We Aren’t Nurses. And Nurses Aren’t EMS Providers.

For the record, I’m sick and tired of the nurse bashing. Not here, but on EMS groups in general. While there’s some overlap between EMS and nursing, the two are entirely different fields and both have a special place. Sometimes, though, EMS proves its special place involves a crash helmet and a short bus.
EMS has very specific education (some might call it training) in a very specific field.  We are the experts in providing autonomous, independent immediate care, usually in non-clinical settings.  We excel at providing immediate care to acute patients in the first hour or so of care.  Honestly, in these settings, EMS does represent definitive care.  What makes EMS unique is our ability to deliver this care outside of a hospital/office setting.  I like to describe us as medical providers using a public safety background to deliver patient care. Talk to more than one experienced nurse or physician about EMS during a cardiac arrest and you’ll hear them acknowledge our very specific expertise in providing care during those first crucial moments of an acute medical crisis.  Outside of the immediate care setting, we start to flounder.  It’s not our fault.  It’s just that’s not what we’re educated to do.
Nurses.  Nurses are different.  Their education is much broader and focused on a wide spectrum of settings.  That makes nurses excellent generalists with opportunities for specialization. While it’s true that most nurses (and possibly even some ER nurses) border on helpless in an emergency setting, I can equally guarantee that most EMS providers would flounder at best in a setting where you’re caring for a patient for more than an hour, day after day, and probably more than one or two patients at a time (except in the most acute care settings in a hospital). And unlike EMS, nursing licensure is easily transferrable between states and there’s a ton of career opportunities in the practice of nursing, nursing administration/management, and nursing education.  Not to mention graduate degrees that provide real value in terms of careers.
EMS providers have knowledge of medicine that’s a mile deep in one field (emergency medicine).  Nurses have a knowledge of medicine that’s a mile wide.  Yes, there’s some overlap between nursing and EMS, as there is with any of the medical professions.  Just because I have skills with an endotracheal tube and a bag-valve mask doesn’t mean that I’m the same as a respiratory therapist. Nursing and EMS are complementary fields.  Neither is a springboard to the other.  Having said that, some of the best clinicians I’ve seen are those who are both RNs and paramedics.  They truly bring the best of both worlds to their patients.  And yes, EMS providers’ skill sets and knowledge belong in settings other than ambulances.  Paramedics would be great additions to the hospital and clinical settings as more facilities recognize the value of paramedic assessment and intervention in the rapidly deteriorating patient.
Let’s quit trying to compare ourselves to nurses.  Let’s quit trying to define ourselves by what we can do.  Instead of bashing nurses, maybe we need to ask why what EMS has been doing hasn’t worked for increasing our pay and respect. The short answer?  The public doesn’t know who we are or what we do.  Combine that with low entry standards and equally low educational standards and we’ve become the Rodney Dangerfield’s of medicine — No respect, I tell ya.


  1. Steve Pike says:

    The analogy I’ve used for years is that comparing nurses to paramedics is like comparing plumbers to electricians: you need both to build a house, and sometimes the use the same tools, but they do different jobs.

  2. Gene Gandy says:

    Excellent comments, Wes and Steve. I echo. I do know some firefighter medics who are also nurses. They usually have Captain on their collars. The more knowledge any provider has, the better. It is the hallmark of the professional to always seek mastery of the craft, and that includes constant self-education. We as medics should use our nurse friends as receptacles of knowledge, and vice versa. There is much that we can learn from each other, and we should be doing that rather than exhibiting silly jealousy and putdowns of the other profession. Rather than putting someone down, we should see what we can learn from them. I have learned some amazing things from patients, for example, just by talking to them. Arrogance never pays off.

  3. Charles Cowles says:

    One day I watched my then 3 year old son play Mario Bros., I watched him select “continue” vs. “quit” at the end of every segment. Surely I had a genius, while most children his age were illiterate, mine was reading and choosing correctly to finish his game. Another time I met with the city attorney and got my traffic ticket dismissed after a brief meeting and a even got the judge to sign off on it, surely I could make a living representing others with the same plight? Instead of being the parent of another Einstein or being a Rusty Hardin, I fell upon the ideal circumstances which projected an illusion of knowledge. Both situations had great outcomes and were defensible, but have some serious flaws. The first step in my journey was 14 years in EMS, paralleled with another few years in nursing, and then after 4 years of medical school and 4 years residency (before the 80 hour work limit) I became an entry level, minimally competent physician. I look back at the journey and wouldn’t have chosen any other path.
    Here are some observations I have made along the way, my time in EMS was surrounded by luck, I never had a patient have frank anaphylaxis from a medicine I gave, I never had a patient I could not intubate and not ventilate, I never had to say that I was the responsible one for a medical error carried out by someone of lesser training, but I have experienced each of these as a physician.
    I thought I knew a lot as a paramedic and could handle anything, and I pretty well did for the 40 mins or so I took care of them. Nursing had a different angle, if something had to be done, you couldn’t simply stall until you arrived at the hospital, you had to carry it out. You had to be the first to catch something, because if you missed something that was caught by someone else, your reputation was ruined, you couldn’t usher the family out for 12 hours and you had to be there to care and answer questions. Nursing is a lot about knowing when to intercept an early sepsis as well as learning what was a normal disease process.
    EMS is a lot about treatment, nursing is a lot about recognizing patterns of illness, medicine is the process of elimination. The medical students who EMS makes fun of in the ER, are hesitating to draw that blood gas because, if the patient had a stroke, are they hypercoagulable? Due to factor V Leiden? Does the patient have collateral circulation if they cause a clot or spasm? What is the drug of choice for thrombus treatment? Lidocaine? What happens if you give local to numb the area and you administer the drug into the neuron itself? These are the level of questions you are responsible for as medical student, as well as following up to 10 patients through the course of their hospitalization, you have to be courteous, efficient, and know when and to whom to delegate. In addition to knowing information like Birbeck granules are shaped like tennis rackets and indicate Langerhans histiocytosis.
    All this to say if you want to work on an ambulance, train to be a paramedic; if you want to work as a nurse, go to nursing school; and if you want to practice medicine, go to medical school. You really don’t know what you don’t know.
    About the public image, respect, and practice: it is all politics. EMS doesn’t have a voice because they don’t take the time, effort, and money to ensure those at city hall or capitol hill know their value and EMS doesn’t articulate what they need nor stand up for much anything. I go to Austin at least 4 times in legislative session, DC once a year, and visit my representatives out of session. I show my support for them and financially support their campaigns and through a few PACs. I don’t “write my congressman” I meet them or call them, I know their staff and who is who in their office. The only real cost is my time. EMS needs advocacy. I see fire, police, and a ton of nurses in the political arena, never EMS. I venture a bet that most reading this can’t name their state reps, I couldn’t when I was in EMS.
    Do your job well, compliment and interact with others who do their job well and don’t mistake your good luck for being genius.

  4. Excellent!

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