Paramedic triage

Displaced · Mar 8, 2009

I want to start off by saying that you should feel a little uncomfortable about this since it is going to be something your ER has not tried yet. But, I believe based on what I have seen first hand from the paramedic curriculum, that any well educated and well experienced paramedic should be able to do the job at triage just fine.

Medics learn about all the worst case scenarios in class, even from the beginning in their EMT-B class. They are taught when to "load and go" or "stay and play" which can translate to a sudden onset chest pain that walks in that any nurse would take back to a room right away vs a abdominal pain x 3 weeks that can afford to wait a little longer.

Our ER Techs are Medics/EMT-B's, and sometimes when we are really short we have them in triage alone. They do a great job and we have never had a problem with them. Just last week we had a one of them rush back with a chest pain, he did the ECG and saw the ST elevation x 3, he yelled for a doc and had a clerk put orders in, got blood and sent it down all before a nurse ever stepped in (we were real busy plus he is very good/fast and *only* a EMT-B).

My point: If it is properly implemented, with the right people, it can work out great. But when it comes to liability and negligence issues, that I don't know about.

MiCountry · Mar 8, 2009

When our ambulance service was hospital bases, we used paramedics in our triage. It has worked well. They helped ED out in their downtime this way. I took my children in several times, and was very happy with how well they triaged real emergencies from the misc ear aches, sprains etc. I took children in for things from airway issues due to allergic reactions to non-emergent sprains. The paramedics got it right every time.

Iam46yearsold · Mar 8, 2009

The State of Texas laws says that all patients triaged need to be assessed by an RN. But on a personal level I feel parameidcs are quite capable of the triage system. I think we can all work together well.

Neveranurseagain, RN · Mar 8, 2009

I too feel paramedics are capable of triaging. But having an EMT-Basic is like having a CNA triage....And yes, I was a CNA before I was an EMT then I became a LVN then became a paramedic and then an RN.

An EMT-Basic only has 110 hrs of classroom...

danjw · Mar 8, 2009

Depends where you are really. I'd be fine with it because where i live, all our paramedics complete a university degree including clinical studies and another probationary year at the end. They get about the same training as the nursing students really. The only exception being volunteer/private service crews and transport officers (who only transfer patients between hospitals). In fact i'd probably prefer the paramedic to the nurse since the entire focus of the medics training is emergency 1st aide / triage

But i understand that a lot of places have paramedics with less training (emt's) that only do short courses. Then i'd rather have a nurse. I think my rule is: If you've spent less than a year studying medical, i don't want you deciding how much of a priority i am.

Then again, i'm the kind of person that won't bother going to a hospital for anything short of a life/death emergency, so i want someone good at the desk

llltapp · Mar 8, 2009

I agree with most of the previous posts. I worked in an ER where paramedics traiged. Then new docs came in and said no paramedic triage, only RN. It all depends on who the person is. Just like I've seen some RN's that don't belong in triage, I've seen paramedics who don't. Bottom line, I think you should have a minimum level of experience before you get behind the wheel of triage. I've seen our paramedics do incredible things, and yet I've seen outright moronicity (is that a word? lol). But, it's the same with RN's , NP's, and ER doctors.

needsmore$ · Mar 10, 2009

WE follow the ENA position statement re-who's able to be assigned to the triage area

That being said, I firmly believe that there are many paramedics that I work with that would do an excellent job and I have worked with several nurses who "on paper" meet the standard, but --- leave aomething to be desired

Larry77, RN · Mar 11, 2009

I'm fine with it as long as they have an RN as a resource....Medics triage all the time in the field so what's the difference in the WR? When it comes to a deeper hx or initiating tx i don't think they are comparable to an RN though...this is where I feel they would need some back-up.

mattwilson · Apr 7, 2009

Paramedics do a lot of the triage at our ER. We see approx 160-200 patients per day and when we have two triages going theres a good chance at least one is a paramedic. About 2 years ago we started hiring paramedics in the ER. They can do pretty much everything the nurse can except be primary on a pt receiving blood, discharge, ect. they can get out and give all meds the nurse can, they can intubate if there isnt a resident or med student before them. Got a little off topic but Paramedics do great at triage.

**canoehead, BSN, RN** · Apr 10, 2009

Triage is what paramedics do every day. I'd be comfortable with planting them in triage anytime.

ivanh3 · Apr 10, 2009

Being both a paramedic and a RN I have mixed feelings about the triage position. Back in the day the two most experienced people in the ER were the charge nurse and triage nurse (often with a minimum of 10 years or more time on the job). Those two people together determined what kind of day the ER was going to have. The question/comparison is moot when RNs with 1 to 2 years of experience are placed in triage. When the amount of experience of the provider (RN, paramedic or otherwise) is that low then there will be problems. Patients will be either under or over triaged. I know under triage is worse, but man, I can't stand it when I get a triage nurse thats sends everyone back marked "red".

Now correct me if I am wrong, but I thought it was a JCAHO requirement to have an RN in triage. I have seen this "gotten around" by having EMTs or paramedics "collect data" and the RN signs off. So if I am right about JCAHO, and paramedics are by themselves in triage then something is wrong in terms of compliance. Not saying the patients are not being triaged properly. Again, that depends on the experience of the provider and (this is important) how much of that experience has been working in a hospital environment. Which leads me to my next point.

I have seen several people make comments that paramedics triage all day long. That is just not true. If anything, a paramedic is more likely to be working in a "reverse" triage situation: two EMTs/medics to 1 patient. Even when there is an MCI the parameters are different. Try black tagging someone in the waiting room and see what happens. Pre-hospital triage and waiting room triage are two different beasts. In the field as paramedics we are allowed certain, umm, allowances because our resources are limited. We don't have almost instant access to x-ray, CT, labs, physicians, surgeons, various medications/procedures. In the hospital the availability/proximity of those items are closer. This changes the rule of triage. In the field unless the circumstances are extreme we are not with our patients for a very long time. Also in general, during an MCI, we get a batch of patients with similar complaints (fire, smoke, exposure, trauma) and that is it (not including your various MCI triggered heart attacks, asthma attacks, and baby deliveries). Contrast that with the waiting room. We might have a patient for 6-12 hours or more. Add to that we are constantly getting new patients with various complaints. So our triage "pool" is always changing. Is there crossover in this skill subset? Yes. And paramedics can do well in hospital triage. I have worked triage in the ER as a paramedic (with my charge as my RN "backup"). I learned how to do it (I think I did well), but it was not the same as field triage.

Ivan