RN to Paramedic Bridge Course

vamedic4, EMT-P · Nov 24, 2008

yeah, but just going to a bridge course and getting a paramedic certificate doesn't make you a paramedic. i'd say that you need to spend several years running 911 calls to become really good in the field. my old flight program encouraged the nurses to get their medic cards. but they were what I'd call "paper medics". sure they had a license, but they'd also straddle a charged line on the scene of an accident and other things that a paramedic would just know not to do.
I've intubated people across the hood of a car, wedged into the corner of a bathroom, worked a countless cardiac arrests with very little help, been in housing projects filled with crackheads and drunks who decide they want to fight us. not saying this to pat my own back by any means, but these are some of the things that you have to do as a medic, it's just part of the job and rarely ever do you get any thanks or shown much appreciation...at least not nearly as much as I get thanked everyday as an ICU nurse.
let me ask...if you wrecked your car on the interstate or had been injured by a GSW (very common 911 calls) would you want an RN who had taken a several week bridge course or a medic (RN or not) who had been doing this for years and seen it hundreds of times?
As both a nurse and a paramedic for quite a while, I'm definitely not trying to continue the age-old argument about which is better/more worthwhile/etc and i'm not slamming flychick08 at all either, but her comment made me want to reply: the license is of little value without the experience behind it...same is true with nursing. Most paramedics might equivilate themselves with critical care nursing, but they probably don't understand what's involved in the ICU. It's not that they CAN'T understand it, they just haven't had the opportunity. I was guilty of the same thing myself and even though I feel that I adapted quickly...I also realize the difference between understanding a concept and putting it into practice.

Very well put. I totally agree.

Dr.Nurse2b · Nov 30, 2008

hey all-
for those of you who consider the short bridge courses a joke, i would like to hear a bit more about your reasoning. i am considering the course.
i have 5 years as a nurse, all of it icu or er. certs include ccrn, tncc, acls, and pals.

i think with your level of education, skill and experience a bridge is the perfect option, however i think you have much to learn in regard to pre-hospital operations...phtls - pre-hospital trauma and life support is a big factor in the street.

my thoughts on the bridge in general...its not a "joke" however as professionals we need to consider the validity of this option in regard to safety and liability.

this is "shake and bake" ... quick and easy, tastes ok too...but not necessarily the best choice...for dinning or pre-hospital care. :)

i think this is an idea that was drummed up to fill empty paramedic positions...same as the idea of using paramedics in er to fill the empty rn positions...i am seeing this more and more in my area.

in my opinion there should be a specific qualification profile for an rn to paramedic bridge...for example critical care experience with acls, etc. i think holding a current emt-b would be a positive attribute as well. in my state one must hold an emt-i before being considered for emt-p.

rn vs emt -- assessment processes differ. one of the biggest problems i had my first year in nursing school was making the adjustment from sample to adpie. :) i heard "think like a nurse" many times.

in the field we have protocols, standing orders and if needed online medical direction. assessment is focused on treating immediate life threatening situations and transporting to an appropriate facility...no need to call the doc unless you want a lot of morphine. :)

the nursing process is broad and encompasses the patient as a whole...its general in that all systems are assessed and plan of care involves treating the present illness, improving quality of life, preventing future illness, etc.

i think one of the most important aspects of paramedicine is airway management. paramedics are very aggressive with treatment. nurses have limited training on airway management as respiratory therapy is used in the units...in the street the medic is respiratory therapy.

i recall reading something about a two week bridge program...i don't think one can learn intubation, breathing treatments and complete enough clinical time in two weeks to become a safe provider.

i consider myself to be competent when it comes to airway management...mainly because i scares the bahjesus out of me. no airway...no patient.

spinal immobilization is also a huge factor in pre-hospital. i have encountered numerous rns that cannot apply a c-collar correctly let alone package a patient for transport. i personally would not want to "practice" immobilization on a live patient with a suspected spinal injury let alone attempt to extricate one.

consider this...when you are in the unit and a patient goes bad you have resources...get me the crash cart, call respiratory, call the doc. when you're on the street you are the resource...there is no one that can help you...you are it.

i started as an emt in 1997. i also worked in the er as a tech and the adjustment was painful for me. i worked in non-emergency transport for 3 months and then got my first assigment with inner city ems (911). this was a fast paced environment...swoop and scoop all the way. i did what i was trained to do in school...lifting, moving, patient care and transport. note that of the four descriptors i used only one is acutal patient care.

if i was a patient in the back of an ambulance and had a choice between an rn or a paramedic for treatment...i'd let them fight it out because either way i think i am in good hands. if i found myself injured somewhere, perhaps in a mva or some trauma i'd want a paramedic to come and get me.

i am certain that most rns could complete a bridge program and become a paramedic but i believe the learning curve will place a lot of pressure on the provider. as an rn - paramedic you will be required to perform, period. learning basic operations while attempting to provide advanced level care is a recipe for disaster...imho.

another consideration...as a paramedic your partner may be a basic emt (certified to a lower standard). as a paramedic you are responsible for your partner's actions. if your emt screws up a treatment you are held liable...just like an rn is held accountable for the actions of an lpn. emts are trained to do their job at the basic level and to understand the role of a paramedic as well. most paramedics come to the table with basic emt experience. an rn who bridged is at a great disadvantage here as they only know nursing and do not know what to expect from their basic emt...remember, you have to depend on your partner. you can't depend on your partner if you have no idea what they are capable of or what they are supposed to be doing.

fyi: my cert expired 4 years ago. i recerted as an emt-i when i started the bsn program. the local medical director recommended that i run through the latter half of the paramedic program before seeking licensure. an rn with acls and emt-i certification can challenge the emt-p national...regardless i will still head back to school and run through the program. short is simply that...short. short does not mean safe.

remember "standards" -- if you pass a bridge then you will be held to the same standard as a paramedic that has had 14 months of paramedic training. drop a patient while extacting from a car, or loading into an ambulance and you will held to the same standard. break teeth while intubating, same standard...ever apply a traction splint for a femur fx? ... regardless, same standard...ever use a fropvd? ... you can blow out someones lungs, regarless, same standard.

no doubt an rn can make the grade in my mind. but in practice will the rn be safe...as safe as a paramedic who trained for 8 months to be an emt, then worked a year to meet clinical requirements, and then trained for 14 months to be a paramedic?

my 2 cents :twocents:

Guest219794 · Dec 1, 2008

All great points.

I have logged a bit of time as a basic EMT. I also ski patrol at a busy mountain. I have boarded and collared people out of MVC's and various wilderness conditions- including our of streams in the winters. I teach pre-hospital assesment and packaging.

The intimidating part is advanced airway management.

hherrn

GilaRRT · Dec 1, 2008

Believe it or not, some of the biggest problems result from lack of good basic airway management knowledge and technique utilization IMHO.

vamedic4, EMT-P · Dec 1, 2008

All great points.
I have logged a bit of time as a basic EMT. I also ski patrol at a busy mountain. I have boarded and collared people out of MVC's and various wilderness conditions- including our of streams in the winters. I teach pre-hospital assesment and packaging.
The intimidating part is advanced airway management.
hherrn

Truthfully, as long as you never forget the basics of airway management, the advanced stuff really isn't that difficult. You can do more with a BVM and correct technique than you can with any misplaced ET tube. When I went through medic school 16 years ago, intubation was the big thing. Having done it a few hundred times it gets easier the more you do. But the truth is, if you can bag them and keep their sats up, you're much better off...intubation carries with it a slew of problems when done incorrectly, even when done correctly the potential for complications is always there.

If you are wary of this in medic school - I urge you to pay very close attention in class. Much of it you'll know (anatomy and what not) but be prepared as there may be things that you weren't aware of. Also, should you get the chance - get to an OR and intubate patients under the eye of the anesthesiologist. This was a requirement for us - and it was awesome! One doc talked to me for about 45 minutes about cases he'd had, difficult airways, how to solve problems...and told me : "if things get crazy...get back to ABC. Simple as that". I never forgot that.

I would like either one of you to take care of me. I have no bias toward either, but I think that a nurse with your background in "hospital" care who is also taking care of me prehospital has a bit of a "leg up" on the other medic. Just being more familiar with critical care of patients in hospital doesn't necessarily make you better, but it does definitely help, assuming you're not going to freak out when you're the only one in the back with my critical needs.

Medic09, BSN, RN, EMT-P · Dec 1, 2008

Also, should you get the chance - get to an OR and intubate patients under the eye of the anesthesiologist. This was a requirement for us - and it was awesome! One doc talked to me for about 45 minutes about cases he'd had, difficult airways, how to solve problems...and told me : "if things get crazy...get back to ABC. Simple as that". I never forgot that.

"Should you get a chance" ???

Please don't tell me there are ANY programs graduating medics without at least a week and ten or fifteen tubes in the OR. That's just to start getting a feel for it! Instruction under the watchful tutelage of an anesthesiologist in controlled conditions is essential to start, and needs to be repeated every year to stay sharp! Where we do yearly rotations, the docs also make sure that we're simply proficient with basic management. Good bagging technique isn't always so simple to accomplish, yet it is the most important of all our skills.

I train on mannikins for scenarios pretty often. It doesn't compare to a real airway. It doesn't look the same and it doesn't feel the same and it doesn't barf the same.

You can take short-cuts on almost any other clinicals (OB is kind of hard to get an idea without 'being there'), but a program that doesn't put students through the OR is irresponsible.

That's my :twocents: .

GilaRRT · Dec 2, 2008

Hehehe...you would be surprised if new medics were hitting the streets with fewer than 10 intubations?

vamedic4, EMT-P · Dec 2, 2008

Medic09...you and I both know that there are programs that simply don't have access to inhospital training, so the possibility of a medic who only has experience with Fred the Head is indeed possible, albeit less so today than 16 years ago when we were all learning skills.

"I train on mannikins for scenarios pretty often. It doesn't compare to a real airway. It doesn't look the same and it doesn't feel the same and it doesn't barf the same."

And this is, of course...oh so very true.

Dr. Tammy, FNP/GNP-C · Dec 2, 2008

Interesting, I thought an RN was far above a Paramedic,

You're killing me. Two different models of care -one is nursing (one profession); the other medicine (another profession). Two different roles paramedics guide, provide and lead care in the prehospital setting-nurses are not trained to manage care in the often unstable setting of prehospital care. Nurses are not trained in incident management. Although this doesn't seem like a big difference, for those who work as medics its the difference between life and death (not the patients). Nurses are trained in care planning; paramedics are trained to use protocols.

but wouldnt an RN who has ER and ICU experience be well qualified enough?

Again, you are killing me. Try to perform this experiment to test this hypothesis (but not in my home town). Get a 20 year vet ER RN or ICU RN without any field exp. and make them the incident commander for all MCI's or the primary on extrication patients with an unstable airway as fire has the Hurst and spreaders going off. Let me know how qualified they are. Of course I could go on and on.

Now flip the script. Try putting a 20 year vet paramedic on a med surg floor and they would be lost. Why? Paramedics aren't trained to care for a floor full of patients. They are not trained in the subtle nuances such as the necesity to get a physician's order to give a Tylenol. Paramedics are trained to recognize pathology and act on their training through online and offline protocols.

In the end, suggesting that nurses or paramedics are above or below one another is similar to suggesting that the color blue is above red. Different professions. Different models of care. Different training styles.

Medic09, BSN, RN, EMT-P · Dec 2, 2008

Hehehe...you would be surprised if new medics were hitting the streets with fewer than 10 intubations?

Yes, I would be. And VERY disappointed. Some OR time and then precepted tubes on the street are essential to learning it right, as we both know. Especially the OR time, which should be repeated periodically. The few programs I've been involved with over the years all provide that. Anything less is irresponsible and I would advise students to stay away from there. But then, I think all 'medic mills' should be shut down, somehow.

Medic09, BSN, RN, EMT-P · Dec 2, 2008

Medic09...you and I both know that there are programs that simply don't have access to inhospital training, so the possibility of a medic who only has experience with Fred the Head is indeed possible, albeit less so today than 16 years ago when we were all learning skills.

Well, if a program can't provide the proper, complete package, they shouldn't be operating. We used to see programs send their students pretty far distances to ensure that they got the appropriate exposure. I don't think 'we can't provide that' is an excuse. The problem is, there are no obligatory standards, and some students are desperate enough or lazy enough to support the medic mills.

getoverit, BSN, RN, EMT-P · Dec 4, 2008

All great points.
I have logged a bit of time as a basic EMT. I also ski patrol at a busy mountain. I have boarded and collared people out of MVC's and various wilderness conditions- including our of streams in the winters. I teach pre-hospital assesment and packaging.
The intimidating part is advanced airway management.
hherrn

Like vamedic and medic09 have said, doing advanced airway techniques over and over again is essential, both with mannikins, in the OR and in the field. The more you do it, the more practice you have under your belt when the next time occurs (and it will happen).

Keeping their sats up with a BVM is the most important and often most-overlooked skill in airway management. I used to always attempt to place an OPA, if the patient tolerated it, then chances are likely they'd tolerate a laryngoscope so I'd intubate them. I'm a little different now and usually don't intubate unless they're a) going to die without being tubed in the next few minutes or b) going to be put on a ventilator.

You can teach a monkey to intubate someone, but you can't teach a monkey to know WHEN to intubate someone. I can't recall any time wishing that I had intubated a patient, but there are a few times when I wish that I hadn't. Take that for what it's worth.

There are some great responses in this thread and I've enjoyed reading all of them. Thanks!