emergency dept staffing with paramedics/emts

Specialties Emergency

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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 been a paramedic for the last 5 years. I work full time for a busy 911 service and perdiem for a very busy 911 service. I was recently hired to work as a paramedic in a ED that see roughly 50,000 patients a year. I am also in the middle of obtaining my masters degree in Health Care Administration. My class is filled with nurses, therapists, and a few Dr's. I am the only paramedic . When my classmates found out that I had been hired to work as a paramedic in a ED I got mixed reactions. The onlder nurses were outraged, the younger or newer nurses thought it was a great idea. The idea of paramedics in the ER's is relatively new in my parts. I began reading this discussion board about an hour ago. I found that posts began in 1999 and are still being added to today. I re-read the first page of this post and the last page in this discussion. How the views have changed!!!

I think that when the idea of Paramedic in the ER came to, nurses felt threatened. Paramedics were not ment to replace nurses, they are ment to compliment the nursing staff. With my limited experiences working in the ER I have found that there are still nurses that treat the medics like crap, but for the most part where I work the medics are held in high regard. We are there to assist the nursing staff. Our job description is spelled out, but there is many gray areas. We primarily function to start IV's, draw labs, do 12 leads, we do splinting, foley's, stocking, and answer all in house codes. Our primary responsibility when going to any code is to entubate and if a DR is not present, to begin ACLS measures. This is generally the only time we push meds.

I found this discussion topic very interesting. Much of what I have read is true. People don't like change. Paramedis in the ED is a big change. But in the face of our national nursing shortage I believe that you will see more and more hospitals adopt this program. With the right leaders and a strong job description I think that this would be a nice fit for many Emergency Departments.

Sorry I seemed to ramble on but I am still processing all of the posts that I have just read. Just trying to throw out some of my initial thoughts..........

When Arizona trained their first class of paramedics out of J.C. Lincoln hospital I had the pleasure of working with all of them. And I wouldn't have had it any other way. And for the past twenty plus years, no matter what state that I have worked in, nor the size of the ER, they have always had paramedics there.

And I wouldn't trade their skills for anything, and to be honest, if they told me that they were going to take away the paramedic and send me another RN, I would not be happy. Especially when they would try to send an RN with no emergency experience.

There is a place and need for all of our skills. Nurses will never be replaced in an ER, and they won't be eliminated on the floors. If I can get trained helpers I am definitely going to use them. And in a bad trauma, give me a paramedic anyday!!!!!!!

To the paramedics in this forum: Thank you for being there for us.

The point is that I look at Paramedics and don't see them as helpers. They are not little techs who run around and perform the various skills that you would have them do. Rather, they are perfectly capable of using their extensive education to conduct patient assessment and be actively involved in clinical decision-making. I would have them assume care of every critical patient who comes through our doors if I had it my way.

Paramedics are very competent. However, I fear this is just another way to cut costs and eliminate RN's.

I am against using Paramedics for this reason. They should receive a fair wage and be used for what they can do instead of trying to replace nurses. There wouldn't be the pressures to use them as cost-cutters if they earned decent money.

You're missing the point. Paramedics are not being used to replace nurses, they are being used to ofset some of the workload that nurses have. I think that everyone would agree that in most places there is a nursing shortage and the health care industry in general is losing money. So why shouldn't the hospitals try and cut costs while at the same time provide some of the essential services....... Paramedics are just as skilled as nurses in many areas: ACLS, IV starts, EKG recognition.... I think you'll see more and more hospitals employee paramedics in Emergency departments before you see the medics moved out and back onto the street.

I don't think that administration should be looking at paramedics to REPLACE RNs, but I do believe that paramedics are a very valuable SUPPLEMENT to the ED. As both a nurse and paramedic, I agree that there is a lot that paramedics will find foriegn to them in the ED. However, a new nurse will find the same things just as foriegn. I believe that using paramedics to start IV's, insert foleys/NG tubes, EKGs, nebulizer treatments, etc helps to free up the RN for more complex care such as managing multiple medication drips, discharge teaching, triage, etc. Contrary to popular belief among nurses, paramedics do not simply follow a "cookbook" of protocols. Paramedics use their considerable critical thinking and patient assessment skills to decide on a course of treatment to stabilize the patient. It is stressed in paramedic school that the protocols that medics follow are simply a guideline and the standing orders that give us the authority to administer treatment. It is up to the medic to determine that the pt is in congestive heart failure as opposed to pnumonia and to begin the appropriate treatment accordingly. Medics so not give drugs simply because it is in the protocol. Every paramedic can tell you that he gave the NTG to reduce preload, thereby decreasing myocardial O2 demand, he gave lasix because it draws Na from the distal loop of Henle and produces diiureses, and he gave the morphine for it's secondary effects as a diuretic and it also reduces anxiety and the workload on the heart. He didn't give the drugs just because that's what the protocol says to do. it is true that they know emergency drugs inside and out, but they can learn many other drugs with no problem. What I learned about pharmocology in nursing school just skimmed the surface of a lot of drugs while paramedic school went in depth with about 100 drugs. If a new nurse has to look up a lot of drugs that they are using in the ED, there is no reason that a paramedic can't do the same.

That being said, there is also a huge difference in the training of an EMT and a paramedic. You cannot generalize that all EMS providers have a limited knowledge base based on the fact that EMT Basics have about 2 months of training. Paramedic school is another VERY intense 1- 1 1/2 years on top of that, plus ALL paramedics are required to be ACLS certified prior to being licensed. Most also have BTLS and PALS. I agree that paramedics do not have the knowledge base to do discharge teaching for most common complaints seen in the ED, they do not have the experience to manage multiple drips through central lines, and they do not have training in patient advocacy.

Paramedics are a valuable addition to the ED staff, but are not a replacement for RNs. Any nurse that underestimates the knowledge, critical thinking, and patient assessment skills of paramedics is doing a great disservice to patients and efficiency in their EDs.

Specializes in ER,GI.

AMEN!!!

I think the question that ntg asked is unbeliveable!!! Do you want a paramedic working on your loved one? Well let me remind ntg, if you ever call 911, you will most likely get a paramedic and/or emt. And the day they save you or your loved one's life, maybe you will realize the importance of the paramedic/emt. As a paramedic and a nurse, I know the importance of both education and experience. Because of my background in both fields, I can say that there are both good and bad paramedic's and nurse's. Depending on the competency of the person, that is who I would want taking care of me (not because of the initial's after the person's name)! Nurse's need to stop feeling threatened by the paramedic in the ER, ICU or CCU. I know many doctor's that would rather have me assisting them in the ER (because of my paramedic experience) than any other nurse. I think every nurse who is interested in critical care (ER or floor), should be required to have their paramedic licensure or have prehospital experience!!

again-

there are worker bees and then there are slugs. All professions, be it doc, RN, EMT-P, tech, etc etc etc., has some of each type. Give me worker bee anytime! I don't really care what they are, it's just really what they actually do.

Specializes in ER, ICU, L&D, OR.

paramedics and emts make good techs, but that is all

I, like others in this thread, feel like EMT-B, EMT-P's are an asset to the ED. The do not replace RN's but the supplement they bring to the ED is priceless. The ED I work has a hospital based ALS ambulance service. The EMS staff is in the ED with the RNs. The full-time staff from both sides work together well.When The EMS staff call in their reports they already know exactly what the RN needs to know and that makes triage SOOOO much easier. FOr the most part they are willing to help in any way they can. They are not glorified aides, they are intelligent well educated professionals. They make my job as an RN alot less hectic. I see things that they learned in Ems training that I did not learn in nursing school like the effects of prolonged extrication on a trauma pt and the effects of collision impact sites on bodily trauma.I intend to take the next EMT-B class in the fall to supplement my training and to benefit my pts. Because that is why we are all here isn't it? To take the best care of our pt as we can with the resourses we have been given. Just my opinion. :cool:

I always get a kick out of this subject when it comes up...... Really nurses what is the difference? The big deal with Medics in the ER is that you seem to feel threatened by Medics....Why?? Because of JACHO and other governing bodies the ER will always have to have a certain number of nurses to staff it. Otherwise Medics can do the same job.

Nurses = 2yr degree Medics = 2 yr degree

So what really is the difference?? The ER that I work in has the same amount of Medics as nurses staffing it. We have the identical job description. The only except is that the Medics have extended roles as "Physician Extenders" under the MD License, along with having our own license. We take our own Pts, Triage, take written and verbal orders, admin drugs, call report and transport our Pts to the floor. We also do Emergency cut downs for airways, Chest tube insertion, Needle decompression, ETT, Central lines, and run all in-house codes, to name a few things that nurses can't do. (These are the things that fall under the MD license). Now I am in nursing school, only to get a raise in pay. (That's due to the shortage of nurses, and that they can demand more money.) But I will never get rid of my Medic license. And the EMTP will come before the RN behind my name. Now I know that this post will cause a lot of stink, but lets face it, times are changing, lets just except it and move on. And I do appreciate Nurses, I would gladly love to have one work beside me any day.

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