The Infamous Cab-ulance

[MedicalPartisan]

I'm curious to know some of the things your patients call the ambulance for. Just recently we've had patients who present to the ED via EMS and c/o ripped cuticle, or a med refill, along with many more complaints that, in my opinion, absolutely do not justify the need for emergency medical services. The worst one lately, though, was a patient who presented to the ED and when getting off the stretcher, stated that they just needed a ride to this side of town to get to their friend's house and simply walked out the EMS bay doors. I was flabbergasted.

What inane EMS runs have you experienced?

[Esme12, ASN, BSN, RN]

Ok paramedics should intubate. Doesn't bother me. Frankly I have enough to do.

I am not arguing with you. I never said nurses were without a scope of practice.... I said they are not forbidden by state statute to intubate.

I asked you to show me a state statute where is prohibits nurses from intubation specifically.

I'm sorry you feel you have been mistreated.

Have a wonderful day.

[BR157]

Ok paramedics should intubate. Doesn't bother me. Frankly I have enough to do.

I am not arguing with you. I never said nurses were without a scope of practice.... I said they are not forbidden by state statute to intubate.

I asked you to show me a state statute where is prohibits nurses from intubation specifically.

I'm sorry you feel you have been mistreated.

Have a wonderful day.

I haven't been mistreated but you have definitely confirmed how Paramedics have felt the nurse world felt about them. Luckily Paramedics know who they are and what they do. Just from reading this I think nurses should be more informed about their own profession before trying to strike down EMS professionals.

You can look at your own website here for state intubation information since it has been discussed many times as evidenced in the search function. There are nurses there complaining about their state not allowing them to intubate and if you follow that lead you will find they are right.

I also found the nurse practice acts to be limiting as to what medications nurses can give in some setting especially with sedation. Interesting reading you might want to do sometime. Your scope is not nearly as broad as you think.

[Esme12, ASN, BSN, RN]

I haven't been mistreated but you have definitely confirmed how Paramedics have felt the nurse world felt about them. Luckily Paramedics know who they are and what they do. Just from reading this I think nurses should be more informed about their own profession before trying to strike down EMS professionals.

You can look at your own website here for state intubation information since it has been discussed many times as evidenced in the search function. There are nurses there complaining about their state not allowing them to intubate and if you follow that lead you will find they are right.

I also found the nurse practice acts to be limiting as to what medications nurses can give in some setting especially with sedation. Interesting reading you might want to do sometime. Your scope is not nearly as broad as you think.

You know...I have no idea what you are talking about. If nurses are stating it is the state that disallows them from intubating they are wrong. I am perfectly aware of the new limitations on propofol because some idiot MD allowed a famous person to die from using it AT HOME. I am also perfectly aware that the are restrictions on certain drugs being used in certain areas and how they must be used by only trained personnel under certain circumstances. NOW I am annoyed....paramedics are never allowed to administer to monitor propofol that I know of which is why they need a nurse.

I have NEVER NOT ONCE struck down any EMS personnel in ANY OF MY POSTS. YOu have however made many derogatory remarks against nurses. I have tried to be patient and supportive. I will now bow out gracefully for I have nothing further to say.

[Gabby-RN]

http://work.chron.com/policies-rn-intubation-4756.html

"Some states, such as Nevada, allow intubation if the nurse has completed special training such as advanced cardiac life support training, or ACLS. In Maine, RNs have been permitted to intubate patients since 1986, according to the Maine Board of Nursing. Other states allow only advanced practice nurses such as nurse anesthetists to intubate. Nurses who work in the field of emergency medicine may be permitted to intubate patients; the Air & Surface Transport Nurses Association notes that intubation is an expectation of practice in that field. In South Carolina, an RN may intubate in an emergency situation if the facility has appropriate written policies, procedures and standing orders."

[Gabby-RN]

I also found the nurse practice acts to be limiting as to what medications nurses can give in some setting especially with sedation. Interesting reading you might want to do sometime. Your scope is not nearly as broad as you think.

You do realize that paramedics are also limited as to what medications they can give and are even further limited as to they need to ask a doctors permission before they can give some medications. Lasix for example is not a protocol medication in all states. I respect the job paramedics do. It is different than the job I do as an RN. I respect paramedics as individuals that in turn respect me. Your job is not better than mine. My job is not better than yours. Our jobs are DIFFERENT. If you feel the way you do about nurses I am not really sure why you are on a nursing forum.

[Gabby-RN]

You do realize that paramedics are also limited as to what medications they can give and are even further limited as to they need to ask a doctors permission before they can give some medications. Lasix for example is not a protocol medication in all states. I respect the job paramedics do. It is different than the job I do as an RN. I respect paramedics as individuals that in turn respect me. Your job is not better than mine. My job is not better than yours. Our jobs are DIFFERENT. If you feel the way you do about nurses I am not really sure why you are on a nursing forum.

Sorry I realized you are a nursing student, according to your profile. Good luck with that. Maybe want to try a new approach because you are sure coming across as someone other than wanting to be a nurse.

[BR157]

Sorry I realized you are a nursing student, according to your profile. Good luck with that. Maybe want to try a new approach because you are sure coming across as someone other than wanting to be a nurse.

I have no idea who you are addressing that to but I am going to respond to some of what you are assuming.

I brought up the idea that Paramedics should be able to decide who needs an ambulance ride and who doesn't. Immediately EMSE started in with the not qualified and lawsuits. I stated that this is already done in many areas of the country but she would not have any of that notion that Paramedics could actually determine who needs an ambulance or not. Her outdated ways of thinking that Paramedics are not smart enough for this needs to go and the fact that she is the boss of this site to instill this crap into nurses who read it is just plain idiotic and biased towards Paramedics. Paramedics are active in Community medicine and are now on the forefront of making a difference even if nurses don't like the idea.

I am on a nursing forum because these discussions were brought to my attention and I felt you should hear from the other side. On this discussion I just made one comment about Paramedics determining if the patient really needed an ambulance and right away some nurse jumped in with a lame comment "just because they intubate". So no, I did not pick this fight but I will not back down either to defend Paramedics.

[tnbutterfly - Mary, BSN]

ADMIN REQUEST

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We promote lively debate. While you are free to disagree with anyone on any type of subject matter, we ask that you keep your comments constructive and respectful. Please refrain from name-calling or other divisive behavior which only serves to derail the thread.

Nurses and paramedics are part of the healthcare team, each playing an important role in the care of the patient......who is the most important person involved in healthcare. Let's not get so caught up in trying to elevate oneself that you lose sight of what is really important.

That being said......please refrain from further discussion of Nurse vs paramedic in this thread. Keep your comments on topic which is what kinds of things people call the ambulance for. If you care to discuss other topics, please start another thread.

Further divisive and rude posting will result in closure of this thread.

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[ambz13]

Your comment makes not sense. If it takes 30 years of "street smarts" to be compared with a new grad with a college degree than I think my point has been made.

Let's make a more realistic comparison here. If your Paramedic who graduates from a certificate program with just the minimum "hours of training" which does not have full college level A&P courses with labs, pharmacology or pathophysiology is compared with one who has a solid Associates degree, where do you think both will be in 5 years. Both will have "street smarts" but the one with a solid education will also have the ability to discount some of the "street smarts" because of the "that's have we've always done it.

Stating Paramedics need to raise their education beyond a tech cert in order to get "advanced skills and protocols or guidelines" is not putting them down.

Hearsay? These conferences have medical directors (doctors) of real EMS agencies, experiences Paramedics and regional/state leaders for EMS. This is not bar room or anonymous forum gossip. We also have some of the headlines makers of serious screw-ups but there are others which don't all make the news because of privacy policies. Exactly how many patients are denied transport is easily skewed because of what I mentioned earlier with the RMA or AMA forms. Usually it is not until a death is involved that we find out a big bad issue with an agency such as with Washington DC. If you don't know about the problems there which have been heavily scrutinized then you probably don't know too much about EMS.

Here is a presentation, including some of the stats you want.

http://gatheringofeagles.us/2010/Presentations/Eckstein - Mandatory Transport.pdf

If you are really serious about learning more for knowledge and not just to start a "picking on poor EMS" emotional mess, I would be happy to provide more data.

Enough with the emotional mud slinging. Higher education for the advancement of any profession is on the table. CMS looks at this when it comes to patient outcomes and reimbursement.

Many in the US would like to move to another country to work in EMS because of their higher education and autonomy. But, work visas and regulation of outsiders entering the work force in another country make this difficult. It is no different with nurses.

You are not my student. I am not trying to teach you anything. But, I am trying to give you more insight to the problems faced today by EMS. It is way more fragmented than nursing and it is probably less than 1/10th the size of nursing.

Your new grad Paramedics in the ER are not running the codes. Paramedics working in the ER do not run code except for maybe some very tiny ER but then there is a doctor nearby to sign the chart. But, even Paramedics will argue that these weekend certs are pretty meaningless. If you only have 4 years of experience then you probably have no clue about when ACLS actually was a cert to be proud of. Now it is just a card and I would not trust anyone based purely on being a cardholder to be proficient at ACLS. This includes some Paramedics. Then NREMT requires ACLS because they test for 46 states which all may have differing education requirements for Paramedics which can be anywhere from 600 hours of training up to an Associates degree in only one state.

You are trying to justify that your 500 hours of clinicals were enough. For most prehospital protocols and procedures, it might be. You stated several areas you did clinicals in. Do you not see have little training you got in any area? A few hours here and there does not necessarily make you qualified to critical care transports such as the example you gave. I hope you at least understand why an RN and/or RT should be with you during a NICU transfer. This type of transfer should be done by a qualified NICU team consisting of RN/RN or RN/RT. The same for Pediatrics. This is not about patting your EGO so we don't hurt your feelings but about the safety of the patient. Having a qualified team to transport a patient is what EMTALA is all about. Not whether you and your brothers and sisters get offended. Unless you have been properly educated and trained, you should not be doing high acuity transports. Paramedic programs do not provide that type training in just 1000 hours. This is not an EMS vs nursing issue. You would not see a nurse who works in an Adult ICU hopping on a NICU transport or a med-surg RN trying to tell an ICU RN how to manage their IABPs. They have enough education and training to know their limitations. That might be the message you need to take from this on your next CCT.

Please refrain from calling Paramedics "stupid monkeys". If you are really this naïve about the situation in the US with Paramedic education, you should make some attempt to get more involved with the broader picture for EMS rather than making personal attacks on those who just restate what has been stated many times by those who are trying to change things in EMS to advance it as a profession.

UMBC Department of Emergency Health Services :: ParamedicHome ---a Bachelors degree to appease you.

I don't know where you live, and I am aware that EMT-B and EMT-P are widely held at the certificate level, but good lord I don't understand where your blatant hatred is coming from.

Your argument begins with ALS units dumping off pts to BLS units because they are uncooperative and would rather sleep at the firehouse and then escalates into a personal attack on EMS providers nationwide.

In my experience as an EMT in my location I have NEVER had an ALS provider "dump" at patient on my that truly needed to be put on a monitor/IV/etc. It always comes down to a conversation of their assessment and my assessment finding no need for an ALS unit to be tied up and me feeling comfortable taking on the patient. Even if this were to happen I hope you're not incinuating that EMT-B providers either have no backbone to say they can't handle it or way too much confidence. We are trained in what our scope of practice is just the same as other healthcare providers.

What I think is bugging most people here is that you are:

Attacking EMS providers for having a certificate and not a college degree----- NOT their fault. A problem with the system at most.

Blaming the cases in which a BLS provider brings in a ALS pt that's in imminent danger on said ALS providers. This is an attack on the morals of paramedics and is (from my experience) very untrue.

In my state we all perform our skills under the state EMS Medical Director protocols. Dr. Roger Stones' MD is what allows us to provide care and the extension of his expertise just like for nurses in the ER.

You are correct on one thing. There is a very omonious dark cloud looming over EMS, particularly in DC. I know what you have read but knowing people within the department, the problem is not from the providers, but from the cheif who runs the department in a constant state of fear for people losing their job over insane reasons (responding to a fire with vitctims inside rather than a less emergent call originally dispatched) and his corrupt buddy Mayor Gray who will soon be gone. I believe the changes in the department will be coming and they will again soon be recognized as one of the best performing departments in the nation.

I do hope you can find some faith in EMS within the personel who opporate within the trashed system. Best wishes.

Oh and FYI, I am an EMT-B and hold an associates which includes the addition of all of my nursing pre-reqs, am I more qualified than my peers?

No.

Maybe a tiny amount of that knowldege can be applied on a routine run, but in a real emergency I need my skills I trained in and the critical knowledge of where when and how to transport. Many of my fellow EMT's and Medics hold MULTIPLE graduate level degrees and would not be any more qualified. healthcare providers keep learning and training and we get better, all of us do.

[ambz13]

Whoa just read through the rest of this thread. Sorry I'm way off topic too

[skylark, BSN, RN]

I had a discussion with a European friend about this a while back. In a "universal healthcare" setting, they don't have this type of problem with people using EMS for non-urgent calls. Why? Because people who call for a cab-ulance get charged with fraud, criminally and civilly.

I would love to know where in Europe this happens : )

Its a worse problem in England that in the US, because healthcare is free and therefore abused.

I work registry/per diem in a London ER when in England and we recently had one of our frequent fliers come in via his 1,000th ambulance ride.

And there is nothing anyone can do to stop this.

He knows exactly what to say - chest pain, tingling jaw, short of breath, etc, etc, and nobody can challenge him.

He is on welfare and so there is no point sending him a bill, it will only get forwarded to taxpayers.

Now the system I DO like is apparently in either Aus or NZ, perhaps someone from that part of the world can enlighten me.

An ambulance ride costs the equivalent of I think around $50. You can pay at the time, or you can have a prepay card that you carry with you.

When you arrive in ER a doc assesses whether the journey by ambulance was clinically neccessary. If it was, you get your $50 back. If it wasn;t the ambulance company keeps your money and you get a letter in the mail educating you about appropriate use of the service.

I'm sure there must be some faults with this, but from what I have heard, it is surely the best system so far?

Anyone?

[brillohead, ADN, RN]

I would love to know where in Europe this happens : )

The friend I was discussing it with lives in Finland.