Use of EMT-Paramedics in Hospitals

I read with interest your article concerning the use of EMT-Paramedics in hospitals in the February 2007 issue of Journal of Emergency Nursing. I have coordinated this type of program in multiple hospitals since 1996.

Our approach to the program was never to use paramedics as a replacement for nurses, but rather to put together a team approach to patient care in the hospital. Many people I have encountered wrongly assume that paramedics are trained for “field” work. This was true in the 70s and early 80s (my first paramedic course was 125 hours), but the curriculum since then has been intense. The items we found lacking in the current paramedic curriculum were interacting with other health care providers, documentation, and interacting with patients and families over an extended period.

We realized that many of these programs (using paramedics in emergency departments) failed because some hospitals were taking nursing assistant roles and converting them into paramedic roles. When you take that approach, you end up with an expensive nursing assistant. Our approach was to look at a team comprised of registered nurses (RNs), paramedics, and nursing assistants. This approach allows an efficient and cost-effective use of skills (we believed that because RNs are the highest paid persons on the team, they should be concentrating on their higher level of skills, and paramedics should focus on mid-grade skills). This model helped decrease patients' length of stay, which allowed us to see more patients, bringing in additional revenue to pay for the program.

Our paramedics worked under the license of a physician medical director; basically, our hospitals were non-transporting EMS agencies. There wasn't an issue of delegated duties from an RN, but the paramedics understood that strong communication with the nurses was paramount to the care of the patient and success of the program. All of our programs have been a success with the nurses. We utilized the paramedics not only in the emergency room, but for urgent care and ICU/CCU units and transport teams, code response, and disaster teams.

Finally, we knew that these paramedics could become future RNs for us. Our concern was not only with the nursing shortage, but with a shortage of critical care nurses. We partnered with a local community college to start a paramedic-to-RN bridge program. We looked closely at the curriculum and mapped out what additional training was needed. The paramedics gained valuable experience working in the CCUs while attending the RN program and had a higher chance of success of “making it” as a critical care RN.