Someone can explain my doubt?

Can anyone explain me what's the difference between a nurse anesthetist and an anesthesiologist? Between a rehabilitation nurse and a physiotherapist? Between a psychiatric and mental health nurse and a psychologist? Between a pre-hospital nurse and a paramedic?

I'm not a health professional but in the future i'll be, and i have this curiosity...

Thanks for the future answers!

Nurse Anesthetist: Advance Practice Nurse with specialized training in Anesthesia

Anesthesiologist: MD with Anesthesia specialty. Commonly supervises the practice of the NA

Rehab Nurse: LPN or RN who practices in rehab facilities

Physiotherapist: ? uncertain what you mean....Physical Therapist? Physiatrist (MD)?

Paramedic: EMT with advanced training, used primarily on ambulances for emergent situations

Pre-hospital nurse: ? Again, not certain to what you're referring. A nursing student?

Nurse Anesthetist: Advance Practice Nurse with specialized training in Anesthesia

Anesthesiologist: MD with Anesthesia specialty. Commonly supervises the practice of the NA

Rehab Nurse: LPN or RN who practices in rehab facilities

Physiotherapist: ? uncertain what you mean....Physical Therapist? Physiatrist (MD)?

Paramedic: EMT with advanced training, used primarily on ambulances for emergent situations

Pre-hospital nurse: ? Again, not certain to what you're referring. A nursing student?

yes, I was referring to physical therapists

Pre-hospital nurse:Those nurses working in ALS ambulance, and nurses who make transfers of critical patients to other hospitals, or even nurses called "flight nurse"...

It comes down to scope.

RN on the ambulance either air or ground has greater scope of practice than a paramedic. Pre-hospital is just that... before hospital.

Not many nurses doing 911 calls in the field are usually rotary-wing flight nurses.

Other nurses on ground ambulances or fixed-wing aircraft are working transport as CCT (Critical Care Transport).

For the transport RN the patients have usually been seen by a doctor and reasonably stabilized before they go.

I use the word stabilized loosely (sometimes not:uhoh3:)

It comes down to scope.

RN on the ambulance either air or ground has greater scope of practice than a paramedic. Pre-hospital is just that... before hospital.

Not many nurses doing 911 calls in the field are usually rotary-wing flight nurses.

Other nurses on ground ambulances or fixed-wing aircraft are working transport as CCT (Critical Care Transport).

For the transport RN the patients have usually been seen by a doctor and reasonably stabilized before they go.

I use the word stabilized loosely (sometimes not:uhoh3:)

Just one more question: a "pre-hospital" nurse and a emergency nurse can do a endotracheal intubation and a manual defibrillation?

Just one more question: a "pre-hospital" nurse and a emergency nurse can do a endotracheal intubation and a manual defibrillation?

When in the hospital or not in the hospital it all comes down to resources available.

Doctor, Intern, R/T, ...

While in the ER there have been scant few opportunities for any defib or intubations I tell you because the doctor is there. Sometimes you are actually restricted in your scope by hospital policy.

In the field you have established protocols that you follow based on necessity/expediency.

If the patient is going bad and need a secure airway then you do it. If you have a shockable rhythm the alternative is what? Exactly... You shock them.

Are you referring specifically to these terms in the U.S. or in Europe since I see you list Portugal as your country?

Pre-hospital Nurses have a much broader role and scope of practice for out of hospital Emergency Medicine and are used more in Europe on ambulances for first response calls. In the U.S., most states will allow nurses to intubate when they are on Flight, Pre-hospital or Specialty teams. In the hospital they have different priorities as members of a team in the Emergency Department. There are other professionals in the U.S. who can intubate inside the hospital which you may not have in Portugal. RNs in the hospital can do defibrillation depending on where they work or if they are on a Rapid Response or Code team.

Physiotherapists in Europe can also have a broader role than what Physicial Therapist have here in the U.S. In the U.S. their education is a Masters degree with a doctorate now being preferred and their focus is usually limited to rehabilitative medicine but in a variety of areas such as homecare, clinics and hospitals. I believe in some countries Physiotherapists are trained in other aspects of medicine such as what is known as Respiratory Therapy in the U.S. as well. I believe the U.K. has Physiotherapists who are utilized as such in the ICUs.

For the most part, the difference is in the education and the specialized focus. A rehab nurse will have the same initial training and education as other entry level RNs but will continue their education/training usually on the job as they work on a specialized unit. Nursing education here in the U.S. is still essentially a 2 year degree for RN and 1 year for LVNs. As I mentioned, a Physical Therapist is a Masters or Doctorate of PT degree but with a very specialized focus.

An Anesthesiologist is a physician who specializes anesteiology.

A Physiatrist is a physician who specializes in rehabilitative medicine.

A Psychologist usually holds a Masters or Doctorate degree specializing in Psychology.

A Psychiatrist is a physician who specializes in mental health or psychology.

In the U.S. a physician can have the degree of M.D. (Medical Doctor) or D.O (Doctor of Osteopathy).

When in the hospital or not in the hospital it all comes down to resources available.

Doctor, Intern, R/T, ...

While in the ER there have been scant few opportunities for any defib or intubations I tell you because the doctor is there. Sometimes you are actually restricted in your scope by hospital policy.

In the field you have established protocols that you follow based on necessity/expediency.

If the patient is going bad and need a secure airway then you do it. If you have a shockable rhythm the alternative is what? Exactly... You shock them.

Thanks for the answer.

I made this question for curiosity. In Portugal I know that some times are the nurses who intubate the sick person in the ressuscitation room and other services (the nurses trained in advanced life support), therefore exist a great lack of doctors in some emergency room's, and this has raised some questions, therefore some doctors more conservatives have raised some problems about nurses intubate.

who want to participate in this theme, feel free:)

I also apologize for any typo. I still have to improve my English

Are you referring specifically to these terms in the U.S. or in Europe since I see you list Portugal as your country?

Pre-hospital Nurses have a much broader role and scope of practice for out of hospital Emergency Medicine and are used more in Europe on ambulances for first response calls. In the U.S., most states will allow nurses to intubate when they are on Flight, Pre-hospital or Specialty teams. In the hospital they have different priorities as members of a team in the Emergency Department. There are other professionals in the U.S. who can intubate inside the hospital which you may not have in Portugal. RNs in the hospital can do defibrillation depending on where they work or if they are on a Rapid Response or Code team.

Physiotherapists in Europe can also have a broader role than what Physicial Therapist have here in the U.S. In the U.S. their education is a Masters degree with a doctorate now being preferred and their focus is usually limited to rehabilitative medicine but in a variety of areas such as homecare, clinics and hospitals. I believe in some countries Physiotherapists are trained in other aspects of medicine such as what is known as Respiratory Therapy in the U.S. as well. I believe the U.K. has Physiotherapists who are utilized as such in the ICUs.

For the most part, the difference is in the education and the specialized focus. A rehab nurse will have the same initial training and education as other entry level RNs but will continue their education/training usually on the job as they work on a specialized unit. Nursing education here in the U.S. is still essentially a 2 year degree for RN and 1 year for LVNs. As I mentioned, a Physical Therapist is a Masters or Doctorate of PT degree but with a very specialized focus.

An Anesthesiologist is a physician who specializes anesteiology.

A Physiatrist is a physician who specializes in rehabilitative medicine.

A Psychologist usually holds a Masters or Doctorate degree specializing in Psychology.

A Psychiatrist is a physician who specializes in mental health or psychology.

In the U.S. a physician can have the degree of M.D. (Medical Doctor) or D.O (Doctor of Osteopathy).

Yes I'm from Portugal but I wanted to compare the differences between the two countries (Portugal and United States or UK too), because in the future, i liked being a nurse, and work in USA (I don't like Portugal lol).

You're right! There are other professionals in the U.S. who can intubate inside the hospital which you may not have in Portugal, for example, in Portugal we don't have respiratory therapist, just nurses and doctors can intubate (nurses and doctors trained in ALS),such as we don't have paramedics (only doctors and nurses can apply for advanced life support algorithm in prehospital care in Portugal, despite the government wanting to create and train paramedics in Portugal, many nurses are against this measure, so it is not regulated yet ...

Sorry for any typo...

Interesting.

Is this an accurate article on EMS in Portugal?

http://www.emsvillage.com/articles/article.cfm?id=232

Interesting.

Is this an accurate article on EMS in Portugal?

http://www.emsvillage.com/articles/article.cfm?id=232

Yes it is.

This article is a bit old, but is the reality of our country. There are very few Emergency and Resuscitation Medical Car (VMER) and the alternative was to put nurses on board the ambulance with an EMT-B within the country to stabilize the patient until arrival of emergency medical vehicle and resuscitation.

Attention: "In my opinion, it is time to invest in the education and training of emergency prehospital personnel. Currently, only physicians and nurses are authorized to start IV's and only a physician can administer medications, intubate or defibrillate." It is wrong. The nurses that are trained in ALS can intubate and defibrillate through medical authorization by radio or mobile phone!

In nowdays, the doctors don't use a map, they use a GPS on Emergency and Resuscitation Medical Car;)

who want to watch, I'll leave here a "video link" about the medical emergency services in Portugal. Sorry to be in Portuguese, but later I will do the translation. For now, i can say that "enfermeiro" is nurse and "médico" is doctor/phsysician and "edema agudo do pulmão" is acute pulmonary edema.

Just one more thing: Appear in the video "SIV ambulances. " In Portugal, the acronym SIV means immediate life support.This ambulances are manned by a nurse and an EMT-b "TAE". This Ambulances are more advanced, and the nurse can do 12-lead ECG, endotracheal intubation, administer emergency drugs, use infusion pumps and use a manual defibrillator (usually they use lifepak 12), without the direct presence of a doctor, just a medical control via radio or mobile phone!

Here are a few links that might be useful to you.

For EMS, training and certification varies from state to state and some states like California, it is by also by county.

http://www.emsworld.com/survey/

This explains the proposed changes for the NREMT testing although not all states use the NREMT.

http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf

This goes into more detail for each level of EMS Technician.

http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

The types of service vary from city to city and even within a city.

http://www.emsworld.com/publication/downloads/8th%20Annual%20Systems%20Survey.pdf

For almost all other healthcare providers in the U.S., they may take a national certification test but then are licensed by each state that they want to work in. Each state can also control the scope of practice and each employer (or Medical Director) can dictate specifically what can and can not be done.

Some examples of Flight, Specialty and CCT teams where RNs have a significant scope of practice for out of hospital situations.

CalStar - California

http://www.calstar.org/

California also utilizes a MICN for CCT and for base hospital operations for EMS personnel.

example:

http://extension.ucsd.edu/studyarea/index.cfm?vAction=singleCourse&vCourse=FPM-70000&vsacategoryid=134&vStudyAreaID=12

California Ambulance CCT nurses

http://www.amrventura.com/CCT.html

Specialty Team

Arkansas Children's Hospital

http://www.archildrens.org/Services/Angel-One-Transport/Angel-One-Team.aspx

Including mobile ECMO

http://www.archildrens.org/Services/ECMO/Mobile-ECMO-Program.aspx

Vanderbilt LifeFlight

http://www.vanderbilthealth.com/lifeflight/15862

Stanford

http://stanfordhospital.org/clinicsmedServices/medicalServices/lifeFlight/teamRoles.html

Boston MedFlight

http://www.bostonmedflight.org/

Florida Hospital

http://floridaflightone.com/Florida_Flight_One/Welcome.html

Duke

http://lifeflight.duhs.duke.edu/modules/lfabout/index.php?id=5

Wake Forrest

http://www.wfubmc.edu/School/Neonatal-and-Perinatal-Medicine/Neonatal-Pediatric-Transport-Service.htm

The U.S. also has a few Physician/Nurse Flight teams such as:

http://em.uchicago.edu/aeromedical.html

Job board on Flightweb where you can see the various positions and requirements of Flight RNs.

http://www.flightweb.com/jobs/

A few states have a specific certification for PreHospital RN.

- Pennsylvania

http://www.pacode.com/secure/data/028/chapter1003/s1003.25b.html

This link provides a great overview of all the skills for the different EMS levels which a PHRN can also do along with their own beyond those listed.

http://www.pabulletin.com/secure/data/vol38/38-48/2162.html

- Illinois

http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1226&ChapAct=210ILCS50/&ChapterID=21&ChapterName=HEALTH+FACILITIES&ActName=Emergency+Medical+Services+%28EMS%29+Systems+Act%2E

- Nevada

http://www.nursingboard.state.nv.us/