Nurses vs EMTs?

allnurses Guide · Mar 10, 2006

I went to a trauma conference where the EMS crews were giving a panel, they said they welcomed nurses on scene (calling us the higher level of care), if we were able to help (and willing to take responsibility for what we did). That said, nursing doesn't teach first aid and first responder skills: I came up on an accident, where a fellow was unconscoius, had just been hit (MVA vs ped). The force had knocked his Tshift over his head, he was on his back. I ran up and asked is he breathing? a woman said "I don't know but he's okay because he has a pulse". I said Yeah but is he breathing? Couldn't tell because of the tshirt, but just then he started with a deep shuddering breath (started agonal resps). She said, oh! now we roll him over so he won't choke! I yelped NO! and so did another woman who had come up. First one says "well I'm a home health nurse!" I snapped back "well I'm a PCU nurse" . She got huffy, left, and the 2nd lady and I stablized the neck so we could get the shirt off for his airway. Later asked at the ER (where I now work), they said they knew someone on scene knew what they were doing before EMS got there, made feel pretty good about it. (That's also when I found out that baby wipes don't clean blood off your hands, just dry it on. :lol2: )

Works2xs · Mar 10, 2006

It's not a "rank" issue. Rather, it's a matter of the right tool for the job. EMTs are trained to perform their skills in the field, where they have to deal with a plethora of environmental issues along with keeping the patient stable and protected, often without the benefit of the tools available to even the most modest of ERs. Unless you've been prepared for such an environment, anybody can get caught flat-footed. While nurses mostly have the educational edge over your run-of-the-mill EMT, it's not specialized toward prehospital care. So determining who's the boss on any particular scene isn't so black and white as looking for the number of initials someone has attached to the backend of their name. One can only hope those involved would practice that oft cited, but poorly executed skill called "communication." Thus, each could do what they do best.

As for the scene described by the OP, sounds like they (the OP) did exactly what they needed to do. Sounded like straight "ABC's".

Regarding first responder status, I'm a little fuzzy. In the OPs scenario, had that EMT failed to clear/secure the patient's airway, could he be held responsible for harm incurred? Could it be surmised that any similarly trained individual would have known the correct course of action, leaving the EMT in the example in a position of negligence? Whereas the average untrained bystander might be given a "pass." I know there's a lot of "slop" in interpreting these things and there's a degree of variation depending on what state you're in. From my brief look on the web, it seems that you are covered by GSL's, unless you are negligent or grossly negligent. Anyone have some clarification on that (link or reference source)?

ShayRN · Mar 10, 2006

I don't have anything to add, I just want to know, How was the little boy?

Chad_KY_SRNA · Mar 10, 2006

Well I am an :redlight:EMT and CNA:redlight:, I would have stabilized the c-spine, log rolled the pt, cleared the airway, and then assessed breathing. Sounds like once the airway was clear he started breathing regularly so rescue breathing was not indicated. I would have continued to stabilize the c-spine and provided other care as needed until an ambulance arrived. Some people frighten me. All that "Skippy" would have done was push emesis, mucous, saliva, etc into that kids lungs and made things far worse. I would have asked to see his Basic Life Support and National Registry of Emeregency Medical Technician's cards after care was turned over to local EMS. He sounds like a liar or an idiot to me. I am so new to EMS and to some of you all I am still a young'en but I agree with the care provided by the OP. There is no Nurse VS EMT, we have to work together to provide the patient with the highest level of care possible. Of course, Thats just my two cents.

flashpoint · Mar 10, 2006

It all depends on the situation. Here, we have a mainly volunteer rescue squad. We have a paid FF/EMT on duty 24/7. Once 911 has been called and the page goes out, all 50 of us are considered "on duty" so technically, the patient could belong to which ever EMT happens to make it to the scene first. Unless the RN is also a member of the rescue squad, the patient should belong to the EMT and their decisions should prevail. However...if the EMT is doing something harmful to the patient, the RN has an obligation to speak up and any good EMT is going to at least consider any suggestion from someone with equal or higher medical training...and very few EMTs here would even think about rescue breathing on anyone without a BVM...we rarely do mouth-to-mouth, even with a barrier device. An EMT with equipment and friends and protocols and a method of transport is more definitive care than an RN armed only with his/her knowledge and skills...until the EMTs get the patient to the hospital, then the RNs take over.

I got into a bit of an argument with an RN a few weeks ago over who should take care of a patient. We responded to a diabetic (who we know VERY well) that passed out in his car. She was the first medical type person there, I arrived shortly after. I identified myself (even though she knows me and knows what I do) and I asked her to move so I could start an assessment while waiting for the ambulance and she told me she wasn't moving because she is an RN. I told her I was aware of that fact and told her that I am a paramedic. She again stated she is an RN and I finally said, "I know you are an RN, but I have D50." She looked at me and said, "What are you going to use the D50 for?" The police officer that responded asked her to step aside as the ambulance pulled into the parking lot. The RN came over to the ambulance and questioned what we were doing...everything from taking his coat off when it was really cold outside to having trouble finding an IV site to giving D50 without an order. She wouldn't move when she was asked to so we could close the ambulance door. We honestly got pretty rude with her when we had to ask (or tell) her to move twice, which I feel bad about, but am also angry that she seemed to refuse to give up the patient.

I wish there were some way we could all work together better. I appreciate any help we get when we are on scene with a patient...as long as the help is really helping and not getting in our way or questioning what we are doing (if what we are doing is safe and appropriate). I am more than willing to pitch in and help in the ER when we have time and it is appropriate to do so...I won't do their work for them or put myself in a potentially liable situation, but I don't mind running smaples to lab or cleaning rooms or things like that. I also understand that once the patient is in the ER, they are the hospital's patient...my protocols don't matter, the liability is not mine, and the RNs are more qualified than I am to give care in that setting.

Trauma Columnist · Mar 10, 2006

As several posters have said, we need to work together. Just as nurses have diverse experiences and abilities to deal with pre-hospital care, so do EMT-B's, EMT-I's and EMT-P's. For all of us - the care of the pt comes first. That should truly be our bottom line.

snowfreeze, BSN, RN · Mar 10, 2006

IN the Pre-hospital environment EMTs/Paramedics have medical command from a physician alas, they do have control. A nurse can be helpful but without a physicians orders we cannot do a whole lot legally except under good samaritan laws which allow chest compressions and ventilation and opening airways with various maneuvers.

GooeyRN, ADN, BSN, CNA, LPN, RN · Mar 10, 2006

forgetting the initials behind everyones name, i gotta say what on earth makes that guy want to do mouth to mouth on a person who is already breathing? He could have been an M.D. PhD. and I would have been looking at him like he had lost his mind...

I agree with you!

luvmy2angels · Mar 10, 2006

This is just my opinion, but I feel that nurses have a much more indepth education than EMTs. We both play a very important role..don't get me wrong. I just think that EMTs are taught what to so in an emergency situation, the first on the scene stuff and stabalizing a pt until transported to the hospital. Now of course we learned that stuff too in school, but not to the extent that the EMTs did. Just the same, we learn more about the causes of diseases and long term effects, treatments, A&P, etc. Were I live the EMT course is 4-6 months and the LPN program is 12-18 months. I think we have a broader education base then the EMTs. Thank goodness for both though!!

buddiage · Mar 10, 2006

I have a question for you all. Who is higher ranked a nurse or an emt. I was an emt in h.s. and always thought that nurses, doctors, ect were higher than us. Now I am a nurse and yesterday a little boy had a seizure in the grocery store. His mother was screaming and people were just freaking out. I went over and made sure the area was clear so he would not injure himself anymore (he had a pretty big fall out of the cart onto his head on his way down). I was starting to check ABC'S and he stoped seizing. He was having a lot of trouble breathing because he had thrown up and it was in his mouth. I told two people who were now saying they had first aid experience that we needed to log rol him so I could clear his airway. The this kid who said he was an emt started yelling that we can't move him because of his head injury and wanted to start rescue breathing. I told him that the child was breathing, but at risk for aspiration and that rescue breathing would cause more damage. So we log rolled him and got the vomit out, he was then able to breathe better and started to come to. When the ambulance got there the emt kid told them "that woman is anurse but she wouldn't listen to me he needed mouth to mouth" The other emt agreed with me on what I did, but then said "but next time be a bit more respectful to an emt because are higher up than you outside of the hospital" I am sorry but I think that is bull. Yes emt's can provide BLS but we have a lot more training and knowledge than them. What do you all think?

OH BROTHER!

Speaking from experience, I was an EMT for 5 years before I spawned a daughter ;-)

Some volunteers, not all, had issues with their ego, and would rub their certification in people's faces for all to see. Nobody is "higher." EMT's are pre-hospital care providers, nurses obviously get the patient "packaged." It was embarrassing to see ego wars on scene (I volunteered on the fire department).

Personally, I agree with you: mouth to mouth is useless if there's food chunks in the airway. He should've known better. I'm curious if this person would mouth to mouth someone who had lose dentures floating in their mouth. Duh?

It is NOT the EMT's job to tell you where you rank. He should've had a paramedic tell him to shut his yap.

Your example was one of the reasons why I got sick of volunteering. I hate it when people are arrogant.

Don't worry about a fragile egotistical pion.

And to luvmy2angels: I love your avatar! I am a Songebob fan, big time! He's just so....coral!

casualjim · Mar 10, 2006

Although I'm "only a nursing student" I've spent the last 21 years in the Navy, mostly in Special Warfare. I've been through the National Registry EMT course, in addition to military "medic" schools, and they ALL teach great stuff. Nursing school teaches great stuff. Having said all of that, all of the "great stuff" taught in those very different schools only serves to lay a foundation. In any job I've ever had, the pre-requisite schooling was just a way to get in the door. I had to do the job for a while to actually "learn my job." Hell, I've been a father for 7 whole years now and I dont' think I'll ever get that one right!

Nurses and EMTs should be thought of as two very different animals living in the same jungle. There is overlap in skills obviously, but the bottom line is that they are different animals. To say that one is "higher than the other," is like saying that an airplane pilot is "higher" than a helocopter pilot. Again, two different animals.

Personally, I'm always very wary of people that will run up on the street and give me their 10 second resume and qualifications. I have a natural affinity for the person that will focus more on how to help the person leaking blood all over the pavement, as opposed to telling me how many initials they get to use after their name. I had a situation where a well-meaning, completely un-trained, high-school drop out with a cell phone and a strong stomach was tons more help than a physician.

I'd rather not get flame sprayed for what I'm about to say, but if you really need to I guess I understand. Bottom line, if you're really into helping people out at wrecks and in the field, it's also a noble profession. Get good at it, get trained for it and get a job as a paramedic. Me personally, I'm ready to work in doors out of the rain. That's why I'm a nursing student, taking my own advice and getting a foundation to build some different skills for my next incarnation as a "different animal." Sorry if I bugged anyone with this. Just my thoughts.

aloha

Jim

buddiage · Mar 10, 2006

Although I'm "only a nursing student" I've spent the last 21 years in the Navy, mostly in Special Warfare. I've been through the National Registry EMT course, in addition to military "medic" schools, and they ALL teach great stuff. Nursing school teaches great stuff. Having said all of that, all of the "great stuff" taught in those very different schools only serves to lay a foundation. In any job I've ever had, the pre-requisite schooling was just a way to get in the door. I had to do the job for a while to actually "learn my job." Hell, I've been a father for 7 whole years now and I dont' think I'll ever get that one right!
Nurses and EMTs should be thought of as two very different animals living in the same jungle. There is overlap in skills obviously, but the bottom line is that they are different animals. To say that one is "higher than the other," is like saying that an airplane pilot is "higher" than a helocopter pilot. Again, two different animals.
Personally, I'm always very wary of people that will run up on the street and give me their 10 second resume and qualifications. I have a natural affinity for the person that will focus more on how to help the person leaking blood all over the pavement, as opposed to telling me how many initials they get to use after their name. I had a situation where a well-meaning, completely un-trained, high-school drop out with a cell phone and a strong stomach was tons more help than a physician.
I'd rather not get flame sprayed for what I'm about to say, but if you really need to I guess I understand. Bottom line, if you're really into helping people out at wrecks and in the field, it's also a noble profession. Get good at it, get trained for it and get a job as a paramedic. Me personally, I'm ready to work in doors out of the rain. That's why I'm a nursing student, taking my own advice and getting a foundation to build some different skills for my next incarnation as a "different animal." Sorry if I bugged anyone with this. Just my thoughts.
aloha
Jim

Good post.