Paramedics in the ED

[EDMEDIC]

This is a rehash of an old article I found on the site from 2005. The article was just asking if RN's had experience working in the ED with medics. The responses varied from positive to mostly negative from the RN's at that time. Some responses from the nurses makes you wonder how they got a degree in anything, but times have changed. My career in EMS started with the fire dept where I retired after 20yrs working in a large metropolitan city. After my retirement, I started my 2nd career working in the ED as a Paramedic back around 2014. It was a new concept at the time in Georgia & myself as well as others were openly treated like EVS techs by the nurses. It was a kind of like, go play in your own sandbox, from the nurses.

Now here it is 2020 and I get nothing but support from the ED providers and RN's (except for the fact that we eliminated LPN's from the ED's in Georgia). I work for a major healthcare system with hospitals, urgent care centers, managed health, ETC. ETC. all over Georgia. Mostly concentrated in the metro Atlanta area & like it or not. If you come into an ED in Metro Atlanta. You will most likely encounter a Paramedic who is not emptying the trash, but a major player in your care team.

In Georgia, Paramedics have unrestricted licenses & whether working in the streets or in the ED. Our scope of practice is set by the medical director where we are employed & only after we have been trained and shown proficiency in the procedure or task. Where I work, when the crap hits the fan. No one cares what letters you have after your name and we all work as a team!

Back to the original question. This is how things flow in my facility. You go to acute care or fast track based on your acuity. Only an RN can triage and assign an acuity and only an RN can discharge a pt. Everything in between, the paramedics do. We can see the same screen you see. We are legally able, trained and proficient at administering any medication ordered by the provider with some exceptions. In Georgia, Paramedics cannot give colloids (we can hang a second and further bags of blood, but not the first even though we are trained to recognize a hemolytic reaction , anti-coagulants( unless on a TPA program) or insulin. We can jack you B/P or glucose up, but we cannot lower it. We are proficient in endotracheal intubation, needle chest decompression, needle cricothyrotomy, intraosseous placement ETC ETC.

Bottom line is. We all have our skills and the patients need all of us working together to save them. If you dont want a medic messing with your patient. Tell me and the charge nurse and I won't help you and after you've stuck the patient 10 times. I'll come and put an 18 EJ in for you because you have destroyed all their distal veins before you ask for help even though I know you won't says thanks. Also Paramedics pick up after themselves. We dont throw the crap in the floor or in the IV carts for others to pick up.

[PeakRN]

On 5/4/2020 at 9:14 AM, EDMEDIC said:

This is a rehash of an old article I found on the site from 2005. The article was just asking if RN's had experience working in the ED with medics. The responses varied from positive to mostly negative from the RN's at that time. Some responses from the nurses makes you wonder how they got a degree in anything, but times have changed. My career in EMS started with the fire dept where I retired after 20yrs working in a large metropolitan city. After my retirement, I started my 2nd career working in the ED as a Paramedic back around 2014. It was a new concept at the time in Georgia & myself as well as others were openly treated like EVS techs by the nurses. It was a kind of like, go play in your own sandbox, from the nurses.

Now here it is 2020 and I get nothing but support from the ED providers and RN's (except for the fact that we eliminated LPN's from the ED's in Georgia). I work for a major healthcare system with hospitals, urgent care centers, managed health, ETC. ETC. all over Georgia. Mostly concentrated in the metro Atlanta area & like it or not. If you come into an ED in Metro Atlanta. You will most likely encounter a Paramedic who is not emptying the trash, but a major player in your care team.

In Georgia, Paramedics have unrestricted licenses & whether working in the streets or in the ED. Our scope of practice is set by the medical director where we are employed & only after we have been trained and shown proficiency in the procedure or task. Where I work, when the crap hits the fan. No one cares what letters you have after your name and we all work as a team!

Back to the original question. This is how things flow in my facility. You go to acute care or fast track based on your acuity. Only an RN can triage and assign an acuity and only an RN can discharge a pt. Everything in between, the paramedics do. We can see the same screen you see. We are legally able, trained and proficient at administering any medication ordered by the provider with some exceptions. In Georgia, Paramedics cannot give colloids (we can hang a second and further bags of blood, but not the first even though we are trained to recognize a hemolytic reaction , anti-coagulants( unless on a TPA program) or insulin. We can jack you B/P or glucose up, but we cannot lower it. We are proficient in endotracheal intubation, needle chest decompression, needle cricothyrotomy, intraosseous placement ETC ETC.

Bottom line is. We all have our skills and the patients need all of us working together to save them. If you dont want a medic messing with your patient. Tell me and the charge nurse and I won't help you and after you've stuck the patient 10 times. I'll come and put an 18 EJ in for you because you have destroyed all their distal veins before you ask for help even though I know you won't says thanks. Also Paramedics pick up after themselves. We dont throw the crap in the floor or in the IV carts for others to pick up.

You seem to have a bit of a chip on your shoulder.

Why did EDs start hiring paramedics? Simply put they are cheaper labor than registered nurses.

Paramedic and nursing education is not the same, I’ve done both. Paramedics are taught the technical skills in order to manage patients outside of the hospital. They perform high risk interventions with less training than those who would typically be performing them in the hospital because the risk is outweighed by the benefit on the street. In the hospital we can lower that risk though by having specialty trained staff perform those interventions. Nurses are instead taught a general basis of care across many care environments and then specialize when they start working in a specific area. The shortest paramedic course is 3 months in the US, the shortest RN are about 16 months but requires a prior bachelors and prerequisites.

[speedynurse, ADN, BSN, RN, EMT-P]

This post was.....a little confusing.

1. I am a paramedic and an RN. I worked hard for my paramedic......I also worked hard for my RN. Spent 2 years in school for my medic......spent 2 years in school for my RN.

2. I have respect for both professions. And honestly - both professions should respect each other’s roles. I don’t think either is better then the other.....just slightly different scope of practices.

3. Plenty of nurses are just as good at the skills or assessments that you mentioned as a paramedic. And vice versa.

Again, your post was a little all over the place. I still basically have a foot in both fields.....work as a nurse and teach both paramedic and nursing students. Mutual respect is important.....

[medic 2 RN, ASN, RN, EMT-P]

RN/ paramedic here, I spent 9 months in 1987-88 obtaining my paramedic cert. Then from 2014 to 2017 getting my basics for RN, and graduated with my ADN in May of 2019, while still working full time in EMS. We pick up after ourselves in our ED because we aren't a bunch of slobs. When I have a pt that is a hard stick I will get the ultrasound and stick them once for their IV. Our hospital based medics come and help us when we get slammed with patients and we thank them for their help. I still work the truck too. Yeah, you have a chip on your shoulder.

[PeakRN]

1 hour ago, medic 2 RN said:

We pick up after ourselves in our ED because we aren't a bunch of slobs.

While I agee with some of this I would like to clarify a bit. I was a messy medic. The floor and bench of my bus were a disaster by the end of my call. That was because we thoroughly cleaned the back after every call. Also since we only us a few calls a day it want a big deal to clean after the call, had I run a 911 system that is constantly churning volume I’m sure that would have been different. Cleaning your workspace type habits were a big change for me.

[EDMEDIC]

First of all, I was responding to a post made by an ancient RN that hated sharing her sand box with paramedics. I may have been at bit harsh and unfair in my statements. The whole purpose of EMS and hospital emergency services is to save lives and get them to unit or another appropriate facility viable. I have nothing, but the utmost respect for RN's. My main complaint is we dont get that back. Paramedics in Georgia, in the ED are nurse extenders. I cant speak for the other 49 states, But in Ga.. Paramedics are flooding the ED's as an extra arm for the RN's. We are not techs that update vitals when your tied up on a facebook chat. I work in what is called a vertical 3 4 5 zone. that's the acuity level we care for in the ED so the RN's are freed up to care for the higher acuity patients. We are allowed to work to our scope of practice to assist the nurses. When I take a vacation day. My phone blows up with my night *** nurses begging me to come in because " we dont have any medics tonight! That's because we do all their lines, labs etc and medicate all their pts with some exceptions. We dont give colloids, anti coags or insulin. It's not in our scope of practice. However, when that trauma rolls in. All you can hear down the hall is " Medic"... I dont claim to be an expert in emergency medicine, but I Know my nurses appreciate me. If you've got a problem with medics in the ED. Do it yourself! I do my own charting and I chart all the meds I give and all the procedures I do. You dont have to sign off on anything I do because the medical director in the ER has already set and approved what I am capable of doing in the ED so take an Ativan and quit worrying about your license. Like the previous commenter said before. We all have our skills and responsibilities & when the crap hits the fan. We are a team! I dont compare myself to a RN and RN's should not compare their selves to medics. It's 2 different disciplines. Booth should be understood and respected! I am not to sure what you do in the er, but its beyond my training & you damn sure dont know what I do on the streets because we do this *** by ourselves, on the side of the road. There are no Doctors, respitory therapist, 10 nurses or techs...…. Its just me in the back of the bus!!!!

[Wuzzie]

Who are you yelling at??

[EDMEDIC]

I aint yelling at anyone. just want this to be a team effort!!!

[Wuzzie]

8 minutes ago, EDMEDIC said:

I aint yelling at anyone. just want this to be a team effort!

Well, it sure sounded like it.

[EDMEDIC]

On 5/10/2020 at 4:37 PM, PeakRN said:

You seem to have a bit of a chip on your shoulder.

Why did EDs start hiring paramedics? Simply put they are cheaper labor than registered nurses.

Paramedic and nursing education is not the same, I’ve done both. Paramedics are taught the technical skills in order to manage patients outside of the hospital. They perform high risk interventions with less training than those who would typically be performing them in the hospital because the risk is outweighed by the benefit on the street. In the hospital we can lower that risk though by having specialty trained staff perform those interventions. Nurses are instead taught a general basis of care across many care environments and then specialize when they start working in a specific area. The shortest paramedic course is 3 months in the US, the shortest RN are about 16 months but requires a prior bachelors and prerequisites.

13 minutes ago, Wuzzie said:

Who are you yelling at??

I'm happy, just typing!

[Uroboros, APRN]

This is another old debate, as evident by the dated article. Seems difficult for medics to make the transition from field to hospital practice, and understandably since the two are very different. In my experience the successful ones were simply tired of those long 24-48 hour shifts and really ready for something different, or working those last few years for drop pay maximizing. It's really more of a personality issue, and less of a true practice paradigm trap.

As the OP states, medics work under their medical director's protocols. And those do not matter in a hospital, since every facility has it's own profundity in volumes of policies, procedure guidelines, and job descriptions. That's why even physicians and APC's have to request and be approved for privileges, since they all differ between hospitals, clinic systems, even departments.

As an ER supervisor for several years at a very busy southwest intercity level one teaching facility I encountered this personnel issue quite a lot. That culture had more to do with medics and fire employees, who were typically older men, taking orders from young female RN's. Certainly not implying that's the issue here, but it sounds along the same personal lines, and again less of a real practice issue.

[Wuzzie]

I was fortunate to work with a great group of medics and nurses who never had this issue. Pissing matches were completely non-existent. It might have helped that for many of them the ED was a side hustle (didn't use "gig" because that is apparently offensive ?) so we also were used to working with them in their main roles. Although I've been out of the ED for awhile I'm still friends with many of them.