RN vs. EMS

Editorial Team / Moderator · May 5, 2010

In Virginia, our protocols vary by "council" -- we have various EMS councils that encompass certain counties, and the councils (including medical directors) define scope of practice for both paramedics (EMT-Ps) and EMT-Basics (EMT-Bs). I'm not sure if statewide EMS protocols exist in Texas, or anywhere else. You might have better luck trying this site, which I found through a quick Google search:

Home - DSHS EMS Trauma Systems

Sorry if you ran into some "paragods," as I call them. As a paramedic (and an RN), I can tell you we're not all full of ourselves.

Edited to add: EMS National Scope of Practice, which is a work in progress: http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

billythekid · May 5, 2010

Absolutely true.. there are alot of nice paragods out there :)

In Virginia, our protocols vary by "council" -- we have various EMS councils that encompass certain counties, and the councils (including medical directors) define scope of practice for both paramedics (EMT-Ps) and EMT-Basics (EMT-Bs). I'm not sure if statewide EMS protocols exist in Texas, or anywhere else. You might have better luck trying this site, which I found through a quick Google search:
Home - DSHS EMS Trauma Systems
Sorry if you ran into some "paragods," as I call them. As a paramedic (and an RN), I can tell you we're not all full of ourselves.
Edited to add: EMS National Scope of Practice, which is a work in progress: http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

Editorial Team / Moderator · May 5, 2010

Absolutely true.. there are alot of nice paragods out there :)

Indeed there are! LOL

billythekid · May 5, 2010

Having been on both sides of the RN-EMS table, I can tell you that both professionals deserve the utmost respect.

Regarding skill sets, EMT basics (entry level in NY State is EMT-D(efibrillation) generally perform head-to-toe assessments focused on identifying respiratory, cardiac, neurological and peripheral vascular abnormalities. It is not specifically in the realm of an EMT-Basic to distinguish certain medical nuances (ie - cardiac wheeze vs. respiratory wheeze).

Hey all,
OK I have just totally worked myself up into a tissy by trying to look for this question
on an EMS website.....as an RN...BAD IDEA!! They are so full of themselves that you can't
even get the content because they are talking about how they are superior to RN's and
make diagnosis and blah blah freakin blah!!! Off the soap box now and soon pulse will return to normal resting rate.
I was actually looking for a list of skills that EMT's and EMT-P's can perform legally in TX. Here is my issue: I work at a chem plant, I am the only RN here. In this world my boss thinks Paramedics are the end all, be all, of the medical world. I have an ER with 3 beds. I have almost 1700 employees at this site. I have 3 paramedics and about 100 EMTs but I really have no idea the scope of an EMT. I pretty much know what a paramedic can do for we have protocols that they follow but I am not sure at all what an EMT basic can actually do. I have only been working in this industry for about 3 months as I was an OR and ER nurse before. The hospital world is VERY different from the Occupational Health World. My dealings with EMS before were when they were dropping my patients off or assisting in a code after dropping my patient off. SO if you have any idea can you please let me know.

Editorial Team / Moderator · May 5, 2010

I pretty much know what a paramedic can do for we have protocols that they follow but I am not sure at all what an EMT basic can actually do.

In re-reading your post, I wanted to add this: whoever created the protocols for your medics needs to also create protocols for the EMT-Bs. The same body (committee, medical director, whoever) should govern both levels. Can you talk to your medical director?

Aliakey · May 5, 2010

LunahRN is very correct... there should be a set of protocols authorized by your medical director, not only for your paramedics, but your basics as well. Without them, the EMT-B's would not know where their scope of practice extends either.

In Texas, the medical director dictates the EMT and EMT-P's scope of practice, and if it's not a skill expected by the National Registry, then we do annual inservices for it (such as central line access).

In the EMS service I work for, we have what's considered as "aggressive protocols", but, we also run in very rural areas where the nearest hospital is not just a few miles away. EMT-B can do the following in our service area:

trauma immobilization/splinting/bandaging,
tractions splints,
MAST pants,
deliver a kiddo (better have a paramedic enroute ;-) ),
oxygen administration,
airway securement (limited to a King airway device),
ventilation assistance (BVM and CPAP),
set up a 12-lead for a responding paramedic (EMT-Bs may not interpret, just put the leads on),
AED use,
blood glucose check,
CPR,
subcutaneous administration of limited medications,
intramuscular administration of limited medications,
nebulized medications,
oral suctioning,
NPA/OPA use,
and as for medications themselves: Epi (1:1000 IM), Glucagon (IM), Oral glucose, albuterol, xopenex, aspirin, Children's Motrin (febrile), racemic epi (neb for pedi), and nitroglycerin (SL).

I think that's it. Many treatments require that a paramedic is dispatched to meet up with them, such as times when aspirin and NTG is given for chest pain. Since a lot of our rural services are volunteer and short on paramedics, this helps the patient tremendously; the paramedic can be dispatched out to meet the crew either on scene or while enroute to the hospital for further interventions. The EMTs are, for the most part, very competent in assessment skills, so it's very unlikely an aspirin will be given to a patient whose presentation suggests a dissecting AAA instead.

In other areas of the state, EMTs and Paramedics are very limited in what their medical director will allow them to do. The "Mother May I (Open It)" IV boxes comes to mind... somewhere in Houston, I think. So I've heard.

I'm sorry you got hit with the Paragod Syndrome; I hate it as well and pray I never get that attitude. Not wanting to defend the attitude, but I think a little stems from some of the expectations we face. They are no worse then what an RN faces when confronting a physician, but really sticks us in a defensive mode. The extra skills and treatments we're allowed to use under our medical director's authority comes at a price... in the service I work for, our monthly case reviews are very similar to the physicians' M&Ms (ouch). A summer vacation in Hades could be more pleasant. In addition, since we have quite a bit of automony in the field (and most patients don't read the textbook on signs/symptoms/adherence to local protocols), we get used to having to defend treatment decisions to receiving physicians, RNs, RTs, and field officers.

I am in no way saying we're perfect (LOL!) or even close, but as an example, I've studied cardiology/12-lead interpretation for two years. When a family phyisican looks at your monitor that shows IVCD in a symptomatic patient with ESRD, and he wants you to wait around for ten minutes for whatever reason because he thinks it's just a benign and strange looking bundle branch block... oh heck no!!! I'll do what's best for my patient: make a quick wager with my partner on the potassium level, haul out of there, and expect that cardiac arrest that'll probably happen enroute with my luck. But, I'll also face the family physician's complaint that I know will get called in within the hour. Kinda makes me a little cranky for the rest of the shift.

As I said, there's no excuse for the Paragod Syndrome... I don't tolerate it with my partner, and he'd kick my butt if I ever acquired it. Just hoping to enlight that's we're not all bad apples... maybe a bit sour with some in the batch, I'll admit.

getoverit, BSN, RN, EMT-P · May 6, 2010

Maybe this website can help you find the answer.

http://www.dshs.state.tx.us/emstraumasystems/default.shtm. I believe TX is a licensure state for EMT-Ps, which can make things different depending on the locale.

LunahRN makes a good point about talking to the medical director who wrote the protocols for the paramedics.

sorry you ran into paramedics who got ya in a "tissy". That happens sometimes. Like aliakey mentioned about the conduction delay in the renal patient....she may disagree with the GP, but he has gone to medical school and she has not. I'm not trying to blast her, but a physician has more education and (usually) more experience than the medic and that should be taken into consideration.

But for the OP, don't generalize all paramedics as "full of themselves" because of a few people on an EMS website. I've been both (REMT-P/RN) for a long time and the majority of paramedics, like RNs, are great people who sacrifice a lot in order to help other people.