SAN ANTONIO, Texas — Texas EMTs and paramedics, despite opposition of the Texas Emergency Nurse Association (ENA), are urged to voice their support for legislation (H.B. 2020 and S.B. 1899) to authorize practice in the hospital emergency department.

Texas legislators are considering the bills which will allow Texas EMTs and paramedics to practice their clinical skills in a hospital setting under the direct supervision of a physician.

“Essentially, these bills propose to expand the settings in which EMTs and paramedics can practice,” Kelly Grayson, paramedic, educator, and EMS1 columnist said.

“This is an important professional advance, whether you have any interest in working in an emergency department or not.”

The San Antonio chapter of the Texas Emergency Nurse Association (ENA) has written a letter opposing the proposed legislation. Carol Twombly, chapter president, wrote “These bills would change the scope of the EMT-P and licensed paramedic to include the initiation of advanced life support measures such as: IVs, intubation, defibrillation/cardioversion and administration of medications under the supervision of a physician who is present in the same area or an area adjacent to the area. These actions would occur in an emergency or urgent care clinical setting, including a hospital emergency room or a freestanding emergency medical care facility.

The Texas ENA is opposed to the passing of these bills and requests members immediately contact their House and Senate representatives.”

In the letter Twombly, expresses concerns about the ability of paramedics to safely operate under the supervision of a physician inside the hospital.

“EMTs and EMT-Paramedics temporarily receiving direction for a physician could create a very unsafe situation during the most critical time in the patients hospital stay. Currently they receive directions (delegation) from a nurse so who do they listen to in this critical situation when the nurse needs help and the physician requests their assistance. Who is accountable when they accidentally misunderstand the delegation instructions,” Twombly wrote.

The bill has garnered support among local EMS providers.

“The legislation would allow paramedics to perform as fully functional ALS providers in the emergency department,” said Josh James, a Texas flight paramedic.

The legislation, if passed, and signed into law by the governor would allow EMS to work under its full scope of practice.

Grayson encourages Texas EMTs and paramedics to contact their elected state representatives. “Be respectful. Be articulate. Refute the ENA falsehoods with reason and facts,” Grayson said.

A template letter, written by Grayson, is available for Texas EMTs and paramedics to voice their opposition.

I am writing today as a registered voter to urge you to vote YES on HB 2020 and SB 1899, which will allow EMTs and paramedics in Texas to practice their clinical skills and knowledge in hospitals, clinics and Emergency Departments, under the direct supervision of a physician. Essentially, these bills will allow Texas EMS professionals to apply their knowledge and skills in a setting far less challenging than the one in which they currently practice, still subject to the strictures and physician oversight under which they currently practice in homes, accident scenes, streets and highways across the state of Texas. The concept of EMS professionals as “physician extenders” has been a time-proven model of medical care for over two generations now, and there is no reason they cannot do the same in a hospital setting.

I would specifically like to rebut some of the assertions made about EMS professionals made in a letter to Texas legislators and specific committee members from Carol Twombly, President of the San Antonio chapter of the Texas Emergency Nurses Association, attached here for your consideration. Mrs. Twombly’s letter is rife with factual inaccuracies and misconceptions.

Texas ENA’s opinion of the education of Texas paramedics, particularly Licensed Paramedics, is firmly rooted in the 1980’s. With the promulgation of the National EMS Educational Standards in 2009, EMS education is no longer a “skills-based” education as contended by Texas ENA. Moreover, Licensed Paramedics in Texas must possess either an associates degree, baccalaureate degree, or postgraduate degree. (link to Texas Administrative Code here). Graduates in paramedic programs across the country have been required to graduate from a nationally-accredited program since 2009.

It is also worth noting that, while nursing education is quite in-depth and comprehensive, the nurse graduate of today is a generalist. The vast majority of direct emergency care training they receive is ad hoc, on-the-job training. Paramedics are taught these skills and knowledge in a formal classroom setting, augmented by extensive supervised clinical training in the field, and, it should be noted, in Emergency Departments. In fact, students in current paramedic education programs often spend more time training in Emergency Departments than their nursing student counterparts.

I would also like to point out that nurses do not practice with autonomy in the hospital setting, as Texas ENA contends. For that matter, neither do many physicians. Nurses work under direct physician orders, written protocols, and hospital policies and procedures, functionally no different than the physician-developed protocols and treatment guidelines written for paramedics. In fact, it can fairly be said that paramedics in the prehospital setting, working with few outside resources and personnel, operate with far greater autonomy than nurses in the Emergency Department.

Texas ENA’s assertion that paramedics practicing their profession in an Emergency Department can somehow compromise patient safety is ludicrous upon its face. We practice the same skills – at least in the Emergency Department – as nurses, with the same physician oversight. We undergo the same education in various specialty certifications such as Advanced Cardiac Life Support. The difference is that, in practice, nurses are expected to utilize this training in the role of a resuscitation team member. Paramedics are expected not only to function as team members, but also to lead the resuscitation as part of their primary job duties.

In closing, I would urge you to consider the merits of HB2020 and SB1899 based not upon misinformation and propaganda aimed at protecting “turf,” but upon facts and the potential for EMS professionals to help relieve some of the burdens on our healthcare system. A YES vote will accomplish that.

We, the EMS professionals of Texas, stand ready to work alongside our nursing colleagues, both inside and outside the hospital environment.

Sincerely,

John Q Paramedic