I think you’re making a more broad point and using 9/11 as an example, but regarding 9/11 specifically, if it weren’t for Jon Stewart and others working alongside him, Congress would’ve long ago stopped providing for the fire and police that were on the front lines that day. So no, of course we don’t take care of people on the backend of the rescue efforts. What do you think this is, some sort of not-fucked country?

I don’t know where you live,but as you are mentioning 911 I guess it’s the US - there are a shitton of ambulance services that use nurses as BLS or ALS providers around the world. (The netherlands, sweden, Italy, Spain, just to name a few. I intentionally do not name the US here,see below)

For the US, UK and to a lesser extent Germany there is a simple reason: You guys did fight tooth and nail not to do so.

But let’s go back a bit further: If you look into the history of EMS it’s not like that the fire departments were that happy to do so (and to this day I am a staunch opponent to them doing so. It’s an all around bad idea) and in many parts of these countries police, cab services and funeral homes did provide the first ambulances, other than charity organisations.

When it became clear that prehospital care was needed in these countries the fire departments or independent “transport only” ambulance services had become the norm in most areas and there indeed were some people that pushed for nurse staffed ambulances - as nurses during the war had shown to be beneficial in that role.

But they were basically scolded, often even publicly insulted, by nursing associations:

• Nursing back then was far from an independent profession like it is today. Back then actual medical skills were largely dependent on doctors orders with very little leeway for interpretation. (From a nursing book in 1958 “if the blood pressure of a patient is too high or too low must,under all circumstances,be decided by the doctor and it’s not upon the nurse to decide this.”) Asking someone who is fully dependent on another profession for decision making to now make independent decisions without that profession and in the worst possible environment and use skills that the same person wouldn’t be allowed to use in their regular workplace understandably was a major cause for concern, dissent and resentment back then. And to some extent this is understandable.

• The second factor was based on the issue of gender and “morals”. Nursing back then was a mostly female profession. Putting them to the scenes ambulances need to respond to (brothels, crime scenes, etc.) would, according to a female nursing director in a UK hospital “corrupt my girls”. Additionally, due to the fact that heavy lifting would be required(see below) and the ambulances would need to be driven by someone, the “poor nurses” would need to work alongside male ambulance drivers and that would also lead to immorality. (Their words, not mine. In case of the UK somewhat insulting to their Queen,imho)

• Another factor was surely the fact that “transport only” ambulances already existed and that (also due to the lack of proper equipment) it was (rightfully so) considered backbreaking work - patients did need to be lifted far more than today, lifting equipment was primitive and medical equipment was far heavier. (I remember defibrillators that had 40kg…and I am not that old). So adding a third person would mean extra cost while you still need men (according to their reasoning back then). And as the first paramedic provides little more than BLS+ it was not that resource intensive to teach the people already doing the job.

Nowadays nursing has developed a lot. But so has paramedicine and it is an independent health care profession in the more professional systems (CAN,UK,IR,AU,NZ,GER,POL,etc.). Because skills,mindset and approaches towards patient care are different. The US with it’s abhorrent EMS system uses nurses in some roles,but tbh, the main reason is a lack of proper paramedic training standards, standardisation and oversight and the results are, well, underwhelming.

And why are nurses not named in line with other first responders in the US and similarly in a lot of other countries?

Because they aren’t first responders. The issue with being a first responder is not the level of care, it’s the “unknown”. Hospitals are, to a certain extent a controlled environment. Even in the ED you most of the time know what’s happening next, even if the next patient is a multi system trauma and comes in without prior notification it’s still your playing field. You have light, it’s warm/cold, you are rarely alone, you have your equipment where it was the day before and the day before. On scene it’s different. The next call might be a mansion. Or in a ditch. Or a methlab. It’s the same people you see in the ED, but now it’s their home turf. I have resuscitated an almost naked 12 year old in -20° C alone (as a in “single responder”) in a park known for it’s shady people. That’s different.

Don’t get me wrong: Nursing has it’s own challenges - I worked both sides long enough to know that I sure as hell won’t ever work another hour in nursing. As a para you have 1 patient most of the time. Not 25. Once you know your call,you can be almost sure that you won’t have another patient until you complete the call there won’t be another patient suddenly taking away your attention. You can leave the patient after like an hour max. And you rarely see them again.

All these things are different in nursing. Multiple patients, changes in priorities, seeing patients day after day - it is its own beast. But it’s different.

I am happy for everyone who does nursing. So am I for every midwife. Or every guy and gal that takes up paramedicine. We all have our place in this hellish trade.

(Source: Working as a paramedic -critcare nowadays - for almost 25 years now, worked inside hospitals for 7, mainly anaesthesia, critcare and ED, now consulting hospitals and EMS)

Funny story. Back in the day, they did a study of highway deaths. One thing that leapt out was that most people who died in traffic accidents could have been saved if they got to the hospital fast enough. Pretty soon it was legislated that every community had to have an EMS system.

Basic Emergency Medical Technicians and Advance Life Saving EMTs [aka paramedics] provide medical care on scene and stabilize patients for rapid transport.

Most Fire Departments in the USA are currently Fire/Rescue with the ambulances operated by the Fire Department. Almost all firefighters are Certified First Responders, trained in CPR and first aid.

Nurses are trained for skills that paramedics don’t need because nurses also do long term care, where EMS is supposed to be off scene as fast as possible.

The special provisions that exist or have been proposed are for first responders because they breathed in dust and were exposed to various health hazards during the response.

What above and beyond taking care of do people who weren’t exposed to any of that in the backend need?

The difference is that first responders willingly put themselves at risk when trying to save people, and in fact hundreds of them were killed while performing their first responder duties on 9/11. No nurses (or doctors for that matter) were killed performing duties at the scene.

Originally, fire departments only dealt with fires. In the 1960’s and 1970’s it became clear that a rapid response health service would be beneficial. Rather than create a whole new system from scratch, that function was tacked onto the existing fire service by having EMTs and paramedics on staff. And the initial focus was primarily on providing rapid transit: delivering the victim to a hospital as quickly as possible. Response time was the dominant metric used to grade emergency medical providers. It took more decades to fully appreciate that treatments applied at the accident scene or in transit could be as important as, or more important than, response time.

There’s an argument to be made that fire departments are somewhat obsolete. They spend most of their time dealing with medical and mental health issues, not fighting fires. We would probably benefit as a society by replacing a lot of firefighters with house call nurses to help manage people’s long-term health issues before they become emergencies.

Of course you did. And nothing can away the heroic and amazing thing you did that day.

BUT! Being at ground zero and simply doing your job as a nurse during a crisis is not the same thing.

Fire and police tend to be male dominated professions.

Nursing is a female dominated profession.

I’m fairly confident that you are generalizing this a bit and that there are police and fire fighting departments on this planet that employ nurses. In general though, first responders who get injured end up in the same system than the people they save and need medical attention: hospitals. If you are in need of nurse aftercare, you are probably off on sick leave - so what would the nurse actually do? Especially in the smaller bf-nowhere operations, I don’t see how you could justify the cost. Plus, most firehouses have paramedics already. They’re not the same as a nurse but bring a lot of similar skills.

Firefighters and EMTs get a little extra glorification to make up for their salaries.

I didn’t know a single nurse that was at ground zero pulling out corpses with cadaver dogs while looking for anyone that might be alive in the rubble.

They’re the roadies at the music festival. Everyone forgets they’re the ones who make it all possible.

Because 343 nurses weren’t murdered by terrorist sons of bitches who dropped a couple skyscrapers on them.