Paramedics in the ER

Specialties Emergency

Published

Hi,

Does anyone allow paramedics to work in their ER? If so, do you have a job description you would be willing to share?

Thanks!

Specializes in CCU/CVU/ICU.

In our ER, the medics do surgery, the nurses wipe butts, and the Doctors flirt and sleep with the nurses who arent wiping butts. All of them (except for the happy doctors) bicker constantly about who is more important...depending on the state...and who has better schooling...and who is smarter.

Usually, it comes down to the medic is cooler, and the nurse makes more money.

There.

Specializes in CCU/CVU/ICU.

All kidding aside, i think it would be in nurses' best interest to resist the wider and common use of paramedics in ERs (or at least limit their scope). This isnt because nurses can do more, or are better at it (as has been hotly debated here)...but rather because medics CAN function in a role apparently VERY similar to the ER nurse. It would be in hospital/corporate best interest as the nurse can be replaced by similar, competent, and cheaper (this is the key here...always about the money) labor. (in the future, ERs staffed by primarily medics with a handful of 'discharge' nurses isnt a far fetched idea)

I dont dislike medics or think they're incapable of doing the ER nurses' jobs....BUT strictly speaking from a 'nurses' perspective, it boils down to a matter of potentially being phased out in EDs....to some degree or another.

Specializes in ED, Flight.

I was orienting one paramedic who was angry that he could not "practice medicine". Ah, reality check here, you don't get to practice medicine anyway, you have specific medical protocols that you follow based on your field assessments that allow you to give certain meds (ACLS) under certain circumstances, but you are practicing under your medical directors license and P&Ps.

I have stated elsewhere that paramedics can have a hard time to shifting mentality to the in-house environment. They can have a hard time shifting mentality to nursing, which is a quite different profession (though one that a good paramedic can usually learn successfully). It is clear to me, as a long-time medic and a new nurse that a paramedic working in the hospital has to know clearly the parameters and stick to them.

Having said that, I'll now go off on a tangent here for a moment and say that JBudd's characterization, while true enough in a literal sense, reveals a real lack of understanding as to how good paramedics are educated, and what they do on the job. This might be instructive for others as well.

In my mind, the paramedic's function (though not education) is closer to a PA than an RN. Consider all the pathophys, etc. we have to learn for nursing. More than most paramedic programs, certainly (though UNM exempted me from Pharm and some other course work based on paramedic school). Consider the emphasis on critical thinking. Then, we are told we may not use medical diagnoses (school here, folks; we all know the real world is different) and when it comes time for interventions all the thinking stops and we turn to the doc and say 'Mother, may I?'. IN our ER I even got chewed out for doing an EKG myself when the EKG tech was legitimately delayed and I had a sick looking CP. The doc and charge backed me up, but I had clearly overstepped bounds. Nurses in our facitlity aren't allowed to do that. Outside I would have done the EKG, interpreted it, and decided on and initiated initial care. A paramedic gathers the data, then has to develop some sort of differential Dx, then decides on a course of action (given, from a limited scope), then prescribes and acts (again given, from a described scope of practice). They then reassess, rethink, and react as appropriate. And we often do this in a location, vehicle, aircraft where we can't turn to medical control for input; even when we'd like to. When we do call for orders, the doc has to rely on our assessment when giving orders. There is an element of consult there; not just order-giving.

Consider the following examples; all real, though short and incomplete.

Paramedic enters a living room to find an elderly patient, wheezing audibly. Asthma? Anaphylaxis? Medication effect? Cardiac etiology? Once I determine what seems to be the cause, I need to treat. Respiratory nebs, SQ Epi, diuretics, cardiac meds are all at my disposal. Which, if any, is appropriate? And all this is happening with EMT-Basics for help, and no easy communication to the ER.

MVA, car vs. 18-wheeler out by Cline's Corners on the interstate. Snowstorm, so no helicopter. Communications poor. Over a two hour drive in the snow back to Albuquerque. Breath sounds diminished, and BP low with open bleeding femur Fx. Are they splinting from the pain, or is this a developing pneumo. Does the chest have to be decompressed? How should the BP be managed? How much fluid shoud they receive (surgeons don't like the patient to bleed pink!) Paramedic's decision and call.

Recently post-partum patient with apparent seizures of Eclampsia. Benzos? Mag? It is a forty minute run to hospital.

Old TBI, seizing in hospital on a med-surg floor where they were being held for a neuro consult for recently frequent seizures. Other than positioning for airway (I was there as a nursing student at the time), the nurses are lost. They said so. Suction wasn't set up. They hesitated to start a line. NO DRUGS available until the critical response team arrives a few minutes later. Outside the hospital, a competent paramedic would have suctioned, started a line, pushed benzos, and where I work would have considered a loading dose of Dilantin if faced with a long transport.

One hour transport from home with an ESRD patient. Lungs edematous. Patient rapidly entering respiratory failure. In addition to addressing the pulmonary edema, the paramedic may have to intubate the patient. They will not only decide that, but also decide which drugs to use to facilitate the intubation, and do it.

ALL of that qualifies as practicing medicine. Sure, it is a limited scope. But it is independant clinical thinking, diagnoses, and therapeutic interventions (some of them pretty drastic).

For what it is worth, every medical director I've worked under has emphasized that we are indeed practicing a level of medicine, and had better be up to it. I won't even dwell on the fact that as an army medic I did more.

So, there you have it. The hospital is a different environment with a different mentality. The teamwork is organized differently. Some paramedics have a hard time grasping this, and adjusting to it. If they can't, then they shouldn't work in the hospital. The more flexible paramedics have a lot to contribute, though I think Dinith raised a valid point in another vein.

If any of you would like, I'd bet your local EMS can arrange ride-alongs so you can see what the medics really do and have time to talk with them and see what they know. They cannot replace nurses; that's a different profession. But you all should know who they are. Many medics have two or four year degrees in EMS, not unlike nurses. Many have other education, as well. Two of the medics I worked with briefly in Mass. were real rocket scientists. Used to make six figures. One still consulted for the gov't on research projects. You can bet they brought serious medical thinking to what they did, and the medical director knew and appreciated it.

BTW, why did this thread get dredged up after more than a year?

Specializes in ER, IICU, PCU, PACU, EMS.

Thank you for your explanation and examples. Many nurses I have spoken to thought paramedics were only 'ambulance drivers'.

We have paramedics in our ED. I live in Illinois. They can give any of the meds that they can give out in the field, we have expanded their drugs to include tylenol & motrin, phenergan IV & Toradol IV & non medicated IV fluids. We are looking at expanding their formulary to include zofran and dilaudid, prior to adding new meds they have to take a med test that shows they understand what they are giving and potential side effects. They assist with trauma's and codes. They also perform EKG's, IV starts, foleys, NG tubes, transport pt to the floors. They don't triage pt's as Joint Comission states has to be an RN. They also can't hang blood or give IV antibiotics. They are a real asset to our department. Hope this helps

Specializes in ED, Flight.

BTW, if someone wants a good idea what a good paramedic does over a span of time, check out Peter Canning's blog: http://medicscribe.blogspot.com/

I used to work as a paramedic in the ED. My job description was identical to the RN's with the exception of not being able to hang blood. I took patients and could give any medication an RN could.

It really does make sense. A medic is trained to do exactly what is required in an ED. They can also be paid about 30% less than an rn. Often times rn school does not prepare a new grad to be ready to go in an ED on day one, but a medic would be. A traditional 2 year RN program might have a student do 1-2 days of ed time with a clinical instructor. In my medic program we did 200 plus hours in just the ED.

Specializes in ER,ICU,L+D,OR.

Medics can be very handy to have assist you. Some are even very cute also.

See, I think they can have more than just an assistant role. I think they should be able to take patients and function essentially the same as an rn in an ed setting.

Specializes in ED, Flight.
Medics can be very handy to have assist you. Some are even very cute also.

I know my wife still thinks at least one medic is pretty cute. :D

Specializes in ED, Flight.
I think they should be able to take patients and function essentially the same as an rn in an ed setting.

I have to disagree. Although I don't think it is hard for a good medic to learn to be an ED nurse; there is still much that is different about nursing, even in the ED setting.

I think I'm a pretty good medic most days. What's more, as the sole provider to my combat team I did traumas, sick call, public health, health maintenance, etc. YET, in the ER I see a broader range of problems in a broader population than I have ever seen before.

Look at it this way. Many of the patients I pick up on the street but do essentially nothing for (and there are many of those). Now, when I hand over those same patients in the ED, the receiving nurse nonetheless does have a role with them. Intake assessment, some initial care, setting up for the doc, finishing and following up after the doc, discharge instructions, etc. It is all stuff that a good medic can learn; but it is not part of a medic's education or normal experience.

Even the acute MI that the medics start in the field gets a new range of drugs and preparation in the ED. Even the trauma that gets initial care in the field gets new steps in care and preparation before surgery.

Just as I said earlier that many nurses don't know how much we medics know and do, I see that medics often underestimate the breadth (and depth) of what goes on in nursing, including the ED.

Nursing is NOT rocket science. It doesn't take a genius, at least to start. But there is a lot to it that medics know nothing about until they get the education and training. Crossing over the roles isn't all that difficult, but it still requires education and training in either direction.

Specializes in CCU/CVU/ICU.

So... what has become apparent in this discussion is that:

1) all medics secretly wish they were ER nurses...or function like one (or at least get paid as well)

2) all ER nurses secretly want to be medics and work in the field (though continuing to be paid like a nurse)

3) Medics (on the 'all-nurses' nursing boards... supposedly for nurses...this one for ER nurses...) will loudly, proudly, and at great length verbalize (and jesticulate) their importance and (in certain areas) superiority to ER nurses ...or that they are *really* more like doctors or PAs than nurses...:wink2: (????)

4) although medics are pre-hospital technicians...they're wanting an expanded in-hospital role...

5) most ER nurses dont realize this influx of readily available (and cheaper) labor is elbowing its way into ERs and reducing nursing jobs....but think it's OK because they're good 'help'.

6)...there was something else...:barf02:

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