Nurses and 911 calls

[chbare]

I work for a private ambulance company on my days off providing ALS coverage for transfers. The company is looking at providing county 911 coverage. My boss recently asked me if I would like to start providing 911 coverage. My co-workers seem pretty excited to work with me. I would be working with experienced paramedic partners and would have very specific protocols regarding the skills I would perform. Both my boss and medical director state that they feel confident in my ability to be part of the pre-hospital team. Does any one have any experience with RN's working in the field? I have limited field experience, 2 years as an EMT -B and EMT -I training, and I do not want to compromise patient care. I jut wanted to know if any of you have had to work with RN's in the field and what experiences did you have?

Thank you,

chbare.

[AZCEP]

Nursing and prehospital care are significantly different from each other. The fact that you have had some EMS training already will make it a bit smoother for you. Most of the prehospital RN's that I am aware of, work critical care transports or on flight. In the flight situation, the RN is mainly concerned with medication administration, while the medic partner is doing the technical skills.

Nursing schools just don't teach people how to use the same tools that medics deal with. On the plus side, most of these same devices don't get used all that often anyway. Traction splints, KED, MAST suits, etc. These short comings can be handled by good interactions with other EMT's/medics on scenes, so you shouldn't have much problem with the transition.

[Ridryder 911]

Az is right. Yes, you could probably do all right because of your experience, but your education was not really not designed for prehospital care. The philosophy and intent of nursing education is a lot different than the Paramedic level, especially on autonomy and delivery of care. I suggest that you might check with local EMS education facilities to see if they would allow you to further your education to finish your Paramedic. In lieu of hospital clinicals, to get more field time. I do this with RN's, to increase their field experience. Most actually, describe learning a lot more cardiac, and it really is a different approach.

I would also be concerned to as well for liability & licensure coverage. Most states EMS will not recognize the RN education level in the prehospital care level. One must have attended and passed a Paramedic course, along with this be sure to investigate your local scope of nursing practice making sure you are covered. As a former nurse educator, I know that I had to ask for "special exemptions and additional educational coverage" in some states to allow the nurse to perform at advanced skills, such as intubations, etc.. the portions not in in the NLNAC (national nursing curriculum) guidelines. In short be sure your arse is covered.. no matter whom, whatever suggested you. I am sure your are very competent but, be safe ..... also check with your malpractice insurance as well..most do not cover "EMS", I had to purchase an additional coverage.

Good luck in your decision, we need as many competent & educated people we can get.

R/R 911

Good luck,

R/R 911

[Ace844]

"chbare,"

I've worked with an individual in a 911 sytem who was both an RN and a medic. This person when they worked the street had no issues as they were a competent provider and had no issue with "role confusion, or who I am today". They also like you had previous pre-hospital experience. This vs someone who was an RN first then 'jumped' into being a medic with no experience makes a difference for both them and perhaps their perspective, JMLO...I think attitude and perspective as well as clinical abilities will in large part dictate your sucess or 'feeling of sucess' in the field. One major plus you have going for you is the extra education. Good luck, Best wishes,

ACE844

[Nate]

I didn't know there was a state that allowed nurses to be part of an EMS team (meaning them and a medic only). :shock:

[Ace844]

I didn't know there was a state that allowed nurses to be part of an EMS team (meaning them and a medic only). :shock:

Actually here in Mass they allow RN's to work pre-hospital in a CCT ground Transport and Flight RN roles. In the instance above the individual held a valid Paramedic cert, so they were able to work "pre-hospital" as a medic....

Hope this helps,

ACE844

[Nate]

If they are a true paramedic then I see no problem with them on a 911 rig, if they aren't a true paramedic and they are being used as a substitute then I see a lawsuit waiting to happen. That would be like taking a CCEMT-Paramedic and putting them in the ICU...while they might be able to do the job, it doesn't mean they are they best person for the job.

[chbare]

I would like to thank every body for their posts. There are many people on this site who have extensive EMS experience, (and even a few who have been in EMS longer than I have been alive) and I value your comments.

I want to emphasize this is something that I am carefully considering, and may not even be an option if my employer does not get the 911 contract. I know there is a significant difference between the nursing education and Paramedic education, and I do not want to compromise prehospital patient care if my training is not considered adequate. I will not even consider working in the prehospital environment until I receive guidance from the state board of nursing, the state EMS board, and my malpractice insurance company. In addition, both my employer and physician medical director would have to develop specific protocols and competencies for prehospital nurses.

A possible route I may consider is applying for reciprocity and testing out at the state EMT-I level and working as an EMT-I. A few people have told me this is a bad idea because of possible role confusion. This is also something I would consider very carefully.

I do have prehospital military experience; ambulatory medicine, patient transport, tactical medicine, and evacuation experience, however, this is still quite different from civilian EMS.

If after I receive guidance I feel there are any doubts about the legalities and my abilities to provide prehospital care I will decline the offer and continue to support the company by strictly sticking to patient transfers.

As of now I am leaning toward holding off on any ambitions of working EMS until after paramedic school.

I would like to thank everybody again for their responses.

Take care,

Chbare.

[mediccjh]

I didn't know there was a state that allowed nurses to be part of an EMS team (meaning them and a medic only). :shock:

PA has the PHRN. It's Pre-Hospital Registered Nurse; bascially the Nurse operates as a Paramedic.

[Callthemedic]

I took a semester of Nursing. I've also worked in a hospital setting from the ED to rehab in another role with nurses. I can't see a comparison between general nursing and paramedicine at all. If one was certed to do IVs after a nursing degree, then that one skill compares. The nursing-model of care is nothing like the medical-model, yet somehow, nurses are moving across into medicine.

I thought nursing bit off more than it could chew with NPs having only a semester of medical-model, now this?

If the trend continues, there will eventualy only be different kinds of nurses. :roll: