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!

Obviously, you are getting your RN because your state does not allow you to practice above your scope of knowledge/practice. I commend you for going on to school....goodluck....

Nope. My state values ems. As I said before, it's common here for medics to work in ER's and function essentially the same as an RN...doing the same skills, triaging, taking pt's, doing education etc. Medics here are actually allowed to do more skills than RN's. It's not that I want to practice above my scope (my scope is already broader than the rn's here) I simply want to be paid better for doing the same work! Thank you for the good luck wishes.

Our medics do not diagnose, nor hang nitro, enroute they give SL nitro, start the Ivs prior if they can, if no IV access..... even sl nitro is not given and they do prehospital care....Never do they hang nitro drip or titrate....in my almost 30 years have I've NEVER seen EMS hang nitro drip and titrate ever

Again, I am sorry you live in such a backwards state. I'm not sure what you teach in your state, but here we understand that time is muscle and if we can re-perfuse in the field instead of waiting until we get to the hospital then why not right? Our medics here are taught how to diagnose an MI. We carry the same pumps they use in house and do nitro, dopamine, lidocaine drips etc. When we do inter-facility transports who knows what other drugs might be hanging.

Some of the EMS services in my state are doing trials of using troponin labs in the field. We have the capability of sending 12 leads over our cell phones. Field thrombolytics are also in use by some of the services in my state. And here if we can not get an IV, we carry IO guns or drills to get access.

And yes 7300 drugs is a bit, and I thinking about it now realize a bit of fluff...but we did them say half that amount.

I still call bs on this. There is around 1700 pages in my nursing drug book. Some of these drugs obviously take up more than one page, meaning there is less than 1700 drugs in the book. You are claiming that you learned about 3500 drugs in nursing school. Could you please explain how you learned about 1800 additional drugs that are not even known to the current nursing drug books?

Mine is bigger than yours! Cannot say anything productive is developing from this topic. The bottom line still remains: PM's are not educated to provide nursing care and RN's are not educated to provide EMS care. It is that easy. Obviously, a certain amount of knowledge and modality crosses over.

Not to say paramedics cannot work in the ER; however, a certain amount of experience and education is required to make a successful transition. The same is true of nurses working in the pre-hospital environment.

This could change if EMS in this country decided to push for standardization of education. Instead, many programs can simply interpret the DOT NSC. Even with the NREMT pushing to have approved programs, I suspect many places will drop the NREMT requirement and simply maintain a state certified shake and bake school.

EMS has a long way to go in this country before they can start looking at taking over the traditional RN role within the hospital. Outside of the USA, a different story.

Specializes in ER,ICU,L+D,OR.
Oh yeah! Again, the REAL reason why most female ER nurses (vast majority) think EMTs are "good help in ER...we should embrace them" (no pun intended!)

Awesome!

Whats wrong with a good embrace. Good for the morale. Ive never known a paramedic to complain after I have given them a hug.

There is also no reason they can not work very well together as a team in the ER.

Specializes in ED, Flight.

Like Gila, I thought the utility of this thread died a few pages ago. BUT, at my age I've been around the block a few times, and Medic15251 I'm just dying of curiosity. What state are you in, that you've been describing in all your posts?

Thanks.

mordechai-sleepy-after-a-small-hours-patient-flight-and-going-to-sleep-before-my-shift-in-the-ED

Nope. My state values ems. As I said before, it's common here for medics to work in ER's and function essentially the same as an RN...doing the same skills, triaging, taking pt's, doing education etc. Medics here are actually allowed to do more skills than RN's. It's not that I want to practice above my scope (my scope is already broader than the rn's here) I simply want to be paid better for doing the same work! Thank you for the good luck wishes.

Again, I am sorry you live in such a backwards state. I'm not sure what you teach in your state, but here we understand that time is muscle and if we can re-perfuse in the field instead of waiting until we get to the hospital then why not right? Our medics here are taught how to diagnose an MI. We carry the same pumps they use in house and do nitro, dopamine, lidocaine drips etc. When we do inter-facility transports who knows what other drugs might be hanging.

Some of the EMS services in my state are doing trials of using troponin labs in the field. We have the capability of sending 12 leads over our cell phones. Field thrombolytics are also in use by some of the services in my state. And here if we can not get an IV, we carry IO guns or drills to get access.

I still call bs on this. There is around 1700 pages in my nursing drug book. Some of these drugs obviously take up more than one page, meaning there is less than 1700 drugs in the book. You are claiming that you learned about 3500 drugs in nursing school. Could you please explain how you learned about 1800 additional drugs that are not even known to the current nursing drug books?

REREAD MY POST ABOUT THE AMOUNT OF DRUGS....THEN BACK OFF YOUR HIGH HOURSE MISSY....

Nope. My state values ems. As I said before, it's common here for medics to work in ER's and function essentially the same as an RN...doing the same skills, triaging, taking pt's, doing education etc. Medics here are actually allowed to do more skills than RN's. It's not that I want to practice above my scope (my scope is already broader than the rn's here) I simply want to be paid better for doing the same work! Thank you for the good luck wishes.

Again, I am sorry you live in such a backwards state. I'm not sure what you teach in your state, but here we understand that time is muscle and if we can re-perfuse in the field instead of waiting until we get to the hospital then why not right? Our medics here are taught how to diagnose an MI. We carry the same pumps they use in house and do nitro, dopamine, lidocaine drips etc. When we do inter-facility transports who knows what other drugs might be hanging.

Some of the EMS services in my state are doing trials of using troponin labs in the field. We have the capability of sending 12 leads over our cell phones. Field thrombolytics are also in use by some of the services in my state. And here if we can not get an IV, we carry IO guns or drills to get access.

I still call bs on this. There is around 1700 pages in my nursing drug book. Some of these drugs obviously take up more than one page, meaning there is less than 1700 drugs in the book. You are claiming that you learned about 3500 drugs in nursing school. Could you please explain how you learned about 1800 additional drugs that are not even known to the current nursing drug books?

OBVIOUSLY THERE'S A REASON YOU REQUIRE ADDITIONAL SCHOOLING....WITH THAT.....I AM DONE ARGUING WITH MEDIC TO RN....MY BACKWARDS STATE JUST PERFORMED THE FIRST FACIAL TRANSPLANT...BUT OH WELL....YOU KEEP UP YOUR SCHOOLING, GET YOUR JOB AS AN RN IN THE ED....THEN TELL ME ONCE AGAIN A MEDIC IS JUST AS QUALIFIED TO WORK AS A LICENSED RN IN THE ED, DOING THE SAME STUFF, RESPONSIBLE FOR THE SAME LICENSE.....OH WAIT....THERE IS NO LICENSE AS A MEDIC.......LOL

Again, I am sorry you live in such a backwards state. I'm not sure what you teach in your state, but here we understand that time is muscle and if we can re-perfuse in the field instead of waiting until we get to the hospital then why not right? Our medics here are taught how to diagnose an MI. We carry the same pumps they use in house and do nitro, dopamine, lidocaine drips etc. When we do inter-facility transports who knows what other drugs might be hanging.

You as a medic cannot....legally diagnose!!!!!!!!!!!!!!!!!!!!!!!You are not educated enough.....

Specializes in ED, Flight.

Back on page 6 of this thread, post #51 (please read it), I already pretty clearly presented a perspective on why it is fair to say that paramedics practice a limited form of medicine.

To use the frequently dredged-up-here example of an MI: when I enter a home, and based on patient Hx, presentation, exam, and 12-lead EKG that I run and interpret all by my little self decide the patient is having an MI - I have made a diagnosis. There is no other word for it. What's more, in the rural service where I work (and have had quite a few MI patients over the years) there usually isn't another paramedic to confirm my thinking. We don't carry IStats on the ambulance or aircraft, so I have no labs. Some crews have them.

So, based on that diagnosis I initiate care. True, limited by protocols. But that is still a limited manner of practicing medicine, according to the MDs I work under. My present medical director doesn't let us forget it. His words. Practicing medicine. I still have to make the decisions and choices. That's a lot of autonomy and responsibility, especially given that there's no one to clean up my mess if I goof up. IV NS, ASA, NTG SL, Morphine, O2. NTG gtt possibly. Withold NTG for a right-sided MI. Electricity for the suitable arrhythmias or pacing. Intubate if needed. Set up and run vent. Dopamine. Etc. If the patient codes in the living room, I completely run that code to the limit of the tools available. All decisions to be made, not just an algorithm.

You know, there's a group of doctors who started out in EMS. They call themselves the Street Medicine Society. Because what they did out there on the streets was street medicine. When I was a small-team combat medic, I was practicing the lowest level of combat medicine.

The practice of medicine isn't characterized by what piece of paper is in your wallet. It is characterized by assessment, diagnosis (even if only tentative), and intervention. Paramedics all over the world do that every day. So, btw, do nurses who move into the prehospital field as flight nurses.

I personally don't like the way some things were represented by medic15251. I don't, however, want that to detract from a true perspective on what paramedics do and are indeed expected to do.

'Nuff said.

You as a medic cannot....legally diagnose!!!!!!!!!!!!!!!!!!!!!!!You are not educated enough.....

I think medic 09 pretty summed up why you are wrong on that point.

OBVIOUSLY THERE'S A REASON YOU REQUIRE ADDITIONAL SCHOOLING

I can't break this subject down to a simpler level for you to grasp. As I have said. In MO where I live, paramedics are allowed to do the same skills and have the same job description from their employer (with one or two minor discrepencies) as an RN. This is the result of many rural areas and a nursing shortage. I chose to go to rn school partly because I wanted to make more money for doing the same job.

OH WAIT....THERE IS NO LICENSE AS A MEDIC.......LOL

Why do I get the strange feeling you are one of those people who is constantly talking about stuff all the time that you know nothing about?

Here is a link to the MO department of health and senior services:http://www.dhss.mo.gov/EMS/Faq.html

From their site:

Can I work in Missouri with just a National Registry Card?

No, Missouri law requires all levels of Emergency Medical Technicians to be licensed. This is both Basic and Paramedics. It does not matter where an EMT is employed; they must be licensed to perform as an EMT.

Paramedics are licensed in MO.

REREAD MY POST ABOUT THE AMOUNT OF DRUGS....THEN BACK OFF YOUR HIGH HOURSE MISSY...

Oh, I read it....I read it and laughed! First you claimed you learned over 7000 drugs in nursing school in under two years. Then when I pointed out how ludacris that was you doubled back and said you really only learned 3500. Next when I pointed out that current drug books don't even have nearly that amount you make outrageous claims of me being on a high horse. So which story are you going with? You don't have to make outrageous claims to make friends!

I see we have gone beyond "mine is bigger than yours" to "my dad can beat up your dad." Better yet, "spider man can beat up bat man." Anybody see a trend here?

Specializes in ED, Flight.

Well, I was just trying to clear things up; but I think I've had my last say. You were right when you said we've passed the point of usefulness. :argue:

I should have stayed 'shut up'. :icon_roll

See ya over at FlightWeb...

No worries. Fly safe. :smokin:

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