Paramedics in the ER

ImThatGuy, BSN, RN · Mar 9, 2011

Patient teaching isn't a paramedic "thing." The paramedic curriculum does not include elements of nutrition, health promotion, taking care of assorted surgical incisions, etc. There's no reason for medics to do this or be expected to off the top of the head. They could hand out pamphlets and read from them though. It wasn't until I got into nursing school that I knew anything about colostomies, for example. I remember being asked about one once when I was a paramedic and I matter of factly told the patient to cover it back up and ask the doctor later, lol.

ObtundedRN, BSN, RN · Mar 9, 2011

In my area they can function as a tech in the ED. And they function under the supervision of the RN, just as any other NA would. Not too much extra they can do from a tech. They can start IVs, draw blood, and do sterile dressing changes on new wounds (

GilaRRT · Mar 9, 2011

Patient teaching isn't a paramedic "thing." The paramedic curriculum does not include elements of nutrition, health promotion, taking care of assorted surgical incisions, etc. There's no reason for medics to do this or be expected to off the top of the head. They could hand out pamphlets and read from them though. It wasn't until I got into nursing school that I knew anything about colostomies, for example. I remember being asked about one once when I was a paramedic and I matter of factly told the patient to cover it back up and ask the doctor later, lol.

Nursing school doesn't include critical elements of ventilator management. I could say I didn't know anything about ventilators prior to respiratory school, but that would be a lie because I had crosstraining. Same concept applies in this situation no? I was trained in ostomy care when I was working EMS. One of our contracts had us providing routine ostomy care to several clients in the home health setting.

ImThatGuy, BSN, RN · Mar 9, 2011

Nursing school doesn't include critical elements of ventilator management. I could say I didn't know anything about ventilators prior to respiratory school, but that would be a lie because I had crosstraining. Same concept applies in this situation no? I was trained in ostomy care when I was working EMS. One of our contracts had us providing routine ostomy care to several clients in the home health setting.

If you're credentialed in it then great, but that's extra stuff. Patient teaching and health promotion isn't extra stuff for nurses, but it obviously is for medics.

I am merely pointing out differences for the lay readroles, but I am not in favor of mixing paramedic and nurse roles. The two professions exist for two reasons. Leave it at that.

GilaRRT · Mar 9, 2011

Nurses are proliferating into the prehospital environment, something they are clearly not taught to do in nursing school. Significant overlap exists, so it's a rather grey area.

FF-PHRN · Mar 9, 2011

Pt teaching is very much part of the paramedics job. I am in my tenth year as a full time paramedic and I can think of many ways pt teaching is involved.

For example, the pt that call that involves an insulin reaction. The pt is triaged, assessed, treated and discharged more or less. It may not be in a hospital setting but all the elements are there. The pt never sees a nurse or Dr. and still gets a good lesson from the medic, that also goes for the family members on scene. The same scene can be played over for various different EMS calls like the asthma attack or minor injuries, etc that are not transported.

I am as pro nurse as anybody, but lets not sell our paramedic brothers and sisters short. They have critical thinking skills also and can adapt very well to the hospital setting as well as nurses adapting to the prehospital setting. We all know most of our knowledge is gained on the job after graduating. I would take a paramedic by my side in a code situation as well as any nurse and I have had tons of experience with both examples. To say they could just read off a pamphlet or have no idea about colostomies is condescending and inacurate.

We have alot to learn from each other and obviously I have learned alot of respect for paramedics whether it be in the back of the ambulance, back of the helicopter, ER, or in the code situation taking place in the middle of a Denny's or some pts bathroom.

The overlap is a gray area because we (nurses and paramedics) have as much in common professionally as we differ. Prehospital and ED care has alot in common. It is the start of pt care for many pts.

Now, have said all this, once out of the ED\prehospital, our differences do become more obvious.

Rant off, flame away!

Aliakey · Mar 14, 2011

For the OP:

I worked as an ED Tech in a 40+ bed emergency department while a Paramedic before I moved into EMS. As stated by previous posters, our skills in the ED are limited to what the hospital policy allowed... for us, invasive skills were very limited compared to what we could do in the field, and included such things as blood draws (no IVs though), 12-lead ECG acquisition, CPR, simple splinting (sugar tong, etc.), some patient education as needed (such as crutch use), and so on. No medication was ever given by a Tech due to hospital policy.

Triage is usually our strength, and in our college's area, patient assessment was taught to ad nauseum. I did require some further education in order to adjust for the hospital setting in triage; priorities and documentation techniques are a little different. And yes, the charge or lead nurse did have to co-sign to the chart after I completed the triage documentation, which was no problem. There was a space specifically for the Tech to sign (if applicable), and for the RN.

However, I will agree that there is a lot the RN learns in their education that the rookie Paramedic only grasps the basics of. But, our role is typically intended for pre-hospital stabilization, treatment, and management of our patients. We try not to hang on to the patients for very long, if we can help it, lol! Right now, I am reading books for my nursing courses that spent 5+ pages on thermoregulation alone, while in paramedic class, that topic was limited to the methods of acquiring temperature measurement, differences between fever and hyperthermia, and treatment of each based on the suspected cause (example, malignant hyperthermia with succinylcholine use, or association of fever with febrile seizures). The RN education goes much more in-depth, but you also manage that patient on a more long-term basis.

However on the flip side, 12-lead ECG and capnography waveform interpretation is part of our in-depth education in my area. We are expected to *know* this, else suffer the painful consequences of the next report review. I've found that it is not the strength of some areas of nursing, while vital in others. Just two different roles that have some ties to each other in many ways, but also very stark differences that should be understood, IMHO.

For the OP, the biggest concern you should consider with paramedics in the ED as Techs is the "work as usual factor". I think most 'medics have some degree of attention deficit disorder, a twisted sense of humor, and like to see chaos brought into some form of order, usually with some sort of paramedic intervention ;-). In the field, we sometimes have to get pretty creative with our limited "tools", need to consider several possible treatment strategies for critical patients in very little time, start IVs while flying over potholes, intubate with a cockroach running across your arm, and you're not quite sure what might await you behind that seedy apartment door. Quite a few Techs did not stay long due to the limitations imposed from hospital policy (even if these limitations were made very clear during the hiring process), while several of those that did remain actually pursued their RN and learned a lot from the ED setting and the nurses that mentored them.

Just my penny's worth.

TraumaSurfer · Mar 14, 2011

If Paramedics could get past the "skills" mentality, they might realize how much they can learn in an ED environment. But, some still measure themselves solely by a few skills and thus limit themselves the chance to experience a very vast specialty of emergency medicine that involves so much more than a few cool skills.

Paramedics are good at triage but primarily for identifying the emergent situations that are taught in their curriculum. There are many other medical emergencies that are not as obvious which they are taught very little about and often miss as evidenced by the several studies that have been done.

Right now the professions that had been recognized has "techs" have advanced their education to gain professional status which is recognized for reimbursement by the insurances. This makes them very valuable to the hospital. Techs are a thing of the 70s and 80s. Like it or not but the Paramedic is still a 'tech' which limits their usefulness within the walls of the hospital except for a few 'tech' skills. Even the skills they do boast about from the field have come into question. Intubation is definitely one of those and many expect to see this skill being taken away and replaced with LMAs or King tubes in the field. The 12-lead EKG can easily be transmitted to the ED and the Paramedic does not have to do the interpretation. As as far as RNs not knowing 12-leads or capnography indepth, that is broad statement that is not true. Many of the 12-lead classes taught to Paramedics have RN educators. RNs can also learn 12-lead EKGs as they apply to ICU situations and have access to the Cardiologists along with watching the changes from beginning to end as well as all the interventions. If you read in the AHA ACLS book, you will find that only about 50% of all ALS EMS agencies have 12-lead capability.

The same for capnography. Both are highly utilized by RNs in the hospital especially in the ED and ICUs. Capnography is now in almost every ED that does conscious or moderate sedation if the patient is not on a ventilator and also an expectation for those on a ventilator. Watching 2 - 6 ETCOs monitors at any given time for the entire shift and every shift gives RNs the advantage over a Paramedic who may only use the ETCO2 to confirm tube placement. Unfortunately, many do only use ETCO2 for tube placement and only know to watch for the wave without much knowledge beyond that. The ETCO2 is also on relatively few EMS trucks in the U.S.

GilaRRT · Mar 14, 2011

Actually, the term "technician" has been officially removed from the paramedic title IAW the national SOP model.

ImThatGuy, BSN, RN · Mar 15, 2011

The 12-lead EKG can easily be transmitted to the ED and the Paramedic does not have to do the interpretation. As as far as RNs not knowing 12-leads or capnography indepth, that is broad statement that is not true. Many of the 12-lead classes taught to Paramedics have RN educators. RNs can also learn 12-lead EKGs as they apply to ICU situations and have access to the Cardiologists along with watching the changes from beginning to end as well as all the interventions. If you read in the AHA ACLS book, you will find that only about 50% of all ALS EMS agencies have 12-lead capability.

Interesting. Around my neck of the woods it's paramedics teaching ACLS to nurses and doctors. Oh well. Regional.

ImThatGuy, BSN, RN · Mar 15, 2011

To say they could just read off a pamphlet or have no idea about colostomies is condescending and inacurate.

How's that condescending? We covered a lot in paramedic school. In fact, I'd say our coverage over cellular transport and fluids and electrolytes was superior to what we covered in nursing school. I'd wager our cardiology and pulmonology teaching was more in depth minus things like. Heck, I received five semester credit hours on my transcript for cardiology and three alone for respiratory emergencies. Unfortunately, we weren't taught anything about managing swallowing disorders (I could read from a pamphlet though) or colostomies. That's what I stated what I did. There are A LOT of problems a person can develop that aren't in the scope of a paramedic. There are too many to know everything about, but it's the expected role of a nurse to teach about that stuff - not the paramedic. Could the medic do it? Absolutely, but it's not part of their curriculum. However, a RNs curriculum will include much more of that, and our books have specific paragraphs with the heading "patient and family teaching."

For the sake of conversation here, I didn't know squat about colostomies, other than poop came out into a bag, until I went to nursing school. Still wouldn't mind not knowing, lol.

FF-PHRN · Mar 15, 2011

ImThatGuy-maybe i misunderstood your post to mean that paramedics are too ignorant to do any teaching. I reread the previous posts a few times to see what I may have missed. It appears our experience with paramedics has been quite different.

The first day I stepped into an ED here, there were paramedics around as techs. In fact if they were a ED tech they were required to be a paramedic otherwise they were the unit secretary. They have worked very well and have a close relationship with the nurses. I will concede the curricullum in nursing is much more broad and the paramedic course is somewhat narrow. I have recruited nurses from the ED to test for the Fire Dept (2 have successfully), I have recruited paramedics from the FD to work with me in the ED and several have. Both have enjoyed their broadened spectrum. In short, there is alot of crossover of knowledge and skill from each.

I dont know anything about colostomies either. Prolly had more successfull rescus pts than ostomy pts.