Nurses vs EMT/Paramedics in EMS

[adamjh3]

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:

 

[TransportJockey]

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

 

[adamjh3]

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.

 

[TransportJockey]

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.

 

[reaper]

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!

 

[JPINFV]

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.

 

[adamjh3]

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?

 

[TransportJockey]

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

 

[adamjh3]

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

 

[8jimi8]

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.

 

[TransportJockey]

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

 

[8jimi8]

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

 

[eveningsky339]

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.

 

[harold1981]

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.

 

[Veneficus]

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.

 

[RCashRN]

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?

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...)

 

[mycrofft]

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?

 

[Dutch-EMT]

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...

 

[ExpatMedic0]

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?

 

[mycrofft]

Thanks Dutch EMT!

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