Nurses vs EMTs?

  1. 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 e 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?
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    Joined: Mar '06; Posts: 16; Likes: 1

    35 Comments

  3. by   KatieRN04
    I agree with you, while EMT's have thier own special training, which I went through, and I was an EMT, now I am an RN, and with experience from both fields, I think the RN has more education and knowledge. An EMT focus is to get the ill patient stabilized, then pass that person on to the ER where RN's and MDs take ove the care due to their more advanced training. And also, while EMT's may have lots of freedom in procedures, and I am sure that someone will reply with a post to argue this next comment, being an RN involves procedures, etc....but it is the nursing process and the critical thinking that goes beyone procedures that makes us a higher rank on the scale.
  4. by   DSplendid
    I was an EMT for over 9 years, and now a student nurse graduating in May, who works in the ER. So let me just say this: first off, your actions were right 100%, second of all, even the "right of school" nurse has more education and training than an experienced EMT. EMT, training is extensive, but is geared to BLS, trauma etc. no disease process, treatment, pathophys....etc...

    Why he even would bring up "who's higher up the chain," shows me, he is being a head case. There is no "higher or lesser" It's just a fact of who has rights to patient care.The EMT who responded, is only "higher than you" outside the hospital, because he in fact, is being paid to respond, in turn that becomes his patient. He doesn't have to listen to you, or even discuss patient care with you. ( I mean after all, you're saying your nurse, but he has no proof of that, also HIPPA) Basically, you just have no rights at the scene. Once in side the hospital and pt care is transferred to a nurse, she is the "higher" one, because it's now her patient. I had a sutitaion similliar years ago, a SNF RN and I an EMT were arguing wether a patient needed to be transferred to the ER. To make a long story short, our medical control, told me, the patient is in her facility, under her care, then she calls the shots. If the patient was d/c'd and stumbled outside, then it would be my patient, and I would call the shots.

    Now, as for you and another EMT, who are off duty and stumble on a pt....your both working under good sam. laws, so I would think no one is higher than the other, and your only using first reponder skills anyway. It's not like you have an 02 tank and c-spine board in your pocket. So that guy, is just being a jerk. The objective was to help the patient, which is what you did. He should be greatful. I think the problem is there has always been a small fued with EMT's and RN's. EMT's complain RN's show them no respect, which I admit has happened to me, but not all the time. RN's argue, EMT's think they now more or are better. And sometimes thats true, I've had many co-workers complain, they are better EMS providers. I think we should all try to work together to achieve pt. care, but guess the fued is still going on.
  5. by   MrScrant
    Sounds to me like you were absolutely right. As long as someone is holding stabilization of the child's head, go ahead and roll him and clear his airway. Why were rescue breaths even considered with an airway obstruction??!! Sounds like that EMT doesn't know his/ her ABC's.

    As far as who is ranked higher, we have different roles. Of course, nurses have more training and education, but EMT's have a different skill set that is specialized for emergency situations outside of the hospital setting. In the medical food chain in the hospital setting, it should go without saying that the hierarchy is DR-RN-EMT.
  6. by   DusktilDawn
    I think the EMT kid should have been spoken about being respectful towards nurses. EMT kid sounds like he still may have a few things to learn.

    Believe me I have great respect for EMTs and don't doubt that they clearly have more of an idea what to do on scene in most instances.

    "but next time be a bit more respectful to an emt because e are higher up than you outside of the hospital"
    The remark surprises me because if EMT kid had his way more harm may have come to this patient. It would have been more prudent for him to have taken the opportunity to educate EMT kid on why his actions were incorrect. Clearly you knew what you were doing.

    Don't believe thats actually a legislative fact, it seems to be this EMT's opinion. What I do know is that when a nurse offers assistance in a situation like you described, she/he will be accountable to the standards that a reasonable and prudent nurse would do under the circumstances. I would take this to include patient advocacy, which would include interceding in actions that could harm the patient.
    Last edit by DusktilDawn on Mar 9, '06
  7. by   smk1
    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...
  8. by   wooh
    In the field, both of us being good samaritans, I'd probably defer to an EMT unless I saw he didn't know what he was doing. (After all, they are trained to respond in the field.) But if the guy started to try giving rescue breaths to someone who is breathing, I'd immediately ask to get credentials (because someone's BLS has obviously expired) and while he's digging out his wallet kick him the hedoublehockeysticks out of the way!
  9. by   traumaRUs
    I guess its not truly a question of who outranks whom but rather who is in the best position to care for the pt.
  10. by   canoehead
    duplicate
    Last edit by canoehead on Mar 9, '06
  11. by   JeanettePNP
    I've seen a pity saying about this once... something about a person's expertise in an emergency being inversely proportional to his verbosity.

    I would hate to be stuck in such a situation...
  12. by   canoehead
    Where I live we have EMT-B (basic), EMT-I (intermediate), and EMT-P (paramedic). The EMT-B's seem to be just a little more knowledgeable than first responders, and sometimes they get dumber the sicker the patient gets. The EMT-P I would defer to because they have more practice in the field, and generally know exactly what they are doing.

    You have to remember also that there are nurses RN- CEN and there are nurses RN- (well we all know who we wouldn't want even touching us in an emergency). I think that the fact that this EMT had an issue with breathing vrs not breathing makes him as useful as a bystander.

    I came across a car accident and there were people running around giving instructions...one very verbal guy I talked to afterwards, he had taken a first aid course two years ago, so he took on the role of director of a multi victim car crash.

    We need a way to identify each other- cops have badges on their lapels- what could WE do?
  13. by   MarcusKspn
    I have two things to say regarding this situation:

    #1) Yes, in a Pre-Hospital situation an EMT is allowed to do more than an RN. Only by a hair though. An RN in a setting where he/she is not at work is limited to BLS. Airway, Breathing, Controlling Bleeding/Circulation, she cannot give any meds because there is no doctor there to supervise and give orders. Even a basic EMT can give Aspirin, Epi-Pen, Nitroglycering, Oxygen, and Charcoal. In an emergency pre-hospital setting that LPN/RN etc don't mean crap. I am an EMT/Fire Fighter with a volunteer department. When I am responding to an emergency I can only to BLS, no IV's, no Intubation, no ACLS. While it can be frustrating I know and accept my limitations. I do use my ACLS knowledge to be sure the paramedic has whatever he needs next in his hand before he can even ask for it. I can also tell you that EMT's/Paramedics have had very bad experiences with the Pediatric Office Nurse running up to the Multi-Car pileup screaming "I AM A NURSE" and have no clue what to do and not realize that unless she is prepared to do CPR there is not anything she can do in the pre-hospital setting. Same as the proctologist running up yelling "I AM A DOCTOR". It is just a completely different scope of practice.

    #2) Now, unless that EMT was WITH the ambulance or first response team that was ON DUTY he was just a bystander - first responder. He was not practicing EMT that was being covered by his Medical Director with no established Duty to Act. As such he had the exact scope of practice that a bystander - nurse had. Couldn't do anything that you couldn't do. At this point you were just two profesionals disagreeing on a course of action. You both were at the same level and do not outrank each other. If he was the EMT on duty and this was officially his patient then YES his orders would have outweight your concern, but since his name would have been on that run-report he would have been responsible for the patients aspiration pneunomia. You know how pissed we get when a family member/friend who is an EMT/Nurse/Doctor tells us how to do our job, its kind of like that.

    #3 (Yes, I reallize I said I only have 3 things to say) COMPROMISE!!!: There were two of you. How about one log rolled to clear the airway while the other held on to the head and maintained inline stabilization of the c-spine. That would be what we would do if we had to clear airway without suction in an emergency with a possible cervical injury.

    My 3 cents, have a good night everyone, and stay safe out there.
  14. by   JBudd
    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" :spin:. 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. )

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