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Paramedics in the Emergency Department

      Dear Editor:
      Creating a role for paramedics in the emergency department helps both nurses and paramedics. The emergency department is provided additional personnel to assist with high-acuity patients, and the paramedic is given option beyond the back of an ambulance for a work environment. However, there are difficulties inherent in putting paramedics in the emergency department. Paramedics typically work in an environment where they must make quick, independent decisions with little, if any, direct medical oversight on the scene. By the nature of the job, paramedics tend to be independent workers who bristle at the thought of too much supervision. Our emergency department has looked at the idea of bringing paramedics into the department twice but found that each side had its concerns. Paramedics were concerned that they were not going to be utilized to the extent of their training. (That training includes such advanced skills as intubation, cricothyroidotomy, continuous positive airway pressure, and EJ cannulation, as well as the ability to administer almost all their medications independently by pre-established protocol.) Comments were made by the paramedics that they wanted to be appreciated for what they were capable of doing. The ED nurses were concerned about being able to supervise the paramedics properly and that the paramedics might go beyond their ED scope of practice. Discussion even included having the paramedic more like a respiratory therapist, in that they provided skills within their scope of practice but outside of direct nursing supervision. No final decisions were reached regarding paramedic utilization on either occasion.
      The ultimate success of a nurse/paramedic team, though, is a team approach—that is, an understanding of the strengths each brings to the table. I have been a paramedic and an ED nurse for more than 20 years and have seen firsthand the nurses who view paramedics as little more than ambulance drivers. I have also seen paramedics who view nurses as incapable of caring for a patient without a physician present. A seasoned paramedic, like a seasoned ED nurse, is able to make rapid assessments, quickly determine the emergent needs of the patient, and provide care. How that is translated to the workday is key to the success of the program. There must be an appreciation for the professionalism and skills of each role to make the team strengthen the department and ultimately be successful.