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Prehospital Care

David Sullivan fpcems at yahoo.com
Sun Apr 9 12:46:08 BST 2006


Mike,
   
  You must be joking? Why is there always a turf battle over who knows what, and blah blah, blah...Why do RNs think that they are more effective providers than medics? Sure, i agree that the training that a paramedic is more narrow, but if working as an RN (specifically) why arent RNs taugh the art of airway managment? I wrote a paper and that was one reason that medics are used in the ED, b/c medics get that type of experience of intubating upside down, in the dark ect...this is valuable experience to cross over into the ED. Also, i feel that RNs dont work as well as medics under pressure to get things done, a paramedic (as you well know) work with one and rarely two other (hopefully similary) trained providers, RNs work on teams ie trauma team, code team what have you....where they can be detailed to one skill, IV, blood draw..ect...even though paramedics have a narrow knowledge base, we treat a wide variety of medical emergencies. I am now knocking on RNs, they do a
 tough job, and are well educated people, but this constant turf battle is just crap, i accept that RNs are higher up on the medical "food chain" but I also accept them as my peers, and i feel that, that respect is reciprocated b/c of the pt care that I provide, pre-hospital. I did a paper on medics working in the ED, and I surveyed local EDs to see what they thought, some had medics and they were well used to provide care, b/c of standing orders ect, traige ect....some hadnt thought of it, and seemed offened at the thought
   
  dave sullivan BA NREMT-P

Mike MacKinnon <mmackinnon at cox.net> wrote:
  Steve

Get real.

I was a medic in Canada (P3) and a Nurse. Now an RN/Medic in the USA. I
never did anything as a medic near what I do as an RN, ever. Paramedic
education is highly specific to a very narrow scope of practice while RN
education (4 years science degree in Canada) is intentionally general
coverage of everything allowing the individual to specialize with a strong
science background. In the pre hospital setting I do much more than the
medics. Everything a medic can do is in the scope of practice of an RN while
the reverse is not true.

If there was a logical choice for a midrange person in hospital (when there
are no PAs or NPs available) it would clearly be an RN not a paramedic. RNs
would be used to the inner workings as well as the ER presentations,
treatments and knowledge base to make decisions. 

A wise man once told my when I was an EMT (P1) planning to be a medic
shooting off my mouth how easy it looked "Son, you don't know what you don't
know.". Steve, your a paramedic looking in and making judgements without the
education or experience of a critical care RN. 

Mike M

-------Original Message-------

From: Steve Urszenyi
Date: 04/08/06 22:57:02
To: 'Trauma &, Critical Care mailing list'
Subject: RE: Prehospital Care

Snippet from Andrew Bowman's post:

<< An added benefit would be the occasional procedure (ETT, central line,
etc) under the tutelage of an ED doc to give tips and tricks. >>

I few years back I was hired with about 3 or 4 other medics by a local
community hospital here in Toronto that wanted to create an ER Paramedic
position. The goal was to augment the physician staff with ALS paramedics to
assist in the Fast Track part of the ER. The very progressive-minded ER
director (an ER MD) envisioned us performing a pseudo Physician's Assistant
role. But guess what the biggest stumbling block was? The nurses' union.
They screamed blue murder that medics in the ER should not be able to do
anything above the skill set of the RNs. Never mind the fact that I do just
that every day out on the road where my skill set far exceeds anything they
are trained or permitted to perform. The program lasted around 8 months and
was then canceled. Oh well.

Steve Urszenyi




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