By: The Musing Medic (@TheMusingMedic)
Here’s The Current Situation
Let me be blunt: paramedics are woefully underutilized in the hospital setting. Typically, paramedics employed by a healthcare system can be found in the ED or on hospital-based response units. This is our comfort zone–our arena. But, in the ED, our training tends to go by the wayside. Our abilities and knowledge are neglected. We are relegated to starting IVs, performing ECGs, and transporting patients. In some places we are able to administer medications, but this usually is the upper limit of what we are allowed to do. So how do we advance the role of the paramedic in the hospital?
Is It Necessary Or Useful For Paramedics To Do More?
As always, the first thing to do is determine need. Physicians in the ED are constantly bombarded with patients at all hours of the day. Some of these patients require more intensive care and procedures. These procedures take time and delay treatment of other patients. This causes a substantial logjam in the ED. I think physicians could collaborate with paramedics to develop a training program that instructs paramedics on performing common procedures such as laceration repair, I&D, and central lines.
I am not insinuating that these procedures are a walk in the park, but I will argue that procedures (for all intents and purposes) can be taught to most people. With enough practice they can be successfully completed. Think about it: send the paramedic in to start a femoral line on a patient requiring pressors, antibiotics, etc. We complete this while you are assessing and discharging the dental pain down the hall. By the time you get back, the procedure is completed.
What About During Codes?
The same can be applied to resuscitations. The physician should act as a leader during these codes and be focusing on the big picture as well as the details. But many times, the physician is tasked with intubations, line insertions, etc. This can be distracting (I have first hand knowledge of this when I’ve run codes in the field) and be a disservice to the patient. Why not charge the paramedic with the intubation (which we do in the field often) or other procedures?
Yes, NPs & PAs Are There Too
I could cover more examples but for the sake of brevity, I will leave it with the two above. I realize that midlevels (PA and NP) are present in many facilities but they too can be taxed with a number of patients. In the days of customer satisfaction and questionable metrics, the best model is proper and innovative utilization of resources. That is where paramedics could come in to use.
A Few Potential Issues & Other Barriers
Potential issues could be resistance from state agencies, hospital administration, and the nursing lobby. If a proper program was developed and the proper channels traversed, there is potential for a new hybrid paramedic to be developed.
Perhaps this is all wishful thinking but new ideas are the foundation of positive change.
Till next time,
The Musing Medic