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

Guests · Sep 3, 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.

RubberDuckieLove · Sep 3, 2014

We do. The paramedics usually live in the swarm room (intake for ambulances and other urgent cases) and they are paired with a RN. They perform a lot of the skills while the RN focuses on assessment and documentation.

applesxoranges, BSN, RN · Sep 3, 2014

In my first hospital, they had several "classes" of ancillary staff but I was informed they recently did away with the paramedics and made everyone into the same "ancillary patient care tech" role.

- They had a patient care tech who would stock, transport patients, and assist with the RN. They could also do EKGs and one or two can do IVs/draw blood. They were basically nursing assistants but the hospital system didn't hire "nursing assistants."

- Nurse externs who would do the same as the patient care techs but only guaranteed weekend hours and they made a little bit more. They could put meds in. The PCTs rebelled and refused to do that. There was one who also worked as a phleb and he could do IVs and draw blood.

- Paramedics who could triage, check in squads, draw blood, and all the other stuff the patient care techs could.

- Phleb - who could draw blood and start IVs and all the stuff the PCTs could do.

- Unit clerk/pct who primarily entered in doctor orders, called hospitals, and could pick up as a pct. However, they usually did not. They did away when they switched to EPIC.

- Private security who would sit with patients to prevent them from harming themselves.

While it sounds like a lot, there was a lot of issues of them not replacing staff that quit or were on sick leave. A lot of people went on sick leave. Usually it was a unit clerk and a paramedic. I picked up a ton of overtime at this job since I could fit into any role except the security.

The paramedics here are really kind of useless. At my old job, if I was the paramedic in the back and not triaging, I would get about 60-75% of all IVs done or do the EKGs, etc. I would cover a section that is larger than what the paramedics here cover. It would be about 15-18 patients and they cover about 10 patients. Here, it is not uncommon for me to have a chest pain and I am trying to finish up the triage, get the IV, EKG, vitals, and history. Which really sucks if I don't get finish up the triage part, then the doctors complain because their notes can't be finished.

The hospital in general is kind of backwards. It's the norm to have 5 patients per nurse. The paramedic is supposed to help out with the pressure by getting IVs, taking patients up (no transport after midnight), getting vitals, EKGs, etc. That does not happen. For a long time we had issues with paramedics playing around and vanishing. There was a huge issue with people not having their assigned phones or not answering them.

For the most part, paramedics stock IV trays. They stock the IV trays quite a bit and that's really the only consistent thing they do or else they will sit in triage and talk with the triage RN.

gues914 · Sep 4, 2014

I work in a level 1 trauma centre which is also a teaching hospital. We have paramedics employed here, mostly working in the ambulatory care areas (a lot of writing patient assessments, IVs, IVP meds, etc., high turnover), but also helping out in the trauma and resuscitation area as well. They don't take any patient assignments, but do work in the areas where there is more of a team setting.

I quite like working with the paramedics here.

xrsm002 · Sep 5, 2014

First of all most paramedics make LESS than nurses. I know I'm a paramedic and only make 14/hr. I am also looking into becoming an RN by doing one of the online paramedic to RN bridge program. Most of the nurses here in Texas that I personally know love having paramedics in the ER. The first one I worked at allowed them to do all of their skills IV, blood draws, EKGs med pushes. The ER I interviewed at today in a different city only allows medics to do blood draws and EKGs. They couldn't give me a valid reason of why they wouldn't let them start IVs. I look at it this way having a medic in the ER takes some of the work off the nurses especially if they get slammed with multiple patients. I know that the NCLEX is 5x harder then our NREMT national test as I had a friend whose a medic just take it. I think nurses that see against paramedics in the ER should be required to ride out with their local EMS.

paramedic-RN · Sep 5, 2014

First of all most paramedics make LESS than nurses. I know I'm a paramedic and only make 14/hr. I am also looking into becoming an RN by doing one of the online paramedic to RN bridge program. Most of the nurses here in Texas that I personally know love having paramedics in the ER. The first one I worked at allowed them to do all of their skills IV, blood draws, EKGs med pushes. The ER I interviewed at today in a different city only allows medics to do blood draws and EKGs. They couldn't give me a valid reason of why they wouldn't let them start IVs. I look at it this way having a medic in the ER takes some of the work off the nurses especially if they get slammed with multiple patients. I know that the NCLEX is 5x harder then our NREMT national test as I had a friend whose a medic just take it. I think nurses that see against paramedics in the ER should be required to ride out with their local EMS.

NCLEX is not harder then NREMT I found both to be easy, I guess it's just like any test, depends how prepared you are. Also I completely agree that ER nurses should have to do like maybe 10 ride outs on a 911 truck.

I worked in an ER where we had medics, they could do everything except hang blood and conscious sedation. Even then a nurse would typically start and sign off on it while they just did it. All of them very quite competent I trusted them as much as any nurse.

loriangel14, RN · Sep 5, 2014

We don't. Paramedics drive the ambulances and answer calls to medical emergencies where I live.

Esme12, ASN, BSN, RN · Sep 5, 2014

I worked at a facility where the medics were the ALS for several communities. LOVED THEM! They answered codes in the house and airway control/intubation. They helped in the ED with IV's, traumas and such...Level 2.

I have also worked with them as staff. They started IV's assessed incoming patients from EMS. They were apart of every trauma and code. LOVED them! THey didn't have a patient assignment....but they were valuable. They monitored patients going to scans and stabilized/stayed with codes then helped transport to ICU.

veriteblesse · Sep 11, 2014

At my ER, every nurse has 5 patients and a partner, that partner is either a patient care tech, emt ,or paramedic. They all basically do the same things (toileting/bed changes/EKG, labs), but paramedics can place IVs (no giving meds though). I do not know if they are all paid the same. But I love this system, I came from a floor where we were lucky if we had even one tech for our whole unit, so having someone who is assigned to my patients only feels like a luxury. And I'm stoked when I have a paramedic, because 1) who doesn't like having a second pair of hands to place a difficult IV? And 2) I like having a partner who is trained in ACLS and experienced with codes. I'm a fairly new nurse, and very new to the ED, so I feel like the paramedic's got my back if **** goes down, you know?

EMSnut45, BSN, RN, EMT-P · Sep 11, 2014

PLEASE don't call EMS providers "ambulance drivers!"

I can run a full ACLS/PALS/NRP cardiac arrest and initiate hypothermia. I can RSI and intubate. I can perform a chricothyrotomy. I can rescue patients from any number of traumatic events and initiate stabilization. I can activate a stroke team at the receiving facility based on my assessment. I can interpret an EKG, identify changes (one of many of which is a STEMI), begin the ACS standard of care and activate the cath lab. I can deliver babies and initiate resuscitation if need be. Would you like for me to continue?

For the 10 years prior to being a paramedic, I was an EMT. Yes, ONE of my responsibilities was to POSSIBLY drive the ambulance. But I did a heck of a lot more than that. My education STARTED with a course that took 200+ hours to complete and was required to take numerous hours of con-ed per year to maintain my LICENSE. I rely on my EMTs to provide care alongside me or to provide their own BLS care to those patients who don't require ALS care. EMTs are not just ambulance drivers.

Oh, and by the way, I am also an RN. My paramedic training took just as many years to complete as my RN and included far more clinical time. And no, I did not take a bridge class. I sat through every second of both degree programs.

Before anyone calls us "ambulance drivers," I challenge you to work just one shift in the back of an ambulance. I'm pretty sure you'd have a different opinion.

We don't. Paramedics drive the ambulances and answer calls to medical emergencies where I live.

akulahawkRN, ADN, RN, EMT-P · Sep 11, 2014

We don't. Paramedics drive the ambulances and answer calls to medical emergencies where I live.

Paramedics and EMTs have, as one of their duties, driving the ambulance. They respond to medical and trauma incidents and often end up seeing many of the same issues that the ED staff does. While an EMT only (usually) has around 150 hours of education in basic first aid and a few other subjects, a paramedic usually has a bit over 1,000 hours of classroom, clinical, and field education before being able to go out on their own and really begin learning.

Unfortunately for them, often they don't have to take the same prerequisites that nurses do, so they usually don't have quite the appreciation for the subtleties in pathophysiology. This doesn't mean they're uneducated. Occasionally you may encounter a paramedic whose knowledge of the body rivals yours, or sometimes exceeds yours. That's OK. Those are the ones that took it upon themselves to continue their education well beyond the basics. When you find those, embrace 'em.

All the above being said, don't look down upon them or belittle them. They're specialists in what they do. Their education is along a different model (medical) and is specifically designed to turn out specialists in one very specific area of medicine. Unless you previously have acquired an education in field work, you won't be able to easily transition to that kind of work. It's just one reason why transport nursing (flight primarily) that does 911 work has the orientation period that they do. It's because nursing does not prepare you for that environment at all.

Because of the nature of their training and the work they do, often they don't have the exposure to the wide variety of what nurses do or know either, so they often don't know how much autonomy nurses actually do have.

If you are lucky enough to have them in your ED and they're able to function to their full scope, a paramedic could very well become one of your best assets in doing patient care. They won't take over your patient because that's not their job and after a while, the good medics will truly understand that without a significant orientation, the can't do your job any more than the reverse is true for them. If you educate each other, I think you'll find that they can be surprisingly good clinicians.

Also, just for us all to remember: some places use the term "paramedic" to describe several levels of prehospital practitioner. The type of person I'm referring to is one that is the highest prehospital practitioner that isn't a physician or a nurse.

I'm also not saying that nurses can not function in the prehospital realm. Many do it every day and are fantastic at it as they bring a very strong knowledge of very high level patient care and merge it with a knowledge of field work.

We all exist for one reason. To do patient care. We just do it differently.

I'm a Paramedic and I'm (recently) an RN. I've seen both sides and I love them both.

Now back to our regularly scheduled program...

In California, only in a certain subset of facilities are paramedics allowed to function as paramedics. These facilities are typically small, rural hospitals. These hospitals may have their own in-house ambulance service and you won't find them doing full-scope work past the ED once they're at the the hospital. I've never worked in a system where this was allowed. All the paramedics that I knew that had a position in an ED were Techs.