Can paramedic or EMT administer an IM med like Haldol or Ativan to help unruly pt?

TraumaSurfer · May 17, 2011

And you have repeatedly made it obvious that you think paramedics are knuckle dragging, idiots incapable of doing anything but scooping up bodies onto ambulances and proceeding at a modest rate of speed to the nearest hospital where critical care nurses will step in and save their lives despite the presence of other members of the healthcare team. Long sentence!

No I don't believe all Paramedics are knuckle dragging idiots but the ridiculously low standards for entry into the profession do allow some in that shouldn't be touching patients.

I think I have mentioned other professions also. But, lets be real, who spends more time with the patient? A Paramedic or an RN. Yes, I have also acknowledge doctors, PAs and others including CNAs in my posts. Unfortunately there is not enough time to mention all of them and those posting here are primarily Paramedics and RNs. I doubt if you consider anyone is more important than a Paramedic for an MVC victim and would take any credit coming your way for a speedy trip to a hospital even if transportation was your only intervention.

Have you still not understood why there is little to no consistency in EMS in the US when it comes to education and testing? When was the last time you actually did something that advocated for the EMS to actually become a profession? Have you kept current with the latest legislation and how it affects different sectors? Do you belong to any EMS association that is active in the advancement of EMS standards?

I still don't know why you are becoming an RN with such a negative attitude towards RNs, their education and hospital techs of whatever title. But then you don't want to work in EMS either.

micuRNEMTP · May 17, 2011

Why did you bother becoming an RN if you knew it all already?
How much hands on time did you get as a Paramedic working in the ICU as a primary without the supervison of an RN?
You put CCRN with your name. Does that mean you were allowed to work in the ICU for hands on experience as an RN? Did you not get a chance to learn anything as an RN if you worked in the ICU or was it all a waste of time for you since you already knew everything as a Paramedic? Do you believe the RN is too stupid to learn 200 meds or ACLS?
Did you not understand that the RN degree was a foundation for what was yet to come and the education did not stop at graduation? Do you know the difference between that and the tech school prep for job readiness of a Paramedic? Once you understand these basic concepts you will know a little more about the different type of educational methods and the certification process for licensing. Bash nursing if you want but at least they have pulled their profession together for some common standards for education and testing. EMS has yet to do that. So I do not consider nursing to be a useless profession and EMS could learn a few things from the way they have managed to raise the standards for over 3 million nurses.

First, I don't know you, and obviously you don't know me. I never suggested that I know everything, nor did I remotely imply such. I was in orientation for 9 weeks with a ARNP and Critical Care P.A. in the ICU. When I work as a Paramedic, I am supervised by a physician, not a RN. When I work as a RN, then I am supervised as a RN.

I put CCRN behind my name, because I earned that title by doing the book work, time in service, and passing the test. I work in a very busy ICU, and work with some great RNs and not so great ones (same as working in the field good & bad medics).

Second, not sure why you seem to think that you can attack me. But hey if it makes you feel like a better person, then go ahead. I have never implied that I didn't learn anything as a RN, that I didn't already know as a Paramedic. I know lots of great RNs, who are hands above a lot of paramedics on their knowledge base, yet I also know a lot of Paramedics who are hands above those/equally as knowledgeable.

I believe that all RNs should know ACLS and the accompanying medicines. If they want to learn the in's and out's of 200 medicines, then I am sure that they can. I only said that I was not required to do this as part of RN school. Passing the NCLEX-RN merely opens one's self to the world of nursing, just as passing the NREMTP opens one to the world of EMS as a Paramedic. Both are a mere Learner's Permit to continue to learn.

As for Tech school, never attended. My Paramedic course was a college program. Be sure of who you are trying to "talk down" towards, especially when you have zero idea of that person's true identity. I happen to love being a paramedic, and being a RN. Bash nursing? I never did that before passing my RN boards, and have not done that in this thread or any other on this or any other site.

The one positive that I will agree with you on is the final statement, EMS could do a lot more to promote / improve their standards. Too many different rules abound state to state, yet if one actually takes the NREMT Paramedic, then they have actually taken the "set" standard to be Nationally Registered in any state, and thus licensed as a Paramedic in any state that accepts that standard for reciprocity.

What I find funny? I can go from a Paramedic to RN, through a college program in 2 semesters, yet at that same college, an RN has to attend all 5 Paramedic semesters. Yet, there are a few "crash" course RN to Paramedic courses available as well.

Either way, I love nursing, and I love being a Critical Care RN, as well as an EMT-Paramedic. The only thing I dislike about nursing? States such as mine do not require any CEUs once you are licensed. If you pay for your license every 2 years on time, then its a one and one type thing. How does that help the profession? At least my employer requires RNs to complete a minimum of 18 hours each year, and complete yearly competencies for each individual care area.

And to answer your next snide remark, sometimes it nice to be furloughed...

TraumaSurfer · May 17, 2011

What I find funny? I can go from a Paramedic to RN, through a college program in 2 semesters, yet at that same college, an RN has to attend all 5 Paramedic semesters. Yet, there are a few "crash" course RN to Paramedic courses available as well.

Could going from Paramedic to RN take only two semesters because you actually obtained a degree with all the appropriate sciences as you claim?

Do you think the 3 month wonders would be okay completing the RN in two semesters? You are the exception and not the rule.

BTW, the NREMT is also written easy enough for the lowest common denomonators which include the 3 month wonders.

Now, does the RN have to repeat all the science classes to be a Paramedic?

What state are you in? Is this a state requirement or just this particular college? There are other states that recognize the sciences and other certs, education or training of the RN and allow them to challenge the test or take an abbreviated course. Even better when they offer the RN a prehospital cert of their own to where there is not a conflict in licensure.

So what state are you in?

As far as the personal attack, read you first post directed at me. Don't really care who you are and maybe it is best if the RNs you work with didn't either as they might take your comments as less than flattering toward their profession.

ImThatGuy, BSN, RN · May 18, 2011

No I don't believe all Paramedics are knuckle dragging idiots but the ridiculously low standards for entry into the profession do allow some in that shouldn't be touching patients.
I think I have mentioned other professions also. But, lets be real, who spends more time with the patient? A Paramedic or an RN. Yes, I have also acknowledge doctors, PAs and others including CNAs in my posts. Unfortunately there is not enough time to mention all of them and those posting here are primarily Paramedics and RNs. I doubt if you consider anyone is more important than a Paramedic for an MVC victim and would take any credit coming your way for a speedy trip to a hospital even if transportation was your only intervention.
Have you still not understood why there is little to no consistency in EMS in the US when it comes to education and testing? When was the last time you actually did something that advocated for the EMS to actually become a profession? Have you kept current with the latest legislation and how it affects different sectors? Do you belong to any EMS association that is active in the advancement of EMS standards?
I still don't know why you are becoming an RN with such a negative attitude towards RNs, their education and hospital techs of whatever title. But then you don't want to work in EMS either.

Geez, you really infer some stupid ideas. When was I ever negative about RNs or hospital tech? Have I been negative about RN education. You're dang right I have, and I'll continue to be because it's nearly as flawed as paramedic education.

I'm not at all concerned about what EMS does in the other 49 states or what nurses are doing in the other 49 states. I'm not a lobbyist, and I don't care to be. I don't have the personality for it. I'll reiterate here that my concern is for the practitioner to do very well what he is allowed to do - whatever type of nurse/whatever level of EMT. Education isn't that consistent anywhere even for nurses. You can become a RN with four or five courses, or you can sit for the very same exam having taken some version of those four or five and additional health assessment, pathophysiology, pharmacology, core nursing classes, etc. I'm all for different levels of NCLEX/licensure in nursing. I don't know much about it because it's a new realm for me, and others appear to be against it.

All I can say for certain, based on MY experience, is that the respiratory, cardiovascular, and shock chapters of BSN acute care aren't nearly as comprehensive as the units of the same covered in paramedic school. The 3000 level, three credit hour pharmacology course covered in nursing school wasn't nearly as comprehensive as the pharmacology included in paramedic school. My 4000 level, three credit hour health assessment course last semester was also no more in depth than the 1000 level, two credit hour health assessment course I took in paramedic school. The only distinct element different in the nurse course was looking through an opthalmoscope and otoscope. The gastroenterology, nephrology, and urology of nursing school covered A LOT more than paramedic school did. However, the bulk of what I gleaned from that is merely what a doctor is going to do about it rather than what I could do about it as a nurse. Add in nurse things like continence, ostomy care, ambulation, gerontology, and that's a difference. The fluids/electrolytes/pH education was about the same in both although a larger focus in the nursing component was dietary acquisition of lytes while a larger focus in the paramedic version was IV fluid selection. This fall I'll take OB/Peds among other courses. I guarantee I'll be screaming the opposite. I'd say as a whole paramedic school sucked when it came to teaching peds. It was more of a cursory glance that included "kids aren't small adults, memorize the pedi vitals, meds are weight-dependent, and good luck." However, I only had four pediatric patients in five years as a paramedic. The OB will be the same. I scored well in OB on National Registry, but I can't for life of me remember a lot of OB stuff although I'm not sure I want to remember it, lol. I wish I didn't have to take OB this fall, but it's part of nursing. It'll be much more comprehensive than paramedic school was on the matter. The book alone is the size of a tractor tire.

In short, being a nurse and then going to paramedic school is going to make a good paramedic program a heck of a lot easier. Having graduated from a great paramedic program, I can attest, has made a good nursing program hands down easier, and because of that knowledge and experience the "difficulties" of nursing school are alien to me.

Again, you didn't mention what you do for a living.

ETA: In the year of nursing school I just completed I did 144 hours of clinical rotations. Paramedic school required 600 clinical hours. Nursing school is 60 college credit hours. Paramedic school was 44 college credit hours.

micuRNEMTP · May 18, 2011

This thread is way off base. The original question regarded medicines that Paramedics can administer.

If you aren't a paramedic, then refrain from telling those of us who are, just what we can and can not do. In addition, the paramedic scope of practice/guidelines varies from state to state, service to service. What I can do here, another paramedic in a different state/country/service may not be able to do.

My apologies for helping distract this thread's initial direction.

ImThatGuy, BSN, RN · May 18, 2011

This thread is way off base. The original question regarded medicines that Paramedics can administer.
If you aren't a paramedic, then refrain from telling those of us who are, just what we can and can not do. In addition, the paramedic scope of practice/guidelines varies from state to state, service to service. What I can do here, another paramedic in a different state/country/service may not be able to do.
My apologies for helping distract this thread's initial direction.

I hate it too, but it always happens when TS and others trained as paramedics end up on the same thread.

micuRNEMTP · May 18, 2011

In short, being a nurse and then going to paramedic school is going to make a good paramedic program a heck of a lot easier. Having graduated from a great paramedic program, I can attest, has made a good nursing program hands down easier, and because of that knowledge and experience the "difficulties" of nursing school are alien to me.

You should do fine... I learned a lot in Paramedic school, then further expanded that knowledge base in RN school... NCLEX was 75 questions long, and from clock in to clock out under 40 minutes... Thank God, I didn't get a lot of OB questions, as I hate OB, always have since day 1 of paramedic school until the 15th birth certificate that I had the displeasure of signing. Heck on those calls, I wish I could have given myself that dose of Haldol/Ativan... I never got comfortable with those calls... Just not my thing.

socalmedic · May 18, 2011

to the OP, as a paramedic I can give IM haldol for "acute behavioral incidents" as well as iv/im valium or versed. this is all within my standing orders, no need for the medical control doc to say yes. I do use sedatives and anti-psychotics often, the ERs dont like me bringing in fighting patients and I dont like to be in a 6x8 box with them. yes i also have RSI in the field. succs, roc and etomidate, this is a skill that is gaining acceptance in the EMS world but is still kinda rare, it is increasing in practice though.

as for the RN verses Medic argument, cant we all just get along. you have your skills and I have mine. we both have very different jobs, and I like mine I dont want to take you job away.

to the medics here, if you ignore TS he will go away.

TraumaSurfer · May 18, 2011

to the medics here, if you ignore TS he will go away.

Do you think such a question would even be asked if EMS had evolved in the medical world a little more in the US?

How many just know they have the meds but have no idea about the EBM behind them?

Ignoring the problems is exactly why EMS has remained the same or gone backwards in eduacation for almost 50 years.

ImThatGuy, BSN, RN · May 18, 2011

Do you think such a question would even be asked if EMS had evolved in the medical world a little more in the US?
How many just know they have the meds but have no idea about the EBM behind them?
Ignoring the problems is exactly why EMS has remained the same or gone backwards in eduacation for almost 50 years.

I think everyone here will agree that we strive to understand physiology, pathophysiology, and pharmacology as it applies to our practice and then some. That (plus better salary) is probably why a lot of EMT-Ps here decided to become RNs. Chances are if we care enough to come to a discussion board and talk about something then we have pretty strong feelings about our respective fields, experience, training, and education.

I'm sure we're also all aware of "those paramedics" who didn't learn all that and merely learned what drug to use and when. It's sad. I didn't like working around people like that, but it's not so much a product of the education as it is the person. I stand by the fact I went to a top notch program, but even still others I tested with didn't know or care to know the details. There are nurses that are the same way, and I'll wager a number of professionals in all walks of life that don't understand why they do what they do but rather do it because that's what they're instructed to do.

Requiring an associate's degree or even a bachelor's degree to become a paramedic would be fine by me, but it's unlikely to happen because most (not all) people that get into EMS aren't the typical icon of higher education and thus aren't the most studious of people. Additionally, few EMS systems, particularly those not fire/gov't based, don't pay enough for the average Joe to care about taking the liberal arts courses and putting in the initiative to get some type of college degree. Most people don't go to school for grins and giggles. They want some money at the end. If you want EMS to become a field that requires more higher education then you're going to have change both salary (which isn't going to happen), and you're going to have to provide room for career growth (which also won't happen unless it's a fire/gov't based system). For that matter, how many private or hosptial service medics and EMTs have you seen walking around with the back of their shirt tail out, food stains on the front of their shirt, wrinkled uniforms, days worth of stubble, and even morbidly obese? You'll see them even on tv. That used to be my assigned partner when I worked. Real confidence inspiring. Then again, I'm a uniform nazi.

TraumaSurfer · May 18, 2011

they want some money at the end. if you want ems to become a field that requires more higher education then you're going to have change both salary (which isn't going to happen), and you're going to have to provide room for career growth (which also won't happen unless it's a fire/gov't based system).

you can not say education does not improve wages or bargaining power with a professional association or legislation. look at nursing and how their standards came about for their profession in the 70s giving it a chance to grow. look at occupational therapists, physical therapists, speech therapists, radiation therapists, radiology technologists, lab technologists and respiratory therapists. all of them have raised the educational standards and have positioned themselves very well with the legislators and insurances. some of these professions were just techs with certificate or diploma programs for education and jobs that paid minimum wage.

very few tech jobs have career ladders which is what ems still is unfortunately. until the standards for the lowest common denominators are raised, including the 3 month wonders, nothing will change. because ems is a tech profession, in the state scope of practice, generally every medication allowed for the paramedic to give is listed. if it is not listed, rarely will a medical director be allowed to place it in the paramedics protocols without a lengthy wavier application. other professions have open ended scope of practices with broad terms which allows their medication list to be expanded easily. that is also a difference between tech and professional status.

you can not now give someone the money and then expect them to go to college. if you can still do everything for more money without the education what incentive is there. it is not different than someone who is a bookkeeper with an assoicates degree wanting the same money as a cpa with a masters degree.

an associates degree in ems is not all liberal arts classes. while math and english comp might not be considered all that cool they are necessary. usually sociology or psychology can be used for the one humanity requirement and either of those should be essential to the education of a paramedic. unfortunately when most in ems fail to realize the revalence of such courses, then there is no point arguing that education is of any value. well over half of the paramedic programs are taught at tech schools without even a decent a&p course and the others are taught at community colleges that have a cert program and also don't require college level a&p.

even the university of tx health sciences has a certicate program that is only about 1000 hours in length total.

http://www.uthscsa.edu/shp/ehs/emt-paramedic.asp

here are examples of some two year degrees.

http://www.alvincollege.edu/emt_ems/pdfs/emt.pdf

https://www1.dcccd.edu/cat1011/programs/degree.cfm?degree=paramedicine_aas&loc=2

brookhaven also has a bridge for rn to paramedic which is 12 credits.

http://www.brookhavencollege.edu/instruction/h-h-services/ems/bridge-program.aspx

http://www.cnm.edu/depts/hwps/progs/pubsafety/ems/paramedic_program.php

ImThatGuy, BSN, RN · May 18, 2011

you can not say education does not improve wages or bargaining power with a professional association or legislation. look at nursing and how their standards came about for their profession in the 70s giving it a chance to grow. look at occupational therapists, physical therapists, speech therapists, radiation therapists, radiology technologists, lab technologists and respiratory therapists. all of them have raised the educational standards and have positioned themselves very well with the legislators and insurances. some of these professions were just techs with certificate or diploma programs for education and jobs that paid minimum wage.
very few tech jobs have career ladders which is what ems still is unfortunately. until the standards for the lowest common denominators are raised, including the 3 month wonders, nothing will change. because ems is a tech profession, in the state scope of practice, generally every medication allowed for the paramedic to give is listed. if it is not listed, rarely will a medical director be allowed to place it in the paramedics protocols without a lengthy wavier application. other professions have open ended scope of practices with broad terms which allows their medication list to be expanded easily. that is also a difference between tech and professional status.
you can not now give someone the money and then expect them to go to college. if you can still do everything for more money without the education what incentive is there. it is not different than someone who is a bookkeeper with an assoicates degree wanting the same money as a cpa with a masters degree.
an associates degree in ems is not all liberal arts classes. while math and english comp might not be considered all that cool they are necessary. usually sociology or psychology can be used for the one humanity requirement and either of those should be essential to the education of a paramedic. unfortunately when most in ems fail to realize the revalence of such courses, then there is no point arguing that education is of any value. well over half of the paramedic programs are taught at tech schools without even a decent a&p course and the others are taught at community colleges that have a cert program and also don't require college level a&p.
even the university of tx health sciences has a certicate program that is only about 1000 hours in length total.
http://www.uthscsa.edu/shp/ehs/emt-paramedic.asp

you do not read before you go flying off the handle. i'm all for liberal arts and higher education. i'm a perpetual student myself. i don't know why you think i'm in opposition to that. :confused:

what i was describing is that most people want more pay with more education, and private ems isn't going to shell out for it. get all the degrees you want. around here private (corp.) service paramedics will still make about $12 an hour, max unless they work for the city fire department i live in which 2.5% more for each additional degree. what the rest of the country is doing i don't know, but i'll wager that random private ambulance service isn't going to let johnny q. paramedic walk in and say "well, i've completed my b.a. in history. i want a raise now."