Paramedics and nurses in the ER?

[C. Howe]

I recently attended an EMT conference where a class was held discussing the integration of paramedics to assist with nurses in the ER because of nursing shortages. I have not seen this occurring first hand in any of the hospitals I have been to and was wondering if this trend is common, growing, or rare and if it is working well for the hospitals that have chosen to do this.

[queenjean]

Our hospital uses 2 EMTs at all times in the ER as intake people. They are the people who initially see the pt if the pt walks in. They follow some pretty good guidelines as far as triage, they get their vital signs, they do an initial assessment, they get their insurance information and a brief medical and medication history. They are a combo of a triage nurse and an intake secretary.

A lot of the nurses were uneasy with this--they thought an RN should do the initial assessment. But having the EMTs has worked out well. In a pinch they can help out with some more "complex" procedures, and when it's really busy they can help enter orders, etc. In general our ER is happy with having them.

[Christie RN2006]

The hospital I work at has several paramedics that work in our ED. They never take an assignment, but they can help the nurses with a lot of things. They can help in triage, obtain vitals, complete primary or secondary assessments, etc. It works really well where I work!

[IndySkies]

I've worked in rural EDs that have paramedics/emts on staff, working along side with RNs, taking assignments, etc., no problems here

[Cyn2school]

I'd be worried about the liability of a less well trained than an RN in the ER. How are they supervised? They're paid less than RN's. Could hospital administrators try to use Paramedics instead as a cost cutting measure?

[flightnurse2b, LPN]

i used to work as a paramedic in the ED. i loved it. i was utilized many different ways and was always appreciated. i did make a considerably less amt of money than the RNs and LPNs i worked with, but it was better than working for the county making pitiful pay and working 24 hr shifts.

[Bidwillty]

we use paramedics in the er and they are wonderful, the assist with many things but dont take an assigment per say, the are assigned to sections and work with the rn, i really miss them when they are not there.

[HouTx, BSN, MSN, EdD]

This may vary depending on what state you're in, but in TX, we have a clear scope-of-practice distinction between 'first responders' and nurses. First responders are licensed to practice outside the hospital only. When they are hired to work in other settings, they must be considered as 'unlicensed' staff because they are working out side their legal scope of practice -- just as an RN would be if he tried to work as a paramedic.

First responders can be a godsend in an ED - they are wonderfully adept at many complex tasks. But, they are performing under direct supervision as a nurse extender. They cannot perform any activities that our BON has ruled as 'cannot be delegated' such as medication admin & nursing assessment.

[nurse_mo1986]

In my ER, we utilize Paramedics in the hosp. setting without any problems noted. EMT's can only work as PCT's, but Paramedics take pt assignments, and do anything the nurses do in the ER. I think it works out well.

[FlyingScot, RN]

Where I worked we used medics in our ED and loved them. There was one assigned to each Zone. They did just about everything. From IVs and EKGs to foley caths, OCL splints, crutch instruction, transports, bedpans...you name it. They cleaned up my pukey patients because they knew I can't stand the sight or smell. If I had a good medic I knew my night would go well. As nurses we were very autonomous and often started treatment (IV's, EKG's, O2, labs) before the doctor even knew the patient was in the room. Or we'd call out and say, for example, "I've got a chest pain in Rm 12. I'm doing aspirin and nitro do you want anything else". As a result our medics were quite autonomous as well. As soon as an order popped up on the screen they'd go and do it without having to ask the RN (or be told to do it). They were excellent at letting us know if a patient just didn't look right. For the most part their role was as a nurse extender. In our situation they were to nurses what the PAs were to the docs. It worked out great. In addition, many of them also worked for our local fire services (about 20 different municipal and township departments transported to us) so it really helped with our relationship with other medics and firefighters especially when we were on city-wide diversion. They knew if we were crying uncle then it really must be bad. So:cheers: here's to you Robin, Gregg, Mike, Tom, Tim, John, Jimmy, Dave and all the rest... Luv you guys and gals too!