Don't worry about being ignorant about something. Everyone, including me, is ignorant about something in this world (I'm far from being one of those "all-knowing" types). Even though I am only an EMT-Basic right now, I've been involved in EMS for almost three years now and have worked with Paramedics on a fairly regular basis to know a good deal about what they can/cannot do. I love educating people about what EMT's and Paramedics do, because it seems like so many people in the public (and in other health care professions) don't know what we actually do and what the extent of our training is.
Since I haven't even started nursing school yet (although I want to starting in Fall '05), I'll admit my knowledge of nursing is only cursory. Since I've only heard from various sources (including RN's themselves) about what nurses can/cannot do, maybe some of you on this forum can enlighten me about what you are allowed to do in your area(s) of practice.
Anyways, just in case anyone doesn't know this already, there are basically three levels of prehospital care providers who work in ambulances and medical helicopters: EMT-Basics, EMT-Intermediates, and EMT-Paramedics. Basics and Intermediates usually don't work in the choppers- you usually have to be at least a medic (or RD or MD) to work on those things. EMT-Basics go through a 120-150 hour course which teaches them basic assesment techniques (i.e., techniques pertaining to Airway, Breathing, Circulation), bandaging, splinting, oxygen administration, CPR, automated external defibrillation, spinal and fracture immobilization, and administration of certain drugs (Glucose, Activated Charcoal, Aspirin, Patient prescribed Nitroglycerin, Epi-Pens, Albuterol (in some states)). EMT's at all levels also have to pass a state or national certification exam once they pass the course.
EMT-Intermediates can do all of the above plus a number of other skills that are considered to be in the "Advanced Life Support" realm of care. In Massachusetts (the state I live in) they are only allowed to do all of the above plus start IV's, give fluid (i.e., NS) boluses, intubate, and give D5 via IV solution.
EMT-Paramedics are considered the highest level of providers in prehospital (ambulance) care. They go through about 800-1000 hours of didactic, clinical, and field education. They can do ALL of the above skills plus give various drugs (including sedatives such as versed and ativan) via IV solution, IM, IV push, and IV suspension, Intraosseous (into the bone), Down an ET tube and other routes under the sun that I can't think of right now. They also intubate, manually defibrillate, do transcutaneous pacing, cardioversion, surgical airways (although not in all states), and needle-chest decompressions (for pneumothoraxes). They can also interpret cardiac rhythms and can interpret 12-lead tracings (sp?). If there's anything I forgot about, anyone can feel free to add in.
Correct me if I'm wrong, but from what I've been told (by both RN's and non-RN's), RN's cannot do a lot of things without a direct order from a physician. In contrast, Paramedics have a lot of autonomy in the patient care they practice because they do not need direct medical control orders for everything they do. Instead, they have a whole set of treatment protocols with "standing orders" already written in by qualified docs. In other words, a bunch of docs have already dictated what kinds of treatments a paramedic can and cannot perform in certain medical and trauma situations. Don't get me wrong, though. Good paramedics, just like good RN's, actively use their noodle to determine what the best course of treatment is for every patient. They aren't just "cookbook providers" who follow protocols blindly. Paramedics also have to call a physician at the ER in order to perform certain procedures and give certain medications. Also, I've been told that RN's cannot do a number of procedures (such as intubation, surgical airways, and needle-chest decompressions) either at all or not without a doc's supervision.
So why would I want to become an RN AND a paramedic? Well, I think it's because EMS is already in my veins, I love working outside, I love the autonomy, and the occasional excitement (80-90% of our calls aren't so exciting, but that's all good). Plus, becoming a paramedic is something I've always wanted to do. So why not just become a paramedic and skip nursing? Well, there are a few reasons. For one thing, RN's have MUCH better pay (but that's all relative). When I first became an EMT, I started out at $9.50/hr. I know people who do EMS full time for a living and have to pull 50-80 hrs a week just to make ends meet (esp. if they have families). On the other hand, I've seen advertisements for RN salaries starting at $30-$34/hr. Now that still might be considered "underpaid," but it's A LOT better than $9.50/hr. Moreover, I've been told (and have read) that the career/specialty mobility in nursing is phenomenal. I mean, if I complete my BSN and get my RN, there are lots of specialty areas that I can choose from, and I could go on to get an advanced practice degree if I wanted to. Plus I could be a flight or Critical Care Transport RN with the right amount of experience and the right credentials. Being a paramedic, I could basically chose from one of two routes- staying on an ambulance and/or going onto a helicopter or going into management and having almost no patient contact at all. I'm not just going into nursing for the money, though. I want to increase my knowledge of medicine so that I can have more theoretical and practical tools to help my patients. As long as I don't get injured (fingers crossed- I should be excercising more), I can still be an EMT (and hopefully a medic in the future) on a part-time basis. So I can be both. I would probably just have to work full time in a hospital and part-time on an ambulance.