Paramedics as primary care givers in ED


  1. Need some help with the limitations which paramedics can provide patient care within the ED. Presently Sparrow Hosp Lansing MIch is trying to use paramedics to supplement Nurses
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  2. 14 Comments

  3. by   iamme445
    When I had medical command priveledges at Passavant Hospital near Pittsburgh I was required to spend 8 hours a year in the ED doing patient care and assisting and getting to know staff. These were the staff members I would be talking to on the radio and bringing patients to.
    I did vital signs, 12 lead EKGs, started IVs, assisted with most procedures including in the cast room, helped with arrests, cleaned glass from cuts, drew blood, took patients to x-ray, gave meds, took patients to the floor when admitted and of course bedpans and urinals were included too along with holding babies and chatting with young children. Ocasionally babysitting a 302 prior to transport to a psych facility was in there too. None of this was paid time, just a required continuing education thing. There are a lot of things a paramedic can help with, kinda an enhanced aid. I can see where this could be very helpful if done apropriately.
    As far as what meds can be given etc. that will depend on what your state allows, as long as it is within the states scope of practice and there are guidelines for the job and a policy for the procedures etc. for the paramedic at your facility then there shouldnt be any problems.
    Hope this answers your question.
    Deanna RN, PHRN, EMT-P
  4. by   HollsRN
    I cant' say we actually us Paramedics in our ER like you are asking, but we do count on them for alot, due to the fact I work in a small rural hospital with the largest hospital at least an hour away. But we do have guide lines for what they can and can not do, because we do utilize them a great deal. Now there is some of the larger hospitals that do use them. I know of one that uses them at times to do triage, and also to assist in the ER. They have a director that over sees them, and he is an EMT-P as well. I am not sure of what exactly their guide lines are, but if you want more info, I would be more than glad to give you his name and how to get in touch with him.
  5. by   wen51
    We have used paramedics in the past to help in triage. We currently have one working as an ED specialty tech--our state law (Kansas) does not allow paramedics to do IV sticks or meds in the ED. They can do EKG's, put patients on monitors, clean wounds, help the physician with splinting,casting, and general aide work. It seems such a waste not to be able to use their paramedic skills, but we have to abide by the laws of our state.
  6. by   Cleveland ED Nurse
    We use medics in Triage, transporting, splinting, doing EKG's. drawing blood and starting IV's, code situations and supposedly to help with other patient care tasks. We have a problem with medics refusing to do certain tasks like toileting and helping clean up patients who have been incontinent. If they do a disagreeable task it is usually incomplete. I hear 'that's not in my scope of care' almost daily. Admin. doesn't hold them accountable to their job description so they aren't much of a 'support'.
  7. by   mwboswell
    Quote from Cleveland ED Nurse
    We use medics in Triage, transporting, splinting, doing EKG's. drawing blood and starting IV's, code situations and supposedly to help with other patient care tasks. We have a problem with medics refusing to do certain tasks like toileting and helping clean up patients who have been incontinent. If they do a disagreeable task it is usually incomplete. I hear 'that's not in my scope of care' almost daily. Admin. doesn't hold them accountable to their job description so they aren't much of a 'support'.
    I think a little one-on-one conference with the nurse manager/director about this, WITH documented facts/incidents, would be in order to help "hold" them to that standard.
  8. by   CraigB-RN
    First place to start is the various state boards that would have any say over this. I'd start with the board that licenses hospitals, then the BON and then the Board of EMS. each may have regulations governing this. This has been a hot topic for what seems like decades.

    Each state is a bit different.
  9. by   mattwilson
    We have quite a few paramedics working in our ER (50,000-60,000 visits per year). Usually we have two nurses per pod (6 rooms per pod) but one of those spots may be filled by a paramedic. Our dept only hires paramedics with a few years expierence and no new medics. They can do pretty much everything I do as a nurse. They can be primary on anything that isnt an "alert" patient (stroke alert, STEMI alert, Trauma alert, ect.), or a patient that gets conscious sedation or are receiving blood. They also need a nurses signature on all discharge instructions and admission paperwork. They have been a great help in the ER and dont take the place of nurses but definetly should get paid more for doing almost the same job. They work the triage desk as well.
  10. by   nghtfltguy
    in the hospital i work at paramedics can provide total care of patients in the ER... everything from a heparin drip to giving adenosine........

    the only thing they can't do in the er...is triage....how stupid is that???

  11. by   nghtfltguy
    a side note on that.... we only have 2 paramedics that work in the ER full time .. they are lucky that they don't have to triage!!!.. and i would trust both of them with my life...

  12. by   mwboswell
    Quote from nghtfltguy
    in the hospital i work at paramedics can provide total care of patients in the ER... everything from a heparin drip to giving adenosine........

    the only thing they can't do in the er...is triage....how stupid is that???

    that's cool (the total care thing-y), BUT are they the ultimate responsible party for the pt's outcomes?
    IE: isn't there an RN delegating them?

    Follow up question - how is their practice regulated?

    Thanks!
  13. by   Pixie.RN
    Quote from mwboswell
    that's cool (the total care thing-y), BUT are they the ultimate responsible party for the pt's outcomes?
    IE: isn't there an RN delegating them?

    Follow up question - how is their practice regulated?

    Thanks!
    Are they under the MD's license, perhaps?

    Edited to add: I say that because I can't imagine a world in which RNs can delegate heparin drips to medics, but can't delegate triage. That doesn't seem logical to me.
    Last edit by Pixie.RN on May 24, '09
  14. by   gonzo1
    This is very interesting. I wonder what is really allowed legally. I wouldn't care if they were allowed to do total patient care. I just wouldn't work in a ER were they did everything, but I was required to sign off on it.

    I worked in one place where LPNs did everything but critical drips, but RNs had to co-sign everything and I do not like that.
    There was no time to check up on what the LPN was doing because RNs had 8 or more pts each and we pretty much just blindly signed off stuff.

    I will never put myself in that situation again.

    So if the medics take care of the patient and my name is no where on the chart fine.

    This is just a ploy by hospitals to save money and it may work for a while but in the long run pt care is most likely to go downhill because most of the medics I know absolutely can't stand the personal care stuff like changing diapers etc.

    I respect them for that. I couldn't do their job. The first time I went to an accident scene and saw a disconnected head and torso I would die.

    Health care keeps getting goofier and goofier

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