Paramedics in Hospitals: Out of Place or Right at Home?

October 2005, EMS Magazine: Welcome to my fifth installment in a series of guest editorials. My goal for these articles is to shake up and change the EMS establishment for the better. To do this, I need your help. Here's one way you can participate: Drop me a line and let me know how you would change EMS as a career field. No area is sacred and all your ideas and opinions count. You can reach me at Docbeaker@aol.com. Put "Solutions for the Future" in the subject line.

Paramedics in hospitals delivering patients or picking them up for transfer is a common sight. But what about a paramedic in scrubs as a full-fledged member of the medical establishment? You won't see that in many places. Let me paint a picture for you that isn't very common in hospitals in the United States.

Imagine a typical paramedic lounging in the dayroom watching television between calls. He's in the middle of a 12-hour shift and has already eaten lunch. Just when the best part of the television movie comes up, he hears a familiar tone from his pager.

When he looks down to see the message, it reads, "MVA. Trauma Room 1 in 5." He gets up from the couch and runs into the hall.

This medic isn't dressed in an EMS uniform. He's not wearing black boots or navy blue pants, but tennis shoes and a set of green scrubs. Instead of running out into a garage and hopping into the ambulance, he runs over to a flight of stairs that will take him down to the emergency department. After all, there's a patient from a motor vehicle accident arriving to Trauma Room 1 in five minutes.

This paramedic is a member of the trauma service in a level-one trauma center. Right now he has to get to the ED and set up to assist the trauma team, which is filtering in from various patient rooms, break rooms and the hospital library.

He gets to the first floor, takes a shortcut through the administration offices and struts into the trauma room two steps ahead of the trauma team director. They have a running bet on who arrives first into the room. The trauma doctor treats the medic as a colleague. After all, they are part of the same team.

The trauma team responds to all major incoming traumas. The medic's job is to manage the airway, intravenous lines and medications, and any other ACLS therapies that might be needed. It's basically the same job he did in the field before becoming a hospital trauma medic. Every now and then he'll let a resident do an ET tube, but they have to be quick to ask. In those instances he'll stand behind the resident watching every move, ready to take over in an instant.

While the doctors and residents manage the surgical and medical aspects of the trauma patient, the trauma medic darts in and out, moving around the patient to make sure his job is complete. He helps a nurse finish setting up the IV. He double-checks the EKG monitor. He finishes cutting off the patient's clothes so the docs can get a better look at the injuries.

Once he finishes the immediate aspects of his job, he assists the regular ED staff in prepping the patient for transport to the trauma suite up in the operating room. He walks with the team as they transfer the patient to surgery. He seldom goes into the actual OR, although the surgeons do let him scrub in from time to time when he asks to look in on an interesting case.

Once the patient enters surgery, the medic washes up and goes back to the ED to manage any follow-up needs, such as securing patient information, taking additional scene information from the field paramedics and securing the patient's belongings.

Then it's back on call to wait for another emergency. Life is quite different than it used to be for this former field medic. For starters, the doctors and nurses treat him as part of the team rather than an interloper. The pay is better than it is for ambulance paramedics—almost equal to that for the ED nurses. And there are benefits.

Aside from their duties on the trauma services team, the medics at this hospital also perform as code medics, responding to all "code blues" or cardiac arrest calls. As members of the code team they perform many of the same duties as they do for a trauma. Virtually all ACLS skills are performed or directed by a medic, just as they would be on the street. This leaves the doctors to work on solving the underlying cause or tackling a more invasive procedure, such as a central line or chest tube. It also frees up nurses and techs to do other tasks. It's amazing how an experienced field medic can do the job of three people while working a cardiac arrest.

The hospital medic is also called to occasionally perform more EMS-oriented tasks. Say there is an MVA outside the hospital. He might be called out to direct the on-scene care and stabilize the patients before moving them to the ED. Few of the other staff know how to properly use a KED, the long spineboard that's been gathering dust in an ED storage room.

Aside from direct patient care duties, the medic also helps with all training sessions applicable to his skills. He teaches ACLS, PALS and BLS to both doctors and nurses. He also assists with other classes, such as an Advanced Trauma Life Support for doctors, that have an EMS-related component.

He enjoys all the benefits of other medical employees: the option to join ongoing research projects or coauthor journal articles with the trauma services; attend various conferences and grand rounds with the physicians; or attend autopsies. To keep up his airway skills, he is required to document five successful intubations per month. To do this he makes use of the ORs, where the CRNAs, or anesthesiologists, supervise his intubations on elective-surgery patients, much as they did when he was a paramedic student over a decade ago.

Overall, life is good for this hospital medic. After a decade of experience as a field paramedic, he decided to approach the hospital trauma committee regarding the use of paramedics inside the ivory walls. He attended several meetings to explain his position and show cost-benefit ratios, establishing how a medic position would fill a clear need of the hospital in a fiscally responsible way, and making it possible for paramedics to advance into another area of medicine.

Does all this sound like a dream come true? While it may not be common, it isn't as far-fetched as some might think. I can see a day when fully practicing paramedics are as commonplace in hospitals and doctor's offices as physician assistants and nurse practitioners. Medicine is changing every day and we need to jump on the bandwagon before it passes us by.

David W. Powers, NREMT-P, BCETS, BCECR, is CEO of the Emergency Response Corps in Surfside Beach, SC. He can be reached at Docbeaker@aol.com.

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