In 1982, after instructor Gene Iannuzzi had delivered the requisite lecture on pre-arrival radio reports to incoming EMTs at New York City's EMS academy, he closed the classroom door, rolled up his sleeves, faced his students and asked them the easiest question they'd get that evening: "What do you think of nurses?"

"At first, the answers were like, 'They're very professional,' 'They're compassionate' and even 'They're really hot,'" says the 65-year-old paramedic, now a professor and EMS Program Director at Borough of Manhattan Community College. "Then, as the class started to loosen up, I heard, 'They think they know our jobs better than we do' and about 20 other things that weren't very nice."

Iannuzzi, an RN himself since 1979, had some bad news for his students: "I told them I'd done a similar presentation for nurses, and guess what? They feel the same about EMS as you do about them. It became a very enlightening discussion."

Gene Iannuzzi. (Courtesy photo)

A debate that never ends

With over 30 years in both EMS and nursing, Iannuzzi is well-positioned to comment on the rivalry between the two groups. He thinks it has more to do with ignorance than experience.

"The reason bad feelings persist is that neither group understands the other," he says. "There's a very slight overlap between paramedics and nurses — particularly in critical care — but mostly, they don't do the same things."

Iannuzzi adds that paramedics who are contemplating nursing careers had better be prepared for a different kind of work, although not necessarily in the ways they imagine.

"Understand what you're getting into: You won't be driving around all day with one partner, feeling the freedom of working in a relatively unstructured environment. However, you'll have just as many opportunities to make a difference by using your experience and your brain.

"This idea medics have that nurses just wait for doctors to tell them what to do is nonsense. In fact, if you're working in a community hospital, odds are you don't have lots of doctors around; and if you're in a teaching hospital, the residents are often inexperienced, which gives you more of a chance to get involved."

According to Iannuzzi, who's managed clinical staffs at St. John's Riverside and North Central Bronx Hospitals in New York, workplace politics have cost paramedics and nurses opportunities to better understand each other.

"When medics reach a certain age and think, 'Instead of working OT on the streets, maybe I could do part time in a hospital,' sometimes they're blocked by nursing organizations that are afraid of members losing jobs. So if I want to hire paramedics to work in the ER, I have to call them 'emergency department techs' and say they'll be limited to doing EKGs and IVs.

"On the other side, when it was hard to find ALS providers in some parts of the state, nurses would say, 'We do critical care, we're in the ER — why can't we just take an AEMT course and do ALS under our nursing licenses?' Well, the EMS community went crazy about that and the nurses got shut out.

"So now we're into this mentality that the other side is to blame. That's sad because we're comparing apples and oranges."

Community paramedicine: Enhancement or oxymoron

Another issue Iannuzzi labels prone to misunderstanding is EMS's relatively new community-paramedicine specialty, which he supports in part.

"Most paramedics are nowhere near as prepared to do well-care as they think they are," he suggests. "I say that after working at the Visiting Nurse Service of New York for five years — a real eye-opening experience.

"Having good assessment skills is only part of community health; you also need to know how to access social services on behalf of your patients and how to teach them about injections, colostomies, feeding tubes and wound care so they don't have to go back to the hospital for those things.

"For paramedics who say they're willing to learn while working within the system, great. What you don't want to hear from them is, 'Oh, we have patient assessment skills, we can teach people to care for themselves.' I don't remember studying colostomies or how to change a Foley in medic school."

Formal education: Effective to a degree

Do degrees make a difference in EMS? Iannuzzi thinks so, but he says improvements in academic programs could make degrees even more valuable.

"I believe paramedics should be college-educated, but getting a degree doesn't necessarily mean they've absorbed everything they need to know. If EMS is going to be taken seriously as a health-care profession, I think we have to make changes to our curricula."

Iannuzzi, who runs the paramedic program at BMCC, feels a two-year degree shouldn't be separated into one year for general education and another for EMS. "We should integrate those things far better than we do," he says.

"Yes, you're going to begin with English and math, because those skills tend to be deficient, but to take two semesters of Anatomy & Physiology before getting started with hands-on medicine doesn't provide enough of a connection between science and practical skills."

The 400-hour EMT

The biggest challenge facing EMS educators, Iannuzzi believes, isn't teaching paramedics; it's preparing entry-level EMTs for their expanding role.

"My original EMT course was 85 hours," he says of New York City's mid-'70s program. "Today the requirement is double that or more. The class I run is 202 hours, but there's enough material to make it 400.

"Look at what EMTs do now: defibrillation, medication administration, even CPAP and 12-lead EKGs in some places. We keep expanding protocols without upgrading the curriculum because people don't want to add a single dollar or a single hour to basic EMS education.

"It's hard to hit a moving target — to coordinate preparation with changing practices. The best we can do as paramedics, nurses and teachers is to work within the system and try to set good examples."

Gene Iannuzzi has been doing that for 44 years.