Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

Prehospital Care

Andrew J Bowman sumieb at compuserve.com
Mon Apr 10 16:24:22 BST 2006


David,

I am an ER nurse who got his start as an ER and Street medic.

My hospital still employs medics in the ER.

Would like to see your paper also if possible.

Andrew

----- Original Message ----- 
From: "David Sullivan" <fpcems at yahoo.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, April 10, 2006 11:18 AM
Subject: RE: Prehospital Care


>
> Mike,
>
>    I was interested in reading your reply to my email, I figured that you
werent out to inflame me, but this seems to be a reoccuring argument, that I
totally dismiss,  an RN and being a paramedic..two totally different
diciplines of medicine, and environments as well. I have had a RN work a
shift in my ambu and it didnt go so well when we had to work up a cardiac
arrest, not that the skills werent there, but I felt the environment made
her uncomfortable.  i will agree that that RNs are awesome long term care
providers and ER RNs are some of the finest trained providers in the
business. Your right, RNs skills dont carry over well onto the "street" and
vise versa, I dont know if there are hosipitals out there that employ
paramedics on the unit floors (ICU, CCU ect...) i wrote a paper on the usage
of paramedics in ERs in So. Eastern MA area, I am curious as to what your
opinion would be....I'll email it to you if you's like.
>
>   Dave Sullivan BA NREMT-P
>
> Mike MacKinnon <mmackinnon at cox.net> wrote:
>   Dave, ill do my best to answer your questions.
>
> But if working as an RN (specifically) why arent RNs taugh the art of
airway
> managment?
>
> RNs are taught the full scope of airway management without the intubation
> skill. I intubated in the ER in Canada as an RN. In the states, it's a
> medicolegal liability. Why would you ever have a lower level of care
perform
> a high risk procedure when there is a physician right there? Secondly, it
> would be a hugely expensive undertaking for the facility to train the RNs
up
> to the skill level where they could intubate safely as there are so many.
> This is the main reasons hospitals cite as the reason they choose to train
> RTs as backup intubators when the physicians are not avaliable, cost.
>
> Medics get that type of experience of intubating upside down, in the dark
> ect...this is valuable experience to cross over into the ED
>
> We arent intubating people upside down in the ER. These people are
intubated
> in exactly the same position every time, in a well lit room with RTs RNs
and
> a physician at the head. I agree with you, as a medic and a flight RN I
have
> valuable experience with unusual intubation techniques , however, they are
> only useful in that setting. I understand what your saying but it just
> dosent translate to the ER.
>
> Also, i feel that RNs dont work as well as medics under pressure to get
> things done
>
> Well now that depends on how you look at it. In the ER i have 5-6 patients
> that i manage wholly by myself. Often under similar (but expanded) medic
> protocols that allow me to get things done. When the crap hits the fan, it
> isnt the Doc thats there, its the RN. I have been both places, and i
totally
> agree that most RNs couldnt manage a day in the field. However, i would
> suggest the same of most medics within the hospital. Its easy to turn it
> around and say this: " I see these medics come in on the fire service, 6
of
> them for ONE patient? How easy must their job be now that they dump
another
> one off on the ER we cannot refuse and go back home to get in bed or
finish
> a movie?". ( or exchange that to 2 for one patient in a 3rd service, in
> anycase, much less than 5:1 for nurses who have these patients either for
> long periods of time or are turning over rooms constantly throughout the
> shift without a chance to sleep or watch tv). I would suggest ER nurses
are
> certainly under pressure at 5:1 the rate of medics (i learned that the
hard
> way).
>
> I am not trying to inflame you. I had the exact same belief structure as
you
> do now not that many years ago. Its a matter of seeing the otherside. I've
> worked in the er with 3 vented ICU patients on 4-5 drips each with one on
an
> IABP (i was the only balloon trained RN in the ER), all by myself because
> the ER was full and the hospital had no beds. It happens weekly. In order
to
> appreciate the differences between the professions you have to be there.
>
> I sometimes hear other RNs spout off about physicians wondering how it is
> that they do all the work and the doc just sit there and writes the orders
> yet makes 4-5 times more yearly? The answer in education, liability,
> responsibility and experience. While these RNs may feel like they have
> treated that MI patient a thousands times and could make the tx and dx
> themselves, that is no substitute for the education that an ER physician
> gets which allows them to pick out that lifesaving Dx which no RN would
ever
> come up with. I correct people quickly because I used to do the same thing
> when i was a medic in regards to RNs (the ER/ICU ones anyway).
>
> I have an immense respect for paramedicine. I still run paramedic classes
do
> refreshers and am about to recert here in the states. However, medics are
> excellent at prehospital, RNs are excellent at hospital stuff. Sometimes a
> transition goes well, but for the most part they are incompatiable. One is
> not better than the other, just very different focus.
>
>
> Mike M
>
> -------Original Message-------
>
> From: David Sullivan
> Date: 04/09/06 04:46:27
> To: Trauma &, Critical Care mailing list
> Subject: RE: Prehospital Care
>
> 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 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
>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>
>
>
> ---------------------------------
> Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo!
> Messenger with Voice.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>
>
>
> ---------------------------------
> How low will we go? Check out Yahoo! Messenger's low  PC-to-Phone call
rates.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>




More information about the trauma-list mailing list