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.