What is a Paramedic?

Some of you are ridiculous with this argument about who is better. It's like asking who is better at transporting goods? A long haul truck driver or a cargo ship captain? Two different things.

They are called flight nurses, not flight paramedics, even if they do have the medic license. There is a reason for that. If they didn't have to be nurses they wouldn't be. Nurses cost more than a medic, so why would the state pay for nurses?

Medics make $14 an hour because they don't take college level, non intro level classes. Keep a 3.74+ gpa in these classes and then we will talk about who is smarter and had more skills. A nurse can learn what you know in very little time. You can't learn what they know and that's why they make $30 plus an hour.

The classes are (and not some combo anatomy class; we take the same ones doctors take) anatomy, physiology, two psychology classes, microbiology, intro to biology, pre-calculus with algebra, statistics and many more. Then they have two more years of nursing school. Don't even try to compare yourself to a nurse.

This argument is clearly an American argument. This argument is not accurate in many other countries in the world such as Canada, Australia, the United Kingdom or South Africa, which employ Emergency Care Practitioners (ECP) -- also branded "super paramedics" -- which bridge the gap of on site care care and physician quality care.

In Canada, paramedics also have the ability to attain a BSc.P (Paramedicine) degree as entry level paramedics, work independently on their own medical license providing the province has a college of paramedics e.g. (British Columbia) to represent them and perform all the exact skills and beyond that of the registered nurse in acute emergency medicine.

Paramedics in Canada are moving towards registration as Registered Paramedics (RP). Nurses need to realize that the Paramedic is going to be more educated in Emergency Medicine, while nurses practice emergency nursing, which are two separate fields. It is called paramedicine for a reason.

In the United States, this may be the case but that's because the health care infrastructure is mediocre at best. Even the RN's in Canada are more educated than RN's in the United States so let's use the argument that RN's in the United States are inferior to other nurses from around the world and need to do their jobs and respect the paramedic's medical judgment which pertains to emergency medicine.

As a CCT-P, I see these lines blurring even more. Expanding scopes are getting dangerously close to the protected RN class. Let's face the real reasons RNs get the big bucks: it's because they deal with problems (insert critical patient/crapped diapers) long term. We medics scoop and run.

If I wanted the big bucks and wanted to put up with the in-hospital politics, cliques and shenanigans, I'd take the upgrade classes and do it. I'd rather run a few calls, chill a bit with no responsibility to any roomed patients and go home. Transport is low money low actual work versus big money and a whole shift of work. Put any title on it you want, but I think it's right that those who work more should get paid more. Just my two cents.

I have read most of these posts and I am disappointed that health care professionals are bickering and arguing over who is better and who can do more.

I think what you all need to remember is that a paramedic role and a nursing role are two completely different professions and are specialised in their own ways. We are all trained for one purpose and that is to provide good, effective patient care.

I would like to clarify the main difference between RN's and EMT-P's.

First, a paramedic is a practitioner, just like a nurse practitioner and a physician's assistant. The paramedic, under established protocols/scope of practice regulations, is authorized to practice under the license of a medical command physician or their own medical director. Medics can practice without direct medical supervision as long as they comply with protocols. Anything an ED physician can do in the first 15-20 minutes of a critical case (short of surgery), we can do in the back of an ambulance. And by the way, we can do central lines pre-hospital - femoral sticks - if approved by the medical director.

RN's practice under their own licenses. Obviously, RN's have a far more expanded scope of practice - especially when it relates to pharmacology. Medics can only give medications approved by state/regional/local medical advisory committees.

However, RN's are certified to practice as pre-hospital RN's qualify as pre-hospital practitioners, just as medics. Yet, they can not exceed the scope of practice of ALS practitioners.

We can sit and debate who is better, but I can tell you after 27 years of being a medic - the best combination of practitioners in the field and in an ED - are the nurse/medic combinations.

When the federal and state governments/bureaucrats decide to get their heads out of their butts, they should look at military hospital ED's. They run efficiently with nurses and medics, because each discipline respects and embraces each other's abilities. But, the nursing associations have blocked any initiative like this because "it will take nursing jobs away."

As a RN/NREMT-P/CEN/CCRN/CPEN and AHA Instructor in ACLS/PALS/BLS, I would love to weigh in on this conversation.

First, RNs have a broader education background which makes them qualified in many, many different arenas within the medical field. True, right out of school a nurse is not prepared as an EMT-P is out of school, but given a small amount of time, the ED-RN should easily be at the same emergency medical knowledge level. To simply dismiss the nurse's role in emergency medicine is simply ignorant.

A nurse can do more procedures than paramedics and nurses can, in fact, do all the same procedures, given the proper training.

I can intubate, not only on my EMT-P cert, but as a RN. I cannot place a central line as an EMT-P because it is a sterile procedure, but as an RN, I place PICCs. Paramedics do not do whatever they feel like doing. A protocol is a written MD order which can be used under certain conditions.

Paramedics and RNs do not diagnose at all; they treatment symptoms. Paramedics are experts in emergency medicine for a short amount of time. ED-RNs are experts in emergency medicine for an extended amount of time.

I've yet to see an RN run an Advanced Life Support scenario, decompress a chest, intubate, perform surgical airways, give controlled drugs without a doctor's prescription. Paramedics do all this solo in difficult, unpredictable and often hazards conditions! Who do you think deserves the higher pay?

I want to ask if paramedics like nursing or not? Is it a kind of nursing? It's closer to nursing or medicine?

EMS as a profession is relatively new. Nursing has a much longer tradition, and people are familiar with the iconic figure in white there to comfort them. Children see me in a store and ask their mothers if I am a police officer. Even the moms don't know what to call me.

Unless we work to improve our profession by encouraging our EMTs to advance their education, improve our presentation so we look like professionals (shirttails in, coffee-stained shirts out) and form a nationwide group that truly represents our interests, we will keep lagging behind nurses in salary and respect. It's not the nurses' fault, but yup, pissing contests from either side are pretty lame.

I am a nurse and a paramedic too. I work in Iran and I think nurses know a lot more and work a lot more, but paramedics need to deal with so many more threatening situations than nurses. But choosing one area of work depends on the character of the care giver and what does he really like more about the job.

Also all nurses are not in the same position. A nurse in ICU or CCU has a much different job from a nurse in emergency room or in the surgery wards. So what is the argument?

I'm a paramedic and also an RN in a Trauma/Surgical ICU in a level I trauma center. I happen to have tremendous respect for paramedics and have experienced first hand the conditions they work in. I also believe that many nurses do not have the same understanding of what paramedics actually go through and what they do 'on the job.' But if I were a patient on my unit, I sure wouldn't want a paramedic taking care of me. Not any nurse can care for crashing fresh hearts or severe traumas right out of surgery. It takes a great deal of skill and experience in an area that paramedics just don't have.

I have never seen a paramedic take pages of orders, participate in a code, manage the vent, manage the balloon pump, manage and titrate multiple line infusions and the SWAN, operate the level-one for rapid blood administration, manage CRRT - all at the same time.

Regardless of popular belief, RNs have tremendous responsibility - and autonomy. On my unit, we primarily follow protocols just like paramedics do, although we do have the support of a physician if needed. I'm not 'knocking' paramedics. I just think we should all have a little more respect for each other and stop all of this nonsense.

I am an ER RN. Nine out of 10 paramedics I deal with are jerks and are only worried about if their hair is perfect or shades are clean. Keep working for your pittance.

I think everyone should appreciate the work that both health professionals do. Both have important roles, this is why the health service is a joke. Work in partnership to treat those who need you.

Nurses make absolutely no critical decisions on their own. They cannot even place bandages on patients without a doctor's approval. That being said, nurses do play a vital role in health care. Just not a role in any life saving critical situations.

I have been on several MVA's and cardiac arrests in which RN's were present and they just cause more confusion and hysteria. On each of the occasions, I have had the RN's removed from the scene by police. I have nothing against nurses; they just have no business in an actual emergency setting. The perfectly controlled settings of the hospital with a physician peering over their shoulder is where they thrive.

Here's the difference: inside the hospital it takes six RN's standing around (only one pushing meds), three respiratory technicians standing around (only one bagging), two care techs standing around, a doctor barking orders, and four security officers doing CPR. On the scene: two EMTs (basic, advanced, paramedic, take your pick) running the code. Now tell me who should get paid more?

Being a Medic/RN, I understand why RN's think Medics are not as advanced. Many RN's don't have a clue as to what Medics are actually allowed to do and the training we go through.

Many of you have said that an RN can do anything a Medic can do. This is just not true. You will never see an RN perform a decompression, surgical airway, amputation... I can keep going. Someone also said any RN can intubate; it just takes training. No kidding -- training that basic RN's don't have! I have only seen one RN intubate and that's because the MD was pregnant and unable to. That RN happened to be a Medic also.

Yes, RN's have a higher level of education, but are you really going to try and say that because you took several business classes to bump you up to a BSN or MSN makes you better when it comes to an emergency situation? RN's get paid more because we have the patient for a longer amount of time, which means a higher bill, which means more money to the hospital.

Medics usually have the patient for, at most, 30 minutes. If you consider the amount of time the Medic spends with the patient, then our pay really isn't that bad. If any RN thinks they are a higher level of care than a Medic, then I encourage you to apply for a Medic job in the field and let's see how quickly you get turned away because you're not a Medic.

Speaking as an RN, I have a great admiration for the work Medics do and would never call it a lesser profession to that of nursing. However Medics focus on one aspect of health: emergency care. This is not the case for RN's who may work in pediatrics, psychiatry, or a number of other specialized fields including emergency care.

I am upset when I hear medics getting upset about nursing wages. If you want the cash, get the degree. Just because some nursing tasks overlap with those of a medic in emergency care and sometimes the medics' scope supersedes that of an RN in emergency care, does not make the job of nurse available to a medic.

Nurses make more money because the profession is older and they have a strong union presence. This is the same way CRNAs are replacing Anesthesiologists in at least 14 states right now.

Paramedics actually perform more skills than nurses. They can do all the med administrations that nurses can do, including operating multiple pumps.

Where paramedics really shine, compared to RNs, is with airway. Paramedics do intubations, blind insertion devices, cricothyrotomy, needle decompressions, and are allowed to change vent settings as needed when transporting a patient.

While we do work off of standing orders or protocols for med administration, the decision, history, and PE to get to that point lies solely with the paramedic. Also, Paramedics have more experience with running ACLS/PALS scenarios.

While nurses know what drugs to give, paramedics have more dynamic cardiology skills. I have been in many EARs and am currently a medical student. My ER attendings all agree that Paramedics are more adept in *emergency* situations in or out of hospital.

They know what step to do next without orders and have experience making those decisions on their own.

As stated before, nurses' unions pretty much completely prohibit anyone from doing a nurse's job, which is why a lot of states don't even let medics work in the ER as a medic. New York is one of them. (you can get the title of PCA).

Now that the scope of practice is evaluated, think about doing everything a nurse does in a snowy ditch, at negative 10 degrees, with three people screaming for your help all at once, then transport on a bumpy ambulance to perform all of those procedures.

I'm not saying RN's aren't extremely important and knowledgeable in their field, however I feel that paramedics have a better understanding of emergent conditions and procedures because that is the basis of their training. RN's are initially trained for all things including Med Surg, Primary Care offices, etc.

I love the nurses I deal with at most ERs, but I would not want them on my emergency scene. You have to think quickly and outside the box.

The best example was a passing nurse stopped at an mva and was treating a pt when we arrived. The person was trying to place a band-aid on a nasty head laceration. Problem was the patient also had dual femur fractures and had punched the steering wheel with his chest.

The nurse would not get out of the way for us to treat the patient. On the other hand, I've watched nurses get very frustrated waiting on doctors with critical patients.

There are some very good nurses out there but in an emergency I would take a street medic anytime.

Registered nurses make more money because the bottom line is we do more than a paramedic does in hospital in the ED. Who cares if paramedics can do things without a doctor's order? It's all protocol anyway!

Prehospital and in-hospital are two different levels of care, but do not ever knock ED nurses because we do save lives just like medics and will always make more money. Wonder why that is? Because we do more.

I would love to see a medic work in hospital and take off pages and pages of orders, dealing with thousands of more drugs than a medic can handle.

"More and more, ambulances resemble full hospitals on wheels, with devices such as electrocardiograms (ECGs) and some X-ray devices onboard."

No, no, no. where did this come from? there are not x-rays machines on board ambulances. Never have been, never will be.

Paramedics are above RN's when it comes to emergency care. If my family is having an emergency I'll take two medics over 100 RN's.

Now in a hospital setting where there is no immediate life threat then I would take an RN. Most typical RN's do not make any decisions and never make any life deciding decisions on any patient; they just do what the Doctors tell them to.

Paramedics have to make choices on their own, according to how they assess the patient. Paramedics have skills such as putting in central lines, crocs, needle decompression, intubation, defibrillation, RSI, pacing, sync defib, IO's, and a large number of other skills that your normal RN out of school is absolutely not allowed to do under any circumstance. So if I'm dying, please send me a medic.

I am both a paramedic and a RN. My passion is paramedic, that's where I can make a real difference. Nurses have the luxury of good lighting, security, patients in beds and doctors to call on.

Paramedics work in conditions that are affected by weather, road conditions, other people, animals, violence... the list goes on. We don't have the luxury of putting the patient on a table to intubate - try straddling an arrest on the toilet - which, by the way, is very common!

Many people can nurse, but good paramedics are a special breed. A ward nurse doesn't see the poverty the patient lives in, the person hanging from the tree, or has to call it on a young patient.

I believe paramedics should be paid far more for the job they do - some of the sights they see are embedded forever in their minds.

Nurses can't do anything a paramedic can't. In fact, one might say a paramedic can do more. It's complete crap that nurses think they're better because they are not, and paramedics should get paid a lot more. I'll tell you that a person is much more likely to appreciate the work that a paramedic does versus what a nurse does.

I think it is BS how poorly paramedics are paid compared to nurses. They are often in a controlled environment with a doctor telling what to do. Paramedics have to think on their own right then and there. They may only have seconds to respond.

I would much rather be treated by a paramedic than a nurse if I coded or was involved in a serious car accident. I actually witnessed a nurse ask an EMT student to start CPR because she didn't know how. I actually think she thought it was above her and just plain lazy.

I hate how they think they are better than us. Please. Let's get you out of your safety zone and see how you do.

Some nurses may be more educated in the "nursing model" but should not lead to the presumption that they are necessarily educated or certified in the types of skills that are useful in an autonomous, prehospital environment.

Further, paramedics are certified and licensed (by the authority of their medical director) to make clinical assessments, diagnoses and treatment decisions autonomously, and choosing treatments from a full suite of standing orders, in most cases without prior authorization.

Specialized skills (which, like knowledge, can be taught) include management of pre-hospital trauma (GSW's, fractures, poisonings, cardiac arrest, etc), IV fluid and drug administration, Rapid Sequence Intubation (RSI), cricothyrotomy, Advanced Cardiac Life Support including cardioversion/defibrillation and meds, 12 lead EKG interpretation and MI (heart attack) treatments, chest decompression, and many others.

The paramedic is often the only one on scene with the skills and training necessary to provide acute level care for the patient, and must provide it while managing other aspects of a potentially dangerous scene as well, not to mention while bumping down the road. Paramedics do take orders from physicians (and many states, including CO include a provision allowing the medic to perform any skill delegated to them by their supervising physician, as long as they have some degree of training in that skill, permitting them to work in emergency department settings) via radio/phone in advanced cases where consultation is mandated or desired.

Paramedics do not take orders from nurses, either, nor do they seek to "be above nurses" as a previous post implied. Many do seek employment outside of prehospital care because of poor wages (avg salary of 30k/year with an AAS degree in paramedicine vs. 60k/year with an AAS in nursing, which is largely due to a strong nursing union and the lack thereof in EMS community).

There may be more nurses than paramedics, but might doesn't necessarily make right, and a nurse with a doctorate level education in the theory of nursing care/nursing administration does not provide a better standard of acute emergency care than a paramedic with an AAS degree (which is currently the highest level of certification you can receive outside of a management degree) and rigorous, specialized training and real street experience.

Paramedics are trained to transport the patient safely to hospital. While transporting the patient they do stabilize them, which could mean administering life saving medications. Most paramedics work within protocol and in conjunction with an emergency department, hence they are not just prescribing any drugs and administering them. A Registered Nurse's training is mostly geared towards a hospital environment. There are some RNs that do work in the field, but most do not. Registered Nurses have varying degrees of education ranging all the way to the Ph.D level. A study showed 35 percent of RN's have bachelors degrees, much higher than a paramedic certificate or associate degree. This is why nurses will not take orders from a paramedic; nurses are more educated. Although paramedics might be able to perform an intubation (this is a skill that can be taught) there are many nurses who can intubate patients. Nurses have more theoretical knowledge because of their length of education. Paramedics serve a vital role in health care, but they are not above a Registered Nurse.

I very much agree with the medic from new jersey. We have the same situation in chicago where a nurse is considered to have more advanced skills than a medic. I think it's total bs because we don't have to be told what to do by a doctor. medics can just do what needs to be done according to their smo. I hate when nurses always think they're better than a paramedic.

Interesting information Anon16144. But, remember, there are paramedics outside of the US, and I don't know if similar rules that US nursing unions have gotten passed apply there too. Also, even in the US, my guess is that if there is a tragedy or a hospital is overworked for some reason, they would welcome a paramedic that could administer, say, a life saving drug even if goes against the normal rules, if there weren't enough nurses to do it themselves.

About drugs being applied 'both orally and intravenously' - That implies that there are only two routes of drug administration. Enteral and parenteral would be more encompassing and accurate.

About 'paramedic skills coming in handy in the ER' - While handy, they are mostly prohibited, thanks to the strength of many nursing unions which prohibit any other title from performing an RN's job. As such, many paramedic skills overlap with nursing skills (ie. IV access, drug administration, NG tubes, etc.) so not much is left for a paramedic to do other than basic PCA/UAP functions. Further, a nurse is considered a higher medical authority than a paramedic and is prohibited by the Nurse Practice Act from delegating an RN function to a healthcare provider who falls below the level of RN. In a few instances, the paramedics skill set fall outside the (non-specially trained) RN's - such as with intubation. The RN cannot delegate a duty he/she him/herself is not authorized to perform. This has always been a sore topic for paramedics who hold the minority voice on the debate (at least in NJ at a ratio of about 1000 active paramedics in the state vs. about 90,000 RNs) and are almost exclusively unable to perform to the full level of their training in-hospital.