RN's in EMS

[DwayneEMTP]

Make no mistake, I do see where RN's have their place in pre-hospital...

Woman! Know your place

Album: Dwayne Stuff

Uploaded 29 Oct 2011 - 10:28

Like that you mean?

As you were...

Dwayne

[DFIB]

Like that you mean?

As you were...

Dwayne

What about the male nurses? Spanking for all?

[txladymedic]

LOL well I wouldn't know...I've only flown with male nurses. I tend to fall into the category of "Well behaved women rarely make history" thing.

It was nice to have somebody when I was flying with a little more experience with ICU patients or with a specialty NICU nurse when you've got a neo with all kinds of issues. And I know that some states don't allow paramedics to do RSI meds but the RN's can and vice-versa in other states so in those situations it's nice to have that ability especially when you are flying.

I still don't see paramedics being phased out and it all becoming RN's working ambulances however.

[Bernhard]

In Germany in most (I even think in all) states, EMS laws restrict pre-clinical access to the Rettungsassistent (paramedic) and emergency physicians (in case one is needed). Nurses without paramedic license are not allowed to staff responsible positions per se. This includes emergency care and non-emergency transport, inter-hospital or intensive care transport and helicopter EMS.

There are some ways to get nurses to paramedic level and vice versa with reduced education time, but both have to take the tests of the other. I don't see the nurse as "best pre-clinical provider" - there are a lot of things a nurse isn't able to handle with "only" a nurse degree. Especially the regular nurses, often they even aren't allowed to do i.v.'s. let alone intubation and even most other care without a direct doctor's order. An experienced nurse from anaesthesy or intensive care sure is better able to handle emergencies, but even they are used to have a doctor in minutes at bedside and a clean environment. The medic is alone - even in germany, where we have the abilitiy to have an doctor on-site, often enough he is far more than just a minute away.

Some hospitals around here even hire paramedics for their emergency department, since they are more organized in stressful multi patients settings. That's the official reasoning, beside that I believe, they simply are cheaper...and nurses associations don't like that.

Beside the law restricting non-medic's staffing ambulances here, almost all nurses I know would be afraid of beeing on the street in the given settings. All nurses I know working in EMS have EMT (Rettungssanitäter) or medic (Rettungsassistent) degrees, which they have to obtain additionally to their nursing school.

As WelshMedic stated, that nurses are able to triage, that's left to us medics here as well: we have the opportunity to turn down a call, not transport to hospital and get a General Practioner. So you don't need a nurse for that. Just a GP system that works.

There's still some truth in what he said...The physician based systems in Germany, France and Austria have huge problems finding enough qualified personel. In Germany there we're cases that during nights a area comparable to the hole state of Rhode island had only one physician available. As the scope of practice varies widly amongst the diffrent regions in this case it means: No ALS care (including NO i.V.'s, NO pain reduction, NO Airway) for everyone who didn't get the doc...

That I consider strange. If there's no doctor (which could happen and will happen more and more), the Rettungsassistent is well able to perform all duties. At least legally and by scope of training (i.v., pain reduction, airway and a lot more are perfectly legal things for medics here). However, I must admit, that a lot of my dear medic colleagues seem to be very comfortable in letting the physician do all the fancy stuff and don't think too much about the job. It has to do with the low pay level and often bad backup by the company/organziation plus very bad representation by medic "unions". Personally I can't understand this and don't hesitate to give the best care I can and let the doctor at home if not needed (there are rules when I HAVE to get him, those are followed, but that does not hinder me to bridge the time until his arrival with all needed stuff).

In Switzerland most EMS are hospital based.In the smaller hospitals the Paramedics usually rotate thru the anaesthesia department, the ER and the ICU beside doing the normal "roadside" work. This gives us the opportunity to train certain skills (intubation, RSI, etc.) and makes it easier to get a "broader" expierence.

In my little german department (krumel knows it) we we're able to do this some 20 years ago - it was common to work in hospital for medics on duty. A welcomed opportunity for practising things. When the pager goes off, you left the hospital and worked on street. I was very sorry when some lawyer (or other suit & tie person i assume) considered this as inappropriate. But there is no thing that hinders a (here: german) paramedic to spend a week in anaesthesy department occasionally - we're supposed to have continuing education anyway, this would count as such. I did it and it sure helps in practising things you're not having often on the street.

So my opinion, based on German law/setting: nurses don't make better paramedics, but they surely can make good ones if they got the same education (which they would be required anyway here if willing to get out on the street).

[Vorenus]

German ICU nurses have in the most cases a broader knowledge about pharmacology than a medic, I`d say (at least a medic that is not doing any personal research), but Bernhard is right - the jobs not only about the clinical knowledge, but also about certain tactical aspects and the ability to work in some unfriendly enviroments.

Edited October 30, 2011 by Vorenus

[zzyzx]

But could Florence Nightingale intubate in a ditch in the middle of the night in the freezing rain like medics so often do?

Specially trained nurses on ambulance sounds like a good idea. And so does greatly expanding a medic's scope after requiring them to get a lot more education. The problem is, how do we pay for all that? Healthcare just keeps getting more and more expensive, and at the same time it doesn't seem to be getting any less wasteful.

[chbare]

But could Florence Nightingale intubate in a ditch in the middle of the night in the freezing rain like medics so often do?

Specially trained nurses on ambulance sounds like a good idea. And so does greatly expanding a medic's scope after requiring them to get a lot more education. The problem is, how do we pay for all that? Healthcare just keeps getting more and more expensive, and at the same time it doesn't seem to be getting any less wasteful.

Intubation was not exactly prolific during the Crimean war.

[DFIB]

Intubation was not exactly prolific during the Crimean war.

lol

[WelshMedic]

Intubation was not exactly prolific during the Crimean war.

Here's a personal (and entirely unrelated) Nightingale anecdote. I did my nursing course back in the 80's in the UK. On one of the internal medicine floors we had a fierce Sister (Charge Nurse/Head Nurse) that insisted that the open end of the pillowcase always faced away from the door. This was still in the time when RN's actually did mundane things like make beds and feed patients. WTF? I hear you say (nursing is great for rituals, I reply). I was a precocious student that was never content to just do as I was told so I decided to question the rationale.

After a little research I found out that NIghtingale has advocated the same during the Crimean War as sand would blow into the hospital tents and get in between the sheets and pillowcases making them uncomfortable for the wounded soldiers.

Yet more than a hundred years later there were still colleagues following her doctrine!! She must have made one heck of a mark on our profession.

Oh and I suddenly feel old by telling this story...

Carl.

Edited October 31, 2011 by WelshMedic

[Kiwiology]

I like that Senior Sister the lesbo off 24 Hours in A&E she can make sure my pillow is facing in a Nightingale approved direction

Speaking of tradition, the next Ambulance Officer starting a drip without gloves is getting told "Oi fella, do you want Semmelweis to come after you? You do know dead have errie powers yeah?"

Edited October 31, 2011 by kiwimedic