PARAMEDICS IN THE ED...Do you have them????

[EDtraumaCNS]

Hi all,

I am interested in seeing if you have paramedics working in your EDs. If so, what kind of ED do you work in (teaching, level one trauma, community, etc.)? Do the paramedics practice to the full extent of their license, or function as glorified techs?

Thanks!

[Anna Flaxis, BSN, RN]

PLEASE don't call EMS providers "ambulance drivers!"

Nobody did.

In my neck of the woods, the ambulance crew consists of two Paramedics. One of them has to drive, or the ambulance goes nowhere.

At any rate, we are hiring Paramedics in my ER to function as techs during the time of day when RN staffing is at its low point. I'm ambivalent about this, as I have worked with EMT techs in the past, and many of them resented taking direction from nurses. I heard grumbling about how much autonomy they had on the rig, and how many more skills they could practice in the field, only to be reduced to glorified CNAs in the ED doing transports and toileting patients. Some of them would hide and not answer their phone. Some of them would give you attitude for asking them to do tasks that were completely within their scope and job description. Some of them would shirk and just do the basic minimum, and yet when a trauma rolled in, all of a sudden there would be five of them right there like Johnny on the Spot.

At first, I took the low morale personally, as if it was something *I* was doing to cause them to behave that way, but after a while I realized that it was part of the culture that existed long before I came on the scene.

I did work with some great EMTs who functioned more like my partner though, particularly when I worked the Fast Track area. There were a couple memorable ones who kicked into high gear and assisted with turning over rooms, rooming patients, collecting urines, doing discharge VS, etc. without being asked. When I worked with them, I really felt like we were in it together.

I'm trying to be optimistic and go into this with a positive attitude, and treat our new Paramedic techs like the patient care partners that they are, and hope that they respond in kind.

By the way, I love Paramedics! They are my heroes.

[akulahawkRN, ADN, RN, EMT-P]

Nobody did.

In my neck of the woods, the ambulance crew consists of two Paramedics. One of them has to drive, or the ambulance goes nowhere.

At any rate, we are hiring Paramedics in my ER to function as techs during the time of day when RN staffing is at its low point. I'm ambivalent about this, as I have worked with EMT techs in the past, and many of them resented taking direction from nurses. I heard grumbling about how much autonomy they had on the rig, and how many more skills they could practice in the field, only to be reduced to glorified CNAs in the ED doing transports and toileting patients. Some of them would hide and not answer their phone. Some of them would give you attitude for asking them to do tasks that were completely within their scope and job description. Some of them would shirk and just do the basic minimum, and yet when a trauma rolled in, all of a sudden there would be five of them right there like Johnny on the Spot.

At first, I took the low morale personally, as if it was something *I* was doing to cause them to behave that way, but after a while I realized that it was part of the culture that existed long before I came on the scene.

I did work with some great EMTs who functioned more like my partner though, particularly when I worked the Fast Track area. There were a couple memorable ones who kicked into high gear and assisted with turning over rooms, rooming patients, collecting urines, doing discharge VS, etc. without being asked. When I worked with them, I really felt like we were in it together.

I'm trying to be optimistic and go into this with a positive attitude, and treat our new Paramedic techs like the patient care partners that they are, and hope that they respond in kind.

By the way, I love Paramedics! They are my heroes.

Having EMT and Paramedics in the ED and using them as Techs with a very reduced scope of practice does not sit well with them. For the Paramedics especially, it would be akin to you being hired on somewhere, being required to have an RN license, and only allowed to perform CNA/PCT tasks. You're right, it is the culture that's the problem and the culture where you were essentially required that the techs become an EMT or Paramedic and then do very little of what they were trained to do.

I sincerely hope that your facility treats the Paramedic Techs better, provides them a scope of practice that's similar to what they're educated for, and encourages the nurses to utilize them to their fullest capability. That tends to make them feel valued and when that happens, morale tends to stay high. If they're hired and called EMTs or Paramedics, it's possible that their legal clinical supervisor is a physician.

It's my hope that the above happens so that everyone gets to develop a positive, team oriented approach to patient care.

[Anna Flaxis, BSN, RN]

I hope so, too.

[~agape~]

I have been a Paramedic for 16 years and I'm also in nursing school (almost finished- yay!). I'm not saying that anyone specifically said that we are "ambulance drivers" in this thread, but we do get that a lot from lay-people and sometimes even health care professionals. It is frustrating at times because it implies that all we do is put them in the back of an ambulance and drive them to the ED like it's a glorified taxi, unaware of what we are actually doing on scene and in the back of that ambulance on the way to the hospital. 13 years ago today, 343 paramedics and firefighters gave their life trying to rescue people at the World Trade Centers, soon after, nurses worked tirelessly trying to save and treat the victims who were fortunate enough to make it out and get to a hospital. I don't think either profession (nurses or medics) get the respect they deserve. I know we don't like to pat ourselves on the back, but society would not be the same without us (nurses and medics). The "ambulance driver" term has got to go and we all need to work together better, recognizing each others strengths, for one common goal- great patient care.

[ChristineN, BSN, RN]

No paramedics in my ER, but we do have EMT's that are super useful. They start IVs, rub labs, transport, do EKGs, assist with codes, and so much more.

We are hiring Paramedics in my ER to function as techs during the time of day when RN staffing is at its low point.

My opposition to medics in our ED has nothing to do with medics and everything to do with protecting nursing jobs.

Medics are fantastic at what they do, and they can do a large part of what the nurses can do... for a lower wage... I can't see why any nurse would endorse bringing medics into their midst.

The "ambulance driver" term has got to go

We can dump it on the "butt wiper" pile.

[Anna Flaxis, BSN, RN]

My opposition to medics in our ED has nothing to do with medics and everything to do with protecting nursing jobs.

Medics are fantastic at what they do, and they can do a large part of what the nurses can do... for a lower wage... I can't see why any nurse would endorse bringing medics into their midst.

To be clear, I am against it, and I've verbalized my feelings about it, but I've been overridden.

I'm not against it out of concern for my or any other nurse's job. Our facility is small, and I have good job security. They're happy with my performance, and they have a hard time recruiting experienced RNs. Management will never hire another nurse unless we organize and demand it as a condition of employment, hence hiring the Paramedics for half of what it would cost to add a nursing shift- it's a token gesture to show that "they're listening" to our concerns.

My concern has to do with things already discussed in this thread, that a Paramedic's scope of practice will be restricted compared to what they are able to do in the field, and that they will be answering to the RNs. I know this will not sit well with medics- been there, done that, as I've described above.

What I would have supported would have been to hire EMT Basics or CNAs to fill that "Tech" function- not Paramedics.

I can do everything a Paramedic can do. That is not the issue. What I need help with when I am swamped are things like making sure vitals are updated, assisting patients to the bathroom, collecting urines, fetching blankets and turkey sandwiches, etc. Those are the types of things that bog me down and I want help with when we're busy. I can't imagine a Paramedic being satisfied with a job like this for very long.

As I said, I'm trying to have a positive attitude about it, and my intention is to partner with these Paramedics as best I can. I am going to put my best foot forward.

[ChristineN, BSN, RN]

I can do everything a Paramedic can do. That is not the issue. What I need help with when I am swamped are things like making sure vitals are updated, assisting patients to the bathroom, collecting urines, fetching blankets and turkey sandwiches, etc. Those are the types of things that bog me down and I want help with when we're busy. I can't imagine a Paramedic being satisfied with a job like this for very long.

As I said, I'm trying to have a positive attitude about it, and my intention is to partner with these Paramedics as best I can. I am going to put my best foot forward.

You can not do everything a paramedics can do. A paramedic can intubate and trach, nurses can not

[akulahawkRN, ADN, RN, EMT-P]

You can not do everything a paramedics can do. A paramedic can intubate and trach, nurses can not

Not entirely true. It's just that as part of their basic education, nurses are not trained to manage the airway beyond the same skill level that a basic EMT can do. I've met nurses that, following the appropriate education, are authorized provide advanced airway management, including RSI and surgical cricothyrotomy. About 15 years ago, my paramedic program covered those things even though were I would end up working didn't allow RSI or surgical cric procedures.

One of my instructors, back then, was a very good flight nurse. Before she started that job, her intubation technique consisted of picking up the telephone and calling RT.

[GrannyRRT]

You can not do everything a paramedics can do. A paramedic can intubate and trach, nurses can not

I disagree.

All (neonatal, pediatric, adult) of our transport nurses can intubate and do crics. To maintain their skills they are expected to intubate in the ER and anywhere else in the hospital. We checked with the BON and both skills are within the nurses' scope of practice.

It is within the nursing scope of practice. The issue which prevents all nurse from intubating would be obtaining enough intubations to maintain proficiency. If you have over 100 nurses in the ER each needing at least 20 intubations every year, that could get challenging. There is also the issue with juggling your duties as a nurse and being tied to the airway.

Paramedics are trained and certified for practicing outside of a hospital. If you take a job somewhere other than an ambulance, you need to expect a different job description. I also know that some Paramedics can notintubate and must use a King tube. Some don't use the IO. Some can not access certain ports. Some cannot RSI medications. Some can not use a ventilator beyond the ATV. It all has to do with your facility or in the ambulance situation, with your medical director.

We use PCTs_(CNA II)since they are trained for the hospital environment and can adapt to any floor if they are floated or want OT. CMS also recognizes their certification for working in other areas as a minimum training standard.

[ChristineN, BSN, RN]

Not entirely true. It's just that as part of their basic education, nurses are not trained to manage the airway beyond the same skill level that a basic EMT can do. I've met nurses that, following the appropriate education, are authorized provide advanced airway management, including RSI and surgical cricothyrotomy. About 15 years ago, my paramedic program covered those things even though were I would end up working didn't allow RSI or surgical cric procedures.

One of my instructors, back then, was a very good flight nurse. Before she started that job, her intubation technique consisted of picking up the telephone and calling RT.

I am not referring to basic EMT training, I am referring to paramedics, who have more training on advanced airways than nurses get in school