paramedics in the ER

[blufoxtrot]

Do any of you have paramedics in your ER? If so what do they do?

[ICUPM]

Markdanurse ... points well stated.

VAMedic : well - not exactly. I am in Virginia, I run rescue as an EMT-B, and I'm soon to be an RN. MANY paramedics enter non-degree certification programs in VA without taking anything like the course work that an RN student takes. NREMT-P does not require the candidate to hold an associates degree. I am unaware of an accreditation process for Paramedic schools but I'd be interetested to hear about it if it exists. VA EMS regulations specify number of contact hours, content of the cirriculum and qualification levels of the instructors.

Don't get me wrong here. I think Paramedics, and EMT's in general can play a valuable role. The training EMT's (that includes paramedics) receive is very focused on stabilizing and transporting a patient to where definitive care can be delivered. It's very specifically focused on spot care of emergency situations. I expect to become a paramedic after graduation so I can continue my volunteer work and not be a helpless RN/EMT-B in the back of an ambulance. I have great respect for paramedics. They are not better or worse than RN's, they are different. It's a different ball game.

As a newbie to this whole nursing thing, it concerns me when I so often see these comparisons reduced to a shopping list of who can perform what procedure. Anyone off the street could be taught to start an IV. Any idiot could put a pill in someones mouth... There's a whole lot more to nursing than the procedures we're taught. Of the three years to complete the ADN program I'm in , all of the nursing procedures were taught and mastered in one year.

Does anybody remember their care plans?? During every semester of my program I am dragged through at least one and often two exhaustive care plans. Exhaustive means; a 100% complete head to toe covering all systems; a complete history including family and psychosocial evaluation; complete analysis of the pathophysiology of disease processes (which may also be any psychological ailment) and appropriate pt and family education; complete analysis of all diagnostic tests including why, how it is performed, how the patient is prepped and recovered, how the test works and what it tells you, risks and risk management, appropriate patient education that takes into consideration the psychosocial develpmental stage of the patient and family, specific cultural considerations, and appropriate therapeutic communication techniques and teaching strategies; complete analysis of all medications the patient has been prescribed including pt specific indications, interactions, therapeutic effect, appropriateness of route dose time ... methods of action and clearance, nutritional considerations that are tailored to the pt condition culture and disease and pt education as above; exhaustive nutritional analysis of every shred of food and fluid that has entered pt's body over the prior three days including complete fluid I&O and ramifications, and a nutrient by nutrient breakdown (including each vitamin individually) of intake versus needs analysis specifically tailored to pt diesase, meds, developmental level (anything from fetus to grandma), culture ...; exhaustive analysis of a massive shopping list of "parameters", such things as air source, elimination patterns, sleep patterns, prosthesis used / needed, coping skills, interpersonal relationships and family support, fitness of the home environment for the recovery process ...; identification of ALL nursing diagnoses that could possibly apply to this patient, sorted in priority order including rationale's; a nursing plan of care that includes appropriate assessments goals, interventions and follow up evaluations for the top three diagnoses. In all of the above, every single statement of fact must be researched and sited from references. These plans are often 100 pages long by the time they're done.

Okay ... now that I got that off my chest my point is that when the nurse enters the room and works with the patient, sometimes all the family and the paramedics hear is "can I get you a glass of orange juice?". What the untrained population doesn't realize, and what we must advocate along the lines of Markdanurse's post, is that an enormous background and rationale goes into much of what nurses do even when it appears innocuous. I think there are very good reasons why RN's should have primary responsibilty for patients. Paramedics are different. If my child was suffering a cardiac event or an allergic reaction in the field, I'll take the paramedic any day. Most nurses I know would be clueless in such situations. But once they get to the hospital I'll take the RN any day.

A Bill was circulating in the VA legislature this year that would have allowed Paramedics to PRACTICE NURSING WITHOUT A LICENSE. Not "start IV's ..." but practice nursing. The bill died in committee but such proposals will continue to surface so long as there is a desperate shortage of providers. People who don't understand the value of nursing and think it's just a question of technical procedures will support such bills for their economic advantages. We can't stand by idle and just watch that happen.

[ICUPM]

BTW - when I referred to "any idiot" and "anyone off the street" I was NOT referring to Paramedics. There's more to being a Paramedic than starting IV's as well ...

[vamedic4, EMT-P]

Markdanurse ... points well stated.

VAMedic : well - not exactly. I am in Virginia, I run rescue as an EMT-B, and I'm soon to be an RN. MANY paramedics enter non-degree certification programs in VA without taking anything like the course work that an RN student takes. NREMT-P does not require the candidate to hold an associates degree. I am unaware of an accreditation process for Paramedic schools but I'd be interetested to hear about it if it exists. VA EMS regulations specify number of contact hours, content of the cirriculum and qualification levels of the instructors.

_________________________________________________________________QUOTE

You are correct ICUPM...I was speaking of the school I attended (Jefferson) as I did not go (as so many providers do) to the local FD to get trained starting at EMT B and working their way up. Most paramedics and others do this because they don't have the time to dedicate 2 years of full time schooling to becoming a prehospital provider.

I went to a college specifically geared toward health professionals and most of us graduated with a degree. And we attended classes right along with our nursing school/PTA school/ RT school brethren. Right down to Sociology and Developmental Psych.

More and more, however, if you are wanting a job in the field of EMS, a degree is desired by companies and fire departments alike.

NREMT doesn't require it but the accreditation process for medic schools does exist, thru the American Medical Association. The Committee on Allied Health Accreditation Agency (CAHEA) is the accrediting body. Virginia does require a specific number of hours of didactic and clinical time, and these must be met or exceeded in order for you to graduate.

At the time I left VA there were only 2 associate degree granting schools in EMS, Jefferson (formerly just the College of Health Sciences) and Tidewater Community College.

Here in Texas we have different levels of providers, even different levels of paramedics. Your NREMT P will get you some places, but having a degree along with your EMT P will enable you to get a paramedic license. It's confusing sometimes.:nuke:

vamedic4

Cleaning out my closet

[ICUPM]

I'm glad to hear about the accreditation. It will help.

If there was a combined RN/Paramedic program available in my area I would have signed up. I'm pretty sure PVCC over near UVa and NOVA both have Paramedic degree programs now.

There are paramedics in our local ER. I can't speak to their scope of practice but I have transfered care to them from the ambulance.

[vamedic4, EMT-P]

I'm glad to hear about the accreditation. It will help.

If there was a combined RN/Paramedic program available in my area I would have signed up.

QUOTE]

I hear that!!! Now I'm just playing catch up!

[rigmedic]

As my screen name implies, I am a medic working on an offshore oil rig. I am the sole medical provider for over 100 personnel, and we are 45 miles offshore. There are no First Responders, there is no "Code Team" to call if something goes wrong.

We do a lot of things that the average street medic doesn't do. We do suturing, we administer antibiotics, we do wound care, we do I&D of abscesses (skin MRSA is a big problem out here), etc.

Having said all of that, I am also completing my nursing degree. The two roles have some crossover, but are also quite different. The paramedic is trained from day one to operate independently in very adverse conditions. The amount of Anatomy, Pharmacology, Microbiology, etc that I received in my paramedic training was miniscule compared to what I have received as a nursing student.

The hard part about being a street paramedic, which is difficult for nurses to understand, is that paramedics are "jacks of all trades". You can literally go from a pediatric code, to a multi-vehicle entrapment, to a gunshot wound in a few hours. Nursing is much more focussed on specialized areas.

I hope that my experiences on both sides of the fence will serve me well. Like others that have already posted, I love being a paramedic. Unfortunately, the sad fact is that nursing is a profession and paramedicine is a trade.

I am working hard to earn my rightful spot in the nursing profession.

[Sheri257]

Well, we have EMT II's . . . but some are actually paramedics. We just don't hire paramedics.

They bring the pt. in, do vitals, start IV's, hang IV fluids, EKG's, help in a code, etc.

They are a great help.

steph

I thought EMT's/paramedics in California could only work as unlicensed assistive personnel in ER's. However, this article says there is an exception for rural areas.

http://home.earthlink.net/~douglaspage/id77.html

Since I believe you live in a rural area Steph, is that why your hospital can use them?

:typing

[nuangel1, BSN, RN]

we have emt students in our er they start iv's hang ivf do ekg and assist but with the nurse .the nurse has to sign off he/she has witnessed the emt's proficiency .oh they may also give certain iv meds with the nurse observing it.

[nghtfltguy, BSN, RN]

what an interesting thread.~

i can tell right away that there are quite a few that don't want medics in the ER.. well in my opinion, i think medics can be a valuable asset in the emergency room. i worked in an ER for many years as a medic, when i was a flight medic, i spent most of my time in the ED working as staff until we got a call. now that i am a flight nurse, instead of medic, i still do the same thing, basically i do the same job.. i just have a different seat on the helicopter..

[mamalle]

yes we have them. they can start IV's, draw blood, transfer pts to tele and medical floors, wound care, ortho care, etc. we are now using them in fast track. Im not to keen on the idea since the nurse has to sign the dispo and give out the meds.. we only have 2 of them now the other are techs.

[ernurse16]

Sounds to me like the RN's are feeling a bit threatening by medics so best way to get rid of them is to bash the medics and their abilities. I have worked in facilities that use medics and they are confined to their scope of practice just as nurses are. They are able to do what they are trained to do just as nurses are.

From the likes of some of the postings on this thread, I would much rather work with a well trained hardworking medic than some of these nurses who feel like medics don't belong in the ER... Are you kidding me??? We work in Emergency Departments... what do medics respond to???? uhhhhh EMERGENCIES!!!!

Nurses don't only eat their young... they apparently like to eat medics too! Try working with a medic in the ER that's is allowed to work within his/her scope or Flight and then come back and repost.

[inova]

We use EMT-B medics. Paramedics are used in other areas of the system for more of an augment for the nurses. Our EMT-B and EMT-P medics do no meds, no assessments, no triage, no IV infusions (only cath placement and phlebotomy) all per state law.