Professions in prehospital care

[Foxbat]

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?

 

[firecoins]

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

 

[JPINFV]

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.

 

[EMTinNEPA]

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)

 

[VentMedic]

double post

 

[VentMedic]

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

 

[Foxbat]

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?

 

[Ridryder911]

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

 

[VentMedic]

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.

 

[mycrofft]

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:

 

[VentMedic]

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.

 

[daedalus]

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.

 

[VentMedic]

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.

 

[reaper]

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.

 

[daedalus]

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.

 

[mycrofft]

Don't blanket qualify RN's

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

 

[VentMedic]

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.

 

[Ridryder911]

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

 

[VentMedic]

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.

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.

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".

 

[VentMedic]

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.

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?

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?

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.