ER nurses compared to EMT's

CraigB-RN, MSN, RN · Oct 24, 2004

Nope. Although in an ideal world patients wouldn't need to spend 3 days in the ER before finding an ICU bed. And I worked in a place many years ago as a paramedic were transports times were so long, deciding to feed your patient was a prehosptial decision. You can't compate the 3, becuase their environments are so different. And any comparasin runs the risk of putting on group down. I've worked in all 3 area's over the past 25 years.

Dixielee, BSN, RN · Oct 25, 2004

I think you are comparing apples and oranges....sort of like police officers are to prison guards.....as lawyers are to judges.....farmers are to cooks...as waitresses are to diners.

All of these professions have a starting point and and end point, but I am not sure you can really make comparisons as the jobs, challenges and responsibilites are very different. All are important in their own way, just different.

By the way, are you perhaps studing to take the MAT?? (Miller analogy test)

Sarah8714 · Oct 25, 2004

ER nurses are to ICU/floor nurses, as EMTs/paramedics are to ER nurses. (Meaning, "stabilize them and get them where they need to be...")
Is this a fair statement?

The only fair statement you have hear is in the timeline of care. Patient seeks medical care via EMS (Paramedics), brought to the ER to be cared by ER nurses, then they are moved ICU/MedSurg/etc for further care. Paramedics are able to work under protocols and do not have to ask or receive orders. A nurse need a doctor's orders for pretty much anything or after their set protocol for certain patients. Nurses take care of the whole patient as Paramedic usually are not with the patient long enough to deal with that.

Think about this - EMT's are to Paramedics as PA's are to Doctors.

paraloco · Dec 16, 2004

The only fair statement you have hear is in the timeline of care. Patient seeks medical care via EMS (Paramedics), brought to the ER to be cared by ER nurses, then they are moved ICU/MedSurg/etc for further care. Paramedics are able to work under protocols and do not have to ask or receive orders. A nurse need a doctor's orders for pretty much anything or after their set protocol for certain patients. Nurses take care of the whole patient as Paramedic usually are not with the patient long enough to deal with that.
Think about this - EMT's are to Paramedics as PA's are to Doctors.

We have different priorities than nurses. We do some things that may make a patient's hospital stay longer and more arduous, but that on scene are necessary. RSII comes to mind. It can be over-used, but it is a very useful tool. We rarely have to worry about much beyond airway management, breathing, and circulation, and the interventions to correct all 3. About 6 years ago, we started using differential based protocols, in which we must come to a differential diagnosis based on our assessments. DUH However, we find ourselves with many patients who do not match up with any particular protocol page. Pleurisy, for example. We are encouraged to be aggressive, and do whatever needs to be done, as long as we can justify it on paper. If I can unload in triage I will, because I know that the ER frequently has to hold onto patients for a long time. Some of my co-workers don't care, and that's unfortunate because we all have to take care of each other.

humiliated · Dec 16, 2004

I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made. For example I had someone bring in a COPD pt. on 4L of O2 because the pt. O2 sats were 90% on RA. I asked the EMT why did they put the pt on 4L as opposed to 2L. They said they were having problems breathing. I asked did you try putting the pt. on 2L to see what his sats were. And they were like, no the pt was having problems breathing. I'm sure it was just this EMT but, I was thinking hello, it's a COPD pt. I understand if they are having difficulty breathing but, they need to be on the lowest O2 as possible, duh, cause they are just going to be retaining CO2. And as it turned out, the pt sats were 100% on 2L NC, so this in my mind improves the pt's outcome.

I would say, like nurses and doctors, there are some good EMT/Paramedics and some bad ones. I believe some EMTS/Paramedics have skills that nurses on a med surg floor don't have. However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge. Likewise, in the ER the doctors are in charge because they have more education than the nurses. In our ER in an emergency setting we nurses do what we need to do if a doctor is not around, ranging from thoracostomy to EJ's to whatever. We as nurses are trained to do what we need to do in an emergency situation, it's just that whoever is the most skilled does the task. Also like someone said in another post, sometimes it's like the ICU is the ER because I have had to take care of very sick pts on vents who may be in the ER for my entire shift. Often at our hospital we are short on beds, so pt's can end up in the ER for days. It's nice to get the experience an ICU nurse, however sometimes it's tough to take care of the very sick because there is so much going on the the ER (people being shot right outside our doors, the detoxing drunks, knifes being pulled on staff, the vented patients, traumas, codes, MIs, DKA, pregnant women bleeding clots the size of a baseball cause they are having a miscarriage, etc). It's so unpredictable, that you never know what you might get. But, we are trained to handle anything. That's why I love the ER, it's an awesome place to learn. You name it, these are all some of the things that have dealt with in the ER and I have ONLY worked there for 3 months.

Okay, I'm done going on my spill.

Before I leave, I just want to say that I respect everyone's contribution to the pt.'s care because not one person can do it all (thank goodness we aren't expected to). However I do ask that everyone that is assigned a job be proficient in their job so someone doesn't have to go back to fix your mistake and to work as a team. And just because it's not your job to know something it's helpful if you still do, cause you never know if you might be the most proficient person around and be expected to save a life or do something that you normally don't do. And sometimes comparing different jobs just seems to make one profession look better than the other. And that's not what the healthcare field is about. I hope that everyone chooses their job because it's what they want to do so they can do their best rather than be envious or look down on others with different titles.

EMTI19 · Dec 16, 2004

"I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made. For example I had someone bring in a COPD pt. on 4L of O2 because the pt. O2 sats were 90% on RA. I asked the EMT why did they put the pt on 4L as opposed to 2L. They said they were having problems breathing. I asked did you try putting the pt. on 2L to see what his sats were. And they were like, no the pt was having problems breathing. I'm sure it was just this EMT but, I was thinking hello, it's a COPD pt. I understand if they are having difficulty breathing but, they need to be on the lowest O2 as possible, duh, cause they are just going to be retaining CO2. And as it turned out, the pt sats were 100% on 2L NC, so this in my mind improves the pt's outcome.

The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge."

First of all, 2L NC is not in my EMT-I protocol. The fact that COPD pt's retain CO2 is not covered in most EMT-B classes.

Second of all, I have RN's that run with me and they are NOT in charge.

Trauma Columnist · Dec 16, 2004

I think we can all agree that both paramedics and EMT's as well as the ER RNs contribute to pt care. I volunteer as a pre-hospital RN and nothing gives me more of an adrenaline rush then running a call with only a fireman to help me and in a house that has limited lighting (why are all houses so dang dark anyway??)!!! I love the pre-hospital environment - but I also love the ER.

Here is a review of an article from an ER MD:

Review

Emergency oxygen therapy for the COPD patient

R Murphy, P Driscoll and R O'Driscoll

Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

Department of Emergency Medicine, Hope Hospital, Salford, UK

Department of Chest Medicine, Hope Hospital

Correspondence to: Dr Murphy ([email protected])

Accepted for publication

June 11, 2001

Keywords: oxygen therapy; chronic obstructive pulmonary disease

http://emj.bmjjournals.com/cgi/content/full/18/5/333

flashpoint · Dec 16, 2004

I'm a paramedic and a nurse (LPN, who works ER and ICU under strict protocols, with RN supervision). I don't think there is much of a comparison. In the field, you need an EMT...someone who is trained to focus in on life threats and correct them or someone who is trained to immediately stabilize until definitive care can be provided. In the hospital, you need a NURSE...someone trained to correct life threats, and once that is done, focus onthe whole patient and help them meet all of their needs. We need everyone on the team to do what we do. Each person is best in their area...nurses can help in the field and EMTs can help in the ER and the hospital, but each person truly shines in their "world."

Here, mostly because of archaic hospital protocols, there are a few things that paramedics are allowed to do that RNs are not...EJs, intubation, intraosseous, needle decompression...however...it doesn't make any group any bigger or better than the other. Paramedics here can give all medications and we only need to get a doctor's order for a few of them...most of them are protocol based and can be given based upon our assessment findings. RNs have to ask first, but are rarely told, "no." They know their stuff, know what needs to be done, and are more than capable of doing it. Also, emergently, they can pretty much do whatever needs to be done until the doctor is available...it is rare for a doctor to even question IVs, ASA, nitro, breathing treatments, etc that a nurse initiates on patient arrival.

renerian, BSN, RN · Dec 17, 2004

I agree with another poster it is compairing unlike things. All are important and unique team members at different time points. Make sense? JMHO.

renerian

renerian, BSN, RN · Dec 17, 2004

I agree with another poster it is compairing unlike things. All are important and unique team members at different time points. Make sense? JMHO.

renerian

shell911rn · Dec 24, 2004

I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made. For example I had someone bring in a COPD pt. on 4L of O2 because the pt. O2 sats were 90% on RA. I asked the EMT why did they put the pt on 4L as opposed to 2L. They said they were having problems breathing. I asked did you try putting the pt. on 2L to see what his sats were. And they were like, no the pt was having problems breathing. I'm sure it was just this EMT but, I was thinking hello, it's a COPD pt. I understand if they are having difficulty breathing but, they need to be on the lowest O2 as possible, duh, cause they are just going to be retaining CO2. And as it turned out, the pt sats were 100% on 2L NC, so this in my mind improves the pt's outcome."
When I was an EMT-B, we discussed the possibility that a high FiO2 could lead to respiratory depression in COPD patients, but our instructor informed us that studies had been done that showed this only occurred in roughly 3% of COPD patients, thus, our protocol instructed us that if a COPD patient was in respiratory distress, we were to give 10-15LPM O2 via simple face mask or 6LPM via NC as we would any other patient in respiratory distress. We didn't have Pulse oximeters in the field (this was only 2 years ago for me) to tell us what a patient's O2 sats were to guide our decision making. Thus, we errored on the side of giving the patient oxygen not knowing whether it was lack of oxygen that was the problem or too much CO2. I guess our county figured lack of oxygen was more harmful in this scenario than respiratory depression that could be counteracted by BVM assist. I always kept the respiratory depression in the back of my head, though, when administering O2 to COPD patients in respiratory depression and if their breathing started to slow, I'd back off on the O2. Most COPD patients won't let you give them much more than 2LPM via NC anyways because they have been informed of this same complication.
And as far as EMT-P's and RN's (you really can't compare EMT-B's to RN's), we are only as similar as the fact we use ACLS protocols to treat patients. Our training is completely different with a medics training being only about 9 months in CA where I'm from, compared with 2 years for RN school. Not to mention I had to have a lot more science. But, medics can intubate which I can't do. EMT-P's in the county I work in can only administer roughly 40 meds to their patients. I have a whole drug book full of meds I can administer and more as they are put on the market. A lot of the medics I come in contact with don't even know what some of the meds are on patient lists. They also can't draw blood or analyze lab values or understand what those lab values mean. Their primary focus is on ACLS protocol or transporting patients to hospitals for further evaluation and treatment so that they can get on to their next call. They don't have time to worry about the details of what's going on with the patient, just are they stable or not, which dictates to them whether a patient can go with a BLS ambulance as opposed to medics and how quickly they need to get the patient to the hospital, and whether they need to initiate any protocols enroute. We also can put in IV lines just about anywhere as nurses, including EJ's. Medics also don't put in foley catheters or flush G tubes or change a dressing on a wound using sterile technique. It's very difficult to be sterile outside the hospital setting. Some medics put in NG tubes but only if they are trying to give charcoal to an uncooperative OD pt. They also don't administer blood in the field. Last but not least, it's more dangerous for medics on the street than nurses who work in ER's because there are many more factors out of a medics control that are going on around the patient. That's not to say we don't have our share of danger in the ER. But, on a daily basis medics face traffic, hazardous materials, fires, people, screaming families, furniture, narrow spaces to work in, lifting patients, driving code three etc. We both serve a role in the EMS system, though, and that's what makes it work.
Michelle