emergency dept staffing with paramedics/emts

doc522 · Jan 28, 2001

I work in a trauma level 1 hospital in Detroit. Most of all the hospitals have techs in the ER. They may be an emt, paramedic, or nursing student, depending on the hosp. Each hospital has there own job protocols laid down. At no time is anyone trying to take away the job of a nurse. But it is nice to have a tech who can lighten the load by doing things such as 12 lead ECG, labs via venapuncture (saline locks in some hospitals), foley caths, Dr. assist/standby (witness), trauma (CPR, surgical prep, etc.), stock and so on. More or less they are there as a third hand. NOT to be nurse replacement. YES, nurses are over worked and have much responsability, but would it be nice to have someone assisting you? Paramedics hold a very important role in EMS. Most are great at there job, then you have the few bad apples that make it look like they skipped class for the course. But you know, the same applies to nurses. Then what do you say about the 10-15 year experiance of emt/paramedic who has seen more GSWs, trauma, and cardiac disorders..., then you have a nurse who has

Flight Medic · Mar 12, 2001

I am really tired of this discussion. I have been in the heart of this topic for over 7 years. And yes, as per the "regs" here I am both an RN an Medic. I would hate to have more RN's mad at me for posting in a bb where once again you "must be an RN" to do something. I am from Iowa, we have medics in the ER with a turnover of about a year. WHY?? Because these competent and skillful people are treated like crap by the nursing staff. Get over it. Has healthcare EVER been black-and-white?? Docs themselves say they practice the "art" of medicine, not the exact science. Paramedics are priceless (although most ED's find a way to pay them less than $11/hr). We need to find a way to work together, for the best interest of the patient...or have we forgotten we are working in the best interest of the patient?

Charles S. Smith, RN, MS · Mar 13, 2001

In our ED, we have a full schedule of paramedics and we love them. RNs focus on the nursing process and medics focus on the delegated tasks. Our RNs and medics have a great relationship because the RNs also teach as we practice. The medics are also in the field and any teaching we can do to prepare them better for pre-hosptial care, the better our patients are when they arrive on the scene. In addition, a hefty percentage of our medics are pursuing RN education. Some of our nurses are also medics. It makes a pretty stable work environment and facilitates the care of our ED patients efficiently and effectively. Our ED serves as a medic/cardiac tech training facility and in our city we have a program of accelerated RN education for medics. Not perfect, of course, but very workable.

regards to all

chas

Ratnikal · Mar 13, 2001

Hello everyone,

i have been a Paramedic for 12 years, and now in the fall I am finally getting off my rump and starting Nursing School. I am in the process of taking non-nursing courses, and this stuff sure is a lot different and more in depth than anything in Paramedic school, as I am sure nursing school will be , too.

Now to the question posed, Paramedics can be a great asset in the ER, or in other areas of the hospital. Our skills are used often in the field (IV's, blood draws, intubation, etc...), and we are so very used to making split second life changing decisions every day.....with no Doctor around for us to confer with, or other healthcare professional. This does not mean I think Paramedics should take the place of a nurse, nor do the job of a nurse.....we are not capable of doing that. However; triage, code teams, clinical skills we can do very well and can take a lot of the pressure of nurses. Also, most nurses I know (ER included) are very nervous or worried about taking such classes as ACLS, PALS, etc....most Paramedics can recite these treatment algorythyms in there sleep (when you work 24 hrs shifts which is the norm for Paramedics, you have to be able to)....in the hospital setting Paramedics are awesome instructors in these classes!!

In summary, I know that the education requirement are hugely different, training standards and length of programs are different but don't sell the Paramedic short, because at what we are trained to do, I feel there is no other healthcare professional better.

Just one other footnote about training, you cannot become a Paramedic by studying at home, like a nurse can through Regents College. In comparing my clinicals for the RN program I am beginning, it only has 200 more clinical hours than my Paramedic program, not much difference.

later

TDGEMTIV · Mar 16, 2001

First I would like to reply to ntg with I have seen some paramedics that I would trust with my life and my family's life more than I would some of the RN's that I have met. You obviously have not. I am an EMT-IV and I also work in the ER of my hospital as a student nurse. To be able to get on in this ER without prior years experience you have to have "EMS Experience". Gee, I wonder why that is. A lot of EMS personnel make dang good ER techs because of being in the pre-hospital field we are more experienced at making quick decisions. Paramedics are taught to give meds and other treatments on their own, whereas a nurse must have a Dr usually telling them what to give. But to the original subject posted, I think hiring EMT's and Medics in your facility would be of excellent benefit to your department. We have certain restrictions with our scope of practice since we are in the ER and not in the field. I really think that my EMS experience has helped me feel more comfortable with my job as a student nurse. I am not trying to take anything away from nurses because they are a necessity. But with the nurse to patient ratio these days and the ER being used as some people's primary care physician, EMS personnel could really come in handy. And for ntg you need to quit feeling threatened by Medics because they aren't going to take over the nurses role. They can be there to help you if you allow them. Most of them are pretty intelligent when it comes to their work. And to answer your question: If I were alone with a paramedic and a nurse and I was dying, I would rather have the paramedic working on me because they are trained to deal with emergency situations on their own when I have seen some ER nurses spaz out. I am not knocking nurses because I'm fixing to be one myself as well as the EMT and eventually a paramedic, but I think that some people should really open up their eyes to what this place would be without EMS

PA-C in Texas · Jan 12, 2004

Some of the absurd comments in this thread really drive me crazy. I can't speak to the issues facing other states, but in Texas, Paramedics can be licensed, and obtaining that licensure requires at least as much education as an ADN. I was a paramedic for six years and I got my Bachelor's degree in Emergency Health Services (Bachelors for Paramedics), then went on to get my Master of Physician Assistant Studies at Texas Tech.

I will never forget the scorn that the ED nurses gave us when I was doing my clinical rotations to become a Paramedic. They particularly didn't like it when the ER Physician would have us come intubate someone in the trauma bay. Nurses do play an important role in health care, but I constantly see nurses knocking other professionals as having substandard skills or education. I worked as a tech while in PA school, and now that I am out in the world, and still involved with EMS, I can say that I would much rather have an individual who just graduated from Paramedic school than a newly turned-out nurse in the ED where I work as a PA. Paramedic school teaches you how to function independently and to use critical thinking skills to thoroughly assess and treat a patient without supervision. Nursing school has always seemed like a two-year indoctrination into a sorority where you learn how to write patient care plans.

Quite frankly, nurses are afraid that their jobs will be lost to Paramedics, hence the animosity. They see people who can work independently and perform many advanced proceedures that nurses cannot. They fought licensure tooth and nail in Texas because they knew they would be loosing the thing that they constantly dangle over people's heads. When I was in Paramedic school and the nurses behaved so badly, I used to remember that while they are minding their foleys and counting calories for the diets they are working up on their PCP's, I will be out doing a rapid sequence induction. Now that I am the one writing the orders, I try to be slightly more friendly to the nurses than they were to me.

Wa State RN · Jan 12, 2004

I am an RN and have had extensive background as a Paramedic in the state of Arizona. Before I left Arizona I worked in an ER as a paramedic (this was before I was a RN). The ER I worked in utilized Parmedics effectively, they were not used to get "leaner" in the ER, in fact, it was proven that most ER nurses did not like to do triage. The constant banging at the triage window, having to deal with unruley patients that wanted care NOW! So they developed a program for paramedics to come in and do ALL the triaging, in fact, what do paramedics do best???? They triage and treat the worst first, in most cases. They are well trained to handle "multiple" people at the window, sure it did get hairy at times, but no worse than on the streets. When we weren't triaging in the front, we went to the back and assisted the docs and RNs with procedures, lab draws, IV starts, documentation of discharging people and helping with in coming ambulance patients. It worked great, and I can tell you that the RN's were happy they never had to do triage again,,, in fact, there are a few hospitals there that do this successfully, but yes, the hospital is taking responsiblility for the paramedics actions and ongoing training and documentation is required, hope this helps!!!

Medic946RN · Jan 12, 2004

Before I became an RN I was (and still am) a Paramedic for over 20yrs. I have worked in facilities where they employed medics in their ED and it worked smoothly. The paramedic was allowed to utilize their full scope of practice, no one felt threatened and the hospital didn't even think of replacing RN's with medics.

I can tell you one thing, the difference between me treating a chest pain patient in an ER room or back of an ambulance is nil. Both pt's get 02, IV, 12 lead, NTG, NTP, ASA and MSO4. The only real difference is as a paramedic I have much more autonomy and can do all those things without even speaking to an MD. In the ER I have to get orders for the meds.

As a nurse I have a broader knowledge base now and I am familiar with a multitude of medications, and proceedures I never needed to know before. But in today's fast paced, over crowded ED, unless I'm holding an ICU patient, I function basically as a glorified paramedic. (Don't hit or yell.) We treat 'em and move 'em. Just my observation.

erjulie · Jan 14, 2004

I currently work in a Level 2 trauma center where we employ EMTs and paramedics in the ED. We also have a Flight team whose paramedics are "dedicated" in the ED on nocs. There is NO ONE I would rather have next to me in a bad trauma then those paramedics. NO ONE.

We are unable due to law to have paramedics triage, but we have a nurse/tech triage system, and I almost without exception want to be teamed with the medic.

We are severely stressed with overwhelming numbers and "holds", and nursing just cannot be everywhere. As in all walks of life, there are some exceptions to the rule, however, I find that this is about equal between all professions.

The biggest asset to a young night staff is the paramedics.

Our paramedics are not nurses, and do not do nursing care. They do foleys, line starts and draws, transport stable patients, CPR, but their level of expertise in "watching over me" is un-rivalled (sp?) especially when (as usual) there is really not a nurse available who can "abandon" her own patients to help me with a crashing patient. I would not be able to be as effective, especially with family, without the EMTs and paramedics. They can keep on eye on the pt while you are dealing with family, or the PD, or whatever. There is no room in this profession for "I don't want them to do my job", I am GLAD someone is willing and able to help me!

veetach · Jan 14, 2004

I totally agree with Julie. I have worked with Paramedics and Emts in the ED, and have never had a bad experience. When bad things go down, I love nothing more than to have a Paramedic at my side.

IMHO Paramedics are a very valuable asset to the ED, and I only wish that the hospital where I work currently would allow it again. (we used to have medics working in and based out of our ER) new management has changed that... unfortunately

I am also an advocate of Paramedics becoming RN's. Some of the best RN's I know are Paramedics, and I salute you all!!!

marcicatherine · Jan 14, 2004

I also agree with Julie. In a code situation, paramedics are extremely valuable. That is what they know, that is what they do best.

We also work on a RN/Paramedic triage system. Again, the paramedics often spot little things that sometimes a RN may miss.

I also turn to paramedics often on the hard IV sticks. For God sakes they put in lines while going 75 mph and bouncing around in the back of an ambulance!

The day we stop employing paramedics will be a sad day indeed.

mercRN · Jan 16, 2004

In our hospital we use EMT's and Paramedics. Our paramedics can push emergency drugs, intubate, and start lines, as well as do dressing changes and EKG's. Our EMT's do alot of our phlebotomy, EKG's and dressing changes. The Paramedic I work with the most is wonderful and teaches us about working in the field as well as what to look for in certain situations. I know he was talking to a friend of his who works in a bigger city hospital about paramedics in the ED and they pay their paramedics $18.00/hr. I don't know what our medics make but he was impressed but didn't want the hour drive to work every day. We live in Ohio but I will try to get more info on employing EMT's and Paramedics in the hospital.