uscbigdawg Posted December 24, 2012 Share Posted December 24, 2012 Overheard an interesting conversation yesterday in the ED. A new PCT was saying that she would never be a PA because as a Paramedic she can do more than they can. Specifically, she was saying that she's authorized to do RSI and central lines where a PA is not allowed to. First, RSI is not difficult and while I know a paramedic can do it, I'd be highly surprised if a PA is not allowed to. Second, a central line, while dangerous is also again, not difficult. I would be surprised if a paramedic is allowed to and a PA not. I'm punting to my elders on this one and asking for clarity. FWIW, I (uncharacteristically) stayed out of the conversation. Just odd to say the least. Rich Link to comment Share on other sites More sharing options...
burnpac Posted December 24, 2012 Share Posted December 24, 2012 Skills in the inpatient environment is under the aegis of medical staff. Because I have intubated scores of times in much rougher situations (as a field paramedic) than an OR or inpatient unit, I feel totally comfortable intubating and it is in my privilege set approved by medical staff. I could also be approved for central lines if I choose. I rarely get the opportunity, and as we have much more qualified and experienced people to do them (ER medical staff and anesthesia staff), I don't see the need to have this procedure in my package. A central line is not difficult if you do a couple a week or day, but inexperienced operators can do significant damage to the patient. Paramedics in our county can do RSI, but not central lines. I doubt that a paramedic in our system would get enough CVL procedures to keep their skills up to snuff. I would be surprised if this a a standard paramedic procedure in most counties and especially urban areas, when getting a critical patient to definitive cardiac and surgical care is what actually increases their chances of survival. A paramedic's scope of practice is different, important, but a microcosm of what is in a PA's scope of practice in Ca. I wouldn't worry about what a PCT says. She will learn about her ignorance the hard way.... :-) Link to comment Share on other sites More sharing options...
flyingsquirrel Posted December 24, 2012 Share Posted December 24, 2012 Apparently this was not the case everywhere, but in all the states I have practiced as a paramedic in, before adult IOs were available in the field, CVC was the only other option we had as paramedics for venous access when peripheral IV access failed. Every ambulance I worked on carried a cordis setup and we were all trained to place them either femoral or subclavian, dealer's choice. Needless to say, these were not placed in full sterile procedures and were used for initial resuscitation only, then relaced. Like any high acuity, low frequency skill we had to verify competency (x3) on a quarterly basis. Once options for adult IO access (EZ-IO and others) became available, our cordis setups became dust collectors overnight. CVC is still in the protocols in some states, either because no one has gotten around to taking it out, or in at least one state, as conscious decision to keep it as a 'back up' to IO access. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 24, 2012 Moderator Share Posted December 24, 2012 EJ's and IO's make much more sense for medics than central lines in the vast majority of situations. As Steve noted, skills such as intubation require practice and repetition. as a former medic myself I am also very comfortable with intubation. of the 18 pa's in our group only the former medics and rt's are privileged for intubation. everyone else is too afraid to try it as they have no skills base and no opportunity to gain one. something to be said for prior experience and/or postgrad training.... Link to comment Share on other sites More sharing options...
sbellin Posted December 24, 2012 Share Posted December 24, 2012 Still volunteering as a Medic the biggest difference I see inthe field between me and the paid crews is not the skill sets but the knowledgebase. Yes, I can intubate, cardiovert, andplace IO’s in the field and in the hospitalbut being able to look at the patient, their bag of medications, and along withthe patient’s complaint come up with a working diagnosis. Field medicine is more by the numbers and PAmedicine allows more free thinking with broader differential diagnostic possibilities. Link to comment Share on other sites More sharing options...
jdobbs Posted December 24, 2012 Share Posted December 24, 2012 A new PCT was saying that she would never be a PA because as a Paramedic she can do more than they can. Yeah that is a very "newbie" thing to say. I was once told by a first responder that he would never want to be a paramedic because if we were in a disaster he could transfuse blood because he was cover by the Good Samaritan clause. It's just ignorance... I just smile and nod as they make fools of themselves. I can tell you a great reason to become a PA though....$45/hour! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted December 25, 2012 Moderator Share Posted December 25, 2012 Yeah that is a very "newbie" thing to say. I was once told by a first responder that he would never want to be a paramedic because if we were in a disaster he could transfuse blood because he was cover by the Good Samaritan clause. Oh. My. God. Things like that remind me how much I miss my first responder days...including the guys who talked a huge game without any logical reasoning to back it up. Just made it all the more fun. Link to comment Share on other sites More sharing options...
PM2PA Posted December 25, 2012 Share Posted December 25, 2012 This guy is obviously a wacker who is all ate up. There is more to life than sticking plastic down someone's throat. Link to comment Share on other sites More sharing options...
KCMA79 Posted December 25, 2012 Share Posted December 25, 2012 Just smile. Then ask them how often they have seen a medic do an I&D, suture, do a pelvic exam, provide pre natal care, insert an IUD, write for a narcotic etc. Then remind them that PAs can tube someone or place a line in CA. Also in CA the individual counties decide the scope of practice of medics. And while something may be allowed in LA County it may or may not be allowed in Riverside County. Or as I said just sit back and smile while they glory in their newbie ignorance. Link to comment Share on other sites More sharing options...
andersenpa Posted December 27, 2012 Share Posted December 27, 2012 PAs can do all the things mentioned in the OP if 1) they are under the scope of the SP and 2) they are credentialed by their facility. Link to comment Share on other sites More sharing options...
mkels Posted December 28, 2012 Share Posted December 28, 2012 Paramedics can also drive around in big trucks with red lights on top, and PAs can't. So there's that, too. Link to comment Share on other sites More sharing options...
Medic207 Posted December 28, 2012 Share Posted December 28, 2012 Really...Then why do so many of us former medics goto PA school? Seriously, after 20 years in ditch medicine, flying rotor-wing, and cutting people out of cars, I can honestly say I don't miss getting up at 3:00am to deal with the drunks. Sure there are some things I miss, and I could go work an EMS shift if I wanted to. This person who told you that probably has reached their "peak" potential in life and couldn't goto PA school anyway. Don't let that influence your thinking. I might add, there are also a bunch of PAs who can do a boat load of stuff I can't/don't do. Your ability to "do" a skill does not necessarily define "who" you are as a professional. Link to comment Share on other sites More sharing options...
aktlr Posted December 28, 2012 Share Posted December 28, 2012 Don't underestimate driving lights and siren as a motivator. RSI is simple until it's not- then it can be terrifying if you don't have a plan. I get to do those things and even cut throats occassionally. But I'd have to be pretty daffy to get confused between the severely limited scope of practice in EMS and the license and the knowledge to practice medicine collaboratively. I like "sticking plastic down someone's throat" but most of us are here because we've already accommodated to the idea of stopping at red lights and want a lot more out of medicine. Link to comment Share on other sites More sharing options...
uscbigdawg Posted December 28, 2012 Author Share Posted December 28, 2012 I did plenty of RSI's and central lines while in the Army. Nothing spectacular IMHO. Just thought I'd share the experience. The comedy is that she is working at our hospital as a Patient Care Tech, even though our regional/local ambulance companies are dying for paramedics. The additional comedy of it is that as a phleb, I make more than her and her amazing scope of practice...that she won't use as a PCT. Rich Link to comment Share on other sites More sharing options...
Guest JMPA Posted December 28, 2012 Share Posted December 28, 2012 Overheard an interesting conversation yesterday in the ED. A new PCT was saying that she would never be a PA because as a Paramedic she can do more than they can. Specifically, she was saying that she's authorized to do RSI and central lines where a PA is not allowed to. First, RSI is not difficult and while I know a paramedic can do it, I'd be highly surprised if a PA is not allowed to. Second, a central line, while dangerous is also again, not difficult. I would be surprised if a paramedic is allowed to and a PA not. I'm punting to my elders on this one and asking for clarity. FWIW, I (uncharacteristically) stayed out of the conversation. Just odd to say the least. Rich just a misinformed nimwit. as a ct surge pa i placed central lines, chest tubes, removed iabp, performed open cardiac massage, and best of all used my brain to improve patient outcomes. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 28, 2012 Moderator Share Posted December 28, 2012 Seriously, after 20 years in ditch medicine, flying rotor-wing, and cutting people out of cars, I can honestly say I don't miss getting up at 3:00am to deal with the drunks. Sure there are some things I miss... l. now I'm at work dealing with drunks at 3 am. I work 100% nights. I do miss the cool ems calls but they were 5% of the calls. if every case was an als call I would still be a medic today. Link to comment Share on other sites More sharing options...
jdobbs Posted December 28, 2012 Share Posted December 28, 2012 Don't underestimate driving lights and siren as a motivator. I probably wouldn't have wandered into medicine if it wasn't for lights and sirens....and the uniform. Chicks dig the uniform. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 28, 2012 Moderator Share Posted December 28, 2012 Chicks dig the uniform. and scars...at least I keep telling myself that.....:) Link to comment Share on other sites More sharing options...
Medic207 Posted December 29, 2012 Share Posted December 29, 2012 @EMEDPA ...right. I used to say after climbing the ranks in EMS to the tippy top, then going to be a PA, I went from the top of one heap to the bottom of the another. Link to comment Share on other sites More sharing options...
Pliskin Posted December 29, 2012 Share Posted December 29, 2012 I probably wouldn't have wandered into medicine if it wasn't for lights and sirens....and the uniform. Chicks dig the uniform. You guys had nice uniforms? God, ours are so sloppy. Link to comment Share on other sites More sharing options...
jdobbs Posted December 30, 2012 Share Posted December 30, 2012 They were solid blue shirt with navy pants. They looked like old school police uniforms which periodically was a problem. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2012 Moderator Share Posted December 30, 2012 ours were hunter green for day uniforms or heather gray jumpsuits at night. Link to comment Share on other sites More sharing options...
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