Nurses vs EMT's in EMS

[Dustdevil]

I think Harold is talking about nursing graduates without critical care qualifications, making the transition into ALS somewhat more difficult. (Correct me if i'm wrong, Harold..)

That is also what I assumed he was referring to. That's why I asked if nurses receive their education there, or elsewhere. If they receive it elsewhere, then a critical care education would be more difficult to set up, especially if there is no existing medical educational infrastructure.

[zippyRN]

if you are starting from a clean sheet of paper and you have the support of legislators , the obvious answer is Degree level paramedics , prepared in the same manner as Nurses and other Health Professionals, but with an obvious and necessary pre-hospital and unscheduled care bias to their placements experience ( for thousands of hours - the EU directive that covers Nurse pre-reg education in Europe specifies 2300 hours of clinical placements).

if legislators are unwilling to create a new type of health professional and empower them to independently possess and administer the relevant medications ( which will include controlled / scheduled drugs i.e. opiate analgesia and benzodiazepines for seizure control and sedation) then a post registration programme for RNs may be the most straightforward way to achieve the outcome , but there are still issues such as possession and independent administration of Prescription meds to square away.

there is an increasing body of experience with Higher education preparation for practice in the Anglo / Canuck / Antipodean model of degree educated paramedics ( with the UK having full health professional status for it;s paramedics) as well as the Dutch/Scandinavian model of post graduate RN paramedics.

the issue of the 'other half' of the crew needs to be addressed as while a dual Paramedic crew may be ideal for certain situations it's also expensive overkill for the vast majority of 999/112/911 work where the only paramedic 'skill' used is patient assessment,

while it causes much gnashing of teeth and wailing in systems where there have traditionally been 2 'trained providers' each with their own scope of practice on the vehicle , the move to a Professional + (still) highly trained but definitely subordinate Assistant / associate practitioner is appealing given the cost advantage of the AP over another practitioner even if the other practitioner has few in any more 'interventions' because autonomy and independent scopes of practice are what influence pay rates - especially if you job evaluate compared to other healthcare roles. - an irony of this is that the Assitant practitioners in the UK still recieve more in quantity and depth training than EMT-Bs ...

I have to say I don't like the idea of using nurses in the prehospital setting.

Here at least, a nurse and a paramedic are very different creatures. Paramedics have a greater scope and almost complete autonomy. They also have slightly more education than nurses although the more important point though is that it is different education.

Paramedics do not have 'complete autonomy' in any jurisdiction on the planet, there are few countires where paramedics are treated as proper health professionals and even then they do not have the level of access to treatment options that other None physician health professionals have.

I am unaware of anywhere where paramedics can actually 'prescribe' medication rather than administer it , where as increasing numbers of places have Nurses , pharmacists and other none physician heralth professionals who can prescribed across the full formularly

I am unaware of anywhere in the world ( apart from the places who require RN as entry to Paramedic programmes e.g. the Nerthrerlands and some Scandinavian countries) where paramedics are required to have more education pre-registration than RNs it ranges from similar to dramatically less - remembering that the USA currently has some of the shortest RN programmes in the world - the associates programmes which do not count elsewhere in the world - the EU specifies 4600 contact hours in Nurse pre-registration education 2300 in practice and 2300 in university - in the Uk this is mainly delivered as 3 *40-45 week academic years.

Paramedics here tend to be taught along the lines of diagnosis. Critical thinkers who can problem solve and apply their knowledge appropriately to figure out whats wrong with a patient and treat accordingly. In this sense, our training in more in the spirit of medicine rather than nursing.

i really don't know what to say here other than the pat you on the head, and then run round the corner and start laughing at your naivety over what is in Nurse education .

It has to be that way, because we don't have medical control: we sort of have to be watered down doctors. Nurses are the educated eyes, ears and hands of doctors, and while in practice, they are much more, their training is still based entirely around the idea that they are part of a team that necessarily involves direct medical oversight.

totally incorrect

Take away a nurse's support structures, other nurses, doctors, fancy gear and I think you've got problems. I've often heard nurses saying, well the doctor should be doing this and that and the other thing, but I wonder how confident they would be if the decision to paralyze and intubate or thrombilyse over PCI, decide on the amount of fluids that post-severe haemorrhage pt should get, leaving a pt at home after deciding that they aren't sick, actually rested on their shoulders.

pats on head, makes comment about naivety and then runs around the corner before startign to laugh

Most of my degree is about educated clinical decision making. When it comes down to (and correct me if I'm wrong), clinical decision making doesn't lay at the heart of nursing.

that's male bovine excrement

Edited April 9, 2010 by zippyRN

[Harold1]

we are talking about nurses who doesn't necessarily have ED, ICU, CCU or Anesthesia-experience. The nursing education is organized locally.

[VentMedic]

we are talking about nurses who doesn't necessarily have ED, ICU, CCU or Anesthesia-experience. The nursing education is organized locally.

What exactly are the requirements for nurses to work on an ambulance in most areas of your country?

Can you post some links?

Edited April 9, 2010 by VentMedic

[Richard B the EMT]

that's male bovine excrement

Hey! That's MY line!

[zippyRN]

Hey! That's MY line!

or we could just become the Penn and Teller of EMTCity !

[Richard B the EMT]

I doubt that. Both of us would want to be Penn Gillette (spelling?), as we both speak out quite often, and Mr. Teller plays a mute.

[Dustdevil]

we are talking about nurses who doesn't necessarily have ED, ICU, CCU or Anesthesia-experience.

I don't see how that makes a rat's arse. The non-nurses don't have any of that experience either!

At least the nurses have a scientific, as well as interpersonal foundation upon which to build. The non-nurses have zip.

And let's not forget that about 95 percent of all EMS work is not critical care.