EMT-Paramedic: A Different Type of Nurse?

The notion of professionalism among emergency services personnel has been a hot topic in the past few years. Our profession has advanced tremendously from the load-and-go funeral home ambulances of our infancy. We are now considered integral members of the allied health team and medical professionals.

I propose another step toward advancement. There are many opportunities for paramedics to advance; sadly, most entail leaving the field of prehospital medicine. Such opportunities include: massage therapist, physician assistant, chiropractor and naturopathic doctor. Numerous options abound both in and out of the medical field. The occupations listed provide a tremendous increase over the average salaries of paramedics. We need experienced medics to stay on the streets and not be forced into other occupations in order to feed their families. We need alternatives that include EMS but provide room for advancement.

I realize that my ideas could produce an unfavorable reaction from many people. Some will consider the ideas foolish. Some may be angry. Some may like the idea in part or in whole. All I want is a reaction. I urge medics to think, debate and create a new world for all of us. New ideas and fresh ways of looking at things are crucial for any field of endeavor to grow.

Paramedics are presently classified as emergency medical technician-paramedic (EMT-P) and are considered part of the allied health team. I propose to alter paramedics' classification and job description and include them in the profession of nursing. I believe paramedics need to rise to the level of pay, respect and privilege that nurses are accustomed to. Whether the title is registered nurse paramedic, field nurse or EMS nurse is not important. What is important are the implications of such a drastic move.

When Florence Nightingale wrapped her first roll of gauze and emptied her first bedpan, the occupation of nursing evolved into one of the most respected in the world. When Johnny and Roy shocked their first ventricular fibrillation and dropped their first endotracheal tubes, they were thought of as nothing more than glorified firemen. Like it or not, we are the stepkids of nursing.

In our world, we perform the jobs of each member of the allied health team, including the nurses. EKG technician, phlebotomist, respiratory therapist, LPN and RN— we do it all. Face it, paramedics are the nurses who perform outside the fluorescent-lit hallways of the hospital.

I realize there are innumerable differences between nurses and medics. The chasm between the two is a wide one. It is this gap, the bundle of differences, that make it more fitting for us to advance. We are poised and ready to move forward.

Although many paramedics are still trained by regional offices in certification programs, the trend is changing. Many schools now offer degree programs from associate to master's level. Our educational regime follows the same progression as nursing. Nurse training began with on-the-job training and hospital programs before moving into accredited college and university programs. Paramedicine is now following the same route.

An analysis of Greenville Technical College (GTC) in South Carolina reveals both similarities and differences between the two programs. GTC offers associate's degree programs in both nursing and emergency medical technician. It is the only school in South Carolina that currently offers a degree in paramedicine. As far as general education, the only difference is that nursing requires microbiology. This would easily be remedied by replacing an elective in the EMT program with the additional science class.

Both programs require similar core classes. The class titles differ, but each covers essentially the same material. Of course, the emphasis is different: nursing in the hospital and EMT in the field. Although the base content is similar, paramedicine goes beyond the core. For nurses to gain knowledge in specialized subjects, the school offers "post-RN specialty courses."1 The courses include management of high-risk pregnancy, dysrhythmia interpretation and pediatric dysrhythmia interpretation. The knowledge in these courses is considered an essential part of the paramedic curriculum. We know it better as OB/GYN, ACLS and PALS.

Many nurses will probably cry foul and say that nursing courses provide more in-depth knowledge than medic courses. This is true. Nurses learn more pathophysiology; they also learn nutrition, which is not taught to paramedics. Nurses need to learn these subjects because their patient care is often long-term, hospital-based and calls for more in-depth knowledge of those subjects. Rather than contradicting my point, it emphasizes it.

I never proposed that paramedics be the same as nurses or vice versa. My proposal is for paramedics to become a different type of nurse. As shown, the two professions are astonishingly similar. It is a shame that one is a full heir and the other is a prodigal son from the streets. To achieve full stature, the current classification for paramedics must change. Points of change include:

• More pay
• More respect
• Licensure rather than certification
• Increased opportunities for education and certification
• End to certificate programs
• Ability to diagnose (perhaps an alternative list of NANDA diagnoses, which are approved nursing diagnoses)
• Removal from fire department systems.

And most of all, the satisfaction of finally being a welcomed member of the family.

Reference

1. Greenville Technical College. Greenville Technical College Catalog, p.92. Greenville, SC: Greenville Technical College, 2000.