emergency dept staffing with paramedics/emts

Deb Rn · Nov 19, 1999

Many communities are lucky to have paramedics that are ACLS certified. In my community, we Have EMT's, who are essentially transport personelle, and often can't initiate an IV or do a blood sugar. The skills are varied and we are trying to achieve one standard for them all. Some arrive in terrible condition, and other patients arrive with an IV established cardiac patches on and have had a course of 3 nitro for CP. The way the patient arrive is dependant upon the crew. Very few of the are certified to intubate, so many arrests arrive with only an airway in place. Things are different all over, thought I would share my ER experiences! TY.

peggy miller · Dec 1, 1999

I work in one of the busiest ER's in my state, seeing about 70,000 patients a year. We only now hired 2 paramedics to work on our unit. We could sure use some extra willing CAPABLE hands. Well, you can imagine my shock when I learned they will only be "glorified aides". The only thing they can do extra ia starting IV's. I can't believe ER management is so ignorant to the capabilities of a paramedic!!!!! I know wellwhat they are capable of because I worked as one myself. I sure hope management changes their attitude!!!!!!! RN's and paramedics can work well together!!!!

HamiltonRN · Feb 2, 2000

I think paramedics have a place in the ED, but need to have a very detailed job description. I work as a RN in a community hospital with 55K visits yearly. Recently, management has started filling nursing vacancies on the schedule with paramedics. That practice is dangerous and puts undue strain on my liscense. Management says "It's better than no one." Our paramedics can start IV's, insert I&O and Foley caths, review d/c info with pt unless pt has a question which is then referred to a nurse, and assist MD's with pelvic exams and other procedures. They are expected to document, but a paramedic's documentation is nothing like nursing documentation. As a "float", there services are an immense help to an already understaffed ED. The practice of reducing liscensed staff and filling vacancies with paramedics must stop!

dparagod · May 22, 2000

Originally posted by CTURNEY:
I am the unit coordinator for an emergency dept which staffs all rn. we see over 42,000 patients yearly and we are working on certification for level 2 trauma center. my administration is interested in staffing with paramedics or emts. can anyone give me any feedback: salaries, experience with emts in eds, licensure, any info?

I have worked in several emergency departments, both Level 1 trauma centers and not, in all instances there were both EMT's/Paramedics,. It has been my experience from the nurses and doctors that they are very valuable, you forget that in the field pararmedics are required to make judgement calls and adapt to situations it is not like inthe ED where you are working in a vacuum environment where yo9u have all the resources you need, i think that in any situation parramedics in the ED are priceless, i am not saying this as a paramedic ias i am also a registered nurse.

MissyS · Jun 27, 2000

Having worked with and without techs in the ER, I have to say that I do enjoy having techs working with me. They provide a great, yet underpaid service. As far as having paramedics replacing RN's in the ER, I think that would be the greatest mistake the medical community could make. Paramedics, while they provide a great service within the confines of their practice, are not nurse's. Neither are physician's assistants. Look what has happened in physician's offices. How many of you have had a patient tell you "why didn't they tell me this in the doctor's office? I wouldn't have had to come tonight to the ER?" Statistically, it has been proven that better patient outcomes are related to RN intervention. Let the administrators and the leaders of our own profession phase nursing out of the medical system. Then, what will patients do? Most nurses are 45 years old. What will we do when we need a nurse? Let us instead "encourage" the hospitals that employ 65% of active RN's to raise salaries to compete with business. We provide a needed service. Ever wonder how "they" make it from birth to death? Mostly the ER's and patient teaching provided by the RN's.

Nurseprotect · Jul 30, 2000

In July 2000 I was working with an EMT in an ER in Houston Texas. Although they are not allowed to assess and triage patients I know this was probably occurring-I was working as an agency nurse at this Hospital. I was quickly preparing a "hot appy" for the OR when the EMT stated that he had placed a new pt. into a room for me. He said he had triaged the pt to the waiting room for an hour and indicated that the patient was stable. Approximately 15 minutes later I was able to assess the new patient. He was obtunded and not even on a monitor! His wife said he was normally just like everyone else and this was a completely new change that happened suddenly. To make this short, he was taken off the monitor and taken to CT scan in my absence and with the permission and direction of the Charge RN who said he was stable-she didn't even assess him or look at him. He arrived back to the ER as I was preparing to go to CT to monitor him continuously and proceeded to go into respiratory arrest within 10 minutes after his return. Toxicity screen and CT were negative. He was intubated and transported to the ICU. The judgement of the EMT in triaging this patient into the waiting area was poor-we are talking about an obtunded patient with no significant past medical history-a 37 year old business executive. The EMT's present on the 5 shifts in which I worked at this facility kept turning off the alarms to my patient's monitors (I think I was the only RN turning the alarms on because they "bothered" everyone. This ER focused on herding the cattle and not focusing on safe care. In this situation the EMTs were given a sense of too much control. I want to make it clear that I would not argue with the fact that there are probably many EMTs out there who I would much rather have my care being provided by than many licensed nurses with whom I have worked. Critical thinking and advanced knowledge and assessment skills are mandatory for effective and safe care. EMTs are trained to follow a lot of "cookbook" type stabilizing measures and very little about critical thinking-there is a big difference. I am also probably wasting my time writing this because it is not going to change anything in health care. Health care will continue to go down the drain and the use of cheaper unlicensed personnel will become the norm.

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Steven S. Lee, RN

Chief Voluntary Officer

Nurseprotect

[email protected]

babynurselsa, RN · Sep 5, 2000

as far as I see with ntg and nurseprotect, is that old attitude. There is a definite benefit to having EMT's in the ER. My

er only in the last few months began to employ EMT's. We had utilized techs for years. Some of our techs were even allowed to triage. I have many friends Who are paramedics who I would totally trust their judgements. I think their scope of duties should be based on whether they are a basic or a paramedic. Think about this, can you run a code alone? Much less in the back of a moving truck?

And as far as discharge teaching goes that should be the nurse's responsibilty. That is a legal issue. If you are turfing off your dc to personell then SHAME ON YOU.

The role of these people is not to replace nursing staff but to provide an important link in the chain we call teamwork. Of course nurses as a whole have a hard time with that one most of the time.

sammy75 · Sep 9, 2000

I got my EMT certification in Jan 2000 and thought about working as an ER Tech while i was going to nursing school but I'm glad I read this board before I made that move. There seems to be a lot of hositility between nurses and EMT/Paramedics. The only purpose should be taking care of the patients.

edrn · Oct 5, 2000

I know of some smaller hospitals that use paramedics in an assistive role in the ed, thatrespond from the hospital in the ambulance for calls. Between calls they are utilized to initiate iv's, assist with phlebotomy and intubate if necessary (many have more experience than the docs). It works for them. We hire them as techs. only. Although the role is a bit degrading the pay is much better. They make awsome techs. As an rn/emt I respect both roles and believe the happy medium is institution dependent. Right now staffing is so poor I can't imagine extra, qualified hands to be refused. It's patient safety. I prefer an RN/Paramedic then an RN, but with the shortage right now, who could say no to helping hands?

BellaC · Oct 9, 2000

I have worked in critical care for 12 years. The last 9 as a critical care tech. We are a level 2 truama center and have a CABG program. I know ALL of the equipment and can assist with any procedure that is performed at the bedside. I can trouble shoot any of the equipment and act as a resource person for the never ending stream of new and inexperienced staff. I also get calls to the ED when there is a bad trauma coming in to help with line insertions and other support that I might be able to provide the staff. They are happy for the help. Keep in mind that there are reason that nurses don't always like the ideas of techs. Hospital administration wouldn't know a really patient if they tripped over one. Nurses are overworked, underpaid and taken for granted. Now some institutions want to fill vacancies with techs. I am really good at what I do. There isn't much that I can't help with in one way or another. However, I can NEVER take the place of a nurse. Nurses have their own lives and families to be concerned for in addition to thier patients' care. All anyone involved in direct patient care wants is to be able to go home without worring about something that they did or didn't do that might harm their patient. If you are going to nursing school a tech job would be a great way to get orientated to the hospital, gain clinical experience and get a really good look at what the "real world" is all about. Check out the job description. Then check out your state nurse associations guidlines for use of UAPs. Talk to some of the people that you would be working with. If one of the gals I work with doesn't have something she needs for her patient I usually can dig it up for her. They don't have to troubleshoot equipment or get tied up in a room for an hour doing a procedure with a doc. This frees up some time for them to spend with thier patients and families. Every little bit counts. If the nurse can trust you to do your job and do it well then you can work as a team to provide a patient with the best possible care. Good luck.

[This message has been edited by BellaC (edited October 08, 2000).]

RNC · Jan 22, 2001

The New York State Nurses Association does not want unlicensed people doing nursing jobs anywhere. If paramedics want ED work then there are plenty of RN programs they can enroll in. I work as a BSN and volunteer as a EMT, paramedics don't have a clue about patient care in the same way nurses do. They do not have the training that RNs do and legislation against this practice of non-licensed staff doing licensed nursing work would be illegal. Check out your nurse licensing rules and regs and ask your state licensing boards. Protest this outrage against nurses, protect your rights to practice nursing!!!

RNC · Jan 22, 2001

Originally posted by sammy75:
I got my EMT certification in Jan 2000 and thought about working as an ER Tech while i was going to nursing school but I'm glad I read this board before I made that move. There seems to be a lot of hositility between nurses and EMT/Paramedics. The only purpose should be taking care of the patients.

Before EMT/paramedics there were nurses and social workers & pharmacists fighting over practice turf. It is a developmental process. Before EMT/paramedics existed 30 years ago nurses ruled. Nurses have been around for 100 years so we are having a turf war with the emt & paramedic, so what, toughen up!