I am currently attempting to co-write an article for a national publication in regards to Problems in EMS. I am both a ER- RN for over 18 years and a field Paramedic. I believe there are some points that need to be addressed and changed.
I would like to hear both the bad and the good points as well. Please, constructive criticism and downplay bashing if possible.
My main focus will be on education, professionalism, and patient care, etc..
If you feel you dont want to post them, you can PM me.
We have pediatric restraints built into our captains chair in the back of every MICU. We fortunately have very few pediatric transports. Hogan, I appreciate your passion and concern regarding the subject and agree with you wholeheartedly.
Ridryder 911, I do have a criticism of EMS as a whole with respect to the educational aspect. I would like to see more pathophysiology in the EMT-B's course. I would also like a more comprehensive curriculum similar to nursing school for paramedics. Becoming a nurse has helped me tremendously in the EMS world and I would like to see more medics with a solid background in broader areas of medicine. I can't tell you how many times I have heard, "Why do we need to know that, we can't do anything for that condition." Well, medics may not be able to do anything, but the knowledge of the disease and related symptoms may explain complaints they are being called for or potential symptoms that may arise. If not anything else, they will be able to understand and relate to the doctors and nurses to whom they are transferring patient care.
This is my opinion based upon my experience. I love EMS and only want to make it better. Thanks!
I appreciate the responses. How do nurses feel that the Paramedic or levels of EMS crews are educated and prepared to administer care, (pitfalls or good points).
Report among nurses and EMT's... professionalism, good or bad ? Are they prepared to assist or work in the ER?..
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
Ridryder 911, I do have a criticism of EMS as a whole with respect to the educational aspect. I would like to see more pathophysiology in the EMT-B's course. I would also like a more comprehensive curriculum similar to nursing school for paramedics. Becoming a nurse has helped me tremendously in the EMS world and I would like to see more medics with a solid background in broader areas of medicine. I can't tell you how many times I have heard, "Why do we need to know .
Many paramedic programs affiliated with large trauma centers or colleges send paramedics through the exact same courses that they send nursing students through. It is ultimately up to the medic to educate himself and to realize that it's more than intubation and drug pushing. I spent 2 full years (5 semesters) getting my medic, and though it was hard, I loved it.
I too would like to see the EMT B education expanded. You can learn almost as much from a Red Cross Standard First Aid course, with the exception of the oxygen therapy and equipment.
And someone still has to deal with the pay issue. Why put yourself through 2 years of school to go work for little more than you would make at a movie theater??
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I think you asked about rapport, and it depends on the work environment for both RNs and EMTs/medics. If you work in a busy system or hospital, you probably have seen nurses or EMS personnell get snippy with each other. As long as you each realize that you're on the same team working toward the same goal...everything gets better.
Report among nurses and EMT's... professionalism, good or bad ? Are they prepared to assist or work in the ER?..
R/r 911
Most of the time they do not "work" in the ER they simply stand there and watch--drives me a little crazy. Traumas as you know get a little crowded and we don't need the medics and emt's standing there watching but we don't usually say anything because they can be quite vested in the case. Only time I've ever seen EMS get involved with the care of a patient was intubating (sometimes they are trying to get their "numbers" in).
As far as education and report I think ours are adequate...there of course are some that give too much report and others famous for not even leaving a copy of their EMS notes.
We have several different EMS companies coming in with patients. One group the one that is attached to our hospital I can't say enough about. They are fantastic, I never have to ask if they did vitalsigns or started a line on a critical pt if it is ALS it is done. Everyone is completely professional from the EMTS up. The BLS calls are also as complete as protocol allows as well.
The other group I am not too sure about. They constantly bring in patients and tell us they did not do anything like question the patient do vitals because "they were just down the street" we have to ask the pt if he has allergies or takes meds because it is not done by this group. They usually fill in the vitals and paper work when they arrive. They bring in patients who have seized without an IV only to have them seize again. Rarely does ALS bring in a pt with an IV or EKG strip and many times they do not even call ahead they just show up with a critical pt.scaryyyy. I know if I were a resident I would cringe if this group showed up. I think there is only one paramedic who follows protocol. I can't say enough about her, she needs to teach her cohorts.I have to admit I made the mistake once of notifying their supervisor after they brought a pt who had overdosed on many meds. They said the pt was "too violent to do anything" the patient arrived somulent with a BP so high she seized upon arrival she did not have an IV in so we scrambled to get an IV in and intubate her as she crumped. As a direct result they made it clear that "when the redhead is on make sure you bring all the drunks to that hospital" (I was told this by another Paramedic) It took months for that to wear off so now I stay quiet now.
Specializes in Trauma Administration/Level I Trauma.
I appreciate the responses. How do nurses feel that the Paramedic or levels of EMS crews are educated and prepared to administer care, (pitfalls or good points).
Report among nurses and EMT's... professionalism, good or bad ? Are they prepared to assist or work in the ER?..
Thanks again..
R/r 911
As a E.R. R.N. and also a EMT-Paramedic from New Orleans I'll give my opinion. I think in general (there are exceptions) EMS does not get the respect it deserves. Time after time I see nurses talk down to them, making comments about "not having an IV", or "dumping on them", etc. Fact is the average R.N. would be overwhelmed in the field especially in a code situation. In the E.R. you have 10 people at your side during a code, in the field it's you and your partner and you are TRULY making medical diagnosis. You diagnosis wrong then you treat wrong and a sentinel event occurs.
I think the animosity often has to do with the power struggle. Some nurses can't accept the fact that a "lowly" EMT can do things they cannot (intubation for example). I do believe things are turning for the better. I think the younger generation of nurses realize what an asset EMS is to emergency care.
As with nursing there are good nurses and bad, same with EMS.
I too believe majority of the post, the power struggle on both sides, and ego's as well.
As an ER nurse, I see excellent paramedics and unskilled "scary" paramedics who I pray won't be the ones who show up if I'm ever in a MVA in their area. I think it's these "scary" medics who receive disrespect from the nurses. Of course there are plenty of nurses with bad attitudes who are impossible to please, hopefully I'm not one, but I'm sure I treat some medics with more respect than others, even though I know I should be respectful of everyone equally. I think disrespect from nurses stems from frustration when the same medics consistently give substandard care to their patients (not obtaining hx, vital signs, at least attempting IV access, initiating protocols). It's not that they aren't knowledgeable, they just don't try as hard as some of the other medics. This attitude is what nurses disrespect, not the medic's lesser education, certainly not their occupation, or that they get to intubate and we don't. The "awesome medics" and "scary medics" supposedly have the same training, maybe went to different schools, but I think the main difference is personal integrity and inherent intelligence. Some have it, some don't.
Let me ask this..."do you think, Paramedic education level should be at least associate degree, baccalaureate level as in Canada?
The "awesome medics" seem to be adequately trained and skilled to make accurate diagnoses using only clinical assessment skills (no imaging, labs, etc.) which I find extremely impressive. So I think the only advantage to requiring more education would be to "weed out" the students who don't have the intelligence or drive to get through a longer course of study. Weeding these people out before they ever graduate might lessen the number of "scary medics" who are produced. Then the only variable would be personal integrity.
Do believe the traditional Paramedic curriculum addresses the majority of the patient emergencies and needs ?
Haven't been through it myself to know what they cover, but the fact that there are skilled and extremely knowledgeable paramedics suggests that it does.
do you actually consider them as health care professional?
Of course! And as with any health care professional from nurse's aides, phlebotomists, on up to MD's and MD specialists there are the good and the bad, and I do think it has something to do with integrity. Some one with integrity will strive to continue their learning after graduation, strive to give the best care they can and go the extra mile for the patient and other people on the medical team.
One of the biggest problems I see is that nurses don't really understand what sort of training EMTs and paramedics have and what they can do. On the flip side, EMTs and paramedics don't fully understand the training that nurses have and what they can do. I've seen nurses get really angry when patients come in without IV access while totally overlooking the fact that the patient has an unstable airway and that the EMT is focusing 100% on that. I've heard paramedics totally bash nurses when they seen them miss what is seeimingly an easy line...even though they miss IVs sometimes too. I hear nurses talk about how paramedics are just a bunch of trained monkeys that can't do anything without a protocol, but paramedics are the first people they turn to when they have a funky EKG or a combative patient. I see paramedics talk about how they could "run the ER" better than RNs who just freak when they have a sexual assault come in or when someone comes in with a 6 week old rash and a hangnail.
I don't really think there is lack of respect as much as there is a lack of knowledge. So many people think that because they can do one job well, they should be able to do the other job well too. Some can, but a lot cannot.
this is your chance to voice, vent.. your opinion!..
about ems (general) .. does it need to be changed, fixed, remain the same... ?...i often hear a lot of complaints and compliments... time to speak out!..
One of the biggest problems I see is that nurses don't really understand what sort of training EMTs and paramedics have and what they can do. On the flip side, EMTs and paramedics don't fully understand the training that nurses have and what they can do.
I don't really think there is lack of respect as much as there is a lack of knowledge. So many people think that because they can do one job well, they should be able to do the other job well too. Some can, but a lot cannot.
Some years ago, my department head decided we needed to understand our EMS folks better, and scheduled all of us to do a 4 or 8 hour ride along (with pay), to strengthen relationships. Worked too.
I appreciate the responses. How do nurses feel that the Paramedic or levels of EMS crews are educated and prepared to administer care, (pitfalls or good points).
Report among nurses and EMT's... professionalism, good or bad ? Are they prepared to assist or work in the ER?..
Thanks again..
R/r 911
Whilst unable to comment on the US, over in the UK we have just started introducing degree qualified paramedics, these have shown a huge improvement in the quality of treatment that patients are recieving in the prehosptial enviornment.
Some of the A&E nurses in the UK do view ambulance staff as little more than stretcher bearers who bring the patient to hosptial, with little specific knowledge, whilst this view is getting less and less, there are still some examples out there of care that is definatly substandard (p211, bp 90/50, chest pain and palpatations without a priority blue light call for example, happened last week).
On the whole though ambulance staff provide an important service and have skills that are not used in the emergency department, their self sufficency in the community with either little or no access to medical assistance is obviously a difference, however the emergency nurses ability to multi patinet care is in contrast to an ambulance personal's normal 1:1 ratio.
It is very hard to compare two jobs, both of who look after acutly ill patients but which require such different skill sets to achieve to a high standard.
One of my colleagues (in the ambulance service) believes that the inclusion of paramedics in trauma / resuss rooms would highten the care in there, whilst he has a point to a degree, being degree qualified with a masteres in ECG interpretation makes him the exception when in the ambulance service wold in the UK not the norm.
There is sometimes a lack of understanding regarding the patients that ambulance staff bring to hosptial, they are often unable to safely leave at home patients who hospital staff consider a waste of time, whilst suspended's (codes in the US) it is important to remember that there is only 2 of them doing it, we have a greater number of staff at hospital.
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Medic2RN, BSN, RN, EMT-P
1,576 Posts
We have pediatric restraints built into our captains chair in the back of every MICU. We fortunately have very few pediatric transports. Hogan, I appreciate your passion and concern regarding the subject and agree with you wholeheartedly.
Ridryder 911, I do have a criticism of EMS as a whole with respect to the educational aspect. I would like to see more pathophysiology in the EMT-B's course. I would also like a more comprehensive curriculum similar to nursing school for paramedics. Becoming a nurse has helped me tremendously in the EMS world and I would like to see more medics with a solid background in broader areas of medicine. I can't tell you how many times I have heard, "Why do we need to know that, we can't do anything for that condition." Well, medics may not be able to do anything, but the knowledge of the disease and related symptoms may explain complaints they are being called for or potential symptoms that may arise. If not anything else, they will be able to understand and relate to the doctors and nurses to whom they are transferring patient care.
This is my opinion based upon my experience. I love EMS and only want to make it better. Thanks!