VentMedic

I disagree for the EMT-B test. Often the CNA requires more hours of training and in some states such as Florida there both a written and skills portion with both being offered in Spanish. The EMT-B is still a 110 hour tech cert in most of the U.S. It requires no college. If the person chooses to go past this cert and enter a college then they should meet the English language proficiency standards.

Here in the states it is a very different situation due to limited education. Unless the state statute has been changed specificially in the state, Paramedics are limited as to legally doing triage and assessment in the hospital without an RN overseeing and co-signing. It is essentially the same as an LVN in some cases and that is what I would compare the Parmedic's practice to in the ED except for the lack of general nursing care rather than to an RN's. The same goes for medications. The meds that could be given by the Paramedic still had to be witnessed and co-signed by the RN. If the patient was admitted to ICU status or level of care beyond the Paramedic and still held in the ED, assignments would often have to be switched to accomondate the Paramedic. I am also familar with this because of working Flight as a Paramedic while stationed at a hospital. We could only assist with a few things and not assume care for any patient fully since report would have to be given with the patient handed off properly. That can waste time getting into flight. Thus even at Flight Paramedic status in the U.S. the education and training varies greatly to where they are not always allowed to do very much inside the hospital. In the U.S. we have not evolved to a true critical level even with the "80 hour" CCEMTP course in addition to the Parmedic cert. The Flight and the CCT Paramedic here in the U.S. should have at least an Associates degree with another 6 month (preferably one year hospital critical care experience) before being allowed to work in an ED as something other than an ED Tech. However, I believe the Canadian system in places has gone well beyond this and there should not be any issue with level of care but rather just the hand off of care to get on the street.

What's the difference if you lie in this situation or lie to the patient about something else? Families of certain cultures want us to lie the spouse of an elderly family member all the time. Sometimes they also do not want anybody to even tell the patient how sick they are and that is all in the name of "protection" as well. I personally believe a person and their spouse has the right to know but often the medical profession will abide by the wishes of the family in some cultures.

It was still alive 2 years ago.

Each situation will be different. If I have seen the lab results for a child and they show the child has inoperable CA but hasn't been told yet, I may lie and say I haven't seen the results. This goes for IFT, Specialty and the ED as well as in the hospital. If I have CF patient who wants to know about certain experimental meds and then wants to know if he qualifies, even though I know he doesn't because of a previous discussion in his care rounds, I will not tell him I know if he does or doesn't. If I have to do a little role playing with an elderly patient because of dementia, I have no problem to do what it takes if the person needs to go the the ED or take a treatment. If you have even worked in a LTC facility, you can tell someone it is Tuesday 2010 a hundred times and they will still be on Saturday 1920. I can be anyone for Bette Davis to Captain Hook if that is who they see me as in their mind regardless of how many times I identify myself. My ambulance can be a train, plane or cruise ship if that is what they want it to be. Some EMT(P)s also can not accept death themselves and will lie to the patient that "you'll be good a new" even the person's body parts are no longer attached or where they should be just so they don't have to deal with a difficult situation themselves. Some EMT(P)s will take a cold stiff SIDS baby into their ambulance and race to the hospital telling the parents the hospital will be able to do something. I do find fault with that but then not everyone handles death the same way or has the training/education and protocols to deal with these situations. I will not tell a child a needle stick doesn't hurt. I will not make promises of candy and delights at the hospital. I also will not go against the wishes of the parents as to what the child should and should not know if it is not necessary. However, I have pretended not to notice things and have made up some excuse to separate the child who is battered from his parents to get him medical help and into protective custody. The same for a battered spouse be it male or female.

This post definitely demonstrates that you do not have a clue about the role RNs play in the hospital situation or what is involved in total patient care. You also missed my point. I didn't say you did not have Speech and English since you already mentioned your education. What I said was Accountants have taken some of the same classes an nurses and all those you have mentioned. Does that make them a nurse also? Do you want to work in prehospital or do you want to work med-surg in a hospital? If you want to be a nurse or "like a nurse" go to nursing school. Those of us who are Paramedics and also have obtained either nursing or RT degrees do understand the differences in patient care. I also had a 2 year degree as a Paramedic when I entered the EMS profession and thought I was "just like a nurse as well". I quickly found out how wrong I was when I started working in a hospital. I was not "like a nurse" or "like an RT" even though some of our skills overlapped. I also gave you an example of how nurses function with a neuro patient which can also be applied to a cardiac patient or just about any type of patient. You just want to start a pissing match that the Parmedic is trained "like a nurse" and can not see any different. You have a few science classes but NO core nursing classes and have not done 1200 hours of clinicals as a nurse. You have taken care of one patient at a time in the back of your truck. You have not had to care for a patient for any length of time or help them make the transition from ICU to Acute Rehab. If you or many of the other EMT(P)s had any of this training and knowledge, there wouldn't be the bashing of nursing homes and their patients on the EMS forums. Go to nursing school if you want to be a nurse. Healthcare has advanced to where it no longer has to settle "like something" anymore. You must have the appropriate training and education to do whatever the patient requires.

The only time I have done that is on very obese women where the breast tissue is stretched thin at the 5th rib and the breast itself is displaced to even lifting it out of the way would still put the electrodes near the 9th rib or lower. I just make a notation about what I did in the computer and on the print out. But, bariatric patients present many problems such as few hospitals have CT Scanners or MRIs to accomondate these patients. Thus, if you take an obese patient suspected of having a CVA they may not be able to do a CT Scan, even at a Stroke Center, and the patient may have to be CCT'd to another facility for the scan and then back to the Stroke Center. The saline implants rarely pose a problem. Not all women have implants just for cosmetic reasons. Some have been breast cancer survivors or even did a prophylactic removal of the tissue due to cancer risk. There are also other types of surgeries and injuries where the woman has had to undergo reconstructive surgery. So don't assume it is just a boob job for vanity to get male Firemen or Chiefs (spenac's article) to grope their breasts. I have a little more to add. If a woman has had a double mastectomy, do not treat her "like a man" and expose the chest to the world or annouce "its okay because she doesn't have any breasts". Use the same standards of privacy as if she still had breasts. If the surgery is recent or even if it is not, be gentle with the sensitive tissue. Also, if there are still sutures, don't pull the skin and electrode away from the incision stressing the suture and causing pain. Carefully pull toward the incision. This also applies for men as well. Also the same for both men and women who have had breast reduction surgery.

Unless the implant that slipped down in the muscle, it is usually not an issue. If one was to attempt to place an electrode on a silicone implant, it would mess up the voltage as would going across the breast tissue.

Did your assessment classes pertain primarily to emergency situations or long term maintenance and care? What treatment plan and preventitive measures were you able to impliment from your finding for those that were not an "emergency"? Could you regulate their diet? Give insulin? Restrict their fluids? Were you able to obtain lab values at scene? It is great that you do have knowledge of these things but there is still the implimentation of what to do with the data you collect and formulating a care plan beyond 15 minutes. Being taught by physicians is not unlike any other profession and that includes nurses. The physician will just teach at your level and may teach differently for an RN, RT or med student. Gee does that make you a Respiratory Therapist also? Yes, that is good to know but what are you going to do about it beyond the 15 minutes you are with the patient. There is the "emergent" and then there is the weeks of care it takes to correct some of these situations and not to have other systems compromised which treating another. Many other majors including Accounting can take prerequisites in Psychology and Death and Dying so it is not just unique to your class. However, you may take one that is again very specific to EMS. Other majors have also been requiring at least two semesters in English Comp for the writing, a semester of Speech for talking and a semester of literature for reading. Again, for the short term it is very different than do a plan of care for a hospice patient and their family. You know you will be out of the sight of the deceased and their family in a few minutes. You also appeared right before the death or just after. You are not with the patient and the family for many 12 hour shifts trying to answer complex questions about death. The patient is essentially dead to you upon arrival or after you drop them off at the hospital. It is not about being one of those medics but understanding the difference between emergent care and total care for the long haul. You can "emergently" correct one lab value but does that fix the problem? You can give a diabetic glucose but does that fix the problem? Can you identify the problem or even care to for fixing that patient's glucose fluctuations? For Paramedics that do Flight, they sometimes struggle with the "act quick" before assessing all the data to see if quick is correct. Thus, they are still only thinking on a very short term when they are picking up a patient who is now on a very long term treatment. You can not just do piecemill or patchwork treatment as what might have been sufficient in the field. All the allied health professions take basically the same prerequisites and some of the same assessment classes as well as the usually Psychology and Death and Dying classes. However, they then specialize and go more indepth into their own specialty. RT takes many of the classes the RN does but no RT says "I'm just like a nurse and can do everything a nurse does." We can do many of the "skills" but we don't do the same care plans from the same assessments. We do a multidisciplinary care plan with the RNs to combine the skills and knowledge of both professions. A Physical Therapist with a Doctorate has many higher sciences than the RN and many different assessments with several overlapping skills. However, I have yet to hear any PT say "I can do what a nurse does or I am just like a nurse". A lot of Paramedics have attempted nursing school with the same attitude you have and have failed miserably because they would not accept there were many ways of approaching patient care based on different assessment or even the same one. They were very caught up in "treat it now" without realizing long term consequences. It is like the argument about "why not have Paramedics start antibiotics in the field?". But, which ones and what organ should we sacrifice must be considered but the Paramedic may only be concerned about here and now issues. Nothing wrong with that but for the long term they must see the whole spectrum of patient care and how every action may bring a reaction and one that might not be desired. You are trained as a Paramedic for prehospital emergent situations. Unless you have been through the RN or even RT program and have worked in that profession, you may not fully understand what they do or know. I would never hold against a nurse in a nursing home that can't read a 12-lead ECG but who is responsible to the care of 25+ patients who are always on the edge of breaking. If these nurses did not do a good job there would just be a constant shuttle between the NH and the hospital. For some in EMS to complain about 1 patient out of 200 per shift being shipped demonstrates a lack of understanding what the care of these patients is about. I don't believe any Paramedic could walk into that job and accept responsibility for 25 patients but yet they view the NH RN as the scum of the earth as it pertains to the nursing profession and not even worthy of the EMT-B's courtesy. All the health care professions just have a different focus toward a similar goal. I personally would want someone who has genuine expertise at the bedside and not someone who is just comparing a few classes or skills and believes they are just like a nurse without the actual education, training and experience. Are you also going to tell the other professions that the Masters and Doctorate are ridiculous? I doubt of PT would agree with you about their doctorate. Even at a doctorate, that is less education and training than an MD. A doctorate is not that difficult to get if you put a little effort into it and this something I do know about. I applaud the NPs for their clinical DNP (starting as a requirement in 2015 I believe) because the Masters was not enough for the advances in medicine. A Bachelors in not even enough for RN or the RRT especially in critical care. Some also think anything more than 1000 hours of training is too much for a Paramedic and the Associates degree is just absurd. We have a poster from Oregon on another forum who complains about it constantly. He also stated something I didn't know about Oregon in that the Associates in not necessarily required upon entry and that you can still work if you promise to get it in a few years. I haven't personally confirmed that but that is disappointing if true and sorta gives me a different opinion about Oregon if they are still bending over for the lowest denominator.

But each situation is different. If you moved to France at the invitation of friends because the offered you a job, you might not wait a year while taking a crash course in French especially if you friends already knew you didn't speak the language. The thing in many parts of the U.S. is that some parts have their own large sections where English is not spoken. That include our border towns, Miami, NYC and many of the China Towns across the country. Some who do come to this country are already skilled and "educated" in first aid and as nursing assistants so they would be of better use in some type of medical employment than washing dishing. I also believe one should have gainful employment and if there are areas that do hire people who speak another language because that is what the majority of their customers are, so be it. They can work and learn. I do not believe here in the U.S. able bodied people should be unemployed because of a few attitudes against "foreigners". These people are not stupid either. They know they probably can not walk into a hospital or EMS company in Kansas and get a job speaking only Spanish, Chinese or Russian. They will more than likely have someone here sponsor them and have already scoped out employment for them. If I remember correctly from the last thread over a year ago that the OP started, that was the situation.

Wow! That was a bad video. In fact I may use it in our next ECG class as an example of what not to do. That was beyond "palming" and more like serious groping. Even a female caregiver doing the ECG should be cautious before doing that much handling of the breast to where it looks like you can't seem to take your hand off of it.

Apologies. I spent too much time reading posts on another forum that have left me disheartened for lack of better words. So, never assume "professional" will always be mentioned in the schools or on the job. This is also a common and obvious question that should have been addressed extensively in the OP's program with even a possible demonstration.

Leave it only if you can get near exact placement for V1, V2 and V3 as well the the others. Usually the bra can be unhooked and not fully removed. If you are off on your placement in any way, it will skew the analysis. If you do continue on with the 12-lead without proper placement, write on the print out which electrodes were malpositioned. A good Cardiologist can usually tell "sloppy" work but if you make them aware of it beforehand, they may cut you some slack and just use the ECG for rhythm analysis and do the diagnostics off the one done at the hospital.

You do not have to make a public viewing for the whole FD and neighborhood when you disrobe the patient. Even in an emergency you can still protect the patient's privacy within reason especially with everyone having a cellphone and access to youtube these days. Even a towel across the chest can offer some privacy and give you access for placement. Even if the person is having an MI, there is no need to cause more anxiety than absolutely necessary. If possible, approach from the patient's left side so you do not have to clumsily reach over the patient. Avoid "palming" the breast. Try to only contact with the back of your hand and use clothes, towel or sheet to move the breast or have the patient move it. I guess you wouldn't mind have 10 firemen stripping off your clothes to display your pride and joy to all the gawkers including children in a public place? It only takes a few seconds to be mindful of one's privacy.

Profanity of that type does not make your argument any more valid or credible. I've already pointed out what was offensive in earlier posts. I don't think I have to keep repeating myself. It seems you want everyone to agree with you about providers who can pass an EMT test but haven't mastered the English language have no place working in the U.S. I have given you examples where that is not so. Since this has gone on for over a year and you seem to be still working in the situation, you may have to weigh your own options. You must know where your employer stands about extending opportunities to those who speak other languages. Instead of trying to get people on an anonymous forum to side with you again after another year has passed, tell your concerns to your employer or find one that agrees with your own personal beliefs.

Read some of your own posts.

Considering some of the comments made in this thread, the racist issue is not far off. People, both patients and providers, who speak another language are not unintelligent as the OP has been using such statements. You just got caught in the crossfire. We are also talking about the EMT-B in this thread and as it is presented, one provider speaks English and one provider does not. Where do you see an issue with that to use the F word toward another forum member who did have a valid post?

You have a non-EMT driver and an EMT? What's the probem? At least one person speaks the same language as the patient. Our interpreters do not hold medical degrees. You can still gather enough information and also provide interpretation assistance at the hospital until another interpreter can be contacted. Was communication with people speaking other languages or other disabilities never mentioned in your EMT class or your ambulance service especially if it has patients speaking other languages? Patients who speak other languages are also not stupid either. There are univeral signs for pain and hopefully bleeding and difficulty breathing will be apparent to you as an EMT. Open your mind and you will be surprised at how well you can communicate with people regardless of language. You also do have a few skills to rely on. Is seems it is your attitude towards non-English speaking patients that is hindering your communication more than the language itself.

If your partner speaks the same language as most of the patients in that area what's the problem? How is your English going to make things clearer for the patient? Ideally, one partner should be bilingual especially if you are workinn an area where another language is also dominant.

Racist? I have not used that word YET in my posts although your comments are getting somewhat offensive with your "smart enough" statements. I would rather not get into a racist debate for a variety of reasons. Also, if I remember correctly your last thread ended up with something about the Russian Mafia controlling PA EMS.

Believe they are smart individuals? Are people who don't speak English usually stupid where you are at? Medical part of an EMT exam? There is not very much to an EMT test that most any individual who even has not mastered the EMT exam can pass even if they use "luck" as many of the American EMTs do. Most have more ambition to put forth the effort to overcome obstacles instead of whining as those in the U.S. tend to do about "how hard the EMT test is". Newsflash for ya: States have been giving DL tests in several languages for many years. A person can be a lousy care giver regardless of what language they speak. The U.S. EMS system even has some blatant examples of that. In the U.S. we do have clinics and hospitals where English is not the primary language. Miami has hospitals where Spanish is spoken and San Francisco has Chinese Hospital. Believe it or not because a person doesn't speak English doesn't mean they don't notice blood spurting out or a patient who can't breathe. You are talking about some first aid as an EMT. We have physicians from around the world who speak NO English that are our guests in hospitals across the country and even do surgery while having no problem communicating what they need to in the OR. If you are well trained and educated to do your job, you know what to do. At the EMT or CNA level, this should not be such a major issue. These are tech certs that can be taught just about anywhere. If the person chooses to get into a college for RN or some other degree, then they will have to meet the requirements of the U.S. education system which will be Right now there are probably over 20 different languages spokens in Haiti by all the medical teams assisting and most know what has to be done regardless of what language is spoken. Ideally one partner would be bilingual if the other partner has not mastered English. Of course, being bilingual is not something that is encourage in this country. The other person might just be bilingual but in another language other than English. Example: Cuban children usually speak no less than 2 languages fluently but often the other language is one the tourists speak such as French. If the other EMT only speaks English, they can give report. If talking over a patient that speaks only Spanish or one of the Chinese languages, the hospital may also have another bilingual interpreter or medical professional to make sure the information is correct. We rarely partnered two people together that spoke no English on the ambulance and we also made sure one did speak Spanish. As EMTs they could find a job in the predominantly Spanish speaking hospitals as ER Techs since many of the hospitals offer their orientation in two languages at least.

Horrific rumor? Didn't you have a thread last year about the Russians taking over the ambulances in PA and posed this same question? Do they not know what the device is or are they just asking for the English term? There are many well educated medical professionals in the U.S. that are excellent clinicians but have not mastered the English language. There are some Americans whose native language is English but to listen to them or read what they have written, you would have your doubts. That also includes some that have managed to get through the U.S. school systems and even through EMT(P) school. We do not have the test given in Spanish but there are EMT mills that can teach enough English to pass an EMT test. With a DL, one could very easily find work with some employers that cater to a specific community.

Let me give you another example of "critical care concept" and "patient care". Take a neuro patient either CVA or TBI (as well as all the other types). In EMS these are both general terms without many specifics. Once they get to the hospital and the physicians do their job to determine damage and insert whatever devices, ICP monitor and EVD, the RN takes over with both the assessment and technical aspects. There is generally not much "skill" involved in the ICP monitoring and drains but they are attached to the patient which involves the assessment part. I can do most of the technical skills and have a fair amount of neuro assessment, definitely more than the average Paramedic because of my ICU and Acute Rehab experience, but even I know my limitations. The RNs in the ICU have expanded their knowledge base in that area more than I have since I have a different focus. There is also another understanding that must be dealt with and that is what part of the brain has been affected and how to interact with a neuro patient. There is a time for quiet and a time for stimulation. Verbal commands must be changed as appropriate to acknowledge motor, auditory, sight recognition and sensory. Not all patients will be able to communicate as one who does not have a brain injury and if you are not aware of all the various aspects of assessment for response, you may just right the patient off as "nonresponsive" to verbal. This is also part of the development and assessment training RNs get in school that is later enhanced for their specialty. However, as these patients leave the ICUs, the med-surg, Rehab and SNF RNs also have the basic concepts for dealing with the physical and communication needs of the patient. But when they are unsure, they ask the specialists be it neuro, Speech or PT/OT about the specific needs of that patient to enhance the patient's recovery. They are not above carrying out the care plans of other disciplines for the good of that patient. This team approach is also a very unfamilar concept for the Paraemedic "who can duplicate" any skill and can do it all. Talking with a patient who has suffered a severe brain injury is something the few EMT(P)s have even given a thought to as evidenced with "BS" or "BLS" and even the "ALS" IFTs. So many EMTs and Paramedic fail broadening their knowledge base and just write off things that other health care professions find very valuable for a patient making a full recovery or at least having some quality of life. This is just one example. There are many others as they pertain to cardiac, spinal cord injury and surgery, GI problems, pulmonary diseases etc. Each patient in each disease category will also have his/her unique set of issues that must be identified and not just "lady with a back drain and dressing that need changing". Again, total patient care to see that all the needs are met for the patient to have a successful transition out of the hospital and to prevent recurrent ED visits and lengthy hospital stays are the goals of the RN as well as all the other disciplines. Just giving a med or doing a skill is not "patient care". Have you ever followed a patient from the ED to Radiology to ICU, to the OR, back and forth to Radiology, CT Scan, IR, MRI, Nuclear Med, Step down unit, med-surg, Acute Rehab or SNF? This course may take some patients a year and each step will be an important one that is dependent upon their nuring care. Nurses will always be there to help coordinate the many, many other professionals that will come and go from that patient's bedside.

A skill can be duplicated but if the overall knowledge base is not there, it means little. RNs initially did and may still do skills from RT,Radiology, PT/OT and dietary. Nurses were also on ambulances long before the Paramedics. If you want economic reasons for cheaper, that would be a Paramedic. A tech that can do a few skills relatively cheaply or with their real job of Firefighting. Disregarding the "cookbook" Paramedics, let's look at how statutes for EMS providers are written. They are generally a list, some states longer than others, of skills and meds. If it isn't on the list a lengthy process may have to be done for approval of that "skill". For some states, like Calfornia, it probably won't happened. Nursing (and RT) generally have open ended scopes of practice. The list of "skills" for the LVN is longer than that of a Paramedic although it has a different focus. You are also focused on the "immediate" skill and result which will probably be the biggest hindrance to the Paramedic's usefulness in home situations. Just going door to door looking for an acute crisis so you can "read an EKG" is not the idea behind home care. Recognizing situations before they become a problem is the key. Would Paramedics be likely to check the feet, heels, bony prominences and other tissue areas such as the buttocks or sacral area? How about evaluating caloric intake and discussing their insulin with them to adjust it for diet and activitiy? How about positioning to prevent skin and joint stress? How much did Paramedics learn about taking a temperature or even the correct routes for certain situations? We could use sepsis as an example. Many Paramedics transport a "fever" from a nursing home and rarely dwell deeper especially if the BP is textbook "norm". They then bitch about lazy nurses that just want to get rid of patients and don't realize the assessment knowledge the RN might be relying on to make that call. Some in EMS don't realize the many types of assessments that are done each day by nurses and other professionals that don't just consist of looking for an obvious emergency. For home care, EMS also has to overcome the mindset of "BS" calls and ALS vs BLS to see the patient care aspect as a whole. They will also have to get over their fascination with L&S which is why many entered EMS. Few entered EMS to do glucose checks and assess BMs all day while discussing diets with patients. Few even realize the importance of that. It may be difficult be very difficult to expand the Paramedic much beyond "welfare checks" in the home care due to attitude. Also, welfare checks don't always address medical issues about to become problems because the Paramedic has limited assessment skills in that area and a very different focus. You can not or should not get into "critical care concepts" as it pertains to patient care unless you have mastered the principles of patient care and that includes covering all patient needs from development, emotional, comfort and prevention as well as the emergencies. Thus, the nursing education does provide them with those concepts which gives them a better understanding to be effective patient care providers in critical care rather than recipe followers or skills robots. If you ever work with CCT and Flight teams, you will see how some Paramedics and RNs approach situations differently especially in assessment and communication. It is easier to teach "skills" than critical care concepts based on knowledge and experience. If you had ever worked in a hospital environment you would see exactly what an RN, RRT, PT and OT bring to each patient. One could argue anyone could do the "skill" of walking a patient but few are going to understand how to assess and develop a care plan to correct or treat a gait problem. If you just "walk" a patient down the hall without extensive knowledge of movement, you have nothing for the patient to enhance their recovery. An uncorrected problem will then lead to more serious problems later and yes even for something that appears to be as simple as a gait issue. If a PT can prevent 2 patients/per month from having surgery, they have proven their worth from an economic stance. Anyone can hand a patient a nebulizer and say breathe in but not all will be able to determine a care plan for that patient as to what device and medicine they qualify for at home. Few can identify the force and have extensive knowledge of over 40 different respiratory devices and medications to make that recommendation. The reason I became a Respiratory Therapist in addition to being a Paramedic was I realized how limited I was to helping a patient breathe. An albuterol neb and an ETT were my only options and neither are enough in some patients. For RT, if vent days are reduced even by one day, that is a huge savings as is every patient that intubation is provented. If the RN catches a problem early or prevents a problem such as an infection or decubitus ulcer, the savings are enormous. It is not about just being "worker bees". These issues are all well studied and well published as are those for justifying those with higher education and not just "techs". If you only look at it as a "skill" from just "doing" the procedure, you are greatly shortchanging the patient and have not taught them anything about their disease or medication to prevent them from another ED visit or hospital stay in the very near future. How many Paramedics can give meds about 30 different ways? Many are not allowed to access the long term vasular access devices. Nurses (and RTs) can be trained to insert a PICC just as they can other central lines for CCT and Flight. Both professions can expand to do just about anything they want because their professions have given them a consistent base education requirement for the medical directors of hospital units to use to their advantage especially with the open ended scopes. If they need people to "manage" an IABP and not just babysit it from point A to point B, they have both RRTs and RNs. If they need an ECMO specialist, both the RN and RRT can step up. But RNs and RRTs have the same capabilities of almost every skill listed in the Paramedic scope. They just have a different focus. If it is decided on day that RNs should intubate in L&D or CCT/Flight, they get the additional education/training and they intubate. The basic foundation is already there. But still, the primary thought is not just about the "skill". Also, instead of reinventing the wheel, we could just utilize what we have and build from that foundation. RNs, NPs and PAs already have the focus for the long run in patient care for the home situations from their experience in discharge care planning, teaching and overall maintenance. EMS complains they are too stressed now. What if they had to do 12 house calls in 8 hours with a schedule to keep? The Paramedic was designed with emergency medicine as the focus. EMS still has not mastered that concept fully at this time. Why add on something else with a totally different focus to which they have few opportunities to gain experience in. Also, if they feel the value of "nursing care" is similar to yours, they would truly be ineffective in an environment which requires knowledge with a very different patient care focus. But back to the general care, what about teaching patients and families to deal with life changing disabilities? How many Paramedics have done a plan of care for a 20 y/o who is a new AKA? How about instructing him on the care of his stump? And yet, there will be PT/OT involvement as well. It takes a team to put a patient back together physicially and emotionally so no one health care professional in the hosptial claims to do it all. That is something Paramedics have a great problem dealing with when they do work in an ED or even in the field. They may be able to fix treat some acute symptoms but they don't fix the problem and some may not have the ability to identify the problem except for a few emergent situations. Thus, a Paramedic working "as a nurse" in the ED may not have to ability to do a little more than just the "usual" assessment to get past the acute. Hopefully the doctor would do the assessment but many rely on RNs to detect issues before they become major problems. That happens all over the hosptial. A doctor who has 35 patients in the hospital to see will not be able to do a thorough assessment each visit. You would just have to work in a hospital to see the value of each profession. You would also have to set aside the "skills" mentality and that everything is an emergency. Nurses and all the others prefer not to allow an emergency to happen for the sake of the patient. Nurses kick themselves, both before and after their supervisors kick them, for not recognizing something sooner that turned in a very serious problem quickly. Failing to do a further assessment for what might see like a minor temp change can be devastating to certain patients. Thus, most of us in the hospital strive to not have to demonstrate what heroes we can be. A day without and emergency means all involved in that patient's care are doing their jobs. It is not always about the "save" from a code but have many you save before they code. It is not about just one profession being better than another or more valuable. If that was the case, Physical Therapists would win without a doubt since their sign-on bonuses make both RTs and RNs drool. Radiology professionals who have their MRI and CT Scan certifications (additional) are being recruited with impressive perks. Why? We have had doctorate degrees in nursing and many professions, not just health care, for decades and even centuries. The DNP just designates advanced training with a clinical doctorate. Actually, nursing is just starting to catch up by getting the DNP into their profession. Many of the other health care professions have already equaled or passed them in education. Physical Therapy has one and it is highly respected by the hospital administrators and insurers. What about all the other professions that require at least a Masters for entry? To teach at that level they must get a doctorate. What about the nonmedical professions? My accountant has a doctorate. Are you going to tell a history professor with a Ph.D. that he is guilty of education creep? Have you never been on a college campus to see all the people with higher education it takes to mold the students for the future? Have you not noticed the education and credentials of those who are doing research that will eventually shape some of what EMS does as well as just about anything else? I have a friend who has a doctorate in music and I am amazed at the job offers he gets from research industries, including medicine, and companies from around the world. Universities have also been requiring higher education for their educators for centuries. However, EMS still has yet to recognize the difference between instruction or trainer and educator which is many EMS programs are in departments ran by nurses.

Let's not forget South Florida which is commonly referred to as the 6th bourough of NY. Then we have a place known as Little Quebec. Mix a few European and South American attitudes in there and you might say I have the best and worst of it all.