Nurses vs EMT/Paramedics in EMS

[esmcdowell]

It should really be decided based on how your state licenses Nurses/Paramedics, I know that up here (MT) Nurses are licensed to practice in "Hospital settings", while Paramedics are licensed to practice in "Prehospital settings", and Nurses only set foot on ambulances for CCT patients, when the local medics arent CCT already

 

[VentMedic]

It should really be decided based on how your state licenses Nurses/Paramedics, I know that up here (MT) Nurses are licensed to practice in "Hospital settings", while Paramedics are licensed to practice in "Prehospital settings", and Nurses only set foot on ambulances for CCT patients, when the local medics arent CCT already

Doesn't St. Vincent's HELP flight program have Flight RNs that do scene response?

But, your point is taken for Paramedics as in many states their statutes make the "prehospital" part clear and that is why they can not function as "Paramedics" inside the hospital. They must work under another title such as ER Tech. For the EMT-B this is an advantage because they can get out from under a very limited scope of practice and be trained with additional skills/knowledge for more opportunities within the hospital.

 

[esmcdowell]

damn, sorry, yes, St. Vincent's in Billings does run a flight RN licensed for prehospital scene response. Forgot about them completely, we don't call the bird very often, being only an hour away from St. V's with CCT medics.

 

[Hal9000]

Doesn't St. Vincent's HELP flight program have Flight RNs that do scene response?

But, your point is taken for Paramedics as in many states their statutes make the "prehospital" part clear and that is why they can not function as "Paramedics" inside the hospital. They must work under another title such as ER Tech. For the EMT-B this is an advantage because they can get out from under a very limited scope of practice and be trained with additional skills/knowledge for more opportunities within the hospital.

Yes, as does St. Patrick's LifeFlight, Community Hospital's CareFlight, and Kalispell Regional Medical Center's ALERT.

You are also correct about the wording of the EMS regulation in Montana. Montana has somewhat poor EMS cohesion on the state level, while nursing has good representation. Also, some areas without Paramedics will utilize nurses with BLS ambulances during certain IFTs.

 

[46Young]

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?

Depts have certain staffing and deployment issues to achieve in suppression. If we're talking about a fire based dept that does EMS transports, we're talking about maybe a 20% RIF if EMS were to be dropped entirely. Just because suppression units have a lower call volume than EMS doesn't validate a reduction in those services. Deployment and staffing issues still need to be maintained regardless. Here's a video I posted some time ago that addresses this issue, from my own dept:

http://www.youtube.com/watch?v=a_K-K6o5cGc

The main financial arguments (not arguing effectiveness, just financial) for fire based EMS are utilizing idle (but still necessary) suppression units, combining the command structure, flexibility in staffing and thus lowered OT, and paying less benefits, paid time off, training, equipment and such than if you had an exclusive third service instead. Divorcing EMS from an EMS transporting FD would result in higher operating costs for fire and EMS collectively. The suppression units would still need to be staffed and deployed, however.

The RIF would be equivalent to the number of EMS positions. To reduce fire staffing further would require a reduction in suppression service.

 

[8jimi8]

Depts have certain staffing and deployment issues to achieve in suppression. If we're talking about a fire based dept that does EMS transports, we're talking about maybe a 20% RIF if EMS were to be dropped entirely. Just because suppression units have a lower call volume than EMS doesn't validate a reduction in those services. Deployment and staffing issues still need to be maintained regardless. Here's a video I posted some time ago that addresses this issue, from my own dept:

http://www.youtube.com/watch?v=a_K-K6o5cGc

The main financial arguments (not arguing effectiveness, just financial) for fire based EMS are utilizing idle (but still necessary) suppression units, combining the command structure, flexibility in staffing and thus lowered OT, and paying less benefits, paid time off, training, equipment and such than if you had an exclusive third service instead. Divorcing EMS from an EMS transporting FD would result in higher operating costs for fire and EMS collectively. The suppression units would still need to be staffed and deployed, however.

The RIF would be equivalent to the number of EMS positions. To reduce fire staffing further would require a reduction in suppression service.

Maybe the FDs need to figure out their funding and staffing separate from those needed to keep the community safe?

What if 2-3 units are responding to calls when large structure or grass fire breaks out in their response district? Are they gonna drop their patients on the curb and change into some turnout gear so that the suppression crew can ride out on the tanker? Or do they have enough FFs to man a suppression crew while some of their brothers are out responding to medicals? In which case... there are enough without the ems coverage. i know this discussion is way off of the OP. just noticing.

 

[JPINFV]

The set of questions I've never seen answered are:

What happens to the EMS response when all of the units are working a fire?

What happens to the fire response when all of the units are on medical calls?

A 20% reduction in force is meaningless when looking at fire group operations if that 20% is not normally available because that 20%'s primary mission is EMS.

 

[46Young]

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.

No, I don't intend to start a trend. I have a family to support, and it would be unfair to them, both in time spent away from the family while in school and also the fiscal irresponsibility in pursuing a degree with such a poor ROI when compared to other, more established and financially rewarding healthcare fields. Even if I were single, I wouldn't gamble four years + of my young life on an education that get me very far career wise.

EMS having the educational requirements that Australia and NZ have is a great thing, but I don't see that happening here. There's no payoff for the educational investment in the US, so most will direct their energy towards a more rewarding field. I mentioned why earlier. That boat passed long ago.

As it stands, I still don't see prehospital 911 ground txp EMS needing much more than the AAS. I don't see having an additional two years education making any real difference in pt outcomes. I don't see how writing 5000 word research essays is going to change my provisional field diagnosis. I'm interested in reviewing established studies and incorporating them into evedence based medicine. I can do that now and correspond with my OMD in regards. If prehospital medicine advances significantly, then sure, a four year degree would be necessary. We're not doing field surgery, after all.

IFT is a different beast, however. A four year degree is necessary for that. Oh yeah, nurses already do IFT ground txp. No need to increase EMS education for the increased IFT scope; just become a nurse and challenge the medic if you also want to do prehospital 911. Same educational investment with a much better reward.

Bottom line, clinical education past the EMS AAS gives little guarantee in improving scope and more importantly compensation for the profession. Most aren't willing to roll the dice on that with four years of their life, should that become available in the US.

 

[EMSLaw]

Bottom line, clinical education past the EMS AAS gives little guarantee in improving scope and more importantly compensation for the profession. Most aren't willing to roll the dice on that with four years of their life, should that become available in the US.

Oh, come now... A bachelor's degree is hardly an advanced qualification. It seems to me that most careers require a bachelor's for entry these days. Certainly anything that can be called a "profession" without laughter requires some degree of education. Of course, if you're content with EMS just being a job, and not part of the medical profession, then sure, a GED and a few hundred hours of tech school is more than enough.

 

[MrBrown]

Oh, come now... A bachelor's degree is hardly an advanced qualification. It seems to me that most careers require a bachelor's for entry these days. Certainly anything that can be called a "profession" without laughter requires some degree of education. Of course, if you're content with EMS just being a job, and not part of the medical profession, then sure, a GED and a few hundred hours of tech school is more than enough.

Agreed

You may be interested to learn that here in NZ and in most other nations law is undergraduate (4 years) and not post-grad.

 

[EMSLaw]

Agreed

You may be interested to learn that here in NZ and in most other nations law is undergraduate (4 years) and not post-grad.

I'm aware, and that was one of the reasons that the first professional degree in law was changed from the LL.B. to the JD in the US forty or fifty years ago, to distinguish the fact that it is a post-graduate degree. Similarly, we have the MD instead of the MB/ChB.

There's a lot of variations out there. I believe in most civil law countries, law is a graduate degree, as well.

 

[46Young]

Maybe the FDs need to figure out their funding and staffing separate from those needed to keep the community safe?

What if 2-3 units are responding to calls when large structure or grass fire breaks out in their response district? Are they gonna drop their patients on the curb and change into some turnout gear so that the suppression crew can ride out on the tanker? Or do they have enough FFs to man a suppression crew while some of their brothers are out responding to medicals? In which case... there are enough without the ems coverage. i know this discussion is way off of the OP. just noticing.

Good depts plan for spikes in call volume through proper staffing/deployment, relocations, and mutual aid. This also allows a whole batallion to go OOS for periodic multi unit drills and meetings without issue. We haven't had a problem. For example, when we have several box alarms going on, or a significant spike in call volume, we go to what's called condition 2. We reduce the response for certain suppression incidents, and also hold low priority calls indefinitely until emough units are available to handle. We did that during both snowstorms. Stubbed toes and such are put on the back burner. We also have condition 3, for incidents like the Pentagon on 9/11 and the assosciated issues.

 

[46Young]

The set of questions I've never seen answered are:

What happens to the EMS response when all of the units are working a fire?

What happens to the fire response when all of the units are on medical calls?

A 20% reduction in force is meaningless when looking at fire group operations if that 20% is not normally available because that 20%'s primary mission is EMS.

See above.

As far as a 20% RIF, the question was how many fire jobs would be cut if EMS was eliminated. Actually, it was how many fire jobs would be cut if EMS was reduced, but I just figured for a total elimination. I figure that there are 41 ambulances with 2 crew on each. 37 engines with four each. 14trucks/towers with 3-4 depending. Eight heavy rescues with four on each. Eight tanker drivers, and four on the hazmat unit. Enough of our officers and engine drivers are dual hatters that we can use engine medics to staff the medic units as we keep a certain amount of suppression staff above headcount to allow for paid time off, training, and sick calls. It's not nice to frequently force holdover OT on your workforce.

 

[46Young]

Oh, come now... A bachelor's degree is hardly an advanced qualification. It seems to me that most careers require a bachelor's for entry these days. Certainly anything that can be called a "profession" without laughter requires some degree of education. Of course, if you're content with EMS just being a job, and not part of the medical profession, then sure, a GED and a few hundred hours of tech school is more than enough.

I'm speaking of a bachelor's when compared to the EMS AAS, the highest level of formal clinical education available in the EMS career track in the US currently. I don't see prehospital 911 EMS as needing much if anything over the AAS at the moment. I just don't. 911 prehospital EMS doesn't seem all that intellectually challenging to me. I'm not saying that I don't enjoy the work, just that it's not brain surgery. It's a relatively narrow field. It's only appropriate to do but so much out in the field when transportation to definitive care while providing stabilization is the main function of the service. As such, advancements to the field will be modest. You can only carry but so much equipment on an ambulance, and how appropriate is it to sit onscene with a pt needing advanced diagnostice and therapies? Prehospital 911 EMS may need 4 years of education at some point in the future, but I don't feel that it's necessary at the moment.

In the future, I would bet on EMS being mostly restricted to 911 ground txp and flight, with IFT becoming the domain of nurses. It's already happening now. Medics do mostly routine txp. Certain pt populations need specialty teams such as NICUs, PICUs, Baloon Pump jobs, vented/sedated pts, etc. The paramedic's education isn't adequate for these types of transports. Some paramedic noctors may argue otherwise, though. Each type of pt needs specialized resources. Nurses have the educational foundation, and then need to specialize to qualify for these teams. How could the paramedic possibly train to handle any and all txp types within IFT?

 

[MrBrown]

I'm aware, and that was one of the reasons that the first professional degree in law was changed from the LL.B. to the JD in the US forty or fifty years ago, to distinguish the fact that it is a post-graduate degree. Similarly, we have the MD instead of the MB/ChB.

There's a lot of variations out there. I believe in most civil law countries, law is a graduate degree, as well.

Brown is shocked somebody out there knows what MBChB is

 

[JPINFV]

MBChB, MBBS, MD, DO. All alphabet soup with same end taste.

 

[EMSLaw]

MBChB, MBBS, MD, DO. All alphabet soup with same end taste.

The bitter aftertaste of crushing student loan debt? If so, you can add JD to the list!

 

[MrBrown]

The bitter aftertaste of crushing student loan debt? If so, you can add JD to the list!

What you haven't made partner yet?

 

[xgpt]

I'd say go with the Nurses unless you are planning on having your medics trained to the level of medics in places like Australia or New Zealand. The system we have in the US is very flawed and I'd say do not go with anything like it.

Why do you say that?

Is it because BLS is ridiculously undertrained?

And what's wrong with paramedics in the USA? (I'm slated to take my EMTB test this coming June)

 

[MrBrown]

Why do you say that?

Is it because BLS is ridiculously undertrained?

And what's wrong with paramedics in the USA? (I'm slated to take my EMTB test this coming June)

Have you seen how criminally inadequate Paramedic training in the US is?

You can be a "Paramedic" in a little as 12 weeks + 200 or so hours of "internship" that requires no college.

Forty years ago in this part of the world it took two years to become Qualified Ambulance Officer who could do little more than give oxygen, yet, in the US you cannot mandate such a requirement for your highest level almost a half century later.

Meanwhile .... in the rest of the world you are looking at four to seven years to become an Intensive Care Paramedic (ALS).