Hospital settles for childs death, faults EMTParamedic

[VentMedic]

Do we know that an RN would have picked up on this pt's situation in some of the opinions here nurses don't ever make mistakes. The medication error form is there just in case an error happens, even though it never has. LOL

Nurses are very aware of med errors. If you are not aware of this also I suggest you do a little research on the topic. A nursing home or inhospital RN may care for 3 - 20 patients at one time. That can add up to over 300 medication contacts per shift.

As far as higher education for nurses yes they go to school longer and learn more disease processes, but the last time I took PALS, ACLS, NRP the er and icu nurses were taking the same course and the same test. Now some of the nurses I know are taking PEPP courses that are primarily for prehospital providers. Hmm same class, same card, god forbid we could have some of the same education.

Let's do a little clarification on "cert classes and education".

A weekend "cert" does not replace higher education.

ACLS, PALS and NRP can be taken by just about anyone with recommendations only for previous education or license. It truly doesn't take much effort to pass any of these classes as they are meant to be an overview of guidelines used in resuscitation.

This is the weakness in EMS that it relies on "certs" to replace solid education.

RNs and other professionals know these "certs" are in addition to their degreed education and any additoin education and training they receive for their profession.

See the Bledsoe article: Vanity in EMS.

http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS

[defib_wizard]

I was making a point that nurses are human too. That no matter who is doing the triage mistakes can and will happen, regardless of education. This is not about med errors. Having 20 patients can keep you from making proper assessments and treatment decisions.

It is only going to get worse with the nursing shortage.

A weekend "cert" does not replace higher education.

Your right! but I know plenty of nurses that have been unable to work the er or icu until they take acls for the first time. They cant work L & D without NRP. Paramedics are required by National Registry to have current CPR and ACLS.

Yes they are cert classes but the nursing profession uses them for qualifications to work also.

I will grant you that this is in rural settings and there is a nursing shortage. In a perfect world a very competant nurse would be the only one doing triage. However in a perfect world we wouldn't be needed because people wouldn't become ill.

The first post stated this was for discussion, so I'm trying to discuss this and be objective.

So a question for you; You are traveling in a rural area and become ill. You go to the hospital & it is a 4 bed er. you are taken into the triage room you realize the person that is triaging you is a paramedic; do you leave, or request a nurse, or let the medic continue?

Maybe this will sway your thinking-

The paramedic has been a medic for over 18 years and worked on a ground ambulance and still works as a flight medic part time.

The nurse graduated from nursing school last year and took acls 6 months ago so she could work the er.

these were the qualifications of the people working during one of my shift days last week.

As i was told recently the rules state that a nurse be on duty in the er they don't say how long they've had to have been one.

As stated before the hospital admin will fill a void however they can.

Let me know how you choose.

VentMedic wrote

See the Bledsoe article: Vanity in EMS.

I read it please explain your point on recommending it. I believe that I've referred to just medics and nurses, not CCEMTP or any other self important initials.

[VentMedic]

I read it please explain your point on recommending it. I believe that I've referred to just medics and nurses, not CCEMTP or any other self important initials.

Is that the only part you go out of that whole article?

Nurses have a stronger educational foundation and don't believe that their "education" exists only in weekend certs. Numerous other professionals also use those same "certs" but it is merely a formality and not an end to all education. Your statement implied that your education levels were the same because the RNs also had to take ACLS and PALS. An EMT-B can also take those classes.

Paramedics are well trained with a technical education for PREHOSPITAL situations. The exception being those that have put some effort forth and have gotten at least an Associates degree in EMS or the sciences.

RNs are educated for the fundamentals of disease processes and have a stronger foundation to specialize than the career school 700 hour Paramedic.

A Flight Paramedic has additional training and if hospital based, do spend a great deal of time in the ED to keep their advanced procedures current and provide assistance. Triage is still done by an RN. Flight Paramedics usually have at least 3 years of experience but even that can vary. Out of 100+ applications that we get for each Flight Paramedic posiition, only 5 - 10 might meet the bare minimum qualifications and that is being generous. Out of that pile, we may get 1 that is a decent candidate for the position.

As Bledsoe pointed out, there are no national standards for the Paramedic and most of the letters they put behind their name. Even the credential EMT-P is variable. Lack of accreditation for the schools at this time leads some medic mills to teach by memorization and "for the exam only" method. The hours to be a Paramedic vary from 500 - 1500. Even the exams vary from state to state. Other professions have a more structured and accredited educational standard. Even 2 years of a mediocre nursing education beats a 3 month "for the exam only" medic mill. At least in nursing, they will get several weeks of orientation and additional education once they graduate to get them up to speed if they have potential. If not, they may be told to seek employment elsewhere. The Paramedic grad from a bad medic mill or online program rarely gets the same benefit and may continue to work on the job regardless of their abilities. All the while they can collect more letters and patches without much accountability through weekend courses. They may even put CCEMT-P behind their name through an inferior knock-off of the UMBC program.

If you want to work "as a nurse", go back to college and get a nursing degree. Isn't that similar to what you tell the nurses that want to work in the field?

[Just Plain Ruff]

but you didn't answer his question.

18 year veteran paramedic wiht a broad base of experience doing triage or a 1 year out RN who took ACLS 6 months ago to get into the ER.

If it was the paramedic doing your triage would you leave or demand that the RN do it?

[JPINFV]

You know, this could all be solved by having a physician do triage.

[Just Plain Ruff]

Now theres a thought, pull in the most green resident and have them do it.

[medicv83]

Man Vent, you sure do think nurses are the end all be all in medicine dont you? Im anxious to see your answer to the question. You seem to think that everyone else in here has to do their research, and that everyone else in here is wrong, and that you are just top of the heap. I can imagine what type of physician you must be. Type that has his little entourage of nurses saying "yes sir, yes sir, yes sir" to everything. All your little statistics and what not, they really dont mean a thing to anyone, especially when your posed with a solid question based on sole experience.

Your right, the ancillary courses that healthcare providers take are just that....Ancillary, however we are all on the same page generally as far as what goes into those ancillary courses. We all (nurses, medics.....) have had to gain information in order to take those courses and have them be easy. I just think you have a thing for nurses as far as their skill and expertise, because you sincerely cannot stop talking about how great they are.

[Just Plain Ruff]

quote="medicv83"]Man Vent, you sure do think nurses are the end all be all in medicine dont you? Im anxious to see your answer to the question. You seem to think that everyone else in here has to do their research, and that everyone else in here is wrong, and that you are just top of the heap. I can imagine what type of physician you must be. Type that has his little entourage of nurses saying "yes sir, yes sir, yes sir" to everything. All your little statistics and what not, they really dont mean a thing to anyone, especially when your posed with a solid question based on sole experience.

Your right, the ancillary courses that healthcare providers take are just that....Ancillary, however we are all on the same page generally as far as what goes into those ancillary courses. We all (nurses, medics.....) have had to gain information in order to take those courses and have them be easy. I just think you have a thing for nurses as far as their skill and expertise, because you sincerely cannot stop talking about how great they are.

[VentMedic]

but you didn't answer his question.

18 year veteran paramedic wiht a broad base of experience doing triage or a 1 year out RN who took ACLS 6 months ago to get into the ER.

If it was the paramedic doing your triage would you leave or demand that the RN do it?

In the majority of states, an RN is not allowed to delegate a responsibility such as triage.

If someone has to bring up a Paramedic with 18 years of broad experience to compare with a 1 year RN, then I am not the only one that thinks highly of RNs.

The other factors to consider, why would a Paramedic of 18 years want to work in an ED? Burnt out or injury?

What was the Paramedic's initial education?

How much effort was put into continuing education during those 18 years besides just the minimum to renew?

Define broad experience. Does that mean the paramedic has seen a few calls of peds, a few of geriatrics, a few belly aches and a few MIs? A few good war stories? A lot of attitude for "BS calls"?

I'd be all for an 18 year experienced, educated and enthuiastic Paramedic to do triage. But, what about all the new Paramedics who might want to do the same job because they decided they didn't like the street? The job description would probably just read "EMT-P cert, some experience preferred".

The new RN may have done 6 months med-surg and 6 months ICU. Both of which involves more education, training and lots of patient contact for 12 hours per shift. The RN could see almost as many patients in that time as an 18 year Paramedic who sees 1 - 2 patients per shift, 2 shifts per week.

The Paramedic is expected to do assessments after just 700 hours or about 6 months of technical training. What is so absurd about an RN with a 2 year college degree that includes 2 semesters of A&P, Pathophysiology and Microbiology with all these courses reinforced through 2 years of the nursing processes courses as well as the 1200 plus clinical hours.

It is this arrogance that always manages to show itself at the regional EMS meetings when the topic of education is presented. So many think that their 6 months of education makes them the same as RNs and continuously try to compare themselfves to other professions. So, instead of establishing our own identity the Paramedics make the case for "don't need no more book learnin'".

I defend Paramedics on a lot of things both inside and out of the hospital. However, I will not defend or stand for the belief that 6 months of training is sufficient to state that the Paramedic is prepared to take on more responsibilities than for PreHospital at this time. Any half-way decent attorney could take just the few questions I presented at the top of this post and make a case.

EMS has not broaden its education and it has become too blind to see the rest of the healthcare professions expand their knowledge and scopes.

Now Ruffems:

" down to the lowly emt/resp therapist"

I know you didn't mean that...at least not the Respiratory Therapist part.

BTW, it hasn't been all roses for 30 years between RNs and RRTs either. However, when the RRTs got out of their "tech" status by achieving an Associates minimum for entry, Bachelors for some of the reimbursement Bills and minimum for some job descriptions with more Masters degrees in the professions, RNs took notes. They saw we were more than someone who just intubated, set up vents and put in A-lines when one was needed. We now had an education to compliment the technical skills.

[Just Plain Ruff]

Now Ruffems:

Quote:

" down to the lowly emt/resp therapist"

mean that I thought resp therapists were lowly? good lord no. probably bad choice of words.

You just had to focus on that one part huh? didn'tcha, huh, say no more know what i mean nudge nudge.

Vent let me ask you this.

What levels of cert or licensure do resp therapists have? Is Resp therapist the basic like EMT and are there more levels of expertise out there? I know that some resp therapists that I've worked with just like emt's and medics I've worked who are not worth their weight in secretions suctioned from a ET tube. Are there levels of cert that resp therapists have?