We have quite a few paramedics working in our ER (50,000-60,000 visits per year). Usually we have two nurses per pod (6 rooms per pod) but one of those spots may be filled by a paramedic. Our dept only hires paramedics with a few years expierence and no new medics. They can do pretty much everything I do as a nurse. They can be primary on anything that isnt an "alert" patient (stroke alert, STEMI alert, Trauma alert, ect.), or a patient that gets conscious sedation or are receiving blood. They also need a nurses signature on all discharge instructions and admission paperwork. They have been a great help in the ER and dont take the place of nurses but definetly should get paid more for doing almost the same job. They work the triage desk as well.