. So most paramedics already have a fundamental grasp of basic patient assessment before they begin paramedic training. Additionally, most paramedics students as current EMT basics are already comfortable just talking with patients, family, instructors and hospital staff. That means they are less likely to have "stage fright" during their paramedic training. They can focus better on the material at hand. I can't find the stats, but many nursing students do not have this type of background as there is no state requirement to be an LPN or CNA first.

So back to the OP. With all of this in mind I feel that a paramedic can do just as well as an RN in triage, given the same additional on the job time and training that a triage RN should get (sadly, not all do). For the posters here who want to poo poo paramedic training you should really get involved with it and learn what it is about. In fact, offer to help with paramedic training at local community colleges. Don't take my word for it. See for yourself.

Ivan

I suggest to all the ER nurses out there: Go take an EMT Basic Course! Yes, I can feel the indignation that many of you have that you are already an RN but you will be amazed at how much you would learn in this basic class. Even better, sign up a go on a ride along with the Fire Dept/Ambulance company in your area! It will give you a more accurate outlook on what paramedics really do and under what conditions they perform them under. And you might even have fun, too!

I had several ER nurses who knew they wanted to be a paramedic. But once they rode with me several times, they decided it was not for them. It was too difficult for them to break away from the security of the hospital, knowing they had unlimited help and MD's to make decisions. The autonomy you work under is challenging. Believe me, it is a lot different out in the trenches when all heck breaks loose, multiple pt's and you are the only ALS person.

Should paramedics replace RN's in triaging? Absolutely not! It it a form of outsourcing-using a lower paid employees to replace an RN. We need to protect our job or will end up with one RN supervising 3 medication aides, 10 pt. care techs that perform all the skilled nursing and the RN having ultimate responsibility for 100 pts.

Paramedics are awesome.

If you are working where paramedics need a nurse as "back-up" you have a serious problem with your paramedic programs. Paramedics in our area can triage better than most of our nurses. They are trained to triage and treat.