Regarding paramedics in ER..why are they paid so terribly ?

ZASHAGALKA, RN · Sep 23, 2005

I dont live in Tx like you, but the Medics there are Licensed too.
Point Proven!!

I don't care about your license status but your scope of practice. Your State's BON will list things that only belong to NP and your State's Health Code will specifically state what is limited to MDs and PAs.

And the part of the health code that covers paramedics will clearly spell out a scope of practice.

So you haven't proven anything except an unwillingness to verify your claims.

So, what State is this wonderfully progressive ER of yours in?

~faith,

Timothy.

Medic173 · Sep 23, 2005

Before you post on claims that you have no proof on, the scope of a Paramedic is determined by the MD, that they are working under. This is true in all 50 states. Why do you think we can do more than an RN in the house and field, because your license doesnt protect you, like ours and the MD we work under. Are we clear. ARE WE CLEAR??

Thanks

The End

ZASHAGALKA, RN · Sep 23, 2005

Before you post on claims that you have no proof on, the scope of a Paramedic is determined by the MD, that they are working under. This is true in all 50 states. Why do you think we can do more than an RN in the house and field, because your license doesnt protect you, like ours and the MD we work under. Are we clear. ARE WE CLEAR??
Thanks
The End

You won't clarify what State you are in so that your claims could be checked.

That says everything that needs to be said about those claims.

(I have no interest in personally challenging you. But you made certain, specific and incredible claims and yet steadfastly refuse to offer any means to verify them.)

~faith,

Timothy.

RainbowSkye · Sep 23, 2005

Okay, here's my experience. And please feel free to disagree if it's different for y'all.

Paramedics are trained/educated to provide pre-hospital care. Their license allows them to provide very specific (and complex care) and give medications under the direction of the EMS medical director and/or ER doc.

However, because a paramedic can do certain procedures and give certain medications in the field doesn't necessarily mean it carries over to an inpatient environment. I mean, you may be able to give Morphine in the field to a patient with chest pain but you may not be able to give antibiotics to someone with an infection.

I've worked in ERs where the policy was for paramedics to only provide care within the confines of their paramedic license. So you might have a situation where the paramedic could intubate a patient, but not give a tetorifice shot. In other cases, the hospital provides the additional skills a paramedic would need to function in the ER (like cathing a patient or accessing a port-a-cath).

RNs are not paramedics and paramedics are not RNs. I think we should respect and learn from each other instead of nitpicking about who is smarter, better educated, whatever. We're all in this together.

Shamira Aizza · Sep 23, 2005

I am a licensed paramedic and RN in the State of Maryland...an associates degree is not required to become a paramedic in Maryland. I am required, however, to maintain my National Registry CERTIFICATION to keep my Maryland paramedic license.

In Pennsylvania, my paramedic card is listed as a certification, as is my prehospital RN card, but I am required to hold a valid Pennsylvania RN license to maintain my PHRN certification.

Texas has an OPTION to be a licensed paramedic (LP). This distinction is only awared to paramedics with at least an associates degree or a certain number of college credits. However, licensure is not required in Texas (certification is just fine), and there is no difference in scope of practice for cert medics vs. LP's.

Regardless, it's NOT TRUE that "most states" license their paramedics; however, after the laws are written in each state and a comparison is made between certification and licensure, there is no difference.

Oregon is the only state that REQUIRES an associates degree to be a paramedic.

And in a civilized health care environment, paramedics will never be able to 'replace' NP's or PA's or any brand of RN. Having worked in EMS for 15 years...6 of those as a paramedic before attending nursing school...I can assure you that the current trends in paramedic education are not setting them up to replace anyone in any environment. Few paramedics can tell you respiratory acidosis vs. metabolic alkylosis from an ABG, let alone know what normal electrolyte levels are...or even to know how to treat it.

And as infuriating and demeaning as that may have sounded, no-one can beat an experienced conscientious paramedic at efficiently AND effectively running a code in some of the worst conditions imaginable. I think paramedics need to realize and accept their role instead of thinking that it somehow translates into other people's jobs. Finally, paramedics need to realize that the nursing lobby is well organized and connected (politically) when compared to EMS, and EMS has a long way to go in executing influence on another profession.

taidan · Sep 23, 2005

I am a licensed paramedic and RN in the State of Maryland...an associates degree is not required to become a paramedic in Maryland

CUrrent paramedics are not required that is true, but any new students taking emt-p under the new DOT curriculam must have an AA degree.

EMt-p was moved up and the new emt-i is occupying the space P '85 had.

FlyingSquirrel · Sep 23, 2005

These are the facts. I can easily support all of the following statements:

1) Medic 173 is FOS. His original post was meant only to inflame. And many of you fell for it.

2) Newer paramedics are VERY well educated; the clinical and classroom hours required of the new DOT curriculum is at least as extensive as that of a typical AAS nursing progam. No states require an AAS degree for paramedics yet THAT I KNOW OF, but that will likely change very soon. At any rate, most paramedics I know have well more education than the minimum that is required for the profession anyway.

3) The low pay that paramedics are forced to tolerate has nothing to do with their value; as someone else said, hospitals would pay RN's $5 an hour is they could. It's simple supply and demand, among other factors.

4) Paramedicine and nursing are very different fields. There is alot of overlap as far as the knowledge levels and skill sets that the two professionals posess, but there are as many differences as similarities. Nurses have a much broader education than paramedics, but the paramedics' is much more focused and in depth. Many entry level skills for paramedics are considered advanced skills for nurses, but nurses possess many skills that paramedics don't, as well.

5) There are few true absolute limitations to paramedic practice. It varies widely by state, but there is no universally-accepted scope of practice like the "Nurse Practice Act" that every state has. In most cases, paramedics can legally do about anything that their local medical directors train and authorize them to do. While not extremely common, it is also not uncommon for paramedics to place central lines, make referrals, give paralytics & intubate, acquire and analyze 12-leads ECG's, give thrombolytics, interpret labs, etc. Paramedics truly do practice medicine, albeit within a very narrow scope.

6) If you think about the skill set that paramedics posess, it makes good sense to try to utilize them in the ED. In a large, busy ED, a "resource paramedic" or two could augment medical and nursing staff by performing assessments, doing EKG's, starting lines, drawing labs, giving meds, acting as a liason between the ED and prehospital services, etc.

Chad_KY_SRNA · Sep 23, 2005

As most of you know I was having problems with my BP a few weeks ago, while in the ER I spoke to one of several paramedics that work in the ER while he was providing care for me and he said that he made better money in the ER than he did as a medic working in the field. He said that he loved his job.

CraigB-RN, MSN, RN · Sep 23, 2005

Before you post on claims that you have no proof on, the scope of a Paramedic is determined by the MD, that they are working under. This is true in all 50 states. Why do you think we can do more than an RN in the house and field, because your license doesnt protect you, like ours and the MD we work under. Are we clear. ARE WE CLEAR??
Thanks
The End

Hmm having been a medic for almost 30 years now and RN for almost 15 years now, and having worked in many different states prehospital and in hosptial as well as flying in different states.. You''ve just proved that you don't know what you are talking about. It's not the "Medical Director" that sets what EMS scope of practice is it's the state practice act and local and regional protocols. THe loop hole is that the specific practice act may not limit skills but the practice act for the MD's PA and NP has verbage that limits the diagnosis and treatment to those specific licensure. The indivudal liability carriers would be having heart failure if they knew what was going on. I won't go so far as to say it's not happening, I took care of ICU patients by my self as a medic, with an RN. That however stopped happening when the hospital system figured out their liability.

I'm not sure what your trying to get at about license protecting anyone. It only protects when you are working withing your scope of practice. If you screw up you screw up and your license won't protect anything.

txspadequeenRN, BSN, RN · Sep 23, 2005

:rotfl: :rotfl: :rotfl: :rotfl: No Way:rotfl: :rotfl: :rotfl: :rotfl:

ERs are opening their eyes and letting Medics do everything that the Nurses do. (Like in the ER I work in). Are ER just Hired Paramedic Physician Extenders to work with the doctors to see Patients. They are going to see Pts, write orders, review results, suture, LPs and Rx Scripts to name a few things. They are going to replace the PA and NP we have now. Wont that suck that the RNs will have to take orders from the Medics. Boy how times are changing. I just found out today that I got this job. I cant wait to see the faces on the RNs. We are going to be starting at $50 hr.

ZASHAGALKA, RN · Sep 23, 2005

I have a lot of respect for paramedics/emts. I love and live in an organized environment - even in chaos, all the help and supplies I could wish to have are at my fingertips. I couldn't work 'in the field'. It takes brains, ingenuity and a flair for that kind of excitement.

And I've worked w/ medics/emts in the ER - most hospitals I've been associated with that truly cared about 'efficiency' in the ER hired them to assist the flow of things. (and they are incredibly during codes/major trauma - of course!)

I stand by my assertion that the pay for medics/emts in the ER is a function of supply and demand and is completely detached from value. Hospitals (any employer for that matter) will pay the bare minimum necessary to recruit and retain. Period.

And I disagree with the notion from 1 poster here that nurses and medics/emts are interchangeable (They also mentioned NPs and PAs, too). It doesn't matter if I, as an RN, could actually handle a NP/PA role; I simply don't have the training the State requires to assume those duties. Believe me, I'm a much better doctor than some of the doctors I work with - but that doesn't entitle me, under law, to actually BE a doctor. You know?

We all have our roles and they are important. The thread was about the pay part of it all. And that is a function of how many of you are out there and how many want to work in a hospital; it has nothing to do with how valuable you actually are.

~faith,

Timothy.

Shamira Aizza · Sep 23, 2005

CUrrent paramedics are not required that is true, but any new students taking emt-p under the new DOT curriculam must have an AA degree. EMt-p was moved up and the new emt-i is occupying the space P '85 had.

Since one of my friends just took the licensure exam last week (no degree), could you provide a link or some verification please.

http://www.miemss.org/ems_plan/EMSPlan_FinalFirstDraft.pdf

This link shows the Maryland plan, and it sez nothing about a degree. It sez it will follow the NSC, which encourages a degree, but does not require it. I've been involved in EMS for a long time in this area as a manager and educator and I keep myself informed. I work for the agency that develops the NSC, so I think I'd know if they started requiring one.