Any NPs in EMS or the Fire Dept?

Dodongo, APRN, NP · Aug 31, 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.

I agree with you here. I became an NP (in part) to have other people do the "heavy lifting" so to speak. Flight nurses and PHRNs can do plenty within their algorithms and protocols that I don't see the utility of a NP or MD on these teams. The point is to pick the patient up and get them to the hospital asap. Studies have shown that the longer you play around with trying to stabilize in the field, the higher the M/M.

InquisitiveAPN · Aug 31, 2018

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

Most of the time it isn't, but like anything in life it has the potential to be very unsafe because it's a completely uncontrolled environment. The partner (EMT basic) that usually worked with me was morbidly obese and incapable of most physical efforts so I never counted on his as backup. I always carried a long flashlight as an impact weapon at night and near dusk and dawn. Also, I had a metal clipboard/holder for our then paper "run reports." During the day I carried a shorter light but still effective weapon. Then there were the dogs...

InquisitiveAPN · Aug 31, 2018

I agree with you here. I became an NP (in part) to have other people do the "heavy lifting" so to speak. Flight nurses and PHRNs can do plenty within their algorithms and protocols that I don't see the utility of a NP or MD on these teams. The point is to pick the patient up and get them to the hospital asap. Studies have shown that the longer you play around with trying to stabilize in the field, the higher the M/M.

Yeah, the flight medics tended to be the best medics in that their tradecraft was best honed. I knew several that became RNs to get a pay bump and be able to push more meds but stayed in the birds They were already ninja experts and when they got tired of flight they became FNPs or went to the ICU for obligate hours and became a CRNA. (I've never met an ACNP.)

Most paramedics who become RNs are a bit let down by nursing school. Although nursing school had more breadth it's very much surface skimming content with obscene care plans and research papers in which format usually trumps content. The two programs complement themselves well although both are fruitless without mutual experience.

I'm a big fan of "load and go." Seldom, have I seen bad outcomes not attributed to running hot to the hospital. I've seen plenty of fish finally go down the drain when crews tried to stay and play. Sit for ten minutes and tool around for an IV (and then drive five mins to hospital) or just haul butt and get to the hospital in five minutes. As a paramedic, I felt the need to try something I thought near impossible when an entire trauma team was in earshot of our sirens.

Trauma Columnist · Sep 1, 2018

Aw yes the danger:

Dogs - they are first of all excited to see new people in THEIR house, the dogs are protective (in some cases) and don't really like to see their owner or someone else in their household hurting, upset, etc...

Guns/weapons - yep. I live in a rural area. Many households have guns, some locked up, many not. Adds to the level of excitement when you are greeted at the door and told "he's downstairs" and so we proceed down a darkly panelled stairway to an even darker basement to find a GSW victim (true story).

Terrain - we see a lot of tractor/combine other farm implement accidents too. You have to know what you are looking at before you get yourself victimized. Grain bins are one of our worst enemies and they are bringing the corn in now.

Lots of dangers - you have to have a very clear head, not go headlong into every scene - scene safety is always always always gotta be the first thing you think of....

AnnieOaklyRN, BSN, RN, EMT-P · Sep 13, 2018

Hello,

I think its kind of a good idea for people with minor stuff like UTIs and that sort of thing for an NP to come on the ambulance and treat them. I don't see us sitting on scene though for an hour while the patient gets sutured, that would tie up resources longer then it would to just drop them off at the hospital. I have seen some EMS systems use an SUV type of unit that still can respond, but it is used so that a transporting ambulance isn't being used. I use to work in a city and I think it would be more beneficial there, when you have many more people using an ambulance as a taxi and using the emergency room for non-urgent things like having ten minutes of nausea and vomiting (yes, I have done this call). I now work in a much more suburban area where we are not abused quite as much and I don't feel it would be beneficial to have an NP in that type of system. What we have spoken about is allowing transport of patient's to urgent care centers rather then emergency rooms, when their complaint is minor. As an indirect way to convince them they don't really need an ambulance, I also think they should have to pay out of pocket for the ambulance if they can go to urgent care and still decide to use us (mostly because they think they will get seen faster, or get there faster).

There are a lot of new trends in EMS, like not using lights and sirens unless the call is coded at the Charlie level or above, not using lights and sirens en route to the hospital unless it is life threatening like a STEMI, severe respiratory distress, Stroke alert, or severe trauma. The problem is EMS is lacking education when it comes to speaking to the public about proper use of an ambulance and the fact that we are coming to your house with traffic if you are calling for a non-life threatening problem like you broke your arm, we aren't using lights and sirens to get you to the hospital, except in the stated cases (I have had many family members and patients ask why we aren't using them), and you are still going out the ER waiting room even if you came by ambulance.

EMS is behind in many things ,which really need to be correct first in my opinion before we start doing something new, like home visits and having an NP diagnose and treat you without transport to the hospital. I honestly think this would quickly become abused, just like the ER, and used in place of a PCP. There are systems in my area that are doing this with paramedics only, no NP, and using medical control instead. We are licensed in my state and not certified so this is why it is allowed.

Annie

Jory, MSN, APRN, CNM · Sep 16, 2018

Unless you are an acute care NP or have a certification as a paramedic, you have to be careful on the waters you are treading.

You are educated/trained/certified as a primary care provider. EMS/Paramedics see acute care patients.

The consensus model for FNPs states that FNPs that work in hospital settings are more than likely working outside of their scope because there is an acute care NP certification. Older FNPs with 20+ years experience have more of a defense because the acute care specialty didn't exist back then.

If something goes wrong, you will be asked by an attorney to review where in your program you learned how to treat those patients and unfortunately, there won't be a good answer to that question.

Trauma Columnist · Sep 17, 2018

Unless you are an acute care NP or have a certification as a paramedic, you have to be careful on the waters you are treading.
You are educated/trained/certified as a primary care provider. EMS/Paramedics see acute care patients.
The consensus model for FNPs states that FNPs that work in hospital settings are more than likely working outside of their scope because there is an acute care NP certification. Older FNPs with 20+ years experience have more of a defense because the acute care specialty didn't exist back then.
If something goes wrong, you will be asked by an attorney to review where in your program you learned how to treat those patients and unfortunately, there won't be a good answer to that question.

Unsure who you are addressing. However, if its me, I'm not an FNP but rather an adult and pediatric CNS and this education encompasses acute and chronic care. I am covered by my education and training plus (and a big plus) I pay extra for my malpractice carrier to cover me pre-hospital.

I do agree an FNP would be not be equipped to practice pre-hospital.

Jory, MSN, APRN, CNM · Sep 18, 2018

Unsure who you are addressing. However, if its me, I'm not an FNP but rather an adult and pediatric CNS and this education encompasses acute and chronic care. I am covered by my education and training plus (and a big plus) I pay extra for my malpractice carrier to cover me pre-hospital.
I do agree an FNP would be not be equipped to practice pre-hospital.

I was referring to the OP.

There is growing concern about FNPs practicing in acute care areas or in practice specialties (such as psych) where they are functioning in the capacity of an APRN specialty for which a certification exists. This is mainly because FNPs are being over-utilized in practice areas where they have very little or no training.

For example, locally where I live a major mental health organization gave all of its FNPs a six month notice that they would be replaced with PMHNPs. The BON in Georgia released a statement (retracted, but I suspect it will come back) that FNPs working in hospital settings were functioning outside of their scope of practice. If they wanted to continue working in a hospital setting they would need to return for the acute care nurse practitioner specialty.

TranquilSpirit · May 20, 2020

I know this is a bump from a couple years ago. However, I have been actively considering this as a future venture and this seemed the most related thread.

I am a nurse who solely performs out-of-hospital duties with a private company. With a private, my "range" is far larger than that of a nurse with a FD. Also, working on the ground it isn't always a high acuity situation. As someone who formerly did flight, I can agree with certainty that flight would not be the best utilization of an NP. These are critical patients (in theory, anyway). But going to a nursing home or assisted living facility, for instance, on a response call, an NP could be utilized quite well. As I see it, anyway. Paramedics and PHRNs are permitted to call in AMAs for many of these individuals as it is. If the patient wishes and should they meet criteria. Many do not want to leave but are forced to by agreements and protocol of the sending facility. If an NP can be in touch with medical control to determine acuity level is appropriate for on-location treatment, why not establish an IV, order IV antibiotics, provide fluids, or take them away, and keep the patient in their bed, and therefore, forego transfer expense, hospital treatment and possible admission (likely admission) expense, etc?

Nursing home are already adapting to the requirements of reimbursements with medicare. Nursing homes MUST do certain things that they do not necessarily feel comfortable with to remain open. They have to do tele monitoring, trach to vents, tube feeding and TPN. If they're capable of this, they're capable of maintaining a patient through a 45 minute NP visit, interventions by a paramedic (such as multiple IV lines), and newly ordered IV medications.

In the end, it would be a matter of expense. Will an NP, in a nursing home providing care for a "yellow" or "green" acuity patient, be cheaper for state and federal reimbursement, than going to see an ER physician? Interestingly enough, those who are providing the reimbursement don't seem to conceive of this idea. And, given that the EMS systems are hospital based, I doubt they'd be happy with this... as they will lose customers.