Employment of Emergency Medical Services (EMS) Personnel in Healthcare Facilities

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Technical Assistance Document
June 1996

ISSUE: With the shortage of professional healthcare personnel, particularly in the rural setting; the healthcare industry is having to rely on specially trained technicians to assist in direct care delivery. Since certified Emergency Medical Technicians (EMTs) and paramedics study a curriculum which has a firm foundation in anatomy, physiology, and patient assessment, they are prepared to make a natural transition into service within the hospital emergency department (ED) or IV team, as long as a job description exists and is consistent with their level of training. 

PROBLEMS: There are a few problems that have developed within some facilities that have employed EMS personnel. Awareness of these concerns, will allow planners to anticipate reactions and avoid conflict.

A. Disagreements have arisen over to whom the EMT should report. These discussions have led to clashes between the medical and nurse practice acts. A paramedic must work under a physician's license when working invasive procedures. The RN can't delegate invasive procedures but can supervise them.

B. EMS personnel are trained specifically for prehospital roles. Clearly there is some overlapping. If job description calls for procedures beyond EMS training, they must be trained and evaluated on that procedure prior to including it in their work assignment.

C. The EMS Act refers to medical supervision which means physicians. An RN may supervise as long as a physician has agreed to be medical director for the paramedic.

D. Traditionally, there have been professional clashes between some nurses and some paramedics. Where this exists, good orientation to increase awareness of each other's functions and background might level the playing field. If the nurses in question are given an opportunity to participate in planning for the new hires, there should be less antagonism.

E. There has been a turf issue with nurses fearing that they will be supplanted. EMS personnel should not be hired to supplant nurses, but to enrich the team and work in collaborative partnership with the nurse.

The following guidelines are suggested when the goal is to employ prehospital personnel for the "in-house" setting.

The following guidelines are suggested when the goal is to employ prehospital personnel for the "in-house" setting.

PREPLANNING

1. Study the guidelines, which the Board of Medical Examiners and the Board of Nurse Examiners promulgate regarding delegation of tasks to EMTs. The Texas Nurses Association (TNA) has recently passed a resolution on Unlicensed Assistive Personnel (UAP). They advocate that in all settings, UAPs who assist the RN or who perform delegated functions or tasks must: 

a. meet uniform screening requirements.
b. complete training programs that are standardized in length, content and competencies and skills; and
c. be subject to regulation and discipline.

The TNA advocates that healthcare facilities employ only those UAPs who have met these standards requirements. (NOTE: EMS personnel meet these requirements.)

2. Acquire prior approval of the accrediting agency, if you do not have JCAHO accreditation. JCAHO states, "certified EMTs should have their duties and their responsibilities to physicians and nurses providing care within the Emergency Services area defined in writing." The job description needs to be clearly defined and based on department need and the delegated tasks, which delineate lines of authority. The job description should assign a name for the job and establish a pay scale commensurate with training level. 

3. If IVs/medications are to be part of the job description, specific delegation should be specifies by the medical staff and outline in a written policy/procedure/standing order. 

DEVELOPMENT OF POSITION

A. Interview as for any other position.

B. Check credentials to assure that the applicant is educationally prepared at the appropriate level and that he/she has EMS certification.

C. Work with the director of the ED, the medical director, and the new employee to set out protocols for supervision.

D. Provide for any inservice education that may be necessary to orient the new employee to the hospital setting and his/her new job responsibilities. Appropriate documentation should be maintained in the employee's file regarding any training that is given to the employee.

Bureau of Emergency Management
June, 1996

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Last updated June 21, 2012