# Professions in prehospital care



## Foxbat (Apr 3, 2009)

Other than EMTs and paramedics, what are the other healthcare providers that work in prehospital environment in the US?
Of course I know there are RNs in flight services and some on critical care trucks, but how many are working for 911 services? What is their job like - requirements (ER experience?), full-time or part-time, scope of practice, salaries? Any other providers - RTs, PAs?


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## firecoins (Apr 4, 2009)

there aren't any other professions pre hospital.  You got the flight nurses.  Occasionally MDs/DOs have fly cars or ride the ambulance.


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## JPINFV (Apr 4, 2009)

Outside of RNs and RTs in critical care transports and RNs on HEMS, essentially none. There are a few states that certify prehospital RNs and PAs though.


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## EMTinNEPA (Apr 4, 2009)

Prehospital practitioners recognized in Pennsylvania...

First Responders
EMTs
EMT-Ps
PHRNs
Physicians

Coming soon: PHPAs (Pre-Hospital Physicians Assistants) and CCEMT-Ps (Critical Care Paramedics)


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## VentMedic (Apr 4, 2009)

double post


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## VentMedic (Apr 4, 2009)

There are now at least 5 HEMS that use RRTs in an RN/RRT configuration.

Several HEMS use RN/RN only. 

Ex.
http://www.nwmedstar.org/Sub.aspx?id=392&linkidentifier=id&itemid=392

RRTs can easily obtain the Paramedic cert if they desire through several community colleges by taking just the sections that pertain to prehospital. With some ride time on an ALS ambulance, it may take less than 200 "hours" for both the EMT and the EMT(P) certs. But, most will just use it as proof of acquiring more knowledge or training (like PALS or ACLS) and will not use the Paramedic as a working license since the RRT's scope will exceed the Paramedics in most states. 

Several states allow PAs, RNs and even dentists to challenge the Paramedic exam. But, on a Flight team, an RN will work usually under his/her nursing license which is usually broader than the Paramedic. 

PAs would be limiting themselves in salary and scope if they just worked as a Paramedic. They would not be utilized to their best possible benefit to the patient. However, their expertise is welcomed (and reimbursed) in EDs, clinics and transports requiring specialized care.

http://www.aapa.org/gandp/issuebrief/emergency.pdf

Society for Emergency Medicine PAs
http://www.sempa.org/

A few states do have a specific certification for Prehospital RNs (PHRN or MICN). 


Examples of states with prehospital RNs:
AZ
http://www.azbn.gov/documents/advisory_opinion/AO%20Prehospital%20Nursing.pdf

PA
http://www.emsi.org/documents/phrn-application-process.pdf

IL
http://www.ilga.gov/commission/jcar/admincode/077/07700515sections.html

CA uses their MICNs in a variety of different way for EMS as well as CCT.
ex.
http://www.sonoma-county.org/cvrems/resources/pdf/policy/st28_liaison.pdf

*Specialty Transport Teams:*
Over 70% of the NICU(neonatal transports are done RN/RRT with the remaining as RN/NNP or RN/RN.

American Academy of Pediatrics database. AAP also provides the guidelines for out of hospital transport of neo/peds.
https://www.aap.org/sections/transmed/DatabaseTM.pdf

Examples of Specialty team configurations in the northwest.
http://egov.oregon.gov/DHS/ph/ems/airmed/2008Specialtyfinal726.pdf

Florida's requirements for neonatal transport
http://www.doh.state.fl.us/cms/RPICC/TransportStandards.pdf



*Highly specialized teams*:

*ECMO*

A 16-Year Neonatal/Pediatric Extracorporeal Membrane Oxygenation Transport Experience 
http://pediatrics.aappublications.org/cgi/content/full/109/2/189

Children's Hospital of Wisconsin
http://www.chw.org/display/PPF/DocID/21276/router.asp

http://www.chw.org/display/PPF/DocID/30684/router.asp

Arkansas Children's Hospital
What is ECMO?
http://www.archildrens.org/medical_services/ecmo/what_is_ecmo.asp

http://www.archildrens.org/medical_services/transport/

http://www.archildrens.org/medical_services/transport/angel_one_staff.asp

http://www.archildrens.org/medical_services/physicians/arranging_transport.asp

More specialty:
Florida Flight 1 (RN/RRT - cardiac)
http://content.floridahospital.org/services/floridaflight1/index.htm

Airmed International (RN/RRT - travels around the world)
http://www.airmed.com/why-airmed/medical-staffing.cfm

http://www.airmed.com/our-services/medical-capabilities.cfm

Airbore Critical Care
http://www.airbornecriticalcare.com/flightteams.html


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## Foxbat (May 1, 2009)

So basically, if I become PHPA or PHRN, I will either do paramedic's job for paramedic's salary, work at a hospital, work on a helicopter, or do interfacility transports as a PA/RN?
There is no way of working for a ground 911 service as RN (except CA) or PA?


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## Ridryder911 (May 1, 2009)

Foxbat said:


> So basically, if I become PHPA or PHRN, I will either do paramedic's job for paramedic's salary, work at a hospital, work on a helicopter, or do interfacility transports as a PA/RN?
> There is no way of working for a ground 911 service as RN (except CA) or PA?



Pretty much, amazing huh? Two different totally professions. Kinda like putting a Chef in auto garage and a mechanic in a kitchen. 

No where in either of their scope of primary education are they taught to function within a prehospital setting. It is not that they could not modify some alike a Paramedic to their setting, it is not their primary role. 

Remember, emergencies do not usually pay. Main reason you will not see PA-C  in EMS is because they are not educated to do so, their focus is mainly upon clinic type setting. The medical model uses a far more reach of diagnostic tools and the needed time. Lab, x-ray, etc is utilized to make a diagnosis. 

R/r 911


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## VentMedic (May 1, 2009)

Ridryder911 said:


> No where in either of their scope of primary education are they taught to function within a prehospital setting. It is not that they could not modify some alike a Paramedic to their setting, it is not their primary role.
> 
> Remember, emergencies do not usually pay. Main reason you will not see PA-C in EMS is because they are not educated to do so, their focus is mainly upon clinic type setting. The medical model uses a far more reach of diagnostic tools and the needed time. Lab, x-ray, etc is utilized to make a diagnosis.
> 
> R/r 911


 
Rid, did you read the additional education requirements for PHRN?  If you take away the very basic A&P and pharmacology of the Paramedic program, you only have a few hours that differ from an RN whose education is at a higher level with the college classes.   And, in many Paramedic programs, the students are get very little intubationor or IV experience during the clinicals. As well the clinicals are not very well structured for patient contact.

This makes perfect sense to have a program like this especially for RNs that work HEMS.   In Florida and California where RNs are used, all they have to do now is challenge the test.  I am all for at least an extra 100-200 hours of additional education and ride time for the RNs.  

RNs have been responding to emergencies quite well in HEMS for many years.


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## mycrofft (May 1, 2009)

*Don't forget incidental prehospital health professionals*

The "incidentals" (my invention) are those of us with a medical / nursing profession but since we work in a medical setting we occasionally have to handle an emergency with the expectation that, since we are RN's or whatever, we know how to manage and run an emergency, possibly better than a EMT or paramed. 

I suggested to my superiors that our nurses get additional training or that certification be required on hiring, and they said "Nurses know all of that already".:blush:


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## VentMedic (May 1, 2009)

mycrofft said:


> The "incidentals" (my invention) are those of us with a medical / nursing profession but since we work in a medical setting we occasionally have to handle an emergency with the expectation that, since we are RN's or whatever, we know how to manage and run an emergency, possibly better than a EMT or paramed.
> 
> I suggested to my superiors that our nurses get additional training or that certification be required on hiring, and they said "Nurses know all of that already".:blush:


 
But then, most nurses know their education is only beginning and that the 2 or 4 year degree plus well over 1200 hours of clinicals is just the beginning. However, they have a better foundation than many Paramedics to prepare them for whatever specialty they choose and that may include some area of emergency medicine. If they additional "skills" training such as intubation and extracation, they may already have the science to know why. They don't all come out of school with the cockiness of feeling they know it all because of a few skills as some Paramedics do. 

Nurses also become masters of moving people. Do you know how many in house transports or even IFTs a nurse may go on in one day with a patient on may med drips, ventilator and all sorts of accessories from halos to other ortho stuff. Log rolling? Nothing new there either. And, since the BVM is being emphasized in CPR and ACLS now, even the nurses who aren't part of code or rapid response teams know how to use one to some extent. 

Even for flight, it doesn't take a nurse long to get up to speed with the EMS side of things. However, it may take a Paramedic a long time to feel comfortable with the IFT role of an advanced team especially if they only had the minimum votech hours. It is also sometimes frustrating for an RN on an RN/Paramedic transport team because they know they may be held to a higher standard than the Paramedic and may also be doing much of the work. 

Of course, not that many nurses want to do EMS and those that do will research what is involved. As it is now, any nurse that wants to be a FF in Florida or CA can just challenge the Paramedic exam and apply (along with a few thousand other Paramedics). In Florida, the pay and benefits are better as a FF than a nurse.


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## daedalus (May 3, 2009)

VentMedic said:


> Rid, did you read the additional education requirements for PHRN?  If you take away the very basic A&P and pharmacology of the Paramedic program, you only have a few hours that differ from an RN whose education is at a higher level with the college classes.   And, in many Paramedic programs, the students are get very little intubationor or IV experience during the clinicals. As well the clinicals are not very well structured for patient contact.
> 
> This makes perfect sense to have a program like this especially for RNs that work HEMS.   In Florida and California where RNs are used, all they have to do now is challenge the test.  I am all for at least an extra 100-200 hours of additional education and ride time for the RNs.
> 
> RNs have been responding to emergencies quite well in HEMS for many years.


There are no RNs working ground 911 in California, and very few cases of RNs actually becoming Paramedics through the loophole you are talking about. For an RN to become a paramedic, s/he would have to demonstrate to the EMS agency that her program taught to the objectives of the national curriculum for paramedics. I know of exactly zero nursing schools that do such. They would also have to have the psychomotor skills of back-boarding and intubation and the like taught to them, and demonstrate proof of this. My own mother openly admits that RNs almost never intubate in any setting, and that they are not taught a thing about it. I have no idea who is going to teach them to do so and provide them with documentation of such that is acceptable to Cal EMS. As well, I highly doubt there is an employer who will hire you even if you are did somehow become a paramedic by using your RN cert and I doubt if my area's medical director would even accredit you to practice. It just doesn't happen. 

RNs and Paramedics have two very different jobs to do. One should not be allowed to become the other very easily. Nurses are taught Nursing Theory, which includes "nursing diagnosis" and long term care of the "client". Paramedics are taught to the "medical model" (according to Dr. Bledsoe) and are trained in differential diagnosis and initial management. If you have ever seen the nursing student's educational process and their "care plans" you would no there is no way to put an RN on an EMS unit. That said, there is no way to put a medic on even a med surg floor.


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## VentMedic (May 3, 2009)

daedalus said:


> There are no RNs working ground 911 in California, and very few cases of RNs actually becoming Paramedics through the loophole you are talking about. For an RN to become a paramedic, s/he would have to demonstrate to the EMS agency that her program taught to the objectives of the national curriculum for paramedics. I know of exactly zero nursing schools that do such. They would also have to have the psychomotor skills of back-boarding and intubation and the like taught to them, and demonstrate proof of this. My own mother openly admits that *RNs almost never intubate in any setting,* and that* they are not taught a thing about it.* I have no idea who is going to teach them to do so and provide them with documentation of such that is acceptable to Cal EMS. As well, I highly doubt there is an employer who will hire you even if you are did somehow become a *paramedic by using your RN cert and I doubt if my area's medical director would even accredit you to practice. It just doesn't happen. *


 
Backboarding? You do know that some hospitals do all sorts of spinal surgeries which requires nurses to move the patient in a variety of cautious ways besides just with a backboard. 

What other roles do MICNs play in the county EMS systems? Their education levels are put to better use than on a ground ambulance with very limited protocols. 

Not that there is much pride to it but the MICNs also teach the LAFD flight team.

How many flight or specialty nurses do you know?  Do you know how extensive their protocols and "skills" lists are?   Do you know how many emergencies they respond to and the level of expertise it takes to get a severely injured patient a long distance back to the appropriate hospital or to stabilize a patient at scene that the ground EMS can not? 

Since EMS in California is primarily Fire Based, the RN would get the Paramedic patch and become a Fire Fighter. You may never know they were an RN. 

Yes, the state of California has made this acceptable in their statutes. They might actually raise the standard in the FDs. However, I would see it as a waste of a good medical education but if they want to be a fire paramedic, so be it. I do know of several fire medics that actually were RNs first but switched for the hours, benefits and security of the FD. This is in both FL and CA. 

Some RNs, usually the MICNs, do challenge the Paramedic exam just to see what all the fuss is about since so many Paramedics complain about how hard it is. Few have any desire to actually work as a Paramedic and most will not get their state license.

It is more advantageous for the RN or RRT (in some states) to remain with that title and not work under a Paramedic license. Again, you can look at CA and how limited the Paramedics scope of practice is even on CCT. But then, some RNs may actually welcome only having 21 meds to know in the entire scope instead of 210+ for just one shift. 

In CA, there is also little opportunity for Paramedics in HEMS except for the LAFD and medicine is not really their focus or strong point. But then, there is little to no opportunity for them in CCT either. In FL, many of the Paramedics trying to pass themselves off as "CCEMT-Ps" shouldn't be anywhere near a CCT. But unlike most nurses, some Paramedics don't know what they don't know. 

Again, nurses know that their education is JUST a foundation and the beginning of their career. They will receive more education and training in their specialization. If your mother has only been a med-surg RN, then she may not have known all of the opportunities out there for nurses. Once one has a good educational foundation, it is not much of a stretch to gain  "skills". If it is to be part of their job description, an RN can get into an OR, NICU, PICU, ICU or ED for intubation training easier than most Paramedic students. Our flight and specialty transport nurses have no problem getting at least 25 live intubations before going at it on their own as well as maintaining their "skills".  As well, L&D nurses also have not problem finding babies to intubate. 

If a nurse works in the ICU setting, he/she had better know a lot about intubation even if they are not doing the actual "skill". They are the ones pushing the RSI or whatever meds and assisting the RRT or MD. Our ICU nurses are very well educated and trained for working in a critical care environment. No, we would not ask or expect a med-surg nurse to do the same things. 



> Paramedics are taught to the "medical model" (according to Dr. Bledsoe) and are trained in differential diagnosis and initial management.


 
Nurses also make these same decisions in the ICUs, Rapid Response Teams and code teams. Even med-surg nurses must make certain differential diagnosis to initiate care. They can not be put on hold or wait 2 hours for a doctor to call back. They are trained to intiate whatever care is necessary or at least identify the need for a Rapid Response team. They also must be educated to the many labs or diagnostics available to point them in the correct direction since a higher level of care and expectation is on their judgement. Paramedics must make a differential diagnosis in order to figure out which protocol or recipe to choose. If you look at the majority of Paramedic protocols, almost all start with the same initial treatments. By the time the Paramedic gets to the fork in the road, med control can advise the Paramedic on the rest of the treatment.


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## reaper (May 3, 2009)

Vent,

Did FL change their licensing? Used to be that an RN had to have their EMT-B, then they could challenge the state test for medic.


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## daedalus (May 3, 2009)

VentMedic said:


> Snipped for brevity



I do not think that we disagree, and California is certainly never the example setting state for EMS. In an ideal world, and how I like to think of the a Paramedic, RNs and medics would be colleagues with two separate jobs to do. LAFD is a poor example of anything EMS, as their medical director is the biggest mistake medical education has ever turned out. Of course RNs would be in a position to be able to teach LAFD medics. 

In my case, when I complete the paramedic program I will have the same prerequisite education as ADN level RNs in California. If everybody had the same education, I find it difficult to support the concept of MICNs. This of course is a pipe dream, and why I am going to progress to higher levels of medical education very soon after paramedic school.


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## mycrofft (May 3, 2009)

*Don't blanket qualify RN's*

Many are "play it safe" specialists without the spirit to do prehospital EMS.


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## VentMedic (May 3, 2009)

reaper said:


> Vent,
> 
> Did FL change their licensing? Used to be that an RN had to have their EMT-B, then they could challenge the state test for medic.


 
Yes, they still have the EMT-B as a requirement. If we get a good flight RN candidate from another state, we refer him/her to a two week mill for the EMT-B and then the Paramedic test. Florida still has the old rule that scene response requires at least an EMT cert. Since everyone on our flight team goes through additional training that usually exceeds the "hours" of training for a Paramedic, it would a little redundant to have RNs with BSNs sit through a paramedic mill with students who have absolutely no education and memorize a few algorithms. This is why I believe the PHRN would be a better alternative. They would not be starting out with learning the knee cap is called a patella but rather would be building from their nursing foundation.

daedalus


> In my case, when I complete the paramedic program I will have the same prerequisite education as ADN level RNs in California. If everybody had the same education, I find it difficult to support the concept of MICNs. This of course is a pipe dream, and why I am going to progress to higher levels of medical education very soon after paramedic school.


 
However, once you get your Paramedic in CA, you will have to find a county that supports the Paramedic for EMS unless you want to be part of the FD.

The concept of the MICN is not difficult to understand. As it is now in CA, the Paramedic is extremely limited and can not provide much care on an IFT or even some ALS patients on scene if you want to compare with ALS in other states. The MICN also makes for a good liason between EMS and the hospitals which is why the counties utilize them. That and the fact it is difficult to find Paramedics with higher education in CA. 



> *Don't blanket qualify RN's*
> Many are "play it safe" specialists without the spirit to do prehospital EMS.


 
READ my posts. 

I did NOT blanket qualify RNs and you shouldn't judge RNs by just those you work with. Not all are burnt out and of no use to patient care. 

Yes, many nurses do want to play it safe because they KNOW their limitations. Those in EMS sometimes do not KNOW what they DON'T KNOW. Some paramedics are very eager to take on a ventilator or IABP just because "it looks simple". Many still have a skills mentality and forget there is some education involved that should accompany the technology. You are not going to find many RNs accepting responsibility for an IABP if they have not had the proper training for it but you usually won't find many Paramedics refusing one even if they have never seen one before. You just have to tell them where the on/off switch is and they are good to go...according to some. The same mentality applies for some when they want the responsibility of RSI just because some other agency is doing it rather than presenting an argument for the patient care. I have better words to describe that other than "spirit". 

Quotes from my posts:


> Again, nurses know that their education is JUST a foundation and the beginning of their career. They will receive more education and training in their specialization.


 


> How many flight or specialty nurses do you know? Do you know how extensive their protocols and "skills" lists are? Do you know how many emergencies they respond to and the level of expertise it takes to get a severely injured patient a long distance back to the appropriate hospital or to stabilize a patient at scene that the ground EMS can not?


 
Not "all" nurses want to work on an ambulance as part of a flight, CCT or specialty team. Yet, some hospitals still put RNs in the back of an ambulance regardless of desire or training for a CCT because they are at least more qualified in many of the patient care aspects for that situation than the Paramedic. 

Nurses working in the ED also initate care for many patients that are brought into the ED by POV. Actually very few of the really sick patients come by ambulance. Many families do bypass that expensive bill or arguments about which hospital the ambulance will take the patient to and just drive their loved ones to the hospital.


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## Ridryder911 (May 3, 2009)

VentMedic said:


> Rid, did you read the additional education requirements for PHRN?  If you take away the very basic A&P and pharmacology of the Paramedic program, you only have a few hours that differ from an RN whose education is at a higher level with the college classes.   And, in many Paramedic programs, the students are get very little intubationor or IV experience during the clinicals. As well the clinicals are not very well structured for patient contact.
> 
> This makes perfect sense to have a program like this especially for RNs that work HEMS.   In Florida and California where RNs are used, all they have to do now is challenge the test.  I am all for at least an extra 100-200 hours of additional education and ride time for the RNs.
> 
> RNs have been responding to emergencies quite well in HEMS for many years.



At this time there is a major shake up in the HEMS business as the two oldest HEMS (>25 years) have recently fired or removed many of their personal to the helicopter vendor. Both were from the largest hospitals in the state, but alas they seen savings at this economic time.The crews are now able to possible be rehired or they will be hiring totally new personnel. I can say it has shaken the flight community as who is next. 

Yes, I do recognize that there are well educated nurses that work in CCU/ICU settings. As well, I also recognize that many of these depend upon having an ancillary group of other allied health care workers to assist them. Many become unaware on how to place electrodes for XII lead, because they have become accustomed to an ECG tech. The same as for vent care and settings because of the speciality provided by the respiratory therapist. 

Ask many of these to mix up and prepare medications and you will get the look of a deer looking into the headlight expression. They are used to pharmacy preparing and even typing the exact drip rate. 

I was a nurse educator that attempted to "bridge" those entering hospital to prehospital. I can assure you that it was that many nurses are not able to successfully make the switch. Placing a person in the stimuli of a small cabin or out in the middle of a highway, a two bed ER with no lab capability is much different than they have became accustomed to. 

Recently I was contracted to assist in preparing many of these so called "speciality nurses" for the NREMT skills portion. They were from various states that had taken an accelerated Paramedic course or "tested out" and I am sorry to say, they are not prepared for the field or prehospital setting. 

Yes, they will be able to pass the simplistic test and then will be a card carrying member, but realistically they are not ready. The lack the understanding to trouble shoot and make those type of critical thinking skills needed outside the clinical setting they are used to. Yes, they may have the "theory" but in a crisis setting under extreme settings, may lack the confidence, the autonomy that is needed. This is the material that should be enforced in a good educated Paramedic program with rigorous simulated scenarios and then progressive clinical settings. 

It is not they are "bad" nurses, far from it. I am sure in their own clinical environment they are extremely gifted. Yet, we need to recognize that there is much difference from a scene flight, rural ED and that of a well equipped ICU. Patients in a well lighted setting with triple lumens, arterial lines, foleys that aid in the determination of the diagnosis is much different than a patient entrapped in a car or a ED that the highest level of care is being provided by a newly graduated P.A.

Yes, I have seen nurses perform these roles for years; as well as seen some pretty crappy care provided by some of them. It is not that they cannot do it, it is they should be prepared as well receive the additional education needed; just alike a Paramedic wanting to enter the Nursing or any other health profession. Similarities yes, but not totally interchangeable. It takes a well grounded nurse to be able to make the change. 

R/r 911


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## VentMedic (May 3, 2009)

Ridryder911 said:


> At this time there is a major shake up in the HEMS business as the two oldest HEMS (>25 years) have recently fired or removed many of their personal to the helicopter vendor. Both were from the largest hospitals in the state, but alas they seen savings at this economic time.The crews are now able to possible be rehired or they will be hiring totally new personnel. I can say it has shaken the flight community as who is next.


The HEMS in Oklahoma had some serious problems primarily due to one or two companies. Don't blanket company. Some have paid attention the mistakes made in your state for many years. 


Ridryder911 said:


> Yes, I do recognize that there are well educated nurses that work in CCU/ICU settings. As well, I also recognize that many of these depend upon having an ancillary group of other allied health care workers to assist them. Many become unaware on how to place electrodes for XII lead, because they have become accustomed to an ECG tech. The same as for vent care and settings because of the specialty provided by the respiratory therapist.
> 
> Ask many of these to mix up and prepare medications and you will get the look of a deer looking into the headlight expression. They are used to pharmacy preparing and even typing the exact drip rate.


 
If you have worked in the hospital, you know why some medications are no longer being mixed at the beside. It is not because of incompetent nurses. 

Yes, technology has advanced to where specialists such as RRTs are required to be also at bedside. However, that does not mean an RN is not aware of the equipment his/her patient is attached to. I am so sorry the ICU nurses in Oklahoma do not know anything about a 12-lead EKG, but then that may also be due to poor nurse educators who are divided in their support of Paramedics and do not do justice to the nursing profession. As for as the ventilators in the ICU, you have never had anything positive to say about the Oklahoma RTs in your area so I can not imagine what your ICUs are like if neither the RNs or RTs know much or can do anything. 



Ridryder911 said:


> I was a nurse educator that attempted to "bridge" those entering hospital to prehospital. I can assure you that it was that many nurses are not able to successfully make the switch. Placing a person in the stimuli of a small cabin or out in the middle of a highway, a two bed ER with no lab capability is much different than they have became accustomed to.


Unless someone has a desire to be in that profession, they should be made to go into it. What type of "bridge" did you provide? Creighton and others have been very successful "bridging" RNs as have the PHRN programs. They are well structured. RNs and RRTs do successfully go through these programs and get just the education/training needed for a Paramedic cert. Could your attitude to where you already thought the RNs were not cut out for prehospital have been part of it? 

Rid, you said yourself you had a difficult time going back into the hospital environment. Why would you want to be a nurse educator at something you are not comfortable with. Could it be because the nurse educators in your area are not qualified and that is the reason the nurses are "failing".


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## VentMedic (May 3, 2009)

Ridryder911 said:


> Recently I was contracted to assist in preparing many of these so called "specialty nurses" for the NREMT skills portion. They were from various states that had taken an accelerated Paramedic course or "tested out" and I am sorry to say, they are not prepared for the field or prehospital setting.


 
Contracted? For what purpose? Did they even know what they were being tested for? Why would an NICU or PICU RN want to take the NREMT? Again, this may reflect on your teaching methods and your preconceived notion that the RNs will fail. RNs have been taking BTLS, PHTLS and the PDQ EMT classes for years and have done very well. Geez, we can tell someone off the street with absolutely no medical education or training to be an EMT-B in just 110 hours. Surely, a qualified instructor can teach RNs how to bandage, splint, control bleeding and do CPR. They have been doing that for years already in the hospital. I don't understand why you think that someone with RN behind their name automatically makes them incapable of easily learning first-aid skills. Why insult the intelligence of an RN by making them go through a class that is geared toward those with absolutely no medical training?

I could also give examples of sitting through ACLS and PALS classes taught by Paramedics who are instructing ICU, ED and PICU RNs who do have experience in working actual codes and pediatrics patients. All I can feel is embarrassment for the Paramedics who should be teaching something they themselves may only have book knowledge and very little experience at. 

We also now have the examples making headlines where some in the profession have to cheat on their NREMT exam to pass and fail miserably when given a test of skills at both levels. What if more agencies tested the competency of their Paramedics and EMTs? What would be the results? This has been a failed area in EMS as many do not maintain good QA/QI records. Thus, many "skills" are now being questioned. 

Nurses get tested on their knowledge every year as a hospital requirement. Maybe if more RNs were to take an interest in prehospital medicine, competency expectations would become the norm. 




Ridryder911 said:


> Yes, they will be able to pass the simplistic test and then will be a card carrying member, but realistically they are not ready. The lack the understanding to trouble shoot and make those type of critical thinking skills needed outside the clinical setting they are used to. Yes, they may have the "theory" but in a crisis setting under extreme settings, may lack the confidence, the autonomy that is needed. This is the material that should be enforced in a good educated Paramedic program with rigorous simulated scenarios and then progressive clinical settings.


 
Critical thinking? You just described EMT-B skills. Do you honestly think ICU RNs do not have critical thinking skills? Specialty RNs including HEMS, NICU, PICU and CVICU have flown to many parts of the country and other countries to bring back sick patients. They rely on their critical thinks skills to do this since they do not have a doctor with them. They do have autonomy. Do you realize how many specialty RNs there are in this country? How you even worked in a good ICU where RNs are required to think? 



Ridryder911 said:


> It is not they are "bad" nurses, far from it. I am sure in their own clinical environment they are extremely gifted. Yet, we need to recognize that there is much difference from a scene flight, rural ED and that of a well equipped ICU. Patients in a well lighted setting with triple lumens, arterial lines, foleys that aid in the determination of the diagnosis is much different than a patient entrapped in a car or a ED that the highest level of care is being provided by a newly graduated P.A.


 
You really are down on every profession but the Paramedic. You have not finished NP or PA school. You are not working as a nurse but use the title. If you use it as a show of accomplishment, that is good. But if you are using it to say I'm one of you even when you are not working in that profession, you do the title an disservice.   You are trying to "educate" and "judge" others with this attitude?



Ridryder911 said:


> Yes, I have seen nurses perform these roles for years; as well as seen some pretty crappy care provided by some of them. It is not that they cannot do it, it is they should be prepared as well receive the additional education needed; just alike a Paramedic wanting to enter the Nursing or any other health profession. Similarities yes, *but not totally interchangeable*. *It takes a well grounded nurse to be able to make the change. *


 
I didn't say they were interchangable. Why do you think I a for the PHRN and its education requirements?

Just how much preparation does a 500 -1000 hour Paramedic program prepare someone? Dissect the Paramedic education and training that is taught now to the majority. Most of the classroom stuff is a mere overview, and it is a shame to even call it that, of what an RN gets for pharmacology and A&P. Pathophyisology? There is little not or no explanations about infection control. The clinicals are hodge podge at best in some places. Even for "skills", the minimum requirements vary. Some may do all of their intubation check offs on manikins and not on the living. For some paramedic students they need contact with 40 "ALS" patients to pass their clinicals. This can include just starting an IV and attaching a cardiac monitor. RNs and RRTs that do a bridge type program will get just the unique prehospital training. They do not need basic A&P in a classroom full of people who have never touched a patient before. 

Again, you seem to think someone with RN and a degree behind their name (and probably female) is not capable of learning something new? At least they do know what patient care is about. Everyday we take people who have been working at Burger King or who what to be a FF and turn them into Paramedics in just a few hours. Some go on to become very good Paramedics and some don't. Many get surprised that they have to do actual patient care and that is usually found out after they finish school. 

Rid, stick to EMS since that is what you have chosen to do. You do have a working knowledge of that. You may no longer be effective as an RN and your attitude towards RNs, NPs, PAs and RRTs reflects your bias. You may no longer be able to look at all the other professions objectively since you are not working in their world. 

I have attempted to improve on some things in EMS but until some realize there is a problem with only 500 - 1000 hours of training with lax medical oversight, which some mistake for autonomy, little will improve. It does no good to criticize other professions which have grown. If nursing wanted EMS, they would already have it. Rid, your job is safe in EMS. If you can no longer be an impartial educator or leave the attitude against nurses at the door, you should not be teaching nurses in anyway. You may become a hindrance to their learning process because you seem to believe they will fail just because they are RNs regardless of what addtional training they have.


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## VentMedic (May 3, 2009)

VentMedic said:


> Unless someone has a desire to be in that profession, they should be made to go into it.


 
Typo from above post. They should not be made to go into it.

In other words in reference to Rid's comments, just because a nurse is a nurse does not mean they should be required to train for working on an ambulance. However, there are people who may have wanted to be both a Paramedic and an RN but choose to get the college BSN education out of the way first. Why criticize those who are RNs that do have an active interest in EMS? They make great liasons for the professions to bridge the hospital and prehospital communication gaps. Isolating the EMS profession and becoming so opinionated or threatened by some with education that might be different from your own just reflects poorly on yourself and profession. Both RNs and RRTs are capable of easily obtaining the necessary skills and education to become successful in some aspect of prehospital. It is jsut that their medical education and knowledge are put to better use on Specialty, CCT and Flight teams rather than on a fire truck.


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## Ridryder911 (May 3, 2009)

I never said that nurses could not be educated upon EMS but just because they are a critical care nurse does not automatically qualify them to work in EMS or HEMS. 

The students and nurses I described earlier as teaching was NOT from Oklahoma but from actually from large hospitals of a different states that was attempting to develop a new flight teams. Guess what? Some states DO require one to administer medication or even tp work on a flight team to be a licensed Paramedic or EMT so yes, they (even though they may even have a DNSc) have to have a NREMT to fulfill that requirement. Please don't lump all nurses into being naturally being suited for the field or aeromedical suited just because they have worked in an aggressive or busy unit, the same as not all Paramedics are suited for nursing or respiratory therapy. 

I find it offensive that you would question my lack of experience. Although my state may be lacking in some areas of medicine does not mean they do not provide competent ICU/ CCU care because it does not border an ocean or several hundred bed hospital. Just because there maybe specific areas that one can be considered behind, we have some of the leading areas of research (i.e Alzheimer's disease, cardiac care). I definitely can point out areas Florida and California lack in and EMS would be one. 

Can you honestly tell me that most of the ICU nurses maintain all their skills? I am seeing more and more skills have that has become specialized and this will make the unit nurse very limited. I ask you, when was the last time you actually have seen the bed side nurse perform a XII lead or perform breathing treatments  in lieu of a tech or therapist? Again, why should they when they have such internal services? With an intensivist at the bed side, when was the last time they alone made the sole determination to elective intubate? 

Although, I may not have traveled abroad as much as you but I have worked as travel nurse in some of the "bigger areas". As I described at one time it was my job was to prepare nurses ready to work in aeronautical and prehospital setting. It was not always as an easy task as you described just because they had ICU experience. Many of them were used to relying upon lab results, hemodynamic monitoring, and other clinical findings that are not routinely provided. 

As a graduate of not just one nursing program, and as one that teaches as an adjunct in a nursing program; I can say the nursing profession does not include critical and or emergency care as part of their required curriculum. Even the NCLEX exam will never include subjects over emergency and critical care.  Each of those are described as a "speciality" areas. Nursing schools cover a broad but little details of disease processes and care. Just because someone has completed collegiate level sciences does not always make them successful in these areas of speciality. In fact the ADN program has more "hands on" and direct patient care than most BSN programs

Let's be realistic and point out that most responsible hospitals have internships for critical care nursing. Those internships alone sometimes are longer than the Paramedic or even nursing courses. It is in these areas that nurses become knowledgeable and gain expertise while obtaining clinical experience, it is NOT from the general nursing program. Again, the emphasis of nursing is psychiatric, obstetrics, medical surgical and a few other limited areas. . 

Just because some Paramedic programs lacks the integrity of producing well educated products, let us not lump all Paramedics as being poorly educated providers. In regards to clinical time, not all Paramedic program are alike as well. The one I teach at has twice the required clinical time than that of many BSN programs. We recognize that a good science foundation is required and clinical exposure is the only way to start out as a entry point. Remember, alike nursing, respiratory therapy education programs are not created equal. Alike our previous conversations. I am sorry to say; that yes you are correct. Many places in the U.S. does not place the emphasis in the educational process; and unfortunately it appears that the places you have lived or work emphasize that type of training. Alike the RT profession, as I know of RT's that attend a Career Tech setting that is associated with a two year college so they can receive their associate degree. 

It's great that Vent you have worked in such an aggressive settings. We also know as well just because of the population of those areas does not always make them being better at providing care, and saying that all "nurses"  and even those within critical care as naturally being great providers just because they work there. Sadly, I say I have seen some of the larger hospitals staff as being burned out and then driven out due to high acuity and high patient ratios. 

I left nursing full time for many reasons after 20+ years. Yes, I work part time as a RN (in fact more than some work and call themselves a full time nurse). The nice thing is I can re-enter full time at any time I choose and almost any area. Ironically, I just hired another RN/Paramedic this week that too has had their fill of the "nursing profession" and returning to the field full time and going to nursing flex time. No is it not that the profession is bad one, but the current philosophy being placed upon the staffing and as well the responsibility is becoming more dangerous both to the patient and the professional nurse.

If you must review my professional choices of not continuing onward to P.A. and NP were personal. I was not aware I would have to disclose them on a public forum. The main reason for me not to finish my NP was not due to lack of enjoyment of nursing but due to some new recent health problems and recognizing that I would not be able to keep up to fulfill the demands physically. As well I have seen the physician extender not being appreciated and recognized professionally & monetary for the level of responsibility they assume. It was definitely not academically nor the lack of wanting to provide better clinical care. 

In regards to sexism; I am surprised and say I find that statement shocking and offensive. No where have I have even referred to the gender of the provider. I will say that I have found the nursing profession as being much more discriminatory than EMS. As I have been often told that "men" have no reason to enter their" profession and that "men" do not understanding the "calling" of the nurse; so please let's not even start that subject. I know of many well educated. clinically experience RN's that were men and was passed by or placed on a night time shift all because of their appendages. Tell me about professional gender discrimination when your gender is < than 10 % of the profession.

You describe "_Nurses get tested on their knowledge every year as a hospital requirement"_. Which is correct, every hopsital that has been JCAHO certified has such requirements. I too can assure you many times it can be comparible to the same as the same as EMT's getting recertified. As I described I have worked as an RN in large hospitals and been "blessed" or "checked" off and yes a "Magnet Status" hospital. 

As one that is both a Registered Nurse and a Paramedic, I can attest all of that work in medicine has some similarities; but at the same time they are different professions. The same as respiratory therapy and nursing are totally different professions but should not be considered the same. 

I was not bashing nor have I bashed the nursing profession. But as one, I also am quite aware of what it is and what it is not. I ask just how long have you been one? 

I am for promoting and changing within the EMS profession, not attempting of replacing it with the staff of another one. Be active in changes, be informed of the changes, promote and support advanced within the educational system that do cause positive changes. Just how much involvement are you with in your State EMS legislation, educational systems? Have you reviewed the new scope/curriculum of the Paramedic? 

Vent, I have always respected your experience, education and opinion even though I might not always agreed upon it. I will say I am really dissapointed in your offensive demeanor. 

R/r 911


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## daedalus (May 3, 2009)

Vent, I will not be working for an FD. There are some limited options in Ventura and Santa Barbara counties for private first in 911 for me until my BS is done. Than off to the bay area.



> Yes, technology has advanced to where specialists such as RRTs are required to be also at bedside. However, that does not mean an RN is not aware of the equipment his/her patient is attached to. I am so sorry the ICU nurses in Oklahoma do not know anything about a 12-lead EKG, but then that may also be due to poor nurse educators who are divided in their support of Paramedics and do not do justice to the nursing profession. As for as the ventilators in the ICU, you have never had anything positive to say about the Oklahoma RTs in your area so I can not imagine what your ICUs are like if neither the RNs or RTs know much or can do anything.


Perhaps it is a pattern around here, but I will rarely find an RN familiar with EKG recognition (expect the ones on Tele or ICU). I have seen nursing education first hand, and they will a very basic flip through on basic dysrhythmias, not enough to be making patient care decisions based on the EKG without additional education in some sort of a new grad program. And forget about twelve leads. I see where you are coming form, with respect to taking an idiot off the street and putting him through a 110 hour course and than a ~1000 hour course, vs an RN who already has a comprehensive education. However, the focus of their education is just so different. Can you imagine the controversy and the response of the ANA if paramedics tried to push their way into the hospital? Why should we been any less active in fighting for our workplace?

As rid/ryder has stated earlier, he did not finish the PA program because he felt EMS is where is heart is. I do not understand sometimes, you seem to think that being a Paramedic is innately a bad thing. What difference does it make if Rid/ryder has his RN and stays in the field, does that make him any less a provider? Why is he not "one of you"? Hospital based ancillary personnel are not superior to us in any social sense. I think it shows dedication and selflessness to our industry that he would obtain more education, and than choose to stay here to help.


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## VentMedic (May 3, 2009)

Rid,


> The students and nurses I described earlier as teaching was NOT from Oklahoma but from actually from large hospitals of a different states that was attempting to develop a new flight teams.


Rid, part of the failure of your flight teams in OK were their incohesiveness and their ability to attract just about anything by their "glamor" ads. 



> Some states DO require one to administer medication or even tp work on a flight team to be a licensed Paramedic or EMT so yes, they (even though they may even have a DNSc) have to have a NREMT to fulfill that requirement.


Did you even read any of my posts as to why I was far the PHRN?

Did you even read my reply to reaper about Florida's requirement and why I would be more for the PHRN?

Why should an RN sit through a class with others who have absolutely no A&P or even desire to be in a Paramedic program (FFs)? They should be able to have an extension of their own education in class that at least utillizes a college reading level. 



> Can you honestly tell me that most of the ICU nurses maintain all their skills? I am seeing more and more skills have that has become specialized and this will make the unit nurse very limited. I ask you, when was the last time you actually have seen the bed side nurse perform a XII lead or perform breathing treatments in lieu of a tech or therapist? Again, why should they when they have such internal services?


 
I see RNs do their own EKGs in the EDs and ICUs every day I work in some hospital in either CA or FL. As well, all the nurses give "breathing treatments" in some ED or on the floors. 

EKG and IV techs were the first to be cut over 20 years ago. Yes, RNs and RRTs do the EKGs on the floors and in the ICUs. RT departments run very slim and concentrate on cath lab, HBO, ICUs and specialty ICUs with transport. 



> We also know as well just because of the population of those areas does not always make them being better at providing care, and saying that all "nurses" and even those within critical care as naturally being great providers just because they work there. Sadly, I say I have seen some of the larger hospitals staff as being burned out and then driven out due to high acuity and high patient ratios.


 
Again Rid, READ my posts. I did not use the work "ALL NURSES" anywhere. We have very little turnover in our ICUs because we offer the RNs a chance to become well educated and give the responsibility of having many different nurse driven protocols. 



> Let's be realistic and point out that most responsible hospitals have internships for critical care nursing. *Those internships alone sometimes are longer than the Paramedic or even nursing courses*. It is in these areas that nurses become knowledgeable and gain expertise while obtaining clinical experience, it is NOT from the general nursing program. Again, the emphasis of nursing is psychiatric, obstetrics, medical surgical and a few other limited areas. .


 
Rid, READ my posts. Did I say anything about med-surg or psych nurses working in EMS?



> The one I teach at has twice the required clinical time than that of many BSN programs.


Please post the name of a Paramedic program that has over 2200 clinical hours just for future reference. 

Take away all the very basic stuff in the Paramedic program like A&P or Pharmacology oversimplified and you merely have a very few hours of a technical certificate. For clinicals, why was 200 hours waiting to start an IV or assist another nurse. Yes, some ride time is appropriate and if you had only read my posts you would have realized this with my comments about prehospital education. 



> Alike the RT profession, as I know of RT's that attend a Career Tech setting that is associated with a two year college so they can receive their associate degree.


 
Guess what? They have to. The Associates degree is mandatory for entry into the RT profession now. 




> Vent, I have always respected your experience, education and opinion even though I might not always agreed upon it. I will say I am really dissapointed in your offensive demeanor.


 
Rid, over the last 2 years I have read so many of your posts where you are everything from a fire captain to a nurse manager over whatever department we were discussing at the time. Yet, it seems you have little respect for nurses and their ability to learn. Yes, I know it can be difficult for some men to be in the nursing profession but you need to get over some of your bias and stereotyping. As well, you seem to change your attitude about NPs and PAs frequently. Thus, it is difficult to know where exactly you stand with these professionals. 

You have offended most of the professionals I work with on a daily bases either on Flight or in the hsopitals. This includes nurses, PAs, NP and RRTs. For the most part I have restrained myself with only little correction here and there. But, you have crossed the line with over generalizations about all RNs and their abilities. Your posts sound more like a frustrated nurse that doesn't fit into the hospital setting. It is too bad you do not have professional examples at your hospitals to show you what excellent and versitile care givers other professionals can be in both out of hospital and inhospital settings.


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## VentMedic (May 3, 2009)

daedalus said:


> Vent, I will not be working for an FD. There are some limited options in Ventura and Santa Barbara counties for private first in 911 for me until my BS is done. Than off to the bay area.
> 
> 
> Perhaps it is a pattern around here, but I will rarely find an RN familiar with EKG recognition (expect the ones on Tele or ICU). I have seen nursing education first hand, and they will a very basic flip through on basic dysrhythmias, not enough to be making patient care decisions based on the EKG without additional education in some sort of a new grad program. And forget about twelve leads. I see where you are coming form, with respect to taking an idiot off the street and putting him through a 110 hour course and than a ~1000 hour course, vs an RN who already has a comprehensive education. However, the focus of their education is just so different. Can you imagine the controversy and the response of the ANA if paramedics tried to push their way into the hospital? Why should we been any less active in fighting for our workplace?


 

Don't compare ALL nurses to your mother or just the few that you have seen. And, if you are judging CCT RNs by the nurse you have used in a few of your posts, you are doing CCT RNs a disservice. That nurse you have described should not be doing CCT by the situations you have described but then this is probably a private ambulance service who may hire anything if the price is right. 



daedalus said:


> As rid/ryder has stated earlier, he did not finish the PA program because he felt EMS is where is heart is. I do not understand sometimes, you seem to think that being a Paramedic is innately a bad thing. What difference does it make if Rid/ryder has his RN and stays in the field, does that make him any less a provider? Why is he not "one of you"? Hospital based ancillary personnel are not superior to us in any social sense. I think it shows dedication and selflessness to our industry that he would obtain more education, and than choose to stay here to help.


 
Helping or becoming a ball and chain to the professions where his heart is not in?
Let Rid do his own typing. 

I knew a long time ago that I would tire of being partnered with the 3 month wonders on the trucks so I joined a flight team which RNs are my partners. I learned something new from them on almost every flight. I also do not teach at any Paramedic program that is not college based and does not have some prerequisites. I know my limitations as to how far I will extend myslf and be fair to the students. Thus, I enjoy explaining advanced concepts to nursing and RT students instead of going over basic medical terminology or A&P. I get several messages from my posts on the forums about ETCO2, SpO2, CPAP, V/Q mismatching, cardiac disorders and even just albuterol. Some will pm me that what I have written is just BS and not needed to be a Paramedic and that I am just wasting my time. Some however will ask for more references.

We have already seen the controversey with using Paramedics in the hospital. It is nothing new. Yes, they can be used in a very limited role but as long as their education is based on "hours of training" and with little else to show for it, their argument is weak. The ENA has also published their opinion on the PHRN instead of making a nurse be a Paramedic. Their points are very valid as to the conflicts in licensure and scope. This is also why I do not wear my RRT credential when flying as a Paramedic. I do not want someone to assume I can do something as an RRT when I have a limited scope and protocols from my medical director I must follow as a Paramedic. 

In CA, Paramedics can not administer very many meds including paralytics. By having the RN work as an MICN and not get the Paramedic cert, they can administer whatever under their nursing license and not have the state EMS office question their practice as a Paramedic. Thus, no licensure conflict when doing a similar job in a similar environment.

There is no reason an RN can not be a licensed and credentialed profession in some aspect of out of hospital medicine and not become a Paramedic. They should not have to give up their identity as a nurse. They specialize all the time including the specialty of "Respiratory Nurse" which is also international. They should be allowed to build on the education they have at a college level and not be forced to take a very basic program at a 10th grade reading level. However, if that is the case, just see the Paramedic for what it is, a technical certificate since the RN will still have to use his/her own RN license to function at a higher level. There also shouldn't be any argument as to why the RN is paid more on flight teams if they are required to maintain both licenses in some states.


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## emtjack02 (May 3, 2009)

This seems to be a long standing argument both on EMS and Nursing forums.  Are there nurses out there that have the background and skills to be able to have additional training and make them a skill and competent prehosptial provider?  Yes.  Are there nurses out there that even with some additional training have no business being out on a rig? Yes.  Bottom line is everyone is different.  I for one hope I am a member of the first group.  To answer rid's question: I last did a 12lead in the hospital last week.  As for doing a neb treatment..really...they are not rocket science.  
I think that we should look at the person individually because as vent pointed out we are having issues with generalizations.


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## daedalus (May 3, 2009)

I do not have the intention of protecting rid/ryder, he is able to do that himself, I agree. I just find your attitude to be very negative when discussing paramedics. I understand your frustration, as you have completed far more education than most paramedics will even dream to attain, and I understand the feelings you must have sitting next to one of these guys in a truck. However not all paramedics are three month wonders, and the concept behind the Paramedic is a physician extender. So power to those who attain the level of education needed of a physician extender and than choose to stay in EMS. This is, after all, an EMS forum, not an RRT or RN forum.


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## daedalus (May 3, 2009)

emtjack02 said:


> This seems to be a long standing argument both on EMS and Nursing forums.  Are there nurses out there that have the background and skills to be able to have additional training and make them a skill and competent prehosptial provider?  Yes.  Are there nurses out there that even with some additional training have no business being out on a rig? Yes.  Bottom line is everyone is different.  I for one hope I am a member of the first group.  To answer rid's question: I last did a 12lead in the hospital last week.  As for doing a neb treatment..really...they are not rocket science.
> I think that we should look at the person individually because as vent pointed out we are having issues with generalizations.


A person's reality is the truth they see through their own eyes. The nurses I am surrounded by at kaiser and other hospitals in LA cannot and do not preform 12 leads or neb treatments. In fact, when I last week asked for a nasal cannula on a med surg floor the RN paged the on call RRT and left the room. Perhaps she did not have access to them. This is the way I see med/surg RNs through my own eyes. This does not take away from their professional status to me, because of the schooling they are required to have. Just because they cannot find a nasal cannula does not make them ineffective RNs, however a RN wihtout any additional training would make an ineffective paramedic, and vice versa.


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## VentMedic (May 3, 2009)

daedalus said:


> I do not have the intention of protecting rid/ryder, he is able to do that himself, I agree. I just find your attitude to be very negative when discussing paramedics. I understand your frustration, as you have completed far more education than most paramedics will even dream to attain, and I understand the feelings you must have sitting next to one of these guys in a truck. However not all paramedics are three month wonders, and the concept behind the Paramedic is a physician extender. So power to those who attain the level of education needed of a physician extender and than choose to stay in EMS. This is, after all, an EMS forum, not an RRT or RN forum.


 
Did you even notice what this thread was about?

The original post:


Foxbat said:


> Other than EMTs and paramedics, *what are the other healthcare providers that work in prehospital environment in the US?*
> Of course I know there are RNs in flight services and some on critical care trucks, but how many are working for 911 services? What is their job like - requirements (ER experience?), full-time or part-time, scope of practice, salaries? Any other providers - RTs, PAs?


 
EMS is over 40 years old. It still has not established an identity for itself. Its minimum education requirements are all over the map with over 50 different certs being recognized by 50 different states with the majority of them differing by one skill. Yet, those in EMS feel they are qualified to say who can or can not be involved in EMS regardless of training or credentials. Some don't think FFs are good enough. Some don't think private ambulance personnel are good enough. And now some think RNs are not good enough for EMS either regardless of training. You want RNs to give up their identity as an RN and acquire a few hours of certificate training to be called a Paramedic to work on an ambulance when they should be working under their nursing license? 

And now you are saying RRTs and RNs with an interest in EMS are not welcome? I guess you better tell emtjack02 he is not welcome since he is listed as PHRN. 

This is a public forum. If you want only EMS providers, then have the moderators close the forum to be by subscription only. There are professional forums that are open only to the members of that profession so there can be information shared freely and no anonymous posts so that credibility can be checked.


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## VentMedic (May 3, 2009)

daedalus said:


> A person's reality is the truth they see through their own eyes. The nurses I am surrounded by at kaiser and other hospitals in LA cannot and do not preform 12 leads or neb treatments. In fact, when I last week asked for a nasal cannula on a med surg floor the RN paged the on call RRT and left the room. Perhaps she did not have access to them. This is the way I see med/surg RNs through my own eyes. This does not take away from their professional status to me, because of the schooling they are required to have. Just because they cannot find a nasal cannula does not make them ineffective RNs, however a RN wihtout any additional training would make an ineffective paramedic, and vice versa.


 
Do you know how the Kaiser system is setup? They are very cost and QA conscious. Not only do they have to account for every piece of equipment used, they must also make sure the O2 and treatment is warranted. Not everyone needs O2 and those that do should be accessed for further therapy. Being on O2 extends the hospital stay as well as leading to complications if it is truly not needed or monitored properly. What you "see" may come with a whole long list of whys.

Again, did you READ any of my posts about the additional education requirements for PHRN, MICN or Flight?

Your over generalized statements or justifying by "I saw one once" are not adding any validity to your arguments.


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## daedalus (May 3, 2009)

VentMedic said:


> Do you know how the Kaiser system is setup? They are very cost and QA conscious. Not only do they have to account for every piece of equipment used, they must also make sure the O2 and treatment is warranted. Not everyone needs O2 and those that do should be accessed for further therapy. Being on O2 extends the hospital stay as well as leading to complications if it is truly not needed or monitored properly. What you "see" may come with a whole long list of whys.
> 
> Again, did you READ any of my posts about the additional education requirements for PHRN, MICN or Flight?
> 
> Your over generalized statements or justifying by "I saw one once" are not adding any validity to your arguments.



The anecdote was not as much to support an argument but rather to show you what I see through my own eyes, so you can see how I came up with my opinions. My statement that you seem to be overtly negative towards prehospital providers is not only directed at this thread, but at others as well. If it is your overall point to teach newer and older members here, than  I understand, but if it is to suggest that hospital personnel have an elitist standing over similarly educated EMS providers, than I believe you are wrong. It is disheartening for me to hear some of your comments, because I am committed to learning, and I should not be at a disadvantage to hospital based providers.


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## VentMedic (May 3, 2009)

daedalus said:


> The anecdote was not as much to support an argument but rather to show you what I see through my own eyes, so you can see how I came up with my opinions.


 
You may see but you may not understand what you see. The nurse may also have been allowing the RTs to put the patient on their service for therapy driven protocols which gives the patient a better follow through of care. 



daedalus said:


> My statement that you seem to be overtly negative towards prehospital providers is not only directed at this thread, but at others as well. If it is your overall point to teach newer and older members here, than I understand, but if it is to suggest that hospital personnel have an elitist standing over similarly educated EMS providers, than I believe you are wrong. It is disheartening for me to hear some of your comments, because I am committed to learning, and I should not be at a disadvantage to hospital based providers.


 
I talk about the educational standards for EMS. Some still believe EMS is perfect including those that can only provide BLS in their area. Some argue that the EMT-B is the end all to all education and will argue they can get the patient to the hospital just as good as the Paramedic. Some Paramedics believe any education past their initial few hours and whatever continuing education are a total waste. If you take offense by my comments toward this, then I guess you aren't as committed to learning as you say you are. 

You want to criticize me for providing more indepth information than what you get in EMT-B or Paramedic school? That is a rather arrogant and ignorant statement. You might as well not listen to any advice offered to you from doctors in the ED either since they are also part of the hospital. 
No wonder EMTs and Paramedics continue to go to medic mills since they have no respect for educators who might have higher education or in some way associated with a hospital. After all, we wouldn't want you to learn how to intubate or start an IV "the hospital way". And, we wouldn't want you to know anything other than what "is on the test". 

It is truly disheartening to see EMS want to alienate itself from the other HEALTH CARE professionals. There is a lot to be learned from them as they have learned from each other. That is what has enabled the other professions to grow and gain recognition by the legislators and those holding the reimbursement strings.

So stay in you own little perfect world of EMS in California. Could it be attitudes such as yours that have enabled the California EMS systems to reach the elite status it holds today? I'm sure the MICNs thank you for their jobs.


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## daedalus (May 3, 2009)

I gladly listen to all teaching given to me by doctors, nurses, respiratory therapists, etc. I am grateful for anyone wiling to teach me. You are jumping to conclusions. I am one of the most pro-education EMTs you will find in Los Angeles and Ventura Counties, and I have changed more than a few minds at the private companies I have and do work for. I cannot believe that you would jump on me for the state of EMS in California. You know from previous posts that if I had my way, Paramedics would have college education and degrees to back up their practice. My only consideration is what is best for my patients, and in the end that is all I care about. That is why I am going to go to PA school next year, and stay involved in EMS at a policy level to get it back on track in California. Along the way I will be taught by RRT, RNs, MDs, and PAs and will be grateful to get it. You have grossly misunderstood me. 

I am not criticizing you for providing information to us here on the forum. It is an amazing thing you do here, and I personally have learned a lot from your explanations of things I do not understand. What I am criticizing is your negativity towards prehospital providers who try to become professionals. I have tried to understand where you are coming from.

To put it simply, the only point I am trying to make, is that I would rather be taught pathophysiology by an RN, CPR by a paramedic, and the treatment of respiratory distress by an RRT. Those are strong points of each career, and there is a difference between those professionals.



> So stay in you own little perfect world of EMS in California. Could it be attitudes such as yours that have enabled the California EMS systems to reach the elite status it holds today? I'm sure the MICNs thank you for their jobs.


I have no illusions as to the state of EMS in California. If you are going to criticize me for living here and trying to be part of the solution, so be it.


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## Ridryder911 (May 3, 2009)

Wow! Vent where does all the venom come from? A person was just describing what they have seen and believe it or not it may have some validity. Not all us can work in an extremist area such as you have. 

I did not read in his post that he was against any furthering education. Just was inquiring upon some things he has viewed. 

I had always held you as a professional peer until today, because I disagreed with your views or challenged you; you then attempted to attack me on a personal level. Your posts upon my local flight services was way out of context unless you are an upper management of Air Methods, you really are just spouting. These hospitals also have educated personnel too and see the writing on the wall of reducing costs such as flight teams as per the rate of hospital reimbursement programs continue to change. As one CFO described, "_why should I pay to go get them when they are going to come to me anyway? _ Having such luxurious teams are nice, but we may see change within the next five years as budgets tighten. 

I do state this, there are many of us that do have as much experience and credentials. Yes there are states between the coastal edges that know how to practice medicine and yes can also provide excellent care. I returned to EMS full time to make a better change within it rather than just be a burned out medic and then whine about it. I have found it is much better to put up or shut up, if I fail so be it; at least I know I did something other than just complain. 

Is having another profession perform our profession a better option? Possibly; but I do doubt that the reimbursement structure that hospital based EMS would encourage those to enter it nor if it was a great option other states would be on the band wagon promoting it. 

There may be better options, that I don't agree. Just because your local system may produce poor Paramedics should not be always looked at as the "general consensus" as you have pointed out in comparing other health care professions. Not all EMS is similar to what you have seen or described. I can only say what I have seen and have discussed in details with State EMS Directors and those that would appear to have the authority to discuss their dilemmas and benefits. 

I agree the current standard curriculum is horrible as I have made this well known. I have and continue to review the new scope/curriculum. It has made some progression. Is it where I want it to be? No. It is those that have limited education or training that ever describes the entry level EMT of being enough. 

The NEMSE National Conference is in Florida this late summer. I do hope you will attend to see what the current standards are and the future of education before making judgement upon the whole profession.

R/r 911


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## VentMedic (May 3, 2009)

Ridryder911 said:


> Wow! Vent where does all the venom come from? A person was just describing what they have seen and believe it or not it may have some validity. Not all us can work in an extremist area such as you have.
> 
> I did not read in his post that he was against any furthering education. Just was inquiring upon some things he has viewed.
> 
> ...


 
So I am supposed to sit back and allow you to continue to insult RNs and RRTs? Do you want to go through the many statements you have made against RRTs during just the past two years regardless of how many times I have stated they have changed they education standards? You've done this not only here but also on emtcity where I have also told you what an RRT is and the difference between educated and OJT. 

I have also told you there are really professionals RNs out there that do take their jobs seriously in HEMS and in many areas of many hospitals. You still generalize and stereotype nurses. Not all nurses are like you see in your area. And as pointing out to daedalus, seeing one nurse do something which may have been for an "unseen" reason may not mean ALL nurses will do that. 

You believe you were attacked at a personal level because I wanted to know if your own attitude about others influences your teaching and testing of others? I also have "seen" how Paramedic instructors treat other professionals in ACLS and PHTLS. Yet, most do pass because they can do what is required. I was at least honest as to why I don't teach at medic mills and no longer work ground ambulances. Your strong opinions may be influencing your effectiveness as a teacher as I am now viewing you differently just from your recent comments about other professions. I already know you have strong religious beliefs, anti-gay and HIV/AIDS sentiments but I truly hope and am fairly sure you do keep those in check as a medical professional. Again, I am just going by what you have posted over the past two years and have made public knowledge. As you tell others, don't type what you don't want scrutinized by others. 

Rid, I think you are looking only at one very small area of EMS in Oklahoma. I think you should visit other states or even other parts of Oklahoma. Florida at least offers ALS to the entire state. There are not very many states that can say that. But then, you also had a problem with that on another thread when YOU said it means nothing if it is crappy ALS as you yourself referred to Florida. So regardless of what myself and others post, you will find some issue with it. For this thread I was talking about California with daedalus, not Florida just so you know which area is producing poor Paramedics as you referred to. Also, what may work in Oklahoma may not work everywhere. I would really not want to go back to BLS only with all volunteers, even though I have seen good volunteers, in the rural areas but if some feel that works best for them in their states, so be it. 



> Is having another profession perform our profession a better option? Possibly; but I do doubt that the reimbursement structure that hospital based EMS would encourage those to enter it nor if it was a great option other states would be on the band wagon promoting it.


 
I never said anything about hospital based EMS but from you statements, you haven't even explored how hospitals and other professions are trying to provide answers to the health care problems. You trashed NPs and PAs on another thread when it was suggested that they also could play a role. You fail to see that hospitals have purchased their own ambulance services to maintain quality and cut costs in the long run for routine transport. Of course, the other decision for some is with a case precedent was set by a lawsuit that now allows the hospital to be sued for hiring incompetent transport services. 

You also believe you are the only one who has even be involved in EMS decision making at a state or national level. Do you think I quote statutes, tax reform Bills and policies as a "hobby"? Also, I have probably been full time in EMS a lot longer than you since I didn't leave it. I just went to a helicopter instead of an ambulance. I kept my professions straight but respected those other than EMS. However, when it comes to major health issues for reform and taxes, I am now looking at whatever or whoever provides the best alternative solution. The good ole boy mentality of taking care of our own just because has gotten EMS nowhere. 

Rid, you are just not looking at the bigger picture of health care. However, I have already assured you that if nursing wanted EMS, they would have taken it long ago. But, that doesn't mean roles don't exist for nurses and other professionals outside of the hospital. EMS has failed to offer any better solutions and are more intent on bickering amongst themselves about whose truck is bigger or who has the most lights then they are about patient care.

BTW, I didn't mention any names for the Oklahoma Helicopter services but you obviously know which ones I was talking about. Defend all you want but you know those problems have existed for a long time.


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## mycrofft (May 4, 2009)

*I'm a nurse who used to be an EMT, a USAF Fire Recueman, USAF med tech, etc.*

I do not tar nursing with one brush, I say that many successful nurses are not a "good fit" for field EMS and the assumption that a nurse's training and temperment are in excess or superior to that needed for being a _good_ EMT-B is incorrect. Sort of like forcing firefighters to be EMS, or law enforcement to be first responders.

Some nurses think they are qualified and ready, then do stuff which is not logical in the street EMS milieu, but perfectly fine in the ER or ICU.


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## Ridryder911 (May 4, 2009)

Vent you win, are you happy? Again alike on other forums your respect has been lowered. I again acknowledge your expertise in respiratory care but that is all. 

R/r 911


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## VentMedic (May 4, 2009)

Ridryder911 said:


> Vent you win, are you happy? Again alike on other forums your respect has been lowered. I again acknowledge your expertise in respiratory care but that is all.
> 
> R/r 911


You are good at slinging criticism but you just can not seem to take it yourself.  

It is a low blow to generalize ALL professions as you do and say your titles show you know when in actuality you may not know ALL.    Even for EMS, you also must realize ALL states are not like Oklahoma.  

I have given many examples of states and services that do have their acts together and give credit where due.  However, I refuse to look the other way when there are areas that need improving in EMS and defend it.  Those that do have also enabled or justified EMS to remain in its present state.   Criticizing other professions to distract from the flaws of EMS doesn't work either.


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## emtjack02 (May 4, 2009)

Foxbat. Did your question at least get answered?


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## wehttam (May 4, 2009)

hmmm maybeu need to get your nursing education int eh caribbean then tell me if a nurse cant function as a paramedic  i am just being a smart A** wil post a nursing cirriculum for you

first program an associates degree program

www.tamcc.edu.gd/Portals/31/docs/A[1].D_Nursing.pdf 

BSC program in jamaica

http://www.utech.edu.jm/faculties/Health&App/RX&Science/BSc_Nursing_details.htm

in the caribbean nurses well i guess the scope of practice is very wide from putting up ivs to catherizing a male pt etc etc etc i guess because resources are limited they are allowed to do more


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## daedalus (May 5, 2009)

wehttam said:


> hmmm maybeu need to get your nursing education int eh caribbean then tell me if a nurse cant function as a paramedic  i am just being a smart A** wil post a nursing cirriculum for you
> 
> first program an associates degree program
> 
> ...


Putting in IVs and inserting a foley? These are things most low level LPNs can do.


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## mycrofft (May 5, 2009)

*USing standardized procedures and protocols, plus certifications,*

at least in California you would be surprised what an employer can ask and enable a LVN, MA, or RN to do. Not always a good thing.


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## emtjack02 (May 5, 2009)

Please help me understand something.  Is there sarcasm I am missing because Im pretty sure that LPN/LVN have been doing task such as foley placement for decades.  As far as RN we have been placing IV since the 60's when the docs let go of it.  So I am missing people point with the last several post.


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## daedalus (May 6, 2009)

emtjack02 said:


> Please help me understand something.  Is there sarcasm I am missing because Im pretty sure that LPN/LVN have been doing task such as foley placement for decades.  As far as RN we have been placing IV since the 60's when the docs let go of it.  So I am missing people point with the last several post.



Thats what I mean, that poster stated that RNs in the carribean were "progressive" because they could place foleys in males and place IVs. That is akin to saying that the basic radio with a CD player or iPod hookup is progressive in a modern vehicle...


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