PARAMEDICS IN THE ED...Do you have them????

PG2018 · Sep 12, 2014

I work in a teaching hospital. We do not have a paramedic role in our facility. All patient-care tasks are performed by RNs.
There has been some talk about implementing a paramedic role but there's a lot of resistance by the nursing staff... taking money out of our pockets by delegating RN tasks to other people.
It would end up being a contentious issue of negotiation in collective bargaining.

My employer utilizes paramedics as techs. We have several techs some of which are EMTs (the basics), some are paramedics, and some are people hired off the street.

They all serve as runners, help in CPR, do call backs, get vitals, draw blood and procure other specimens, attach 12 leads, restock rooms, clean up rooms, and the paramedics insert IVs. Beyond that, they're not fully utilized as paramedics, but I don't know what else they'd be doing.

I've seen one of the paramedics insert urinary catheters, and I've seen some of the non-paramedic techs insert IVs. I'm not very clear on who delineates their work activities, but sometimes I see each category of them jump their scope of practice. I like having techs, and I like having the paramedics. Sometimes IVs can take a long time on the wrong patients, and a simple task is well delegated to a competent provider who can't engage in other time consuming tasks such as entering assessments, etc. I've heard the paramedics have intubated before after giving the doctors and respiratory therapists their turn. We have RNs who are also paramedics but interestingly they are not allowed to intubate even though they work with the same EMS services that provide paramedics to our ER. Odd really. I do find that the medics are hands down better at EKG interpretation than the nursing staff, but we know nursing doesn't teach a lot of practical activities. If I hadn't gone to paramedic school I'd know a lot less about rhythm interpretation than I do.

I like having the paramedics, and I started out in healthcare as a paramedic many years ago although I let my credentials lapse. I did keep the EMT-B though for sentimental purposes.

GrannyRRT · Sep 12, 2014

I am not referring to basic EMT training, I am referring to paramedics, who have more training on advanced airways than nurses get in school

If the nurse is going to be intubating, their training will exceed what is required by the Paramedic program. No EMS program around my city or county has a set minimum per year for intubations. The schools wanted only 5. Since we do not allow Paramedic students to intubate, if they didn't get a chance on the ambulance, they allowed mannequin intubations. Our nurses also have seen several intubations and have given the RSI meds prior to getting on transport. Add that to a BSN with more anatomy, physiology and pathology, I would say a nurse with 20 intubations is on the right path and with more than some Paramedics. A new Paramedic with only 5 mannequin intubations should have close supervision for a few intubations and definitely not doing RSI without an experienced Paramedic or Transport RN with them.

EKG interpretation is fairly simple. Reading 12 Lead EKG is more advanced and many ER, ICU, CVICU_ and cath lab nurses have taken several advanced classes which are rare to for a Paramedic to take.

I have also intubated alot of mangled airways from too many Paramedic attempts. Everyone has a bad day and a great day. It is knowing when to step back for a different intubator or that different equipment is needed to keep from butchering the airway which is what divides the professionals from others regardless of profession.

Editorial Team / Moderator · Sep 13, 2014

Wow, paramedic students don't intubate, GrannyRRT? That is terrible! When I was a paramedic student, we spent shifts in the OR with a CRNA, doing at least 10 in a mellow, controlled setting. Good stuff.

For the record, I never drove an ambulance, I was too darn short. Hahahaha!

PG2018 · Sep 14, 2014

Wow, paramedic students don't intubate, GrannyRRT? That is terrible! When I was a paramedic student, we spent shifts in the OR with a CRNA, doing at least 10 in a mellow, controlled setting. Good stuff.

I've heard of some unfortunate programs around the country taking the intubation opportunities away from paramedic students. Joyfully, my program required ten successful intubations in the OR back when I was in the emergency respiratory care component of the paramedic program in 2001 as well as a certain number of hours spent with the anesthesia provider monitoring the patient. I actually did 12 and recall having one patient that I found it rather difficult to do requiring two attempts. Those were fun, and I reflect on that as perhaps the most exciting and enjoyable technical skill I have ever learned in healthcare. I never worked in the field long and think I only did it twice in an ambulance and perhaps once later with a combitube. In fact, I learned more about the whole operative process back then in those repeat observations and participations than I ever did standing in a corner like a wallflower in nursing school. I think we only went to the OR twice in nursing school.

muesli · Sep 14, 2014

No, except for students. I don't know why they would want to, although I'm not a paramedic so I can't speak to that. Paramedics are very qualified and can intubate, give meds according to protocol and assess. Why would they want to share duties with a nurse and let the residents handle the intubations? Seems to me that takes away all the fun. In our facility BTW, paramedic students intubate during their rotation in the OR.

Anna Flaxis, BSN, RN · Sep 15, 2014

You can not do everything a paramedics can do. A paramedic can intubate and trach, nurses can not

Actually, I have been trained to do both of those things (I've had PHTLS), and according to the laws of the state in which I practice, it is within my scope. It is the facility that I work for that restricts my scope of practice. Am I proficient? No, because I have not been allowed to practice.

I've worked for a facility that allowed RNs to insert IOs, and now I work for one that does not. I've worked for a facility that did not allow RNs to insert EJs, and now I work for one that does. There are many procedures that I've been allowed to do in one setting and not in others. The scope of practice of an RN in my state is actually fairly broad and not very specifically defined. There are many procedures that most certainly are in our scope of practice according to state law that individual facilities restrict.

The laws governing Paramedic practice are much more specifically defined, so I would venture to say that, at least where I practice, RNs have a much broader scope of practice than Paramedics do.

That is not to start a micturation match with Paramedics. As I've stated earlier in this thread, I hold Paramedics in high regard.

paramedic-RN · Sep 15, 2014

If the nurse is going to be intubating, their training will exceed what is required by the Paramedic program. No EMS program around my city or county has a set minimum per year for intubations. The schools wanted only 5. Since we do not allow Paramedic students to intubate, if they didn't get a chance on the ambulance, they allowed mannequin intubations. Our nurses also have seen several intubations and have given the RSI meds prior to getting on transport. Add that to a BSN with more anatomy, physiology and pathology, I would say a nurse with 20 intubations is on the right path and with more than some Paramedics. A new Paramedic with only 5 mannequin intubations should have close supervision for a few intubations and definitely not doing RSI without an experienced Paramedic or Transport RN with them.
EKG interpretation is fairly simple. Reading 12 Lead EKG is more advanced and many ER, ICU, CVICU_ and cath lab nurses have taken several advanced classes which are rare to for a Paramedic to take.
I have also intubated alot of mangled airways from too many Paramedic attempts. Everyone has a bad day and a great day. It is knowing when to step back for a different intubator or that different equipment is needed to keep from butchering the airway which is what divides the professionals from others regardless of profession.

Okay I have to disagree 118% on the 12 lead EKG interpretations, I would say I'm proficient at reading them but I've met medics that have incredible 12 lead skills, seriously I was riding w a medic once who was giving report to the ER MD and pointed out something in the EKG. The MD was unfamiliar with it and the medic did this little mini lesson on it to the MD. Just one example but my point is I've never seen a nurse even ICU ones w the level of understanding I've seen in most medics.

Nursing school is where you learn a little about everything but paramedic school is a lot about just one thing....emergencies... so you spend 2-3 semesters alone and take entire semester long classes on 12 leads, intubations and RSI. I've found that medics also have a much deeper understanding of RSI than ER nurses. Ask any nurse about succs and myasthenia gravis contraindications....then ask a medic, the medic will rattle that off before you finish the question (again just one example.) Intubating's not hard I don't think practice matters as much as understanding the meds and the procedure, it's like starting an IV once you've done it 10 times it's all the same. Of course here and there you have a difficult one but even then a technician with a lot of practice will likely have problems.

I hate to get sucked into the ancient medic vs. RN debate, as with any profession you have your good apples and your bad, I root for both sides!