# Nurses vs EMT/Paramedics in EMS



## harold1981 (Apr 4, 2010)

In my country a choice has to be made whether to continue with a nurse-based ambulanceservice or to start with a EMT/paramedic-based EMS-system. Can anyone give me good arguments why EMT/paramedics would be better than nurses (with ED or ICU-background)?


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## TransportJockey (Apr 4, 2010)

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.


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## adamjh3 (Apr 4, 2010)

CCT/RN will pay way better than any Paramedic job.


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## RCashRN (Apr 4, 2010)

i dont know where you live, but i think pre-hospital treatment is for EMT's/paramedics and not nurses.  nurses aren't (usually) geared for the initial, acute onset treatment... we're geared more for the stabilization and focused care, initiation of longer-term care.  you take your typical ER nurse, or even more so ICU nurse, and set them down in the middle of a multi-vehicle accident and they're gonna freak out and/or freeze up.  even being halfway through my testing i can tell you the first few chaotic scenes i go to, i dont know how i'm going to handle it.  paramedics are trained for it from the onset where nurses arent.


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## TransportJockey (Apr 4, 2010)

It was thought over at the city that the OP is in Holland. Where their EMS is run by CCRNs


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## RCashRN (Apr 4, 2010)

jtpaintball70 said:


> It was thought over at the city that the OP is in Holland. Where their EMS is run by CCRNs



hmm wow.  i would think a CEN would be better suited than a CCRN, unless the CEN's and lumped in with the CCRN's.  things are surely much different there, but i just dont see most nurses as being able to handle a mass-casualty incident without some degree of difficulty.  not initially, anyway... i'm sure it would get better over time... but green medic vs. green nurse... i'd rather have the green medic at a MCI.


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## Shishkabob (Apr 4, 2010)

Depends wholly on the education.


If they are all educated the same, there is no reason one or the other can't work in the hospital or pre-hospital setting... it's just what they're used to.

Generally it does take a different set of skills / mentality to work in the field then in the ER.  It tends to be up to the person and not the education that makes that determination though.


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## 8jimi8 (Apr 4, 2010)

RCashRN said:


> i dont know where you live, but i think pre-hospital treatment is for EMT's/paramedics and not nurses.  nurses aren't (usually) geared for the initial, acute onset treatment... we're geared more for the stabilization and focused care, initiation of longer-term care.  you take your typical ER nurse, or even more so ICU nurse, and set them down in the middle of a multi-vehicle accident and they're gonna freak out and/or freeze up.  even being halfway through my testing i can tell you the first few chaotic scenes i go to, i dont know how i'm going to handle it.  paramedics are trained for it from the onset where nurses arent.



And this is exactly why I am taking a paramedic course rather than challenging.


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## TransportJockey (Apr 4, 2010)

RCashRN said:


> hmm wow.  i would think a CEN would be better suited than a CCRN, unless the CEN's and lumped in with the CCRN's.  things are surely much different there, but i just dont see most nurses as being able to handle a mass-casualty incident without some degree of difficulty.  not initially, anyway... i'm sure it would get better over time... but green medic vs. green nurse... i'd rather have the green medic at a MCI.



A lot of the CCRNs I know at the hospital I worked at started as CENs, so it might be something similar there


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## 8jimi8 (Apr 4, 2010)

however I would like to add to the conversation.

If the RN has been properly trained and has practiced alongside other emergency workers such as fire crews / other EMS, they can do just as good of a job as a paramedic (NOTE I SAID WITH MORE TRAINING)

You see for me, I have the educational background to understand and incorporate new procedures; however the reciprocal jump from EMT to RN, I don't feel would be an equivalent conversion... (based on what I have seen of two different EMT programs ... my basic and my intermediate)  

Perhaps when i take Paramedic 2 (a different program altogether from where I have been studying) I will see a more stringent educational basis, being that this will be from a very well reputed land based program.

When you get down to it, the didactic material is less than what I received as a nurse, just a few different skills.  The priniciples are the same ABCs, eliminate life threats, prioritization of a rapid transport to a facility with definitive care.


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## RCashRN (Apr 4, 2010)

8jimi8 said:


> And this is exactly why I am taking a paramedic course rather than challenging.



wish i could've afforded that option, but couldn't.  fortunately, the EMS service that serves the hospital i work at is one of the tops services in the state... if they'll hire me, i plan on doing lots of ride time and learning before jumping into being primary "P" on the truck.


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## 8jimi8 (Apr 4, 2010)

what about when your partner *needs* another EMT-P, isn't it unfair for your to assume that it is ok for you to not be bringing the necessary training to the equation of the partnership?


Please do not take this as an inflammatory personal attack.  RCashRN has more experience as an RN than I do... possibly more education as an RN (sorry havent read your profile recently and not sure if you are a BSN).

My goal is to fly as an RN.  I know what the industry standards are for minimum entry level into that field.  I exactly do not want to be a flight RN with zero scene experience.

Sure it is a financial burden and a burden on so many other parts of my life; however I refuse to show up to do a job without the necessary preparations.


What is the situation in California?  I've seen many people talking about RNs riding rigs, is this only for interfacility transport, or is it as 911 EMS?


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## ExpatMedic0 (Apr 4, 2010)

Ummm.... Paramedics! thats what we are for. As I have stated before the minimum education level for RN and Paramedic are the same in my state at the community college level. Both require an AAS, all the same basic education classes and science classes, HOWEVER one is trained only for pre-hospital care and emergency's as a Paramedic, the nursing program is completely different with complete different content and overall objectives. 

   The only problem with Paramedics in the U.S. is that the training and education varys to much from state to state.


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## ExpatMedic0 (Apr 4, 2010)

PS: no offense to nurses, there great and do a great job and have a lot of training, more so than paramedics in most states... but I would never let one touch me outside of a hospital in an emergency unless they where a very experienced ED nurse


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## eveningsky339 (Apr 4, 2010)

If the RNs are given courses in pre-hospital medicine, sure, they would be better.  But paramedics are already trained specifically in that area, so a paramedic system would be simpler and, frankly, more effective.

Can you imagine sticking a nursing home RN on an ambulance?  Yeah, no.


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## adamjh3 (Apr 5, 2010)

8jimi8 said:


> What is the situation in California?  I've seen many people talking about RNs riding rigs, is this only for interfacility transport, or is it as 911 EMS?



When I did my Ride-along for my EMT class we did five CCT transfers, we would rendevous with an RN, they'd bring their EKG, drug bag, vent, etc., etc., and drop it in the rig, then they'd handle most of the medical side of the transfer, while we did the lifting and grunt work. I know they can do way more than that, but that's just the scope that I've seen them in in my EXTREMELY limited time in the field. 

I'm looking forward to hearing about what else an RN can do in the field, as one of the ones I got the chance of working with definitely got the wheels up in my head turning, thinking that might be the route I want to take.


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## mycrofft (Apr 5, 2010)

*Training, speed and money*

EMT's (that included Paramedics at the time; still does) were invented here to quickly upgrade the availability in the early Seventies onwards of some sort of improved quality of immediate care and transport. 
Fast and economical: EMT/Paramedic.

RN's if trained are capable but you will need to train them up from scratch, mostly. Some you will recruit. Takes longer to do, but you can get a greater depth of knowledge and care.

If you want to essentially do "house calls" and not just prepare and transport, maybe you want nurses, but the expense and time factors will be quite a bit higher. "EMT" and "Nurse" are not different ruings on the same ladder, they are very different here in the USA; being just titles, you can make either what you want of them, given time.


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## 8jimi8 (Apr 5, 2010)

eveningsky339 said:


> If the RNs are given courses in pre-hospital medicine, sure, they would be better.  But paramedics are already trained specifically in that area, so a paramedic system would be simpler and, frankly, more effective.
> 
> Can you imagine sticking a nursing home RN on an ambulance?  Yeah, no.




So are you working with LVNs or RNs in your nursing home?

because there is quite a difference.


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## EMSLaw (Apr 5, 2010)

8jimi8 said:


> So are you working with LVNs or RNs in your nursing home?
> 
> because there is quite a difference.



A difference in the scope of practice, certainly, and the level of responsiblity.  A major difference in academic preparation when comparing a BSN- or MSN- prepared RN to an LVN/LPN.

But skills degrade over time, and I think that, rather than the education of the provider in question, is the biggest problem I've seen with nursing home staff.  Most of them are hard working and well meaning, but they simply don't spend enough time responding to emergencies to remember (because I'm sure they do know, or did) what they're supposed to do.


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## John E (Apr 5, 2010)

*or even...*



eveningsky339 said:


> If the RNs are given courses in pre-hospital medicine, sure, they would be better.  But paramedics are already trained specifically in that area, so a paramedic system would be simpler and, frankly, more effective.
> 
> Can you imagine sticking a nursing home RN on an ambulance?  Yeah, no.



Can you imagine sticking an EMT into a nursing home...? 

John E


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## Akulahawk (Apr 6, 2010)

mycrofft said:


> EMT's (that included Paramedics at the time; still does) were invented here to quickly upgrade the availability in the early Seventies onwards of some sort of improved quality of immediate care and transport.
> Fast and economical: EMT/Paramedic.
> 
> *RN's if trained are capable but you will need to train them up from scratch, mostly.* Some you will recruit. Takes longer to do, but you can get a greater depth of knowledge and care.
> ...


I've said it before and I'll say it again. I've heard straight from more than a few program chief flight RN's and they all say that it takes LONGER to train an ER/ICU RN to be a flight RN that does scene calls than it does to train that same RN who's already experienced as a Paramedic. It's not so much a change in _technical_ training, but a mental shift. A good  ER/ICU RN with EMT training, a Paramedic Internship, and some FTO time would probably make an excellent (and safe) prehospital provider. 

RN's just aren't trained for the prehospital environment (and the safety considerations, patient packaging, etc for that environment) right out of school. It's not a knock on their knowledge, but simply recognition of their own training limitations... and I recognize my own limitations as a medic as well. I wouldn't do as well as an RN in the ICU (and certain portions of the ER) setting without the appropriate education, scopes of practice notwithstanding.


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## EMS_rabbit (Apr 6, 2010)

I think that you should get rid of all nurse based ambulances for the following reasons:
1. Nurses can use more meds then paramedics so if you manned the rig with medics you wouldn't have to carry so many meds.
2. Nurses are medication happy when a doctor isn't breathing down their neck, shoot they'd do an IVP just because they can.
3. Nurses are just plain idiots!  They don't listen to signs and symptoms of patients they just like to play god.
4. EMT's don't know as much as Nurses so they are more likely to just treat the patient's symptoms instead of trying to beat the doctors at a treatment plan.


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## adamjh3 (Apr 6, 2010)

EMS_rabbit said:


> I think that you should get rid of all nurse based ambulances for the following reasons:
> 1. Nurses can use more meds then paramedics so if you manned the rig with medics you wouldn't have to carry so many meds.
> 2. Nurses are medication happy when a doctor isn't breathing down their neck, shoot they'd do an IVP just because they can.
> 3. Nurses are just plain idiots!  They don't listen to signs and symptoms of patients they just like to play god.
> 4. EMT's don't know as much as Nurses so they are more likely to just treat the patient's symptoms instead of trying to beat the doctors at a treatment plan.



Did someone forget their [/sarcasm] tag, or...?


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## JPINFV (Apr 6, 2010)

EMS_rabbit said:


> 4. EMT's don't know as much as Nurses so they are more likely to just treat the patient's symptoms instead of trying to beat the doctors at a treatment plan.



Well... that's it. Ambulances should be manned by EMS fellowship trained, emergency medicine board certified emergency physicians. 
B)


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## fortsmithman (Apr 6, 2010)

JPINFV said:


> Well... that's it. Ambulances should be manned by EMS fellowship trained, emergency medicine board certified emergency physicians.
> B)



Like they have in France.


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## JPINFV (Apr 6, 2010)

fortsmithman said:


> Like they have in France.



Except we'll take the middle road when it comes to, say, trauma. No need for lights and sirens, but we won't sit on scene all day waiting for the patient to magically get better.


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## 8jimi8 (Apr 6, 2010)

EMS_rabbit said:


> I think that you should get rid of all nurse based ambulances for the following reasons:
> 1. Nurses can use more meds then paramedics so if you manned the rig with medics you wouldn't have to carry so many meds.
> 2. Nurses are medication happy when a doctor isn't breathing down their neck, shoot they'd do an IVP just because they can.
> 3. Nurses are just plain idiots!  They don't listen to signs and symptoms of patients they just like to play god.
> 4. EMT's don't know as much as Nurses so they are more likely to just treat the patient's symptoms instead of trying to beat the doctors at a treatment plan.



Curious if this poster is intelligent enough to figure out how he directly contradicted his original assertions.  

Wonder if the mods will be removing his post...?


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## Veneficus (Apr 6, 2010)

JPINFV said:


> Except we'll take the middle road when it comes to, say, trauma. No need for lights and sirens, but we won't sit on scene all day waiting for the patient to magically get better.



But could we cut them open and fix them on scene?

To briefly defend the french though I owe them no allegiance, a blunt force traumatic arrest patient could be ejected from the car onto a waiting table at a gethering of scrubbed in legends in trauma surgery and there would be very little that could be done for them.


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## Scott33 (Apr 6, 2010)

8jimi8 said:


> Curious if this poster is intelligent enough to figure out how he directly contradicted his original assertions.
> 
> Wonder if the mods will be removing his post...?



I think it was more an exercise in attention seeking


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## TransportJockey (Apr 6, 2010)

EMS_rabbit said:


> I think that you should get rid of all nurse based ambulances for the following reasons:
> 1. Nurses can use more meds then paramedics so if you manned the rig with medics you wouldn't have to carry so many meds.
> 2. Nurses are medication happy when a doctor isn't breathing down their neck, shoot they'd do an IVP just because they can.
> 3. Nurses are just plain idiots!  They don't listen to signs and symptoms of patients they just like to play god.
> 4. EMT's don't know as much as Nurses so they are more likely to just treat the patient's symptoms instead of trying to beat the doctors at a treatment plan.



For his sake I hope he forgot his sarcasm tags. OTherwise that's the biggest steaming pile I've read on this forum in a long time.


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## Shishkabob (Apr 6, 2010)

Granted the whole post was just... yeah... I thought I'd correct just one thing:



EMS_rabbit said:


> 1. Nurses can use more meds then paramedics



Not true.


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## TransportJockey (Apr 6, 2010)

Linuss said:


> Granted the whole post was just... yeah... I thought I'd correct just one thing:
> 
> 
> 
> Not true.



Meh, depends on what their standing orders are.


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## EMSLaw (Apr 6, 2010)

Veneficus said:


> To briefly defend the french though I owe them no allegiance, a blunt force traumatic arrest patient could be ejected from the car onto a waiting table at a gethering of scrubbed in legends in trauma surgery and there would be very little that could be done for them.



Trauma arrests tend to stay dead, as we all well know.  I know of at least one local case where a patient was struck by a car /in front of the regional trauma center/ and didn't make it.  I'm sure there are plenty of such stories out there.


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## Shishkabob (Apr 6, 2010)

jtpaintball70 said:


> Meh, depends on what their standing orders are.



And that's what makes it not true.


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## Veneficus (Apr 6, 2010)

EMSLaw said:


> Trauma arrests tend to stay dead, as we all well know.  I know of at least one local case where a patient was struck by a car /in front of the regional trauma center/ and didn't make it.  I'm sure there are plenty of such stories out there.



But a lot of people try to demonstrate the failure of the French EMS system (which is diametrically opposed to the US system in most respects) because the French physican on scene tried to resuscitate a famous princess unsuccessfully.


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## Melclin (Apr 6, 2010)

JPINFV said:


> Except we'll take the middle road when it comes to, say, trauma. No need for lights and sirens, but we won't sit on scene all day waiting for the patient to magically get better.



Hey, hey, if you wanna get pissy about Princess Di, you have to be a subject of the queen...(despite Her Majesty's hatred of said princess)  You had your revolution, you don't get to complain about the french killing your royalty 



adamjh3 said:


> Did someone forget their [/sarcasm] tag, or...?



I want to say "Evidently", but after a year of living on these forums...I just don't know anymore.

EDIT: Speak of the devil, Vene.


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## nemedic (Apr 6, 2010)

John E said:


> Can you imagine sticking an EMT into a nursing home...?
> 
> John E



It can suck at times. I'm currently doing just that, while I'm looking to get a PT job at one of the local ambulance companies, then go FT once a slot opens up


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## John E (Apr 6, 2010)

*What was the name of that character...*

on Trauma again? Oh yeah, it's "Rabbit"...

John E


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## adamjh3 (Apr 6, 2010)

John E said:


> on Trauma again? Oh yeah, it's "Rabbit"...
> 
> John E



Was that the one that did a 45 second diagnosis of a Pericardial Tamponade?


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## Veneficus (Apr 6, 2010)

adamjh3 said:


> Was that the one that did a 45 second diagnosis of a Pericardial Tamponade?



How long is it supposed to take?


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## adamjh3 (Apr 6, 2010)

Veneficus said:


> How long is it supposed to take?



I don't know. But doesn't it need an ECHO? Or at least X-rays? 

I'm just a student, I don't know for sure, that's why I'm forming my reply as questions. 

It can't be diagnosed in the field, right?

I know the dude in the show runs up with his stethoscope, listens for a few seconds, yells "PERICADIAL TAMPONADE!!11ONE!!1" And thrusts a syringe into the Pt's chest. 

If that's how it works, cool... but I doubt it h34r:


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## TransportJockey (Apr 6, 2010)

adamjh3 said:


> I don't know. But doesn't it need an ECHO? Or at least X-rays?
> 
> I'm just a student, I don't know for sure, that's why I'm forming my reply as questions.
> 
> It can't be diagnosed in the field, right?



It can definately be suspected though


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## adamjh3 (Apr 6, 2010)

jtpaintball70 said:


> It can definately be suspected though



Yes, I know. But you can't run up, the only thing you check is heart sounds, diagnose it, and treat it in the pre-hospital setting. And yes, I did edit that little tid-bit in there before I realized you had posted. 

The point I was trying to help illustrate is that the show is absolutley ridiculous. Sometimes. Though most of the females in it are quite attractive. But now this has gotten way off topic.


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## TransportJockey (Apr 6, 2010)

What you need is a low BP, JVD, and muffled heart tones. So it is possible to just walk up and listen to the heart if you've already got the BP. 

It's called Beck's Triad

And I've seen it treated in the field once by a CCT team.


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## reaper (Apr 6, 2010)

First time you hear one, you will know!

Even in the ED, they do not wait on xrays or echo's. The MD makes a clinical judgment.

Remember, that pt will not be around for long, once the fluid builds enough to stop the heart!


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## JPINFV (Apr 6, 2010)

The problem with "issues" like this is that no show can give justice to the time frames involved. It's like complaining that on NCIS, they only show Abby either right as she gets a hit on some database search or right after. They aren't showing the hours it takes to actually run the search. Similarly, even the real emergency medical shows (e.g. Trauma: Life in the ER and Paramedics on Discovery: Health) cut out a lot of the time between the action. There are proper complaints, but how scenes are speed up or other issues regarding time shouldn't be one of them. They simply can't have a call take 10 minutes on scene or show the entire transport time.


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## adamjh3 (Apr 6, 2010)

jtpaintball70 said:


> What you need is a low BP, JVD, and muffled heart tones. *So it is possible to just walk up and listen to the heart if you've already got the BP. *
> 
> It's called Beck's Triad
> 
> And I've seen it treated in the field once by a CCT team.



Yes, I know, but he didn't, he ran to the patient, first one there, listening was the only thing he did. 

Is it called narrowing pulse pressures? Where say you take baseline and it's 160/70, next set is 140/80, 120/100 etc. Is that the correct term for it?


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## TransportJockey (Apr 6, 2010)

adamjh3 said:


> Yes, I know, but he didn't, he ran to the patient, first one there, listening was the only thing he did.
> 
> Is it called narrowing pulse pressures? Where say you take baseline and it's 160/70, next set is 140/80, 120/100 etc. Is that the correct term for it?



That is narrowing pulse pressures. And it can also be a sign of PCT. But the 3 main signs are Hypotension, JVD, and muffled heart tones


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## adamjh3 (Apr 6, 2010)

Awesome, thanks guys, I learned a lot from this thread.


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## 8jimi8 (Apr 6, 2010)

jtpaintball70 said:


> That is narrowing pulse pressures. And it can also be a sign of PCT. But the 3 main signs are Hypotension, JVD, and muffled heart tones



Sorry JT, it is a narrowing pulse pressure, not just hypotension 

you can be hypotensive without a narrowing pulse pressure e.g. 70/30 is still a WDL pulse pressure; however it is dangerously hypotensive.


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## TransportJockey (Apr 6, 2010)

8jimi8 said:


> Sorry JT, it is a narrowing pulse pressure, not just hypotension
> 
> you can be hypotensive without a narrowing pulse pressure e.g. 70/30 is still a WDL pulse pressure; however it is dangerously hypotensive.



I stand corrected then  I was told Narrowing pulse pressure was a secondary sign with marked hypotension being the primary sign. I'll have to remember that though


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## 8jimi8 (Apr 6, 2010)

The narrowing pulse pressure is a trending of blood pressures where you will start to see the systolic BP drop closer and closer to the DBP.  DBP does not drop because the body is struggling to force blood through the heart, however the tamponade prevents that heart from expanding enough to increase the SBP... therefore as the vitals trend... the SBD approaches the DBP.


And people don't die instantaneously from it.  I've seen doctors take an hour to finally order the echo....

then the surgeon performing the pericardial window took over 45 minutes to finally release the pressure

and OH man... it was a volcanoe of yellow, straw colored fluid spouting in a huge fountain out of her chest....

then i got the pleasure of the doctor squirting me during a chest tube placement...

good thing i was wearing their surgery scrubs at the time, or i might have had to go home and change lol


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## eveningsky339 (Apr 6, 2010)

John E said:


> Can you imagine sticking an EMT into a nursing home...?
> 
> John E



They come in with patients all the time.  If only they were the ones taking care of the residents.  (no sarcasm)

This is just another ZOMG EMT vs NURSE thread.  Nurses are (mostly) trained to function within a clinical setting.  EMTs are trained to function in a pre-hospital setting.  Make what you will of the difference in training.


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## harold1981 (Apr 7, 2010)

We are talking about one of the Dutch-Antillian islands, were we do believe that the Dutch nurse-based system for pre-hospital care is among the best in the world, to be preffered above the American paramedic-model. However I don't think we can afford the Dutch system. 
And untill we can afford it, we have nurses on the bus, without any specific ambulance-training. 
Maybe it's about time that we start thinking about alternative (and indeed cheaper) options to upgrade this system to ILS- and ALS-level.


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## Veneficus (Apr 7, 2010)

harold1981 said:


> We are talking about one of the Dutch-Antillian islands, were we do believe that the Dutch nurse-based system for pre-hospital care is among the best in the world, to be preffered above the American paramedic-model. However I don't think we can afford the Dutch system.
> And untill we can afford it, we have nurses on the bus, without any specific ambulance-training.
> Maybe it's about time that we start thinking about alternative (and indeed cheaper) options to upgrade this system to ILS- and ALS-level.



why not just send the nurses to an american style paramedic program instead of starting from scratch?

If you already have the nurse, it would be far superior to having a US style paramedic without the nursing background.


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## RCashRN (Apr 8, 2010)

8jimi8 said:


> what about when your partner *needs* another EMT-P, isn't it unfair for your to assume that it is ok for you to not be bringing the necessary training to the equation of the partnership?
> 
> 
> Please do not take this as an inflammatory personal attack.  RCashRN has more experience as an RN than I do... possibly more education as an RN (sorry havent read your profile recently and not sure if you are a BSN).
> ...



i would be riding third-person at first.  i wouldn't want to start as someone's only partner on the truck - you know if that happened, all hell would break loose.  i've already started doing a little ride time, and my (two) NREMT-P's i rode with last time were completely comfortable with me and my level of skill to function with them that day.  i'd like to think that in a pinch situation, ie - MCI, i could function at least as well as an EMT-B or EMT-I partner that most of our local trucks are equipped with (usually 1 P and one I or B, some are lucky enough to have 2 P's).  i have absolutely no plan to jump straight into RSI, etc etc, on my first day, all alone as the P... but i wouldn't hesitate to attempt what was needed if i felt comfortable and competent with it.  and i have 100% faith that the director of the service i want to go to work part time with feels the exact same way and would see that i was 100% comfortable before advancing to a "full" partner on the truck.  

i'm an ADN.  7 years in the ER (this week, as a matter of fact, haha).  6 months in ICU prior to that.  in SC, DHEC requires RN's challenging the NREMT-P to have (IIRC) at least 3-5 years of ER/ICU experience, and current ACLS/BLS. you actually have to submit a resume to DHEC and they have to approve you for a refresher course.  i'm also ENPC (emegency nursing pediatric course) certified, and have already taken PEPP for if/when i do get my P.

yes, i've still got a LONG way to go.  i know it's still a lot different, but we do get horribly sick and injured patients into the ER quite frequently with no prehospital care... gotta love the full-blown cardiac arrests that arrive by POV ("he passed out while we were driving down the road" - and now he's straight-up purple and pretty well dead!), the tombstoning MI's that drive themselves to the hospital ("well, i didnt want to bother anybody..."), and the GSW's in life-ending places that walk up to the ambulance door and ring the bell to be let in... yes we have a doctor right there with us 99% of the time, and the environment is pretty well controlled... but it does give us ER nurses a little insight into the "outside" world.

i'm not out to be a para-god.  or even a nurse-god, for that matter.  i'm wanting to step outside of the nursing "box"  little bit, but still function in the emergency medicine setting. i get asked daily by people who work with our EMS service - "have you taken your test yet?" "are you a paramedic yet?" "when do you take you written?" "have you passed yet?" i'm not tooting my own horn, but i like to think that is does say something in my favor that i haven't had one person from the service NOT give me a positive statement and tell me they can't wait to work with me on a truck in the near future.  i honestly can't think of one person out of 50+ that work there who hasn't given me a positive comment - and everyone with that service has mentioned something about it to me - not even neutral comments, like "good luck"... it's "you're gonna be a great paramedic" or "i can't wait to work with you" or even "you can come be my partner when you pass".  even though *i'm* not comfortable with the idea, they are, based on what they see of my nursing skills and thought processes in the ER.  i didn't think i'd pass my practicals the first time through... but everyone else (ER and EMS) believed 100% that i would.  i plan to go in as a very green paramedic... we've all seen them.  doesn't mean they're bad paramedics, they're just new and a little shell-shocked at first.  i know i'll be the same way when the time comes.  but i know better than to overstep my boundaries.  i have classes, classes, classes to take too... PHTLS, basic extrication, HAZMAT, etc etc.  not all of us nurses out there are know-it-alls, not all of us hate EMS personnel, we don't all think "you" are idiots or para-gods or whatever the term you want to use is, and some of us (meaning ME here!) admire paramedics and want to be like you too. 

(this turned in to a novel and a rambling mess... i do apologize... it's late and i do that when i'm sleepy! 12 long hours today...)


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## mycrofft (Apr 10, 2010)

*Nurses versus paramedics in EMS*

Paradigm check.
1. What's the image that jumps to mind when you hear "nurse"? A twentysomething white female with a starched lilttle hat? The picture you see in my avatar? Something else?
2. What is it you have in minds as "EMS"? Urban street ambulance, interfacility transport, emergency room, dispensary in the outback, or ??
3. Likeise "Paramedic".

This applies to everyone. Most folks do not become nurses, at least in the USA, to do field EMS work; there are a small wedge of us who do, mostly former EMT's or military medics of some stripe.

There is the slippery subject of temperment and "spirit", related to that sentence above. Just as boots and a rifle don't make a soldier, training and certification do not make an EMS worker out of a nurse, or anyone. It is like the concept of "warrior spirit" in the military, where you do not want to be of the majority in battle who at least initially freeze up. In EMS, you will see it in slow and inappropriate measures, maybe even refusing to treat.
Hence my earlier reply/comments. Only a fraction of extant nurses, especially older ones like me, will be able to do it. Gotta train 'em.

ADDENDUM: Sorry of this looks redundant, for some reason part of the second page didn't show up for me. Don't think of me as redundant, just reiterative! 

Did I mention I'm not redundant?


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## Dutch-EMT (Apr 10, 2010)

harold1981 said:


> In my country a choice has to be made whether to continue with a nurse-based ambulanceservice or to start with a EMT/paramedic-based EMS-system. Can anyone give me good arguments why EMT/paramedics would be better than nurses (with ED or ICU-background)?



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...


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## ExpatMedic0 (Apr 10, 2010)

I think its interesting a nurse can challenge the Paramedic cert but a Paramedic with several years experience and degree can not challenge the RN to work in the ED. The nursing board wont allow that, we have to take a 1 year bridge course.
Does the nurse challenging the exam need to take any training in ambulance operations, hazmat, pre-hospital extraction and packaging, cricoidotomy, intubation, chest decompression, crime scene awareness/ scene safety, and many many other things nurses do not do?


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## mycrofft (Apr 11, 2010)

*Thanks Dutch EMT!*

Does anyone doubt the cultural spin imparted to the USA paradigm by its fire department roots?


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## 8jimi8 (Apr 11, 2010)

schulz said:


> I think its interesting a nurse can challenge the Paramedic cert but a Paramedic with several years experience and degree can not challenge the RN to work in the ED. The nursing board wont allow that, we have to take a 1 year bridge course.
> Does the nurse challenging the exam need to take any training in ambulance operations, hazmat, pre-hospital extraction and packaging, cricoidotomy, intubation, chest decompression, crime scene awareness/ scene safety, and many many other things nurses do not do?


from my online perusal, most states that allow an RN to challenge, also require the RN to complete a paramedic refresher course to learn all of the "skills and procedures" that you mentioned.  The one year brdige course is supposed to catch a paramedic up on the _education_ they are missing.  Can you see the difference between having a generalized education and then learning new skills vs having a specialized education and skills and trying to apply that specialty to a generalized field?  Emts aren't trained to take care of 7 people at once, for 12 to 16 hours at a time.  That make sense?


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## mycrofft (Apr 12, 2010)

*That's because nursing is a profession different from Paramedicking.*

I must be typing with invisible ink or something, but nursing is not a linear or related type of practice versus paramedics (who are officialy "EMT-Paramedics"). Whole lot of ethics, history, orientation to role, dietetics, microbiology, chemstries, other basic college courses (unless you are a product of the nurse mills getting underwriting from hospitals) .... different. 

An EMT-Paramedic works within standardized protocols as extensons of physicians. Nurses work with nursing diagnoses, and can use medical diagnoses within and in accordance to standardized procedures, but as members of a profession, not as extensions. A nurse may learn and be certified in a number of techniques and remain in her/his profession. A technician must learn a whole profession to be a nurse.


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## RCashRN (Apr 23, 2010)

8jimi8 said:


> from my online perusal, most states that allow an RN to challenge, also require the RN to complete a paramedic refresher course to learn all of the "skills and procedures" that you mentioned.  The one year brdige course is supposed to catch a paramedic up on the _education_ they are missing.  Can you see the difference between having a generalized education and then learning new skills vs having a specialized education and skills and trying to apply that specialty to a generalized field?  Emts aren't trained to take care of 7 people at once, for 12 to 16 hours at a time.  That make sense?



yes.  i had to take a refresher course that includes all those skills.  given, my instructor catered to the ones in the class who were already NREMT-P's and i kinda got skipped over... so i had som coworkers/friends/local P's go back through skills with me countless times.  you have to submit a resume to state DHEC with your work history too, you must have at least 3-5 years of ICU or ER experience, along with ACLS and some other stuff before they approve you to take the refresher course.


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## VentMedic (Apr 23, 2010)

schulz said:


> I think its interesting a nurse can challenge the Paramedic cert but a Paramedic with several years experience and degree can not challenge the RN to work in the ED. The nursing board wont allow that, we have to take a 1 year bridge course.


 
If the LVN with 2x more education and clinical experience than the 700 - 1000 hour Paramedic (or less in some states) and patient care experience in the hospital, can not challenge it, why should a Paramedic whose curriculum is very focused on just emergency care be allowed? That is just one module for RNs. The RN already knows IVs and has experience with many, many more meds than the 30 that are generally in a Paramedic's box. The Paramedic at this time is also still considered a "certificate" of training in most states which makes it even easier to be challenged.

There is nothing in the Paramedic curriculum that prepares them for total patient care or sets a foundation without even as much as college level A&P, pathophysiology or microbiology. The few hundred hours of emergency training a Paramedic gets is only one focus module that RNs can take. Look at the threads on this forum and you should be able to figure out that some here would be overwhelmed by the expectations in a hospital where there are concerns for the safety of the patient and other health care providers.

I also find this whole argument ridiculous since just about anyone, regardless of interest in medicine or motive to be a Paramedic, can generally pass the EMT and Paramedic with no problem just to get hired by a FD or have bragging rights to a patch but never work as a Paramedic. I don't see many people going through nursing school for the same reasons and that patient care thing is emphasized from day 1 of their program. Some Paramedics that have tried to take the bridge to nursing have failed because their only motives were getting the credential and money. The Excelsior program was an easy alternative since it required less then two weeks of patient contact in the program. Now that more states want proof of several hundred hours of patient contact as a nursing student, it is not as popular. 



schulz said:


> Does the nurse challenging the exam need to take any training in ambulance operations, hazmat, pre-hospital extraction and packaging, cricoidotomy, intubation, chest decompression, crime scene awareness/ scene safety, and many many other things nurses do not do?


 
You have just mentioned "skills" which Paramedics pick up with very little educational foundation. In most states nurses can do "skills" such as intubation, central line placement, chest decompression and cricoidotomy it that is what their job title calls for and generally their scope of practice can be expanded. The numbers in the studies for some Paramedics also show that intubation, IVs, medications and medical emergencies are the weak areas. For RNs these may be their strongest areas. Some Paramedic students may never get the opportunity to see or do any of these "skills" on a live patient as some schools accept intubation done on a manikin. RNs may assist in hundreds of intubation which can include doing RSI meds as well as all the maintenance and "rescue" medications for many hours afterwards for stabilization. RNs may also get the opportunity of seeing many bedside tracheotomies performed to which they will assist in with a physician that might love to teach and discuss the entire procedure each time in great detail. And how many central lines do you think they will assist in and care for? How many PICCs will some of these RNs insert? At least when they are ready to be trained for actually doing the skills, they have some idea what it is and the mistakes that can be made. We have no problem teaching RNs to do the actual intubation once they join the Flight or Specialty teams. The Paramedic also seldom gets to see a broad range of patients especially with the few hours of clinicals and some areas just want the "40 ALS patient" contact. Some areas still allow those to be done on an ALS engine with no transport capability. 

As far as crime scene, besides a little paragraph in the textbook, the other training you had was a Police Officer telling you to stay out of certain areas. Due to the increased violence in the hospital and dealing with violent patients, maybe several at one time, for 8 or 12 hours every day they work, RNs do have some knowledge about safety and crime scenes. Some EMT(P)s fail to realize it is the RN that cares for those patients you can't wait to dump off your truck after just a few minutes of transport and that you have done everything in your power to upset the patient even more. That might even include slamming Narcan just to see their patient react and to watch the nurses take a beating while trying to restrain the patient physically and chemically after starting another IV which the Paramedic had watched the patient pull out after the Narcan for even more amusement.

If the RN has an interest in emergency medicine, they generally will take the correct path of experience and education to achieve their goal especially if it is Flight or CCT. An RN working in a hospital learns quickly about not taking on an assignment they are not qualified for. Paramedics generally will accept patients (ALS and CCT) they are not qualified for either because they have no clue what they do not know or out of cockiness.


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## VentMedic (Apr 23, 2010)

harold1981 said:


> We are talking about one of the Dutch-Antillian islands, were we do believe that the Dutch nurse-based system for pre-hospital care is among the best in the world, to be preffered above the American paramedic-model. However I don't think we can afford the Dutch system.
> And untill we can afford it, we have nurses on the bus, without any specific ambulance-training.
> Maybe it's about time that we start thinking about alternative (and indeed cheaper) options to upgrade this system to ILS- and ALS-level.


 
As far the topic of this thread, this country would greatly reduce quality of patient care and reduce their chances of expanding their scope to perform certain care at the patient's home rather than transporting if they went with some watered down system like that in the U.S.   If they went with a system like that which exists in other countries, they might find the costs being very similar to what they are now.  Having a  health care system with well educated and qualified people is not cheap.  Even in the U.S., which only emphasizes minimal standards that are ridiculously low, the systems are very costly.


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## JPINFV (Apr 23, 2010)

VentMedic said:


> You have just mentioned "skills" which Paramedics pick up with very little educational foundation. In most states nurses can do "skills" such as intubation, central line placement, chest decompression and cricoidotomy it that is what their job title calls for and generally their scope of practice can be expanded. The numbers in the studies for some Paramedics also show that intubation, IVs, medications and medical emergencies are the weak areas. For RNs these may be their strongest areas.
> 
> Some Paramedic students may never get the opportunity to see or do any of these "skills" on a live patient as some schools accept intubation done on a manikin. RNs may assist in hundreds of intubation which can include doing RSI meds as well as all the maintenance and "rescue" medications for many hours afterwards for stabilization. RNs may also get the opportunity of seeing many bedside tracheotomies performed to which they will assist in with a physician that might love to teach and discuss the entire procedure each time in great detail. And how many central lines do you think they will assist in and care for? How many PICCs will some of these RNs insert? At least when they are ready to be trained for actually doing the skills, they have some idea what it is and the mistakes that can be made. We have no problem teaching RNs to do the actual intubation once they join the Flight or Specialty teams. The Paramedic also seldom gets to see a broad range of patients especially with the few hours of clinicals and some areas just want the "40 ALS patient" contact. Some areas still allow those to be done on an ALS engine with no transport capability.



Seriously, how often are most RNs intubating patients? CRNAs and prehospital nurses? Sure. However, how often is the average med/surge, scrub nurse, SNF nurse, or heck, even emergency nurses intubating? Similarly, how often are these same nurses doing crics, decompressions, or central lines? By "doing" I mean actually performing the procedure. Not assisting. Not observing. As in the physician isn't even in the room and the RN goes, "Let's intubate!" The vast amount of RNs (which, for the record, challenging isn't limited to just "Code team or rapid response team nurses," but in many cases RNs as a whole) are not intubating, nor performing any of those other procedures, on even an irregular basis. You say this *may* be an individual nurse's strongest area, but then intubation similarly *may* be an individual paramedic's strongest area. 

Similarly, assisting in a procedure is not the same as performing a procedure. A scrub tech doesn't get to be the primary surgeon after assisting with hundreds of operations. An EMT-B doesn't get to manually defibrillate on his own despite assisting with manual defibrillations potentially hundreds of times. That's because doing, assisting, and observing are three different things. Sure, you can learn a lot by assisting and observing, but the mere act of doing either or both does not mean that an individual is competent to perform an intervention on their own.


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## Veneficus (Apr 23, 2010)

JPINFV said:


> Similarly, assisting in a procedure is not the same as performing a procedure. A scrub tech doesn't get to be the primary surgeon after assisting with hundreds of operations. An EMT-B doesn't get to manually defibrillate on his own despite assisting with manual defibrillations potentially hundreds of times. That's because doing, assisting, and observing are three different things. Sure, you can learn a lot by assisting and observing, but the mere act of doing either or both does not mean that an individual is competent to perform an intervention on their own.



But if they stayed at a Holiday Inn the night before...


 

just kidding


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## VentMedic (Apr 23, 2010)

JPINFV said:


> Seriously, how often are most RNs intubating patients? CRNAs and prehospital nurses? Sure. However, how often is the average med/surge, scrub nurse, SNF nurse, or heck, even emergency nurses intubating? Similarly, how often are these same nurses doing crics, decompressions, or central lines? By "doing" I mean actually performing the procedure. Not assisting. Not observing. As in the physician isn't even in the room and the RN goes, "Let's intubate!" The vast amount of RNs (which, for the record, challenging isn't limited to just "Code team or rapid response team nurses," but in many cases RNs as a whole) are not intubating, nor performing any of those other procedures, on even an irregular basis. You say this *may* be an individual nurse's strongest area, but then intubation similarly *may* be an individual paramedic's strongest area.
> 
> Similarly, assisting in a procedure is not the same as performing a procedure. A scrub tech doesn't get to be the primary surgeon after assisting with hundreds of operations. An EMT-B doesn't get to manually defibrillate on his own despite assisting with manual defibrillations potentially hundreds of times. That's because doing, assisting, and observing are three different things. Sure, you can learn a lot by assisting and observing, but the mere act of doing either or both does not mean that an individual is competent to perform an intervention on their own.


 
JP, you still have a lot to learn about nurses and hospital situations as well as all the other medical professions.  You should not judge everyone by just the one nursing home nurse you know.   Are you really so naive at this point that you believe a critical care RN and those that have chosen to work in a SNF are the same? Both can be quality professionals with their own areas of expertise and skill sets but I doubt the SNF RN wants to do RSI and intubate.  They at least realize their limitiations. 

You have not worked in critical care units or on specialty teams. You have not worked in Pedi ICUs or L&D. You have never been on a hospital code or rapid response team. You have never been on a Flight team. You can not speak for what ALL RNs can or can not do.   Nursing is a vast field. EMS is very, very limited. You also seem to think all EMTs and Paramedics are the same because they had the same training. But, even if they are that training is very limited to just one small area of medicine.  The majority of patients in a hospital are also not necessarily transported by ambulance but some EMT(P)s believe that is the only way to get there.  You make a lot of generalizations without realizing how large the field of medicine actually is and the opportunities in it.

In some of the hospitals I have been in, the Rapid Response and Code teams can definitely function without a doctor present. If it is determined the patient needs intubating the RN gives the medication and I, the RRT, intubates.  If it is a Flight or Specialty RN, they can do the intubation. If it is in L&D, the RN can intubate.   If a baby has a pneumo when they are on some serious ventilation in the ICU, the closest person who is trained to do a needle decompression can perform it in an emergency. That could be the RRT or the RN who has had this training.   

If a Paramedic is only doing one or two intubations per year while the Flight, Specialty or CCT RN is required to do at least 10 per year, who do you think might be a little better. The fact that RNs know they must have certain experience and continue to practice to stay current sets them apart.  

Even having seen advanced procedures being done is better than never having seen them performed except on a manikin.

Also, I personally don't like that fact that some some EMT(P)s who have no interest in patient care are actually placed into a situation to where they might have to touch patients either.  

JP, with the education you have now, you should be starting to think beyond the "EMT-B" level to at least start to process advanced concepts in medicine better and to recognize some of the other specialty areas in medicine.

Also for the sake of this topic, there are a few states here in the U.S. that allows RNs to function in prehospital EMS within their own scope as RNs and perform whatever skills their medical director determines.  They may not need another "cert" such as PHRN or MICN.


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## VentMedic (Apr 23, 2010)

Veneficus said:


> But if they stayed at a Holiday Inn the night before...
> 
> 
> 
> ...


 
I hope you are kidding. If you have traveled to as many countries as you claim, you should already know how RNs can function in prehospital. The Dutch system is a good example.  However, you may have no experience here in the U.S. with the RN that works Flight or Specialty or in the many different critical care situations.


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## JPINFV (Apr 23, 2010)

Vent... I was going to actually try a response, but I'm tired of playing your games. You make broad sweeping claims, such as 'nurses do this, that, or the other thing, therefore it's only right and proper that they can challenge paramedic licensure.' However, when challenged on that, you back track to claiming that only a few nurses who are in the minority (response teams and flight nurses) are somehow representative of all nurses while lashing out with personal attacks. If you meant only response team and flight nurses, why continue with using the general term of "nurse" when clearly you don't mean all nurses? Since I have zero clue on what part of your posts you're going to sit and 'clarify,' it isn't worth my time to respond to your diatribes.


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## Shishkabob (Apr 23, 2010)

VentMedic said:


> You have not worked in critical care units or on specialty teams. You have not worked in Pedi ICUs or L&D. You have never been on a hospital code or rapid response team. You have never been on a Flight team. You can not speak for what ALL RNs can or can not do.
> 
> In some of the hospitals I have been in, the Rapid Response and Code teams can definitely function without a doctor present. If it is determined the patient needs intubating the RN gives the medication and I, the RRT, intubates.  If it is a Flight or Specialty RN, they can do the intubation. If it is in L&D, the RN can intubate.



You're speaking of specialty units and not the average RN.  The average RN, in my experience in Texas, cannot intubate, and are not taught how to intubate.  They have to take extra education to do it.


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## dudemanguy (Apr 23, 2010)

As someone who is neither a paramedic or an RN, but has worked with both and has family that are both. I dont think theres any comparison between a paramedics level of training and a nurses. Nursing requires much greater depth of knowledge and training, there is no comparison. I think the education gap between a paramedic and an RN is probably the same as an EMT basic and a paramedic.
I'm not saying RNs are trained to do EVERYTHING a paramedic is, but the few skills they arent trained would be relatively easy for them to learn. 

I also find it amusing that the medical students in here already seem to have a poor view of nurses. When they are interns they will likely quickly learn that its the nurses that are gonna repeatedly save their butt.


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## Shishkabob (Apr 23, 2010)

You are admittedly not in the medical field but somehow know that nurses will save a Doctors butt?  Or that nurses are vastly superior to Paramedics in knowledge?  How is it that a nurse, with less education than a doctor, can be viewed in such a high regard by you, but when you say a medic has less then a nurse, that the medic is inferior?  Double standard much?

Now, I'm not an RN myself, but I know many Medic/RNs and they have said the same thing:  Nurses don't compare to medics when it comes to cardiology and trauma.  That is the paramedic specialty.  Of course that's not the sum of what we do.  8jimi8 here, who is an RN himself, even said he wants to be a medic because it'd be more education in the realm of airway and cardiology.  

Yes, education is lacking in EMS, no one denies that.  But to say one is better than the other, when there are vastly different systems that require different amounts of education for BOTH levels, is laughable.  I've met idiot nurses, and I've met idiot medics.  They exist both places, and to make a generalization like you just did is confusing.


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## VentMedic (Apr 23, 2010)

Linuss said:


> You're speaking of specialty units and not the average RN. The average RN, in my experience in Texas, cannot intubate, and are not taught how to intubate. They have to take extra education to do it.


 
Emergency medicine is a SPECIALTY. Do you not consider the Paramedic to be a specialist in emergency medicine? The difference here is that the RN has obtained a general education foundation in the sciences and some experience in different patient care areas where as the Paramedic only gets the specialty part without the education or experience. And, please do not be led into believing that working as an EMT-B for 5 years is the "experience" that is required.

The average Paramedic in TX only has 600 hours of training with no A&P. They know very little about most of the medications that is used in the hospital or even just in the ED. They do not have college level Pharmacology which would make even learning those meds a challenge.

Just because the RN doesn't learn intubation in nursing school does not mean they can not learn it later. Don't the flight and specialty RNs in TX intubate? There is just some much one can learn in a 2 - 4 year program. They also don't learn enough to work in a critical unit but will receive many months of additional education and training later. This, of course I'm sure some Paramedics find funny since they learn all they need to know in a few extra hours to be called "CCEMT-P". Or, they can just buy a book to study the test question for FP-C or CCP and just take a test. We all know they are then "critical care certified". 

Do you know how difficult it is to teach some Paramedics who have never had any college level A&P a few simple concepts about medication and "advanced" procedures? That is why we still get the "lido numbs the heart" and "CPAP pushes lung water". Have you ever tried to talk about hemodynamics or acid-base beyond the few paragraphs in the Paramedic text with an ICU RN or RRT? I think you might be amazed at how little you know. The acid-base taught in the Paramedic text is about at the 8th grade level.



> Now, I'm not an RN myself, but I know many Medic/RNs and they have said the same thing: Nurses don't compare to medics when it comes to cardiology and trauma.


 
Nurses aren't constantly trying to compare themselves to Paramedics. They are still very secure with themselves if they can't intubate since they don't base their who professional status on a couple of skills. The Paramedics on the other hand believe that since they can do a few meds on basically a dead person in a code and intubate, they must be just like doctors or at least way better than any other health care professional.


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## Shishkabob (Apr 23, 2010)

Let's be fair here, Vent.  In general, a new grad RN cannot intubate, and a new grad medic can, correct?   (Atleast in my area)


Glad you called Paramedicne a specialty... so then why are you for RNs being able to challenge it instead of going through the proper channels like they have to for their specialties? 


Yes, I will agree, we (new grads) don't know much about most of the medications used in the hospital.  On the flip side, does a new grad RN have much, if any, understanding of what's done in the field themselves?    I had a new grad RN go in to a 5 minutes explanation of what Benzos were, failing to realize that the Benzo she was giving was common place on an ambulance.


(PS, Texas is 624 hours minimum )
(PPS My school did more than 624)


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## MrBrown (Apr 23, 2010)

VentMedic said:


> The average Paramedic in TX only has 600 hours of training with no A&P. They know very little about most of the medications that is used in the hospital or even just in the ED. They do not have college level Pharmacology which would make even learning those meds a challenge.



Nah that's just 12 week wonders who work at the Houston Fire Department



VentMedic said:


> Just because the RN doesn't learn intubation in nursing school does not mean they can not learn it later.



I agree wholeheartedly the hardest thing to learn if you have a good knowledgebase is the physical skill itself; for me the hardest part of cannulating somebody is the skill of sticking in the IV cathether, everybody else is 100 yards behind going "what does interstitial mean?" 



VentMedic said:


> Do you know how difficult it is to teach some Paramedics who have never had any college level A&P a few simple concepts about medication and "advanced" procedures?



While my experience in doing so is limited, the few people I have tried to educate have been so hard to teach because they just don't understand the fundementals of what you are saying.

I am shocked how horrendously easy it is to get certified in the US, I know one or two people who have taken the standard required number of hours and know so little it is frightening.  

I know people who can cannulate and use one or two cardiac meds and they struggle with basic concepts of body fluid compartmentilisation and are totally incapable of reading an ECG beyond having been taught what one or two rhythms LOOK like, not how to interpret them but what they LOOK like.

One example that stands to mind is trying to teach somebody about hyperglycaemia and HONK; it was almost impossible as the person in this particular case had virtually no knowledge of osmolarity or how glucose is regulated.  This is somebody who was able to cannulate and infuse yet they could barely understand osmotic shift.


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## VentMedic (Apr 23, 2010)

JPINFV said:


> Vent... I was going to actually try a response, but I'm tired of playing your games. You make broad sweeping claims, such as 'nurses do this, that, or the other thing, therefore it's only right and proper that they can challenge paramedic licensure.' However, when challenged on that, you back track to claiming that only a few nurses who are in the minority (response teams and flight nurses) are somehow representative of all nurses while lashing out with personal attacks. If you meant only response team and flight nurses, why continue with using the general term of "nurse" when clearly you don't mean all nurses? Since I have zero clue on what part of your posts you're going to sit and 'clarify,' it isn't worth my time to respond to your diatribes.


 
I never many any claim that all RNs are the same. I clearly put Flight, Specialty and  critical care into my posts.  

Now, if you want to discuss generalizations, let's look at the profession you have chosen which is the Doctor of Osteopathic Medicine or DO.  You can spend the rest of the day trying to say it is just the same as MD but anybody will tell you differently...especially the MDs.   We are told by the MD attendings to watch the DO residents more closely so they don't muck up the patients. In fact, if given the choice we will push the MD resident to the head of the line for "skills" such as intubation, central line placement and "running" the code before we will allow the DO resident to get near the patient. In the Pedi/Neo ICUs, the DO residents hang in the back watching the MD residents.    We have heard about how inferior the DO is for years and it will take alot to change the attitudes that exist.  This is no different than the EMT, like yourself at this point, who has only heard the worst about the RN mostly on these EMS forums.  You have now stereotyped all RNs to be like the few you have seen. 

You as a DO student will have a very tough road with your poor attitude towards nursing, who could be your best friends during your residency.  

It might also surprise you to know that EMS providers just make up a small portion of all health care workers.  It might even surprise you more to know that out of all the EMTs, like yourself, not many get the opportunity to work the "cool" calls or do 911 EMS. 

As far as the "challenge the Paramedic licensure" thing, my initial response was to schultz who can't figure out why Paramedics, some with just 600 hours of training and no college level courses, and very limited or focused training can not challenge the RN.   Imagine if all the FFs or 3 month wonder Paramedics  could challenge the RN just for the money and no interest in patient care?    Imagine if *ALL* RNs wanted to work on the ambulances?  That might actually be a good thing and EMS in the U.S. could be raised to the level that exists in other countries where RNs are more active in prehospital.


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## Shishkabob (Apr 23, 2010)

MrBrown said:


> Nah that's just 12 week wonders who work at the Houston Fire Department


  I'm still waiting for my questioned I asked you a few weeks ago:  What is with your recent obsessions with TEEX? 



> I agree wholeheartedly the hardest thing to learn if you have a good knowledgebase is the physical skill itself;


 In all honesty, what's left to learn after you know the didactic portion?  






> While my experience in doing so is limited, the few people I have tried to educate have been so hard to teach because they just don't understand the fundementals of what you are saying.



Yeah because the minority is obviously representative of the majority.




			
				Vent said:
			
		

> You have now stereotyped all _______s to be like the few you have seen.



Ironic for this forum.


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## JPINFV (Apr 23, 2010)

VentMedic said:


> I never many any claim that all RNs are the same. I clearly put Flight, Specialty and  critical care into my posts.



You clearly put flight, specialty, and critical care in the post I quoted at the very end after mentioning all of the procedures that RNs are supposedly competent on solely because they observe or assist with the procedure constantly. 



> Now, if you want to discuss generalizations, let's look at the profession you have chosen which is the Doctor of Osteopathic Medicine or DO.  You can spend the rest of the day trying to say it is just the same as MD but anybody will tell you differently...especially the MDs.   We are told by the MD attendings to watch the DO residents more closely so they don't muck up the patients. In fact, if given the choice we will push the MD resident to the head of the line for "skills" such as intubation, central line placement and "running" the code before we will allow the DO resident to get near the patient. In the Pedi/Neo ICUs, the DO residents hang in the back watching the MD residents.    We have heard about how inferior the DO is for years and it will take alot to change the attitudes that exist.  This is no different than the EMT, like yourself at this point, who has only heard the worst about the RN mostly on these EMS forums.  You have now stereotyped all RNs to be like the few you have seen.



Yet, amazingly enough, there are DOs teaching and treating patients all over the place. Yet, amazingly enough, DOs are licensed by the same medical board as MDs in the majority of states. Yet, amazingly enough, I can't think of a single state that limits the scope of practice of DOs to anything other than an unrestricted licensed to practice medicine. 

However, where exactly am I slamming RNs? Where have I stereotyped RNs? I can make a lot of the same claims about RNs about physicians (regardless of MD or DO). I don't want a dermatologist intubating me. I don't want a radiologist running a code. I don't want a PM&R specialist on an ambulance. It's as much a mischaracterization of physicians to say that all physicians are competent to do _____ solely because they are a physician as it is to say that about nurses of any levels or EMS providers of any levels. 



> You as a DO student will have a very tough road with your poor attitude towards nursing, who could be your best friends during your residency.


Where have I shown that I have a poor attitude towards nurses? Because I don't believe that a nurse is equal to a physician? Because I believe that not all nurses know how to do all procedures? Because I believe that there are actual limits to what a nurse can and can not competently do?



> It might also surprise you to know that EMS providers just make up a small portion of all health care workers.  It might even surprise you more to know that out of all the EMTs, like yourself, not many get the opportunity to work the "cool" calls or do 911 EMS.


Oh, really? You mean that every 3rd health care provider isn't an EMS provider? Like, OMG, I can't totally believe that!!!111oneonetwoshift1!:unsure:

What? You mean that not all EMS providers run 911? I so can't totally not believe that considering that neither of the two companies that I've worked for had 911 contracts. 


What ever... Once again you've shown that when someone says something you don't like you have to engage in personal attacks. Welcome to the ignore list.


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## VentMedic (Apr 23, 2010)

JPINFV said:


> Yet, amazingly enough, there are DOs teaching and treating patients all over the place. Yet, amazingly enough, DOs are licensed by the same medical board as MDs in the majority of states. Yet, amazingly enough, I can't think of a single state that limits the scope of practice of DOs to anything other than an unrestricted licensed to practice medicine.


 
And here you are making generalizations. While a state may not limit a scope of practice, that does not mean the DO will be welcome in the ICUs or other specialties. It doesn't mean they will even get the same opportunities in their residency as I have already mentioned. It also doesn't mean patients have to choose a DO over MD as their PCP.



JPINFV said:


> Oh, really? You mean that every 3rd health care provider isn't an EMS provider? Like, OMG, I can't totally believe that!!!111oneonetwoshift1!:unsure:
> 
> What? You mean that not all EMS providers run 911? I so can't totally not believe that considering that neither of the two companies that I've worked for had 911 contracts.
> 
> ...


 
That's right JP, not every EMT works on a 911 truck. Your company may have had 911 contracts to run with an ALS truck from the FD but that also doesn't mean the truck you were on did.

And where is the personal attack by telling you that not all EMT-Bs are the same and work in the same capacity with every company?

And don't you have this in your signature?
"EMS = *E*xcusing *M*inimal *S*tandards"


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## MrBrown (Apr 23, 2010)

Linuss said:


> I'm still waiting for my questioned I asked you a few weeks ago:  What is with your recent obsessions with TEEX?



Because in all honesty it would be an understatement to say I am horrendously disgusted and at a loss to understand how anybody from instructor to regulator to student to medical director can think 12 weeks of instruction is acceptable to learn advanced life support?

We had one of these wonder people who had been to some quick and dirty patch factory come down here.  Thier level of knowledge was so inadequate it wasn't funny.  

I guess if we require four years of education and internship for Paramedic (somewhere between I and P) and six or seven years for Intensive Care Paramedic (ALS) we are doing something wrong because obviously 12 weeks plus a couple hundred hours of skills experience is adequate?

The minority may not be representative of the majority but honestly which do you think stands out; the guy who went to a decent two year program or somebody who rocked down to the couple month zero-to-hero school?

In the 1970s it took two years to become a Qualified Ambulance Officer (who couldn't really do much except dish out oxygen and one or two meds) and yet somehow, forty years later, the American system cannot mandate such a requirement at even the top level, let alone the bottom.

While it is easy to point fingers at other people I should say we've taken a huge backward step here in New Zealand.  Gone are the days when it took a year or more to become a qualified Ambulance Officer and one was required to do a large number of pre-block course assignments around anatomy and phys because that is "not relevant when crewing an ambulance" so 24 weeks part-time is now acceptable it seems.  Never mind the mandatory Bachelors Degree or higher for Paramedic and above and in mandating such a qualification a huge disparity is created between what is now styled "Ambulance Technician" (I sure as hell wouldn't call them a 'clinician') and higher levels.


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## JPINFV (Apr 23, 2010)

VentMedic said:


> Another patronizing post


----------



## VentMedic (Apr 23, 2010)

Quote:
Originally Posted by *VentMedic* 

 
_Another patronizing post_





__________________


Now isn't that so much easier than trying to talk about something you have not yet obtained any experience with.


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## dudemanguy (Apr 23, 2010)

Linuss said:


> You are admittedly not in the medical field but somehow know that nurses will save a Doctors butt?  Or that nurses are vastly superior to Paramedics in knowledge?  How is it that a nurse, with less education than a doctor, can be viewed in such a high regard by you, but when you say a medic has less then a nurse, that the medic is inferior?  Double standard much?



I said I'm neither a paramedic or a nurse, never said I wasnt in the medical field. I'm an EMT-B and a CNA. 

I also never said paramedics are inferior to nurses. I was simply trying to address the assertion that paramedics should be able to test out as RNs. I can maybe understand an RN testing out to be a Paramedic, although I agree with mycrofft that the two jobs require different mindsets, and that a good nurse wouldnt necessarily make a good paramedic. I dont see how a paramedic could test out to be an RN, at least not without substantially more education than the minimum paramedic requirements.

I was not trying to dismiss paramedics, or imply that their training standards are insufficient for the job they perform. Ill leave that to people who would know better than me.


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## Veneficus (Apr 23, 2010)

dudemanguy said:


> I also find it amusing that the medical students in here already seem to have a poor view of nurses. When they are interns they will likely quickly learn that its the nurses that are gonna repeatedly save their butt.



I think you watch way too much tv or listen to way too much nursing propaganda.

But I would love to hear how a nurse is going to save me repeatedly and from what exactly?

But fair warning before you post some nonsense about not knowing a medication, a dose, cutting off the wrong limb, being afraid to order a test, touch a patient, or fill out a form, keep in mind I am educated in a far different system than the one that produces interns who stand around and watch people work their first year.

I also didn't come to medical school right out of high school or college. I have considerable experience in healthcare. 

As of my schooling to date I can do anything a nurse can do, I am positively sure she cannot say the same statement about me.


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## JPINFV (Apr 23, 2010)

dudemanguy said:


> I also find it amusing that the medical students in here already seem to have a poor view of nurses. When they are interns they will likely quickly learn that its the nurses that are gonna repeatedly save their butt.



Who has a poor view of nurses unless a poor view is not seeing nurses as all knowing gods of health care? I don't want a med surge nurse intubating me any more than a dermatologist. Does that mean I have a poor view of dermatologists?


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## VentMedic (Apr 23, 2010)

Veneficus said:


> As of my schooling to date I can do anything a nurse can do, I am positively sure *she* cannot say the same statement about me.


 
You assume all nurses are women and they probably wear short white dresses ready to "service" all male doctors in your fantansies as well. Get over the dated thinking. I don't know what country you are from but I doubt if nurses are all women in every country just like they are not in the U.S. Not all Paramedics are men either. Welcome to the year 2010. 

If you can do everything that a nurse can, why are you envious of Smash and wanting to work for his/her system?

From the Dilaudid thread:

Originally Posted by *Smash* 

 


> _I think ems should carry as many options for pain relief as possible. That said, I don't know how much added benefit there would be from a third opioid agent if morphine and fentanyl are carried. I'd go for ketamine or a hypnotic instead._


_


Veneficus said:



			can I come and work for you guys?
		
Click to expand...

_ 
Again, this "I can start an IV and you can't so I must be just like a doctor...nan nan nah nah!" mentality has been the downfall of EMS in the U.S. 



> But I would love to hear how a nurse is going to save me repeatedly and from what exactly?


If you ever make it to doing a residency, you'll find out. There probably isn't a doctor that has completed their residency that hasn't been thankful to have a nurse around to prevent them from looking really stupid in front of the attending at some point. If you screw up writing an order, you'll find out how well educated the RNs are. They are the patient's line of defense to keep you (if you even become a doctor) from doing more harm when you make a mistake.


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## VentMedic (Apr 23, 2010)

JPINFV said:


> Who has a poor view of nurses unless a poor view is not seeing nurses as all knowing gods of health care? I don't want a med surge nurse intubating me any more than a dermatologist. Does that mean I have a poor view of dermatologists?


 
And he continues to use those examples....

Nobody here said anything about a med surg nurse intubating. However, there have been several threads on the EMS forums about EMT-Bs intubating after just a couple hours of extra training and few saw any problem with that.  Afterall, it is "just a skill" and some believe no eduation is required. 

You might also be surprised to know that dermatologists are MDs who may have intubated in their internship before specializing in skin disorders.


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## 8jimi8 (Apr 24, 2010)

Veneficus said:


> But I would love to hear how a nurse is going to save me repeatedly and from what exactly?





from being human.  Just last night a 3rd year ordered ativan on a patient who was ALLERGIC to ativan.

another example?  Ordered D5W on a diabetic teenager with IICP.

It's not about Nurses saving Drs.  It's about the HC TEAM saving lives.

Doctors treat diseases.

Nurses treat patients.

This thread isn't about a pissing match between HCPs.

The tangent that it has taken, is "Why can RN's challenge the NREMT-P and not vice versa."

And i'll reiterate for anyone who still wants to ask that question.  Because RN's have the foundational education to adapt to the specialization of pre-hospital care.  Paramedics cannot because it is not possible to extrapolate pre-hospital care and generalize it to non-emergent situations.


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## Veneficus (Apr 24, 2010)

8jimi8 said:


> It's not about Nurses saving Drs.  It's about the HC TEAM saving lives.



That is my impression on it, but if somebody tries to take a shot at me, i usually fire back. 




8jimi8 said:


> Doctors treat diseases.
> 
> Nurses treat patients..



I respectfully disagree with this statement.

From my perspective the whole purpose of medicine is helping the patient. sometimes it requires medical knowledge, sometimes social help, and now and again something as simple answering a question regarding how much it will cost or disrupt their life.

I would agree there are many "scientists" in medicine who have no people skills and focus on pathology. There are also a fair number who of providers just doing a job.  




8jimi8 said:


> The tangent that it has taken, is "Why can RN's challenge the NREMT-P and not vice versa.".



Because their advanced education buys them that privilege. 



8jimi8 said:


> And i'll reiterate for anyone who still wants to ask that question.  Because RN's have the foundational education to adapt to the specialization of pre-hospital care.  Paramedics cannot because it is not possible to extrapolate pre-hospital care and generalize it to non-emergent situations.



Well said.


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## rhan101277 (Apr 24, 2010)

In Mississippi you can no longer challenge NREMT-P as a RN.


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## Hal9000 (Apr 24, 2010)

Veneficus said:


> That is my impression on it, but if somebody tries to take a shot at me, i usually fire back.
> 
> 
> 
> ...




I won't add anything useful, but I agree with this post.


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## MrBrown (Apr 24, 2010)

Veneficus said:


> From my perspective the whole purpose of medicine is helping the patient. sometimes it ... [is] as simple answering a question regarding how much it will cost



Hmm you mean healthcare costs money? 

*Checks last hospital bill mmm $0.00 ..... fascinating, what is this concept you speak of


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## Shishkabob (Apr 24, 2010)

8jimi8 said:


> And i'll reiterate for anyone who still wants to ask that question.  Because RN's have the foundational education to adapt to the specialization of pre-hospital care. * Paramedics cannot because it is not possible to extrapolate pre-hospital care and generalize it to non-emergent situations.*



As opposed to vene, I'd disagree.  


Correct, we typically arent taught the non-emergent side of medicine as much as hospital based providers... but more often than not, the vast majority of calls we go on are NOT emergent, and it seems we do somewhat fine.  (Exceptions not included)


And on the same token, I've seen nurses in CPR, ACLS and PALS classes utterly fail at just practicing fake emergent situations.  So the lack of doing something does not just rest on one subset of providers, and does not pay much attention to education, and this is where experience helps a little bit.


As Vent said before, Paramedicine is a specialty of emergency medicine, but that's not our limit.





MrBrown said:


> *Checks last hospital bill mmm $0.00 ..... fascinating, what is this concept you speak of





The correct way h34r:


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## ExpatMedic0 (Apr 24, 2010)

What about the thosands of Paramedics in Oregon with the exact same foundtional education requirments? Please see below

https://www.pcc.edu/about/catalog/emt.pdf
http://www.pcc.edu/about/catalog/nur.pdf

What about the tens of thosands of Paramedics with degree's in science and health care? Why is it that you think these Paramedics specificly are incabable of being ED nurses?



8jimi8 said:


> from being human.  Just last night a 3rd year ordered ativan on a patient who was ALLERGIC to ativan.
> 
> another example?  Ordered D5W on a diabetic teenager with IICP.
> 
> ...


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## 8jimi8 (Apr 24, 2010)

schulz said:


> What about the thosands of Paramedics in Oregon with the exact same foundtional education requirments? Please see below
> 
> https://www.pcc.edu/about/catalog/emt.pdf
> http://www.pcc.edu/about/catalog/nur.pdf
> ...



Not without training.

The pre-reqs may be the same, but the education is not.

Without searching on the internet... 

please explain the insulin curve to me and list a common combination of 3 types of insulin that will closest mimic the average normal insulin levels.

Regarding an insulin sliding scale what lab values my be taken into account when administering insulin?

What is the significance of creatinine of 1.8 and how would you modify your therapeautic insulin sliding scale?


Just an example of a small piece of the difference between what paramedics study and what nurses study.

Not trying to antagonize anyone, just clearly illustrate my point.


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## 8jimi8 (Apr 24, 2010)

rhan101277 said:


> In Mississippi you can no longer challenge NREMT-P as a RN.



good thing i'm taking the full course load and not challenging!


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## VentMedic (Apr 24, 2010)

schulz said:


> What about the tens of thosands of Paramedics with degree's in science and health care? Why is it that you think these *Paramedics specificly are incabable of being ED nurses*?


 
Every licensed health care professional has taken those same sciences and then go on to advanced degrees such as Bachelors, Masters and Doctorate in their chosen fields. None of them hold themselves out to be nurses even though much of even their focus education overlaps with nurses. By your logic, RTs, RRTs, SLPs, OTs and PTs should also be working in the ED as nurses. Actually some of these professions would be better qualified than the Paramedic since they do contain some of the nursing core elements in their education.

It essentially comes down to the Paramedic being unhappy with the limitations of their profession and trying to take shortcuts into a profession they believe is superior to theirs. That should be a compliment to nurses but in the process nursing should not have to lower their standards or dilute their profession with people who do not have the same education or possess the same skills and knowledge that makes their profession different from others. 

EMS has also become accustomed to the quick patch and believe that everything should come to them as easily as their own patches and "skills". EMS providers also base their worth on "skills" and not education. The argument presented here is also "I can do exactly what skills I have seen nurses do" but have no clue what nurses actually know.


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## ExpatMedic0 (Apr 24, 2010)

OHSU is our primary state burn and trauma center. They choose to use a Paramedic in the trauma bay instead of an RN... and not as an ED tech... he/she works there full scope including intubation amongst many other things. OHSU is not the only hospital doing this either, other hospital have followed.

This is one clear example of how a Paramedic can not only fill the roll of a nurse in the ED but is a better choice in some areas.


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## VentMedic (Apr 24, 2010)

schulz said:


> OHSU is our primary state burn and trauma center. They choose to use a Paramedic in the trauma bay instead of an RN... and not as an ED tech... he/she works there full scope including *intubation* amongst many other things.


 
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.

BTW, isn't OHSU a teaching hospital? Are you saying they have no doctors or residents that intubate so they must rely totally on the Paramedic to intubate? That doesn't speak well for that trauma unit or for them as a teaching facility.

Our patients also don't spend much time in the trauma bay. They get what needs to be done initially and moved either to the OR, another section of the ED or to the ICU.  Other aspects of care are then initiated which the Paramedic would not be qualified for and the RN is the best choice.


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## ExpatMedic0 (Apr 24, 2010)

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. 



VentMedic said:


> 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.


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## VentMedic (Apr 24, 2010)

schulz said:


> 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.


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## ExpatMedic0 (Apr 24, 2010)

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...


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## VentMedic (Apr 24, 2010)

schulz said:


> 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".


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## ExpatMedic0 (Apr 24, 2010)

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


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## VentMedic (Apr 24, 2010)

schulz said:


> 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.


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## JPINFV (Apr 24, 2010)

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


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## 46Young (Apr 25, 2010)

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.


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## Shishkabob (Apr 25, 2010)

46Young said:


> 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...


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## VentMedic (Apr 25, 2010)

Linuss said:


> 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.


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## 46Young (Apr 25, 2010)

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.


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## 46Young (Apr 25, 2010)

VentMedic said:


> 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.


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## VentMedic (Apr 25, 2010)

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.


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## Veneficus (Apr 25, 2010)

46Young said:


> 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?


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## MrBrown (Apr 25, 2010)

46Young said:


> 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?



46Young said:


> 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 test*http://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.


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## Veneficus (Apr 25, 2010)

MrBrown said:


> Perhaps you could start a trend?
> 
> 
> 
> ...



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?


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## MrBrown (Apr 25, 2010)

Veneficus said:


> 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)


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## iamjeff171 (Apr 25, 2010)

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...


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## VentMedic (Apr 25, 2010)

iamjeff171 said:


> 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. 



iamjeff171 said:


> 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? 



iamjeff171 said:


> 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. 



iamjeff171 said:


> 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:



Dutch-EMT said:


> 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.
> ...


 
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.


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## iamjeff171 (Apr 25, 2010)

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...


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## esmcdowell (Apr 25, 2010)

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


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## VentMedic (Apr 25, 2010)

esmcdowell said:


> 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.


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## esmcdowell (Apr 25, 2010)

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.


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## Hal9000 (Apr 25, 2010)

VentMedic said:


> 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.


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## 46Young (Apr 26, 2010)

Veneficus said:


> 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.


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## 8jimi8 (Apr 26, 2010)

46Young said:


> 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
> 
> ...



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.


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## JPINFV (Apr 26, 2010)

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.


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## 46Young (Apr 26, 2010)

MrBrown said:


> Perhaps you could start a trend?
> 
> 
> 
> ...



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.


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## EMSLaw (Apr 26, 2010)

46Young said:


> 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.


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## MrBrown (Apr 26, 2010)

EMSLaw said:


> 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.


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## EMSLaw (Apr 26, 2010)

MrBrown said:


> 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.


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## 46Young (Apr 26, 2010)

8jimi8 said:


> 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.


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## 46Young (Apr 26, 2010)

JPINFV said:


> 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?
> 
> ...



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.


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## 46Young (Apr 26, 2010)

EMSLaw said:


> 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?


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## MrBrown (Apr 26, 2010)

EMSLaw said:


> 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


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## JPINFV (Apr 26, 2010)

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


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## EMSLaw (Apr 27, 2010)

JPINFV said:


> 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!


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## MrBrown (Apr 27, 2010)

EMSLaw said:


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



What you haven't made partner yet?


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## xgpt (Apr 27, 2010)

jtpaintball70 said:


> 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)


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## MrBrown (Apr 27, 2010)

xgpt said:


> 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).


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## xgpt (Apr 27, 2010)

MrBrown said:


> 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.
> 
> ...



12 weeks? :wacko:


 I know you can get your EMT-*BASIC *in <6 months.

EMT-I takes longer than that...

but full-on paramedic w/ all of the associated certs take around *two years* from what I've heard.

Am I just wrong here?


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## JPINFV (Apr 27, 2010)

As with everything in EMS, it depends on where you go. I know places where you can become an EMT in 2 weeks.


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## xgpt (Apr 27, 2010)

MrBrown said:


> 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.
> 
> ...



But no...I haven't _seen_ any criminal inadequacy...I've only been doing this since February...and I've never run with a paramedic unit...


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## dudemanguy (Apr 27, 2010)

MrBrown said:


> 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.
> 
> ...



Out of curiousity I was looking up EMS training in Australia and found that it only takes 4 weeks to become an "ambulance transport officer"...In the US a first responder course usually takes longer, and they arent even allowed to crew an ambulance. So should I begin an online crusade to improve Australian EMS based on one school I found online?. 

I agree that EMS in the US should have better education standards. But do you have any statistics to prove that Australian or New Zealand EMS has far superior patient outcomes than in the US? I mean if not then what is the point really, bragging rights? If you have a paramedic with a 3 year degree making decisions that a doctor (with 11 plus years of training) makes here in the US, is that having higher education standards?


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## VentMedic (Apr 27, 2010)

dudemanguy said:


> In the US a first responder course usually takes longer, and they arent even allowed to crew an ambulance.


 
Check again. In some states you only need to be an "ambulance driver" here in the U.S. and complete EVOC to be on an ambulance.

Do you agree that one should be pushing potentially harmful medications and doing advanced procedures without as much as a decent A&P or Pharmacology course? 

3 years is not even that much just as an Associates is pitiful as the last couple of health care professions with that degree in the U.S. now have come to that realization and are doing something about it.


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## JPINFV (Apr 27, 2010)

dudemanguy said:


> Out of curiousity I was looking up EMS training in Australia and found that it only takes 4 weeks to become an "ambulance transport officer"...In the US a first responder course usually takes longer, and they arent even allowed to crew an ambulance. So should I begin an online crusade to improve Australian EMS based on one school I found online?.



You might be comparing apples to oranges here. Clock hours (total length of time in hours) is different than calendar days. I know of EMT programs that are completed in 2 weeks.


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## MrBrown (Apr 27, 2010)

dudemanguy said:


> Out of curiousity I was looking up EMS training in Australia and found that it only takes 4 weeks to become an "ambulance transport officer"...In the US a first responder course usually takes longer, and they arent even allowed to crew an ambulance.



ATO/PTOs do non emergent transport, they are really nothing more than a driver and have very strict critera about who they can and cannot transport.



dudemanguy said:


> So should I begin an online crusade to improve Australian EMS based on one school I found online?.



*Absolutely!*.  For the record I use the Houston Fire Department 12 week + internship program because it is not the "best" that any system, concept or idea is judged by but rather the worst.

Oh and just one? .... Lets have a look:

Nebraska 12 week program with no health science requirement - thier "Associates Degree" requires only an "introduction" to A&P!
http://programs.mpcc.edu/Accelerated_EMT-Paramedic.html

Dallas Fire Rescue - 24 week program with no health science requirement
http://www8.utsouthwestern.edu/utsw/cda/dept29240/files/90946.html

Green Bay, WI - 36 week program with no health science requirement
http://www.nwtc.edu/academics/degrees/publicsafety/emergency-responders/Pages/Paramedic.aspx#tabs-4

Four month Colorado program who proudly boast a graduate serving as an instructor!
http://www.aims.edu/academics/ems/emsDept/

Some of our guys have taken the "authentic" NREMT Paramedic practice tests for a bit of fun and they score above 90% with little difficulty; I score around 80-85% because the questions are so basic it is not funny.  I am not an Intensive Care Paramedic.

There are some good programs out there;

Bellingham, WA
http://www.btc.ctc.edu/DegreesCertificates/programs/PRG-DegreesCertificates.asp?Program=26

Temple, TX
http://www.templejc.edu/dept/ems/Pdf/Handbooks/CertificateCurriculum.pdf

Eastern Kentucky University
http://www.justice.eku.edu/ssem/emc/

Now, by contrast check out international Programs

New Zealand 3 year BHSc(Paramedic) (non ALS)
http://www.aut.ac.nz/study-at-aut/s...-courses/bachelor-of-health-science-paramedic

UK FdSc Paramedic 
http://www.gre.ac.uk/fd/subjects/hsc/b780

Australia (NSW) Paramedic (non ALS) 3 year BClinicalPrac(Paramedic)
http://www.csu.edu.au/courses/undergraduate/paramedic/

Australia (NSW) Intensive Care Paramedc (ALS) Post Graducate Certificate
http://www.csu.edu.au/courses/postgraduate/intensive_care_paramedic/index.html

Canadian Primary Care Paramedic (two years)
http://www.georgianc.on.ca/programs/PARA/outline/

Canadian Advanced Care Paramedic (one year)
http://www.georgianc.on.ca/programs/PARM/outline/


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## dudemanguy (Apr 27, 2010)

MrBrown said:


> Some of our guys have taken the "authentic" NREMT Paramedic practice tests for a bit of fun and they score above 90% with little difficulty; I score around 80-85% because the questions are so basic it is not funny.  I am not an Intensive Care Paramedic.



I did take some NREMT-basic practice tests before taking the actual NREMT exam. I dont know if they were "authentic", or what that even means. I do know every practice test I took was far easier than the actual test. 

The fact these people got 90% and found it easy is proof the tests werent very authentic. The NREMT exam is made to be difficult for everyone who takes it, since the difficulty of the questions asked is based on your answers to previous questions and the skill level you've demonstrated. Get a question right, and the next is harder, and so on. Get one wrong, and the next is easier. Hence someone taking the actual NREMT who finds the questions easy and thinks they got 90% right, probably failed. I'm sure there are lots of people who could pass some paramedic NREMT online simulation test that wouldnt make it through a paramedic course and internship.

Having said that I'm not claiming that the NREMT exam is some end all be all, only addressing the notion that doing good on some practice tests means someone is more than qualified to be a paramedic in the US. 

I do get a little annoyed at some of the medics with paragod syndrome on this forum, and it IS nice to see them get put in their place by others with more education and experience. But the 911 EMT's and medics I've seen work were amazing to watch in action, total professionals. Then again I havent been to California, Texas or Florida, so my view might change .


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## JPINFV (Apr 27, 2010)

dudemanguy said:


> The NREMT exam is made to be difficult for everyone who takes it, since the difficulty of the questions asked is based on your answers to previous questions and the skill level you've demonstrated. Get a question right, and the next is harder, and so on. Get one wrong, and the next is easier. Hence someone taking the actual NREMT who finds the questions easy and thinks they got 90% right, probably failed.



Well... last time I recerted I recerted by exam and took the NREMT progressive CBT for the first time... yea. Less than 30 minutes, 70 some-odd questions that were fairly easy, and a new card with 2 more years on it in the mail. What's easy for one person isn't necessarily easy for someone else. Similarly, just because a CBT is progressive doesn't mean it's going to be hard. "Harder" and "hard" are not the same thing.


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## dudemanguy (Apr 27, 2010)

JPINFV said:


> Well... last time I recerted I recerted by exam and took the NREMT progressive CBT for the first time... yea. Less than 30 minutes, 70 some-odd questions that were fairly easy, and a new card with 2 more years on it in the mail. What's easy for one person isn't necessarily easy for someone else. Similarly, just because a CBT is progressive doesn't mean it's going to be hard. "Harder" and "hard" are not the same thing.



I passed mine first time at 71 questions, but that was the Basic, not paramedic. Again I'm not saying the NREMT is some ultimate test of EMS knowledge. The main point I was making is that the actual test was harder than any of the practice exams I took.

Edit: I should also add that even if someone thought the NREMT wasnt very hard, I severely doubt they got 90% on it. So if someone says hey I got 90% on a practice test so I could get 90% on the NREMT...I doubt it. I got 89% on the last online test I took before the real one, and even though mine shut off at 71, I know I didnt get anywhere near that percentage right.


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## MrBrown (Apr 27, 2010)

NREMT tests are designed to be adaptive so that if you answer a lot of questions correctly then the questions get harder.


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## xgpt (Apr 27, 2010)

VentMedic said:


> Check again. In some states you only need to be an "ambulance driver" here in the U.S. and complete EVOC to be on an ambulance.
> 
> Do you agree that one should be pushing potentially harmful medications and doing advanced procedures without as much as a decent A&P or Pharmacology course?
> 
> 3 years is not even that much just as an Associates is pitiful as the last couple of health care professions with that degree in the U.S. now have come to that realization and are doing something about it.




I thought Pharmacology/A&P were required for paramedic...I know the paramedic degree program I've briefly looked into at the local community college requires it. And a bunch of other "hard" (as opposed to social) science courses for graduation.

and an Associates takes 2 years to get. Right?


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## Melclin (Apr 28, 2010)

dudemanguy said:


> Out of curiousity I was looking up EMS training in Australia and found that it only takes 4 weeks to become an "ambulance transport officer"...In the US a first responder course usually takes longer, and they arent even allowed to crew an ambulance. So should I begin an online crusade to improve Australian EMS based on one school I found online?.
> 
> I agree that EMS in the US should have better education standards. But do you have any statistics to prove that Australian or New Zealand EMS has far superior patient outcomes than in the US? I mean if not then what is the point really, bragging rights? If you have a paramedic with a 3 year degree making decisions that a doctor (with 11 plus years of training) makes here in the US, is that having higher education standards?



I might add to what has been said that some of those courses you find online are private companies that run very expensive courses that have little to no actual career outcomes... they are rip off merchants basically. If you can get jobs, its usually in a first aid role.

There is a multitude of "EMS" companies/courses/jobs out there in the private sector playing on peoples fear of injury and public liability. They usually have fancy titles like "EMT" or "Medic" but are officially not any more than a first aider. They often drive around to events of to places of employment in ambulances, complete with lights and sirens, but it is a purely a PR thing. They are most certainly not allowed to transport pts.

Then there are _slightly_ more reputable transport companies, but it is a very different landscape than in the states, where IFT and 911 have interchangeable personnel. These companies are nothing more than ambulance shaped taxis driven by first aiders. They are not considered to be "in EMS", there is no way for them to become part of "the ambulance service" "(state mandated emergency service) without a degree. 000 (911) response is purely by the ambulance service (except in certain mass casualty provisions) and hospitals requiring ambulances for IFT of sick people simply request the services of that which would otherwise be an emergency ambulance. Emergency IFT appears less common here than it appears to be in the states though, largely I imagine, because of our liberal ability to bypass hospitals and lack of insurance issues (woo socialised medicine  ).


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## MrBrown (Apr 28, 2010)

We have universal healthcare, the UK in comparison where doctors, nurses, ambos etc are directly employed by the NHS is socialised medicine.

I just had to clear that up coz its a peeve of mine. 

Also likewise here in NZ, people who work for the one or two private operators are really just a lot of smoke and mirrors.  They often have very little training and compete only in the "event" medical market.  They aren't allowed to actually transport patients as that is purely the domain of the 111 (911) vehicles.

Heck in Oz its what, a year long course to become a Patient Taxi Operator, sorry, Patient Transfer Officer?


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## Melclin (Apr 28, 2010)

MrBrown said:


> We have universal healthcare, the UK in comparison where doctors, nurses, ambos etc are directly employed by the NHS is socialised medicine.
> 
> I just had to clear that up coz its a peeve of mine.
> 
> ...



Universal healthcare. You are quite correct. My bad. 

The length of time varies with particular qualification. I've seen cert IIIs and cert IVs so between 6 months and a year of pretty casual technical college type education. This is for a scope that varies between AED+O2 only - through to what is known here as BLS (its what our ambulance officers had back when they were called ambulance officers), which is aspirin, nitro, neb salbutamol and methoxyflurane (pain relief).


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## MrBrown (Apr 28, 2010)

Back in the day of the Lifepak 10 and really big orange and white plano drug boxes (which I note MICA still use)


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## jjesusfreak01 (May 27, 2010)

VentMedic said:


> 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.



Wake County EMS in my area does this using something they call an Advanced Practice Paramedic. They ride in single responder vehicles (essentially cop cars with different markings) and do ALS backup on calls (they actually backup ALS trucks) as well as community paramedicine. The difference is that this is what they sign up for. They are trained above the level of standard paramedics, have a scope of practice that is significantly greater, but still get to respond to actual traumas on a regular basis.


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## medichopeful (May 27, 2010)

xgpt said:


> and an Associates takes 2 years to get. Right?



Depends on how often you go to class, but in general yes


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## EMSLaw (May 28, 2010)

jjesusfreak01 said:


> Wake County EMS in my area does this using something they call an Advanced Practice Paramedic. They ride in single responder vehicles (essentially cop cars with different markings) and do ALS backup on calls (they actually backup ALS trucks) as well as community paramedicine. The difference is that this is what they sign up for. They are trained above the level of standard paramedics, have a scope of practice that is significantly greater, but still get to respond to actual traumas on a regular basis.



See, that sounds great, but then I realized that's exactly what Paramedics in my state already do.  I'd be interested to know just how large their scope of practice actually is.


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## JPINFV (May 28, 2010)

It's my understanding that the advanced practice paramedics do essentially two things. First, they do welfare checks and other preventative measures to help keep frequent flyers (especially legitimate freq. fliers such as patients who are having trouble controlling their BGL) out of the system by providing home checks. 

The second thing they do is they respond to all of the critical calls so that there's a provider who's regularly performing the high risk/low utilization skills and to act as kinda of a director type person to make sure everything that needs to be done is being done.


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## jjesusfreak01 (May 28, 2010)

JPINFV said:


> It's my understanding that the advanced practice paramedics do essentially two things. First, they do welfare checks and other preventative measures to help keep frequent flyers (especially legitimate freq. fliers such as patients who are having trouble controlling their BGL) out of the system by providing home checks.
> 
> The second thing they do is they respond to all of the critical calls so that there's a provider who's regularly performing the high risk/low utilization skills and to act as kinda of a director type person to make sure everything that needs to be done is being done.


That is correct.

To clarify, their scope of practice is not much greater than a standard Paramedic in regards to emergency prehospital care. The expanded scope primarily refers to their community paramedicine skills.


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## EMSLaw (May 28, 2010)

JPINFV said:


> It's my understanding that the advanced practice paramedics do essentially two things. First, they do welfare checks and other preventative measures to help keep frequent flyers (especially legitimate freq. fliers such as patients who are having trouble controlling their BGL) out of the system by providing home checks.
> 
> The second thing they do is they respond to all of the critical calls so that there's a provider who's regularly performing the high risk/low utilization skills and to act as kinda of a director type person to make sure everything that needs to be done is being done.



I used to be very critical of the NJ EMS system - and I still am, to an extent.  But my opinion has been changing.  I've had some limited exposure to other systems, including all-ALS-all-the-time systems, and it seems that there are significant benefits to the tiered response model.

One of those benefits is that it keeps Paramedic skills sharp.  Because our paramedics only respond, at least in theory, to calls that involve actually sick people (for lack of a better way to put it) the use their paramedic-level skills with significantly greater frequency.  Rather than intubating once a month, they might intubate once a shift.  RSI is reasonably common.

That's not to say the system is perfect, but its the same sort of benefit that the few advanced practice medics see in Wake County. 

But for the most significantly high-risk skills, the problem is that there simply isn't frequent call for them.  How many crics can an average medic expect to perform in a /career/?  In an entire county, there might be one or two cases where that sort of intervention is justified in a given year.  Even an advanced paramedic won't be able to keep up on those skills.  

The community health aspects of it are interesting, though, and something we really don't do.  It's a change in the role of EMS from emergency-based to something else, but that might not be a bad thing.


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## jjesusfreak01 (May 28, 2010)

My personal opinion is that systems should be placing basics with medics. I know that this is becoming increasingly popular for a few reasons, one being that it is cheaper than running dual medic rigs. A second is that it avoids problems of command structure on calls. A downside will be that the medics will end up treating a lot of BLS patients. I know that won't do anything to keep their advanced skills sharp, but then again, in the smaller EMS systems that have a limited geographic region, you need the medics around for the ALS calls. Another obvious downside is that it will put the basics in the driver's seat for most calls.

I think the greatest benefit though of pairing medics and basics is that it will give the basics a more experienced on the job teacher, and moreover, will also give them a much better starting point if they do go on to be medics. 

Any thoughts?


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## JPINFV (May 28, 2010)

EMSLaw said:


> I used to be very critical of the NJ EMS system - and I still am, to an extent.  But my opinion has been changing.  I've had some limited exposure to other systems, including all-ALS-all-the-time systems, and it seems that there are significant benefits to the tiered response model.
> 
> One of those benefits is that it keeps Paramedic skills sharp.  Because our paramedics only respond, at least in theory, to calls that involve actually sick people (for lack of a better way to put it) the use their paramedic-level skills with significantly greater frequency.  Rather than intubating once a month, they might intubate once a shift.  RSI is reasonably common.
> 
> That's not to say the system is perfect, but its the same sort of benefit that the few advanced practice medics see in Wake County.




Here's the problem with US EMS. Yes, there's a handful of low use, high risk benefit procedures that when you need it, you need it and it's important to have at least someone available to respond on calls where there's an increased incidence of the procedure being performed. However, what about all of the other bread and butter interventions paramedic level interventions? Converting SVT? Albuterol treatments? Narcotics? Narcan? Fluids (i.e. sepsis)? The list goes on with interventions that are more often and much less dangerous than crics. I think when the "paramedic oversaturation" arguments are thrown around in truly unsaturated systems (i.e. not having the fire department throw several paramedics on every apparatus, but all ambulances having paramedics) that the tendency to look just at the high risk interventions and not all of the other interventions.


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## EMSLaw (May 28, 2010)

JPINFV said:


> Here's the problem with US EMS. Yes, there's a handful of low use, high risk benefit procedures that when you need it, you need it and it's important to have at least someone available to respond on calls where there's an increased incidence of the procedure being performed. However, what about all of the other bread and butter interventions paramedic level interventions? Converting SVT? Albuterol treatments? Narcotics? Narcan? Fluids (i.e. sepsis)? The list goes on with interventions that are more often and much less dangerous than crics. I think when the "paramedic oversaturation" arguments are thrown around in truly unsaturated systems (i.e. not having the fire department throw several paramedics on every apparatus, but all ambulances having paramedics) that the tendency to look just at the high risk interventions and not all of the other interventions.



I think that was my point, though.  Paramedics, as far as I can see, get ample opportunity to practice their bread and butter paramedic-level skills.  While not every ALS call requires intervention, enough of them do, and are spread among the relatively few paramedic rigs that they stay in practice.  

Is there really a benefit to having a paramedic on every ambulance?  We get into a lot of shouting matches that usually devolve into "Every patient deserves an ALS assessment" and "EMT-Bs are undereducated/stupid/dangerous."  I'd need to see some solid evidence as to the patient outcomes to make a determination either way.


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