Key Responsibilities and Required Skills for Ambulance Nurse

🎯 Role Definition

The Ambulance Nurse (EMS Nurse) is a registered nurse who provides high-acuity, pre-hospital care and critical care transport to patients across a wide range of medical and traumatic presentations. Working as part of an ambulance crew, the Ambulance Nurse performs rapid assessment and stabilization, administers advanced clinical interventions, documents care in electronic patient care reports (ePCR), and coordinates handoff to emergency department or receiving teams. This role requires advanced airway and circulation management, safe patient movement and transfer, and adherence to EMS protocols, infection control policies, and state nursing practice acts. Ideal for nurses with experience in emergency departments, intensive care, or critical care transport, this position emphasizes autonomous clinical judgment, teamwork with paramedics and EMTs, and consistent delivery of compassionate pre-hospital care.

Keywords: ambulance nurse, EMS nurse, pre-hospital care, critical care transport nurse, emergency nurse, patient transport, ambulance RN, trauma nurse, interfacility transport.

📈 Career Progression

Typical Career Path

Entry Point From:

Emergency Department (ED) Registered Nurse with 1–3 years of acute care experience.
Intensive Care Unit (ICU) Registered Nurse with critical care skills.
Paramedic transitioning to RN or EMS experience combined with nursing licensure.

Advancement To:

Clinical Supervisor / Shift Lead – Ambulance Services
Critical Care Transport Nurse / Flight Nurse (aeromedical)
EMS Program Manager or Director of Clinical Services
Nurse Educator / Preceptor for EMS and transport teams

Lateral Moves:

Interfacility Transport Nurse (ground or air)
Emergency Department Nurse (triage or fast-track)
Community Paramedicine or Mobile Integrated Health RN

Core Responsibilities

Primary Functions

Perform rapid, systematic primary and secondary surveys in pre-hospital and transport settings to identify life-threatening conditions and prioritize interventions, ensuring immediate stabilization before and during ambulance transport.
Deliver advanced airway management including endotracheal intubation support, supraglottic airway placement, ventilator setup and adjustments, and management of mechanically ventilated patients in a moving ambulance.
Initiate and manage vascular access including peripheral IVs, central line management during transport, and intraosseous (IO) access when indicated, following scope of practice and agency protocols.
Administer emergency medications (including controlled substances when authorized) via IV, IO, intramuscular, or inhalation routes, titrating doses based on patient response and monitoring for adverse effects.
Perform advanced cardiac monitoring and interpretation of 12-lead and continuous ECG strips, recognize arrhythmias and ischemic changes, and implement ACLS and dysrhythmia treatment protocols.
Provide full cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS) interventions, defibrillation, and post-resuscitation care in pre-hospital scenarios.
Assess and manage traumatic injuries including hemorrhage control, splinting and immobilization (spinal/ limb), pneumothorax recognition and management, and safe movement/extrication coordination with rescue personnel.
Conduct on-scene triage during multi-patient incidents and mass-casualty events, communicate triage decisions clearly to incident command and receiving hospitals.
Perform comprehensive patient handoffs to emergency department and inpatient teams, ensuring accurate transfer of clinical information, interventions performed, and response to treatment.
Document all assessments, treatments, medications, and patient responses in the electronic patient care report (ePCR) with clarity, timeliness, and compliance with legal and agency standards.
Coordinate logistics of interfacility transports, verifying acceptance by receiving facilities, appropriate escorting staff, necessary equipment and oxygen supply, and adherence to transport criteria.
Manage and troubleshoot onboard medical equipment (monitors, ventilators, infusion pumps, suction units), ensuring functionality and addressing issues during transport.
Conduct frequent reassessments en route, adjust treatment plans as patient condition evolves, and escalate care when necessary by contacting medical control or higher-level clinicians.
Implement infection prevention practices including isolation precautions, appropriate PPE usage, decontamination procedures between calls, and safe handling/disposal of biohazardous materials.
Participate in medication reconciliation and verify patient identity, allergies, and advanced directives or DNR/AND orders prior to initiating or continuing therapies during transport.
Provide compassionate patient- and family-centered communication, explain procedures, obtain consent when possible, and manage anxiety for patients and family members in high-stress pre-hospital environments.
Act as a clinical resource and mentor to paramedics and EMTs on the ambulance team—modeling best practices, delegating appropriately, and providing constructive feedback during after-action reviews.
Complete and submit required regulatory and quality assurance documentation, incident reports, and near-miss reports in a timely manner to support continuous improvement.
Participate in quality improvement initiatives, chart reviews, case reviews, and morbidity/mortality rounds to identify trends and opportunities to enhance pre-hospital care outcomes.
Maintain situational awareness and personal safety on-scene, coordinate with law enforcement and fire/rescue when required, and adhere to vehicle and scene safety protocols during transport operations.
Provide targeted patient education and discharge instructions as appropriate during transport or at transfer, including medication instructions, wound care, and follow-up resources.
Assist with scene management in non-traditional environments (industrial sites, public events, remote locations), adapting clinical care to resource-limited situations while maintaining standards of care.

Secondary Functions

Maintain stock levels, checklists, and readiness of medications, airway equipment, immobilization devices, and monitoring supplies; coordinate resupply and restocking with logistics teams.
Support training programs by participating in simulation drills, skills labs, onboarding of new hires, and acting as a preceptor for student nurses and new ambulance nurses.
Contribute clinical content and feedback to policies, clinical practice guidelines, and local protocols for pre-hospital and transport care.
Participate in community outreach, public education, and injury prevention programs representing the ambulance service and promoting public health initiatives.
Collaborate with billing and coding teams to ensure accurate clinical documentation supports reimbursement for advanced life support and transport-related services.
Assist in scheduled vehicle and equipment maintenance checks, reporting defects and coordinating repairs to maintain operational readiness.
Engage in data collection for performance metrics (response times, clinical interventions, outcomes) and support research or retrospective review projects when requested.
Participate in interagency drills and mass-casualty exercises to improve interoperability and emergency response coordination.
Support infection control audits, controlled-substance accountability processes, and compliance with state regulatory inspections.
Serve on clinical committees or working groups focused on clinical governance, safety, and quality improvement for the ambulance or EMS service.

Required Skills & Competencies

Hard Skills (Technical)

Advanced clinical assessment skills for rapid triage and identification of life-threatening conditions in the pre-hospital environment.
Proficient in advanced airway management, including endotracheal intubation, use of supraglottic devices, and ventilator operation during transport.
ACLS, PALS (for pediatric calls), and BLS certification current and demonstrable.
IV therapy, intraosseous access, medication preparation and titration, and safe controlled-substance handling in accordance with agency policies.
ECG interpretation and application of ACLS algorithms for arrhythmia management and STEMI recognition.
Trauma management skills: hemorrhage control, splinting, spinal immobilization, chest decompression techniques where within scope.
Experience with mechanical ventilation management, oxygen therapy, and non-invasive ventilation modalities in mobile settings.
Competence with electronic patient care report (ePCR) systems and digital documentation workflows.
Familiarity with ambulance equipment: monitors/defibrillators, infusion pumps, suction, pneumatic splints, and transport stretchers.
Knowledge of local and state EMS protocols, HIPAA regulations, patient consent/DNR laws, and scope-of-practice for nursing in pre-hospital care.
Basic vehicle safety awareness and ability to secure patients and equipment in moving ambulance environments.

Soft Skills

Calm, decisive critical-thinking and clinical decision-making under time pressure and in noisy, unpredictable environments.
Strong verbal and written communication skills for clear handoff to ED teams, collaboration with paramedics/EMTs, and documentation.
Teamwork and leadership: ability to lead clinical care on-scene and delegate appropriately while maintaining a cooperative crew dynamic.
Empathy and strong patient advocacy skills; ability to provide compassionate care to patients and families in crisis.
Adaptability and flexibility to fluctuating call volumes, variable patient acuity, and non-traditional work schedules (nights, weekends, holidays).
Resilience and stress management to function effectively after challenging calls and critical incidents.
Attention to detail for medication dosing, charting accuracy, and equipment checks.
Cultural competency and sensitivity when interacting with diverse patient populations and communities.
Time management and prioritization to perform multiple tasks efficiently during transport.
Conflict resolution skills for interactions with patients, families, or multi-agency partners during stressful incidents.

Education & Experience

Educational Background

Minimum Education:

Current Registered Nurse (RN) license in the state(s) of operation.
Current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications.

Preferred Education:

Bachelor of Science in Nursing (BSN) or equivalent.
Certifications such as Critical Care Registered Nurse (CCRN), Certified Flight Registered Nurse (CFRN), or Transport Registered Nurse (TPN) preferred.
Pediatric Advanced Life Support (PALS) and Pre-Hospital Trauma Life Support (PHTLS) or TNCC preferred.

Relevant Fields of Study:

Nursing (Associate or Bachelor level)
Emergency Medicine or Critical Care Nursing
Paramedicine / EMS (combined education or prior licensure)

Experience Requirements

Typical Experience Range: 2–5 years of acute care experience in Emergency Department, Intensive Care Unit, or prior EMS/transport nursing.

Preferred: 3–5+ years’ experience in emergency nursing, trauma, or critical care with documented experience in patient transport, high-acuity interventions, or interfacility transfers. Prior ambulance, flight, or critical care transport experience strongly preferred.