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Paramedic vs Nurse
Ok, I have been thinking and asking alot of people about this. I figured why not ask my peeps on FFN. When there is an accident on the interstate and a off duty nurse arrives and assists in medical aid, and the local firefighting/ ems response arrives to transport. If the EMS has a paramedic on board can they take the patient without the nurse going along or does the medics have to take the nurse along as well? I know that if a Doctor is assisting, then the Doc. has to go for being higher but does a Nurse? Who is higher a nurse or a paramedic?
Replies to This Discussion
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Permalink Reply by Robert St. Germain on
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For my area, I know all the nurses in my town. The only thing that bothers me is that there are people out there that profess to be nurses or doctors, and they are not. I know that may sound weird to some people, but there are some weird people out there. The other isue that might come into play is privacy laws. Yes granted we want to save peoples lives, but living in a lawsuit happy enviornment, the laws for that type of situation needs to be enforced. Now if (god Forbid), the nurse gets into the ambulance and it gets into an accident and the nurse is killed, can there be a lawsuit? If it were me personally, the paramedic has presidence in this type of situation, not a nurse. But thats just my opinion. There must be laws in your state that cover these types of situation. Its a matter of are they allowed to get into that ambulance or not.
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Permalink Reply by Station10Capt106 on
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Yep, what Ralph said (you beat me to it).
While help is appreciated we need to remember that most nurses & doctors are trained for hospital care & intervention, not prehospital care. There is a big difference in the two. We are familiar w/ our equipment, where it is and how we use it. We know our standing orders and protocols.
Remember that any questions in regard to authority should be direct to your medical control. Let them make that decision.
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Permalink Reply by Capt./Chaplain Mike Petrosky on
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The way in usually ends up is that you get on scene and you are rendering care and a usually good meaning doc or rn shows up to "help". Usually they have not a clue as to what is and has to happen in order for us to do our job. One good way to get them off your back is to ask what type of dr. or RN they are and if they are going to take pt. care and responsiblity of the pt. and all the EMT-P's and below them? Usually not, which is a good thing. Don't get me wrong, dr. and rn's are great in their own fields, but in the prehospital setting - unless they are a flight RN, etc. that I know personally, please back away. And don't you love it when you ask what type of rn they are and they answer-"OB/GYN"-yikes, we're at an extrication here folks-unless the pt, is breaking water. . .
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Permalink Reply by Justin Sandoval on
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O, Thanks for all the feed back. I was on the same page as everyone elses discussion. I have never been in the "whole nurse on scene" situation, but I have thought alot about it and needed the answer. Anyways I agree with everything that has been said in regards to the nurses training in prehospital care. I understand we are trainined in emergency situations like stabilizing, extricating, haz mat, etc. and a nurse just might not know what to do. I agree nurses are really good at what they do, I'm not trying to find a reason to down talk nurses I was just wonderin. The main reasoning for this discussion is that I understand that our training is totally different than theres but is there a technicality that overides us? So even though we are better trained in our line of work but technically they still overide us due to them being under doctors?
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Permalink Reply by Fireyladd - Retired Chief Sharp on
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The question must be asked. "Excuse me Nurse, but are you willing to go to the hospital with this patient, cause if your not then kindly step back". Even if its a Doctor. If they are not willing to go to the hospital you have no obligation to involve them in the call. That is how it runs in Oregon anyhow. That medical person is nothing but a civilian unless they are willing to go to the hospital with this patient. i have taken great pleasure in asking a Doctor this question and seeing them step back or actually have one removed from my scene because they wernt willing to go with the patient. Follow your protocols or standing orders.
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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Who is higher a nurse or a paramedic?
A nurse is higher training wise... period. What a lot of paramedics and EMS folks don't fully understand is that a registered nurses biggest assests are two fold.
Number one, they are patient advocates. All nurses truly care for what is best for the patient, and this includes providing emergency care prior to your arrival.
Number two, is their ability to do patient assessment. It does not matter if they are trauma nurses, or work on the med/surg floor. This is the bread and butter of their being.... Nurses assess patients and in many cases, if you think about your personal experiences, it's a nurse that you have to talk to first before actually seeing a doctor. And in my area, it's a nurse practitioner that you see and not a doctor.
With this being said, if the nurse has it together, upon your arrival, they should brief you as far as what they have or have not assessed, and then ask you how they can help. The incident scene is yours, not theirs... Period. But you would be foolish not to use nurses to help you out, if safe to do so without compomising their safety.
Examples of how to use a nurse on scene:
1. with a nurse, you can have someone competent to be with the green and yellow tags, should you have several patients and your attention is focused on rescuing / extricating red tags...
2. with a nurse, you can have immediate counseling and support for the victims
3. with a nurse, and with a critically injured patient, you have another set of hands to help you with patient stabilization should you be working in a rural area with a long response to the hospital or time to kill waiting for the medivac chopper to arrive for patient transport.
4. with a nurse, communicating with the trauma nurses is a breeze because again, the nurses ability to assess the victim 100% of the time is going to totally out do anything you could possibly say in a face to face report to the 'higher' medical authority.
Use registered nurses to your advantage. Approach these individuals as a resources and your incident will be just that much better. Come off with a cocky arrogant attitude and things probably won't be as pleasant. It's not about you... it's not about the nurse, it's about the patient...
And as far as doctors, I too had an experience working on an unconcsious victim in our downtown area with an individual pushing through the crowd, exclaiming, "I'm a doctor, let me through!". Ever have this one happen? Within 30 seconds of his arrival, I interupted him and asked him a key question. Remember it's our scene, not theirs, regardless if they are a doctor or nurse.
What was the question?
What kind of doctor are you?
His answer... "uh... I'm a doctor of philosophy..."
Ask questions, challenge authority! To not do this could make you look very foolish... And no one likes that... You have to put your people skills abilities to work, evaluate these individuals who offer help and gently steer them away when possible to save them any embarrassment and to not upset the patient(s) with extra things to worry about. If the individual does not get out of your way, immediately request a LEO and have the person quietly removed. Please remain professional and remember that if the person is unstable enough to pretent to be something that they are not, then they also have the potential for harming your patient. Be sneaky, quiet, calm, monotoned voice, etc. You have enough problems to deal with usually, so distracting these individuals is a high priority. Use your truckee's for this... It's just like having a personal bouncer next to you!
CBz
CBz
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well for us we dont allow anyone besides our paramedics do the job. Like i said they would need to prove they are who they say they are, and there is a liability issue here. What if someone says they are a nurse and there not. Listen folks we live in a world where not everyone is honest. And i would much have my paramedics do the work then someone I dont know.
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Permalink Reply by Marshall Flick on
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I would have to say that whomever assumes Incident Command is in charge. Even if that is an EMT-B that just graduated.
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Permalink Reply by Oldman on
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Nurses for the most part have a different scope of practice which does not extend outside the clinical or hospital setting. As a general rule, nurses must have orders from a physician to treat whereas paramedics are able to operate under a delegated practice. I'm sure that state laws vary, but generally a nurse does not have to ride in with the patient as they are much like a first responder.
But as has been said, don't discount the value of a nurse. I have been on many scenes where the nurse is also, or was a paramedic, and or a trauma nurse. Especially when a patient is going south quick, fast, and in a hurry. It's been my experience that a competent trauma nurse will tell the medic something to the effect that, they work at ABC trauma center, or are a CCRN, etc.
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Permalink Reply by Paul Montpetit on
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Ralph....Sure an glad that you said "MOST" nurses....LOL...Looking at one here bud...worked and Nationally certified in both Burn intensive care and ER...But, I have to point out that Nurses actually have NO authority in a pre-hospital setting....until I became a medic I couldn't even pop a line in prehospital....Pretty dumb in my book...only do about a hundred a week at work.....LOL Personally I would like to see someone come up with a bridge program to get more nurses riding in rigs....I know many don't because they don't want to go back and have someone "teach" them the basics...but would love to learn what happens in the field and why....They don't need to learn direct pressure, dressings and bandages...give them what they need and you may find that your "manpower" shortages disappear......Paul
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I'm with you on this one... kind of...
As soon as we arrive on scene, generally speaking, I shoo everyone away. The less people on scene the better. However, with that said, it has always been painfully obvious if it's a trauma certified registered nurse.
You can pick out the women who work as critical care trauma nurses very easily. They are the ones who would eat their young in a heart beat. Simply put, you don't mess around with these types of nurses. They are not known for not being able to quickly commuicate with you.
And chances are pretty good that if they feel comfortable with the provider level on scene, you won't see them hanging around too long. As mentioned prior in this posting, there are tons of nurses with varied specialties, most not having a clue about what we do in the field. But if you happen to have the opportunity to work side by side with one of these very competent nurses, take advantage of it.
And if the nurse agrees to maintain patient contact, including the ride to the hospital, wouldn't your agencies medical protocol be thrown out the window? We all know the ruling about using the highest level of medical care available when it comes to EMS delivery. This is why a physician can have so much autonomy.
I would be very cautious when it comes to removing a nurse who can identify themselves as being 'real' and is willing to maintain patient contact. How about this policy when you have an ER trauma nurse who just got off duty and was on her way home stop at an accident scene. She is performing life saving actions and a firefighter tells her that she cannot be on scene because of policies. If there is a negative outcome with the patient, you can bet that this policy would be challenged where I live and work.
What is missing out of your agencies policies is any form of pre-planning for disasters using medically trained people at hospitals, identifying them ahead of time with ID Photo badges. To not make use of all the available resources before the 'big one' is another incident where people get together after the fact and make the conclusion that I have shared with you. This is an example of why we should learn from other folks mistakes.
To not use qualified personnel in county would be a mistake. If it was your wife, husband or child, wouldn't you prefer a critical care nurse to be the one taking care of you right there in the field? Or would you truly prefer using an EMT or Paramedic? The nurse isn't going to dictate how you remove or handle the patient, he or she would be there doing only life saving actions, pre-identified through city or county policy. Whoever the medical director is for your jurisdication can easily make this happen with the stroke of a pen.
Failure to prepare is preparing for failure...
CBz
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Hey you scum sucking pig....!!!! LOL....I'll put you back in your little bone box....as a patient if you keep it up.....LOL....Good thing I like you.....
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