Not sure where this is headed. I will never make the statement that RN > Medic. Ever. I addressed the statement that RN's cannot do any more than a medic in regards to the H&T's of ACLS (see above).
Replacing EMS with nursing revisited
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Not sure where this is headed. I will never make the statement that RN > Medic. Ever. I addressed the statement that RN's cannot do any more than a medic in regards to the H&T's of ACLS (see above).
If this is the best argument we've got, than I guess I better start sizing white caps...
Barely motivated mongo fire recruits are taught this stuff in three weeks. Do you really think RNs couldn't be taught?
Just looking at your location, did you do this in Saudi Arabia or in TX? We're talking US EMS here. I just skimmed through a couple of regional TX EMS protocol lists here and was not able to find anything mentioning administration of potassium or blood.
Aidey
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Paramedics could have those same standing orders, depending on the agency and Med director.
I will revise my statement to make it a little clearer -
RNs and Paramedics are limited to the same level of care when it comes to ACLS when they have equal access to lab tests and medications, assuming both have standing orders allowing them to interpret the tests and initiate treatment.
I will revise my statement to make it a little clearer -
RNs and Paramedics are limited to the same level of care when it comes to ACLS when they have equal access to lab tests and medications, assuming both have standing orders allowing them to interpret the tests and initiate treatment.
By no means the best argument, if there even should be an argument.
My overall point in each of my posts in this thread have been that Medics and RN's are trained in different ways, to do different things, from different standpoints.
Is there a lot of crossover? Yep. We are all part of a team, with the same goal, to take care of the sick and injured.
To use a football analogy, sometimes the Halfback throws a pass.
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Shishkabob
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There is no such thing as "Texas EMS protocols"
Texas is a delegated practice state, with individual medical directors deciding what they do and do not want their EMS personnell to do.
If my med control wants me to crack a chest on the field and teaches me how, I'm allowed to as a Paramedic.
Giving K+ or blood is not that rare here for IFTs
If a hospital were to set things up that way, I'd agree with that. But how many hospitals take on that level of perceived liability? (key word: perceived)
Typical ED setup is for the medic to work as a tech while the RN supervises patient care. Tennessee EMS regs even specifically notate that medics in the hospital setting are to be under nursing supervision. So, the trend is to not allow medics to function to their full scope. Even if they did, the protocols would have to be modified from the state-recommended protocols, which no service here strays from. (talking specifically about TN)
In the matter of medics independently taking patient loads in the ED, my only complaint against this is that it lowers my chances of getting an ED position as an RN.
We're getting pretty off-topic here, though.
JPINFV
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You know, this is where I get to sit back and laugh at these sort of arguments. Yes, RNs and paramedics work under both patient specific orders (written or online med control) AND under standing orders. Anything past that is going to be determined by the practice setting more than anything else. There's more than a slight difference between an RN poking the patient's emergency physician to clarify something than a paramedic calling in. Similarly, with a physician available to do things, like reviewing lab results, it's easier to justify more standing orders for paramedics. This is, of course, ignoring verbal orders where the RN gets a lab results, walks over to the physician and says something along the lines of, "Hey, the lab results came back with _____ for bed ___. Want me to hang ____?" Situations like that make the discussion about standing orders for RNs vs paramedics a 'missing the forest because of the trees' time discussion.
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I am back in The States now, haven't updated my location yet.
When I have hung blood, colloids, and other drips it was in the US, right here in the Lone Star State. Granted, you won't find this stuff in very many if any ground 911 systems, however on most flight and critical care services you will find it more often than not.
Even though there is a nurse and a paramedic on the heli, as the medic I had just as much ability to hang any of the above mentioned items as the nurse did. Every decision we made about patient care was made as a team, and our skill sets were identical. There were no skills exclusive to the RN or to the paramedic. Believe it or not this was more of an increase in scope and skills for the nurse than the paramedic.
I am not taking a side in this argument. I think the RN/Medic model in critical care is perfect because both professionals play off the strengths of the other, and also are there to have each others back when either person encounters difficulty.
The solution to the issues here is not to cut out any one profession, whether it be RN, medic, firefighter, first responder, etc. Even though I agree that professional medics need to have degrees, and there needs to be bachelor's and masters options for EMS professionals, I am also aware that there needs to be a vocational route for fire personnel and other first responders to be able to provide certain ALS interventions. Let's face the facts, there are too many rural areas where it is not possible to have close ALS coverage...require degrees for all ALS personnel, and the people residing in these communities will be waiting 30 mins, and hour, sometimes more for any sort of ALS care.
I mentioned in a thread a month or two ago that with a little tweaking of the current accepted levels of certification or licensure in EMS, a lot of our woes could be alleviated.
Maintain the current ECA and EMTB certs. Eliminate the intermediate. Create a vocational paramedic certification reserved for professional who do not transport patients, but only provide care as a first responder. A hybrid between the current EMTI and the current EMTP.
For individuals who are going to work on transporting ALS units, require them to have a degree and call them a licensed professional paramedic. With this should follow an increase in scope of practice as appropriate.
Also, I don't think any patients should be treated by EMTBs, regardless of their acuity. If EMTBs are to be involved in transport, it should be as a driver only. People who provide care to patients should have degrees. I know that is going to rub some the wrong way, but if you're serious about wanting to be in EMS as a profession, bite the bullet and get your medic degree, simple as that.
When I have hung blood, colloids, and other drips it was in the US, right here in the Lone Star State. Granted, you won't find this stuff in very many if any ground 911 systems, however on most flight and critical care services you will find it more often than not.
Even though there is a nurse and a paramedic on the heli, as the medic I had just as much ability to hang any of the above mentioned items as the nurse did. Every decision we made about patient care was made as a team, and our skill sets were identical. There were no skills exclusive to the RN or to the paramedic. Believe it or not this was more of an increase in scope and skills for the nurse than the paramedic.
I am not taking a side in this argument. I think the RN/Medic model in critical care is perfect because both professionals play off the strengths of the other, and also are there to have each others back when either person encounters difficulty.
The solution to the issues here is not to cut out any one profession, whether it be RN, medic, firefighter, first responder, etc. Even though I agree that professional medics need to have degrees, and there needs to be bachelor's and masters options for EMS professionals, I am also aware that there needs to be a vocational route for fire personnel and other first responders to be able to provide certain ALS interventions. Let's face the facts, there are too many rural areas where it is not possible to have close ALS coverage...require degrees for all ALS personnel, and the people residing in these communities will be waiting 30 mins, and hour, sometimes more for any sort of ALS care.
I mentioned in a thread a month or two ago that with a little tweaking of the current accepted levels of certification or licensure in EMS, a lot of our woes could be alleviated.
Maintain the current ECA and EMTB certs. Eliminate the intermediate. Create a vocational paramedic certification reserved for professional who do not transport patients, but only provide care as a first responder. A hybrid between the current EMTI and the current EMTP.
For individuals who are going to work on transporting ALS units, require them to have a degree and call them a licensed professional paramedic. With this should follow an increase in scope of practice as appropriate.
Also, I don't think any patients should be treated by EMTBs, regardless of their acuity. If EMTBs are to be involved in transport, it should be as a driver only. People who provide care to patients should have degrees. I know that is going to rub some the wrong way, but if you're serious about wanting to be in EMS as a profession, bite the bullet and get your medic degree, simple as that.
So, you don't have EMS protocols in Texas? I wonder what that nice list of protocols I linked to was for, then. Weird.
Transporting a patient from one facility to another with blood already hanging is one thing. Hanging the blood yourself is another. It's the same in Tennessee. The patient can pretty much have anything running IV for IFT's. The medic didn't initiate it. IFT with a solution already hanging has nothing to do with interventions that you're implementing during or post-resuscitation, which is what I was addressing with the blood/KCl comment (ACLS H&T's.. I feel like I'm repeating myself in every post I make).
I would question the legitimacy of your statement regarding the implication that a medic in TX can do anything that medical control tells them to. Where do you draw the line? Is the scope of practice unlimited?
Again, this is all getting off-topic and turning into a medic vs RN thread. My only point in rebutting what was mentioned re: ACLS H&T's was the ignorance of the statement, NOT to say that one profession is better than the other.
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Fair enough. When I think of EMS, I usually don't even think of flight services, because they're a completely different animal.
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Linuss is pointing out that while you may be looking at EMS protocols from certain agencies, the list is not exhaustive and there is no set in stone official "State of Texas Paramedic Scope of Practice."
Each agency has its own protocols, approved by the medical director of that agency. As Linuss pointed out earlier, if a medical director is willing to provide the training and take on the liability, he or she can authorize just about any prehospital treatment desired and have it carried out by the paramedic on the call.
That much is understood. I'm sorry if I was unclear in my wording, but what I said was that I skimmed through a couple of regional protocols (not one uniform "state" protocol) and could not find anything related to hanging blood or K+.
Sorry to burst your bubble, but there ARE prehospital nurses that do ride the bus. Some states have specific prehospital certification for RN's. I believe you're referring to the Johnson & Johnson nursing recruitment commercial. It's not a slam against EMS. It's just showing nurses working in different areas.
firetender
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Show Me The Money!
It's been mentioned before but not quite this way. Nurses have done very well when it comes to setting minimum standards, specialties and ADEQUATE COMPENSATION at each level. I would imagine they have discussed a specialty or increased training in pre-hospital care but probably rejected it.
Why?
Let's listen to the Chairperson of the Board: "Wouldn't that be making us downwardly mobile?"
Case closed.
To even re-vamp billing to reflect in-house visits covered by medicare still makes an R.N. (SPECIALIST!) with a minimum base salary of $20/hr. (you think they'd even stand for that little?!) out of reach for the uninsured. An ambulance would be a Boutique Service!
Paramedic is a specialty unto its own and should design its own upward mobility based on that specialty. There is no benefit to having a complete R.N. education; just more poop to juggle in your head when what the job demands is ACTION!
It's been mentioned before but not quite this way. Nurses have done very well when it comes to setting minimum standards, specialties and ADEQUATE COMPENSATION at each level. I would imagine they have discussed a specialty or increased training in pre-hospital care but probably rejected it.
Why?
Let's listen to the Chairperson of the Board: "Wouldn't that be making us downwardly mobile?"
Case closed.
To even re-vamp billing to reflect in-house visits covered by medicare still makes an R.N. (SPECIALIST!) with a minimum base salary of $20/hr. (you think they'd even stand for that little?!) out of reach for the uninsured. An ambulance would be a Boutique Service!
Paramedic is a specialty unto its own and should design its own upward mobility based on that specialty. There is no benefit to having a complete R.N. education; just more poop to juggle in your head when what the job demands is ACTION!
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That website also highlights only 10 cities or counties in the second largest state in the US. Of the agencies listed it doesn't even mention some of the more advanced in the state...
Don't get me wrong, colloids, blood, potassium, etc. in the prehopsital setting are the exception, not the rule, but they can be found in multiple ground and flight critical care services in Texas and I'm sure throughout the country. I don't think the average medic (or nurse for that matter) should be hanging these items or doing a number of other treatments reserved for practitioners with additional training and education, but the point is that there are many paramedics out there who are capable of competently doing so and increasing the chances of a positive patient outcome.
Like I said in the last post on the previous page, the solution is not as simple as cutting out any one provider all together and replacing them with someone who has more education...we are in too deep for that.
jjesusfreak01
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I consider myself "rubbed". As an EMT, I won't even think about asking to run a true code, or handle any patient best served by the skills and knowledge of a paramedic, but EMTs have their place in the back of an ambulance as a primary provider. Many many patients transported by EMS in the US need little more than a taxi ride to the hospital, and this gives the EMT the ability to practice assessment skills that they may use further down the line in their education as a paramedic, nurse, pa, or md. Remembering that I work in a system where all trucks have a medic, what is the harm in letting me take care of the kid with the broken arm, or even the woman having a panic attack? Who knows, at some point I may find myself alone providing care for a real medical emergency, and at that point, the last thing that needs to be going through my head is, "where is the medic". Although I agree that EMT-B should be considered an ephemeral position, a skin to be shed when one attains a higher level of training in the medical field, it is doing a disservice to EMTs to suggest that they cannot be primary providers. If all I am going to do is drive, my 180 hour class and 3+ months I will spend as a third rider to teach me proper assessment and treatment are totally wasted. They should just drop the EMT class down to 10 hours, teach you all the monkey skills, and then put you through a driving course.
Also, nurses are still awesome, but have a totally different role from paramedics. Though both operate under standing and written orders, the nurses training can't be simply patched with a 2 month course to make them a paramedic, nor can the medic's training be easily patched to make them a nurse. There is a huge difference between operating under standing orders when the doctor is 10ft away and 10 miles away. You are trying to climb a huge hill here. Most nurses sign up to be nurses, which means that they wanted to take care of people, both physically and mentally, but what they aren't signing up for is diagnosing and treating emergent patients. This is what medics sign up for. Arguing that they can easily take each other's place is like arguing that a duck could replace a swan. Its just silly.
On a practical note, I think it is possible to train nurses for EMS, but I think it would require a year of specialty emergency training, and selection for nurses that honestly desired to work in EMS. This is the heart of the issue. Every medic wanted to work in EMS, but few nurses do, or they would be paramedics.
RIGHT, since being able to fill out the flow sheet is something only RNs are qualified to do
Initiating blood is not terriblely hard, nor is monitoring for transfusion reaction. Deciding if it's a good or bad idea is a bit tougher.
I'm sure I can find any number of nurses who have never initiated or titrated any number of vasoactives that I've used as part of various protocols in the past.
Your right, this is becoming an RN vs Medic thread. If you really want to know what high level providers are capable of, seek out an experinced, well trained CCT crew. I can garuntee you can't tell who's the medic and who's the RN solely on knowledge base.
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