Paramedics in the ER

hi,

I am a paramedic working for a hospital based ambulance and in between calls we work in the E.D.

We, as paramedics, take patients, give report to floor or another facility if the patient is being transferred, administer medications (all routes), do 1:1 critical care patients, obvioulsy documentation, intubations, IVs/blood draws, IO (rarley needed), defibrilate/pace/cardiovert, put in foleys (depending on the medic, some will not), dressings.... What we cannot do is discharge patients, but that may be changing soon. Also we cannot hang blood because I beleive that is a federal law. Although I will be able to as soon as I pass NCLEX

You need to check with your state when developing the scope of practice. I live in a state where we are allowed to work within a hospital under a doctors license.

Hope this helps

Swtooth

Our medics can do inital triage, give all PO meds, start IV's, do EKG's, draw blood.

They can not hang blood (must been done by RN), d/c a patient, insert a Foley or straight cath or give IV meds.

The state I live in allows them to function as a medic in a hospital setting but P&P of the specific facility largely dictates what they can and can't do. Like we do not allow them to intubate a patient, though in the field they obviously can. They are also not allowed to do IO's but in the field they can. We also limit meds to just PO because it got confusing as to what they could and couldn't give ----

Which state do you work in. We really want paramedics in the ED but are starting from the ground up. Would appreciate some info and maybe a job description. Anything would help. I live in IN which is much more advanced then were I work (KY). Thanks

We have medics in our ER; they can triage, EKGs, IVs/labs, foleys, splints, transports, and D/Cs.

CANNOT give any meds at all (other than NS or LR with no added meds) and do not take their own pts-they're paired with an RN.

Wehave paramedics in our ER, CFD is great, I would choose them over most md's and even RN's when it comes to procedures

Paramedics should only be relegated tech duties in the ER, stocking, splinting,ekgs,vitals,transport.

In the ER IVs, meds,everything else is nurses realm..

We have EMT's and EMT II's . . . .and some have their Paramedic licence but we don't utilize them as medics.

Our EMT II's can start IV's, draw blood, give meds. I appreciate the help when we are busy as I'm the only nurse in the ER. We have one EMT and one EMT II (who also may be a medic). We have an in-house ambulance also so if they get a call, I'm all alone. Well, the doc can come over but he is seeing office patients - his clinic is about 20 feet from the back door of the ER.

I like having EMT's in the ER.

steph

I used to work one of those little country ERs decades ago. First as an EMT, then as the charge nurse whose job it was to treat ER pts also. The good lod days.

Paramedics should only be relegated tech duties in the ER, stocking, splinting,ekgs,vitals,transport.

In the ER IVs, meds,everything else is nurses realm..

Why? In most of the country Paramedics spend more time in school and clinicals than most RN students; they are required to treat and diagnose on their own, no physician around, no reference books, no year of "orientation" or "on the job training" (as many new nurses have to go through now) and specifically trained for the emergency situation--the next 60 - 90 minutes not the next 30 days like most RN's.

Why? In most of the country Paramedics spend more time in school and clinicals than most RN students; they are required to treat and diagnose on their own, no physician around, no reference books, no year of "orientation" or "on the job training" (as many new nurses have to go through now) and specifically trained for the emergency situation--the next 60 - 90 minutes not the next 30 days like most RN's.

Hmm after being an EMTP and an Instructor as well as a a preceptor for 20 years before becoming an RN. IT takes about a year for that paramedic to become fully functional on their own.

It's not a whos better type thing, the paramedic program is more focused and the nurisng eduction is more generalized. Neither are ready to go at it alone the day they graduate. Both learn most of what they need to function on the job. Paramedics aren't tought to worry about things like the osmolarity of a medication when choosing access routes. Can they learn those kind of things. Not only Yes, but they do.

Unfortunatly in today busy ER's, nurses dont' work at to much more than a techician level. We're to busy to do the things that we claim to make us better. Pt teaching and such.

IT's more a mindset than individual skills and knowledge. I didn't want to become a nurse till my EMT partner looked at me and said I sounded like a ###### nurse one day.

Can EMT=P's work in the ER, Yes, but so can nurses work prehospital.

You will find that many ERs have paramedics who work as "techs", doing the tech jobs mentioned...EKGs, IVs, labs, NGs,foleys, dressing changes, vitals, intake/output...and the list goes on.

Your organization has to ask itself: What is our ultimate goal here? What do we feel comfortable allowing these people to do? Most nursing practice acts prohibit "unlicensed assistive staff" (including paramedics) from performing as they do in the field, so if that is one of your goals then they are going to have to have medical direction - and protocols.

There is a hospital in Dallas Texas, Methodist Hospital (downtown). The paramedics there are allowed to operate just as they would in the field. Give them a call and speak to the ER manager. Perhaps they can give you some input about their program and that may help you spawn your own.

Good luck to you.

vamedic4;)

This is the one topic that can be debated for the remainder of any of our careers. Paramedics in the ED, RN's in the "pre-hospital" area (FIELD).

Well, this is the one topic that I have experience with from every angle. There are many shared skills --- but does that EQUAL shared practice? Well, yes, in some environments - your perspective is determined from where YOU stand!

The short answer is yes AND no. It just depends on the practice environment. I have been a medic a loooong time, and I've been a nurse in 18+ facilities - so I have some meaningful experience.

errneducator - feel free to send me a PM with some contact info for you - I think I may have what you need, but in the interest of all - I'll not debate this again here.

I think it comes down to just what it is - BOTH are healthcare providers - but, their preparation is different.

And I just plan to continue to RESPECT the differences and (in the ED) the COMMONALITIES of practice!

PRACTICE SAFE!