Utilizing paramedics for in-patient critical care surge capacity

INTRODUCTION: While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in an inability of a hospital or emergency department to create surge capacity to deal with large numbers of ill or injured patients. Utilizing paramedics in acute-care hospitals or at alternate care sites could serve as expansion staff to supplement existing nursing staff allowing fewer nurses to care for a larger numbers of patients during a disaster, act of terrorism, or public health emergency. While the procedures performed for nursing do vary from hospital to hospital, there are national certifications for both emergency nursing (CEN) and critical care nursing (CCRN) that can be used to establish a standard for comparison. METHODS: A detailed review and curriculum mapping of the specific educational objectives and competencies of the U.S. Department of Transportation National Standard Curriculum for the Emergency Medical Technician-Paramedic as well as the competencies and criteria for board certification as a Certified Emergency Nurse (CEN) and Critical Care Registered Nurse (CCRN) was performed. RESULTS: Approximately 90 percent of the CEN and CCRN knowledge skills and competencies are met or exceeded by the National Standard Paramedic Curriculum. CONCLUSIONS: With appropriate training and orientation, paramedics may be used in an in-patient setting to augment emergency and critical care nursing staff during a disaster, act of terrorism, or public health emergency.