Paramedic triage

firecoins · Oct 15, 2009

Did you read the whole thread, from the beginning? There are a lot of good thoughts on this issue, from both sides, and many from those of us who are both medics and ED RNs.

Not only did I read the thread, I read the responses to my post. The responses indicated it only mattered if you had the RN after my name or not.

To reiterate, I don't believe a medic can step into and ED and do an RN's job any more than I'd expect an RN to be able to go out and do a medic's job. Not without the proper training, and the ED isn't like the back of the rig. No politics on my part -- just reality as I've experienced it, from being both a medic and ED RN. Hope I'm clear on that. :)

Medics have worked in the ER as well as in the field. I don't expect an RN can jump into a rig and be a medic. And there are lots of aspects that RNs in the ER do the medics do not do. I do not expect a medic to be instantly ready to do without the extra training. 1 common aspect between both is triage. Hence I have no problem with medic doing triage. We already do this as apart of our job. Where we do it is what differs.

JoeDEDRN · Oct 16, 2009

Not only did I read the thread, I read the responses to my post. The responses indicated it only mattered if you had the RN after my name or not.
Medics have worked in the ER as well as in the field. I don't expect an RN can jump into a rig and be a medic. And there are lots of aspects that RNs in the ER do the medics do not do. I do not expect a medic to be instantly ready to do without the extra training. 1 common aspect between both is triage. Hence I have no problem with medic doing triage. We already do this as apart of our job. Where we do it is what differs.

I'd love to agree with you, but I can't. Agreed, triage is a common task to both professions, that is where it stops though. As a paramedic your scenario is pretty well set for you. You are responding to an emergency where you will be triaging mostly life threatening situations. Your transport rules are set. Most is fairly concrete, not all though. Now you are in the ED, nothing concrete here aside from the obvious, breathing or not, fever or not, fracture or not, etc.

Anyone who has triaged for a while will admit, it can be a very humbling experience. History plays such a large part, yet so does intuition and experience. Aside from the rare multi-casualty incident you come upon on the streets, triage is relatively straight forward. I am in NO WAY trivializing what paramedics do, because I am not. I have done both sides and I know.

On the outside you have a 38 year old male with chest pain and a good story and you are going in with him, no brainer. Now take that same scenario and toss in the vomiting child for two days with 12 hours of limited output and only one bed in the ED. Now it gets gray.

Do I think an experienced paramedic can triage in an ED? Of course. Do I think they do it as effectively as an expereinced RN in an ED? Sorry, but no, we possess different educational experiences.

firecoins · Oct 17, 2009

ED nurses are special breed. I would not trost most other RNs in that role of triage so just having an RN in that position. There is something ED RNs learn that other RNs don't seem to have in my opinion.

In what way is a paramedic situation set? I don't know that I agree or disagree because its more complicated than ALS or BLS.

JoeDEDRN · Oct 17, 2009

ED nurses are special breed. I would not trost most other RNs in that role of triage so just having an RN in that position. There is something ED RNs learn that other RNs don't seem to have in my opinion.
In what way is a paramedic situation set? I don't know that I agree or disagree because its more complicated than ALS or BLS.

Agreed. What I was trying to convey was that, as a paramedic, your situations are usually focused on a single patient. In multiple patient scenarios your choices are usually fairly clear cut. In a mass casualty scene you say who goes first, but transports are lined up for the next and your receiving hospitals are usually dictated by trauma levels.

Again I am in no way taking anything away from the paramedic. What I am saying is the opportunities to make a bad decision presents itself many times over in the triage area of the ED than out on the streets. I really do think they are two different types of triage with two sets of very different considerations. Granted the basics are there.

Pat_Pat RN · Oct 17, 2009

So than this is a political thing has has nothing to do with whether paramedics being capable of doing triage. Your saying medics can do triage but you want an RN instead because you don't want RNs losing possible jobs. As long as we are clear on that.

I don't know that I'd say it was "political". It is a requirement by JHACO....and I don't agree with 99% of what they say, but as long as they say "it is so", then we must do it.

ivanh3 · Oct 17, 2009

Some RNs were on par with me but most weren't in the same ball park. It would seem from this expereince that I would be fine for triage in the ER.

Hope you are able to operate that ambulance safely while you are so vigorously patting yourself on the back. Unfortunately, this conversation is not about you. It is not about any single individual. That is to say the topic at hand is not "Firecoins ability to triage". This is a dialogue about paramedics functioning successfully in ER triage. When I read comments from super medics about how advanced they are compared to RNs I just cringe.

1 common aspect between both is triage. Hence I have no problem with medic doing triage. We already do this as apart of our job. Where we do it is what differs.

For the record, again...pre-hospital triage is a different beast from ER triage. I am sure of this because I have done both extensively. Different set of rules, but there is some overlap, and medics do have a strong skill set as do RNs. I have no doubt that a paramedic given the same ER triage training as an RN would do just fine, as long as that medic is not too busy gushing at themselves in the mirror. As other have opined here, it is not just a matter of ability but also policy as well.