Any NPs in EMS or the Fire Dept?

TheMurseChronicles, BSN, RN, EMT-P · Aug 25, 2018

Hi! I'm not a NP, but I have thoroughly researched this topic. The use of mid-level providers is still a relatively new thing in EMS. LAFD has an awesome nurse practitioner unit staffed with a paramedic and NP. Most NPs in EMS are FNPs (trending towards ENPs), with previous ER or critical care transport experience. This is mainly because with acute care NP programs you are certified for either the pediatric or adult population, so it limits the population you can treat legally. They are being adapted into many community paramedicine programs to help reduce the abuse from "frequent fliers". For example, they may treat an asthma exacerbation on scene and prescribe medication to prevent getting a call back later that week. They can suture minor lacerations, treat infections, and other general "urgent care" concerns from the comfort of the patient's home. These are the things I hear of them doing for the most part, I too look forward to replies from EMS NPs. It is a really interesting field, evolving the methodology in which we manage acute and chronic conditions in the prehospital setting.

eg1014, MSN, APRN, NP · Aug 25, 2018

Hi! I'm not a NP, but I have thoroughly researched this topic. The use of mid-level providers is still a relatively new thing in EMS. LAFD has an awesome nurse practitioner unit staffed with a paramedic and NP. Most NPs in EMS are FNPs (trending towards ENPs), with previous ER or critical care transport experience. This is mainly because with acute care NP programs you are certified for either the pediatric or adult population, so it limits the population you can treat legally. They are being adapted into many community paramedicine programs to help reduce the abuse from "frequent fliers". For example, they may treat an asthma exacerbation on scene and prescribe medication to prevent getting a call back later that week. They can suture minor lacerations, treat infections, and other general "urgent care" concerns from the comfort of the patient's home. These are the things I hear of them doing for the most part, I too look forward to replies from EMS NPs. It is a really interesting field, evolving the methodology in which we manage acute and chronic conditions in the prehospital setting.

Thanks so much for your input!

I had a strong feeling they were using FNPs for this, especially considering the fact that they'd have to treat anyone in the population. I just didn't know if this would be an environment that the "consensus model" didn't necessarily agree with, considering it is a more acute care setting.. but I can see how it is now trending towards ENP's, as you said.

Seems like a really interesting field and I also hope we have some more input from anyone out here working in this field.

Thanks again!

eg1014, MSN, APRN, NP · Aug 25, 2018

I'm also curious to know how paramedics or other EMS personnel feel about this newly implemented position for NP's?

Feel free to drop a comment about your thoughts!

Trauma Columnist · Aug 25, 2018

I'm an APRN who is also a pre-hospital RN (PHRN) in Illinois. Illinois is one of the few states where this is an actual license versus certification. I've been a volunteer on my rural Fire Dept for over 19 years now. We average 400 calls/year (fairly low volume). My qualifications when I jioined:

RN x6 years (3 in level one trauma ED, 2 in adult ICU and 1 year PICU)

BLS/ACLS

TNCC

TNS (trauma nurse specialist which is an Illinois-specific certification)

ENPC

I then had to do 10 intubations in the OR, and demonstrate competency with needle decompression. Over the years I've had to recertify everything as well as demonstrate competencies.

I am very careful to ensure my documentation reflects an APRN level of assessment as that is the licensure level I'm held to but my performance is based on my PHRN license - does that make sense?

Dodongo, APRN, NP · Aug 25, 2018

Case Western University has a Post-Master's Specialty Certificate in Flight Transport for ACNPs. It's 4 courses - one is the emergency care of children to allow you to care for all ages.

InquisitiveAPN · Aug 28, 2018

Hi! I'm not a NP, but I have thoroughly researched this topic. The use of mid-level providers is still a relatively new thing in EMS. LAFD has an awesome nurse practitioner unit staffed with a paramedic and NP. Most NPs in EMS are FNPs (trending towards ENPs), with previous ER or critical care transport experience. This is mainly because with acute care NP programs you are certified for either the pediatric or adult population, so it limits the population you can treat legally. They are being adapted into many community paramedicine programs to help reduce the abuse from "frequent fliers". For example, they may treat an asthma exacerbation on scene and prescribe medication to prevent getting a call back later that week. They can suture minor lacerations, treat infections, and other general "urgent care" concerns from the comfort of the patient's home. These are the things I hear of them doing for the most part, I too look forward to replies from EMS NPs. It is a really interesting field, evolving the methodology in which we manage acute and chronic conditions in the prehospital setting.

When I was in paramedic school back around 2001 this was discussed. It strikes me as sort of a time suck to be doing anything like suturing, etc on an EMS call. Having been in EMS, most of the houses weren't houses I'd want to sit down in without roaches or something crawling all over me much less do procedures. I let the credential lapse in 2008 or so and EMT lapsed in a year ago. I've got to say without body armor and a gun I don't think I'd so EMS these days and do t recommend it to anyone.

MikeFNPC, MSN · Aug 29, 2018

At a professional meeting several years ago, I met a NP who worked for the San Antonio FD. He told me he just did physicals that were required for the job. He didn't write Rx's or schedule test, he had to direct anything abnormal to a medical clinic.

allennp · Aug 29, 2018

as a current FNP and previous medic I do not see a lot of usefulness in a NP working prehospital. A focused prehospital EMS program gives in my opinion a much better clinical and didactic program for managing issues in the field, vs a ACNP or FNP, the benefit of prescriptive authority is minimal with the guidelines and protocols that have been developed. Plus who the *ell wants to work 24 hr shifts in the field hauling backboards and intoxicated folks.

Trauma Columnist · Aug 29, 2018

I think (with 19 years exp as a pre-hospital RN + 12 years as an RN + 12 years as an APRN) that RNs have a role prehospital but not so much APRNs.

eg1014, MSN, APRN, NP · Aug 31, 2018

When I was in paramedic school back around 2001 this was discussed. It strikes me as sort of a time suck to be doing anything like suturing, etc on an EMS call. Having been in EMS, most of the houses weren't houses I'd want to sit down in without roaches or something crawling all over me much less do procedures. I let the credential lapse in 2008 or so and EMT lapsed in a year ago. I've got to say without body armor and a gun I don't think I'd so EMS these days and do t recommend it to anyone.

Yikes.. the last part of your statement. I always wondered how unsafe it felt to go into random people's homes..

eg1014, MSN, APRN, NP · Aug 31, 2018

I'm an APRN who is also a pre-hospital RN (PHRN) in Illinois. Illinois is one of the few states where this is an actual license versus certification. I've been a volunteer on my rural Fire Dept for over 19 years now. We average 400 calls/year (fairly low volume). My qualifications when I jioined:
RN x6 years (3 in level one trauma ED, 2 in adult ICU and 1 year PICU)
BLS/ACLS
TNCC
TNS (trauma nurse specialist which is an Illinois-specific certification)
ENPC
I then had to do 10 intubations in the OR, and demonstrate competency with needle decompression. Over the years I've had to recertify everything as well as demonstrate competencies.
I am very careful to ensure my documentation reflects an APRN level of assessment as that is the licensure level I'm held to but my performance is based on my PHRN license - does that make sense?

Yes, thank you!