Nurses vs EMT/Paramedics in EMS

[ExpatMedic0]

A paramedic is a Specialist in emergency medicine and rapid stabilization. If you do not like that Paramedics are used instead of an RN in the trauma bay of our states best hospital you take that up with them. It makes perfect since to me. But of course it will be a cold day in hell the day your an advocate for Paramedics.

And again you are just listing "skills". You are not a nurse. You are working with some "skills" in the scope of being a Paramedic. Does that Paramedic wear the "title" RN on their name tag? I also can do exactly the same things as a RN as an RRT in the specialty units. I am not a nurse and have no desire to become a nurse since the rest of my scope of practice is very focused. RRTs can also do exactly the same things as a Paramedic and much more on transport but do not hold themselves out to be Paramedics. RNs can also do the exact same things as Paramedics but do not hold themselves out to be Paramedics. PAs can do the exact same things as Paramedics but do not hold themselves out to be Paramedics.

The Paramedic should stop trying to be what they are not and attempt to see what their profession actually is. This identity crisis is just further compounding the issues in EMS.

 

[VentMedic]

But of course it will be a cold day in hell the day your an advocate for Paramedics.

I advocate for the best care for the PATIENT and not just the ego of the Paramedic. You just stated the Paramedic is a specialist in trauma stabilization. That is just one small part of the total care that is involved in a complex trauma patient. The fact that you can not see beyond the trauma bay is exactly why the Paramedic is limited.

 

[ExpatMedic0]

weird.... so the ED doctor decides to use Paramedics in the trauma bay because they are not as good as nurses in that area? wait let me just hear you say a Paramedic is more qualified and specialized in that field... Go ahead its ok you can say positive things about Paramedics sometimes...

 

[VentMedic]

weird.... so the ED doctor decides to use Paramedics in the trauma bay because they are not as good as nurses in that area? wait let me just hear you say a Paramedic is more qualified and specialized in that field... Go ahead its ok you can say positive things about Paramedics sometimes...

By your argument, every patient that comes into the ED will have to be a candidate for the trauma bay so the Paramedic can be "like a nurse". The RN is flexible to not only work the trauma bay but also all those "boring medical" patients as well. You know, those patients that aren't cool traumas and not worthy of a Paramedic's attention since they are "trauma bay specialists". There is a whole lot more to patient care and again, that is what you fail to see.

The fact that a doctor uses the Paramedic for a few tech skills means a nurse can also be freed up for other things involved in patient care. Other "specialists" are utilized much the same way and none of them go around saying "they are nurses".

 

[ExpatMedic0]

I think someone needs to turn there frown upside down. In your world all Paramedics are 600 hour trained fire department meat heads that wear a badge on there shoulder to get chicks and think we are Johny Gage. Maybe its some sick fantasy you have, I am not sure....

Well I will let you rant and rave and get the last word in.. LIKE ALWAYS. Have fun with that

 

[VentMedic]

I think someone needs to turn there frown upside down. In your world all Paramedics are 600 hour trained fire department meat heads that wear a badge on there shoulder to get chicks and think we are Johny Gage. Maybe its some sick fantasy you have, I am not sure....

Well I will let you rant and rave and get the last word in.. LIKE ALWAYS. Have fun with that

In my world there are specialists and many different health care professionals who make up a health care system and team.

You seem to have a problem seeing the uniqueness of being a Paramedic as well as the limitations. You have failed to read through all the courses that each health care professional takes to make them unique. It is more than just the initial prerequisites. Stop trying to be a nurse without the actual nursing education. If you want to be a nurse, go back to school and pick up the nursing courses. You still haven't finished the Paramedic degree so you could probably switch majors fairly easily. Once you do go through nursing school, you will see how much you do not know about that profession.

Believe it or not but there are many Paramedics who do have degrees and many of them work for FDs. They don't have to constantly compare themselves to nurses or declare "just like a nurse or doctor" to feel secure in their profession. They know who and what they are as well as their limitations. They also know they are just one part of the healthcare system.

 

[JPINFV]

Edit: Never mind, EMS boards isn't the proper place to discuss the rise of the noctor.

 

[46Young]

http://sandmansprogress.blogspot.com/2006/07/rise-of-noctor.html

I think that the paramedic profession will stay as it is now, pretty much, and shouldn't try and pretend that it's more than it is. Increased education would allow us to progress and expand into other areas of medicine, but there's a problem with that:

For the medic to attain this hypothetical advanced education (in the US) they would have to take many if not all of the same courses as nurses, RT's, and other related fields. The money sucks for the most part, and the profession lacks the organization to effect real change in wages and benefits. Education alone isn't the magic bullet. IF the medic wants to do "real IFT", such as CCT, NICU's PICU's and such, they're not going to do 4-6 years of advanced paramedic schooling for relatively lousy pay, they'll just become an RN or RRT, or maybe a PA if they want to be more like a doctor. I'd be a fool to go to school for four years for a fragmented profession with a poor chance of significant clinical advancement, and low pay, when I could instead enter the more established medical professions and be guaranteed the increased scope and pay.

Edit: if you think the IAFF is tough, attempt to take away business from the nursing profession and see what happens.

The educational progression for the paramedic past the AAS is mostly admin stuff that grooms one for supervisor positions. IF the advanced classes existed, they would likely be the same as nursing pre reqs, so the medic would be better off just doing the nursing program instead. I don't feel that prehospital EMS needs a whole lot past the AAS level of education, anyway.

 

[Shishkabob]

Edit: if you think the IAFF is tough, attempt to take away business from the nursing profession and see what happens.

I've already heard some nurses complain about pioneering EMS agencies doing community paramedicine...

 

[VentMedic]

I've already heard some nurses complain about pioneering EMS agencies doing community paramedicine...

There have been several agencies that have attempted to do community paramedicine throughout the past 30 years but some of the programs were dropped because the Paramedic didn't like doing something that wasn't an "emergency". If you complain about doing routine calls, IFTs and responding to 911 calls that are medical and not trauma, then doing community paramedicine probably isn't for you. Unless the attitudes can be changed in EMS with a different patient care focus, those who don't like doing community paramedicine will give cause for complaints.

 

[46Young]

Let's accept the paramedic profession for what it is. We have a few procedures, and maybe 30 meds or so. Besides just getting someone to the hospital in an expiditious fashion, the only real effect in pt outcomes are with the pt presenting with severe respiratory distress/failure. Maybe pain management, D50 for the diabetic, and reperfusion therapy via MONA/fentanyl w/an approprite txp destination should be included. These pts are few and far between for the most part. CVA's and other time sensitive pts such as legit traumas need rapid txp more than anything else. Our job, for the most part, is customer service and safe transport. I learned that early on and accepted that.

As far as the paramedic being a team member in an ED in whatever capacity, you're not really the authority on making any pt care decisions, just performing skills and treatments for the MD's and nurses. If you want to do what nurses, RT's, PA's and doctors do, you're going to become one rather than pretend or convince yourself that you're on par with them.

 

[46Young]

There have been several agencies that have attempted to do community paramedicine throughout the past 30 years but some of the programs were dropped because the Paramedic didn't like doing something that wasn't an "emergency". If you complain about doing routine calls, IFTs and responding to 911 calls that are medical and not trauma, then doing community paramedicine probably isn't for you. Unless the attitudes can be changed in EMS with a different patient care focus, those who don't like doing community paramedicine will give cause for complaints.

Yeah, that's the other thing, the vast majority of medics, 911 bound via third service, private, or fire based, envision 911 prehospital EMS, where every call is a an exciting life threatening emergency. Look at most new medics that can only get an IFT gig while waiting for 911. They can't stand it after a while, and can't wait to get out of that side of EMS. It's not difficult work, but many see it as mundane and "BS". I tell people that I do IFT on a per diem basis, and most tell me something like "I'll never go back to doing that. Why do you want to do that?" Some older medics welcome it since the overall workload and call types are less stressful and demanding than 911, but many think that IFT is beneath them.

Edit: As such, the vast majority of existing medics would naturally have little desire to advance their clinical knowledge to the benefit of the profession, since those advances would be mostly in IFT and community health, which isn't what most envisioned doing in the first place.

 

[VentMedic]

That's also like the earlier discussion with the Paramedic in the trauma bay. There was no mention of the routine aspects of patient care such as foleys, bathing, bed pans, dressing decubitus ulcers on the elderly and diabetic, patient teaching for self care and all the many things that are part of taking care of a patient. Intubation is just one skill and even as an RRT, it is just one part of the job. It doesn't make me less of an RRT if the doctor, Paramedic or RN intubates. If the flight RN or Paramedic needs an intubation to stay current, most MDs and RRTs are happy to help them out by giving them the laryngoscope. I also know there is much more to airway management and critical care after the tube is placed.

If you want to be just like another profession you have to accept it all which includes the routine patient care as well as the "cool skills" in the trauma bay.

 

[Veneficus]

Edit: As such, the vast majority of existing medics would naturally have little desire to advance their clinical knowledge to the benefit of the profession, since those advances would be mostly in IFT and community health, which isn't what most envisioned doing in the first place.

Unfortunately for them, the emergency only mentality is quckly decreasing in value to society and if they don't start accepting more of a routine healthcare role, they will in a few years find their numbers being reduced. Then you have an education that not only pays low, but that can't find you a job at all.

Without going into the firemedic debate and just looking at numbers, how many fire positions would currently be eliminated without EMS or EMS positions eliminated without fire?

 

[MrBrown]

I'd be a fool to go to school for four years for a fragmented profession with a poor chance of significant clinical advancement, and low pay, when I could instead enter the more established medical professions and be guaranteed the increased scope and pay.

Perhaps you could start a trend?

I don't feel that prehospital EMS needs a whole lot past the AAS level of education, anyway.

While I am unsure of the exact comparisons between our Degrees and yours, I know people who are on exchange to US Universities in our first and second year and who are only able to choose second or third year Bachelors Degree classes in the US to match the educational complexity.

To give you an idea this challenge testhttp://www.aut.ac.nz/__data/assets/...-SCIENCE-NON-FORMAL-RPL-CHALLENGE-TEST-V2.pdf covers the material in one of our first year classes for the Paramedic Science degree while in third year, for example, we are having to write 5,000-6,000 word research essays.

Also we do not have any "general education" requirements because they are all covered in the final year at high school pretty much (we do 13 years compared to your 12) so ..... I am therefore highly suspicious that an "associate degree" would give you the knowledge beyond our second year Degree classes.

While it's probably an improvement I am not sure even that would be acceptable to practice advanced life support.

 

[Veneficus]

Perhaps you could start a trend?



While I am unsure of the exact comparisons between our Degrees and yours, I know people who are on exchange to US Universities in our first and second year and who are only able to choose second or third year Bachelors Degree classes in the US to match the educational complexity.

To give you an idea this challenge testhttp://www.aut.ac.nz/__data/assets/...-SCIENCE-NON-FORMAL-RPL-CHALLENGE-TEST-V2.pdf covers the material in one of our first year classes for the Paramedic Science degree while in third year, for example, we are having to write 5,000-6,000 word research essays.

Also we do not have any "general education" requirements because they are all covered in the final year at high school pretty much (we do 13 years compared to your 12) so ..... I am therefore highly suspicious that an "associate degree" would give you the knowledge beyond our second year Degree classes.

While it's probably an improvement I am not sure even that would be acceptable to practice advanced life support.

You're such a tease, I thought you posted a multiple choice practice test. I was going to take it. The learning objectives seem very reasonable though.

You think I have enough education to challenge the exam?

 

[MrBrown]

You're such a tease, I thought you posted a multiple choice practice test. I was going to take it.

Sure, answer all the questions and I will send it to Brenda at AUT for marking B)

 

[iamjeff171]

nurse vs. paramedic is kind of apples and oranges in my opinion.

Paramedicine is very limited/specific, and i know numerous medics who have left to go on to nursing/med school, due to this fact. some of my fellow classmates are going through the medic program with the intent of bridging over to nursing, so they dont have to wait on the year long waiting list to get into nursing school.both the nursing and medic programs have all of the same prerequisites in my program; and honestly in a&P and pharm us medic students were running circles around most of the nursing students (i'm assuming due to the A&P learned in basic). my particular school has had 3 students go straight from medic school into med school in the last year.

is the typical nurse better suited for ems than the typical paramedic? i would say no. however with training i wouldnt see why not. the training/education is directed at different parts of the health care system, and it wouldn't make sense to say that either one could simply walk into the position of the other. if you want to be a nurse, you should go be trained/educated to be a nurse; if you want to be a medic, go get trained/educated in paramedicine.

The comment has been made numerous times that medic school doesnt include subjects such as A&P, pharm, etc. this isnt necessarily the case everywhere. my particular program is 5 semesters long (6 if you count emt-b), and we go WAY beyond the minimum state requirements. we have clinicals in the ICU, social services, cath lab, and even a several days of rotations one on one with our program medical director in addition to ER/Ambulance rides. due to these high standards, the program i am enrolled in has a 100% pass rate on NR. fortunately the services in my area have helped push for these high standards by not hiring sub-par medics out of the medic-mills (btw the teex program previously mentioned is about 2 hours from my house)

i would imagine the number of nurses wanting to go into ems is probably not large. it seems to me that this would be the biggest problem with staffing an ems agency with nurses. it seems to me that its hard enough to keep hospitals staffed with nurses...

 

[VentMedic]

and honestly in a&P and pharm us medic students were running circles around most of the nursing students (i'm assuming due to the A&P learned in basic).

This has got to be the funniest thing I have read so far.

my particular school has had 3 students go straight from medic school into med school in the last year.

After just a two year degree they got accepted into med school?
Which med school?

is the typical nurse better suited for ems than the typical paramedic? i would say no. however with training i wouldnt see why not. the training/education is directed at different parts of the health care system, and it wouldn't make sense to say that either one could simply walk into the position of the other.

We can expand the scope of the EMT-B with just 110 hours of training to allow them to start IVs and do ETI in just a few more hours. If they go just another 80 - 110 more hours they can get an EMT-Intermediate patch and do all sorts of cool things.

if you want to be a nurse, you should go be trained/educated to be a nurse; if you want to be a medic, go get trained/educated in paramedicine.

The comment has been made numerous times that medic school doesnt include subjects such as A&P, pharm, etc. this isnt necessarily the case everywhere. my particular program is 5 semesters long (6 if you count emt-b), and we go WAY beyond the minimum state requirements. we have clinicals in the ICU, social services, cath lab, and even a several days of rotations one on one with our program medical director in addition to ER/Ambulance rides. due to these high standards, the program i am enrolled in has a 100% pass rate on NR. fortunately the services in my area have helped push for these high standards by not hiring sub-par medics out of the medic-mills (btw the teex program previously mentioned is about 2 hours from my house)

i would imagine the number of nurses wanting to go into ems is probably not large. it seems to me that this would be the biggest problem with staffing an ems agency with nurses. it seems to me that its hard enough to keep hospitals staffed with nurses...

Some of this is agreeable.

However, did you notice the requirements for nurses as they pertain to the OP? This discussion was not about the U.S. but it just evolved to that point. It is about a country that already has a great EMS system in place with nurses but the OP is looking at alternatives to save money.

Here's an earlier post from Dutch-EMT:

To answer this question, I (as a Dutch) know the positive and negative points of our Nurse-based ambulanceservice.

Positive:
Ambulance-nurses have a lot of experience with different patiënts.
Not only medical, but also with social and communication-skills with patiënts and family the nurses are well-trained. Also they saw a lot patiënts, and the clinical view is well educated through the years. Also the ICU/ER/Anesthesia education and working-experience is a good basic for an Ambulance-nurse.
In the hospital the specialized nurses also work with the most medication used on an ambulance and do the interpretations of vital signs (and ECG interpretation).

Lets say that 60% of the ambulance-rides are non-urgent.
Mostly the common healthproblems, interclinical transports, psychological care, etc. 40% are urgent calls. 30% of the urgent calls are medical problems and 10% are trauma/accidents.

I can say for sure that the trauma-skills can be learned easely to a specialized nurse within that year of ambulance-education.
Ambulance nurses in the Netherlands are working with the drivers, so there are no doctors involved in the ambulance-care at all.
Every service has a medical chief, that's the only doctor in the whole organisation. It's a formal function. He signs the protocols the ambulance-nurses work with. This sign can be seen as an order to the nurse to use the protocols properly.

Negative:
The Dutch system costs a lot money.
All ambulances are ALS equiped and have the same qualyfied crew.
There are plans to create a kind of BLS ambulance for the interclinical transports and the "discharge-rides".

Also negative: To become an ambulance-nurse, it takes a lot of years to get on it. For the funtion of ambulance-driver, a lot people stand in line.
So the chance to become ambulance-driver is very very small...

Those I highlighted in red actually should not be negative points.
The U.S. system has a Paramedic ready to go in less than 6 months with an abundance of medics graduating from the mills all over the country. However, many of those don't want to do actual patient care and don't get enough clinical experience to realize there are patients involved.

Another good article:

http://www.jems.com/news_and_articles/articles/EMS_in_The_Netherlands.html

While this system might be expensive the alternative could be costly in other ways especially if the U.S. system was used as the role model for training quick and cheap. The U.S. also uses instructors who only require a cert at the level they are teaching and not much more. Thus, they could start up a medic mill in no time and start mass producing.

 

[iamjeff171]

rereading my comment about a&P in emt being advantageous, that does seem a little silly. if i could attribute it to anything i would guess it has to due with the clinical experience gained from the basic program and from working IFT.

the intermediate patch is useless in my state (nevermind i'm currently an EMT-I ). even if you do get some advanced skills you lack the other necessary clinical knowledge to take advantage of them. i doubt anyone would argue that. i dont think the minimum requirements are enough to prepare emt-bs to be effective EMS clinicians. but does that mean it is enough to prepare nurses? i know a nurse would be starting off with a much greater knowledge base, but EMS isnt just a list of skills...

The students in my class who have been accepted med school had prior degrees.

i will agree that having two ALS providers on a truck is an excellent thing. even in school when we are running codes in class it is noticeable how much easier and better assessments run with two providers. its always nice to have someone with comparable skill sets looking over your shoulder.

And yes, this topic has gone off on a bit of a tangent, as they will sometimes do...