Article: Paramedics equal to RNs

[SummitRN]

In an article published on the major EMS website, EMS1, an article claims that Paramedics have more education than nurses and, through unbelievable math, are nearly as qualified as a nurse with CCRN and CEN certifications.

Why paramedics are qualified emergency care providers

This article is making the rounds on Facebook as Paramedics advocate to practice with similar or greater autonomy than RNs in the hospital environment.

[BR157]

Probably the same thing as some Flight Paramedics do who are hospital based or who are already working to their full scope in some ERs now. They can start IVs, do triage, give medications, transport monitored or vented patients, intubate anywhere there is a need, respond to emergencies and even do interfacility transports if there is a need. Many residents (doctors) turn to Paramedics for intubation advice especially when they do their EMS ride along. Paramedics are versatile especially in emergencies. RTs are not really needed in most situations where there is a Paramedic present such as in the ER and on rapid responses or codes. The Paramedic can be a greater help to the RNs and Doctors than some of the others who respond now.

[BR157]

When discussing RSI, you're still in the ACLS realm.

Zofran for nausea, ativan for seizures, morphine for trauma pain, other than those, I believe we're right back at ACLS meds. Correct me if I'm wrong.

The CCT RN manages the iv's-meds, not the medic. At least in NY/NJ. Maybe not in TX.

I will gladly correct you since you are wrong.

ACLS is Advanced Cardiac Life Support.

RSI is Rapid sequence intubation. Sometimes cardiac patients need intubating and sometimes not. There are also more pharmacological ways to intubate besides just RSI.

The typical ACLS algorithm does not go into RSI. Intubation method of choice with be the preference of the intubator, agency and the use of that specific protocol.

Paramedics carry many medications and they don't call an RN to give an IV medication.

This is a small sampling of what just a Paramedic can carry but may give more. Space is limited on an ambulance. CCPs can carry many more and usually give all the same meds as an RN.

Adenosine

Albuterol Sulfate

Amiodarone

Amyl Nitrate

Aspirin

Atropine Sulfate

Bumetanide

Calcium Chloride

Calcium Gluconate

Dexamethasone

Dextrose

Diazepam

Diltiazem Hydrochloride

Diphenhydramine Hydrochloride

Dopamine Hydrochloride

Duodote

Epinephrine

Etomidate

Fentanyl Citrate

Furosemide

Glucagon

Haloperidol

Hydroxocobalamin

Ipratropium Bromide

Levalbuterol Hydrochloride

Lidocaine

Magnesium Sulfate

Methylprednisolone Sodium Succinate

Midazolam

Morphine Sulfate

Naloxone

Nitroglycerin

Ondansteron

Oxygen

Pralidoxime

Prednisolone

Promethazine

Sodium Bicarbonate

Sodium Nitrite

Sodium Thiosulfate

Succinylcholine

Vecuronium Bromide

Here is an example of a Critical Care Paramedic job in New York.

NewYork-Presbyterian Careers | Job Search | Critical Care Paramedic

Transform your career at NewYork-Presbyterian, where you'll perform assessment and treatment while transporting patients to appropriate medical facilities. You'll join our Ground Based Inter-Hospital Neonatal, Pediatric and Adult Transport Team, working side by side with internationally renowned physicians affiliated with our Ivy League campuses. You'll utilize state-of-the-art technology, including mobile delivery of nitric oxide and Extra Corporeal Membrane Oxygenation (ECMO). And you'll thrive in a culture of continuous learning, within one of New York's largest Community Training Centers for American Heart Association programs. With over 90,000 calls for service annually, you'll step into a fast-paced environment where paramedics see and achieve more than most can imagine.

[Yuppers21]

Truly, this is all very interesting as I have very little knowledge on the scope of practice a paramedic has. However, with all this back and forth banter I still have not seen a good argument for why paramedics are needed in the ER?

Probably the same thing as some Flight Paramedics do who are hospital based or who are already working to their full scope in some ERs now. They can start IVs, do triage, give medications, transport monitored or vented patients, intubate anywhere there is a need, respond to emergencies and even do interfacility transports if there is a need.

There are already staff that currently exist who can start IV's, do triage, give medications, intubate and run codes without paramedics. So how does the addition of a paramedic improve this? If an ER is understaffed, it is often due to budget issues, not lack of qualified applicants who can be trained for the role (of course, certain rural areas are the exception).

I can hardly argue agaisnt a movement to bring paramedics into the ER setting if there is a need for it. Is it a staffing and cost saving measure, such as the use of NPs and PAs in what was once strictly physician territory? Everyone can provide anecdotal evidence of an incompetent clincian in field A and a super star cowboy in field B, but that's neither here nor there. Smart, competent and hardworking people entering every field of healthcare. The question is how does incorporating a role that has been formed and molded to provide the best care possible pre-hospital into a model that has been functioning quite well on it's own without them benefit the population as a whole? I'm ICU, not ER so I am not aware of the particulars in this arena. No opinion here, just trying to understand

[Yuppers21]

Many residents (doctors) turn to Paramedics for intubation advice especially when they do their EMS ride along. Paramedics are versatile especially in emergencies. RTs are not really needed in most situations where there is a Paramedic present such as in the ER and on rapid responses or codes. The Paramedic can be a greater help to the RNs and Doctors than some of the others who respond now.

Sorry, I just have to address this as I feel you have completely undervalued the respiratory therapist in all this. A RTs value goes far beyond intubation and short term ventilator set up/management. While one can argue that a RT is not needed in a RR or code if a paramedic is present, no argument is needed to prove that a paramedic is also not required when a RT is present - because it is already has been done so -successfully- for quite some time now . I get what you are saying, but what I don't get is this - who needs a Jack of All (emergency) Trades when all the specialists are already there? MD, RN, RT, Tech? Again, ICU experience here, not ER so maybe I have come to some incorrect conclusions?

[emtb2rn, BSN, RN, EMT-B]

BR157,

Are you an RN, a nursing student or what with respect to nursing? Just trying to figure out where the chip on your shoulder comes from....

[TiffyRN, BSN, PhD]

So how does the addition of a paramedic improve this? If an ER is understaffed, it is often due to budget issues, not lack of qualified applicants who can be trained for the role (of course, certain rural areas are the exception).

I can hardly argue agaisnt a movement to bring paramedics into the ER setting if there is a need for it. Is it a staffing and cost saving measure, such as the use of NPs and PAs in what was once strictly physician territory?

Yes, is this a measure to fill a need, decrease costs, or create jobs for Paramedics? My husband went from medic to RN (Excelsior). There was plenty to learn. He also had to learn to adjust to bring less independent. Hate it, but that's the truth, medics generally function more autonomously.

[BR157]

Sorry, I just have to address this as I feel you have completely undervalued the respiratory therapist in all this. A RTs value goes far beyond intubation and short term ventilator set up/management. While one can argue that a RT is not needed in a RR or code if a paramedic is present, no argument is needed to prove that a paramedic is also not required when a RT is present - because it is already has been done so -successfully- for quite some time now . I get what you are saying, but what I don't get is this - who needs a Jack of All (emergency) Trades when all the specialists are already there? MD, RN, RT, Tech? Again, ICU experience here, not ER so maybe I have come to some incorrect conclusions?

Many hospitals have already proven an RT is not needed in the ER or in most areas of the hospital. RNs, LPNs, EMTs and Paramedics can do almost every thing an RT can do and much more. KentuckyOne Health recently made this well known in national news as the RTs tried to challenge their lay off decision.

A Paramedic is much more versatile and has a very expansive scope of practice over an RT. Free standing ERs are now the thing of the future and RTs really can not go much outside of the hospital. Even some of the major hospitals which had utilized RTs on transport have began the transition to using Paramedics instead even with peds and neonates.

I hate to see anyone lose their job but sometimes you have to think about hiring the best suited professionals who have a more broader knowledge of patient care rather than just doing one thing in some patient care situations. It sucks to bring a patient into the ER who needs to be placed on the hospital's BIPAP, ventilator or even need to be intubated and having to wait 10 - 20 minutes for RT to be paged and arrive. Most of the time they don't have the equipment and have to go back to where ever and retrieve it which can take another 10 - 20 minutes. While the Paramedics need to get back in service, they often must stay to do what the RTs should be doing. It is frustrating for any of us involved in EMS as it stretches our resources thin to be held up in the ER but no Paramedic is going to walk out if they can stay and help. If another Paramedic was in the ER working under their full scope of practice rather than just as a tech, hand off would be much easier. The Paramedic could put the patient on whatever equipment, do the iSTAT or even intubate as well as assisting the RN with IVs and medications. The RNs usually have to draw the blood gases and then wait for lab or do the iSTAT themselves. The RT can only bag and put the patient on the ventilator in most of the ERs I have been in.

[SummitRN, BSN, RN]

I see comedy hour has returned. Here is BR157 to tell us how incompetent and useless all those associate and bachelor prepared RTs are. Tell us BR, is there any 2-4 year degreed healthcare profession that a 1 year vo-tech schooled Paramedic can't replace, at least for the cool and exciting” parts? You are the stereotypical paragod who thinks only in terms of skills, not knowledge, and it is based in your limited experience and ignorance of other professions. BR is a disgrace to his profession which does have many respected, professional, paramedics who rock at their job and don't have delusions of grandeur or insult other professions. Nobody is impressed by a list of 30 ACLS/emergency drugs you can give out of necessity in the prehospital field.

If he got a weekend crash course in a FAST exam, BR would be telling us how paramedics could replace ultrasound and echo techs, but not before explaining how they suck and a paramedic could do it faster and better.

[FlyingScot, RN]

Many hospitals have already proven an RT is not needed in the ER or in most areas of the hospital. RNs, LPNs, EMTs and Paramedics can do almost every thing an RT can do and much more. KentuckyOne Health recently made this well known in national news as the RTs tried to challenge their lay off decision.

A Paramedic is much more versatile and has a very expansive scope of practice over an RT. Free standing ERs are now the thing of the future and RTs really can not go much outside of the hospital. Even some of the major hospitals which had utilized RTs on transport have began the transition to using Paramedics instead even with peds and neonates.

I hate to see anyone lose their job but sometimes you have to think about hiring the best suited professionals who have a more broader knowledge of patient care rather than just doing one thing in some patient care situations. It sucks to bring a patient into the ER who needs to be placed on the hospital's BIPAP, ventilator or even need to be intubated and having to wait 10 - 20 minutes for RT to be paged and arrive. Most of the time they don't have the equipment and have to go back to where ever and retrieve it which can take another 10 - 20 minutes. While the Paramedics need to get back in service, they often must stay to do what the RTs should be doing. It is frustrating for any of us involved in EMS as it stretches our resources thin to be held up in the ER but no Paramedic is going to walk out if they can stay and help. If another Paramedic was in the ER working under their full scope of practice rather than just as a tech, hand off would be much easier. The Paramedic could put the patient on whatever equipment, do the iSTAT or even intubate as well as assisting the RN with IVs and medications. The RNs usually have to draw the blood gases and then wait for lab or do the iSTAT themselves. The RT can only bag and put the patient on the ventilator in most of the ERs I have been in.

I. Have. No. Words.

[ixchel]

BR157, or whatever it is - you clearly have no idea what the scope of practice of RNs and RTs is. Do you realize there is more to the ER than simply stabilizing a patient? Do you know what the RN and RT do after the patient is stable? RT goes WAY beyond simply intubating and giving some nebs.

I will never say I could replace you. Your experience in the field blows mine away in the hospital. But the hospital is my turf and no, you could not simply replace me, nor my RT coworkers. I couldn't replace my RT coworkers either. Actually, out of all the numbers I need to dial frequently, I have only three groups memorized - hospitalists, nursing assistants, and RTs. And guess which one I call first when a patient is at the very start of looking bad? RT.

No, you cannot replace them, nor would I want you to. Nor would I also want them or us to replace you.

[BR157]

BR157, or whatever it is - you clearly have no idea what the scope of practice of RNs and RTs is. Do you realize there is more to the ER than simply stabilizing a patient? Do you know what the RN and RT do after the patient is stable? RT goes WAY beyond simply intubating and giving some nebs.

I will never say I could replace you. Your experience in the field blows mine away in the hospital. But the hospital is my turf and no, you could not simply replace me, nor my RT coworkers. I couldn't replace my RT coworkers either. Actually, out of all the numbers I need to dial frequently, I have only three groups memorized - hospitalists, nursing assistants, and RTs. And guess which one I call first when a patient is at the very start of looking bad? RT.

No, you cannot replace them, nor would I want you to. Nor would I also want them or us to replace you.

Do you have RTs just in the ER? What do they do? From your post it seems you still have to call them every time you want them. They still have to come to you which means they have to leave their other patients. Yeah, Paramedic students have to spend a day or two shadowing RTs in the hospital and get to hear all about this.

I actually do know what happens to a patient after they are intubated in the ER and in the ICUs and in transport. Paramedics on flight teams do spend a lot of time in the hospitals.

RTs are great at ventilator management in the ICUs but they are very limited in what they can do beyond that. Even on this forum the nurses have talked about doing all of their own RT procedures. I am not saying anything new.

For the ER, and only in the ER, why have another healthcare professional with such a limited scope just hanging out or waiting to be called which could take 20 minutes to get to a critically ill patient in respiratory distress in the ER? You can't really say a Paramedic is replacing an RT in the ER when they are not there anyway. RTs will still be around in the ICUs.

Do you see the RTs as an "EQUAL"?

If you do, why can you not see a Paramedic as an equal team member?

The bill in Texas is not about replacing RNs in any way. It is about allowing Paramedics to work in the ER with the same scope of practice they have on the ambulances instead of just being a tech do EKGs and cleaning patients. Is that really so hard for some to accept? How about a team player who can actually help the nurses?

Doesn't anyone work with Paramedics now in the ER? Why do some think this it is so strange? Some hospitals like Vanderbilt have had Paramedics in their ER work to their full scope of practice for many years. Giving nebs and doing labs, including blood gases, are a huge part of a Paramedic's job in the ER already in some states. Texas just wants to get their state up to speed with others.

[BR157]

I see comedy hour has returned. Here is BR157 to tell us how incompetent and useless all those associate and bachelor prepared RTs are. Tell us BR, is there any 2-4 year degreed healthcare profession that a 1 year vo-tech schooled Paramedic can't replace, at least for the cool and exciting” parts? You are the stereotypical paragod who thinks only in terms of skills, not knowledge, and it is based in your limited experience and ignorance of other professions. BR is a disgrace to his profession which does have many respected, professional, paramedics who rock at their job and don't have delusions of grandeur or insult other professions. Nobody is impressed by a list of 30 ACLS/emergency drugs you can give out of necessity in the prehospital field.

If he got a weekend crash course in a FAST exam, BR would be telling us how paramedics could replace ultrasound and echo techs, but not before explaining how they suck and a paramedic could do it faster and better.

The only one calling RTs incompetent and useless is you.

RTs have been vanishing from the ERs, transport and some other areas of the hospital for a long time now. They are great at ventilator management but they are specialists and with a very limited scope of practice when it comes to helping out in the ER except for the ventilators. RTs are stretched very thin in the hospital and for them to come to the ER, they must leave other patients. Many RTs would rather not have the ER as part of their assignment. It is also not fair to their other patients to have their treatments missed totally because the RT is tied up in the ER babysitting a ventilator.

I will again tell you that Paramedics are not as uneducated as you make them out to be. I have quoted the Licensed requirement for Texas with the Associates degree in EMS required. A hospital can also require whatever higher education they want for a job. I have already made an issue about the skills thing when others tried going that route. Why is it so difficult for you to believe a Paramedic can have an education?

An ambulance may only carry 30 medications and some carry more. CCPs and FP-C do carry more. But, if a Flight RN only has access to 40 meds on a helicopter, is that person less of an RN? Paramedics may only carry a few meds but that does not mean their education has been limited to only those medications.

I would hope the ER doctors can do a FAST. US Techs usually work M-F 8 - 4. A CT Scan can be done if no US is available. But then there are small hospitals where the Radiology Tech is also the US Tech and is also on call after hours. Yes, Paramedics can be trained and educated to do US and Texas has had US on some ambulances for almost 10 years. I think your experience is very limited when it comes to EMS and the many different hospital settings.

You started this discussion but you failed to address the real bill involved in Texas. You came to the nursing forum wanting to ruffle some emotions rather than addressing the real bill you referred to. You are trying what the ENA chapter president did in Texas and the ENA ended up apologizing for her.

Now your post is more about name calling and personal attacks. You have no valid arguments. Paramedics have been in the ERs for decades and a few places allow them to practice to their full scope of practice and beyond in the ER. Texas just wants to give that a chance if there is a need in the ERs.