paramedics in the ER

Medic2RN, BSN, RN, EMT-P · Feb 10, 2007

medics know TRAUMA, on average how many patients in the ER are trauma, most are medicals. Is a medic taught to do wound care? NO Is a medic taught to give Blood? Call Report? Check orders? Administer drugs, other than MONA? NO!!!

I think there is a common misunderstanding of exactly what paramedics are capable of performing. They don't solely deal with traumas, they don't only start IVs in the a/c, they don't only deal with MONA medications. Who are the ones that bring in many of these medical emergencies to the ED? The department I previously worked for had a wide variety of medical protocols. Trauma is easy, the challenge is the medical call. We were taught how to begin treatment for CVAs, MIs - which type the pt was experiencing and how to specifically treat it, HTN emergencies, cardiogenic shock, CHF, airway issues: RSI, surgical crichs, retrograde intubations, etc. I think the skill set and especially the critical thinking skills are grossly underestimated by some. At least that is my experience when talking to other nurses.

With that being said, I still believe that paramedics should not replace RNs in the ED; however, there are roles that they can fill.

RoxanRN · Feb 10, 2007

Medic2RN -- Well said!!! :yelclap:

Actually, no they don't. "Most" suggests that at least more than half, i.e at least 26 states. As it stands, only Oregon requires an associates degree for their paramedics.
If you have a link to support your comment, I'd be interested in seeing it.

OK... I misspoke. Most programs out there are associates degree. It is getting progressively more difficult to find certificate only programs. I don't know of any non-degree programs in my state. The four or five predominate and most sought-after medic programs are degreed.

Don't forget, I've been a paramedic for 14 years, and have worked in three states and the district...the paramedic skill argument snow job won't work here.

I didn't intend to get into a pissing contest or turf war, but suffice to say, I've been in EMS for 20 years. When I got my medic 13 years ago, I was among the few in my state at the time who were degreed. I have since worked in 3 states, held NREMT-P as well as the respective state licenses and worked in a variety of system types (transfer/3rd service, rural, high-volume). Medics most definitely have a skill set which compliment the ER (please notice I didn't say "take over").

Dinith88 · Feb 10, 2007

Are ER just Hired Paramedic Physician Extenders to work with the doctors to see Patients. They are going to see Pts, write orders, review results, suture, LPs and Rx Scripts to name a few things. Wont that suck that the RNs will have to take orders from the Medics..

This is a little scarey...(and a lot of BS).

Write orders? Do medics even know how to interpret lab results?

Run in-house codes? LP's? Scripts? on a 2-year degree at best?

Whatever crack your hospital is smoking must be tainted...

markdanurse · Feb 10, 2007

Sounds like teeituptom is upset and has experienced it first hand that ERs are opening their eyes and letting Medics do everything that the Nurses do. (Like in the ER I work in). Are ER just Hired Paramedic Physician Extenders to work with the doctors to see Patients. They are going to see Pts, write orders, review results, suture, LPs and Rx Scripts to name a few things. They are going to replace the PA and NP we have now. Wont that suck that the RNs will have to take orders from the Medics. Boy how times are changing. I just found out today that I got this job. I cant wait to see the faces on the RNs.

Whoa! Hold on now Medic 173. Medics replacing a physician assistant and a nurse practitioner? I think not. Almost all PA's and NP's have master"s degrees, are trained in advanced pharmacology, advanced anatomy and physiology, differential diagnosis, as well as many other upper level graduate courses. Last I checked, paramedics do not have a DEA number for prescriptive priveleges. As an RN, I would quit before taking an order from a paramedic. I have trained paramedic students in the ER I work in. They are responsible for only the drugs they carry in their drug boxes in the field. Thus, there are many medications used in an ER that a paramedic cannot legally administer, let alone prescribe.

Furthermore, I have heard comments on this blog like: RN = 2 years and Paramedic = 2 years. I dispute the validity of this statement. Try 1 - 1 1/2 to 2 years of prerequisites depending upon whether the program is an ADN versus a BSN program. These prerequisites include anatomy & physiology, biology, psychology, sociology, lifespan developmental psychology, pathophysiology, chemistry, and much more. An ADN has 3 - 3 1/2 years of education in most ADN programs prior to graduation. Most BSN programs require 4 - 5 years. EMT Basics can get educated over the summer in Arizona (3 months) and qualify to take their state and national certifications. After a year of practice (not a year of formal continuing education), they can apply to a paramedic program. Out here in Arizona, a full time paramedic program takes 6 months, a 3/4 time program takes 9 months, and a part-time program takes 12 months. Thus actual time of formal education for paramedics in Arizona in the full time programs is 9 months. Now I realize paramedic training differs from state to state, but they all take the same national certification exam, and thus all have a fairly universal body of knowledge.

Are paramedics useful in an ER? Yes. Do they have the same body of knowledge as an RN working in the ER? No. Should an RN and Paramedic be interchangeable? Absolutely not. The paramedic scope of practice is limited. They are not taught nearly in depth enough to understand why they do what they do to treat life threatening emergencies. Many paramedics I worked with who later became RN's have commented to me that they really never knew why the interventions they performed in the field worked until after becoming an RN.

By the way, in nearly every ER I have worked in that utilizes paramedics ( and I have worked a few), paramedics are not allowed to intubate, put in chest tubes, do cut downs, insert central lines, etc. It's not that they aren't trained to do it, it is just that hospital policy says they cannot do it for liability/insurance reasons. Thus, it is left to the PA's and physicians to do it, not paramedics.

Also, for the nurses that are attacking the other nurses opinion that paramedics should not be used in the ER...please just leave her alone. She has a right to her opinion. Just because she disagrees with yours does not make it wrong. I have worked with many ER nurses who feel the same way as her. I never reprimanded them even though I didn't agree. Paramedics are useful in an ER setting.

markdanurse · Feb 10, 2007

If medics want to be a nurse......GO TO NURSING SCHOOL!!!!!!
If medics want to be medics...........RIDE ON THE RIG!!!!!!!!!!!!!!!!!
If RN's keep letting other specialties take over our job, where is the quality of care going to be???

Well said Nurse Brandie!

Okay fellow professionals. Listen up, as what Brandie said makes a valid point. We must not give give up our career roles to other specialties. Any of you that do not believe this is an issue, please consider the following:

1. Anesthesia started out being administered by nurses, that's right, nurses...not physicians. Nursing gave this role up to physician anesthesiologists. Yes, we still have the CRNA profession, but now there is a new role out there called the Anesthesiologist Assistant (AA). It is a master's degree program that physicians created to keep the midlevel anesthesia providers under their thumbs. The position pays as well as, if not more than, a nurse anesthetist.

2. Physical Therapy and Occupational Therapy started off as subspecialties of nursing. Yes, PT's and OT's were orginally nurses that received specialty training in the activities of PT and OT. But we gave these positions away too and now the PT has become a clinical doctorate degree and the OT has become a master's degree.

3. Midwives originally birthed babies, not physicians. In fact, the first known male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job.

4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why?

So yes, the idea of paramedics taking over the ER nurse's role is a real threat, and it should not be taken lightly. Paramedics are great to have in the ER...but paramedics are paramedics and nurses are nurses.

vamedic4, EMT-P · Feb 12, 2007

:rollThe ANA is pushing to get medics out of the ER. I know this because I am doing my thesis on medics in the ER: Good or BAd.
The above is true, because nurses (by and large) feel threatened by an "encroachment" on their duties and abilities to care for patients. Be advised this isn't true of ALL nurses, because as others have stated, most work as a team "together".
In my personal opinion, medics do have a place in the ER, however, it is under the RN, for example, medics know TRAUMA, on average how many patients in the ER are trauma, most are medicals. Is a medic taught to do wound care? NO Is a medic taught to give Blood? Call Report? Check orders? Administer drugs, other than MONA? NO!!!
I know that the author has no formal training as a medic, because if she did shed know that
1. Most of our calls anymore ARE medical...due to an aging population and other factors.
2. While we can't HANG blood, we can transport patients with BLOOD HANGING and monitor for signs of distress/reaction, and changing or discontinuing the therapy as necessary.
3. Call report...are you kidding?? Anytime we take a patient from one facility to another we call report to the receiving facility and give a full synopsis of the events of the trip. I usually did it about 15 minutes out if I had the time.
And the drugs?? Here in Texas we have about 40 or so meds that we can administer should the need arise. Anything from glucose to fentanyl, epi to morphine.
As for the part about medics wanting to work as nurses...I don't think they truly do, they do it because nursing allows them a way to make a better life for themselves (because RNs schedules aren't anywhere near as crazy as a medic's, and RNs get paid a ton more). But for me?? If I could get paid in the field what an RN made in the hospital? I'd be riding the box forever. There's something very rewarding about getting to the scene 2 minutes into a crisis, and getting your patient to the hospital for definitive care in the safest and best way you know how.
markdanurse....
In Virginia, as in other states, nursing students and medic students go through the same courses for prereq's..the EXACT same. Same micro, same a&p, same english, all of it. The only difference is the core courses, the courses that make up the actual nursing or paramedic curriculum.
Yes, medics can be an asset to the ER, but their role needs to be very well delineated. If the physicians in the ER and the medical control docs feel comfortable with the medics and their skills set, then they can and are allowed to practice with full authority in that setting...under the license of the physician. If not, then we're working under the license of the RN, as a "tech", and have a different set of rules and duties we have to follow.
As long as we don't lose sight of the fact that whatever our title, the focus is the same.
vamedic4
(former)MICU/911 medic
Have a good Monday all.

Rbike · Feb 14, 2007

Wow, what a bunch of responses to having Paramedics in the ER. I personally agree that Paramedics in the ER are an excellent choice. I personally believe that Paramedics are trained to critically think and most nurses are trained to ask for orders from the doctor.

pkapple · Feb 14, 2007

Any body know the actual state regs re these issues? Seems Joint commission requires an Rn to triage and also to do initial assessment in a hospital. Any Nurse practice act folks know if an RN can take "orders" from a medic? Where I work its not clear cut and really needs to be clarified . We have a medic, who does pretty much the same as an RN, but the RN has to cosign assessments. Can a Medic "supervise" LPN's ??? WE only staff one RN at night, so could we legally have a medic in this role? Lots of questions from here in FLorida. I am not knocking having medics in the ER. I really want to know what is legal. I know on the truck a medic can either follow protocol or call for orders-guess this puts them under a doc's direction or supervision, but in house there may only be a PA-NP directing the ER, NP under protocols/PA pretty much independant-with sup doc available by phone or whatever. How does this affect the medic????

Any one know of a good resource to find florida paramedic codes/laws and joint commission "rules" ?? Trying to read thru the actual state regs has just made me more confused.

mommy2BCD · Feb 16, 2007

This cannot be for real. There is no way that a paramedic can write Rxs. I did a search on "physician extenders" and the articles refer to these as PAs and NPs. Those are masters degree programs. IF this job desription you gave is correct this would be illegal. Paramedics do not have the authority to write orders, or prescriptions , period. If you can show professional documentation of such a claim, I might believe it.

"Wont that suck that the RNs will have to take orders from the Medics." And to comment on this quote. As a member of the healthcare "Team" especially in the ER I would think that you wouldn't have the "haha haha I am better than you" demeanor. Grow up and be a professional. Your post is absurd.

Sounds like teeituptom is upset and has experienced it first hand that ERs are opening their eyes and letting Medics do everything that the Nurses do. (Like in the ER I work in). Are ER just Hired Paramedic Physician Extenders to work with the doctors to see Patients. They are going to see Pts, write orders, review results, suture, LPs and Rx Scripts to name a few things. They are going to replace the PA and NP we have now. Wont that suck that the RNs will have to take orders from the Medics. Boy how times are changing. I just found out today that I got this job. I cant wait to see the faces on the RNs.

txspadequeenRN, BSN, RN · Feb 16, 2007

let me ease your mind here some.. this is a very old thread and this particular poster did nothing but cause trouble on here. he had to be trolling.. cause nobody in their right mind would believe this bunk.. but i remember him ruffling some feathers.

this cannot be for real. there is no way that a paramedic can write rxs. i did a search on "physician extenders" and the articles refer to these as pas and nps. those are masters degree programs. if this job desription you gave is correct this would be illegal. paramedics do not have the authority to write orders, or prescriptions , period. if you can show professional documentation of such a claim, i might believe it.
"wont that suck that the rns will have to take orders from the medics." and to comment on this quote. as a member of the healthcare "team" especially in the er i would think that you wouldn't have the "haha haha i am better than you" demeanor. grow up and be a professional. your post is absurd.

**canoehead, BSN, RN** · Feb 16, 2007

I personally believe that Paramedics are trained to critically think and most nurses are trained to ask for orders from the doctor.

Dear God. Duck and cover rbike, how's that for critical thinking?

:studyowl:

BrnEyedGirl, BSN, MSN, RN, APRN · Feb 17, 2007

Wow,..what an interesting discussion we have here,...I'm new to ER and our ER is having this same huge debate right now,..I'm just sitting back and watching and listening, as I really don't know the answers,...it's seems that much of the debate in our hospital is more of an issue of hospital policy,..we have many EMT's and paramedics in our ER (why they work for the pay they do is beyond me) but they work a shift right along with the

RN

,,.I was told yesterday that many changes are about to happen,.."EMT's or paramedics are trained for pre hospital emergency care and transport until they can get the pt to a hospital for furthur care",..for instance I was told the EMT's can give a pt an ASA, it is considered standard of care for CP/ poss MI,.but they can't give tylenol as it is not part of any emergency protocol,...our EMT's/Paramedics can not triage (what exactly do they do in the field?) they cannot take orders over the phone from the doc's (what are all those calls for med control?) The explanation (lame as it may be) that I got, was that due to chronic understaffing (which has now been fixed YEAH) the EMT's/paramedics have been assuming the role of

RN

out of necessity, that it was not legal, not safe and will be stopped,....guess we'll see what happens over then next few months.