ER nurses compared to EMT's

Peg804 · Apr 1, 2005

Just have to add my 2 cents for what it is worth. I have been in prehospital care for almost 26 yrs-since I was 16. I an also an ED nurse now and hold HP certification-or prehospital RN depending on your state, I also work on a critical care interfacility transport team-land and air. Believe me, and I know others will agree with me, they are completely worlds, and I love them all. Each has different, yet the same focus. As an HP-it is my job to get the patient to more advanced care than the prehospital team can give them in the field. I have a lot of autonomy here. In the ED it is my job to be that care-to work as a part of a different team to get the patient stabilized. And as part of the interfacility team I take that patient to either a higher level of care, sometimes to a speciality facility, sometimes to a facility closer to home. It is in this capacity that I can combined my prehospital world with my ED nurse world, cause this job description calls for me to be both. I can intubate the patient, decomp chest, etc if I need to, but I can also manage the meds, and the nursing care. Yes, evens bedpans if it comes to it.

Unless you are a prehospital RN, or HP you are not incharge in the prehospital world. You do not have the training or the qualifications. Even the simple things like patient packaging, Haz Mat, Vehicle Rescue, etc. yes, I have had nurses, and even an MD come up to me and ask if they could help. And yes I have had them help. I had the MD-a pediatrician helping with rehab at a multiple bus accident.

Unfortunatley Prehospital people are not treated well by ED staff, I have seen it and I have experienced it. Most ED staff do not know the differences in the levels of prehospital providers, and I cannot stand it when I hear Ambulance Driver!!!!! ED staff do not realize the stuff that happens in the field. By the time the patient gets to the ED they are packaged, out of the twisted metal that was their car, off the bathroom floor where they were wedged between the toilet and wall. Sometimes I want to scream at some of the people I encounter when I hear Why did you bring that patient here???? Guess what if we all don;t work together none of us will have jobs

ufmedic · Apr 1, 2005

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Guess what if we all don;t work together none of us will have jobs

Believe me, and I know others will agree with me, they are completely worlds, and I love them all. Each has different, yet the same focus. {QUOTE}

I agree, most of the nurses that give prehospital providers a hard time, don't really understand what it's like in the field. Working in both worlds, I can see a HUGE difference in the way I am treated running 911 calls with only "Paramedic" on my shirt, as opposed to critical care inter-facility with RN,BSN,CCRN and "flight nurse" on my badge. But it goes both ways...sometimes the street medic that will immediately start to give report to the flight medic on a scene flight and pretty much leave the flight nurse out of the loop.EMS is focused primarily on stabilization and transport to appropriate care, while the hospital provides the definitive care.

MFlash · Apr 4, 2005

So my question to you is ....did you take the opportunity to remind the EMT why he should put the pt on 2L of 02 rather that 4L or did you snap at him/her? Keep in mind. EMT's go through a few weeks of crammed training. Nurses get a couple of years and lots of experience. As someone that was once an EMT in a rural town that transported patients to a major hospital, I appreciated the nurses that took the time to show me (in a respectful way) when I did something wrong and tell me I did a good job when I did something right. They make all the difference in the world.

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.

needsmore$ · Apr 4, 2005

As the preceptor for our ED, I work with our local EMS. New nurses to the ED get to spend a shift riding with the medics- just a small taste of life on the other side of our doors. I started this last year with my GN program. The girls seemed to enjoy it- Even if there were not a lot of calls-they got to spend time with the medics- check out their equipment, protocols, etc. It also has helped bring our staff and the prehospital group closer together.

Something for other EDs to think about during their training.

Rambob · Apr 4, 2005

So my question to you is ....did you take the opportunity to remind the EMT why he should put the pt on 2L of 02 rather that 4L or did you snap at him/her? Keep in mind. EMT's go through a few weeks of crammed training.
I agree with the spirit of most of these responses. However, lets not sell those EMTs too short. As a long-time EMT/Paramedic Instructor, I find that EMTs usually do something the way it was taught to them. The state dictates what is to be taught. A few years ago, the state mandated that O2 by NC and NRB was to be delivered at 8 L/m. Now wasn't that stoooopid. And they also have to go by the protocols set up by their Medical Director (MD or DO).
Some of the finer points of 2L vs. 4L should be addressed during Con-Ed.
However, Con-Ed is not continuing. It is usually just a repeat of what they were taught before. Again.... state guidelines.
When I see someone doing something incorrectly, my first thought is:
"Who taught this guy ?"
Training time is short, now aroung 200 hours. That's a lot for volunteers.
To be honest, my Nursing program could have been condensed down into about 6 months from the two long years.
After reading most of the posts in this section, I am extremly happy at the open-mindedness.
Bob

kimm1163 · Apr 6, 2005

I have been reading the responses to ER nurses vs EMT's to gather some data for a paper I am writing. Currently in NH there is a bill in progress to improve NH interfacility transport. The passing of this bill would allow EMTs, RNs, Nurse Practitioners, Physician assistants or physicians to be responsible for patients in a land or water vehicle during transport. There is a big transport issue in the North Country. I believe this is important in transporting ICU patients from acute to acute hospital. I know this isn't quite comparing the two disciplines but it is a way they can and may work together.

I also know EMTs work in our ER to supplement our nursing shortage. Does this happen everywhere? The following was a reply from an ER nurse to help me with my paper:

"Paramedics work in the ER but their role (and training) is different than an RN's. In their paramedic education they learn to assess and treat by following a proscribed set of rules and protocols. (Is airway clear? No - clear airway by repositioning, remove foreign bodies, place airway adjunct, perform trach. etc. If breathing inadequate...give supplemental O2, support resp with BVM, perform emergency thoracotomy, whatever. They learn only the meds on their state protocol list.)

Don't confuse a hospital employeed paramedic with paramedic 'students' who may do other tasks with direct RN or MD supervision - such as intubation. Paramedics DO NOT intubate in the ED as part of their job description as an employee.

Paramedics supplement nsg. care by doing tasks such as VS, IV starts, blood draws, assisting in codes (can give those meds because they're the ones on their pre-hosp. protocols), EKGs, physical assessments, responding to hospital codes.

Paramedics are not covered under the nurse practice act and are governed by EMS.

Our hospital defines the paramedic's role in the job description but it is not specific as to exact duties but simply gives guidelines.

So, paramedics help in the ED, do not replace a nurse's functions, do NOT work in the triage role (which is a complex setting that even RNs are not assigned to until working in the ED for 6-12 months and undergoing specialized education and competency evaluation.)"