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!

It is all stuff that a good medic can learn; but it is not part of a medic's education or normal experience.

I have to disagree. Most programs today require a great deal of time in the ed. Much of a medic student's time in an ed is spent following an rn. They see and experience first hand what an rn does in an ed.

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

Quite the opposite. Many medics would never want to work in house. FOr myself though, I enjoyed working as a medic in an ed, but didn't think it was fair that I was doing the same job but getting paid less for it. That's why I went to nursing school.

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... (????)

It sounds like you have a large chip on your shoulder there bud! I would wager that many of the medics that post on this board are also rn's. The two jobs, while quite different, are very much overlapping and related.

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

Where are you getting that term? Last time I checked EMT stood for emergency medical technician not prehospital. The fact is that medics are being utilized in many areas of medical care such as in house code teams, ed's, anesthesia departments, urgent care's, etc.

Dinnith88 maybe it's time to start challenging some of your archaic beliefs and practices.

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Specializes in CCU/CVU/ICU.

Dinnith88 maybe it's time to start challenging some of your archaic beliefs and practices.

you're probably right... i was just trying to get someones goat. At least you *kinda* bit.. :yeah:

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Specializes in CCU/CVU/ICU.
. Some are even very cute also.

ah yes... the *real* reason why medics are readily accepted into the ED...and why some nursing personalities migrate to the ER...:redbeathe

I think someone should write to NBC and complain about there not being any paramedic stars on 'ER'...that way the world could know the TRUTH! Sexy medics re-attaching limbs, doing brain-surgery, and sexing-up their sexy RN and MD co-stars...both in the ED and in the rigs!

:typing

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Specializes in ER, IICU, PCU, PACU, EMS.
ah yes... the *real* reason why medics are readily accepted into the ED...and why some nursing personalities migrate to the ER...:redbeathe

I think someone should write to NBC and complain about there not being any paramedic stars on 'ER'...that way the world could know the TRUTH! Sexy medics re-attaching limbs, doing brain-surgery, and sexing-up their sexy RN and MD co-stars...both in the ED and in the rigs!

:typing

They did have paramedic stars on 'ER', but they all became doctors on the show!

On one show they were on the MICU, the next you'd see them in a white coat.....

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Specializes in ED, Flight.
I have to disagree. Most programs today require a great deal of time in the ed. Much of a medic student's time in an ed is spent following an rn. They see and experience first hand what an rn does in an ed.

Well, I guess we'll continue to disagree on some of this. I'm a bit surprised that you, as a medic and nurse, think that medics can step right into the nursing role in the ED.

For one thing, I see the reality differently than you. I have trained and precepted overseas and on the East coast and here in NM. Nowhere, even recently, have I seen paramedic students spend what I would call "a great deal of time" in the ED. Typically, they spend something like a six or eight week rotation, twice a week, in the ER. Not much different than nursing student rotations. "A great deal of time" is, to my mind, a bit misleading. I spent similar time rotating through NICU. Does that make a NICU nurse? Or does it just mean that now I have a bit more of a clue than someone else?

What's more, they come to the ED as paramedic STUDENTS, not working medics. The focus of their rotations, and their own focus, is to complete a certain checklist of paramedic skills during the rotation. X number of IV starts, x number of IV med administrations, x number of adult assessments, x number of peds assessments, etc. Most of them also help out generally, if they can; but their minds are clearly on learning and practicing this new set of skills called paramedic skills. They aren't there to learn to be ER nurses, nor are they doing so. But they do come out with a better idea of it all than someone who hasn't been there. That's about it.

To apply your logic, let's consider this. Over the years I have spent quite a few hours in the OR intubating patients, and then monitoring their status with the anesthesiologist. Do you want to suggest that because of all the time I've spent at the head of the bed (usually), that I can step in as an anesthesiologist? Or maybe that, because I've observed so many procedures and surgeries, that I can step in even as an OR nurse with little or no further training? Doesn't really make sense, does it?

What IS true, is that we medics do learn to do nursing pretty quickly if we want to. We already are comfortable approaching patients, touching them, performing skills, etc. So much of what makes new nurses and students hesitate, we've already gotten past. Maybe our orientation and path to proficiency can be faster and shorter; but in no way can I see a medic right off the street doing all that we do without some specific education and training. Nor can a nurse just walk out, jump in the back of the bus, and do well what we do on the street every day. And no one, medic or nurse, can be genuinely proficient and expert without getting quite a bit of experience.

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Specializes in ED, Flight.

BTW, did ya notice all the nurses gathered round to watch the medics duke it out for their entertainment? ;) :lol2:

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I'm a bit surprised that you, as a medic and nurse, think that medics can step right into the nursing role in the ED.

I'm not saying that a brand new paramedic would be 100% proficient working in an ED in a nursing role. What I am saying is that this medic would be better prepared than a brand new nurse. Of course there would be some minimal, additional training needed.

Nowhere, even recently, have I seen paramedic students spend what I would call "a great deal of time" in the ED.

Then you need to open your eyes. As I said earlier I spent 200 hours of clinicals in an ED. It is probably typically more than that now. The training in the majority of states now is all standardized, meaning that a medic student in Wisconsin would have a comparative program to a student in Tennessee. This is compared to a traditional ADN RN who might do two shifts in the ED of "observation time".

I guess what I am trying to say is that paramedic school prepares a medic to be a competent and capable medic on day one, while nursing school teaches more theories and basics that leaves a new grad rn needing an extensive amount of orientation time and on the job training before they are prepared to function independently. This is why many hospitals offer new grad programs to their rn's that combine class time and clinical time that typically last up to a year where as a new medic might have 2-4 weeks riding as a third person or a double medic before they are turned loose.

Again the two professions are very different, but they do overlap and have similarities. With the right additional training a medic can become a great nurse or vice versa.

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Specializes in ED, Flight.

15251, my eyes are wide open, and see very well what goes on. I've been a medic student; in three different frameworks in two countries. I've been the training officer for an ALS service. I've precepted medic students in Mass. and in NM. I've worked with them on their rotations in our ED. I already noted that they typically do 6 or 8 week rotations, twice a week. So, we were already on the same page. That adds up to between 150 and 200 hours in the ED.

That is NOT a lot of time in the ED. Sorry. It just isn't. It is the same amount of time that I did for any of my rotations in hospital units in nursing school. ED, NICU, Peds, Med-Surg, Tele, Community Health, etc. Only my Peds ED rotation was just a 'visit' for two nights. All the others were 7 week rotations. During those rotations I worked a nursing role under supervision. In fact, a much more thorough and clinical role than most medic students get to do in the ED. So much so that I was sometimes nervous about my role/responsibilty in ways that I never had to be as a medic student in-house. I was managing patient care, while medic students are doing 'skills' and 'tasks' and completing a checklist. None of that made me proficient or 'qualified' in those departments. And TOTAL clinical time for nursing was more over 16 months than the TOTAL time my paramedic students got over their two-year programs.

When you are there as a student, your focus is narrower and more limited, as I've already noted. A paramedic doesn't have significant experience of working in the ED if the only exposure was those 200 hours during school. Actually, a nursing student who does a same-length rotation is more likely to have a real experience of the ED.

I'm surprised that you think of your 200 hours paramedic ED time as more significant than your nursing clinicals. I know that my nursing clinicals were a pretty intense (and positive) experience. Maybe we've just had different experiences.

In addition, what the paramedic most has to offer, s/he doesn't get to do in the ED. Not as a medic, and not as a nurse. Outside I run codes, intubate, prescribe and administer a fair number of serious drugs on my own, manage the vent. In the hospital I only play a role in codes, don't intubate or dart chests, and except for a few standing orders and initiating some protocols, I need orders for meds, etc. Yet the rest of the nursing role is stuff that medics aren't typically taught and have no reason to know from the street.

The one thing I'll agree with you on, is that medics are taught to be independant thinkers and initiators; as I've noted elsewhere.

I came to the ED with a fair amount of experience and experiences. Military, SAR, flight. After a year I am still learning to do the nursing with a high level of proficiency. It isn't rocket science. Anyone can learn to do it; certainly paramedics. But it does take time, mentoring, and exposure to really get it down. It is more than "minimal".

Any good paramedic can do this. If they're smart, they'll come ready and wanting to learn - A LOT. If they're cocky they'll walk in thinking that 'in a month I can do it all.' Then they won't learn as much, and the patients will get only minimally competent care.

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A paramedic doesn't have significant experience of working in the ED if the only exposure was those 200 hours

Then we have a fundamental disagreement. It has been my observation that traditional adn programs in my area put their students through a couple of shifts in an ed. They basically just observe and might attempt an iv start or pass some po meds.

The math is not difficult. It comes down to what is more, both time wise and experience wise... Two shifts of observation time only or 200 hours of practicing assessments, pushing meds, starting iv's, intubating, doing pt education, etc. To me the answer is clear. Paramedic school provides more clinical experience that is more relevant to working in an ED than nursing school does.

This is why many hospitals won't even let new grads work in their ED. They want them to get "work experience" on the floor first. Those hospitals that are willing to hire a new grad do extensive orientation programs for a year or so before they turn the nurse loose.

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Cannot agree with you on this one. The problem being, paramedic programs range from shake and bake courses lasting six months to comprehensive programs that rival or exceed the length of their counterpart nursing programs. Unfortunately, EMS is very much a mixed bag right now regarding core educational requirements. Heck, EMT-I's are out providing nearly identical levels of care to a paramedic in some places, and they are doing so with less than 200 hours of training in some cases.

Once EMS pulls things together and eliminates shake and bake protocol schools we may finally realize the full potential of the paramedic. Until then, all of this will only bring the truly educated and competent paramedic providers down. Work on solidifying the role of the paramedic in the field, then come take the ER from us. :D

Look, PM students are in the ER to get skills checked off and see patients. They do not go to ER to learn how to function as nurses.

I think I really like 09's point. The core techniques are essentially the same. An assessment is an assessment and an IV is an IV; however, translating that into the EMS or hospital environment is the real trick. A PM is no more qualified to work as an ER nurse than an ER nurse is qualified to work as a paramedic.

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The problem being, paramedic programs range from shake and bake courses lasting six months to comprehensive programs that rival or exceed the length of their counterpart nursing programs.

You bring up a good point. EMS is in it's infancy compared to nursing. Until an associates degree is required for entry into the field and EMS has a bigger voice in government, it will still be viewed as more of a vocation than a profession.

I think we can find some common ground that a paramedic is currently an expanding roll that will most likely evolve quite a bit in the years to come. They should not be viewed as a replacement for nurses but as simply one answer of many to a nursing shortage that will only get worse in the years to come as the baby boomers age.

Look, PM students are in the ER to get skills checked off and see patients. They do not go to ER to learn how to function as nurses.

I see what you are saying, but ED nurses focus mainly on the very same things that medic students are trying to get checked off in skill wise. ED nurses have very limited time with their patients. It's been my experience that a typical day in an ed for an rn is very technical in nature. The focus is not so much on a "nursing care plan" and moving the patient from sickness to wellness. It seems more focused on assessing the situation, stabilizing and treating the pt, then moving them to the appropriate place (be it discharged to home or admitted to a specific unit). Correct me if I am wrong but these are all technical skills. Much like a paramedic would do.

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