RN's in EMS

[Bernhard]

German ICU nurses have in the most cases a broader knowledge about pharmacology than a medic,

Depends on the medic and depends on the nurse. ICU and anaesthesy dept. nurses are far better in emergency situations than regular nurses, that is true.

BTW, I partly stand corrected - krumel points me to the fact, that in my state, nurses (acoompanied by a doctor) are allowed to do intensive care transports and flights instead of a Rettungsassistent. They just may not be dispatched to emergencies then.

Note: If there is a difference between ground and air transport is still in debate between krumel and me and as soon as I found my commentary to the EMS laws, I may win at least this one.

[Vorenus]

Note: If there is a difference between ground and air transport is still in debate between krumel and me and as soon as I found my commentary to the EMS laws, I may win at least this one.

I have to admit I don`t know for sure how we do it around here, `cause I don`t have anything to do with Intensive Care Transports - but, I do seem to remember (from school) that in the past, mainly nurses did intensive care tansports, or a paramedic that had to get an extra certification in nursing stuff.

Now i see only paramedics on the intensive care tansport vehicle, some I know from sight and one was a teacher of mine in school.

When it comes to air transport, I`d say that nurses wouldn`t be allowed to do that, at least not in the most cases, simply due to a lack of space. With the smaller machines, there`s only space for the pilot, the paramedic, the doc and the patient (I`m thinking Eurocopter) - but around here, a "Flight Paramedic" is really counted as part of the flying crew, rather than the medical (that`s on the ground), so they do a lot of navigating and stuff - I can`t see a nurse doing that.

With the bigger machines, where there are more seating possibilites, a nurse might be around. I did a neonatal transfer a while ago, from the hospital to the helicopter landing space, and was accompanied by a doc and the neonatal nurse who both did the transfer in the heli, but that was a bigger machine.

Edited November 1, 2011 by Vorenus

[krumel]

The 3-seated aircrafts (although also on the EC135 a 4 person crew is possible and this is a good choice if you're doing critical care transport) are not that adequate for critical care transport.

This is one of the reasons (together with the "more space"-point) that most critical-care helos in GER use EC145, BK117 or Bell's...

[zippyRN]

Just wondering--I read an article the other day that mentioned that one day the future of EMS may be with RN's providing the care on an ambulance! The reasons they listed were that the Board of Nursing has their stuff together and could easily dominate the field of prehospital medicine if they wanted to! I know there is always that debate over the who's who of emergency medicine, RN vs Paramedic, but I never thought that RN's would want to start working the EMS system. I know that they are involved in flight care right now, and that they have the ASTNA (Air and Surface Transport Nurse Association), but do you think it will stop there? Are they going to remain the hospital? And if they choose to work in the field as a street medic (not critical care) will they be performing as a medic, or will they allow an RN an expanded scope? I think that the profession should continue to grow. Paramedics and EMT's are prehospital providers, RN's are hosptial based providers. Any thoughts on this?

Registered Nurses are NOT 'hospital based providers' , RNs work in every health setting going.

in the case of the USA while paramedics and their fire monkey / for -profit bosses are happy to be treated and trained as taxi drivers service development won't take place. This is in part due to the fragmented and billing orientated way in which healthcare i nthe USA (doesn't) work ...

If you look at the model the UK, Canada and Aus has and the Kiwis are heading towards, where Paramedic preparation for practice is equal to the preparation of other Health Professionals i.e. 'proper' Health Professional status, near ( 2/3 or 3/4) if not degree level entry, legal accountability for own practice ( not as the proxy of the medical director) proper own account responsibility and accountabilty to possess administer and in some cases supply medication ... ...

[craig]

Registered Nurses are NOT 'hospital based providers' , RNs work in every health setting going.

in the case of the USA while paramedics and their fire monkey / for -profit bosses are happy to be treated and trained as taxi drivers service development won't take place. This is in part due to the fragmented and billing orientated way in which healthcare i nthe USA (doesn't) work ...

If you look at the model the UK, Canada and Aus has and the Kiwis are heading towards, where Paramedic preparation for practice is equal to the preparation of other Health Professionals i.e. 'proper' Health Professional status, near ( 2/3 or 3/4) if not degree level entry, legal accountability for own practice ( not as the proxy of the medical director) proper own account responsibility and accountabilty to possess administer and in some cases supply medication ... ...

like I said...Australia, heaps better medically than America...ahhh, God's country and now above pararity to the US$....how cool is that

Edited November 2, 2011 by craig

[zippyRN]

I think we should staff every ambulance with a physician, but I may be a little biased.

there's strong arguments for field physician availability, but one on every ambulance ... as if enough ambulances don't fall over due to elevated centre of gravity ....

http://www.bclocalne.../130160053.html this is the opposite of the topic but I thought it was worth making a comment on.

Personally I have no problems with nurses being in the ambulance as the have great skills, but were I have the problem is paramedicine is a skill set on its own and nurses are not trained in the things we do and vice versa. If a nurse wants to be in the back of an amublance why didnt they become a paramedic in the first place?

that's a bit of a circular argument - a lot fo the skills f patient assessment, and decision making are independent of location - where each different location emphasises different skills aobut the location ....

Like the physician staffed ambulance that killed Princess Diana ?

Stay and play killed Diana not physcian to scene they had three options

1. rapid transfer to an operating theatre

2. open her chest on the back of the ambulance ( or on a pub table as London Hems doctors did sucessfully to someone)

3. fart about trying to 'stabilise for transport'

I heard a car crash killed Princess Diana. Geez man, at least go with Michael Jackson's physician if you want a good example. Yes, he wasn't on an ambulance, but boy, what a screw up.

I think paramedics trained as RN's are the best providers out there. Your day to day RN on an emergency scene? Ummmm, not so much. I'm not sure what it is about RN training that makes them fall apart on the scene of an emergency but its been my luck that it has happened unilaterally with me. I can give you the horror stories of ACLS instructors and RN sometimes but you probably get the picture. Paramedics: Good in an emergency, bad at just about everything else. RNs: Good at everything else except emergencies.

the ability and training to work at a scene is not magically something which paramedics and EMTs have exclusively

I submit that by virtue of education even a two year AAS RN is a far more qualified to practice prehospital medicine than a Paramedic in the US where the Paramedic may have received as little as sixteen weeks of "education" plus a few hundred hours of clinical skills (cough Houston Fire Department cough)

Does that mean you can just throw an ICU or ED RN out into an ambulance and they will be sufficiently dexterous without additional role-specific skill consolidation? Maybe not, but maybe you never know ... I can teach a 10 year old to put a drip into somebody and even I can shove a plastic tube through the right hole fairly easily.

exactly

Kiwimedic

No way a brand new AAS RN or a BSN will be able to step onto an ambulance and function. By virtue of education only as you say...seriously? Come on now...lay off the sauce

who said brand new and who said anything about not providing adequate role specific orientation and training ?

The 3-seated aircrafts (although also on the EC135 a 4 person crew is possible and this is a good choice if you're doing critical care transport) are not that adequate for critical care transport.

This is one of the reasons (together with the "more space"-point) that most critical-care helos in GER use EC145, BK117 or Bell's...

MD900 will happily take 3 or 4 seated people and one supine in the back

if you make the next jump to S92 sized aircraft ....

or just go the whole hog and use a merlin or chinook as the RAF MERT do in Afg.

[krumel]

MD900 is a pretty cool Helo and has definitly enough room for critical care transport. I "tested it" once and quite like it..BUT: It's not that common in Central-Europe due to some issues MD has with it's replacement parts....

[Just Plain Ruff]

http://www.bclocalne.../130160053.html this is the opposite of the topic but I thought it was worth making a comment on.

Personally I have no problems with nurses being in the ambulance as the have great skills, but were I have the problem is paramedicine is a skill set on its own and nurses are not trained in the things we do and vice versa. If a nurse wants to be in the back of an amublance why didnt they become a paramedic in the first place?

The artical above tells of the pilot program intergrating paramedics into the emergency hospital system, this has been mentioned through out BC for a few years and my comment was that if I wanted to be a nurse that is what I would have to school for. Now in our community about 10 years back Northen health hired a few of us paramedics to be available to go into the hospital if shit hit the fan, or if they couldnt man the hospital to full staff. It is a good idea in an emergency situation but I kind of think that the paramedics are going to get board as we all know that we are adrenaline junkies and when the pagers go off the heart rate goes up. Well just my two cents...........................

I started in the ER as a medic and worked the ambulance as well, just like this article.

Nothing like pissing the ENA off regarding putting medics in the ER. Our nurse manager had to justify to the ENA (28 years ago) why medics would work in the ED and take away jobs from nurses?

Her main response to their questions was that in a rural hospital with only 8 beds, getting a nurse to work there was damn near impossible and until the ENA could get her some nurses to take the night shift where they might only see one patient in a shift, then the ENA needs to butt out of the hospitals and her decision. The ENA went away.

Now they have EMT's, medics, PCA's, techs and nurses all working side by side. It seems to work well. In Missouri there are things that medics can do in the hospital based on their licensure that nurses aren't allowed by the hospital to do, eg intubate and some other things. Medics in Missouri are also able to spike a bag of blood which 10 years ago they were only allowed to spike the bag when they were in the ambulance. More on that in a later post.